Health Insurance (Pathology Services Table) Regulations 2019 (Cth)

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Health Insurance (Pathology Services Table) Regulations 2019

made under the

Health Insurance Act 1973

Compilation No. 1

Compilation date: 30 March 2020

Includes amendments up to:F2020L00341

Registered:22 April 2020

About this compilation

This compilation

This is a compilation of the Health Insurance (Pathology Services Table) Regulations 2019 that shows the text of the law as amended and in force on 30 March 2020 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register ( The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents

1Name

This instrument is the Health Insurance (Pathology Services Table) Regulations 2019.

3Authority

This instrument is made under the Health Insurance Act 1973.

4Pathology services table

For the purposes of subsection 4A(1) of the Act, Schedule 1 prescribes a table of pathology services.

5Dictionary

The Dictionary in Part 4 of Schedule 1 defines certain words and expressions that are used in this instrument, and includes references to certain words and expressions that are defined elsewhere in this instrument.

Schedule 1Pathology services table

Note: See sections 4 and 5.

Part 1General application provisions1.1Precedence of items
  1. (1)

    If a service is described:

    1. (a)

      in an item in general terms; and

    2. (b)

      in another item in specific terms;

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

  1. (2)

    Subject to subclause (3), if:

    1. (a)

      subclause (1) does not apply; and

    2. (b)

      a service is described in 2 or more items;

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

  1. (3)

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

1.2Circumstances in which services rendered following 2 requests to be taken to have been rendered following one request

(1) In subclause (2):

serviceincludes assay, estimation and test.

(2) Two or more pathology services (other than services to which, under clause 1.3, 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:

  1. (a)

    the services are listed in the same item; and

  2. (b)

    that item is not item 74990 or 74991; and

  3. (c)

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

1.3Services to which clause 1.2 does not apply
  1. (1)

    Clause 1.2 does not apply to a pathology service described in subclause (2) if:

    1. (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

    2. (b)

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

    3. (c)

      the pathology provider of the service writes on the account for the service that the service has a “rule 3 exemption”.

  2. (2)

    For the purposes of subclause (1), the pathology services are:

    1. (a)

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

    2. (b)

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

    3. (c)

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

    4. (d)

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

    5. (e)

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

    6. (f)

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

      1. (i)

        cis‑platinum or cyclosporin therapy of a patient; or

      2. (ii)

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

    7. (g)

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

    8. (h)

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

1.4Referral of designated tests by one pathology practitioner to another
  1. (1)

    In this clause:

designated testmeans 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.

  1. (2)

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

  2. (3)

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

    1. (a)

      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) applies to each designated test rendered by the referring APP; and

    2. (b)

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

  3. (4)

    If a referring APP has not rendered a designated test:

    1. (a)

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

    2. (b)

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

(5) For the purposes of paragraph (3)(b), the maximum number of designated tests to which the relevant item applies is as follows:

  1. (a)

    for item 66652, 66715, 66790, 66817, 66821 or 66827—2 less the number of designated tests rendered by a referring APP;

  2. (b)

    for item 65158, 66805, 69498 or 71092—3 less the number of designated tests rendered by a referring APP;

  3. (c)

    for item 71156 or 71170—4 less the number of designated tests rendered by a referring APP;

  4. (d)

    for item 65181 or 66724—5 less the number of designated tests rendered by a referring APP.

  1. (6)

    For the purposes of paragraph (4)(b), the maximum number of designated tests to which the relevant item applies is as follows:

    1. (a)

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

    2. (b)

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

    3. (c)

      for item 71156 or 71170—3;

    4. (d)

      for item 65181 or 66724—4.

  2. (7)

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

1.5Items not to be split

Except as stated in clause 1.4, an item applies only to one approved pathology practitioner for a single patient episode.

1.6Certain pathology services to be treated as one service
  1. (2)

    If a medical practitioner (other than a specialist or consultant physician), 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.

  2. (3)

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

    1. (a)

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

    2. (b)

      either:

      1. (i)

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

      2. (ii)

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

    3. (c)

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

  3. (4)

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

    1. (a)

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

    2. (b)

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

    3. (c)

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

  4. (5)

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

1.7Meaning of set of pathology services
  1. (1)

    In clause 1.6:

set of pathology services means a group of pathology services:

  1. (a)

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

  2. (b)

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

  3. (c)

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

  4. (d)

    none of which is referred to in item 66900, 69484, 73070, 73071, 73072, 73073, 73074, 73075 or 73076.

