Health Insurance (Pathology Services Table) Regulations 2011 (Cth)

Health Insurance (Pathology Services Table) Regulations 2011

Select Legislative Instrument 2011 No. 188 as amended

made under the

Health Insurance Act 1973

This compilation was prepared on 1 August 2012
taking into account amendments up to SLI 2012 No. 167

Prepared by the Office of Legislative Drafting and Publishing,
Attorney-General’s Department, Canberra

Contents

1Name of Regulations [see Note 1]                            4

2Commencement                                                 4

3Repeal                                                            4

4Dictionary                                                         4

5Pathology services table                                        4

Schedule 1Pathology services table 5

Part 1Preliminary 5

Division 1.1 Interpretation

Division 1.2 General application provisions

Part 2Services and fees 13

Division 2.1 Group P1 — Haematology

Division 2.2 Group P2 — Chemical

Division 2.3 Group P3 — Microbiology

Division 2.4 Group P4 — Immunology

Division 2.5 Group P5 — Tissue pathology

Division 2.6 Group P6 — Cytology

Division 2.7 Group P7 — Genetics

Division 2.8 Group P8 — Infertility and pregnancy tests

Division 2.9 Group P9 — Simple basic pathology tests

Division 2.10 Group P10 — Patient episode initiation

Division 2.11 Group P11 — Specimen referred

Division 2.12 Group P12 — Management of bulk‑billed services

Division 2.13 Group P13 — Bulk billing incentive for episodes consisting of a P10 service

Part 3Abbreviations 83

Part 4Complexity levels for histopathology items 117

Dictionary

Notes 129

Name of Regulations [see Note 1]

These Regulations are the Health Insurance (Pathology Services Table) Regulations 2011.

Commencement

These Regulations commence on 1 November 2011.

Repeal

The Health Insurance (Pathology Services Table) Regulations 2010 are repealed.

Dictionary

The Dictionary at the end of these Regulations defines certain words and expressions and includes references to certain words and expressions that are defined elsewhere in these Regulations.

Pathology services table

For subsection 4A (1) of the Act, these Regulations prescribe a table of pathology services set out in Schedule 1.

Schedule 1 Pathology services table

(regulation 5)

Part 1 Preliminary

Division 1.1 Interpretation

1.1.1Abbreviations

The abbreviations in Part 3 may be used to identify particular pathology services or groups of pathology services.

The names of services or drugs not listed in Part 3 must be written in full.

Division 1.2 General application provisions

1.2.1Precedence of items

If a service is described:

(a)in an item in general terms; and

(b)in another item in specific terms;

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

Subject to subclause (3), if:

(a)subclause (1) does not apply; and

(b)a service is described in 2 or more items;

only the item that provides the lower or lowest fee for the service applies to the service.

If an item is expressed to include a pathology service that is described in another item, the other item does not apply to the service in addition to the first‑mentioned item, whether or not the services described in the 2 items are requested separately.

1.2.2Circumstances in which services rendered following 2 requests to be taken to have been rendered following 1 request

In subclause (2):

service includes assay, estimation and test.

Two or more pathology services (other than services to which, under clause 1.2.3, 2.1.1 or 2.2.2, this clause does not apply) rendered for a patient following 2 or more requests are taken to have been rendered following a single request if:

(a)the services are listed in the same item; and

(b)that item is not item 74990 or 74991; and

(c)the patient’s need for the services was determined under subsection 16A (1) of the Act on the same day even if the services are rendered by an approved pathology practitioner on more than 1 day.

1.2.3Services to which clause 1.2.2 does not apply

Clause 1.2.2 does not apply to a pathology service described in subclause (2) if:

(a)under a request for a service, other than a request for a service described in paragraph (2) (a), no more than 6 tests are requested; and

(b)the tests are performed within 6 months of the request; and

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

Note Rule 3 in the Health Insurance (Pathology Services Table) Regulations 2009 has been replaced by clause 1.2.2.

For subclause (1), the pathology services are:

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

(b)quantitative estimation of lithium for a patient undergoing lithium therapy; and

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

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

(e)a service described in any of items 66500 to 66512, in relation to methotrexate or leflunomide therapy of a patient; and

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

(i)cis‑platinum or cyclosporin therapy of a patient; or

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

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

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

1.2.4Referral of designated tests by 1 pathology practitioner to another

In this clause:

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

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

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

(a)the amount mentioned in item 65150, 65153, 65175, 65176, 65177, 65178, 66650, 66695, 66698, 66701, 66704, 66707, 66711, 66722, 66725, 66728, 66731, 66785, 66800, 66803, 66812, 66819, 66825, 69384, 69387, 69390, 69393, 69396, 69494, 69495, 71089, 71091, 71153, 71155, 71157, 77165, 71166 or 71167 (as the case may be) is payable for each designated test rendered by the referring APP; and

(b)subject to subclause (5), the amount mentioned in item 65158, 65181, 66652, 66697, 66715, 66724, 66790, 66805, 66817, 66821, 66827, 69401, 69498, 71092, 71156 or 71170 (as the case may be) is payable for each designated test rendered by the receiving APP.

If a referring APP has not rendered a designated test:

(a)for the first designated test that is rendered by the receiving APP — the amount mentioned in item 65157 65180 66651 66696, 66714, 66723, 66789, 66804, 66816, 66820, 66826, 69400, 69497, 71090, 71154 or 71169 (as the case may be) is payable; and

(b)for each subsequent designated test (if any) that is rendered by the receiving APP — subject to subclause (6), the amount mentioned in item 65158, 65181, 66652, 66697, 66715, 66724, 66790, 66805, 66817, 66821, 66827, 69401, 69498, 71092, 71156 or 71170 (as the case may be) is payable for each test rendered.

For paragraph (3) (b), the maximum number of designated tests for which the fee mentioned in the relevant item is payable is as follows:

(a)for item 66652, 66715, 66790, 66817, 66821 or 66827:

(b)for item 65158, 66805, 69498 or 71092:

(c)for item 71156 or 71170:

(d)for item 65181 or 66724:

where:

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

For paragraph (4) (b), the maximum number of designated tests for which the fee mentioned in the relevant item is payable is as follows:

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

(b)for item 65158, 66805, 69498 or 71092 — 2;

(c)for item 71156 or 71170 — 3;

(d)for item 65181 or 66724 — 4.

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

1.2.5Items not to be split

Except as stated in clause 1.2.4 the amount mentioned in an item is payable only to 1 approved pathology practitioner for a single patient episode.

1.2.6Certain pathology services to be treated as 1 service

In this clause:

general practitioner has the meaning given by subclause 1.2.7 (1).

set of pathology services has the meaning given by subclause 1.2.7 (2).

If a general practitioner, participating midwife or participating nurse practitioner requests a set of pathology services, the pathology services in the set are to be treated as individual pathology services in accordance with this clause.

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

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

(b)either:

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

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

(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.

If the fees mentioned in 2 or more items that describe any of the services in the set of pathology services are the same, and higher than the fees mentioned in the other items that describe the services in the set:

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

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

(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.

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 mentioned in any of the items that describe the pathology services that are to be treated as the 1 pathology service.

1.2.7Meaning of general practitioner and set of pathology services

In clause 1.2.6:

general practitioner means a medical practitioner who:

(a)is not a consultant physician in any specialty; and

(b)is not a specialist in any specialty.

In clause 1.2.6 and subject to subclause (3):

set of pathology services means a group of pathology services:

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

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

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

(d)none of which is referred to in item 66900, 69484, 73053 or 73055.

In clause 1.2.6, an item mentioned in this subclause is to be excluded from a set of pathology services:

(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, 66610, 66639, 66642, 66651, 66652, 66663, 66666, 66696, 66697, 66714, 66715, 66723, 66724, 66780, 66783, 66789, 66790, 66792, 66804, 66805, 66816, 66817, 66820, 66821, 66826, 66827, 66832, 69325, 69328, 69331, 69379, 69383, 69400, 69401, 69419, 69451, 69489, 69492, 69497, 69498, 69500, 71076, 71090, 71092, 71096, 71148, 71154, 71156, 71169, 71170, 73309, 73312, 73315, 73318, 73321 or 73324; or

(b)an item in Group P10 (Patient episode initiation), Group P11 (Specimen referred), Group P12 (Management of bulk‑billed services) or Group P13 (Bulk billing incentive for episodes consisting of a P10 service).

