Health Insurance (Pathology Services Table) Regulations 2006 (Cth)

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Health Insurance (Pathology Services Table) Regulations 2006

Select Legislative Instrument 2006 No. 274 as amended

made under the

Health Insurance Act 1973

This compilation was prepared on 10 October 2007

taking into account amendments up to SLI 2007 No. 339

Prepared by the Office of Legislative Drafting and Publishing,

Attorney‑General’s Department, Canberra

Contents

1Name of Regulations [see Note 1]

These Regulations are the Health Insurance (Pathology Services Table) Regulations 2006.

2Commencement

These Regulations commence on 1 November 2006.

3Health Insurance (Pathology Services Table) Regulations 2005 – repeal

The Health Insurance (Pathology Services Table) Regulations 2005 are repealed.

4Definitions

In these Regulations:

Act means the Health Insurance Act 1973.

this table means these Regulations.

5Pathology services table

The table of pathology services set out in Schedule 1 is prescribed for subsection 4A (1) of the Act.

Schedule 1Table of pathology services

(regulation 5)

Part1Prescription of table1APrescription of table

For section 4A of the Act, these Regulations prescribe a table of pathology services that sets out:

  1. (a)

    in Part 2 — rules for interpretation of the table; and

  2. (b)

    in Part 3:

    1. (i)

      items of pathology services; and

    2. (ii)

      the amount of fees applicable for each item; and

  3. (c)

    in Parts 4 and 5 — additional supporting information.

Part2Rules of interpretation1Interpretation of table
  1. (1)

    In this table:

item means:

  1. (a)

    an item mentioned, by number, in column 1 of:

    1. (i)

      Part 3; or

    2. (ii)

      Part 3 of the diagnostic imaging services table; or

    3. (iii)

      Part 3 of the general medical services table; and

  2. (b)

    in a reference immediately followed by a number — the item so numbered.

patient episode means:

  1. (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:

    1. (i)

      on the same day; or

    2. (ii)

      if more than 1 test is performed on the 1 specimen within 14 days — on the same or different days;

whether the services:

  1. (iii)

    are requested by 1 or more practitioners; or

  2. (iv)

    are described in a single item or in more than 1 item; or

  3. (v)

    are rendered by 1 approved pathology practitioner or more than 1 approved pathology practitioner; or

  4. (vi)

    are rendered on the same or different days; or

  1. (b)

    a pathology service to which rule 4 refers that is provided in the circumstances set out in that rule that relate to the service.

receiving APP, in relation to a patient episode, means an approved pathology practitioner in an approved pathology authority who:

  1. (a)

    receives a request from a referring APP to render a designated test or tests; and

  2. (b)

    renders each test included in the designated test that the referring APP has not performed.

recognised pathologist means:

  1. (a)

    a medical practitioner recognised as a specialist in pathology under subsection 3D (1) of the Act; or

  2. (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, in relation to a patient episode, means an approved pathology practitioner in an approved pathology authority who:

  1. (a)

    has been requested to render one or more designated tests; and

  2. (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 1 or more of the tests included in the designated test; and

  3. (c)

    requests a receiving APP in another approved pathology authority to render:

    1. (i)

      the test or tests that the approved pathology practitioner is unable to render; or

    2. (ii)

      all of the tests that are included in the designated test; and

  4. (d)

    renders each test included in the designated test, other than the test or tests in respect of which the request mentioned in paragraph (c) is made.

serial examinations means a series of examinations requested on 1 occasion whether or not:

  1. (a)

    the materials are received on different days by the approved pathology practitioner; or

  2. (b)

    the examinations or cultures were requested on 1 or more request forms by the treating practitioner.

  1. (2)

    In these rules, a reference to a request to an approved pathology practitioner includes a reference to a request for a pathologist‑determinable service to which subsection 16A (6) of the Act applies.

  2. (3)

    A reference to a Group in the table includes every item in the Group and a reference to a Subgroup in the table includes every item in the Subgroup.

2Precedence of items
  1. (1)

    If a service is described:

    1. (a)

      in an item in general terms; and

    2. (b)

      in another item in specific terms;

only the item that describes the service in specific terms applies to the service.

  1. (2)

    Subject to subrule (3), if:

    1. (a)

      subrule (1) does not apply; and

    2. (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.

  1. (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.

Application of items 74990 and 74991

  1. (4)

    Despite subrules (1), (2) and (3):

    1. (a)

      if the pathology service described in item 74991 is provided to a person, either that item or item 74990, but not both those items, applies to the service; and

    2. (b)

      if item 74990 or 74991 applies to a pathology service, the fee specified in that item applies in addition to the fee specified in any other item in this table that applies to the service.

  2. (5)

    For items 74990 and 74991:

bulk‑billed, in relation to apathology service, means:

  1. (a)

    a medicare benefit is payable to a person in respect of the service; and

  2. (b)

    under an agreement entered into under section 20A of the Act:

    1. (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

    2. (ii)

      the practitioner accepts the assignment in full payment of his or her fee for the service provided.

Commonwealth concession card holder means a person who is a concessional beneficiary within the meaning given by subsection 84 (1) of the National Health Act 1953.

unreferred service means a pathology service that:

  1. (a)

    is provided to a person by, or on behalf of, a medical practitioner, being a medical practitioner who is not a consultant physician, or specialist, in any speciality (other than a medical practitioner who is, for the purposes of the Act, both a general practitioner and a consultant physician, or specialist, in a particular speciality); and

  2. (b)

    has not been referred to the medical practitioner by another medical practitioner or person with referring rights.

  1. (6)

    For item 74991:

ASGCmeans the document titled Australian Standard Geographical Classification (ASGC) 2002, published by the Australian Bureau of Statistics, as in force on 1 July 2002.

practice location, in relation to the provision of a pathology service, means the place of practice in respect of which the practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Medicare Australia CEO.

regional, rural or remote area means an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification.

Rural, Remote and Metropolitan Areas Classification has the meaning given by subrule 3 (1) of Part 2 of Schedule 1 to the general medical services table.

SLA means a Statistical Local Area specified in the ASGC.

SSD means a Statistical Subdivision specified in the ASGC.

3Circumstances in which services rendered following 2 requests to be taken to have been rendered following 1 request

(1)In subrule (2), service includes assay, estimation and test.

(2)Two or more pathology services (other than services to which, under rule 4, this rule does not apply) rendered for a patient following 2 or more requests are taken to have been rendered following a single request if:

  1. (a)

    the services are listed in the same item; and

  2. (b)

    that item is not item 74990 or 74991; and

  3. (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.

4Services to which rule 3 does not apply
  1. (1)

    Rule 3 does not apply to a pathology service described in item 65060, 65070, 65120, 65123, 65126, 65129, 65150, 65153, 65156, 66500, 66503, 66506, 66509, 66512, 66515, 66584 or 66800 if:

    1. (a)

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

    2. (b)

      the service is rendered to an inpatient of a hospital; and

    3. (c)

      the service is rendered in relation to each specimen as soon as possible after the specimen is taken; and

    4. (d)

      the account for the service is endorsed ‘Rule 3 Exemption’.

  2. (2)

    Rule 3 does not apply to a pathology service described in subrule (3) if:

    1. (a)

      under a request for a service, other than a request for a service described in paragraph (3) (a), no more than 6 tests are requested; and

    2. (b)

      the tests are performed within 6 months of the request; and

    3. (c)

      the account for the service is endorsed ‘Rule 3 Exemption’.

  3. (3)

    For subrule (2), the pathology services are:

    1. (a)

      estimation of prothrombin time (INR) for a patient undergoing anticoagulant therapy; and

    2. (b)

      quantitative estimation of lithium for a patient undergoing lithium therapy; and

    3. (c)

      a service described in item 65070 in relation to a patient undergoing chemotherapy for neoplastic disease or immunosuppressant therapy; and

    4. (d)

      a service described in item 65070 in relation to clozaril, ticlopidine hydrochloride, methotrexate, gold, sulphasalazine or penicillamine therapy of a patient; and

    5. (e)

      a service described in any of items 66500 to 66515, in relation to methotrexate or leflunomide therapy of a patient; and

    6. (f)

      quantitative estimation of urea, creatinine and electrolytes in relation to:

      1. (i)

        cis‑platinum or cyclosporin therapy of a patient; or

      2. (ii)

        chronic renal failure of a patient being treated in a dialysis program conducted by a recognised hospital; and

    7. (g)

      quantitative estimation of albumin and calcium in relation to therapy of a patient with vitamin D, its metabolites or analogues; and

    8. (h)

      quantitative estimation of calcium, phosphate, magnesium, urea, creatinine and electrolytes for a cancer patient receiving bisphosphonate infusions.

5Item taken to refer only to the first service of a particular kind
  1. (1)

    For an item in Group P1 (Haematology):

    1. (a)

      if pathology services of a kind referred to 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

    2. (b)

      if:

      1. (i)

        tests (except tests mentioned in item 65099, 65102, 65105 or 65108) are carried out in relation to a patient episode; and

      2. (ii)

        specimen material from the patient episode is stored; and

      3. (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 1 patient episode.

  2. (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. (3)

    For items 65099 and 65102:

compatibility tests by crossmatch means that, in addition to all the tests described 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 1 or more accepted crossmatching techniques.

6Referral of designated tests by 1 pathology practitioner to another
  1. (1)

    In this rule:

designated test means a pathology test relating to a patient episode that is a test of a kind described in item 65150, 65175, 66650, 66695, 66711, 66722, 66785, 66800, 66812, 66819, 66825, 69384, 69494, 71089, 71153 or 77165.

  1. (2)

    This rule applies where 1 or more designated tests are referred by a referring APP to a receiving APP in another approved pathology authority.

  2. (3)

    If a referring APP has rendered 1 or more designated tests:

    1. (a)

      the amount specified 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

    2. (b)

      subject to subrule (5), the amount specified 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.

  3. (4)

    If a referring APP has not rendered a designated test:

    1. (a)

      for the first designated test that is rendered by the receiving APP — the amount specified 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

    2. (b)

      for each subsequent designated test (if any) that is rendered by the receiving APP — subject to subrule (6), the amount specified 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:

  1. (a)

    for item 66652, 66715, 66790, 66817, 66821 or 66827 —

  2. (b)

    for item 65158, 66805, 69498 or 71092 —

  3. (c)

    for item 71156 or 71170 —

  4. (d)

    for item 65181 or 66724 —

  5. (e)

    for item 66697 or 69401 —

where:

X is the number of designated tests rendered by a referring APP.

