Health Insurance (Pathology Services Table) Regulation 2015 (Cth)
Health Insurance (Pathology Services Table) Regulation 2015
Select Legislative Instrument No. 85, 2015
made under the
Health Insurance Act 1973
Compilation No. 3
Compilation date: 1 July 2016
Includes amendments up to: F2016L00745
Registered: 15 July 2016
About this compilation
This compilation
This is a compilation of the Health Insurance (Pathology Services Table) Regulation 2015 that shows the text of the law as amended and in force on 1 July 2016 (the compilation date).
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.
Uncommenced amendments
The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register ( The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Editorial changes
For more information about any editorial changes made in this compilation, see the endnotes.
Modifications
If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.
Self‑repealing provisions
If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
Contents
1............................ Name.................................................................................. 1
3............................ Authority............................................................................ 1
4............................ Schedules........................................................................... 1
5............................ Pathology services table..................................................... 1
6............................ Dictionary........................................................................... 1
Schedule 1—Pathology services table 2
Part 1—Preliminary 2
Division 1.1—Interpretation 2
1.1.1...................... Abbreviations..................................................................... 2
Division 1.2—General application provisions 3
1.2.1...................... Precedence of items........................................................... 3
1.2.2...................... Circumstances in which services rendered following 2 requests to be taken to have been rendered following one request................................. 3
1.2.3...................... Services to which clause 1.2.2 does not apply................... 3
1.2.4...................... Referral of designated tests by one pathology practitioner to another 4
1.2.5...................... Items not to be split............................................................ 5
1.2.6...................... Certain pathology services to be treated as one service..... 5
1.2.7...................... Meaning of set of pathology services................................. 6
1.2.8...................... Satisfying requirements described in pathology service.... 7
1.2.9...................... Application of items—services provided with autologous injections of blood or blood products.................................................................... 8
Part 2—Services and fees 9
Division 2.1—Group P1: haematology 9
2.1.1...................... Services to which clause 1.2.2 does not apply................... 9
2.1.2...................... Item taken to refer only to the first service of a particular kind 9
Division 2.2—Group P2: chemical 15
2.2.1...................... Creatinine ratios............................................................... 15
2.2.2...................... Services to which clause 1.2.2 does not apply................. 15
2.2.3...................... Limitation on certain items.............................................. 15
2.2.5...................... Thyroid function testing................................................... 16
2.2.6...................... Limitation on certain items.............................................. 16
2.2.7...................... Nutritional and toxicity metals testing............................. 16
Division 2.3—Group P3: microbiology 26
2.3.1...................... Meaning of serial examinations or cultures.................... 26
2.3.2...................... Antigen detection............................................................. 26
2.3.3...................... Investigation for hepatitis serology.................................. 26
2.3.4...................... Limitation on certain items.............................................. 26
2.3.5...................... Hepatitis C viral RNA testing.......................................... 27
Division 2.4—Group P4: immunology 34
2.4.1...................... Limitation on certain items.............................................. 34
2.4.2...................... Tests in Group P4 relating to antibodies.......................... 34
2.4.3...................... HLA‑B27 typing.............................................................. 34
2.4.4...................... Antineutrophil cytoplasmic antibody tests....................... 34
Division 2.5—Group P5: tissue pathology 40
2.5.1...................... Tests on biopsy material.................................................. 40
2.5.2...................... Limitations on items 72858 and 72859............................ 41
Division 2.6—Group P6: cytology 44
2.6.1...................... Tests on biopsy material.................................................. 44
Division 2.7—Group P7: genetics 47
2.7.1...................... Haemochromatosis testing............................................... 47
2.7.2...................... HLA‑B27 typing.............................................................. 47
2.7.3...................... Limitation on items 73339 and 73340............................. 47
Division 2.8—Group P8: infertility and pregnancy tests 52
2.8.1...................... Limitation on item 73523................................................. 52
Division 2.9—Group P9: simple basic pathology tests 53
Division 2.10—Group P10: patient episode initiation 54
2.10.1.................... Items in Group P10 not to apply in certain circumstances 54
Division 2.11—Group P11: specimen referred 59
2.11.1.................... Items in Group P11 not to apply in certain circumstances 59
2.11.2.................... Application of an item in Group P11 to a service excludes certain other items 59
2.11.3.................... Circumstances in which an item in Group P11 does not apply 59
Division 2.12—Group P12: management of bulk‑billed services 61
2.12.1.................... Application of items 74990 and 74991............................ 61
Division 2.13—Group P13: bulk‑billing incentive 64
Part 3—Abbreviations 65
Part 4—Complexity levels for histopathology items 90
Part 5—Dictionary 96
Endnotes100
Endnote 1—About the endnotes 100
Endnote 2—Abbreviation key 101
Endnote 3—Legislation history 102
Endnote 4—Amendment history 103
1Name
This is the Health Insurance (Pathology Services Table) Regulation 2015.
3Authority
This instrument is made under the Health Insurance Act 1973.
4Schedules
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
5Pathology services table
For subsection 4A(1) of the Act, Schedule 1 prescribes a table of pathology services.
6Dictionary
The Dictionary in Part 5 of Schedule 1 defines certain words and expressions that are used in this instrument, and includes references to certain words and expressions that are defined elsewhere in this instrument.
Schedule 1—Pathology services table
Note:See section 5.
Part 1—Preliminary
Division 1.1—Interpretation
1.1.1Abbreviations
(1)The abbreviations in Part 3 may be used to identify particular pathology services or groups of pathology services.
(2)The names of services or drugs not listed in Part 3 must be written in full.
Division 1.2—General application provisions
1.2.1Precedence of items
(1)If a service is described:
(a)in an item in general terms; and
(b)in another item in specific terms;
only the item that describes the service in specific terms applies to the service.
(2)Subject to subclause (3), if:
(a)subclause (1) does not apply; and
(b)a service is described in 2 or more items;
only the item that provides the lower or lowest fee for the service applies to the service.
(3)If an item is expressed to include a pathology service that is described in another item, the other item does not apply to the service in addition to the first‑mentioned item, whether or not the services described in the 2 items are requested separately.
1.2.2Circumstances in which services rendered following 2 requests to be taken to have been rendered following one request
(1)In subclause (2):
service includes assay, estimation and test.
(2)Two or more pathology services (other than services to which, under clause 1.2.3, 2.1.1 or 2.2.2, this clause does not apply) rendered for a patient following 2 or more requests are taken to have been rendered following a single request if:
(a)the services are listed in the same item; and
(b)that item is not item 74990 or 74991; and
(c)the patient’s need for the services was determined under subsection 16A(1) of the Act on the same day even if the services are rendered by an approved pathology practitioner on more than 1 day.
1.2.3Services to which clause 1.2.2 does not apply
(1)Clause 1.2.2 does not apply to a pathology service described in subclause (2) if:
(a)under a request for a service, other than a request for a service described in paragraph (2)(a), no more than 6 tests are requested; and
(b)the tests are performed within 6 months of the request; and
(c)the pathology provider of the service writes on the account for the service that the service has a rule 3 exemption.
(2)For subclause (1), the pathology services are:
(a)estimation of prothrombin time (INR) for a patient undergoing anticoagulant therapy; and
(b)quantitative estimation of lithium for a patient undergoing lithium therapy; and
(c)a service described in item 65070 in relation to a patient undergoing chemotherapy for neoplastic disease or immunosuppressant therapy; and
(d)a service described in item 65070 in relation to
clozaril, ticlopidine hydrochloride, methotrexate, gold, sulphasalazine or penicillamine therapy of a patient; and
(e)a service described in any of items 66500 to 66512, in relation to methotrexate or leflunomide therapy of a patient; and
(f)quantitative estimation of urea, creatinine and electrolytes in relation to:
(i)cis‑platinum or cyclosporin therapy of a patient; or
(ii)chronic renal failure of a patient being treated
in a dialysis program conducted by a recognised hospital; and
(g)quantitative estimation of albumin and calcium in relation to therapy of a patient with vitamin D, its metabolites or analogues; and
(h)quantitative estimation of calcium, phosphate, magnesium, urea, creatinine and electrolytes for a cancer patient receiving bisphosphonate infusions.
1.2.4Referral of designated tests by one pathology practitioner to another
(1)In this clause:
designated test means a pathology test relating to a patient episode that is a test of a kind mentioned in item 65150, 65175, 66650, 66695, 66711, 66722, 66785, 66800, 66812, 66819, 66825, 69384, 69494, 71089, 71153 or 77165.
(2)This clause applies if one or more designated tests are referred by a referring APP to a receiving APP in another approved pathology authority.
(3)If a referring APP has rendered one or more designated tests:
(a)the amount mentioned in item 65150, 65153, 65175, 65176, 65177, 65178, 66650, 66695, 66698, 66701, 66704, 66707, 66711, 66722, 66725, 66728, 66731, 66785, 66800, 66803, 66812, 66819, 66825, 69384, 69387, 69390, 69393, 69396, 69494, 69495, 71089, 71091, 71153, 71155, 71157, 77165, 71166 or 71167 (as the case may be) is payable for each designated test rendered by the referring APP; and
(b)subject to subclause (5), the amount mentioned in item 65158, 65181, 66652, 66697, 66715, 66724, 66790, 66805, 66817, 66821, 66827, 69401, 69498, 71092, 71156 or 71170 (as the case may be) is payable for each designated test rendered by the receiving APP.
(4)If a referring APP has not rendered a designated test:
(a)for the first designated test that is rendered by the receiving APP—the amount mentioned in item 65157, 65180, 66651, 66696, 66714, 66723, 66789, 66804, 66816, 66820, 66826, 69400, 69497, 71090, 71154 or 71169 (as the case may be) is payable; and
(b)for each subsequent designated test (if any) that is rendered by the receiving APP—subject to subclause (6), the amount mentioned in item 65158, 65181, 66652, 66697, 66715, 66724, 66790, 66805, 66817, 66821, 66827, 69401, 69498, 71092, 71156 or 71170 (as the case may be) is payable for each test rendered.
(5)For paragraph (3)(b), the maximum number of designated tests for which the fee mentioned in the relevant item is payable is as follows:
(a)for item 66652, 66715, 66790, 66817, 66821 or 66827:
(b)for item 65158, 66805, 69498 or 71092:
(c)for item 71156 or 71170:
(d)for item 65181 or 66724:
where:
X is the number of designated tests rendered by a referring APP.