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

(a)both approved pathology authorities are employed (including employed under contract) by the same person, whether or not the person is also an approved pathology authority; or

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

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

(d)the approved pathology authorities are partners (whether or not either or both of the approved pathology authorities are individuals and whether or not other persons are in partnership with either or both of the approved pathology authorities); or

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

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

1.2.8Satisfying requirements described in pathology service

Unless the contrary intention appears, a requirement contained in the description of a pathology service in Part 2 is satisfied if:

(a)for a requirement for information — the information:

(i)is included in the request for the service; or

(ii)was supplied in writing on an earlier occasion to the approved pathology authority that rendered the service, and has been kept by the approved pathology authority; or

(b)for a requirement for laboratory test results — the results are:

(i)included in the request for the service; or

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

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

Part 2 Services and fees

Division 2.1 Group P1 — Haematology

2.1.1Services to which clause 1.2.2 does not apply

Clause 1.2.2 does not apply to a pathology service described in item 65060, 65070, 65120, 65123, 65126, 65129, 65150, 65153 or 65156 if:

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

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

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

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

Note Rule 3 in the Health Insurance (Pathology Services Table) Regulations 2009 has been replaced by clause 1.2.2.

Clause 1.2.2 does not apply to a pathology service described in item 65109 or 65110 if:

(a)the service is rendered:

(i)for a service described in item 65109 — on 1 of not more than 5 occasions in a period of 24 hours; and

(ii)for a service described in item 65110 — on 1 of not more than 2 occasions in a period of 24 hours; and

(b)the service was requested on a separate occasion to any other occasions on which the service was requested in the period of 24 hours; and

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

Note Rule 3 in the Health Insurance (Pathology Services Table) Regulations 2009 has been replaced by clause 1.2.2.

2.1.2Item taken to refer only to the first service of a particular kind

For an item in Group P1 (Haematology):

(a)if pathology services of a kind mentioned in item 65090 or 65093 are rendered for a patient during a period when the patient is in hospital, the item applies only to the first pathology service of that kind rendered for the patient during the period; and

(b)if:

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

(ii)specimen material from the patient episode is stored; and

(iii)in response to a request made within 14 days of the patient episode, further tests (except tests mentioned in item 65099, 65102, 65105 or 65108) are carried out on the stored material;

the later tests and the earlier tests are taken to be part of 1 patient episode.

Items 65102 and 65108 apply only if a minimum of 6 units are issued for a patient’s care in any 1 day.

For items 65099 and 65102:

compatibility tests by crossmatch means that, in addition to all the tests mentioned in paragraphs (a) and (b) of the item, donor red cells from each unit must have been tested directly against the serum of the patient by 1 or more accepted crossmatching techniques.

Group P1 — Haematology
Item	Pathology service	Fee ($)
65060	Haemoglobin, erythrocyte sedimentation rate, blood viscosity — 1 or more tests	7.90
65066	Examination of: (a) a blood film by special stains to demonstrate Heinz bodies, parasites or iron; or	10.45
(b) a blood film by enzyme cytochemistry for neutrophil alkaline phosphatase, alpha‑naphthyl acetate esterase or chloroacetate esterase; or (c) a blood film using any other special staining methods including periodic acid Schiff and Sudan Black; or (d) a urinary sediment for haemosiderin; including a service described in item 65072
65070	Erythrocyte count, haematocrit, haemoglobin, calculation or measurement of red cell index or indices, platelet count, leucocyte count and manual or instrument generated differential count (not being a service where haemoglobin only is requested) — 1 or more instrument‑generated set of results from a single sample and (if performed): (a) a morphological assessment of a blood film; and (b) any service in item 65060 or 65072	17.05
65072	Examination for reticulocytes including a reticulocyte count by any method — 1 or more tests	10.25
65075	Haemolysis or metabolic enzymes — assessment by 1 or more of the following tests: (a) erythrocyte autohaemolysis test; (b) erythrocyte osmotic fragility test; (c) sugar water test; (d) G–6–PD (qualitative or quantitative) test; (e) pyruvate kinase (qualitative or quantitative) test; (f) acid haemolysis test;	52.30
(g) quantitation of muramidase in serum or urine; (h) Donath Landsteiner antibody test; (i) other erythrocyte metabolic enzyme tests	90.80
65078	Tests for the diagnosis of thalassaemia consisting of haemoglobin electrophoresis or chromatography and at least 2 of: (a) examination for HbH; or (b) quantitation of HbA2; or	90.80
(c) quantitation of HbF; including (if performed) any service described in item 65060 or 65070
65079	A test described in item 65078 if rendered by a receiving APP — 1 or more tests	90.80
65081	Tests for the investigation of haemoglobinopathy consisting of haemoglobin electrophoresis or chromatography and at least 1 of: (a) heat denaturation test; or	97.25
(b) isopropanol precipitation test; or (c) tests for the presence of haemoglobin S; or (d) quantitation of any haemoglobin fraction (including S, C, D, E); including (if performed) any service described in item 65060, 65070 or 65078
65082	A test described in item 65081 if rendered by a receiving APP — 1 or more tests	97.25
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) any test described in item 65060, 65066 or 65070	166.95
65087	Bone marrow — examination of aspirated material (including clot sections where necessary), including (if performed) any test described in item 65060, 65066 or 65070	83.65
65090	Blood grouping (including back‑grouping if performed) — ABO and Rh (D antigen)	11.20
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)	22.15
65096	Blood grouping (including back‑grouping if performed), and examination of serum for Rh and other blood group antibodies, including: (a) identification and quantitation of any antibodies detected; and (b) (if performed) any test described in item 65060 or 65070	41.30
65099	Compatibility tests by crossmatch — all tests performed on any 1 day for up to 6 units, including: (a) all grouping checks of the patient and donor; and (b) examination for antibodies and, if necessary, identification of any antibodies detected; and (c) (if performed) any tests described in item 65060, 65070, 65090 or 65096	109.65
65102	Compatibility tests by crossmatch — all tests performed on any 1 day in excess of 6 units, including: (a) all grouping checks of the patient and donor; and (b) examination for antibodies and, if necessary, identification of any antibodies detected; and	165.70
(c) (if performed) any tests described in item 65060, 65070, 65090, 65096, 65099 or 65105
65105	Compatibility testing using at least a 3 cell panel and issue of red cells for transfusion — all tests performed on any 1 day for up to 6 units, including: (a) all grouping checks of the patient and donor; and (b) examination for antibodies and, if necessary, identification of any antibodies detected; and	109.65
(c) (if performed) any tests described in item 65060, 65070, 65090 or 65096
65108	Compatibility testing using at least a 3 cell panel and issue of red cells for transfusion — all tests performed on any 1 day in excess of 6 units, including: (a) all grouping checks of the patient and donor; and (b) examination for antibodies and, if necessary, identification of any antibodies detected; and (c) (if performed) any tests described in item 65060, 65070, 65090, 65096, 65099 or 65105	165.70
65109	Release of fresh frozen plasma or cryoprecipitate for the use in a patient for the correction of a coagulopathy — 1 release	13.00
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	13.00
65111	Examination of serum for blood group antibodies (including identification and, if necessary, quantitation of any antibodies detected)	23.35
65114	1 or more of the following tests: (a) direct Coombs (antiglobulin) test; (b) qualitative or quantitative test for cold agglutinins or heterophil antibodies	9.15
65117	1 or more of the following tests: (a) spectroscopic examination of blood for chemically altered haemoglobins; (b) detection of methaemalbumin (Schumm’s test)	20.40
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	13.80
65123	2 tests described in item 65120	20.50
65126	3 tests described in item 65120	28.05
65129	4 or more tests described in item 65120	35.75
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	25.50
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	25.50
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	56.95
65147	Quantitation of anti‑Xa activity when monitoring is required for a patient receiving a low molecular weight heparin or heparinoid — 1 test	38.15
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	71.40
65153	2 tests described in item 65150	142.80
65156	3 or more tests described in item 65150	214.20
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	71.40
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	71.40
65159	Quantitation of circulating coagulation factor inhibitors by Bethesda assay — 1 test	71.40
65162	Examination of a maternal blood film for the presence of fetal red blood cells (Kleihauer test)	10.50
65165	Detection and quantitation of fetal red blood cells in the maternal circulation by detection of red cell antigens using flow cytometric methods including (if performed) any test described in item 65070 or 65162	34.70
65166	A test described in item 65165 if rendered by a receiving APP — 1 or more tests	34.70
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	25.50
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	25.50
65176	2 tests described in item 65175	49.00
65177	3 tests described in item 65175	72.45
65178	4 tests described in item 65175	95.85
65179	5 tests described in item 65175	119.30
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	25.50
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	23.45

Division 2.2 Group P2 — Chemical

2.2.1Creatinine ratios

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

(a)involves the measurement of a substance in urine; and

(b)requires calculation of a substance/creatinine ratio;

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

2.2.2Services to which clause 1.2.2 does not apply

Clause 1.2.2 does not apply to a pathology service described in item 66500, 66503, 66506, 66509, 66512, 66584 or 66800 if:

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

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

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

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

Note Rule 3 in the Health Insurance (Pathology Services Table) Regulations 2009 has been replaced by clause 1.2.2.