  1. (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:

    1. (a)

      for item 66652, 66715, 66790, 66817, 66821 or 66827 — 1;

    2. (b)

      for item 65158, 66805, 69498 or 71092 — 2;

    3. (c)

      for item 71156 or 71170 — 3;

    4. (d)

      for item 65181 or 66724 — 4;

    5. (e)

      for item 66697 or 69401 — 5.

  2. (7)

    Items in Group P10 (Patient episode initiation) do not apply to a receiving APP in subrule (2).

7Items not to be split

Except as stated in rule 6, the amount specified in an item is payable only to 1 approved pathology practitioner in respect of a single patient episode.

8Creatinine ratios – Group P2 (Chemical)

A pathology service mentioned in an item in Group P2 (Chemical) (except item 66500) that:

  1. (a)

    involves the measurement of a substance in urine; and

  2. (b)

    requires calculation of a substance/creatinine ratio;

is taken to include the measurement of creatinine necessary for the calculation.

9Thyroid function testing
  1. (1)

    For item 66719:

abnormal level of TSH means a level of TSH that is outside the normal reference range in respect of the particular method of assay used to determine the level.

  1. (2)

    Except where paragraph (a) of item 66719 is satisfied, the amount specified in the item is not payable for a pathology service described in the item unless the pathologist who renders the service has a written statement from the medical practitioner who requested the service that satisfies subrule (3).

  2. (3)

    The written statement from the medical practitioner must indicate:

    1. (a)

      that the tests are required for a particular purpose, being a purpose specified in paragraph (b) of item 66719; or

    2. (b)

      that the medical practitioner who requested the tests suspects the patient has pituitary dysfunction; or

    3. (c)

      that the patient is on drugs that interfere with thyroid hormone metabolism or function.

10Meaning of serial examinations or cultures

For an item in Group P3 (Microbiology):

  1. (a)

    serial examinations or cultures means a series of examinations or cultures requested on 1 occasion whether or not:

    1. (i)

      the materials are received on different days by the approved pathology practitioner; or

    2. (ii)

      the examinations or cultures were requested on 1 or more request forms by the treating practitioner; and

  2. (b)

    if:

    1. (i)

      tests are carried out in relation to a patient episode; and

    2. (ii)

      specimen material from the patient episode is stored; and

    3. (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 1 patient episode.

11Investigation for hepatitis serology
  1. (1)

    The fee applying in a single patient episode that includes any of items 69475, 69478 and 69481 is the fee specified for 1 only of those items.

  2. (2)

    Item 69478 applies to a service in relation to which:

    1. (a)

      a practitioner requests 2 tests for immune status or viral carriage; or

    2. (b)

      the clinical notes indicate that the service is required for:

      1. (i)

        pre‑operative assessment; or

      2. (ii)

        post‑exposure to blood or other body fluids assessment; or

      3. (iii)

        assessment before blood or tissue donation.

  3. (3)

    Item 69481 applies to a service in relation to a patient who displays 1 or more of the characteristics of acute or chronic hepatitis.

12Tests in Group P4 (Immunology) relating to antibodies

For items in Group P4 (Immunology), in items 71119, 71121, 71123 and 71125, if:

  1. (a)

    tests are carried out in relation to a patient episode; and

  2. (b)

    specimen material from the patient episode is stored; and

  3. (c)

    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 1 patient episode.

13Tests on biopsy material – Group P5 (Tissue pathology) and Group P6 (Cytology)
  1. (1)

    For items in Group P5 (Tissue pathology):

biopsy material means all tissue (other than a bone marrow biopsy) received by an approved pathology practitioner:

  1. (a)

    from a medical procedure, or group of medical procedures, performed on a patient at the same time; or

  2. (b)

    after being expelled spontaneously from a patient.

cytology means microscopic examination of 1 or more stained preparations of cells separated naturally or artificially from their normal environment by methods recognised as adequate to demonstrate their structure to a degree sufficient to enable an opinion to be formed about whether they are likely to be normal, abnormal but benign, or abnormal and malignant but, in accordance with customary laboratory practice, does not include examination of a blood film and a bone marrow aspirate.

separately identified specimen means an individual specimen collected, identified so that it is clearly distinguished from any other specimen, and sent for testing by or on behalf of the treating practitioner responsible for the procedure in which the specimen was taken.

(2)For Groups P5 and P6 of the pathology services table, services in Group P6 include any services described in Group P5 on the material submitted for a test in Group P6.

  1. (3)

    For subrule (2), any sample submitted for cytology from which a cell block is prepared does not qualify for a Group P5 item.

(4)If more than 1 of the services mentioned in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 are performed in a single patient episode, only the fee for the item performed having the highest specified fee is applicable to the services.

  1. (5)

    If more than 1 histopathological examination is performed on separate specimens, of different complexity levels, from a single patient episode, only the fee for the examination having the highest specified fee is applicable to the examinations.

(6)In items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 a reference to a complexity level is a reference to the level given to a specimen type mentioned in Part 5 of this table.

  1. (7)

    If:

    1. (a)

      more than 1 of the services mentioned in items 72846, 72847 and 72848; or

    2. (b)

      more than 1 of the services mentioned in items 73059, 73060 and 73061;

are performed in a single patient episode, only the fee for the item performed having the higher or highest specified fee applies to the services.

14Items in Groups P10 (Patient episode initiation) and P11 (Specimen referred) not to apply in certain circumstances
  1. (1)

    For this rule and items in Groups P10 (Patient episode initiation) and P11 (Specimen referred):

approved collection centre has the same meaning as in Part IIA of the Act.

institution means a place at which residential accommodation or day care is, or both residential accommodation and day care are, made available to:

  1. (a)

    disadvantaged children; or

  2. (b)

    juvenile offenders; or

  3. (c)

    aged persons; or

  4. (d)

    chronically ill psychiatric patients; or

  5. (e)

    homeless persons; or

  6. (f)

    unemployed persons; or

  7. (g)

    persons suffering from alcoholism; or

  8. (h)

    persons addicted to drugs; or

  9. (i)

    physically or mentally handicapped persons;

but does not include:

  1. (j)

    a hospital; or

  2. (k)

    a residential care facility; or

  3. (l)

    accommodation for aged persons that is attached to a residential care facility or situated within a residential care facility complex.

prescribed laboratory means a laboratory operated by:

  1. (a)

    the Commonwealth; or

  2. (b)

    an authority of the Commonwealth; or

  3. (c)

    a State or internal Territory; or

  4. (d)

    an authority of a State or internal Territory; or

  5. (e)

    an Australian tertiary education institution.

residential care facility means a facility in which residential care, within the meaning of section 41‑3 of the Aged Care Act 1997, is provided.

specimen collection centre has the same meaning as in Part IIA of the Act.

treating practitionerhas the same meaning as in paragraph 16A (1) (a) of the Act.

  1. (2)

    If a service described in an item in Group P10 is rendered by, or on behalf of, an approved pathology practitioner who is a recognised pathologist, the relevant item does not apply to the service if:

    1. (a)

      the service is rendered upon a request made in the course of an out‑patient service at a recognised hospital; or

    2. (b)

      the service is rendered to a public patient at a recognised hospital.

  2. (3)

    An item in Group P10 or P11 does not apply to a pathology service to which subsection 16A (7) of the Act applies.

  3. (4)

    An item in Group P10 or P11 does not apply to a pathology service unless at least 1 item in Groups P1 to P8 also applies to the service.

  4. (5)

    Subject to subrule (7), if 1 item in Group P10 applies to a patient episode, no other item in the Group applies to the patient episode.

  5. (6)

    An item in Group P11 applies only to the approved pathology practitioner or approved pathology authority to whom the specimen mentioned in the item was referred.

  6. (7)

    If, in respect of the same patient episode:

    1. (a)

      services referred to in 1 or more items in Group P5 and 1 or more of Groups P1, P2, P3, P4, P6, P7 and P8 are rendered by an approved pathology practitioner in the laboratory of another approved pathology authority; or

    2. (b)

      services referred to in 1 or more items in Group P6 and 1 or more of Groups P1, P2, P3, P4, P5, P7 and P8 are rendered by an approved pathology practitioner in the laboratory of another approved pathology authority;

the fee specified in the applicable item in Group P10 applies to both approved pathology practitioners.

  1. (8)

    If more than 1 specimen is collected from a person on the same day for the provision of pathology services:

    1. (a)

      in accordance with more than 1 request; and

    2. (b)

      in or by a single approved pathology authority;

the fee specified in the applicable item in Group P10 applies once only to the services.

  1. (9)

    The fee specified in item 73940 applies only once in respect of a single patient episode.

15Application of an item in Group P11 (Specimen referred) to a service excludes certain other items

If item 73940 applies to a patient episode, none of the items in Group P10 applies to any pathology service rendered by the approved pathology authority or approved pathology practitioner who claimed item 73940 in respect of the patient episode.

16Circumstances in which an item in Group P11 (Specimen referred) does not apply
  1. (1)

    An item in Group P11 does not apply to a referral if:

    1. (a)

      a service in respect of the same patient episode has been carried out by the referring approved pathology authority; and

    2. (b)

      the approved pathology authority to which the referral is made is related to the referring approved pathology authority.

  2. (2)

    An approved pathology authority is related to another approved pathology authority for subrule (1) if:

    1. (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

    2. (b)

      either of the approved pathology authorities is employed (including employed under contract) by the other; or

    3. (c)

      both approved pathology authorities are corporations and are connected entities within the meaning of the Corporations Act 2001; or

    4. (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

    5. (e)

      both approved pathology authorities are operated by the Commonwealth or an authority of the Commonwealth; or

    6. (f)

      both approved pathology authorities are operated by the same State or internal Territory or an authority of the same State or internal Territory.

  3. (3)

    An item in Group P11 does not apply to a referral if the following common tests are referred either singly or in combination (except if the following items are referred in combination with other items not similarly specified): 65060, 65070, 65120, 66500, 66503, 66506, 66509, 66512, 66515, 66536, 66596, 69300, 69303, 69333 or 73527.