(6)For paragraph (4)(b), the maximum number of designated tests for which the fee mentioned in the relevant item is payable is as follows:
(a)for item 66652, 66715, 66790, 66817, 66821 or 66827—1;
(b)for item 65158, 66805, 69498 or 71092—2;
(c)for item 71156 or 71170—3;
(d)for item 65181 or 66724—4.
(7)Items in Group P10 (Patient episode initiation) do not apply to a receiving APP in subclause (2).
1.2.5Items not to be split
Except as stated in clause 1.2.4 the amount mentioned in an item is payable only to one approved pathology practitioner for a single patient episode.
1.2.6Certain pathology services to be treated as one service
(1)In this clause:
general practitioner means a medical practitioner who:
(a)is not a consultant physician in any specialty; and
(b)is not a specialist in any specialty.
set of pathology services has the meaning given by subclause 1.2.7(1).
(2)If a general practitioner, participating midwife or participating nurse practitioner requests a set of pathology services, the pathology services in the set are to be treated as individual pathology services in accordance with this clause.
(3)If the fee mentioned in an item that describes any of the services in the set of pathology services is higher than the fees mentioned in the other items that describe the services in the set:
(a)the pathology service described in the first‑mentioned item is to be treated as one pathology service; and
(b)either:
(i)the pathology service in the set that is described in the item that mentions the second‑highest fee is to be treated as one pathology service; or
(ii)if 2 or more items that describe any of those services mentions the second‑highest fee—the pathology service described in the item that mentions the second‑highest fee, and has the lowest item number, is to be treated as one pathology service; and
(c)the pathology services in the set, other than the services that are to be treated as one pathology service under paragraphs (a) and (b), are to be treated as one pathology service.
(4)If the fees mentioned in 2 or more items that describe any of the services in the set of pathology services are the same, and higher than the fees mentioned in the other items that describe the services in the set:
(a)the pathology service in the set that is described in the item that mentions the highest fee, and has the lowest item number, is to be treated as one pathology service; and
(b)the pathology service in the set that is described in the item that mentions the highest fee, and has the second‑lowest item number, is to be treated as one pathology service; and
(c)the pathology services in the set, other than the services that are to be treated as one pathology service under paragraphs (a) and (b), are to be treated as one pathology service.
(5)If pathology services are to be treated as one pathology service under paragraph (3)(c) or (4)(c), the fee for the one pathology service is the highest fee mentioned in any of the items that describe the pathology services that are to be treated as the one pathology service.
1.2.7Meaning of set of pathology services
(1)In clause 1.2.6:
set of pathology services means a group of pathology services:
(a)that consist of services that are described in at least 4 different items; and
(b)all of which are requested in a single patient episode; and
(c)each of which relates to a patient who is not an admitted patient of a hospital; and
(d)none of which is referred to in item 66900, 69484, 73053 or 73055.
(2)However, a set of pathology services does not include the following items:
(a)an item in Group P10 (Patient episode initiation), Group P11 (Specimen referred), Group P12 (Management of bulk‑billed services) or Group P13 (Bulk‑billing incentive);
(b)if a service is requested by an approved pathology practitioner of an approved pathology authority and rendered by another approved pathology practitioner of an approved pathology authority that is not related to the approved pathology authority of the first‑mentioned approved pathology practitioner—item 65079, 65082, 65157, 65158, 65166, 65180, 65181, 66606, 66610, 66639, 66642, 66651, 66652, 66663, 66666, 66696, 66697, 66714, 66715, 66723, 66724, 66780, 66783, 66789, 66790, 66792, 66804, 66805, 66816, 66817, 66820, 66821, 66826, 66827, 66832, 66834, 66837, 69325, 69328, 69331, 69379, 69383, 69400, 69401, 69419, 69451, 69489, 69492, 69497, 69498, 69500, 71076, 71090, 71092, 71096, 71148, 71154, 71156, 71169, 71170, 73309, 73312, 73315, 73318, 73321 or 73324.
(3)An approved pathology authority is related to another approved pathology authority for paragraph (2)(b) if:
(a)both approved pathology authorities are employed (including employed under contract) by the same person, whether or not the person is also an approved pathology authority; or
(b)either of the approved pathology authorities is employed (including employed under contract) by the other; or
(c)both approved pathology authorities are corporations and are connected entities within the meaning of the Corporations Act 2001; or
(d)the approved pathology authorities are partners (whether or not either or both of the approved pathology authorities are individuals and whether or not other persons are in partnership with either or both of the approved pathology authorities); or
(e)both approved pathology authorities are operated by the Commonwealth or an authority of the Commonwealth; or
(f)both approved pathology authorities are operated by the same State or internal Territory or an authority of the same State or internal Territory.
1.2.8Satisfying requirements described in pathology service
Unless the contrary intention appears, a requirement contained in the description of a pathology service in Part 2 is satisfied if:
(a)for a requirement for information—the information:
(i)is included in the request for the service; or
(ii)was supplied in writing on an earlier occasion to
the approved pathology authority that rendered
the service, and has been kept by the approved pathology authority; or
(b)for a requirement for laboratory test results—the results are:
(i)included in the request for the service; or
(ii)obtained from another laboratory test performed in the same patient episode; or
(iii)included in results from an earlier laboratory test that have been kept by the approved pathology authority.
1.2.9Application of items—services provided with autologous injections of blood or blood products
An item in the table does not apply to a service mentioned in the item if the service is provided to a patient at the same time as, or in connection with, an injection of blood or a blood product that is autologous.
Part 2—Services and fees
Division 2.1—Group P1: haematology
2.1.1Services to which clause 1.2.2 does not apply
(1)Clause 1.2.2 does not apply to a pathology service described in item 65060, 65070, 65120, 65123, 65126, 65129, 65150, 65153 or 65156 if:
(a)the service is rendered in relation to one or more specimens taken on any of not more than 6 occasions in a period of 24 hours; and
(b)the service is rendered to an inpatient of a hospital; and
(c)the service is rendered in relation to each specimen as soon as possible after the specimen is taken; and
(d)the pathology provider of the service writes on the account for the service that the service has a rule 3 exemption.
(2)Clause 1.2.2 does not apply to a pathology service described in item 65109 or 65110 if:
(a)the service is rendered:
(i)for a service described in item 65109—on one of not more than 5 occasions in a period of 24 hours; and
(ii)for a service described in item 65110—on one of not more than 2 occasions in a period of 24 hours; and
(b)the service was requested on a separate occasion to any other occasions on which the service was requested in the period of 24 hours; and
(c)the pathology provider of the service writes on the account for the service that the service has a rule 3 exemption.
2.1.2Item taken to refer only to the first service of a particular kind
(1)For an item in Group P1 (Haematology):
(a)if pathology services of a kind mentioned in item 65090 or 65093 are rendered for a patient during a period when the patient is in hospital, the item applies only to the first pathology service of that kind rendered for the patient during the period; and
(b)if:
(i)tests (except tests mentioned in item 65099, 65102, 65105 or 65108) are carried out in relation to a patient episode; and
(ii)specimen material from the patient episode is stored; and
(iii)in response to a request made within 14 days of the patient episode, further tests (except tests mentioned in item 65099, 65102, 65105 or 65108) are carried out on the stored material;
the later tests and the earlier tests are taken to be part of one patient episode.
(2)Items 65102 and 65108 apply only if a minimum of 6 units are issued for a patient’s care in any 1 day.
(3)For items 65099 and 65102:
compatibility tests by crossmatch means that, in addition to all the tests mentioned in paragraphs (a) and (b) of the item, donor red cells from each unit must have been tested directly against the serum of the patient by one or more accepted crossmatching techniques.