2.2.3Limitation on certain items

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

(a)items 66539 and 66607;

(b)item 66605, 66606 or 66610.

For any particular patient, each of items 66551 and 66660 is applicable not more than 4 times in a 12 month period.

For any particular patient, each of items 66554 and 66830 is applicable not more than 6 times in a 12 month period.

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

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

For any particular patient, item 66517 is applicable not more than 3 times in a pregnancy.

2.2.4Serum B12 and red cell folate testing

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

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

2.2.5Thyroid function testing

For item 66719:

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

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

The written statement from the medical practitioner must indicate:

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

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

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

2.2.6Limitation on certain items

For any particular patient, each of items 66655, 66659 and 69482 is applicable not more than once in a 12 month period.

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

2.2.7Nutritional and toxicity metals testing

For this clause:

metal toxicity testing group means items 66825, 66826, 66827, 66828, 66831 and 66832.

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

An item in the nutritional metals testing group or the metal toxicity testing group does not apply to a service performed if medicare benefits are paid or payable for tests that are performed for the same patient in 3 patient episodes requested within 6 months before the request for that service, under any of:

(a)that item; or

(b)the other item in the same group; or

(c)an item in the other group.

Group P2 — Chemical
Item	Pathology service	Fee ($)
66500	Quantitation in serum, plasma, urine or other body fluid (except amniotic fluid), by any method, except reagent tablet or reagent strip, (with or without reflectance meter) of acid phosphatase, alanine aminotransferase, albumin, alkaline phosphatase, ammonia, amylase, aspartate aminotransferase, bicarbonate, bilirubin (total), bilirubin (any fractions), C‑reactive protein, calcium (total or corrected for albumin), chloride, creatine kinase, creatinine, gamma glutamyl transferase, globulin, glucose, lactate dehydrogenase, lipase, magnesium, phosphate, potassium, sodium, total cholesterol, total protein, triglycerides, urate or urea — 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 or more tests described in item 66500	17.80
66517	Quantitation of bile acids in blood in pregnancy	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	20.20
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	40.40
66536	Quantitation of HDL cholesterol	11.10
66539	Electrophoresis of serum for demonstration of lipoprotein subclasses: (a) if the cholesterol is >6.5 mmol/L and triglyceride >4.0 mmol/L; or (b) in the diagnosis of types III and IV hyperlipidaemia	30.80
66542	Oral glucose tolerance test for the diagnosis of diabetes mellitus, that includes: (a) administration of glucose; and (b) at least 2 measurements of blood glucose; and (c) (if performed) any test described in item 66695	19.10
66545	Oral glucose challenge test in pregnancy for the detection of gestational diabetes that includes: (a) administration of glucose; and (b) 1 or 2 measurements of blood glucose; and (c) (if performed) any test in item 66695	15.90
66548	Oral glucose tolerance test in pregnancy for the diagnosis of gestational diabetes that includes: (a) administration of glucose; and	20.05
(b) at least 3 measurements of blood glucose; and (c) (if performed) any test in item 66695
66551	Quantitation of glycosylated haemoglobin performed in the management of established diabetes	16.90
66554	Quantitation of glycosylated haemoglobin performed in the management of pre‑existing diabetes where the patient is pregnant — including a service in item 66551 (if performed)	16.90
66557	Quantitation of fructosamine performed in the management of established diabetes — each test to a maximum of 4 tests in a 12 month period	9.75
66560	Microalbumin — quantitation in urine	20.25
66563	Osmolality, estimation by osmometer, in serum or in urine — 1 or more tests	24.85
66566	Quantitation of: (a) blood gases (including pO2, oxygen saturation and pCO2); and	33.95
(b) bicarbonate and pH; including any other measurement (eg haemoglobin, lactate, 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	42.90
66572	Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 3 specimens performed on any 1 day	51.90
66575	Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 4 specimens performed on any 1 day	60.85
66578	Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 5 specimens performed on any 1 day	69.80
66581	Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 6 or more specimens performed on any 1 day	78.80
66584	Quantitation of ionised calcium (except if performed as part of item 66566) — 1 test	9.75
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	47.85
66590	Calculus, analysis of 1 or more	30.80
66593	Ferritin — quantitation, except if requested as part of iron studies	18.10
66596	Iron studies, consisting of quantitation of: (a) serum iron; and (b) transferrin or iron binding capacity; and (c) ferritin	32.75
66599	Serum B12 or red cell folate and, if required, serum folate	23.75
66602	Serum B12 and red cell folate and, if required, serum folate	43.25
66605	Vitamins — quantitation of vitamin B1, B2, B3, B6 or C in blood, urine or other body fluid — one or more tests	30.80
66606	A test described in item 66605 if rendered by a receiving APP — one or more tests	30.80
66607	Vitamins — quantitation of vitamin A or E in blood, urine or other body fluid — one or more tests in a 6 month period	76.25
66608	Vitamin D or D fractions — one or more tests	42.55
66609	A test described in item 66608 if rendered by a receiving APP — one or more tests	42.55
66610	A test described in item 66607 if rendered by a receiving APP — one or more tests	76.25
66623	All qualitative and quantitative tests on blood, urine or other body fluid for: (a) a drug or drugs of abuse (including illegal drugs and legally available drugs taken other than in appropriate dosage); or (b) ingested or absorbed toxic chemicals;	41.80
including a service described in item 66800, 66803, 66806, 66812 or 66815 (if performed), but excluding: (c) the surveillance of sports people and athletes for performance improving substances; and (d) the monitoring of patients participating in a drug abuse treatment program
66626	Detection or quantitation or both of a drug, or drugs, of abuse or a therapeutic drug, on a sample collected from a patient participating in a drug abuse treatment program, including all tests on blood, urine or other body fluid, not including: (a) the surveillance of sports people and athletes for performance improving substances; and (b) the detection of nicotine and metabolites in smoking withdrawal programs	24.25
66629	Beta‑2‑microglobulin — quantitation in serum, urine or other body fluids — 1 or more tests	20.25
66632	Caeruloplasmin, haptoglobins, or prealbumin — quantitation in serum, urine or other body fluids — 1 or more tests	20.25
66635	Alpha‑1‑antitrypsin — quantitation in serum, urine or other body fluid — 1 or more tests	20.25
66638	Isoelectric focussing or similar methods for determination of alpha‑1‑antitrypsin phenotype in serum — 1 or more tests	49.40
66639	A test described in item 66638 if rendered by a receiving APP — 1 or more tests	29.40
66641	Electrophoresis of serum or other body fluid to demonstrate: (a) the isoenzymes of lactate dehydrogenase; or (b) the isoenzymes of alkaline phosphatase; including the preliminary quantitation of total relevant enzyme activity — 1 or more tests	29.40
66642	A test described in item 66641 if rendered by a receiving APP — 1 or more tests	29.40
66644	C‑1 esterase inhibitor — quantitation	20.30
66647	C‑1 esterase inhibitor — functional assay	45.40
66650	Alpha‑fetoprotein, CA‑15.3 antigen (CA15.3), CA‑19.9 antigen (CA19.9), CA‑125 antigen (C125), cancer associated serum antigen (CASA), carcinoembryonic antigen (CEA), human chorionic gonadotrophin (HCG), neuron specific enolase (NSE) thyroglobulin in serum or other body fluid, in the monitoring of malignancy or in the detection or monitoring of gestational trophoblastic disease or a hepatic or germ cell tumour — quantitation — 1 test	24.50
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	24.50
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	20.45
66653	2 or more tests described in item 66650	44.90
66655	Prostate specific antigen — quantitation	20.30
66656	Prostate specific antigen (PSA) quantitation in the monitoring of previously diagnosed prostatic disease (including a test to which item 66655 applies)	20.30
66659	Prostate specific antigen (PSA), quantitation of 2 or more fractions of PSA and any derived index, including, if performed, a test described in item 66656, in the follow up of a PSA result that lies at or above the age‑related median but below the age‑related, method‑specific 97.5% reference limit	37.55
66660	Prostate specific antigen (PSA), quantitation of 2 or more fractions of PSA and any derived index, including, if performed, a test described in item 66656, in the follow up of a PSA result that lies at or above the age‑related, method‑specific 97.5% reference limit, but below 10 µg/L	37.55
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	80.50
66663	A test described in item 66662 if rendered by a receiving APP — 1 or more tests	80.50
66665	Lead quantitation in blood or urine (other than for occupational health screening purposes) to a maximum of 3 tests in a 6 month period — each test	30.80
66666	A test described in item 66665 if rendered by a receiving APP — 1 or more tests	30.80
66667	Quantitation of serum zinc in a patient receiving intravenous alimentation — each test	30.80
66671	Quantitation of serum aluminium in a patient in a renal dialysis program — each test	37.15
66674	Quantitation of: (a) faecal fat; or (b) breath hydrogen in response to loading with disaccharides; 1 or more tests within a 28 day period	40.20
66677	Test for tryptic activity in faeces in the investigation of diarrhoea of longer than 4 weeks duration in children under 6 years old	11.25
66680	Quantitation of disaccharidases and other enzymes in intestinal tissue — 1 or more tests	74.95
66683	Enzymes — quantitation in solid tissue or tissues other than blood elements or intestinal tissue — 1 or more tests	74.95
66686	Performance of 1 or more of the following procedures: (a) growth hormone suppression by glucose loading; (b) growth hormone stimulation by exercise; (c) dexamethasone suppression test; (d) sweat collection by iontophoresis for chloride analysis; (e) pharmacological stimulation of growth hormone	51.00
66695	Quantitation in blood or urine of hormones and hormone binding proteins — ACTH, aldosterone, androstenedione, C‑peptide, calcitonin, cortisol, DHEAS, 11‑deoxycortisol, dihydrotestosterone, FSH, gastrin, glucagon, growth hormone, hydroxyprogesterone, insulin, LH, oestradiol, oestrone, progesterone, prolactin, PTH, renin, sex hormone binding globulin, somatomedin C(IGF –1), free or total testosterone, urine steroid fraction or fractions, vasoactive intestinal peptide — 1 test	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	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 — each test to a maximum of 4 tests	13.30
66698	2 tests described in item 66695	44.00
66701	3 tests described in item 66695	57.30
66704	4 tests described in item 66695	70.60
66707	5 or more tests described in item 66695	83.90
66711	Quantitation in saliva of cortisol in: (a) the investigation of Cushing’s syndrome; or (b) the management of children with congenital adrenal hyperplasia; 1 test	30.35
66712	2 tests described in item 66711	43.35
66714	A test described in item 66711, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP	30.35
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	12.95
66716	TSH quantitation	25.20
66719	Thyroid function tests (comprising the service described in item 66716 and 1 or more of the following tests — free thyroxine, free T3, for a patient, if at least 1 of the following conditions is satisfied: (a) the patient has an abnormal level of TSH;	35.05
(b) the tests are performed: (i) for the purpose of monitoring thyroid disease in the patient; or (ii) to investigate the sick euthyroid syndrome if the patient is an admitted patient; or (iii) to investigate dementia or psychiatric illness of the patient; or (iv) to investigate amenorrhoea or infertility of the patient; (c) the medical practitioner who requested the tests suspects the patient has a pituitary dysfunction;
(d) the patient is on drugs that interfere with thyroid hormone metabolism or function
66722	TSH quantitation described in item 66716 and 1 test described in item 66695	38.15
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	38.15
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	13.25
66725	TSH quantitation described in item 66716 and 2 tests described in item 66695	51.40
66728	TSH quantitation described in item 66716 and 3 tests described in item 66695	64.65
66731	TSH quantitation described in item 66716 and 4 tests described in item 66695	77.90
66734	TSH quantitation described in item 66716 and 5 tests described in item 66695	91.15
66743	Quantitation of alpha‑fetoprotein in serum or other body fluids during pregnancy except if requested as part of item 66750 or 66751	20.25
66749	Amniotic fluid, spectrophotometric examination of, and quantitation of: (a) lecithin/sphingomyelin ratio; or (b) palmitic acid, phosphatidylglycerol or lamellar body phospholipid; or	33.15
(c) bilirubin, including correction for haemoglobin; 1 or more tests
66750	Quantitation, in pregnancy, of any 2 of the following to detect foetal abnormality: (a) total human chorionic gonadotrophin (total HCG); (b) free alpha human chorionic gonadotrophin (free alpha HCG); (c) free beta human chorionic gonadotrophin (free beta HCG);	40.00
(d) pregnancy associated plasma protein A (PAPP‑A);
(e) unconjugated oestriol (uE₃); (f) alpha‑fetoprotein (AFP); including (if performed) a service described in item 73527 or 73529
66751	Quantitation, in pregnancy, of any 3 or more tests described in item 66750	55.60
66752	Quantitation of acetoacetate, beta‑hydroxybutyrate, citrate, oxalate, total free fatty acids, cysteine, homocysteine, cystine, lactate, pyruvate or other amino acids and hydroxyproline (except if performed as part of item 66773 or 66776) — 1 test	24.85
66755	2 or more tests described in item 66752	39.10
66756	Quantitation of 10 or more amino acids for the diagnosis of inborn errors of metabolism — up to 4 tests in a 12 month period on specimens of plasma, CSF and urine	98.95
66757	Quantitation of 10 or more amino acids for monitoring of previously diagnosed inborn errors of metabolism in 1 tissue type	98.95
66758	Quantitation of angiotensin converting enzyme, or cholinesterase — 1 or more tests	24.85
66761	Test for reducing substances in faeces by any method (except reagent strip or dipstick)	13.25
66764	Examination for faecal occult blood (including tests for haemoglobin and its derivatives in the faeces except by reagent strip or dip stick methods) with a maximum of 3 examinations on specimens collected on separate days in a 28 day period	8.95
66767	2 examinations described in item 66764 performed on separately collected and identified specimens	17.95
66770	3 examinations described in item 66764 performed on separately collected and identified specimens	26.90
66773	Quantitation of products of collagen breakdown or formation for the monitoring of patients with proven low bone mineral density and, if performed, a service described in item 66752 — 1 or more tests	24.80
66776	Quantitation of products of collagen breakdown or formation for the monitoring of patients with metabolic bone disease or Paget’s disease of bone and, if performed, a service described in item 66752 — 1 or more tests	24.80
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	40.20
66780	A test described in item 66779 if rendered by a receiving APP — 1 or more tests	40.20
66782	Porphyrins or porphyrins precursors — detection in plasma, red cells, urine or faeces — 1 or more tests	13.25
66783	A test described in item 66782 if rendered by a receiving APP — 1 or more tests	13.25
66785	Porphyrins or porphyrins precursors — quantitation in plasma, red cells, urine or faeces — 1 test	40.20
66788	Porphyrins or porphyrins precursors — quantitation in plasma, red cells, urine or faeces — 2 or more tests	66.30
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	40.20
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	26.05
66791	Porphyrin biosynthetic enzymes — measurement of activity in blood cells or other tissues — 1 or more tests	74.95
66792	A test described in item 66791 if rendered by a receiving APP — 1 or more tests	74.95
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	18.25
66803	2 tests described in item 66800	30.70
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	18.25
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	12.45
66806	3 tests described in item 66800	42.15
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	35.05
66815	2 tests described in item 66812	59.95
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	35.05
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	24.90
66819	Quantitation of copper, manganese, selenium or zinc (except if item 66667 applies), in blood, urine or other body fluid — 1 test