17Abbreviations
  1. (1)

    The abbreviations in Part 4 may be used to identify particular pathology services or groups of pathology services.

  2. (2)

    The names of services or drugs not listed in Part 4 must be written in full.

18Certain pathology services to be treated as 1 service
  1. (1)

    In this rule:

general practitioner has the meaning given by subrule 18A (1).

set of pathology services has the meaning given by subrule 18A (2).

  1. (2)

    If a general 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 rule.

  2. (3)

    If the fee specified in 1 item that describes any of the services in the set of pathology services is higher than the fees specified in the other items that describe the services in the set:

    1. (a)

      the pathology service described in the first‑mentioned item is to be treated as 1 pathology service; and

    2. (b)

      either:

      1. (i)

        the pathology service in the set that is described in the item that specifies the second‑highest fee is to be treated as 1 pathology service; or

      2. (ii)

        if 2 or more items that describe any of those services specify the second‑highest fee — the pathology service described in the item that specifies the second‑highest fee, and has the lowest item number, is to be treated as 1 pathology service; and

    3. (c)

      the pathology services in the set, other than the services that are to be treated as 1 pathology service under paragraphs (a) and (b), are to be treated as 1 pathology service.

  3. (4)

    If the fees specified 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 specified in the other items that describe the services in the set:

    1. (a)

      the pathology service in the set that is described in the item that specifies the highest fee, and has the lowest item number, is to be treated as 1 pathology service; and

    2. (b)

      the pathology service in the set that is described in the item that specifies the highest fee, and has the second‑lowest item number, is to be treated as 1 pathology service; and

    3. (c)

      the pathology services in the set, other than the services that are to be treated as 1 pathology service under paragraphs (a) and (b), are to be treated as 1 pathology service.

  4. (5)

    If pathology services are to be treated as 1 pathology service under paragraph (3) (c) or (4) (c), the fee for the 1 pathology service is the highest fee specified in any of the items that describe the pathology services that are to be treated as the 1 pathology service.

18AMeaning of general practitioner and set of pathology services
  1. (1)

    In rule 18:

general practitioner means a medical practitioner who:

  1. (a)

    is not a consultant physician in any specialty; and

  2. (b)

    is not a specialist in any specialty.

  1. (2)

    In rule 18 and subject to subrule (3):

set of pathology services means a group of pathology services:

  1. (a)

    that consists of services that are described in at least 4 different items; and

  2. (b)

    all of which are requested in a single patient episode; and

  3. (c)

    each of which relates to a patient who is not an admitted patient of a hospital; and

  4. (d)

    none of which is referred to in item 73053 or 73055.

  1. (3)

    In rule 18, an item mentioned in this subrule is to be excluded from a set of pathology services:

    1. (a)

      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, 66609, 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, 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 or 73321; or

    2. (b)

      an item in Group P10 (Patient episode initiation), Group P11 (Specimen referred) or Group P12 (Management of bulk‑billed services).

  2. (4)

    An approved pathology authority is related to another approved pathology authority for paragraph (3) (a) if:

    1. (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

    2. (b)

      either of the approved pathology authorities is employed (including employed under contract) by the other; or

    3. (c)

      both approved pathology authorities are corporations and are connected entities within the meaning of the Corporations Act 2001; or

    4. (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

    5. (e)

      both approved pathology authorities are operated by the Commonwealth or an authority of the Commonwealth; or

    6. (f)

      both approved pathology authorities are operated by the same State or internal Territory or an authority of the same State or internal Territory.

19Hepatitis 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.

20Haemochromatosis testing

For items 73317 and 73318:

elevated serum ferritin, for a patient, means a level of ferritin above the normal reference range in respect of the particular method of assay used to determine the level.

21Serum B12 and red cell folate testing
  1. (1)

    Items 66599 and 66602 do not apply to more than 3 patient episodes that include a service described in item 66599 or 66602, or any combination of those items, in a 12 month period.

  2. (2)

    Item 66599 does not apply to a service described in that item if the service was provided as part of the same patient episode as a service described in item 66602.

22Nutritional and toxicity metals testing
  1. (1)

    For this rule:

metal toxicity testing group means items 66825, 66826, 66827 and 66828.

nutritional metals testing group means items 66819, 66820, 66821 and 66822.

  1. (2)

    An item in the nutritional metals testing group or the metal toxicity testing group does not apply in relation 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:

    1. (a)

      that item; or

    2. (b)

      the other item in the same group; or

    3. (c)

      an item in the other group.

23Antineutrophil cytoplasmic antibody tests

For subsection 16A (3) of the Act, a request for an antineutrophil cytoplasmic antibody immunofluorescence test is taken to include a request for an antineutrophil proteinase 3 antibody test and an antimyeloperoxidase antibody test if:

  1. (a)

    the immunofluorescence test performed as a result of the request is abnormal; or

  2. (b)

    a previous immunofluorescence test was abnormal; or

  3. (c)

    those antibodies have been previously detected.

24Satisfying requirements described in pathology service

Unless the contrary intention appears, a requirement contained in the description of a pathology service in Part 3 is satisfied if:

  1. (a)

    in the case of a requirement for information, the information:

    1. (i)

      is included in the request for the service; or

    2. (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

  2. (b)

    in the case of a requirement for laboratory test results, the results are:

    1. (i)

      included in the request for the service; or

    2. (ii)

      obtained from another laboratory test performed in the same patient episode; or

    3. (iii)

      included in results from an earlier laboratory test that have been kept by the approved pathology authority.

25Limitation on certain items
  1. (1)

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

  2. (2)

    For any particular patient, each of items 66819, 66820, 66821, 66822, 66825, 66826, 66827 and 66828 is applicable not more 3 times in a 6 month period.

  3. (3)

    For any particular patient, the following items are applicable not more than once in a 12 month period:

    1. (a)

      items 66655 and 66659;

    2. (b)

      item 69491 or 69492;

    3. (c)

      item 69499 or 69500.

  4. (4)

    For any particular patient, the following items are applicable not more than twice in a 12 month period:

    1. (a)

      items 66539, 71075, 71127, 71135 and 71137;

    2. (b)

      item 66605 or 66606;

    3. (c)

      item 69488 or 69489.

  5. (5)

    For any particular patient, each of items 66551, 69445, 69451, 71079, 73314, 73315 and 73523 is applicable not more than 4 times in a 12 month period.

  6. (6)

    For any particular patient, each of items 66554 and 71077 is applicable not more than 6 times in a 12 month period.

  7. (7)

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

  8. (8)

    For any particular patient, item 69418 or 69419 is applicable not more than twice in a 24 month period.

  9. (9)

    For any particular patient, item 66750 or 66751 is applicable not more than once in a pregnancy.

26Antigen 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 specified 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.

27HLA‑B27 typing

If a pathology service described in item 71148, 73320 or 73321 is rendered as a pathologist‑determinable service, the amount specified in the item is not payable for a pathology service described in the item unless the recognised pathologist who renders the service records, in writing, the reasons for rendering the service and the result of the pathology service described in item 71147.

Part3Services and fees

Item

Pathology service

Fee ($)

Group P1 — Haematology

65060

Haemoglobin, erythrocyte sedimentation rate, blood viscosity — 1 or more tests

7.95

65066

Examination of:

  1. (a)

    a blood film by special stains to demonstrate Heinz bodies, parasites or iron; or

  2. (b)

    a blood film by enzyme cytochemistry for neutrophil alkaline phosphatase, alpha‑naphthyl acetate esterase or chloroacetate esterase; or

  3. (c)

    a blood film using any other special staining methods including periodic acid Schiff and Sudan Black; or

  4. (d)

    a urinary sediment for haemosiderin;

    including a service described in item 65072

10.55

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) — 1 or more instrument‑generated set of results from a single sample and (if performed):

  1. (a)

    a morphological assessment of a blood film; and

  2. (b)

    any service in item 65060 or 65072

17.20

65072

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

10.30

65075

Haemolysis or metabolic enzymes — assessment by 1 or more of the following tests:

  1. (a)

    erythrocyte autohaemolysis test;

  2. (b)

    erythrocyte osmotic fragility test;

  3. (c)

    sugar water test;

  4. (d)

    G‑6‑P D (qualitative or quantitative) test;

  5. (e)

    pyruvate kinase (qualitative or quantitative) test;

  6. (f)

    acid haemolysis test;

52.90

  1. (g)

    quantitation of muramidase in serum or urine;

  2. (h)

    Donath Landsteiner antibody test;

  3. (i)

    other erythrocyte metabolic enzyme tests

65078

Tests for the diagnosis of thalassaemia when indicated on the basis of an abnormal full blood examination or by the clinical need for family studies, consisting of haemoglobin electrophoresis or chromatography and at least 2 of:

  1. (a)

    examination for HbH; or

  2. (b)

    quantitation of HbA2; or

  3. (c)

    quantitation of HbF;

including (if performed) any service described in item 65060 or 65070

91.75

65079

A test described in item 65078 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18 and 18A)

91.75

65081

Tests for the investigation of haemoglobinopathy (including S, C, D, E), other than thalassaemia, when indicated on the basis of an abnormal full blood examination or by the clinical need for family studies, consisting of haemoglobin electrophoresis or chromatography and at least 1 of:

  1. (a)

    heat denaturation test; or

  2. (b)

    isopropanol precipitation test; or

  3. (c)

    tests for the presence of haemoglobin S; or

  4. (d)

    quantitation of any haemoglobin fraction (including S, C, D, E);

including (if performed) any service described in item 65060, 65070 or 65078

98.25

65082

A test described in item 65081 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18 and 18A)

98.25

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):

  1. (a)

    special stains or immunohistochemical techniques (if any); and

  2. (b)

    any test described in item 65060, 65066 or 65070

168.75

65087

Bone marrow — examination of aspirated material (including clot sections where necessary), including (if performed):

  1. (a)

    special stains or immunohistochemical techniques (if any); and

  2. (b)

    any test described in item 65060, 65066 or 65070

84.55

65090

Blood grouping (including back‑grouping if performed) — ABO and Rh (D antigen)

11.25

65093

Blood grouping — Rh phenotypes, Kell system, Duffy system, M and N factors or any other blood group system — 1 or more systems, including item 65090 (if performed)