| Group P1—Haematology | ||
| Item | Pathology service | Fee ($) |
| 65060 | Haemoglobin, erythrocyte sedimentation rate, blood viscosity—one or more tests | 7.85 |
| 65066 |
Examination of: (a) a blood film by special stains to demonstrate Heinz bodies, parasites or iron; or (b) a blood film by enzyme cytochemistry for neutrophil alkaline phosphatase, alpha‑naphthyl acetate esterase or chloroacetate esterase; or |
10.40 |
|
(c) a blood film using any other special staining methods including periodic acid Schiff and Sudan Black; or (d) a urinary sediment for haemosiderin; including a service described in item 65072 |
||
| 65070 |
Erythrocyte count, haematocrit, haemoglobin, calculation or measurement of red cell index or indices, platelet count, leucocyte count and manual or instrument generated differential count (not being a service where haemoglobin only is requested)—one or more instrument‑generated set of results from a single sample and (if performed): (a) a morphological assessment of a blood film; and (b) any service in item 65060 or 65072 |
16.95 |
| 65072 | Examination for reticulocytes including a reticulocyte count by any method—one or more tests | 10.20 |
| 65075 |
Haemolysis or metabolic enzymes—assessment by one or more of the following tests: (a) erythrocyte autohaemolysis test; (b) erythrocyte osmotic fragility test; (c) sugar water test; (d) G–6–PD (qualitative or quantitative) test; (e) pyruvate kinase (qualitative or quantitative) test; (f) acid haemolysis test; (g) quantitation of muramidase in serum or urine; (h) Donath Landsteiner antibody test; (i) other erythrocyte metabolic enzyme tests |
51.95 |
| 65078 |
Tests for the diagnosis of thalassaemia consisting of haemoglobin electrophoresis or chromatography and at least 2 of: (a) examination for HbH; or (b) quantitation of HbA2; or (c) quantitation of HbF; including (if performed) any service described in item 65060 or 65070 |
90.20 |
| 65079 | A test described in item 65078 if rendered by a receiving APP—one or more tests | 90.20 |
| 65081 |
Tests for the investigation of haemoglobinopathy consisting of haemoglobin electrophoresis or chromatography and at least one of: (a) heat denaturation test; or (b) isopropanol precipitation test; or (c) tests for the presence of haemoglobin S; or (d) quantitation of any haemoglobin fraction (including S, C, D, E); including (if performed) any service described in item 65060, 65070 or 65078 |
96.60 |
| 65082 | A test described in item 65081 if rendered by a receiving APP—one or more tests | 96.60 |
| 65084 | Bone marrow trephine biopsy—histopathological examination of sections of bone marrow and examination of aspirated material (including clot sections where necessary), including (if performed) any test described in item 65060, 65066 or 65070 | 165.85 |
| 65087 | Bone marrow—examination of aspirated material (including clot sections where necessary), including (if performed) any test described in item 65060, 65066 or 65070 | 83.10 |
| 65090 | Blood grouping (including back‑grouping if performed)—ABO and Rh (D antigen) | 11.15 |
| 65093 | Blood grouping—Rh phenotypes, Kell system, Duffy system, M and N factors or any other blood group system—one or more systems, including item 65090 (if performed) | 22.00 |
| 65096 |
Blood grouping (including back‑grouping if performed), and examination of serum for Rh and other blood group antibodies, including: (a) identification and quantitation of any antibodies detected; and (b) (if performed) any test described in item 65060 or 65070 |
41.00 |
| 65099 |
Compatibility tests by crossmatch—all tests performed on any 1 day for up to 6 units, including: (a) all grouping checks of the patient and donor; and (b) examination for antibodies and, if necessary, identification of any antibodies detected; and (c) (if performed) any tests described in item 65060, 65070, 65090 or 65096 |
108.90 |
| 65102 |
Compatibility tests by crossmatch—all tests performed on any 1 day in excess of 6 units, including: (a) all grouping checks of the patient and donor; and (b) examination for antibodies and, if necessary, identification of any antibodies detected; and (c) (if performed) any tests described in item 65060, 65070, 65090, 65096, 65099 or 65105 |
164.60 |
| 65105 |
Compatibility testing using at least a 3 cell panel and issue of red cells for transfusion—all tests performed on any 1 day for up to 6 units, including: (a) all grouping checks of the patient and donor; and (b) examination for antibodies and, if necessary, identification of any antibodies detected; and (c) (if performed) any tests described in item 65060, 65070, 65090 or 65096 |
108.90 |
| 65108 |
Compatibility testing using at least a 3 cell panel and issue of red cells for transfusion—all tests performed on any 1 day in excess of 6 units, including: (a) all grouping checks of the patient and donor; and (b) examination for antibodies and, if necessary, identification of any antibodies detected; and (c) (if performed) any tests described in item 65060, 65070, 65090, 65096, 65099 or 65105 |
164.60 |
| 65109 | Release of fresh frozen plasma or cryoprecipitate for the use in a patient for the correction of a coagulopathy—one release | 12.90 |
| 65110 | Release of compatible fresh platelets for the use in a patient for platelet support as prophylaxis to minimise bleeding or during active bleeding—one release | 12.90 |
| 65111 | Examination of serum for blood group antibodies (including identification and, if necessary, quantitation of any antibodies detected) | 23.20 |
| 65114 |
One or more of the following tests: (a) direct Coombs (antiglobulin) test; (b) qualitative or quantitative test for cold agglutinins or heterophil antibodies |
9.10 |
| 65117 |
One or more of the following tests: (a) spectroscopic examination of blood for chemically altered haemoglobins; (b) detection of methaemalbumin (Schumm’s test) |
20.25 |
| 65120 | Prothrombin time (including INR where appropriate), activated partial thromboplastin time, thrombin time (including test for the presence of heparin), test for factor XIII deficiency (qualitative), Echis test, Stypven test, reptilase time, fibrinogen, or one of fibrinogen degradation products, fibrin monomer or D‑dimer—one test | 13.70 |
| 65123 | Two tests described in item 65120 | 20.35 |
| 65126 | Three tests described in item 65120 | 27.85 |
| 65129 | Four or more tests described in item 65120 | 35.50 |
| 65137 | A test for the presence of lupus anticoagulant, not being a service connected with a service to which item 65175, 65176, 65177, 65178 or 65179 applies | 25.35 |
| 65142 | Confirmation or clarification of an abnormal or indeterminate result of a test mentioned in item 65175, by testing a specimen collected on a different day—one or more tests | 25.35 |
| 65144 | Platelet aggregation in response to ADP, collagen, 5HT, ristocetin or other substances, or heparin, low molecular weight heparins, heparinoid or other drugs—one or more tests | 56.55 |
| 65147 | Quantitation of anti‑Xa activity when monitoring is required for a patient receiving a low molecular weight heparin or heparinoid—one test | 37.90 |
| 65150 | Quantitation of von Willebrand factor antigen, von Willebrand factor activity (ristocetin cofactor assay), von Willebrand factor collagen binding activity, factor II, factor V, factor VII, factor VIII, factor IX, factor X, factor XI, factor XII, factor XIII, Fletcher factor, Fitzgerald factor, circulating coagulation factor inhibitors other than by Bethesda assay—one test | 70.90 |
| 65153 | Two tests described in item 65150 | 141.85 |
| 65156 | Three or more tests described in item 65150 | 212.75 |
| 65157 | A test described in item 65150, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP—one test | 70.90 |
| 65158 | A test described in item 65150, if rendered by a receiving APP, where one or more tests in the item have been rendered by the referring APP—one test | 70.90 |
| 65159 | Quantitation of circulating coagulation factor inhibitors by Bethesda assay—one test | 70.90 |
| 65162 | Examination of a maternal blood film for the presence of fetal red blood cells (Kleihauer test) | 10.45 |
| 65165 | Detection and quantitation of fetal red blood cells in the maternal circulation by detection of red cell antigens using flow cytometric methods including (if performed) any test described in item 65070 or 65162 | 34.45 |
| 65166 | A test described in item 65165 if rendered by a receiving APP—one or more tests | 34.45 |
| 65171 | A test for the presence of antithrombin III deficiency, protein C deficiency, protein S deficiency or activated protein C resistance in a first degree relative of a person who has a proven deficiency mentioned in this item—one or more tests | 25.35 |
| 65175 | A test for the presence of antithrombin III deficiency, protein C deficiency, protein S deficiency, lupus anticoagulant, activated protein C resistance, if the request for the test specifically identifies that the patient has a history of venous thromboembolism—quantitation by one or more techniques—one test | 25.35 |
| 65176 | Two tests described in item 65175 | 48.65 |
| 65177 | Three tests described in item 65175 | 71.95 |
| 65178 | Four tests described in item 65175 | 95.20 |
| 65179 | Five tests described in item 65175 | 118.50 |
| 65180 | A test described in item 65175, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP—one test | 25.35 |
| 65181 | A test described in item 65175, if rendered by a receiving APP, where one or more tests in the item have been rendered by the referring APP—one test | 23.30 |
Division 2.2—Group P2: chemical
2.2.1Creatinine ratios
A pathology service mentioned in an item in Group P2 (Chemical) (except item 66500) that:
(a)involves the measurement of a substance in urine; and
(b)requires calculation of a substance/creatinine ratio;
is taken to include the measurement of creatinine necessary for the calculation.
2.2.2Services to which clause 1.2.2 does not apply
Clause 1.2.2 does not apply to a pathology service described in item 66500, 66503, 66506, 66509, 66512, 66584 or 66800 if:
(a)the service is rendered in relation to one or more specimens taken on any of not more than 6 occasions in a period of 24 hours; and
(b)the service is rendered to an inpatient of a hospital; and
(c)the service is rendered in relation to each specimen as soon as possible after the specimen is taken; and
(d)the pathology provider of the service writes on the account for the service that the service has a rule 3 exemption.
2.2.3Limitation on certain items
(1)For any particular patient, the following items are applicable not more than twice in a 12 month period:
(a)items 66539 and 66607;
(b)item 66605, 66606 or 66610.
(2)For any particular patient, each of items 66551 and 66660 is applicable not more than 4 times in a 12 month period.
(3)For any particular patient, each of items 66554 and 66830 is applicable not more than 6 times in a 12 month period.
(4)For any particular patient, item 66626 is applicable not more than 36 times in a 12 month period.
(5)For any particular patient, item 66750 or 66751 is applicable not more than once in a pregnancy.
(6)For any particular patient, item 66517 is applicable not more than 3 times in a pregnancy.
(7)For any particular patient, item 66838 is applicable not more than once in a 12 month period.
2.2.5Thyroid function testing
(1)For item 66719:
abnormal level of TSH means a level of TSH that is outside the normal reference range for the particular method of assay used to determine the level.
(2)Unless paragraph (a) of item 66719 is satisfied, the amount mentioned in the item is not payable for a pathology service mentioned in the item unless the pathologist who renders the service has a written statement from the medical practitioner who requested the service that satisfies subclause (3).
(3)The written statement from the medical practitioner must indicate:
(a)that the tests are required for a particular purpose, being a purpose mentioned in paragraph (b) of item 66719; or
(b)that the medical practitioner who requested the tests suspects the patient has pituitary dysfunction; or
(c)that the patient is on drugs that interfere with thyroid hormone metabolism or function.
2.2.6Limitation on certain items
(1)For any particular patient, each of items 66655, 66659 and 66841 is applicable not more than once in a 12 month period.
(2)For any particular patient, each of items 66819, 66820, 66821, 66822, 66825, 66826, 66827 and 66828 is applicable not more than 3 times in a 6 month period.
2.2.7Nutritional and toxicity metals testing
(1)In this clause:
metal toxicity testing group means items 66825, 66826, 66827, 66828, 66831 and 66832.
nutritional metals testing group means items 66819, 66820, 66821 and 66822.
(2)An item in the nutritional metals testing group or the metal toxicity testing group does not apply to a service performed if medicare benefits are paid or payable for tests that are performed for the same patient in 3 patient episodes requested within 6 months before the request for that service, under any of:
(a)that item; or
(b)the other item in the same group; or
(c)an item in the other group.