  1. (2)

    However, a set of pathology services does not include the following items:

    1. (a)

      an item in Group P10 (Patient episode initiation), Group P11 (Specimen referred), Group P12 (Management of bulk‑billed services) or Group P13 (Bulk‑billing incentive);

    2. (b)

      if a service is requested by an approved pathology practitioner of an approved pathology authority and rendered by another approved pathology practitioner of an approved pathology authority that is not related to the approved pathology authority of the first‑mentioned approved pathology practitioner—item 65079, 65082, 65157, 65158, 65166, 65180, 65181, 66606, 66610, 66639, 66642, 66651, 66652, 66663, 66666, 66696, 66697, 66714, 66715, 66723, 66724, 66780, 66783, 66789, 66790, 66792, 66804, 66805, 66816, 66817, 66820, 66821, 66826, 66827, 66832, 66834, 66837, 69325, 69328, 69331, 69379, 69383, 69400, 69401, 69451, 69489, 69492, 69497, 69498, 69500, 71076, 71090, 71092, 71096, 71148, 71154, 71156, 71169, 71170, 73309, 73312, 73315, 73318, 73321 or 73324.

  2. (3)

    An approved pathology authority is related to another approved pathology authority for the purposes of paragraph (2)(b) if:

    1. (a)

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

    2. (b)

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

    3. (c)

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

    4. (d)

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

    5. (e)

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

    6. (f)

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

1.8Satisfying requirements described in pathology service

A requirement contained in the description of a pathology service in Part 2 is satisfied if:

  1. (a)

    for a requirement for information—the information:

    1. (i)

      is included in the request for the service; or

    2. (ii)

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

  2. (b)

    for a requirement for laboratory test results—the results are:

    1. (i)

      included in the request for the service; or

    2. (ii)

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

    3. (iii)

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

1.9Application of items – services provided with autologous injections of blood or blood products

An item in the table does not apply to a service mentioned in the item if the service is provided to a patient at the same time as, or in connection with, an injection of blood or a blood product that is autologous.

1.10Application of items – services provided with harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells

An item in the table does not apply to a service mentioned in the item if the service is provided to a patient at the same time as, or in connection with, the harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells.

Part 2Services and feesDivision 2.1Group P1: haematology2.1.1Services to which clause 1.2 does not apply
  1. (1)

    Clause 1.2 does not apply to a pathology service described in item 65060, 65070, 65120, 65123, 65126, 65129, 65150, 65153 or 65156 if:

    1. (a)

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

    2. (b)

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

    3. (c)

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

    4. (d)

      the pathology provider of the service writes on the account for the service that the service has a “rule 3 exemption”.

  2. (2)

    Clause 1.2 does not apply to a pathology service described in item 65109 or 65110 if:

    1. (a)

      the service is rendered:

      1. (i)

        for a service described in item 65109—on one of not more than 5 occasions in 24 hours; and

      2. (ii)

        for a service described in item 65110—on one of not more than 2 occasions in 24 hours; and

    2. (b)

      the service was requested on a separate occasion to any other occasions on which the service was requested in that period; and

    3. (c)

      the pathology provider of the service writes on the account for the service that the service has a “rule 3 exemption”.

2.1.2Item taken to refer only to the first service of a particular kind
  1. (1)

    For an item in Group P1 (Haematology):

    1. (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

    2. (b)

      if:

      1. (i)

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

      2. (ii)

        specimen material from the patient episode is stored; and

      3. (iii)

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

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

  2. (2)

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

  3. (3)

    For each of items 65099 and 65102:

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

Group P1—Haematology

Column 1

Item

Column 2

Pathology service

Column 3

Fee ($)

65060

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

7.85

65066

Examination of:

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

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

(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

10.40

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 in relation to which haemoglobin only is requested)—one or more instrument‑generated set of results from a single sample and (if performed):

(a) a morphological assessment of a blood film; and

(b) any service in item 65060 or 65072

16.95

65072

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

10.20

65075

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

(a) erythrocyte autohaemolysis test;