22.35

65096

Blood grouping (including back‑grouping if performed), and examination of serum for Rh and other blood group antibodies, including:

  1. (a)

    identification and quantitation of any antibodies detected; and

  2. (b)

    (if performed) any test described in item 65060 or 65070

41.65

65099

Compatibility tests by crossmatch — all tests performed on any 1 day for up to 6 units, including:

  1. (a)

    all grouping checks of the patient and donor; and

  2. (b)

    examination for antibodies and, if necessary, identification of any antibodies detected; and

  3. (c)

    (if performed) any tests described in item 65060, 65070, 65090 or 65096

(Item is subject to rule 5)

110.80

65102

Compatibility tests by crossmatch — all tests performed on any 1 day in excess of 6 units, including:

  1. (a)

    all grouping checks of the patient and donor; and

  2. (b)

    examination for antibodies and, if necessary, identification of any antibodies detected; and

  3. (c)

    (if performed) any tests described in item 65060, 65070, 65090, 65096, 65099 or 65105

(Item is subject to rule 5)

167.50

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:

  1. (a)

    all grouping checks of the patient and donor; and

  2. (b)

    examination for antibodies and, if necessary, identification of any antibodies detected; and

  3. (c)

    (if performed) any tests described in item 65060, 65070, 65090 or 65096

(Item is subject to rule 5)

110.80

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:

  1. (a)

    all grouping checks of the patient and donor; and

  2. (b)

    examination for antibodies and, if necessary, identification of any antibodies detected; and

  3. (c)

    (if performed) any tests described in item 65060, 65070, 65090, 65096, 65099 or 65105

(Item is subject to rule 5)

167.50

65109

Release of fresh frozen plasma or cryoprecipitate for the use in a patient for the correction of a coagulopathy — 1 release

13.10

65110

Release of compatible fresh platelets for the use in a patient for platelet support as prophylaxis to minimize bleeding or during active bleeding — 1 release

13.10

65111

Examination of serum for blood group antibodies (including identification and, if necessary, quantitation of any antibodies detected)

23.60

65114

1 or more of the following tests:

  1. (a)

    direct Coombs (antiglobulin) test;

  2. (b)

    qualitative or quantitative test for cold agglutinins or heterophil antibodies

9.25

65117

1 or more of the following tests:

  1. (a)

    spectroscopic examination of blood for chemically altered haemoglobins;

  2. (b)

    detection of methaemalbumin (Schumm’s test)

20.60

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 1 of fibrinogen degradation products, fibrin monomer or D‑dimer — 1 test

14.05

65123

2 tests described in item 65120

20.60

65126

3 tests described in item 65120

28.35

65129

4 or more tests described in item 65120

36.10

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

25.75

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 — 1 or more tests

25.75

65144

Platelet aggregation in response to ADP, collagen, 5HT, ristocetin or other substances; or heparin, low molecular weight heparins, heparinoid or other drugs — 1 or more tests

57.55

65147

Quantitation of anti‑Xa activity when monitoring is required for a patient receiving a low molecular weight heparin or heparinoid — 1 test

38.55

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 — 1 test

(Item is subject to rule 6)

72.15

65153

2 tests described in item 65150

(Item is subject to rule 6)

144.35

65156

3 or more tests described in item 65150

(Item is subject to rule 6)

216.50

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 — 1 test

(Item is subject to rules 6, 18 and 18A)

72.15

65158

A test described in item 65150, if rendered by a receiving APP, where 1 or more tests in the item have been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18 and 18A)

72.15

65159

Quantitation of circulating coagulation factor inhibitors by Bethesda assay — 1 test

72.15

65162

Examination of a maternal blood film for the presence of fetal red blood cells (Kleihauer test)

10.55

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

35.05

65166

A test described in item 65165 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18 and 18A)

35.05

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 — 1 or more tests

25.75

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 1 or more techniques — 1 test

(Item is subject to rule 6)

25.75

65176

2 tests described in item 65175

(Item is subject to rule 6)

49.45

65177

3 tests described in item 65175

(Item is subject to rule 6)

73.20

65178

4 tests described in item 65175

(Item is subject to rule 6)

96.85

65179

5 tests described in item 65175

(Item is subject to rule 6)

120.55

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 — 1 test

(Item is subject to rules 6, 18 and 18A)

25.75

65181

A test described in item 65175, if rendered by a receiving APP, where 1 or more tests in the item have been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18 and 18A)

23.70

Group P2 — Chemical

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 acetoacetate, acid phosphatase, alanine aminotransferase, albumin, alkaline phosphatase, ammonia, amylase, aspartate aminotransferase, beta‑hydroxybutyrate, 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, lactate dehydrogenase, lipase, magnesium, phosphate, potassium, pyruvate, sodium, total cholesterol, total protein, triglycerides, urate or urea — 1 test

9.75

66503

2 tests described in item 66500

11.75

66506

3 tests described in item 66500

13.75

66509

4 tests described in item 66500

15.75

66512

5 tests described in item 66500

17.80

66515

6 or more tests described in item 66500

19.80

66518

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

20.40

66519

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

40.85

66536

Quantitation of HDL cholesterol

11.25

66539

Electrophoresis of serum for demonstration of lipoprotein subclasses:

  1. (a)

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

  2. (b)

    in the diagnosis of types III and IV hyperlipidaemia

(Item is subject to rule 25)

31.15

66542

Oral glucose tolerance test for the diagnosis of diabetes mellitus, that includes:

  1. (a)

    administration of glucose; and

  2. (b)

    at least 2 measurements of blood glucose; and

  3. (c)

    (if performed) any test described in item 66695

19.30

66545

Oral glucose challenge test in pregnancy for the detection of gestational diabetes that includes:

  1. (a)

    administration of glucose; and

  2. (b)

    1 or 2 measurements of blood glucose; and

  3. (c)

    (if performed) any test in item 66695

16.10

66548

Oral glucose tolerance test in pregnancy for the diagnosis of gestational diabetes that includes:

  1. (a)

    administration of glucose; and

  2. (b)

    at least 3 measurements of blood glucose; and

  3. (c)

    (if performed) any test in item 66695

20.30

66551

Quantitation of glycosylated haemoglobin performed in the management of established diabetes

(Item is subject to rule 25)

17.10

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)

(Item is subject to rule 25)

17.10

66557

Quantitation of fructosamine performed in the management of established diabetes — each test to a maximum of 4 tests in a 12 month period

9.85

66560

Microalbumin — quantitation in urine

20.50

66563

Osmolality, estimation by osmometer, in serum or in urine — 1 or more tests

25.10

66566

Quantitation of:

  1. (a)

    blood gases (including pO2, oxygen saturation and pCO2); and

34.30

  1. (b)

    bicarbonate and pH;

including any other measurement (eg haemoglobin, potassium or ionised calcium) or calculation performed on the same specimen — 1 or more tests on 1 specimen

66569

Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 2 specimens performed on any 1 day

43.35

66572

Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 3 specimens performed on any 1 day

52.45

66575

Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 4 specimens performed on any 1 day

61.50

66578

Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 5 specimens performed on any 1 day

70.55

66581

Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 6 or more specimens performed on any 1 day

79.65

66584

Quantitation of ionised calcium (except if performed as part of item 66566) — 1 test

9.85

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 1 blood specimen

48.35

66590

Calculus, analysis of 1 or more

31.15

66593

Ferritin — quantitation, except if requested as part of iron studies

18.35

66596

Iron studies, consisting of quantitation of:

  1. (a)

    serum iron; and

  2. (b)

    transferrin or iron binding capacity; and

  3. (c)

    ferritin

33.10

66599

Serum B12 or red cell folate and, if required, serum folate

(Item is subject to rule 21)

24.05

66602

Serum B12 and red cell folate and, if required, serum folate

(Item is subject to rule 21)

43.75

66605

Vitamins — quantitation of vitamins A, B1, B2, B3, B6, C and E in blood, urine or other body fluid

(Item is subject to rule 25)

31.15

66606

A test described in item 66605 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18, 18A and 25)

31.15

66608

Vitamin D or D fractions — 1 or more tests

43.00

66609

A test described in item 66608 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18 and 18A)

43.00

66623

All qualitative and quantitative tests on blood, urine or other body fluid for:

  1. (a)

    a drug or drugs of abuse (including illegal drugs and legally available drugs taken other than in appropriate dosage); or

  2. (b)

    ingested or absorbed toxic chemicals;

including a service described in item 66800, 66803, 66806, 66812 or 66815 (if performed), but excluding:

  1. (c)

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

  2. (d)

    the monitoring of patients participating in a drug abuse treatment program

42.25

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:

  1. (a)

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

  2. (b)

    the detection of nicotine and metabolites in smoking withdrawal programs

(Item is subject to rule 25)

24.55

66629

Beta‑2‑microglobulin — quantitation in serum, urine or other body fluids — 1 or more tests

20.50

66632

Caeruloplasmin, haptoglobins, or prealbumin — quantitation in serum, urine or other body fluids — 1 or more tests

20.50

66635

Alpha‑1‑antitrypsin — quantitation in serum, urine or other body fluid — 1 or more tests

20.50

66638

Isoelectric focussing or similar methods for determination of alpha‑1‑antitrypsin phenotype in serum — 1 or more tests

29.70

66639

A test described in item 66638 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18 and 18A)

29.70

66641

Electrophoresis of serum or other body fluid to demonstrate:

  1. (a)

    the isoenzymes of lactate dehydrogenase; or

  2. (b)

    the isoenzymes of alkaline phosphatase;

including the preliminary quantitation of total relevant enzyme activity — 1 or more tests

29.70

66642

A test described in item 66641 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18 and 18A)

29.70

66644

C‑1 esterase inhibitor — quantitation

20.50

66647

C‑1 esterase inhibitor — functional assay

45.90

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), mammary serum antigen (MSA), 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 — 1 test

(Item is subject to rule 6)

24.75

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 — 1 test

(Item is subject to rules 6, 18 and 18A)

24.75

66652

A test described in item 66650, if rendered by a receiving APP, where 1 or more tests in the item have been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18 and 18A)

20.65

66653

2 or more tests described in item 66650

(Item is subject to rule 6)

45.40

66655

Prostate specific antigen — quantitation

(Item is subject to rule 25)