| Group P2—Chemical | ||
| Item | Pathology service | Fee ($) |
| 66500 | Quantitation in serum, plasma, urine or other body fluid (except amniotic fluid), by any method, except reagent tablet or reagent strip, (with or without reflectance meter) of acid phosphatase, alanine aminotransferase, albumin, alkaline phosphatase, ammonia, amylase, aspartate aminotransferase, bicarbonate, bilirubin (total), bilirubin (any fractions), C‑reactive protein, calcium (total or corrected for albumin), chloride, creatine kinase, creatinine, gamma glutamyl transferase, globulin, glucose, lactate dehydrogenase, lipase, magnesium, phosphate, potassium, sodium, total cholesterol, total protein, triglycerides, urate or urea—one test | 9.70 |
| 66503 | Two tests described in item 66500 | 11.65 |
| 66506 | Three tests described in item 66500 | 13.65 |
| 66509 | Four tests described in item 66500 | 15.65 |
| 66512 | Five or more tests described in item 66500 | 17.70 |
| 66517 | Quantitation of bile acids in blood in pregnancy | 19.65 |
| 66518 | Investigation of cardiac or skeletal muscle damage by quantitative measurement of creatine kinase isoenzymes, troponin or myoglobin in blood—tests performed on only one specimen in a 24 hour period | 20.05 |
| 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 | 40.15 |
| 66536 | Quantitation of HDL cholesterol | 11.05 |
| 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 |
30.60 |
| 66542 |
Oral glucose tolerance test for the diagnosis of diabetes mellitus, that includes: (a) administration of glucose; and (b) at least 2 measurements of blood glucose; and (c) (if performed) any test described in item 66695 |
18.95 |
| 66545 |
Oral glucose challenge test in pregnancy for the detection of gestational diabetes that includes: (a) administration of glucose; and (b) one or 2 measurements of blood glucose; and (c) (if performed) any test in item 66695 |
15.80 |
| 66548 |
Oral glucose tolerance test in pregnancy for the diagnosis of gestational diabetes that includes: (a) administration of glucose; and (b) at least 3 measurements of blood glucose; and (c) (if performed) any test in item 66695 |
19.90 |
| 66551 | Quantitation of glycosylated haemoglobin performed in the management of established diabetes | 16.80 |
| 66554 | Quantitation of glycosylated haemoglobin performed in the management of pre‑existing diabetes where the patient is pregnant—including a service in item 66551 (if performed) | 16.80 |
| 66557 | Quantitation of fructosamine performed in the management of established diabetes—each test to a maximum of 4 tests in a 12 month period | 9.70 |
| 66560 | Microalbumin—quantitation in urine | 20.10 |
| 66563 | Osmolality, estimation by osmometer, in serum or in urine—one or more tests | 24.70 |
| 66566 |
Quantitation of: (a) blood gases (including pO2, oxygen saturation and pCO2); and (b) bicarbonate and pH; including any other measurement (e.g. haemoglobin, lactate, potassium or ionised calcium) or calculation performed on the same specimen—one or more tests on one specimen |
33.70 |
| 66569 | Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 2 specimens performed on any 1 day | 42.60 |
| 66572 | Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 3 specimens performed on any 1 day | 51.55 |
| 66575 | Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 4 specimens performed on any 1 day | 60.45 |
| 66578 | Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 5 specimens performed on any 1 day | 69.35 |
| 66581 | Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 6 or more specimens performed on any 1 day | 78.25 |
| 66584 | Quantitation of ionised calcium (except if performed as part of item 66566)—one test | 9.70 |
| 66587 | Urine acidification test for the diagnosis of renal tubular acidosis including the administration of an acid load, and pH measurements on 4 or more urine specimens and at least one blood specimen | 47.55 |
| 66590 | Calculus, analysis of one or more | 30.60 |
| 66593 | Ferritin—quantitation, except if requested as part of iron studies | 18.00 |
| 66596 |
Iron studies, consisting of quantitation of: (a) serum iron; and (b) transferrin or iron binding capacity; and (c) ferritin |
32.55 |
| 66605 | Vitamins—quantitation of vitamin B1, B2, B3, B6 or C in blood, urine or other body fluid—one or more tests | 30.60 |
| 66606 | A test described in item 66605 if rendered by a receiving APP—one or more tests | 30.60 |
| 66607 | Vitamins—quantitation of vitamin A or E in blood, urine or other body fluid—one or more tests in a 6 month period | 75.75 |
| 66610 | A test described in item 66607 if rendered by a receiving APP—one or more tests | 75.75 |
| 66623 |
All qualitative and quantitative tests on blood, urine or other body fluid for: (a) a drug or drugs of abuse (including illegal drugs and legally available drugs taken other than in appropriate dosage); or (b) ingested or absorbed toxic chemicals; including a service described in item 66800, 66803, 66806, 66812 or 66815 (if performed), but excluding: (c) the surveillance of sports people and athletes for performance improving substances; and (d) the monitoring of patients participating in a drug abuse treatment program |
41.50 |
| 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 |
24.10 |
| 66629 | Beta‑2‑microglobulin—quantitation in serum, urine or other body fluids—one or more tests | 20.10 |
| 66632 | Caeruloplasmin, haptoglobins, or prealbumin—quantitation in serum, urine or other body fluids—one or more tests | 20.10 |
| 66635 | Alpha‑1‑antitrypsin—quantitation in serum, urine or other body fluid—one or more tests | 20.10 |
| 66638 | Isoelectric focusing or similar methods for determination of alpha‑1‑antitrypsin phenotype in serum—one or more tests | 49.05 |
| 66639 | A test described in item 66638 if rendered by a receiving APP—one or more tests | 29.20 |
| 66641 |
Electrophoresis of serum or other body fluid to demonstrate: (a) the isoenzymes of lactate dehydrogenase; or (b) the isoenzymes of alkaline phosphatase; including the preliminary quantitation of total relevant enzyme activity—one or more tests |
29.20 |
| 66642 | A test described in item 66641 if rendered by a receiving APP—one or more tests | 29.20 |
| 66644 | C‑1 esterase inhibitor—quantitation | 20.15 |
| 66647 | C‑1 esterase inhibitor—functional assay | 45.10 |
| 66650 | Alpha‑fetoprotein, CA‑15.3 antigen (CA15.3), CA‑19.9 antigen (CA19.9), CA‑125 antigen (C125), cancer associated serum antigen (CASA), carcinoembryonic antigen (CEA), human chorionic gonadotrophin (HCG), neuron specific enolase (NSE) thyroglobulin in serum or other body fluid, in the monitoring of malignancy or in the detection or monitoring of gestational trophoblastic disease or a hepatic or germ cell tumour—quantitation—one test | 24.35 |
| 66651 | A test described in item 66650, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP—one test | 24.35 |
| 66652 | A test described in item 66650, if rendered by a receiving APP, where one or more tests in the item have been rendered by the referring APP—one test | 20.30 |
| 66653 | Two or more tests described in item 66650 | 44.60 |
| 66655 | Prostate specific antigen—quantitation | 20.15 |
| 66656 | Prostate specific antigen (PSA) quantitation in the monitoring of previously diagnosed prostatic disease (including a test to which item 66655 applies) | 20.15 |
| 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 at or above the age‑related median but below the age‑related, method‑specific 97.5% reference limit | 37.30 |
| 66660 | 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 at or above the age‑related, method‑specific 97.5% reference limit, but below 10 µg/L | 37.30 |
| 66662 | Quantitation of hormone receptors on proven primary breast or ovarian carcinoma or a metastasis from a breast or ovarian carcinoma or a subsequent lesion in the breast—one or more tests | 79.95 |
| 66663 | A test described in item 66662 if rendered by a receiving APP—one or more tests | 79.95 |
| 66665 | Lead quantitation in blood or urine (other than for occupational health screening purposes) to a maximum of 3 tests in a 6 month period—each test | 30.60 |
| 66666 | A test described in item 66665 if rendered by a receiving APP—one or more tests | 30.60 |
| 66667 | Quantitation of serum zinc in a patient receiving intravenous alimentation—each test | 30.60 |
| 66671 | Quantitation of serum aluminium in a patient in a renal dialysis program—each test | 36.90 |
| 66674 |
Quantitation of: (a) faecal fat; or (b) breath hydrogen in response to loading with disaccharides; one or more tests within a 28 day period |
39.95 |
| 66677 | Test for tryptic activity in faeces in the investigation of diarrhoea of longer than 4 weeks duration in children under 6 years | 11.15 |
| 66680 | Quantitation of disaccharidases and other enzymes in intestinal tissue—one or more tests | 74.45 |
| 66683 | Enzymes—quantitation in solid tissue or tissues other than blood elements or intestinal tissue—one or more tests | 74.45 |
| 66686 |
Performance of one or more of the following procedures: (a) growth hormone suppression by glucose loading; (b) growth hormone stimulation by exercise; (c) dexamethasone suppression test; (d) sweat collection by iontophoresis for chloride analysis; (e) pharmacological stimulation of growth hormone |
50.65 |
| 66695 | Quantitation in blood or urine of hormones and hormone binding proteins—ACTH, aldosterone, androstenedione, C‑peptide, calcitonin, cortisol, DHEAS, 11‑deoxycortisol, dihydrotestosterone, FSH, gastrin, glucagon, growth hormone, hydroxyprogesterone, insulin, LH, oestradiol, oestrone, progesterone, prolactin, PTH, renin, sex hormone binding globulin, somatomedin C(IGF –1), free or total testosterone, urine steroid fraction or fractions, vasoactive intestinal peptide—one test | 30.50 |
| 66696 | A test described in item 66695, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP | 30.50 |
| 66697 | A test described in item 66695, if rendered by a receiving APP, where one or more tests in the item have been rendered by the referring APP—each test to a maximum of 4 tests | 13.20 |
| 66698 | Two tests described in item 66695 | 43.70 |
| 66701 | Three tests described in item 66695 | 56.90 |
| 66704 | Four tests described in item 66695 | 70.15 |
| 66707 | Five or more tests described in item 66695 | 83.35 |
| 66711 |
Quantitation in saliva of cortisol in: (a) the investigation of Cushing’s syndrome; or (b) the management of children with congenital adrenal hyperplasia; one test |
30.15 |
| 66712 | Two tests described in item 66711 | 43.05 |
| 66714 | A test described in item 66711, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP | 30.15 |
| 66715 | A test described in item 66711, if rendered by a receiving APP, where one test in the item has been rendered by the referring APP—one test | 12.85 |
| 66716 | TSH quantitation | 25.05 |
| 66719 |
Thyroid function tests (comprising the service described in item 66716 and one or more of the following tests—free thyroxine, free T3, for a patient, if at least one of the following conditions is satisfied: (a) the patient has an abnormal level of TSH; (b) the tests are performed: (i) for the purpose of monitoring thyroid disease in the patient; or (ii) to investigate the sick euthyroid syndrome if the patient is an admitted patient; or (iii) to investigate dementia or psychiatric illness of the patient; or (iv) to investigate amenorrhoea or infertility of the patient; (c) the medical practitioner who requested the tests suspects the patient has a pituitary dysfunction; (d) the patient is on drugs that interfere with thyroid hormone metabolism or function |
34.80 |
| 66722 | TSH quantitation described in item 66716 and one test described in item 66695 | 37.90 |
| 66723 | A test described in item 66722, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP—one test | 37.90 |