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	30.80
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	21.95
66822	Quantitation of copper, manganese, selenium or zinc (except if item 66667 applies), in blood, urine or other body fluid — 2 or more tests	52.80
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	30.80
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	30.80
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	21.95
66828	Quantitation of aluminium (except if item 66671 applies), arsenic, beryllium, cadmium, chromium, gold, mercury, nickel or strontium, in blood, urine or other body fluid or tissue — 2 or more tests	52.80
66830	Quantitation of BNP or NT‑proBNP for the diagnosis of heart failure in patients presenting with dyspnoea in a hospital Emergency Department	58.90
66831	Quantitation of copper or iron in liver tissue biopsy	31.15
66832	A test described in item 66831 if rendered by a receiving APP	31.15
66900	Carbon‑labelled urea breath test using oral C‑13 or C‑14 urea, including the measurement of exhaled ¹³CO₂ or ¹⁴CO₂, (except if item 12533 applies) for: (a) the confirmation of Helicobactor pylori colonisation; or (b) the monitoring of the success of eradication of Helicobactor pylori	78.15

Division 2.3 Group P3 — Microbiology

2.3.1Meaning of serial examinations or cultures

For an item in Group P3 (Microbiology):

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

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

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

(b)if:

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

(ii)specimen material from the patient episode is stored; and

(iii)in response to a request made within 14 days of the patient episode, further tests are carried out on the stored material;

the later tests and the earlier tests are taken to be part of 1 patient episode.

2.3.2Antigen detection

If a pathology service described in item 69316, 69317, 69319, 69494, 69495, 69496, 69497 or 69498 is rendered as a pathologist‑determinable service, the amount mentioned in the item is not payable for the service unless the recognised pathologist who renders the service records, in writing, the reasons for rendering the service.

2.3.3Investigation for hepatitis serology

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

2.3.4Limitation on certain items

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

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

(a)item 69482;

(b)item 69491 or 69492;

(b)item 69499 or 69500.

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

For any particular patient, item 69380, 69488 or 69489 is applicable not more than twice in a 12 month period.