20.50

66656

Prostate specific antigen (PSA) quantitation in the monitoring of previously diagnosed prostatic disease (including a test to which item 66655 applies)

20.50

66659

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

(Item is subject to rule 25)

37.80

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 — 1 or more tests

81.35

66663

A test described in item 66662 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18 and 18A)

81.35

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

31.15

66666

A test described in item 66665 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18 and 18A)

31.15

66667

Quantitation of serum zinc in a patient receiving intravenous alimentation — each test

31.15

66671

Quantitation of serum aluminium in a patient in a renal dialysis program — each test

37.55

66674

Quantitation of:

  1. (a)

    faecal fat; or

  2. (b)

    breath hydrogen in response to loading with disaccharides;

1 or more tests within a 28 day period

40.65

66677

Test for tryptic activity in faeces in the investigation of diarrhoea of longer than 4 weeks duration in children under 6 years old

11.35

66680

Quantitation of disaccharidases and other enzymes in intestinal tissue — 1 or more tests

75.75

66683

Enzymes — quantitation in solid tissue or tissues other than blood elements or intestinal tissue — 1 or more tests

75.75

66686

Performance of 1 or more of the following procedures:

  1. (a)

    growth hormone suppression by glucose loading;

  2. (b)

    growth hormone stimulation by exercise;

  3. (c)

    dexamethasone suppression test;

  4. (d)

    sweat collection by iontophoresis for chloride analysis;

  5. (e)

    pharmacological stimulation of growth hormone

51.55

66695

Quantitation in blood or urine of hormones and hormone binding proteins — ACTH, aldosterone, androstenedione, C‑peptide, calcitonin, cortisol, cyclic AMP, 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, vasopressin (antidiuretic hormone) — 1 test

(Item is subject to rule 6)

30.70

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

(Item is subject to rules 6, 18 and 18A)

30.70

66697

A test described in item 66695, if rendered by a receiving APP, where 1 or more tests in the item have been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18 and 18A)

13.30

66698

2 tests described in item 66695

(Item is subject to rule 6)

44.00

66701

3 tests described in item 66695

(Item is subject to rule 6)

57.30

66704

4 tests described in item 66695

(Item is subject to rule 6)

70.60

66707

5 tests described in item 66695

(Item is subject to rule 6)

83.90

66710

6 or more tests described in item 66695

(Item is subject to rule 6)

97.45

66711

Quantitation in saliva of cortisol in:

  1. (a)

    the investigation of Cushing’s syndrome; or

  2. (b)

    the management of children with congenital adrenal hyperplasia;

    1 test

    (Item is subject to rule 6)

30.70

66712

Two tests described in item 66711

(Item is subject to rule 6)

43.80

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

(Item is subject to rules 6, 18 and 18A)

30.70

66715

A test described in item 66711, if rendered by a receiving APP, where 1 test in the item has been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18 and 18A)

13.10

66716

TSH quantitation

25.45

66719

Thyroid function tests (comprising the service described in item 66716 and 1 or more of the following tests — estimation of free thyroxine index, free thyroxine, free T3, total T3, thyroxine binding globulin) for a patient, if at least 1 of the following conditions is satisfied:

  1. (a)

    the patient has an abnormal level of TSH;

35.45

  1. (b)

    the tests are performed:

    1. (i)

      for the purpose of monitoring thyroid disease in the patient; or

    2. (ii)

      to investigate the sick euthyroid syndrome if the patient is an admitted patient; or

    3. (iii)

      to investigate dementia or psychiatric illness of the patient; or

    4. (iv)

      to investigate amenorrhoea or infertility of the patient;

  1. (c)

    the medical practitioner who requested the tests suspects the patient has a pituitary dysfunction;

  2. (d)

    the patient is on drugs that interfere with thyroid hormone metabolism or function

(Item is subject to rule 9)

66722

TSH quantitation described in item 66716 and 1 test described in item 66695

(Item is subject to rule 6)

38.55

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 — 1 test

(Item is subject to rules 6, 18 and 18A)

38.55

66724

A test described in item 66722, if rendered by a receiving APP, where 1 or more tests in the item have been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18 and 18A)

13.40

66725

TSH quantitation described in item 66716 and 2 tests described in item 66695

(Item is subject to rule 6)

51.95

66728

TSH quantitation described in item 66716 and 3 tests described in item 66695

(Item is subject to rule 6)

65.35

66731

TSH quantitation described in item 66716 and 4 tests described in item 66695

(Item is subject to rule 6)

78.75

66734

TSH quantitation described in item 66716 and 5 tests described in item 66695

(Item is subject to rule 6)

92.15

66743

Quantitation of alpha‑fetoprotein in serum or other body fluids during pregnancy except if requested as part of item 66750 or 66751

20.50

66749

Amniotic fluid, spectrophotometric examination of, and quantitation of:

  1. (a)

    lecithin/sphingomyelin ratio; or

  2. (b)

    palmitic acid, phosphatidylglycerol or lamellar body phospholipid; or

33.50

  1. (c)

    bilirubin, including correction for haemoglobin;

1 or more tests

66750

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

  1. (a)

    total human chorionic gonadotrophin (total HCG);

  2. (b)

    free alpha human chorionic gonadotrophin (free alpha HCG);

40.45

  1. (c)

    free beta human chorionic gonadotrophin (free beta HCG);

  2. (d)

    pregnancy associated plasma protein A (PAPP‑A);

  1. (e)

    unconjugated oestriol (uE3);

  2. (f)

    alpha‑fetoprotein (AFP);

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

(Item is subject to rule 25)

66751

Quantitation, in pregnancy, of any 3 or more tests described in item 66750

(Item is subject to rule 25)

56.20

66752

Quantitation of citrate, oxalate, total free fatty acids, cysteine, homocysteine, cystine or other amino acids and hydroxyproline (except if performed as part of item 66773 or 66776) — 1 test

25.10

66755

2 or more tests described in item 66752

39.50

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

100.00

66757

Quantitation of 10 or more amino acids for monitoring of previously diagnosed inborn errors of metabolism in 1 tissue type

100.00

66758

Quantitation of angiotensin converting enzyme, or cholinesterase — 1 or more tests

25.10

66761

Test for reducing substances in faeces by any method (except reagent strip or dipstick)

13.40

66764

Examination for faecal occult blood (including tests for haemoglobin and its derivatives in the faeces) by:

  1. (a)

    an immunological method; and

9.05

  1. (b)

    a chemical method (except reagent strip or dip stick);

with a maximum of 3 examinations on specimens collected on separate days in a 28 day period — 1 examination by both methods

66767

2 examinations by both methods described in item 66764 performed on separately collected and identified specimens

18.15

66770

3 examinations by both methods described in item 66764 performed on separately collected and identified specimens

27.20

66773

Quantitation of products of collagen breakdown for the monitoring of patients with proven low bone mineral density and, if performed, a service described in item 66752 — 1 or more tests

25.10

66776

Quantitation of products of collagen breakdown for the monitoring of patients with metabolic bone disease or Paget’s disease of bone and, if performed, a service described in item 66752 — 1 or more tests

25.10

66779

Adrenaline, noradrenaline, dopamine, histamine, hydroxyindoleacetic acid (5HIAA), hydroxymethoxymandelic acid (HMMA), homovanillic acid (HVA), metanephrines, methoxyhydroxyphenylethylene glycol (MHPG), phenylacetic acid (PAA) or serotonin — quantitation — 1 or more tests

40.65

66780

A test described in item 66779 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18 and 18A)

40.65

66782

Porphyrins or porphyrins precursors — detection in plasma, red cells, urine or faeces — 1 or more tests

13.40

66783

A test described in item 66782 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18 and 18A)

13.40

66785

Porphyrins or porphyrins precursors — quantitation in plasma, red cells, urine or faeces — 1 test

(Item is subject to rule 6)

40.65

66788

Porphyrins or porphyrins precursors — quantitation in plasma, red cells, urine or faeces — 2 or more tests

(Item is subject to rule 6)

67.00

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 — 1 test

(Item is subject to rules 6, 18 and 18A)

40.65

66790

A test described in item 66785, if rendered by a receiving APP, where 1 or more tests in the item have been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18 and 18A)

26.35

66791

Porphyrin biosynthetic enzymes — measurement of activity in blood cells or other tissues — 1 or more tests

75.75

66792

A test described in item 66791 if rendered by a receiving APP — 1 or more tests

(Item is subject to rules 18 and 18A)

75.75

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 — 1 test

(Item is subject to rule 6)

18.45

66803

2 tests described in item 66800

(Item is subject to rule 6)

31.05

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 — 1 test

(Item is subject to rules 6, 18 and 18A)

18.45

66805

A test described in item 66800, if rendered by a receiving APP, where 1 or more tests in the item have been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18 and 18A)

12.60

66806

3 tests described in item 66800

(Item is subject to rule 6)

43.65

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 — 1 test

(Item is subject to rule 6)

35.45

66815

2 tests described in item 66812

(Item is subject to rule 6)

60.60

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 — 1 test

(Item is subject to rules 6, 18 and 18A)

35.45

66817

A test described in item 66812, if rendered by a receiving APP, where 1 or more tests in the item have been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18 and 18A)

25.15

66819

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

(Item is subject to rules 6, 22 and 25)

31.15

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 — 1 test

(Item is subject to rules 6, 18, 18A, 22 and 25)

31.15

66821

A test described in item 66819, if rendered by a receiving APP, where 1 or more tests in the item have been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18, 18A, 22 and 25)

22.20

66822

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

(Item is subject to rules 6, 22 and 25)

53.35

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 — 1 test

(Item is subject to rules 6, 22 and 25)

31.15

66826

A test described in item 66825 if rendered by a receiving APP where no tests have been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18, 18A, 22 and 25 )

31.15

66827

A test described in item 66825, if rendered by a receiving APP, where 1 or more tests in the item have been rendered by the referring APP — 1 test

(Item is subject to rules 6, 18, 18A, 22 and 25)

22.20

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

(Item is subject to rules 6, 22 and 25)

53.35

Group P3 — Microbiology

69300

Microscopy of wet film material other than blood, from 1 or more sites, obtained directly from a patient (not cultures) including (if performed):

  1. (a)

    differential cell count; or

  2. (b)

    examination for dermatophytes; or

  3. (c)

    dark ground illumination; or

  4. (d)

    stained preparation or preparations using any relevant stain or stains;