| 66724 | A test described in item 66722, if rendered by a receiving APP, where one or more tests in the item have been rendered by the referring APP—one test | 13.15 |
| 66725 | TSH quantitation described in item 66716 and 2 tests described in item 66695 | 51.05 |
| 66728 | TSH quantitation described in item 66716 and 3 tests described in item 66695 | 64.20 |
| 66731 | TSH quantitation described in item 66716 and 4 tests described in item 66695 | 77.40 |
| 66734 | TSH quantitation described in item 66716 and 5 tests described in item 66695 | 90.55 |
| 66743 | Quantitation of alpha‑fetoprotein in serum or other body fluids during pregnancy except if requested as part of item 66750 or 66751 | 20.10 |
| 66749 |
Amniotic fluid, spectrophotometric examination of, and quantitation of: (a) lecithin/sphingomyelin ratio; or (b) palmitic acid, phosphatidylglycerol or lamellar body phospholipid; or (c) bilirubin, including correction for haemoglobin; one or more tests |
32.95 |
| 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); (c) free beta human chorionic gonadotrophin (free beta HCG); (d) pregnancy associated plasma protein A (PAPP‑A); (e) unconjugated oestriol (uE3); (f) alpha‑fetoprotein (AFP); including (if performed) a service described in item 73527 or 73529 |
39.75 |
| 66751 | Quantitation, in pregnancy, of any 3 or more tests described in item 66750 | 55.25 |
| 66752 | Quantitation of acetoacetate, beta‑hydroxybutyrate, citrate, oxalate, total free fatty acids, cysteine, homocysteine, cystine, lactate, pyruvate or other amino acids and hydroxyproline (except if performed as part of item 66773 or 66776)—one test | 24.70 |
| 66755 | Two or more tests described in item 66752 | 38.85 |
| 66756 | Quantitation of 10 or more amino acids for the diagnosis of inborn errors of metabolism—up to 4 tests in a 12 month period on specimens of plasma, CSF and urine | 98.30 |
| 66757 | Quantitation of 10 or more amino acids for monitoring of previously diagnosed inborn errors of metabolism in one tissue type | 98.30 |
| 66758 | Quantitation of angiotensin converting enzyme, or cholinesterase—one or more tests | 24.70 |
| 66761 | Test for reducing substances in faeces by any method (except reagent strip or dipstick) | 13.15 |
| 66764 | Examination for faecal occult blood (including tests for haemoglobin and its derivatives in the faeces except by reagent strip or dip stick methods) with a maximum of 3 examinations on specimens collected on separate days in a 28 day period | 8.90 |
| 66767 | Two examinations described in item 66764 performed on separately collected and identified specimens | 17.85 |
| 66770 | Three examinations described in item 66764 performed on separately collected and identified specimens | 26.70 |
| 66773 | Quantitation of products of collagen breakdown or formation for the monitoring of patients with proven low bone mineral density and, if performed, a service described in item 66752—one or more tests | 24.65 |
| 66776 | Quantitation of products of collagen breakdown or formation for the monitoring of patients with metabolic bone disease or Paget’s disease of bone and, if performed, a service described in item 66752—one or more tests | 24.65 |
| 66779 | Adrenaline, noradrenaline, dopamine, histamine, hydroxyindoleacetic acid (5HIAA), hydroxymethoxymandelic acid (HMMA), homovanillic acid (HVA), metanephrines, methoxyhydroxyphenylethylene glycol (MHPG), phenylacetic acid (PAA) or serotonin—quantitation—one or more tests | 39.95 |
| 66780 | A test described in item 66779 if rendered by a receiving APP—one or more tests | 39.95 |
| 66782 | Porphyrins or porphyrins precursors—detection in plasma, red cells, urine or faeces—one or more tests | 13.15 |
| 66783 | A test described in item 66782 if rendered by a receiving APP—one or more tests | 13.15 |
| 66785 | Porphyrins or porphyrins precursors—quantitation in plasma, red cells, urine or faeces—one test | 39.95 |
| 66788 | Porphyrins or porphyrins precursors—quantitation in plasma, red cells, urine or faeces—2 or more tests | 65.85 |
| 66789 | A test described in item 66785 if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP—one test | 39.95 |
| 66790 | A test described in item 66785, if rendered by a receiving APP, where one or more tests in the item have been rendered by the referring APP—one test | 25.90 |
| 66791 | Porphyrin biosynthetic enzymes—measurement of activity in blood cells or other tissues—one or more tests | 74.45 |
| 66792 | A test described in item 66791 if rendered by a receiving APP—one or more tests | 74.45 |
| 66800 | Quantitation in blood, urine or other body fluid by any method (except reagent tablet or reagent strip) of any of the following used therapeutically by the patient from whom the specimen was taken: amikacin, carbamazepine, digoxin, disopyramide, ethanol, ethosuximide, gentamicin, lignocaine, lithium, netilmicin, paracetamol, phenobarbitone, phenytoin, primidone, procainamide, quinidine, salicylate, theophylline, tobramycin, valproate or vancomycin—one test | 18.15 |
| 66803 | Two tests described in item 66800 | 30.50 |
| 66804 | A test described in item 66800 if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP—one test | 18.15 |
| 66805 | A test described in item 66800, if rendered by a receiving APP, where one or more tests in the item have been rendered by the referring APP—one test | 12.35 |
| 66806 | Three tests described in item 66800 | 41.85 |
| 66812 | Quantitation, not elsewhere described in this table by any method or methods, in blood, urine or other body fluid, of a drug being used therapeutically by the patient from whom the specimen was taken—one test | 34.80 |
| 66815 | Two tests described in item 66812 | 59.55 |
| 66816 | A test described in item 66812 if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP—one test | 34.80 |
| 66817 | A test described in item 66812, if rendered by a receiving APP, where one or more tests in the item have been rendered by the referring APP—one test | 24.75 |
| 66819 | Quantitation of copper, manganese, selenium or zinc (except if item 66667 applies), in blood, urine or other body fluid—one test | 30.60 |
| 66820 | A test described in item 66819 if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP—one test | 30.60 |
| 66821 | A test described in item 66819, if rendered by a receiving APP, where one or more tests in the item have been rendered by the referring APP—one test | 21.80 |
| 66822 | Quantitation of copper, manganese, selenium or zinc (except if item 66667 applies), in blood, urine or other body fluid—2 or more tests | 52.45 |
| 66825 | 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—one test | 30.60 |
| 66826 | A test described in item 66825 if rendered by a receiving APP where no tests have been rendered by the referring APP—one test | 30.60 |
| 66827 | A test described in item 66825, if rendered by a receiving APP, where one or more tests in the item have been rendered by the referring APP—one test | 21.80 |
| 66828 | 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 | 52.45 |
| 66830 | Quantitation of BNP or NT‑proBNP for the diagnosis of heart failure in patients presenting with dyspnoea in a hospital emergency department | 58.50 |
| 66831 | Quantitation of copper or iron in liver tissue biopsy | 30.95 |
| 66832 | A test described in item 66831 if rendered by a receiving APP | 30.95 |
| 66833 |
25‑hydroxyvitamin D, quantification in serum, for the investigation of a patient who: (a) has signs or symptoms of osteoporosis or osteomalacia; or (b) has increased alkaline phosphatase and otherwise normal liver function tests; or (c) has hyperparathyroidism, hypo‑ or hypercalcaemia, or hypophosphataemia; or (d) is suffering from malabsorption (for example, because the patient has cystic fibrosis, short bowel syndrome, inflammatory bowel disease or untreated coeliac disease, or has had bariatric surgery); or (e) has deeply pigmented skin, or chronic and severe lack of sun exposure for cultural, medical, occupational or residential reasons; or (f) is taking medication known to decrease 25OH‑D levels (for example, anticonvulsants); or (g) has chronic renal failure or is a renal transplant recipient; or (h) is less than 16 years of age and has signs or symptoms of rickets; or (i) is an infant whose mother has established vitamin D deficiency; or (j) is an exclusively breastfed baby and has at least one other risk factor mentioned in a paragraph in this item; or (k) has a sibling who is less than 16 years of age and has vitamin D deficiency |
30.05 |
| 66834 | A test described in item 66833 if rendered by a receiving APP | 30.05 |
| 66835 | 1, 25‑dihydroxyvitamin D—quantification in serum, if the request for the test is made by, or on advice of, the specialist or consultant physician managing the treatment of the patient | 39.05 |
| 66836 |
1, 25‑dihydroxyvitamin D—quantification in serum, if: (a) a patient has hypercalcaemia; and (b) the request for the test is made by a general practitioner managing the treatment of the patient |
39.05 |
| 66837 | A test described in item 66835 or 66836 if rendered by a receiving APP | 39.05 |
| 66838 | Serum vitamin B12 test | 23.60 |
| 66839 | Quantification of vitamin B12 markers such as holoTranscobalamin or methylmalonic acid, where initial serum vitamin B12 result is low or equivocal | 42.95 |
| 66840 | Serum folate test and, if required, red cell folate test for a patient at risk of folate deficiency, including patients with malabsorption conditions, macrocytic anaemia or coeliac disease | 23.60 |
| 66841 | Quantitation of HbA1c (glycated haemoglobin) performed for the diagnosis of diabetes in asymptomatic patients at high risk | 16.80 |
| 66900 |
Carbon‑labelled urea breath test using oral C‑13 or C‑14 urea, including the measurement of exhaled 13CO2 or 14CO2, (except if item 12533 of the general medical services table applies) for: (a) the confirmation of Helicobactor pylori colonisation; or (b) the monitoring of the success of eradication of Helicobactor pylori |
77.65 |
Division 2.3—Group P3: microbiology
2.3.1Meaning of serial examinations or cultures
For an item in Group P3 (Microbiology):
serial examinations or cultures means:
(a)a series of examinations or cultures requested on one occasion whether or not:
(i)the materials are received on different days by the approved pathology practitioner; or
(ii)the examinations or cultures were requested on one or more request forms by the treating practitioner; and
(b)if:
(i)tests are carried out in relation to a patient episode; and
(ii)specimen material from the patient episode is stored; and
(iii)in response to a request made within 14 days of the patient episode, further tests are carried out on the stored material;
the later tests and the earlier tests are taken to be part of one patient episode.
2.3.2Antigen detection
If a pathology service described in item 69316, 69317, 69319, 69494, 69495, 69496, 69497 or 69498 is rendered as a pathologist‑determinable service, the amount mentioned in the item is not payable for the service unless the recognised pathologist who renders the service records, in writing, the reasons for rendering the service.
2.3.3Investigation for hepatitis serology
The fee applying in a single patient episode that includes any of items 69475, 69478 and 69481 is the fee specified for only one of those items.
2.3.4Limitation on certain items
(1)For any particular patient, item 69336 is applicable not more than once in each period of 7 days.
(2)For any particular patient, the following items are applicable not more than once in a 12 month period:
(a)item 69482;
(b)item 69491 or 69492;
(c)item 69499 or 69500.
(3)For any particular patient, item 69418 or 69419 is applicable not more than twice in a 24 month period.