For any particular patient, each of items 69445, 69451 and 69483 is applicable not more than 4 times in a 12 month period.

2.3.5Hepatitis C viral RNA testing

For items 69499 and 69500:

Hepatitis C sero‑positive, for a patient, means 2 different assays of Hepatitis C antibodies are positive.

serological status is uncertain, for a patient, means any result where 2 different assays of Hepatitis C antibodies are inconclusive.

Group P3 — Microbiology
Item	Pathology service	Fee ($)
69300	Microscopy of wet film material other than blood, from 1 or more sites, obtained directly from a patient (not cultures) including (if performed): (a) differential cell count; or (b) examination for dermatophytes; or (c) dark ground illumination; or	12.60
(d) stained preparation or preparations using any relevant stain or stains; 1 or more tests
69303	Culture and (if performed) microscopy to detect pathogenic micro‑organisms from nasal swabs, throat swabs, eye swabs and ear swabs (except swabs taken for epidemiological surveillance), including (if performed): (a) pathogen identification and antibiotic susceptibility testing; or	22.15
(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): (a) pathogen identification and antibiotic susceptibility testing; or	34.00
(b) a service described in items 69300, 69303, 69312 and 69318; 1 or more tests on 1 or more specimens
69309	Microscopy and culture to detect dermatophytes and other fungi causing cutaneous disease, from skin scrapings, skin biopsies, hair and nails (excluding swab specimens) and including (if performed): (a) the detection of antigens not elsewhere specified in this table; or (b) a service described in items 69300, 69303, 69306, 69312 and 69318; 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): (a) pathogen identification and antibiotic susceptibility testing; or	34.00
(b) a service described in items 69300, 69303, 69306 and 69318; 1 or more tests on 1 or more specimens
69316	Detection of Chlamydia trachomatis by any method — 1 test	28.85
69317	This item applies if: (a) 1 test described in item 69316 is performed; and (b) 1 test described in item 69494 is performed	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): (a) pathogen identification and antibiotic susceptibility testing; or	34.00
(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: (a) 1 test described in item 69316 is performed; and (b) 2 tests described in item 69494 are performed	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): (a) pathogen identification and antibiotic susceptibility testing; or (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): (a) microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or (b) pathogen identification and antibiotic susceptibility testing; including a service mentioned in item 69300	43.30
69325	A service described in item 69324 if the microscopy and culture is performed by a receiving APP	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): (a) microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or (b) pathogen identification and antibiotic susceptibility testing; including a service described in item 69300	85.55
69328	A service described in item 69327 if the microscopy and culture is performed by a receiving APP	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): (a) microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or (b) pathogen identification and antibiotic susceptibility testing; including a service described in item 69300	128.85
69331	A service described in item 69330 if the microscopy and culture is performed by a receiving APP	128.85
69333	Urine examination (including serial examination) by any means other than simple culture by dip slide, including: (a) cell count; and (b) culture; and (c) colony count; and (d) (if performed) stained preparations; and (e) (if performed) identification of cultured pathogens; and	20.70
(f) (if performed) antibiotic susceptibility testing; and (g) (if performed) examination for pH, specific gravity, blood, protein, urobilinogen, sugar, acetone or bile salts
69336	Microscopy of faeces for ova, cysts and parasites, that includes the use of: (a) a concentration technique; and (b) fixed stains or antigen detection for cryptosporidia and giardia;	33.65
and includes a service mentioned in item 69300 (if performed)
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): (a) pathogen identification and antibiotic susceptibility testing; and	53.25
(b) the detection of clostridial toxins; and (c) a service described in item 69300; not more than 1 examination in a 7 day period
69354	Blood culture for pathogenic micro‑organisms (other than viruses), including sub‑cultures and (if performed): (a) identification of any cultured pathogen; and (b) necessary antibiotic susceptibility testing; to a maximum of 3 sets of cultures — 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	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	181.45
69380	Genotypic testing for HIV antiretroviral resistance in a patient with confirmed HIV infection if the patient’s viral load is greater than 1 000 copies per ml at any of the following times: (a) at presentation; or (b) before antiretroviral therapy; or (c) when treatment with combination antiretroviral agents fails; — maximum of two tests in a 12 month period	775.50
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	181.45
69384	Quantitation of 1 antibody to microbial antigens not elsewhere described in this table — 1 test	15.75
69387	2 tests described in item 69384	29.20
69390	3 tests described in item 69384	42.65
69393	4 tests described in item 69384	56.10
69396	5 or more tests described in item 69384	69.55
69400	A test described in item 69384 if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP — 1 test	15.75
69401	A test described in item 69384 if a referring APP has performed a test or tests described in item 69384 — each test to a maximum of 4 tests	13.45
69405	Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of 1 of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and (b) (if performed) a service described in 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:	29.20
(a) the determination of 2 of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and (b) (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
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:	42.65
(a) the determination of 3 of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and
(b) (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
69413	Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of 4 of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and (b) (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481	56.10
69415	Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of all of the following — rubella immune status, specific syphilis serology, carriage of hepatitis B, hepatitis C antibody, HIV antibody; and (b) (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481	69.55
69418	A test for high risk human papillomaviruses (HPV) in a patient who: (a) within the 2 year period before the test, has received excisional or ablative treatment for high grade squamous intraepithelial lesions (HSIL) of the cervix; or	64.00
(b) within the 2 year period before the test, has had a positive HPV test after excisional or ablative treatment for HSIL of the cervix; or
(c) is undergoing annual cytological review following treatment for HSIL of the cervix; 1 test
69419	A test described in item 69418 if the test is performed by a receiving APP — 1 test	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	92.80
69451	A test described in item 69445 if the test is performed by a receiving APP — 1 test	92.80
69471	Test of cell‑mediated immunity in blood for the detection of latent tuberculosis 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	15.75
69478	2 tests described in item 69475	29.45
69481	Investigation of infectious causes of acute or chronic hepatitis — 3 tests described in item 69475	40.80
69482	Quantitation of hepatitis B viral DNA in patients who are hepatitis B surface antigen positive and have chronic hepatitis B but are not receiving antiviral therapy — 1 test	153.10
69483	Quantitation of hepatitis B viral DNA in patients who: (a) are hepatitis B surface antigen positive; and (b) have chronic hepatitis B; and (c) are receiving antiviral therapy; 1 test	153.10
69484	Supplementary test for hepatitis B surface antigen or hepatitis C antibody using a different assay on a specimen that yielded a reactive result on initial testing	17.20
69488	Quantitation of HCV RNA load in plasma or serum in: (a) the pre‑treatment evaluation, of a patient with chronic HCV hepatitis, for antiviral therapy; or (b) the assessment of efficacy of antiviral therapy for such a patient; if the test is requested by, or on the advice of, the specialist or consultant physician who manages the treatment of the patient (including a service described in item 69445 or 69499)	181.45
69489	A test described in item 69488 if the test is performed by a receiving APP	181.45
69491	Nucleic acid amplification and determination of hepatitis C virus (HCV) genotype if: (a) the patient is HCV RNA positive and is being evaluated for antiviral therapy of chronic HCV hepatitis; and	206.20
(b) the request for the test is made by, or on the advice of, the specialist or consultant physician managing the treatment of the patient
69492	A service described in item 69491 if the test is performed by a receiving APP	206.20
69494	Detection of a virus, microbial antigen or microbial nucleic acid (not elsewhere described in this table) — 1 test	28.85
69495	2 tests described in item 69494	36.10
69496	3 or more tests described in item 69494	43.35
69497	This item applies to a test described in item 69494 if: (a) a referring APP has not performed the test described in item 69494; and (b) a receiving APP performs the test described in item 69494; 1 test	28.85
69498	This item applies to a test described in item 69494 if: (a) a referring APP has performed the test or tests described in item 69494; and	7.25
(b) a receiving APP has performed the test or tests described in item 69494; 1 test
69499	Detection of hepatitis C viral RNA if at least 1 of the following criteria is satisfied: (a) the patient is hepatitis C sero‑positive; (b) the patient’s serological status is uncertain after testing;	92.80
(c) the test is performed for the purpose of: (i) determining the hepatitis C status of an immunosuppressed or immunocompromised patient; or
(ii) the detection of acute hepatitis C prior to seroconversion where considered necessary for the clinical management of the patient
69500	A test described in item 69499 if the test is performed by a receiving APP	92.80

Division 2.4 Group P4 — Immunology

2.4.1Limitation on certain items

For any particular patient, items 71075, 71127, 71135 and 71137 are applicable not more than twice in a 12 month period.

For any particular patient, item 71079 is applicable not more than 4 times in a 12 month period.

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

2.4.2Tests in Group P4 relating to antibodies

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

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

(b)specimen material from the patient episode is stored; and

(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.