1 or more tests

12.60

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):

  1. (a)

    pathogen identification and antibiotic susceptibility testing; or

22.15

  1. (b)

    a service described in item 69300;

specimens from 1 or more sites

69306

Microscopy and culture to detect pathogenic micro‑organisms from skin or other superficial sites, including (if performed):

  1. (a)

    pathogen identification and antibiotic susceptibility testing; or

  2. (b)

    a service described in items 69300, 69303, 69312 and 69318;

1 or more tests on 1 or more specimens

34.00

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):

  1. (a)

    the detection of antigens not elsewhere specified in this table; or

  2. (b)

    a service described in items 69300, 69303, 69306, 69312 and 69318;

1 or more tests on 1 or more specimens

48.45

69312

Microscopy and culture to detect pathogenic micro‑organisms from urethra, vagina, cervix or rectum (except for faecal pathogens), including (if performed):

  1. (a)

    pathogen identification and antibiotic susceptibility testing; or

  2. (b)

    a service described in items 69300, 69303, 69306 and 69318;

1 or more tests on 1 or more specimens

34.00

69316

Detection of Chlamydia trachomatis by any method — 1 test

(Item is subject to rule 26)

28.85

69317

This item applies if:

  1. (a)

    1 test described in item 69316 is performed; and

  2. (b)

    1 test described in item 69494 is performed

(Item is subject to rule 26)

36.10

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):

  1. (a)

    pathogen identification and antibiotic susceptibility testing; or

34.00

  1. (b)

    a service described in items 69300, 69303, 69306 and 69312;

1 or more tests on 1 or more specimens

69319

This item applies if:

  1. (a)

    1 test described in item 69316 is performed; and

  2. (b)

    2 tests described in item 69494 are performed

(Item is subject to rule 26)

43.25

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):

  1. (a)

    pathogen identification and antibiotic susceptibility testing; or

  2. (b)

    a service described in item 69300, 69303, 69306, 69312 or 69318;

specimens from 1 or more sites

48.45

69324

Microscopy (with appropriate stains) and culture for mycobacteria — 1 specimen of sputum, urine or other body fluid or 1 operative or biopsy specimen, including (if performed):

  1. (a)

    microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or

  2. (b)

    pathogen identification and antibiotic susceptibility testing;

including a service mentioned in item 69300

43.30

69325

A service described in item 69324 if the microscopy and culture is performed by a receiving APP

(Item is subject to rules 18 and 18A)

43.30

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):

  1. (a)

    microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or

  2. (b)

    pathogen identification and antibiotic susceptibility testing;

includinga service described in item 69300

85.55

69328

A service described in item 69327 if the microscopy and culture is performed by a receiving APP

(Item is subject to rules 18 and 18A)

85.55

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):

  1. (a)

    microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or

  2. (b)

    pathogen identification and antibiotic susceptibility testing;

includinga service described in item 69300

128.85

69331

A service described in item 69330 if the microscopy and culture is performed by a receiving APP

(Item is subject to rules 18 and 18A)

128.85

69333

Urine examination (including serial examination) by any means other than simple culture by dip slide, including:

  1. (a)

    cell count; and

  2. (b)

    culture; and

  3. (c)

    colony count; and

  4. (d)

    (if performed) stained preparations; and

  5. (e)

    (if performed) identification of cultured pathogens; and

20.70

  1. (f)

    (if performed) antibiotic suseptibility testing; and

  2. (g)

    (if performed) examination for pH, specific gravity, blood, albumin, urobilinogen, sugar, acetone or bile salts

69336

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

  1. (a)

    a concentration technique; and

  2. (b)

    fixed stains or antigen detection for cryptosporidia and giardia;

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

(Item is subject to rule 25)

33.65

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 1 examination in a 7 day period

19.25

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):

  1. (a)

    pathogen identification and antibiotic susceptibility testing; and

  2. (b)

    the detection of clostridial toxins; and

  3. (c)

    a service described in item 69300

Not more than 1 examination in a 7 day period

53.25

69354

Blood culture for pathogenic micro‑organisms (other than viruses), including sub‑cultures and (if performed):

  1. (a)

    identification of any cultured pathogen; and

  2. (b)

    necessary antibiotic susceptibility testing;

to a maximum of 3 sets of cultures — 1 set of cultures

30.95

69357

2 sets of cultures described in item 69354

61.85

69360

3 sets of cultures described in item 69354

92.80

69363

Detection of Clostridium difficile or Clostridium difficile toxin (except if a service described in item 69345 has been performed) — 1 or more tests

28.85

69378

Quantitation of HIV viral RNA load in plasma or serum in the monitoring of a HIV sero‑positive patient not on antiretroviral therapy — 1 or more tests on 1 or more specimens

181.45

69379

A test described in item 69378 if the quantitation is performed by a receiving APP — 1 or more tests on 1 or more specimens

(Item is subject to rules 18 and 18A)

181.45

69381

Quantitation of HIV viral RNA load in plasma or serum in the monitoring of a HIV sero‑positive patient on antiretroviral therapy — 1 or more tests on 1 or more specimens

181.45

69382

Quantitation of HIV viral RNA load in cerebrospinal fluid in a HIV sero‑positive patient — 1 or more tests on 1 or more specimens

181.45

69383

A test described in item 69381 if the quantitation is performed by a receiving APP — 1 or more tests on 1 or more specimens

(Item is subject to rules 18 and 18A)

181.45

69384

Quantitation of 1 antibody to microbial or exogenous antigens not elsewhere described in this table — 1 test

(Item is subject to rule 6)

15.75

69387

2 tests described in item 69384

(Item is subject to rule 6)

29.75

69390

3 tests described in item 69384

(Item is subject to rule 6)

43.75

69393

4 tests described in item 69384

(Item is subject to rule 6)

57.75

69396

5 tests described in item 69384

(Item is subject to rule 6)

71.75

69399

6 or more tests described in item 69384

(Item is subject to rule 6)

85.75

69400

This item applies to a test described in item 69384 if:

  1. (a)

    a referring APP has not performed a test described in item 69384; and

  2. (b)

    a receiving APP performs a test described in item 69384;

1 test

(Item is subject to rules 6, 18 and 18A)

15.75

69401

A test described in item 69384 if a referring APP has performed a test or tests described in item 69384 — 1 test

(Item is subject to rules 6, 18 and 18A)

14.00

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:

  1. (a)

    the determination of 1 of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and

  2. (b)

    (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481

15.75

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:

  1. (a)

    the determination of 2 of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and

  2. (b)

    (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481

28.00

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:

  1. (a)

    the determination of 3 of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and

  2. (b)

    (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481

39.35

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:

  1. (a)

    the determination of 4 of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and

  2. (b)

    (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481

50.65

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:

  1. (a)

    the determination of all of the following — rubella immune status, specific syphilis serology, carriage of hepatitis B, hepatitis C antibody, HIV antibody; and

  2. (b)

    (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481

61.95

69418

A test for high risk human papillomaviruses (HPV) in a patient who:

  1. (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

64.00

  1. (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

  1. (c)

    is undergoing annual cytological review following treatment for HSIL of the cervix;

    1 test

(Item is subject to rule 25)

69419

A test described in item 69418 if the test is performed by a receiving APP — 1 test

(Item is subject to rules 18, 18A and 25)

64.00

69445

Detection of hepatitis C viral RNA in a patient undertaking antiviral therapy for chronic HCV hepatitis (including a service described in item 69499) — 1 test

(Item is subject to rule 25)

92.80

69451

A test described in item 69445 if the test is performed by a receiving APP — 1 test

(Item is subject to rules 18, 18A and 25)

92.80

69471

Test of cell‑mediated immunity in blood for the detection of active tuberculosis or atypical mycobacterial infection in an immunosuppressed or immunocompromised patient — 1 test

35.15

69472

Detection of antibodies to Epstein Barr Virus using specific serology — 1 test

15.75

69474

Detection of antibodies to Epstein Barr Virus using specific serology — 2 or more tests

28.85

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 — 1 test, including:

  1. (a)

    Hepatitis A antibody test; or

15.75

  1. (b)

    Hepatitis B antibody or antigen test; or

  2. (c)

    Hepatitis C antibody test; or

  3. (d)

    Hepatitis D antibody test in a patient who is Hepatitis B surface antigen positive

    (Item is subject to rule 11)

69478

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 — 2 tests, including:

  1. (a)

    Hepatitis A antibody test; or

  2. (b)

    Hepatitis B surface or core antibody test; or

  3. (c)

    Hepatitis B surface antigen test; or

  4. (d)

    Hepatitis B ‘e’ antibody or ‘e’ antigen test; or

  5. (e)

    Hepatitis C antibody test; or

  6. (f)

    Hepatitis D antibody test in a patient who is Hepatitis B surface antigen positive

    (Item is subject to rule 11)

29.45

69481

Investigation of infectious causes of acute or chronic hepatitis — 3 tests, including:

Microbial antibody testing — Schistosoma

STO

69384

Microbial antibody testing — streptococcal serology — anti‑DNASE B titre

ADNB

69384

Microbial antibody testing — streptococcal serology — anti‑streptolysin O titre

ASOT

69384

Microbial antibody testing — Streptococcus pneumoniae

PCC

69384

Microbial antibody testing — tetanus

TET

69384

Microbial antibody testing — Thermoactinomyces vulgaris

THE

69384

Microbial antibody testing — thermopolyspora

TPS

69384

Microbial antibody testing — Toxocara

TOC

69384

Microbial antibody testing — Toxoplasma

TOX

69384

Microbial antibody testing — TPHA (Treponema pallidum haemagglutination test)

TPHA

69384

Microbial antibody testing — Treponema pallidum haemagglutination test

TPHA

69384

Microbial antibody testing — trichinosis

TOS

69384

Microbial antibody testing — typhus, Weil‑Felix

TYP

69384

Microbial antibody testing — Varicella zoster

VCZ

69384

Microbial antibody testing — VDRL (Venereal Disease Research Laboratory)