(4)For any particular patient, item 69380, 69488 or 69489 is applicable not more than twice in a 12 month period.
(5)For any particular patient, each of items 69445, 69451 and 69483 is applicable not more than 4 times in a 12 month period.
2.3.5Hepatitis C viral RNA testing
For items 69499 and 69500:
Hepatitis C sero‑positive, for a patient, means 2 different assays of Hepatitis C antibodies are positive.
serological status is uncertain, for a patient, means any result where 2 different assays of Hepatitis C antibodies are inconclusive.
| Group P3—Microbiology | ||
| Item | Pathology service | Fee ($) |
| 69300 |
Microscopy of wet film material other than blood, from one or more sites, obtained directly from a patient (not cultures) including (if performed): (a) differential cell count; or (b) examination for dermatophytes; or (c) dark ground illumination; or (d) stained preparation or preparations using any relevant stain or stains; one or more tests |
12.50 |
| 69303 |
Culture and (if performed) microscopy to detect pathogenic micro‑organisms from nasal swabs, throat swabs, eye swabs and ear swabs (except swabs taken for epidemiological surveillance), including (if performed): (a) pathogen identification and antibiotic susceptibility testing; or (b) a service described in item 69300; specimens from one or more sites |
22.00 |
| 69306 |
Microscopy and culture to detect pathogenic micro‑organisms from skin or other superficial sites, including (if performed): (a) pathogen identification and antibiotic susceptibility testing; or (b) a service described in items 69300, 69303, 69312 and 69318; one or more tests on one or more specimens |
33.75 |
| 69309 |
Microscopy and culture to detect dermatophytes and other fungi causing cutaneous disease, from skin scrapings, skin biopsies, hair and nails (excluding swab specimens) and including (if performed): (a) the detection of antigens not elsewhere specified in this table; or (b) a service described in items 69300, 69303, 69306, 69312 and 69318; one or more tests on one or more specimens |
48.15 |
| 69312 |
Microscopy and culture to detect pathogenic micro‑organisms from urethra, vagina, cervix or rectum (except for faecal pathogens), including (if performed): (a) pathogen identification and antibiotic susceptibility testing; or (b) a service described in items 69300, 69303, 69306 and 69318; one or more tests on one or more specimens |
33.75 |
| 69316 | Detection of Chlamydia trachomatis by any method—one test | 28.65 |
| 69317 |
This item applies if: (a) one test described in item 69316 is performed; and (b) one test described in item 69494 is performed |
35.85 |
| 69318 |
Microscopy and culture to detect pathogenic micro‑organisms from specimens of sputum (except when part of items 69324, 69327 and 69330), including (if performed): (a) pathogen identification and antibiotic susceptibility testing; or (b) a service described in items 69300, 69303, 69306 and 69312; one or more tests on one or more specimens |
33.75 |
| 69319 |
This item applies if: (a) one test described in item 69316 is performed; and (b) 2 tests described in item 69494 are performed |
42.95 |
| 69321 |
Microscopy and culture of post‑operative wounds, aspirates of body cavities, synovial fluid, CSF or operative or biopsy specimens, for the presence of pathogenic micro‑organisms involving aerobic and anaerobic cultures and the use of different culture media, and including (if performed): (a) pathogen identification and antibiotic susceptibility testing; or (b) a service described in item 69300, 69303, 69306, 69312 or 69318; specimens from one or more sites |
48.15 |
| 69324 |
Microscopy (with appropriate stains) and culture for mycobacteria—one specimen of sputum, urine or other body fluid or one operative or biopsy specimen, including (if performed): (a) microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or (b) pathogen identification and antibiotic susceptibility testing; including a service mentioned in item 69300 |
43.00 |
| 69325 | A service described in item 69324 if the microscopy and culture is performed by a receiving APP | 43.00 |
| 69327 |
Microscopy (with appropriate stains) and culture for mycobacteria—2 specimens of sputum, urine or other body fluids or operative or biopsy specimens, including (if performed): (a) microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or (b) pathogen identification and antibiotic susceptibility testing; including a service described in item 69300 |
85.00 |
| 69328 | A service described in item 69327 if the microscopy and culture is performed by a receiving APP | 85.00 |
| 69330 |
Microscopy (with appropriate stains) and culture for mycobacteria—3 specimens of sputum, urine or other body fluids or operative or biopsy specimens, including (if performed): (a) microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or (b) pathogen identification and antibiotic susceptibility testing; including a service described in item 69300 |
128.00 |
| 69331 | A service described in item 69330 if the microscopy and culture is performed by a receiving APP | 128.00 |
| 69333 |
Urine examination (including serial examination) by any means other than simple culture by dip slide, including: (a) cell count; and (b) culture; and (c) colony count; and (d) (if performed) stained preparations; and (e) (if performed) identification of cultured pathogens; and (f) (if performed) antibiotic susceptibility testing; and (g) (if performed) examination for pH, specific gravity, blood, protein, urobilinogen, sugar, acetone or bile salts |
20.55 |
| 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) |
33.45 |
| 69339 | Microscopy of faeces for ova, cysts and parasites using concentration techniques examined after examination described in item 69336 performed on a separately collected and identified specimen collected within 7 days of the examination described in item 69336—not more than one examination in a 7 day period | 19.10 |
| 69345 |
Culture and (if performed) microscopy without concentration techniques of faeces for faecal pathogens, using at least 2 selective or enrichment media and culture in at least 2 different atmospheres including (if performed): (a) pathogen identification and antibiotic susceptibility testing; and (b) the detection of clostridial toxins; and (c) a service described in item 69300; not more than one examination in a 7 day period |
52.90 |
| 69354 |
Blood culture for pathogenic micro‑organisms (other than viruses), including sub‑cultures and (if performed): (a) identification of any cultured pathogen; and (b) necessary antibiotic susceptibility testing; to a maximum of 3 sets of cultures—one set of cultures |
30.75 |
| 69357 | Two sets of cultures described in item 69354 | 61.45 |
| 69360 | Three sets of cultures described in item 69354 | 92.20 |
| 69363 | Detection of Clostridium difficile or Clostridium difficile toxin (except if a service described in item 69345 has been performed)—one or more tests | 28.65 |
| 69378 | Quantitation of HIV viral RNA load in plasma or serum in the monitoring of a HIV sero‑positive patient not on antiretroviral therapy—one or more tests | 180.25 |
| 69379 | A test described in item 69378 if the quantitation is performed by a receiving APP—one or more tests on one or more specimens | 180.25 |
| 69380 |
Genotypic testing for HIV antiretroviral resistance in a patient with confirmed HIV infection if the patient’s viral load is greater than 1 000 copies per ml at any of the following times: (a) at presentation; (b) before antiretroviral therapy; (c) when treatment with combination antiretroviral agents fails; maximum of 2 tests in a 12 month period |
770.30 |
| 69381 | Quantitation of HIV viral RNA load in plasma or serum in the monitoring of a HIV sero‑positive patient on antiretroviral therapy—one or more tests on one or more specimens | 180.25 |
| 69382 | Quantitation of HIV viral RNA load in cerebrospinal fluid in a HIV sero‑positive patient—one or more tests on one or more specimens | 180.25 |
| 69383 | A test described in item 69381 if the quantitation is performed by a receiving APP—one or more tests on one or more specimens | 180.25 |
| 69384 | Quantitation of one antibody to microbial antigens not elsewhere described in this table—one test | 15.65 |
| 69387 | Two tests described in item 69384 | 29.00 |
| 69390 | Three tests described in item 69384 | 42.35 |
| 69393 | Four tests described in item 69384 | 55.70 |
| 69396 | Five or more tests described in item 69384 | 69.10 |
| 69400 | A test described in item 69384 if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP—one test | 15.65 |
| 69401 | A test described in item 69384 if a referring APP has performed a test or tests described in item 69384—each test to a maximum of 4 tests | 13.35 |
| 69405 |
Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of one of the following: rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and (b) (if performed) a service described in one or more of items 69384, 69475, 69478 and 69481 |
15.65 |
| 69408 |
Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of 2 of the following: rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and (b) (if performed) a service described in one or more of items 69384, 69475, 69478 and 69481 |
29.00 |
| 69411 |
Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of 3 of the following: rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and (b) (if performed) a service described in one or more of items 69384, 69475, 69478 and 69481 |
42.35 |
| 69413 |
Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of 4 of the following: rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and (b) (if performed) a service described in one or more of items 69384, 69475, 69478 and 69481 |
55.70 |
| 69415 |
Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of all of the following: rubella immune status, specific syphilis serology, carriage of hepatitis B, hepatitis C antibody, HIV antibody; and (b) (if performed) a service described in one or more of items 69384, 69475, 69478 and 69481 |
69.10 |
| 69418 |
A test for high risk human papillomaviruses (HPV) in a patient who: (a) within the 2 year period before the test, has received excisional or ablative treatment for high grade squamous intraepithelial lesions (HSIL) of the cervix; or (b) within the 2 year period before the test, has had a positive HPV test after excisional or ablative treatment for HSIL of the cervix; or (c) is undergoing annual cytological review following treatment for HSIL of the cervix; one test |
63.55 |
| 69419 | A test described in item 69418 if the test is performed by a receiving APP—one test | 63.55 |
| 69445 | Detection of hepatitis C viral RNA in a patient undertaking antiviral therapy for chronic HCV hepatitis (including a service described in item 69499)—one test | 92.20 |
| 69451 | A test described in item 69445 if the test is performed by a receiving APP—one test | 92.20 |
| 69471 | Test of cell‑mediated immunity in blood for the detection of latent tuberculosis in an immunosuppressed or immunocompromised patient—one test | 34.90 |
| 69472 | Detection of antibodies to Epstein Barr Virus using specific serology—one test | 15.65 |
| 69474 | Detection of antibodies to Epstein Barr Virus using specific serology—2 or more tests | 28.65 |
| 69475 | Detection of hepatitis antigens or antibodies to determine immune status or viral carriage following exposure or vaccination to Hepatitis A, Hepatitis B, Hepatitis C or Hepatitis D—one test | 15.65 |