2.4.3HLA‑B27 typing

If a pathology service mentioned in item 71148 is rendered as a pathologist‑determinable service, the amount mentioned in the item is not payable for a pathology service mentioned 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 mentioned in item 71147.

2.4.4Antineutrophil 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:

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

(b)a previous immunofluorescence test was abnormal; or

(c)those antibodies have been previously detected.

Group P4 — Immunology
Item	Pathology service	Fee ($)
71057	Electrophoresis, quantitative and qualitative, of serum, urine or other body fluid, collected in a 28 day period, to demonstrate: (a) protein classes; or	33.10
(b) presence and amount of paraprotein; including the preliminary quantitation of total protein, albumin and globulin — one specimen type
71058	Examination as described in item 71057 — two or more specimen types	50.85
71059	Immunofixation, immunoelectrophoresis or isoelectric focusing of: (a) urine for detection of Bence Jones proteins; or	35.90
(b) serum, plasma, or other body fluid; and characterisation of a paraprotein or cryoglobulin — examination of one specimen type (eg serum, urine or CSF)
71060	Examination as described in item 71059 of 2 or more specimen types	44.35
71062	Electrophoresis and immunofixation or immunoelectrophoresis or isoelectric focussing of CSF for the detection of oligoclonal bands and including if required electrophoresis of the patient’s serum for comparison purposes — 1 or more tests	44.35
71064	Detection and quantitation of cryoglobulins or cryofibrinogen — 1 or more tests	20.90
71066	Quantitation of total immunoglobulin A (by any method) in serum, urine, or other body fluid — 1 test	14.65
71068	Quantitation of total immunoglobulin G (by any method) in serum, urine, or other body fluid — 1 test	14.65
71069	2 tests described in item 71066, 71068, 71072 or 71074	22.90
71071	3 or more tests described in item 71066, 71068, 71072 or 71074	31.15
71072	Quantitation of total immunoglobulin M (by any method) in serum, urine, or other body fluid — 1 test	14.65
71073	Quantitation of all 4 immunoglobulin G subclasses	106.85
71074	Quantitation of total immunoglobulin D (by any method) in serum, urine, or other body fluid — 1 test	14.65
71075	Quantitation of immunoglobulin E (total) — 1 test	23.15
71076	A test described in item 71073 if the test is performed by a receiving APP — 1 test	106.85
71077	Quantitation of immunoglobulin E (total) in the follow up of a patient with proven immunoglobulin‑E‑secreting myeloma, proven congenital immunodeficiency or proven allergic bronchopulmonary aspergillosis — 1 test	27.25
71079	Detection of specific immunoglobulin E antibodies to single or multiple potential allergens	27.00
71081	Quantitation of total haemolytic complement	40.80
71083	Quantitation of complement components C3 and C4 or properdin factor B — 1 test	20.30
71085	2 tests described in item 71083	29.15
71087	3 or more tests described in item 71083	37.95
71089	Quantitation of complement components or breakdown products of complement proteins not elsewhere described in an item in this table — 1 test	29.35
71090	This item applies to a test described in item 71089 if: (a) a referring APP has not performed the test described in item 71089; and	29.35
(b) a receiving APP performs the test described in item 71089; 1 test
71091	2 tests described in item 71089	53.20
71092	This item applies to a test described in item 71089 if: (a) a referring APP has performed the test or tests described in item 71089; and (b) a receiving APP performs the test or tests described in item 71089; 1 test	23.85
71093	3 or more tests described in item 71089	76.95
71095	Quantitation of serum or plasma eosinophil cationic protein, or both, to a maximum of 3 assays in 1 year, for monitoring the response to therapy in corticosteroid treated asthma, in a child aged less than 12 years	40.80
71096	A test described in item 71095 if the quantitation is performed by a receiving APP	40.80
71097	Antinuclear antibodies — detection in serum or other body fluids, including quantitation if required	24.60
71099	Double‑stranded DNA antibodies — quantitation by 1 or more methods other than the Crithidia method	26.70
71101	Antibodies to 1 or more extractable nuclear antigens — detection in serum or other body fluids	17.50
71103	Characterisation of an antibody detected in a service described in item 71101 (including that service)	52.40
71106	Rheumatoid factor — detection by any technique in serum or other body fluids, including quantitation if required	11.40
71119	Antibodies to tissue antigens not elsewhere specified in this table — detection, including quantitation if required, of 1 antibody	17.45
71121	Detection of 2 antibodies specified in item 71119	20.95
71123	Detection of 3 antibodies specified in item 71119	24.40
71125	Detection of 4 or more antibodies specified in item 71119	27.85
71127	Functional tests for lymphocytes — quantitation, other than by microscopy, of: (a) proliferation induced by 1 or more mitogens; or (b) proliferation induced by 1 or more antigens; or	177.55
(c) estimation of 1 or more mixed lymphocyte reactions; including a test described in item 65066 or 65070 (if performed)
71129	2 tests described in item 71127	219.30
71131	3 or more tests described in item 71127	261.10
71133	Investigation of recurrent infection, by qualitative assessment, for the presence of defects in oxidative pathways in neutrophils by the nitroblue tetrazolium (NBT) reduction test	10.45
71134	Investigation of recurrent infection, by quantitative assessment, of oxidative pathways by flow cytometric techniques, including a test described in item 71133 (if performed)	104.75
71135	Quantitation of neutrophil function, comprising at least 2 of the following: (a) chemotaxis; (b) phagocytosis; (c) oxidative metabolism; (d) bactericidal activity;	209.35
including any test described in item 65066, 65070, 71133 or 71134 (if performed)
71137	Quantitation of cell‑mediated immunity by multiple antigen delayed type hypersensitivity intradermal skin testing using a minimum of 7 antigens	30.45
71139	Characterisation of 3 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations, including a total lymphocyte count or total leucocyte count by any method, on 1 or more specimens of blood, CSF or serous fluid	104.75
71141	Characterisation of 3 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations on 1 or more disaggregated tissue specimens	198.70
71143	Characterisation of 6 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations for the diagnosis (but not monitoring) of an immunological or haematological malignancy, including a service described in 1 or both of items 71139 and 71141 (if performed), on a specimen of blood, CSF, serous fluid or disaggregated tissue	261.75
71145	Characterisation of 6 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations for the diagnosis (but not monitoring) of an immunological or haematological malignancy, including a service described in 1 or more of items 71139, 71141 and 71143 (if performed) on 2 or more specimens of disaggregated tissues or 1 specimen of disaggregated tissue and 1 or more specimens of blood, CSF or serous fluid	427.35
71146	Enumeration of CD34+ cells, only for the purposes of autologous or directed allogeneic haemopoietic stem cell transplantation, including a total white cell count on the pheresis collection	104.75
71147	HLA‑B27 typing	40.80
71148	A test described in item 71147 if a receiving APP performs the test	40.80
71149	Complete tissue typing for 4 HLA‑A and HLA‑B Class I antigens (including any separation of leucocytes), including (if performed) a service described in item 71147	109.00
71151	Tissue typing for HLA‑DR, HLA‑DP and HLA‑DQ Class II antigens (including any separation of leucocytes) — phenotyping or genotyping of 2 or more antigens	119.65
71153	Testing, for assessment or diagnosis of systemic inflammatory disease or vasculitis, for the presence of an antibody by 1 of the following tests: (a) antineutrophil cytoplasmic antibody (ANCA) immunofluorescence test; (b) antineutrophil proteinase 3 antibody (PR3 ANCA) test; (c) antimyeloperoxidase antibody (MPO ANCA) test;	34.80
(d) antiglomerular basement membrane antibody (GBM ANCA) test
71154	This item applies to a test described in item 71153 if: (a) a referring APP has performed a test or tests described in item 71153; and	34.80
(b) a receiving APP performs the test described in item 71153; 1 test
71155	Testing for the presence of 2 antibodies by tests mentioned in item 71153	47.75
71156	This item applies to a test described in item 71153 (other than a test described in item 71154) if: (a) a referring APP has performed the test or tests described in item 71153; and (b) a receiving APP performs the test or tests described in item 71153; 1 test	12.95
71157	Testing for the presence of 3 antibodies by tests mentioned in item 71153	60.70
71159	Testing for the presence of 4 antibodies by tests mentioned in item 71153	73.65
71163	Detection of 1 of the following antibodies (of 1 or more class or isotype) in the assessment or diagnosis of coeliac disease or other gluten hypersensitivity syndromes, including a service described in item 71066 (if performed): (a) antibodies to gliadin; (b) antibodies to endomysium; (c) antibodies to tissue transglutaminase; 1 test	24.90
71164	2 or more tests mentioned in item 71163, including a service described in item 71066 (if performed)	40.15
71165	Antibodies to tissue antigens (acetylcholine receptor, adrenal cortex, heart, histone, insulin, insulin receptor, intrinsic factor, islet cell, lymphocyte, neuron, ovary, parathyroid, platelet, salivary gland, skeletal muscle, skin basement membrane and intercellular substance,	34.80
thyroglobulin, thyroid microsome or thyroid stimulating hormone receptor) — detection, including quantitation if required, of 1 antibody
71166	Detection of 2 antibodies described in item 71165	47.75
71167	Detection of 3 antibodies described in item 71165	60.70
71168	Detection of 4 or more antibodies described in item 71165	73.65
71169	This item applies to a service described in item 71165 if: (a) a referring APP has not performed the service described in item 71165; and (b) a receiving APP performs the service described in item 71165	34.80
71170	This item applies to a service described in item 71165 if: (a) a referring APP has performed the test or tests described in item 71165; and (b) a receiving APP performs the test or tests described in item 71165; 1 test	12.95
71180	Antibody to cardiolipin or beta‑2 glycoprotein I – detection, including quantitation if required; 1 antibody specificity (IgG or IgM)	34.80
71183	Detection of 2 antibodies described in item 71180	47.75
71186	Detection of 3 or more antibodies described in item 71180	60.70
71189	Detection of specific IgG antibodies to 1 or more respiratory disease allergens not elsewhere specified	15.60
71192	2 items described in item 71189	28.55
71195	3 or more items described in item 71189	40.30
71198	Estimation of serum tryptase for the evaluation of unexplained acute hypotension or suspected anaphylactic event, assessment of risk in stinging insect anaphylaxis, exclusion of mastocytosis, monitoring of known mastocytosis	40.80
71200	Detection and quantitation, if present, of free kappa and lambda light chains in serum for the diagnosis or monitoring of amyloidosis, myeloma or plasma cell dyscrasias	60.00
71203	Determination of HLAB5701 status by flow cytometry or cytotoxity assay prior to the initiation of Abacavir therapy including item 73323 if performed	40.80