VDRL

69384

Microbial antibody testing — Yersinia enterocolitica

YER

69384

Microbial antigen testing — Chlamydia

MCCH

69494

Microbial antigen testing — Clostridium difficile

CLDT

69363

Microbial antigen testing — group B streptococcus

STB

69494

Microbial antigen testing — Haemophilus influenzae

HI

69494

Microbial antigen testing — herpes simplex virus

HSV

69494

Microbial antigen testing — Neisseria gonorrhoeae

GON

69494

Microbial antigen testing — Neisseria meningitidis

NMG

69494

Microbial antigen testing — respiratory syncytial virus

RSVN

69494

Microbial antigen testing — Streptococcus pneumoniae

SPN

69494

Microbial antigen testing — Varicella zoster

VCZN

69494

Micropolyspora faeni

MIC

69384

Microscopic examination of — faeces for parasites

OCP

69336–39

Microscopic examination of — wet film material other than blood

MWFM

69300

Microscopy and culture of — material from nose, throat, eye or ear

MCSW

69303

Microscopy and culture of — material from skin

MCSK

69309

Microscopy and culture of — postoperative wounds, aspirates of body cavities

MCPO

69321

Microscopy and culture of — superficial sites

MCSS

69306

Microscopy and culture of — urethra, vagina, cervix or rectum

MCGR

69312

Microscopy and culture of — specimens of sputum

MCSP

69318

Microscopy and culture of — specimens of sputum, urine or other body fluids for mycobacteria — 1 specimen

AFB1

69324

Microscopy and culture of — specimens of sputum, urine or other body fluids for mycobacteria — 2 specimens

AFB2

69327

Microscopy and culture of — specimens of sputum, urine or other body fluids for mycobacteria — 3 specimens

AFB3

69330

Microscopy and culture to detect pathogenic micro‑organisms including Chlamydia

MCCH

69494

Microscopy, culture, identification and sensitivity of urine

UMCS

69333

Mitochondria — tissue antigens — antibodies

MA

71119

Mouth — cytology on specimens from

SMCY

73043

Mumps — microbial antibody testing

MUM

69384

Murray Valley encephalitis — microbial antibody testing

MVE

69384

Mycobacteria microscopy and culture of sputum — 1 specimen

AFB 1

69324

Mycobacteria microscopy and culture of sputum — 2 specimens

AFB 2

69327

Mycobacteria microscopy and culture of sputum — 3 specimens

AFB 3

69333

Mycoplasma pneumoniae — microbial antibody testing

MYC

69384

Myoglobin

MYOG

66518

N‑acetyl procainamide

NAPC

66812

Neisseria gonorrhoeae by NAA techniques and chlamydia by any method

CHGO

69494

Neisseria gonorrhoeae — microbial antigen testing

GON

69494

Neisseria meningitidis — antigens

NMG

69494

Neisseria meningitidis — microbial antibody testing

MEN

69384

Neisseria meningitidis — microbial antigen testing

NMG

69494

Netilmicin

66800

Neural tube defects and Down’s syndrome

NTDD

66750, 66751

Neuron — tissue antigens — antibodies

ANE

71165

Neutrophil cytoplasm — tissue antigens — antibodies

ANCA

71165

Neutrophil functions

NFT

71135

Newcastle disease — microbial antibody testing

NCD

69384

Nickel

NI

66825, 66828

Nipple discharge — cytology on specimens from

SMCY

73043

Nitrazepam

NITR

66812

Nordothiepin

NDIP

66812

Norfluoxetine

NFLE

66812

Nortriptyline

NORT

66812

Nose — cytology on specimens from

SMCY

73043

Nose — microscopy and culture of material from

MCSW

69303

Nuclear antigens — detection of antibodies to

ANA

71097

Oestradiol

E2

66695

Oestriol

E3

66750, 66751

Oestrone

E1

66695

Oligoclonal proteins

OGP

71062

Op/biopsy specimens — microscopy and culture of material from

MCPO

69321

Oral glucose challenge test — gestational diabetes

OGCT

66545

Oral glucose tolerance test — gestational diabetes

GTTP

66542

Osmolality, serum or urine

OSML

66563

Ovary — tissue antigens — antibodies

AOV

71165

Oxalate

OXAL

66752

Oxazepam

OXAZ

66812

PAA (phenyl acetic acid)

PAA

66779

Palmitic acid in amniotic fluid

PALM

66749

Pap smear

CCR

73053

Papanicolaou test

CCR

73053

Paracetamol

PARA

66800

Parainfluenza 1 — microbial antibody testing

PF1

69384

Parainfluenza 2 — microbial antibody testing

PF2

69384

Parainfluenza 3 — microbial antibody testing

PF3

69384

Paraprotein characterisation — by electrophoresis and immunoelectrophoresis or immunofixation or isoelectric focussing

PPRO

71059

Paraprotein characterisation — on concurrently collected serum or urine

PPSU

71060

Paraprotein quantitation — by electrophoresis

EPPI

71057

Paraquat

PARQ

66812

Parasites — microscopic examination of faeces

OCP

69336–39

Parathyroid hormone (PTH)

PTH

66695

Parathyroid — tissue antigens — antibodies

PTHA

71165

Paratyphi — microbial antibody testing

PTY

69384

Partial thromboplastin time

PTT

65120

Patient episode initiation fees

PEI

73922–39

Pentobarbitone

PENT

66812

Perhexiline

PHEX

66812

Pertussis — microbial antibody testing

PER

69384

Phenobarbitone

PHBA

66800

Phensuximide

PHEN

66812

Phenylacetic acid

PAA

66779

Phenytoin

PHEY

66800

Phosphate

PHOS

66500

Phosphatidylglycerol

PTGL

66749

Platelet — aggregation

PLTG

65144

Platelet — count

PLTC

65070

Platelet — tissue antigens — antibodies

APA

71165

PM‑Sc1 — tissue antigens — antibodies

PM1

71119

Poliomyelitis — microbial antibody testing

PLO

69384

Porphobilinogen in urine

UPG

66782

Porphyrins — quantitative test, 1 or more fractions

PR

66785

Porphyrins in urine — qualitative test

UPR

66782

Potassium

K

66500

Prealbumin

PALB

66632

Prednisolone

PRED

66812

Pregnancy serology — 1 test

MSP1

69405

Pregnancy serology — 2 tests

MSP2

69408

Pregnancy serology — 3 tests

MSP3

69411

Pregnancy serology — 4 tests

MSP4

69413

Pregnancy testing

73806

Pregnancy testing — diagnosis of Down’s syndrome and neural tube defect

NTDD

66750, 66751

Pregnancy testing — HCG detection

HCG

73527, 73529

Pregnancy testing — HCG quantitation

HCG

73529

Primidone

PRIM

66800

Procainamide

PCAM

66800

Progesterone

PROG

66695

Prolactin

PROL

66695

Propranolol

PPNO

66812

Prostate specific antigen

PSA

66655–59

Protein — C

PROC

65142, 65171, 65175–79

Protein — S

PROS

65142, 65171, 65175–79

Protein, quantitation of — alpha fetoprotein

AFP

66650–53, 66743, 66750, 66751

Protein, quantitation of — alpha‑l‑antitrypsin

AAT

66635

Protein, quantitation of — beta‑2‑microglobulin

BMIC

66629

Protein, quantitation of — caeruloplasmin

CPLS

66632

Protein, quantitation of — C‑l esterase inhibitor

CEI

66644

Protein, quantitation of — classes or presence and amount of paraprotein by electrophoresis

EPPI

71057, 71058

Protein, quantitation of — ferritin (see also Iron studies)

FERR

66593

Protein, quantitation of — for Down’s syndrome/neural tube defect testing

NTDD

66750, 66751

Protein, quantitation of — haptoglobins

HGLB

66632

Protein, quantitation of — microalbumin

MALB

66560

Protein, total — quantitation of

PROT

66500

Proteus OX 19 — microbial antibody testing

POX

69384

Proteus OXK — microbial antibody testing

POK

69384

Prothrombin gene mutation

PGM

73308, 73311

Prothrombin time

PT

65120

Pyruvate

PVTE

66500

Q fever — microbial antibody testing

QFF

69384

Quinalbarbitone

QUIB

66812

Quinidine

QUIN

66800

Quinine

QNN

66812

Rapid plasma reagin test — microbial antibody testing

RPR

69384

RAST

RAST

71079

Rectum — microscopy and culture of material from

MCGR

69312

Red blood cells — Kleihauer

KLEI

65162

Red cell folate and serum B12

B12F

66602

Red cell folate and serum B12 and serum folate if required

B12F

66602

Red cell folate and serum folate

RCF

66599

Red cell porphyrins — qualitative test

RCP

66782

Referred specimen fee

73940

Renin

REN

66695

Reptilase test

REPT

65120

Respiratory syncytial virus — microbial antibody testing

RSV

69384

Respiratory syncytial virus — microbial antigen testing

RSVN

69494

Reticulin — tissue antigens — antibodies

RCA

71119

Reticulocyte count

RETC

65072

Rheumatoid factor

RF

71106

Rheumatoid factor — quantitation

RFQ

71106

Ross River virus — microbial antibody testing

RRV

69384

RSV (respiratory syncytial virus) — microbial antibody testing

RSV

69384

RSV (respiratory syncytial virus) — microbial antigen testing

RSVN

69494

Rubella — serology

RUB

69384

Salicylate (aspirin)

SALI

66800

Salivary gland — tissue antigens — antibodies

ASG

71165

Salmonella typhi (H) — microbial antibody testing

SAH

69384

Salmonella typhi (O) — microbial antibody testing

SAO

69384

Schistosoma — microbial antibody testing

STO

69384

Scl‑70 — tissue antigens — antibodies

SCL

71119

Selenium

SE

66819, 66822

Semen examination

SEE

73523

Semen examination — for spermatozoa (post vasectomy)

SES

73521

Serology — in pregnancy (see Pregnancy serology)

Serotonin

5HT

66779

Serum — Bl2

B12

66599

Serum — folate (with Bl2 red cell folate)

B12F

66602

Serum — folate (with Bl2)

B12

66599

Sex hormone binding globulin

SHBG

66695

Skeletal muscle — tissue antigens — antibodies

SLA

71165

Skin — cytology

SMCY

73043

Skin — microscopy and culture of material from

MCSS

69306

Skin — microscopy, culture and Chlamydia of material from

MCSK

69309

Skin basement membrane — tissue antigens — antibodies

SKA

71165

Smooth muscle — tissue antigens — antibodies

SMA

71119

Snake venom

HISS

66623

Sodium

NA

66500

Solid tissue or tissues — chemical assays

ENZS

66683

Solid tissue or tissues — cytology of fine needle aspiration

FNCY

73049

Solid tissue or tissues — cytology of fine needle aspiration by, or in presence of pathologist