| 69478 | Two tests described in item 69475 | 29.25 |
| 69481 | Investigation of infectious causes of acute or chronic hepatitis—3 tests described in item 69475 | 40.55 |
| 69482 | Quantitation of hepatitis B viral DNA in patients who are hepatitis B surface antigen positive and have chronic hepatitis B but are not receiving antiviral therapy—one test | 152.10 |
| 69483 |
Quantitation of hepatitis B viral DNA in patients who: (a) are hepatitis B surface antigen positive; and (b) have chronic hepatitis B; and (c) are receiving antiviral therapy; one test |
152.10 |
| 69484 | Supplementary test for hepatitis B surface antigen or hepatitis C antibody using a different assay on a specimen that yielded a reactive result on initial testing | 17.10 |
| 69488 |
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 69445 or 69499) |
180.25 |
| 69489 | A test described in item 69488 if the test is performed by a receiving APP | 180.25 |
| 69491 |
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 |
204.80 |
| 69492 | A service described in item 69491 if the test is performed by a receiving APP | 204.80 |
| 69494 | Detection of a virus, microbial antigen or microbial nucleic acid (not elsewhere described in this table)—one test | 28.65 |
| 69495 | Two tests described in item 69494 | 35.85 |
| 69496 | Three or more tests described in item 69494 | 43.05 |
| 69497 |
This item applies to a test described in item 69494 if: (a) a referring APP has not performed the test described in item 69494; and (b) a receiving APP performs the test described in item 69494; one test |
28.65 |
| 69498 |
This item applies to a test described in item 69494 if: (a) a referring APP has performed the test or tests described in item 69494; and (b) a receiving APP has performed the test or tests described in item 69494; one test |
7.20 |
| 69499 |
Detection of hepatitis C viral RNA if at least one 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 (ii) the detection of acute hepatitis C prior to seroconversion where considered necessary for the clinical management of the patient |
92.20 |
| 69500 | A test described in item 69499 if the test is performed by a receiving APP | 92.20 |
Part 4—Complexity levels for histopathology items
| Complexity levels for histopathology items | |
| Specimen type | Complexity level |
| Adrenal resection, neoplasm | 5 |
| Adrenal resection, not neoplasm | 4 |
| Anus, all specimens not otherwise specified | 3 |
| Anus, neoplasm, biopsy | 4 |
| Anus, neoplasm, radical resection | 6 |
| Anus, submucosal resection—neoplasm | 5 |
| Appendix | 3 |
| Artery, all specimens not otherwise specified | 3 |
| Artery, biopsy | 4 |
| Bartholin’s gland—cyst | 3 |
| Bile duct, resection—all specimens | 6 |
| Bone—all specimens not otherwise specified | 4 |
| Bone, biopsy, curettings or fragments—lesion | 5 |
| Bone, biopsy or curettings quantitation—metabolic disease | 6 |
| Bone, femoral head | 4 |
| Bone marrow, biopsy | 4 |
| Bone, resection, neoplasm—all sites and types | 6 |
| Brain neoplasm, resection—cerebello‑pontine angle | 4 |
| Brain or meninges, biopsy—all lesions | 5 |
| Brain or meninges, not neoplasm—temporal lobe | 6 |
| Brain or meninges, resection—neoplasm (intracranial) | 5 |
| Brain or meninges, resection—not neoplasm | 4 |
| Branchial cleft, cyst | 4 |
| Breast, excision biopsy, guidewire localisation—non‑palpable lesion | 6 |
| Breast, excision biopsy, or radical resection, malignant neoplasm or atypical proliferative disease—all specimen types | 6 |
| Breast, incision biopsy or needle biopsy, malignant neoplasm—all specimen types | 4 |
| Breast, microdochectomy | 6 |
| Breast, orientated wide local excision for carcinoma with margin assessment | 7 |
| Breast tissue—all specimens not otherwise specified | 4 |
| Bronchus, biopsy | 4 |
| Carotid body—neoplasm | 5 |
| Cholesteatoma | 3 |
| Digits, amputation—not traumatic | 4 |
| Digits, amputation—traumatic | 2 |
| Ear, middle and inner—not cholesteatoma | 4 |
| Endocrine neoplasm—not otherwise specified | 5 |
| Extremity, amputation—not otherwise specified | 4 |
| Extremity, amputation or disarticulation—neoplasm | 6 |
| Eye, conjunctiva—biopsy or pterygium | 3 |
| Eye, cornea | 4 |
| Eye, enucleation or exenteration—all lesions | 6 |
| Eye—not otherwise specified | 4 |
| Fallopian tube, biopsy | 4 |
| Fallopian tube, ectopic pregnancy | 4 |
| Fallopian tube, sterilisation | 2 |
| Fetus with dissection | 6 |
| Foreskin—new born | 2 |
| Foreskin—not new born | 3 |
| Gallbladder | 3 |
| Gallbladder and porta hepatis‑radical resection | 6 |
| Ganglion cyst, all sites | 3 |
| Gum or oral mucosa, biopsy | 4 |
| Heart—not otherwise specified | 5 |
| Heart valve | 4 |
| Hernia sac | 2 |
| Hydrocele sac | 2 |
| Jaw, upper or lower, including bone—radical resection for neoplasm | 6 |
| Joint and periarticular tissue, without bone—all specimens | 3 |
| Joint tissue, including bone—all specimens | 4 |
| Kidney, biopsy including transplant | 5 |
| Kidney, nephrectomy transplant | 5 |
| Kidney, partial or total nephrectomy—not neoplasm | 4 |
| Kidney, partial or total nephrectomy or nephroureterectomy—neoplasm | 6 |
| Large bowel, colostomy—stoma | 3 |
| Large bowel (including rectum), biopsy—all sites | 4 |
| Large bowel (including rectum), biopsy, for confirmation or exclusion of Hirschsprung’s Disease | 5 |
| Large bowel (including rectum), polyp | 4 |
| Large bowel (including rectum), segmental resection—neoplasm | 6 |
| Large bowel (including rectum), submucosal resection—neoplasm | 5 |
| Large bowel, segmental resection—colon, not neoplasm | 5 |
| Larynx, biopsy | 4 |
| Larynx, partial or total resection | 5 |
| Larynx, resection with nodes or pharynx or both | 6 |
| Lip biopsy—all specimens not mentioned | 3 |
| Lip wedge resection or local excision with orientation | 4 |
| Liver—all specimens not otherwise specified | 5 |
| Liver, hydatid cyst or resection for trauma | 4 |
| Liver, total or subtotal hepatectomy—neoplasm | 6 |
| Lung, needle or transbronchial biopsy | 4 |
| Lung, resection—neoplasm | 6 |
| Lung segment, lobar or total resection | 6 |
| Lung, wedge biopsy | 5 |
| Lymph node, biopsy—all sites | 4 |
| Lymph node, biopsy, for lymphoma or lymphoproliferative disorder | 5 |
| Lymph nodes, regional resection—all sites | 5 |
| Mediastinum mass | 5 |
| Muscle, biopsy | 6 |
| Nasopharynx or oropharynx, biopsy | 4 |
| Nerve, biopsy neuropathy | 5 |
| Nerve, neurectomy or removal of neoplasm | 4 |
| Nerve—not otherwise specified | 3 |
| Nose, mucosal biopsy | 4 |
| Nose or sinuses, polyps | 3 |
| Odontogenic neoplasm | 5 |
| Odontogenic or dental cyst | 4 |
| Oesophagus, biopsy | 4 |
| Oesophagus, diverticulum | 3 |
| Oesophagus, partial or total resection | 6 |
| Oesophagus, submucosal resection—neoplasm | 5 |
| Omentum, biopsy | 4 |
| Ovary with or without tube—neoplasm | 5 |
| Ovary with or without tube—not neoplasm | 4 |
| Pancreas, biopsy | 5 |
| Pancreas, cyst | 4 |
| Pancreas, subtotal or total with or without splenectomy | 6 |
| Parathyroid gland(s) | 4 |
| Penisectomy—simple | 4 |
| Penisectomy with node dissection | 5 |
| Peritoneum, biopsy | 4 |
| Pituitary neoplasm | 4 |
| Placenta—not third trimester | 4 |
| Placenta—third trimester, abnormal pregnancy or delivery | 4 |
| Pleura or pericardium, biopsy or tissue | 4 |
| Products of conception, spontaneous or missed abortion | 4 |
| Products of conception, termination of pregnancy | 3 |
| Prostate—all types of specimen not otherwise specified | 4 |
| Prostate, radical prostatectomy or cystoprostatectomy for carcinoma | 7 |
| Prostate, radical resection | 6 |
| Retroperitoneum, neoplasm | 5 |
| Salivary gland—all specimens not otherwise specified | 4 |
| Salivary gland, Mucocele | 3 |
| Salivary gland, neoplasm—all sites | 5 |
| Sinus, paranasal, biopsy | 4 |
| Sinus, paranasal, resection—neoplasm | 6 |
| Skin—all specimens not otherwise specified including all neoplasms and cysts | 3 |
| Skin, biopsy—blistering skin diseases | 4 |
| Skin, biopsy—inflammatory dermatosis | 4 |
| Skin, biopsy—investigation of alopecia where serial horizontal sections are taken, except for male pattern baldness | 5 |
| Skin, biopsy—investigation of lymphoproliferative disorder | 5 |
| Skin, eyelid, wedge resection | 4 |
| Skin, local resection—orientation | 4 |
| Skin, resection of malignant melanoma or melanoma in situ | 5 |
| Small bowel—all specimens not otherwise specified | 5 |
| Small bowel—biopsy, all sites | 4 |
| Small bowel, diverticulum | 3 |
| Small bowel, resection—neoplasm | 6 |
| Small bowel, submucosal resection—neoplasm | 5 |
| Soft tissue, infiltrative lesion—extensive resections at least 5 cm in maximal dimension | 6 |
| Soft tissue, lipoma and variants | 3 |
| Soft tissue, neoplasm, not lipoma—all specimens | 5 |
| Soft tissue—not otherwise specified | 4 |
| Spleen | 5 |
| Stomach—all specimens not otherwise specified | 4 |
| Stomach, endoscopic biopsy or endoscopic polypectomy | 4 |
| Stomach, resection, neoplasm—all specimens | 6 |
| Stomach, submucosal resection—neoplasm | 5 |
| Tendon or tendon sheath, giant cell neoplasm | 4 |
| Tendon or tendon sheath—not otherwise specified | 3 |
| Testis and adjacent structures, castration | 2 |
| Testis and adjacent structures, neoplasm with or without nodes | 5 |
| Testis and adjacent structures—not otherwise specified | 3 |
| Testis and adjacent structures, vas deferens sterilisation | 2 |
| Testis, biopsy | 5 |
| Thymus—not otherwise specified | 5 |
| Thyroglossal duct—all lesions | 4 |
| Thyroid—all specimens | 5 |
| Tissue or organ—all specimens not otherwise specified | 3 |
| Tissue or organ not otherwise specified, abscess | 3 |
| Tissue or organ not otherwise specified, haematoma | 3 |
| Tissue or organ not otherwise specified, malignant neoplasm with regional nodes | 6 |
| Tissue or organ not otherwise specified, neoplasm local | 4 |
| Tissue or organ not otherwise specified, pilonidal cyst or sinus | 3 |
| Tissue or organ not otherwise specified, thrombus or embolus | 3 |
| Tissue or organ not otherwise specified, veins varicosity | 3 |
| Tongue, biopsy | 4 |
| Tongue or tonsil, neoplasm local | 5 |
| Tongue or tonsil, neoplasm with nodes | 6 |
| Tonsil, biopsy—excluding resection of whole organ | 4 |
| Tonsil or adenoids or both | 2 |
| Trachea, biopsy | 4 |
| Ureter, biopsy | 4 |
| Ureter, resection | 5 |
| Urethra, biopsy | 4 |
| Urethra, resection | 5 |
| Urinary bladder—all specimens not otherwise specified | 4 |
| Urinary bladder, partial or total with or without prostatectomy | 6 |
| Urinary bladder, transurethral resection of neoplasm | 5 |
| Uterus and/or cervix—all specimens not otherwise specified | 4 |
| Uterus, cervix cone, biopsy (including LEEP or LLETZ biopsy) | 5 |
| Uterus, cervix, curettings or biopsy | 4 |
| Uterus, endocervix, polyp | 3 |
| Uterus, endometrium, polyp | 3 |
| Uterus, with or without adnexa, malignant neoplasm—all specimen types not otherwise specified | 6 |
| Uterus with or without adnexa, neoplasm, Wertheim’s or pelvic clearance | 6 |
| Vagina, biopsy | 4 |
| Vaginal mucosa, incidental | 3 |
| Vagina, radical resection | 6 |
| Vulva or labia, biopsy | 4 |
| Vulval, subtotal or total with or without nodes | 6 |
Part 5—Dictionary
Note:All references in the Dictionary to a provision are references to a provision in this Schedule, unless otherwise indicated.
