Health Insurance (Pathology Services Table) Amendment Regulations 2005 (No. 1) (Cth)

Health Insurance (Pathology Services Table) Amendment Regulations 2005 (No. 1)¹

Select Legislative Instrument 2005 No. 67

I, PHILIP MICHAEL JEFFERY, Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.

Dated 22 April 2005

P. M. JEFFERY

Governor-General

By His Excellency’s Command

JULIE BISHOP

Minister for Ageing

Name of Regulations

These Regulations are the Health Insurance (Pathology Services Table) Amendment Regulations 2005 (No. 1).

Commencement

These Regulations commence on 1 May 2005.

Amendment of Health Insurance (Pathology Services Table) Regulations 2004

Schedule 1 amends the Health Insurance (Pathology Services Table) Regulations 2004.

Schedule 1 Amendments

(regulation 3)

[1] Schedule 1, Part 2, paragraph 4 (1) (a)

substitute

(a)the service is rendered in relation to 1 or more specimens taken on any of not more than 6 occasions in a period of 24 hours; and

[2] Schedule 1, Part 2, rule 19

omit

For items 69442, 69444 and 69445:

insert

For item 69444:

[3] Schedule 1, Part 2, after rule 24

insert

Limitation on certain items

(1)For any particular patient, items 66539, 69442, 71075, 71127, 71135 or 71137 are applicable not more than twice in a 12 month period.

(2)For any particular patient, item 66626 is applicable not more than 36 times in a 12 month period.

(3)For any particular patient, items 66655, 66659, 69443 or 69444 are applicable not more than once in a 12 month period.

(4)For any particular patient, item 66750 is applicable not more than once in a pregnancy.

(5)For any particular patient, item 69336 is applicable not more than once in each period of 7 days.

(6)For any particular patient, items 69445, 71079, or 73523 are applicable not more than 4 times in a 12 month period.

(7)For any particular patient, item 71077 is applicable not more than 6 times in a 12 month period.

[4] Schedule 1, Part 3, item 65072

substitute

65072

Examination for reticulocytes including a reticulocyte count by any method — 1 or more tests

10.30

[5] Schedule 1, Part 3, items 66518 and 66519

substitute

66518	Investigation of cardiac or skeletal muscle damage by quantitative measurement of creatine kinase isoenzymes, troponin or myoglobin in blood — tests performed on only 1 specimen in a 24 hour period	20.40
66519	Investigation of cardiac or skeletal muscle damage by quantitative measurement of creatine kinase isoenzymes, troponin or myoglobin in blood — tests performed on 2 or more specimens in a 24 hour period	40.85

[6] Schedule 1, Part 3, item 66539

substitute

66539

Electrophoresis of serum for demonstration of lipoprotein subclasses:

(a) if the cholesterol is >6.5 mmol/L and triglyceride >4.0 mmol/L; or

(b) in the diagnosis of types III and IV hyperlipidaemia

(Item is subject to rule 25)

31.15

[7] Schedule 1, Part 3, item 66626

substitute

66626

Detection or quantitation or both of a drug, or drugs, of abuse or a therapeutic drug, on a sample collected from a patient participating in a drug abuse treatment program, including all tests on blood, urine or other body fluid, not including:

(a) the surveillance of sports people and athletes for performance improving substances; and

(b) the detection of nicotine and metabolites in smoking withdrawal programs

(Item is subject to rule 25)

24.55

[8] Schedule 1, Part 3, item 66655

substitute

66655

Prostate specific antigen (PSA) quantitation

(Item is subject to rule 25)

20.50

[9] Schedule 1, Part 3, item 66659

substitute

66659

Prostate specific antigen (PSA), quantitation of 2 or more fractions of PSA and any derived index, including, if performed, a test described in item 66656, in the follow up of a PSA result that lies in the equivocal range of the particular method of assay used to determine the level

(Item is subject to rule 25)

37.80

[10] Schedule 1, Part 3, items 66669 and 66670

substitute

66669

Quantitation of copper, manganese, selenium or zinc (except if item 66667 applies), in blood, urine or other body fluid or tissue — 1 test

(Item is subject to rule 22)

31.15

66670

Quantitation of copper, manganese, selenium or zinc (except if item 66667 applies), in blood, urine or other body fluid or tissue — 2 or more tests in relation to the same patient

(Item is subject to rule 22)

53.35

[11] Schedule 1, Part 3, items 66672 and 66673

substitute

66672

Quantitation of aluminium (except if item 66671 applies), arsenic, beryllium, cadmium, chromium, gold, mercury, nickel or strontium, in blood, urine or other body fluid or tissue — 1 test

(Item is subject to rule 22)

31.15

66673

Quantitation of aluminium (except if item 66671 applies), arsenic, beryllium, cadmium, chromium, gold, mercury, nickel or strontium, in blood, urine or other body fluid or tissue — 2 or more tests in relation to the same patient

(Item is subject to rule 22)