Division 2.5 Group P5 — Tissue pathology

2.5.1Tests on biopsy material

For items in Group P5 (Tissue pathology):

biopsy material means all tissue received by an approved pathology practitioner:

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

(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.

For Group P5, services in Group P6 include any services described in Group P5 on the material submitted for a test in Group P6.

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

If more than 1 of the services mentioned in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 are performed in a single patient episode, only the fee for the item performed having the highest specified fee is applicable to the services.

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.

In items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 a reference to a complexity level is a reference to the level given to a specimen type mentioned in Part 4 of this table.

(a)more than 1 of the services mentioned in items 72846, 72847, 72848, 72849 and 72850; or

(b)more than 1 of the services mentioned in items 73059, 73060, 73061, 73064 and 73065 of Division 2.6;

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.

Group P5 — Tissue pathology
Item	Pathology service	Fee ($)
72813	Examination of complexity level 2 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 1 or more separately identified specimens	72.00
72816	Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 1 separately identified specimen	86.95
72817	Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 2 to 4 separately identified specimens	97.45
72818	Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 5 or more separately identified specimens	107.75
72823	Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 1 separately identified specimen	97.80
72824	Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 2 to 4 separately identified specimens	142.30
72825	Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 5 to 7 separately identified specimens	181.45
72826	Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 8 to 11 separately identified specimens	195.90
72827	Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 12 to 17 separately identified specimens	210.35
72828	Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 18 or more separately identified specimens	224.80
72830	Examination of complexity level 5 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 1 or more separately identified specimens	276.00
72836	Examination of complexity level 6 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 1 or more separately identified specimens	420.00
72838	Examination of complexity level 7 biopsy material with multiple tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy, and professional opinion or opinions — 1 or more separately identified specimens	470.00
72844	Enzyme histochemistry of skeletal muscle for investigation of primary degenerative or metabolic muscle diseases or of muscle abnormalities secondary to disease of the central or peripheral nervous system — 1 or more tests	30.95
72846	Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen — 1 to 3 antibodies except those mentioned in item 72848	60.00
72847	Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen — 4 to 6 antibodies	90.00
72848	Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen — 1 to 3 of the following antibodies: (a) oestrogen; (b) progesterone; (c) c‑erb‑B2 (HER2)	75.00
72849	Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen — 7 to 10 antibodies	105.00
72850	Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen — 11 or more antibodies	120.00
72851	Electron microscopic examination of biopsy material — 1 separately identified specimen	185.60
72852	Electron microscopic examination of biopsy material — 2 or more separately identified specimens	247.45
72855	Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear — 1 separately identified specimen	185.60
72856	Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear — 2 to 4 separately identified specimens	247.45
72857	Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear — 5 or more separately identified specimens	288.70

Part 4 Complexity levels for histopathology items

Specimen type	Complexity level
Adrenal resection, neoplasm	5
Adrenal resection, not neoplasm	4
Anus, all specimens not otherwise specified	3
Anus, neoplasm, biopsy	4
Anus, neoplasm, radical resection	6
Anus, submucosal resection — neoplasm	5
Appendix	3
Artery, all specimens not otherwise specified	3
Artery, biopsy	4
Bartholin’s gland — cyst	3
Bile duct, resection — all specimens	6
Bone — all specimens not otherwise specified	4
Bone, biopsy, curettings or fragments — lesion	5
Bone, biopsy or curettings quantitation — metabolic disease	6
Bone, femoral head	4
Bone, resection, neoplasm — all sites and types	6
Bone marrow, biopsy	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, orientated wide local excision for carcinoma with margin assessment	7
Breast tissue — all specimens not otherwise specified	4
Bronchus, biopsy	4
Carotid body — neoplasm	5
Cholesteatoma	3
Digits, amputation — not traumatic	4
Digits, amputation — traumatic	2
Ear, middle and inner — not cholesteatoma	4
Endocrine neoplasm — not otherwise specified	5
Extremity, amputation — not otherwise specified	4
Extremity, amputation or disarticulation — neoplasm	6
Eye, conjunctiva — biopsy or pterygium	3
Eye, cornea	4
Eye, enucleation or exenteration — all lesions	6
Eye — not otherwise specified	4
Fallopian tube, biopsy	4
Fallopian tube, ectopic pregnancy	4
Fallopian tube, 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 — not otherwise specified	5
Heart valve	4
Hernia sac	2
Hydrocele sac	2
Jaw, upper or lower, including bone — radical resection for neoplasm	6
Joint and periarticular tissue, without bone — all specimens	3
Joint tissue, including bone — all specimens	4
Kidney, biopsy including transplant	5
Kidney, nephrectomy transplant	5
Kidney, partial or total nephrectomy — not neoplasm	4
Kidney, partial or total nephrectomy or nephroureterectomy — neoplasm	6
Large bowel, colostomy — stoma	3
Large bowel (including rectum), biopsy — all sites	4
Large bowel (including rectum), biopsy, for confirmation or exclusion of Hirschsprung’s Disease	5
Large bowel (including rectum), polyp	4
Large bowel (including rectum), segmental resection — neoplasm	6
Large bowel (including rectum), submucosal resection — neoplasm	5
Large bowel, segmental resection — colon, not neoplasm	5
Larynx, biopsy	4
Larynx, partial or total resection	5
Larynx, resection with nodes or pharynx or both	6
Lip biopsy — all specimens not mentioned	3
Lip wedge resection or local excision with orientation	4
Liver — all specimens not otherwise specified	5
Liver, hydatid cyst or resection for trauma	4
Liver, total or subtotal hepatectomy — neoplasm	6
Lung, needle or transbronchial biopsy	4
Lung, resection — neoplasm	6
Lung segment, lobar or total resection	6
Lung, wedge biopsy	5
Lymph node, biopsy — all sites	4
Lymph node, biopsy, for lymphoma or lymphoproliferative disorder	5
Lymph nodes, regional resection — all sites	5
Mediastinum mass	5
Muscle, biopsy	6
Nasopharynx or oropharynx, biopsy	4
Nerve, biopsy neuropathy	5
Nerve, neurectomy or removal of neoplasm	4
Nerve — not otherwise specified	3
Nose, mucosal biopsy	4
Nose or sinuses, polyps	3
Odontogenic neoplasm	5
Odontogenic or dental cyst	4
Oesophagus, biopsy	4
Oesophagus, diverticulum	3
Oesophagus, partial or total resection	6
Oesophagus, submucosal resection — neoplasm	5
Omentum, biopsy	4
Ovary with or without tube — neoplasm	5
Ovary with or without tube — not neoplasm	4
Pancreas, biopsy	5
Pancreas, cyst	4
Pancreas, subtotal or total with or without splenectomy	6
Parathyroid gland(s)	4
Penisectomy — simple	4
Penisectomy with node dissection	5
Peritoneum, biopsy	4
Pituitary neoplasm	4
Placenta — not third trimester	4
Placenta — third trimester, abnormal pregnancy or delivery	4
Pleura or pericardium, biopsy or tissue	4
Products of conception, spontaneous or missed abortion	4
Products of conception, termination of pregnancy	3
Prostate — all types of specimen not otherwise specified	4
Prostate, radical prostatectomy or cystoprostatectomy for carcinoma	7
Prostate, radical resection	6
Retroperitoneum, neoplasm	5
Salivary gland — all specimens not otherwise specified	4
Salivary gland, Mucocele	3
Salivary gland, neoplasm — all sites	5
Sinus, paranasal, biopsy	4
Sinus, paranasal, resection — neoplasm	6
Skin — all specimens not otherwise specified including all neoplasms and cysts	3
Skin, biopsy — blistering skin diseases	4
Skin, biopsy — inflammatory dermatosis	4
Skin, biopsy — investigation of alopecia where serial horizontal sections are taken, except for male pattern baldness	5
Skin, biopsy — investigation of lymphoproliferative disorder	5
Skin, eyelid, wedge resection	4
Skin, local resection — orientation	4
Skin, resection of malignant melanoma or melanoma in situ	5
Small bowel — all specimens not otherwise specified	5
Small bowel — biopsy, all sites	4
Small bowel, diverticulum	3
Small bowel, resection — neoplasm	6
Small bowel, submucosal resection — neoplasm	5
Soft tissue, infiltrative lesion — extensive resections at least 5 cm in maximal dimension	6
Soft tissue, lipoma and variants	3
Soft tissue, neoplasm, not lipoma — all specimens	5
Soft tissue — not otherwise specified	4
Spleen	5
Stomach — all specimens not otherwise specified	4
Stomach, endoscopic biopsy or endoscopic polypectomy	4
Stomach, resection, neoplasm — all specimens	6
Stomach, submucosal resection — neoplasm	5
Tendon or tendon sheath, giant cell neoplasm	4
Tendon or tendon sheath — not otherwise specified	3
Testis and adjacent structures, castration	2
Testis and adjacent structures, neoplasm with or without nodes	5
Testis and adjacent structures — not otherwise specified	3
Testis and adjacent structures, vas deferens sterilization	2
Testis, biopsy	5
Thymus — not otherwise specified	5
Thyroglossal duct — all lesions	4
Thyroid — all specimens	5
Tissue or organ — all specimens not otherwise specified	3
Tissue or organ not otherwise specified, abscess	3
Tissue or organ not otherwise specified, haematoma	3
Tissue or organ not otherwise specified, malignant neoplasm with regional nodes	6
Tissue or organ not otherwise specified, neoplasm local	4
Tissue or organ not otherwise specified, pilonidal cyst or sinus	3
Tissue or organ not otherwise specified, thrombus or embolus	3
Tissue or organ not otherwise specified, veins varicosity	3
Tongue, biopsy	4
Tongue or tonsil, neoplasm local	5
Tongue or tonsil, neoplasm with nodes	6
Tonsil, biopsy — excluding resection of whole organ	4
Tonsil or adenoids or both	2
Trachea, biopsy	4
Ureter, biopsy	4
Ureter, resection	5
Urethra, biopsy	4
Urethra, resection	5
Urinary bladder — all specimens not otherwise specified	4
Urinary bladder, partial or total with or without prostatectomy	6
Urinary bladder, transurethral resection of neoplasm	5
Uterus and/or cervix — all specimens not otherwise specified	4
Uterus, cervix cone, biopsy (including LEEP or LLETZ biopsy)	5
Uterus, cervix, curettings or biopsy	4
Uterus, endocervix, polyp	3
Uterus, endometrium, polyp	3
Uterus, with or without adnexa, malignant neoplasm — all specimen types not otherwise specified	6
Uterus with or without adnexa, neoplasm, Wertheim’s or pelvic clearance	6
Vagina, biopsy	4
Vaginal mucosa, incidental	3
Vagina, radical resection	6
Vulva or labia, biopsy	4
Vulval, subtotal or total with or without nodes	6