In this Schedule:
abnormal level of TSH, for item 66719, has the meaning given by clause 2.2.5.
Act means the Health Insurance Act 1973.
approved collection centre, for Group P10, has the meaning given by clause 2.10.1.
ASGC, for item 74991, has the meaning given by subclause 2.12.1(3).
biopsy material, for Group P5, has the meaning given by clause 2.5.1.
bulk‑billed, for a pathology service, means:
(a)a medicare benefit is payable to a person for the service; and
(b)under an agreement entered into under section 20A of the Act:
(i)the person assigns to the practitioner by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and
(ii)the practitioner accepts the assignment in full payment of his or her fee for the service provided.
Commonwealth concession card holder, for items 74990 and 74991, has the meaning given by subclause 2.12.1(2).
compatibility tests by crossmatch, for items 65099 and 65102, has the meaning given by clause 2.1.2.
cytology, for Group P5, has the meaning given by clause 2.5.1.
designated test, has the meaning given by clause 1.2.4.
elevated serum ferritin, for items 73317 and 73318, has the meaning given by clause 2.7.1.
general practitioner, has the meaning given by clause 1.2.6.
group, for a group in this table, means every item in the group.
Hepatitis C sero‑positive, for items 69499 and 69500, has the meaning given by clause 2.3.5.
institution, for Group P10, has the meaning given by clause 2.10.1.
item means:
(a)an item mentioned, by number, in column 1 of a table in:
(i)this Schedule; or
(ii)the diagnostic imaging services table; or
(iii)the general medical services table; or
(b)in a reference immediately followed by a number—the item so numbered.
metal toxicity testing group, has the meaning given by clause 2.2.7.
nutritional metals testing group, has the meaning given by clause 2.2.7.
patient episode means:
(a)a pathology service or pathology services (other than a pathology service to which paragraph (b) refers) provided for a single patient whose need for the service or services was determined under section 16A of the Act:
(i)on the same day; or
(ii)if more than one test is performed on the one specimen within 14 days—on the same or different days;
whether the services:
(iii)are requested by one or more practitioners, participating midwives or participating nurse practitioners; or
(iv)are described in a single item or in more than one item; or
(v)are rendered by one approved pathology practitioner or more than one approved pathology practitioner; or
(vi)are rendered on the same or different days; or
(b)a pathology service to which clause 1.2.3, 2.1.1 or 2.2.2 refers that is provided in the circumstances, set out in the clause, that relate to the service.
Pharmaceutical Benefits Scheme means the scheme for the supply of pharmaceutical benefits established under Part VII of the National Health Act 1953.
practice location, for item 74991, has the meaning given by subclause 2.12.1(3).
prescribed laboratory, for Group P10, has the meaning given by clause 2.10.1.
receiving APP, for a patient episode, means an approved pathology practitioner in an approved pathology authority who:
(a)receives a request from a referring APP to render a designated test or tests; and
(b)renders each test included in the designated test that the referring APP has not performed.
recognised pathologist means:
(a)a medical practitioner recognised as a specialist in pathology under subsection 3D(1) of the Act; or
(b)a medical practitioner in relation to whom there is in force a determination under paragraph 3DB(4)(a) or subsection 3E(1) of the Act that the practitioner is recognised as a specialist in pathology.
referring APP, for a patient episode, means an approved pathology practitioner in an approved pathology authority who:
(a)has received a request to render one or more designated tests; and
(b)is unable, because of the lack of facilities in, or expertise or experience of the staff of, the laboratory of the authority, to render one or more of the tests included in the designated test; and
(c)requests a receiving APP in another approved pathology authority to render:
(i)the test or tests that the approved pathology practitioner is unable to render; or
(ii)all of the tests that are included in the designated test; and
(d)renders each test included in the designated test, other than the test or tests for which the request mentioned in paragraph (c) is made.
regional, rural or remote area, for item 74991, has the meaning given by subclause 2.12.1(3).
request, received by an approved pathology practitioner, includes a request for a pathologist‑determinable service to which subsection 16A(6) of the Act applies.
residential care facility, for Group P10, has the meaning given by clause 2.10.1.
rule 3 exemption means the exemption that has effect because of the operation of clause 1.2.2.
separately identified specimen, for Group P5, has the meaning given by clause 2.5.1.
serial examinations means a series of examinations requested on one occasion, whether or not:
(a)the materials are received on different days by the approved pathology practitioner; or
(b)the examinations or cultures were requested on one or more request forms by the treating practitioner.
serial examinations or cultures, for Group P3, has the meaning given by clause 2.3.1.
serological status is uncertain, for items 69499 and 69500, has the meaning given by clause 2.3.5.
set of pathology services, has the meaning given by clause 1.2.7.
SLA, for item 74991, has the meaning given by subclause 2.12.1(3).
specimen collection centre, for Group P10, has the meaning given by clause 2.10.1.
SSD for item 74991, has the meaning given by subclause 2.12.1(3).
treating practitioner, for Group P10, has the meaning given by clause 2.10.1.
unreferred service, for items 74990 and 74991, has the meaning given by subclause 2.12.1(3).
Endnotes
Endnote 1—About the endnotes
The endnotes provide information about this compilation and the compiled law.
The following endnotes are included in every compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Abbreviation key—Endnote 2
The abbreviation key sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.
Editorial changes
The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.
If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.
Misdescribed amendments
A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.
If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.
Endnote 2—Abbreviation key
| ad = added or inserted | o = order(s) |
| am = amended | Ord = Ordinance |
| amdt = amendment | orig = original |
| c = clause(s) | par = paragraph(s)/subparagraph(s) |
| C[x] = Compilation No. x | /sub‑subparagraph(s) |
| Ch = Chapter(s) | pres = present |
| def = definition(s) | prev = previous |
| Dict = Dictionary | (prev…) = previously |
| disallowed = disallowed by Parliament | Pt = Part(s) |
| Div = Division(s) | r = regulation(s)/rule(s) |
| ed = editorial change | reloc = relocated |
| exp = expires/expired or ceases/ceased to have | renum = renumbered |
| effect | rep = repealed |
| F = Federal Register of Legislation | rs = repealed and substituted |
| gaz = gazette | s = section(s)/subsection(s) |
| LA = Legislation Act 2003 | Sch = Schedule(s) |
| LIA = Legislative Instruments Act 2003 | Sdiv = Subdivision(s) |
| (md) = misdescribed amendment can be given | SLI = Select Legislative Instrument |
| effect | SR = Statutory Rules |
| (md not incorp) = misdescribed amendment | Sub‑Ch = Sub‑Chapter(s) |
| cannot be given effect | SubPt = Subpart(s) |
| mod = modified/modification | underlining = whole or part not |
| No. = Number(s) | commenced or to be commenced |
Endnote 3—Legislation history
| Number and year | Registration | Commencement | Application, saving and transitional provisions |
| 85, 2015 | 19 June 2015 (F2015L00851) | 1 July 2015 (s 2) | — |
| 143, 2015 | 21 Aug 2015 (F2015L01301) | Sch 1 (item 113): 1 Sept 2015 (s 2(1) item 1) | — |
| 173, 2015 | 30 Oct 2015 (F2015L01722) | Sch 1 (items 19–30) 1 Nov 2015 (s 2(1) item 1) | — |
| Name | Registration | Commencement | Application, saving and transitional provisions |
| Health Insurance Legislation Amendment (2016 Measures No. 1) Regulation 2016 | 9 May 2016 (F2016L00745) | Sch 1 (item 10):1 July 2016 (s 2(1) item 1) | — |
Endnote 4—Amendment history
| Provision affected | How affected |
| s 2............................................. | rep LIA s 48D |
| Schedule 1 | |
| Part 1 | |
| Division 1.2 | |
| c 1.2.7........................................ | am No 173, 2015 |
| Part 2 | |
| Division 2.5 | |
| c 2.5.2........................................ | ad No 173, 2015 |
| Group P5 Table........................... | am No 173, 2015 |
| Division 2.7 | |
| Group P7 Table........................... | am No 143, 2015 |
| Division 2.10 | |
| Group P10 Table......................... | am No 173, 2015 |
| Division 2.12 | |
| c 2.12.1...................................... | am No 173, 2015; F2016L00745 |
| Division 2.13 | |
| Division 2.13 heading.................. | rs No 173, 2015 |
| Division 2.13.............................. | am No 173, 2015 |
| Group P13 Table......................... | am No 173, 2015 |
| Part 5 | |
| Part 5......................................... | am No 173, 2015 |
| Schedule 2.................................. | rep LIA s 48C |
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