53.35

[12] Schedule 1, Part 3, item 66750

substitute

66750

Quantitation, in pregnancy, of any 2 of the following to detect foetal abnormality:

(a) total human chorionic gonadotrophin (total HCG);

(b) free alpha human chorionic gonadotrophin (free alpha HCG);

(d) pregnancy associated plasma protein A (PAPP‑A);

40.45

(e) unconjugated oestriol (uE₃);

(f) alpha-fetoprotein (AFP);

including (if performed) a service described in item 73527 or 73529

(Item is subject to rule 25)

[13] Schedule 1, Part 3, item 69336

substitute

69336

Microscopy of faeces for ova, cysts and parasites, that includes the use of:

(a) a concentration technique; and

(b) fixed stains or antigen detection for cryptosporidia and giardia;

and includes a service mentioned in item 69300 (if performed)

(Item is subject to rule 25)

33.65

[14] Schedule 1, Part 3, items 69378, 69381 and 69382

substitute

69378	Quantitation of HIV viral RNA load in plasma or serum in the monitoring of a HIV sero-positive patient not on antiretroviral therapy — 1 or more tests on 1 or more specimens	181.45
69381	Quantitation of HIV viral RNA load in plasma or serum in the monitoring of a HIV sero-positive patient on antiretroviral therapy — 1 or more tests on 1 or more specimens	181.45
69382	Quantitation of HIV viral RNA load in cerebrospinal fluid in a HIV sero‑positive patient — 1 or more tests on 1 or more specimens	181.45

[15] Schedule 1, Part 3, items 69442, 69443, 69444 and 69445

substitute

69442	Quantitation of HCV RNA load in plasma or serum in: (a) the pre-treatment evaluation, of a patient with chronic HCV hepatitis, for antiviral therapy; or (b) the assessment of efficacy of antiviral therapy for such a patient; if the test is requested by, or on the advice of, the specialist or consultant physician who manages the treatment of the patient (including a service described in item 69444 or 69445) (Item is subject to rule 25)	181.45
69443	Nucleic acid amplification and determination of hepatitis C virus (HCV) genotype if: (a) the patient is HCV RNA positive and is being evaluated for antiviral therapy of chronic HCV hepatitis; and (b) the request for the test is made by, or on the advice of, the specialist or consultant physician managing the treatment of the patient	206.20
(Item is subject to rule 25)
69444	Detection of Hepatitis C viral RNA if at least 1 of the following criteria is satisfied: (a) the patient is Hepatitis C sero-positive; (b) the patient’s serological status is uncertain after testing; (c) the test is performed for the purpose of: (i) determining the Hepatitis C status of an immunosuppressed or immunocompromised patient; or	92.80
(ii) the detection of acute Hepatitis C prior to seroconversion where considered necessary for the clinical management of the patient (Item is subject to rules 19 and 25)
69445	Detection of Hepatitis C viral RNA in a patient undertaking antiviral therapy for chronic HCV hepatitis (including a service described in item 69444) — 1 test (Item is subject to rule 25)	92.80

[16] Schedule 1, Part 3, item 71073

substitute

71073

Quantitation of all 4 immunoglobulin G subclasses

108.00

[17] Schedule 1, Part 3, items 71075, 71077 and 71079

substitute

71075

Quantitation of immunoglobulin E (total) — 1 test

(Item is subject to rule 25)

23.40

71077

Quantitation of immunoglobulin E (total) in the follow up of a patient with proven immunoglobulin-E-secreting myeloma, proven congenital immunodeficiency or proven allergic bronchopulmonary aspergillosis — 1 test

(Item is subject to rule 25)

27.55

71079

Detection of specific immunoglobulin G or E antibodies to single or multiple potential allergens

(Item is subject to rule 25)

27.30

[18] Schedule 1, Part 3, item 71127

substitute

71127

Functional tests for lymphocytes — quantitation, other than by microscopy, of:

(a) proliferation induced by 1 or more mitogens; or

(b) proliferation induced by 1 or more antigens; or

179.45

including a test described in item 65066 or 65070 (if performed)

(Item is subject to rule 25)

[19] Schedule 1, Part 3, items 71135 and 71137

substitute

71135

Quantitation of neutrophil function, comprising at least 2 of the following:

(a) chemotaxis;

(b) phagocytosis;

(d) bactericidal activity;

including any test described in item 65066, 65070, 71133 or 71134 (if performed)

(Item is subject to rule 25)

211.60

71137

Quantitation of cell-mediated immunity by multiple antigen delayed type hypersensitivity intradermal skin testing using a minimum of 7 antigens

(Item is subject to rule 25)

30.80

[20] Schedule 1, Part 3, item 73523

substitute

73523

Semen examination (other than post-vasectomy semen examination), including:

(a) measurement of volume, sperm count and motility; and

(b) examination of stained preparations; and

(d) (if performed) differential count and 1 or more chemical tests

(Item is subject to rule 25)

42.50

Note

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