Dictionary

abnormal level of TSH for item 66719 — see clause 2.2.5 of Schedule 1.

Act means the Health Insurance Act 1973.

approved collection centre for Group P10 — see clause 2.10.1 of Schedule 1.

ASGC for item 74991 — see clause 2.12.1 of Schedule 1.

biopsy material for Group P5 — see clause 2.5.1 of Schedule 1.

bulk‑billed for items 74990 and 74991 — see clause 2.12.1 of Schedule 1.

Commonwealth concession card holder for items 74990 and 74991 — see clause 2.12.1 of Schedule 1.

compatibility tests by crossmatch for items 65099 and 65102 — see clause 2.1.2 of Schedule 1.

cytology for Group P5 — see clause 2.5.1 of Schedule 1.

designated test — see clause 1.2.4 of Schedule 1.

elevated serum ferritin for items 73317 and 73318 — see clause 2.7.1 of Schedule 1.

general practitioner — see clause 1.2.7 of Schedule 1.

Group, for a Group in the table, means every item in the Group.

Hepatitis C sero‑positive for items 69499 and 69500 — see clause 2.3.5 of Schedule 1.

item means:

(a)an item mentioned, by number, in column 1 of a table in:

(i)Schedule 1; or

(ii)Schedule 1 to the diagnostic imaging services table; or

(iii)Schedule 1 to the general medical services table; and

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

institution for Groups P10 — see clause 2.10.1 of Schedule 1.

metal toxicity testing group — see clause 2.2.7 of Schedule 1.

nutritional metals testing group — see clause 2.2.7 of Schedule 1.

patient episode means:

(a)a pathology service or pathology services (other than a pathology service to which paragraph (b) refers) provided for a single patient whose need for the service or services was determined under section 16A of the Act:

(i)on the same day; or

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

whether the services:

(iii)are requested by 1 or more practitioners, participating midwives or participating nurse practitioners; or

(iv)are described in a single item or in more than 1 item; or

(v)are rendered by 1 approved pathology practitioner or more than 1 approved pathology practitioner; or

(vi)are rendered on the same or different days; or

(b)a pathology service to which clause 1.2.3, 2.1.1 or 2.2.2 refers that is provided in the circumstances, set out in the clause, that relate to the service.

practice location for item 74991 — see clause 2.12.1 of Schedule 1.

prescribed laboratory for Groups P10 — see clause 2.10.1 of Schedule 1.

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

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

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

recognised pathologist means:

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

(b)a medical practitioner in relation to whom there is in force a determination under paragraph 3DB (4) (a) or subsection 3E (1) of the Act that the practitioner is recognised as a specialist in pathology.

referring APP, for a patient episode, means an approved pathology practitioner in an approved pathology authority who:

(a)has received a request to render one or more designated tests; and

(b)is unable, because of the lack of facilities in, or expertise or experience of the staff of, the laboratory of the authority, to render 1 or more of the tests included in the designated test; and

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

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

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

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

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

residential care facility for Groups P10 — see clause 2.10.1 of Schedule 1.

Rural, Remote and Metropolitan Areas Classification for item 74991 — see clause 2.12.1 of Schedule 1.

separately identified specimen for Group P5 — see clause 2.5.1 of Schedule 1.

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

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

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

serial examinations or cultures for Group P3 — see clause 2.3.1 of Schedule 1.

serological status is uncertain for items 69499 and 69500 — see clause 2.3.5 of Schedule 1.

set of pathology services — see clause 1.2.7 of Schedule 1.

SLA for item 74991 — see clause 2.12.1 of Part 2 to Schedule 1.

specimen collection centre for Groups P10 — see clause 2.10.1 of Schedule 1.

SSD for item 74991 — see clause 2.12.1 of Schedule 1.

Subgroup, for a Subgroup in the table, means every item in the Subgroup.

treating practitioner for Group P10 — see clause 2.10.1 of Schedule 1.

unreferred service for items 74990 and 74991 — see clause 2.12.1 of Schedule 1.

Notes to the Health Insurance (Pathology Services Table) Regulations 2011

Note 1

The Health Insurance (Pathology Services Table) Regulations 2011 (in force under the Health Insurance Act 1973) as shown in this compilation comprise Select Legislative Instrument 2011 No. 188 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
2011 No. 188	26 Oct 2011 (see F2011L02126)	1 Nov 2011
2012 No. 58	20 Apr 2012 (see F2012L00907)	1 May 2012	—
2012 No. 167	13 July 2012 (see F2012L01553)	1 Aug 2012	—

Table of Amendments

ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted
Provision affected	How affected
Schedule 1
Part 2
C. 2.6.1................................	am. 2012 No. 58
C. 2.10.1.............................	am. 2012 No. 58
Note to c. 2.10.1 (7)..........	rep. 2012 No. 58
Dictionary
Dictionary............................	am. 2012 No. 167