FNCP

73051

Somatomedin

SOMA

66695

Sotalol

SALL

66812

Specific IgE or IgG antibodies

RAST

71079

Specimen referred fee

73940

Sperm antibodies

SAB

73525

Sperm antibodies — penetrating ability

SPA

73525

Sputum — cytology (1 specimen)

BFCY

73045

Sputum — cytology (3 specimens)

SPCY

73047

Sputum — for mycobacteria — 1 specimen

AFB1

69324

Sputum — for mycobacteria — 2 specimens

AFB2

69327

Sputum — for mycobacteria — 3 specimens

AFB3

69330

Sputum — microscopy and culture of specimens

MCSP

69318

Stelazine

STEL

66812

Steroid fraction or fractions in urine

USF

66695

Streptococcal serology — anti‑DNASE B titre — microbial antibody testing

ADNB

69384

Streptococcal serology — anti‑streptolysin O titre — microbial antibody testing

ASOT

69384

Streptococcus — Group B

STB

69494

Streptococcus pneumoniae — CSF antigens

SPN

69494

Streptococcus pneumoniae — microbial antibody testing

PCC

69384

Streptococcus pneumoniae — microbial antigen testing

SPN

69494

Strontium

SR

66825, 66828

Stypven test

STYP

65120

Sugar water test

SWT

65075

Sulthiame (Ospolot)

SUL

66812

Supplementary testing for Hepatitis C antibodies

HCST

69441

Syphilis serology

STS

69387

Testosterone

TES

66695

Tetanus — microbial antibody testing

TET

69384

Thalassaemia studies

TS

65078

Theophylline

THEO

66800

Thermoactinomyces vulgaris — microbial antibody testing

THE

69384

Thermopolyspora — microbial antibody testing

TPS

69384

Thiopentone

TOPO

66812

Thioridazine

THIO

66812

Throat — microscopy and culture of material from

MCSW

69303

Thrombin time

TT

65120

Thrombophilia testing (see individual thrombophilia tests)

Thyroglobulin

TGL

66650

Thyroglobulin — tissue antigens — antibodies

ATG

71165

Thyroid function tests (including TSH)

TFT

66719

Thyroid microsome — tissue antigens — antibodies

TMA

71165

Thyroid stimulating hormone (if requested on its own, or as a preliminary test to thyroid function testing)

TSH

66716

Thyroid stimulating hormone (if requested with other hormones referred to in item 66695)

TSH

66722–34

Tissue transglutaminase antibodies

TTG

71163

Tobramycin

66800

Total protein

PROT

66500

Toxocara — microbial antibody testing

TOC

69384

Toxoplasma — microbial antibody testing

TOX

69384

TPHA (Treponema pallidum haemagglutination test) — microbial antibody testing

TPHA

69384

Treponema pallidum haemagglutination test — microbial antibody testing

TPHA

69384

Trichinosis — microbial antibody testing

TOS

69384

Triglycerides

TRIG

66500

Trimipramine

TRIM

66812

Troponin

TROP

66518

Tryptic activity in faeces

TAF

66677

TSH receptor antibody test — tissue antigens — antibodies

TSHA

71165

Tuberculosis

MANT

73811

Tumour markers — CA‑15.3 antigen

CA15

66650

Tumour markers — CA‑19.9 antigen

CA19

66650

Tumour markers — CA‑125 antigen

C125

66650

Tumour markers — carcinoembryonic antigen

CEA

66650

Tumour markers — mammary serum antigen

MSA

66650

Tumour markers — prostate specific antigen

PSA

66656

Tumour markers — prostatic acid phosphatase — 1 or more fractions

ACP

66656

Tumour markers — thyroglobulin

TGL

66650

Typhus, Weil‑Felix — microbial antibody testing

TYP

69384

Urate

URAT

66500

Urea

U

66500

Urea, electrolytes, creatinine

U&E

66515

Urethra — microscopy and culture of material from

MCGR

69312

Urine — acidification test

UAT

66587

Urine — catalase test

UCAT

73805

Urine — cystine (cysteine)

UCYS

66782

Urine — cytology — on 1 specimen

BFCY

73045

Urine — cytology — on 3 specimens

SPCY

73047

Urine — haemoglobin

UHB

66782

Urine — microscopy, culture, identification and sensitivity

UMCS

69333

Urine — porphobilinogen

UPG

66782

Urine — porphyrins — qualitative test

UPR

66782

Urine — steroid fraction or fractions

USF

66695

Urine — urobilinogen

UUB

66782

Vagina — microscopy and culture of material from

MCGR

69312

Vagina — cytology on specimens from

CVO

73057

Valproate (Epilim)

VALP

66800

Vancomycin

VAN

66800

Varicella zoster — microbial antibody testing

VCZ

69384

Varicella zoster — microbial antigen testing

VCZN

69494

Vasoactive intestinal peptide

VIP

66695

Vasopressin

ADH

66695

VDRL (Venereal Disease Research Laboratory) — microbial antibody testing

VDRL

69384

Viscosity of blood or plasma

VISC

65060

Vitamins — B12

B12

66599

Vitamins — D

VITD

66608

Vitamins — folate

RCF

66599

Vitamins — quantitation of A, B1, B2, B3, B6, C or E

VIT

66605

VMA (see HMMA)

Von Willebrand’s factor

VWF

65150

Von Willebrand’s factor antigen

VWA

65150

Warfarin

WFR

66812

Yersinia enterocolitica — microbial antibody testing

YER

69384

Zinc

ZN

66667–70

Part5Complexity 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, biopsy, curettings or fragments — lesion

5

Bone, biopsy or curettings quantitation — metabolic disease

6

Bone, femoral head

4

Bone, resection, neoplasm — all sites and types

6

Bone marrow, biopsy

4

Bone — all specimens not otherwise specified

4

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 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 or disarticulation — neoplasm

6

Extremity, amputation — not otherwise specified

4

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, sterilization

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 valve

4

Heart — not otherwise specified

5

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 or nephroureterectomy — neoplasm

6

Kidney, partial or total nephrectomy — not neoplasm

4

Large bowel (including rectum), biopsy — all sites

4

Large bowel (including rectum), biopsy, for confirmation or exclusion of Hirschsprung’s Disease

5

Large bowel, colostomy — stoma

3

Large bowel (including rectum), polyp

4

Large bowel, segmental resection — colon, not neoplasm

5

Large bowel (including rectum), segmental resection — neoplasm

6

Large bowel (including rectum), submucosal resection — 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, hydatid cyst or resection for trauma

4

Liver, total or subtotal hepatectomy — neoplasm

6

Liver — all specimens not otherwise specified

5

Lung, needle or transbronchial biopsy

4

Lung, resection — neoplasm

6

Lung, wedge biopsy

5

Lung segment, lobar or total resection

6

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 with node dissection

5

Penisectomy — simple

4

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, radical resection

6

Prostate — all types of specimen not otherwise specified

4

Retroperitoneum, neoplasm

5

Salivary gland, Mucocele

3

Salivary gland, neoplasm — all sites

5

Salivary gland — all specimens not otherwise specified

4

Sinus, paranasal, biopsy

4

Sinus, paranasal, resection — neoplasm

6

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

Skin — all specimens not otherwise specified including all neoplasms and cysts

3

Small bowel — biopsy, all sites

4

Small bowel, diverticulum

3

Small bowel, resection — neoplasm

6

Small bowel, submucosal resection — neoplasm

5

Small bowel — all specimens not otherwise specified

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, endoscopic biopsy or endoscopic polypectomy

4

Stomach, resection, neoplasm — all specimens

6

Stomach, submucosal resection — neoplasm

5

Stomach — all specimens not otherwise specified

4

Tendon or tendon sheath, giant cell neoplasm

4

Tendon or tendon sheath — not otherwise specified

3

Testis, biopsy

5

Testis and adjacent structures, castration

2

Testis and adjacent structures, neoplasm with or without nodes

5

Testis and adjacent structures, vas deferens sterilization

2

Testis and adjacent structures — not otherwise specified

3

Thymus — not otherwise specified

5

Thyroglossal duct — all lesions

4

Thyroid — all specimens

5

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

Tissue or organ — all specimens not otherwise specified

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, partial or total with or without prostatectomy

6

Urinary bladder, transurethral resection of neoplasm

5

Urinary bladder — all specimens not otherwise specified

4

Uterus, cervix, curettings or biopsy

4

Uterus, cervix cone, biopsy (including LEEP or LLETZ biopsy)

5

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

Uterus and/or cervix — all specimens not otherwise specified

4

Vagina, biopsy

4

Vagina, radical resection

6

Vaginal mucosa, incidental

3

Vulva or labia, biopsy

4

Vulval, subtotal or total with or without nodes

6

Notes to the Health Insurance (Pathology Services Table) Regulations 2006

Note 1

The Health Insurance (Pathology Services Table) Regulations 2006 (in force under the Health Insurance Act 1973) as shown in this compilation comprise Select Legislative Instrument 2006 No. 274 amended as indicated in the Tables below.

Table of Instruments

Year and

Number

Date of FRLI registration

Date of

commencement

Application, saving or

transitional provisions

2006 No. 274

20 Oct 2006 (see F2006L03305)

1 Nov 2006

2007 No. 60

30 Mar 2007 (see F2007L00805)

1 Apr 2007 (see r. 2)

—

2007 No.101

27 Apr 2007 (see F2007L00990)

1 May 2007

—

2007 No. 339

8 Oct 2007 (see F2007L03855)

1 May 2007

—

Table of Amendments

  1. ad. = added or inserted

    am. = amended rep. = repealed rs. = repealed and substituted

Provision affected

How affected

Schedule 1

Part 2

Part 2.......................................

am. 2007 Nos. 101 and 339

Part 3

Part 3.......................................

am. 2007 Nos. 60 and 101

Part 4

Part 4.......................................

am. 2007 No. 101

Part 5

Part 5.......................................

am. 2007 No. 101

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