(b) erythrocyte osmotic fragility test;

(c) sugar water test;

(d) G–6–PD (qualitative or quantitative) test;

(e) pyruvate kinase (qualitative or quantitative) test;

(f) acid haemolysis test;

(g) quantitation of muramidase in serum or urine;

(h) Donath Landsteiner antibody test;

(i) other erythrocyte metabolic enzyme tests

51.95

65078

Tests for the diagnosis of thalassaemia consisting of haemoglobin electrophoresis or chromatography and at least 2 of:

(a) examination for HbH; or

(b) quantitation of HbA2; or

(c) quantitation of HbF;

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

90.20

65079

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

90.20

65081

Tests for the investigation of haemoglobinopathy consisting of haemoglobin electrophoresis or chromatography and at least one of:

(a) heat denaturation test; or

(b) isopropanol precipitation test; or

(c) tests for the presence of haemoglobin S; or

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

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

96.60

65082

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

96.60

65084

Bone marrow trephine biopsy—histopathological examination of sections of bone marrow and examination of aspirated material (including clot sections if necessary), including (if performed) any test described in item 65060, 65066 or 65070

165.85

65087

Bone marrow—examination of aspirated material (including clot sections if necessary), including (if performed) any test described in item 65060, 65066 or 65070

83.10

65090

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

11.15

65093

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

22.00

65096

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

(a) identification and quantitation of any antibodies detected; and

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

41.00

65099

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

(a) all grouping checks of the patient and donor; and

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

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

108.90

65102

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

(a) all grouping checks of the patient and donor; and

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

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

164.60

65105

Compatibility testing using at least a 3 cell panel and issue of red cells for transfusion—all tests performed on any 1 day for up to 6 units, including:

(a) all grouping checks of the patient and donor; and

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

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

108.90

65108

Compatibility testing using at least a 3 cell panel and issue of red cells for transfusion—all tests performed on any 1 day in excess of 6 units, including:

(a) all grouping checks of the patient and donor; and

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

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

164.60

65109

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

12.90

65110

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

12.90

65111

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

23.20

65114

One or more of the following tests:

(a) direct Coombs (antiglobulin) test;

(b) qualitative or quantitative test for cold agglutinins or heterophil antibodies

9.10

65117

One or more of the following tests:

(a) spectroscopic examination of blood for chemically altered haemoglobins;

(b) detection of methaemalbumin (Schumm’s test)

20.25

65120

Prothrombin time (including INR if appropriate), activated partial thromboplastin time, thrombin time (including test for the presence of heparin), test for factor XIII deficiency (qualitative), Echis test, Stypven test, reptilase time, fibrinogen, or one of fibrinogen degradation products, fibrin monomer or D‑dimer—one test

13.70

65123

Two tests described in item 65120

20.35

65126

Three tests described in item 65120

27.85

65129

Four or more tests described in item 65120

35.50

65137

A test for the presence of lupus anticoagulant, not being a service connected with a service to which item 65175, 65176, 65177, 65178 or 65179 applies

25.35

65142

Confirmation or clarification of an abnormal or indeterminate result of a test mentioned in item 65175, by testing a specimen collected on a different day—one or more tests

25.35

65144

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

56.55

65147

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

37.90

65150

Quantitation of von Willebrand factor antigen, von Willebrand factor activity (ristocetin cofactor assay), von Willebrand factor collagen binding activity, factor II, factor V, factor VII, factor VIII, factor IX, factor X, factor XI, factor XII, factor XIII, Fletcher factor, Fitzgerald factor, circulating coagulation factor inhibitors other than by Bethesda assay—one test

70.90

65153

Two tests described in item 65150

141.85

65156

Three or more tests described in item 65150

212.75

65157

A test described in item 65150, if rendered by a receiving APP, if no tests in the item have been rendered by the referring APP—one test

70.90

65158

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

70.90

65159

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

70.90

65162

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

10.45

65165

Detection and quantitation of fetal red blood cells in the maternal circulation by detection of red cell antigens using flow cytometric methods including (if performed) any test described in item 65070 or 65162

34.45

65166

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

34.45

65171

A test for the presence of antithrombin III deficiency, protein C deficiency, protein S deficiency or activated protein C resistance in a first degree relative of a person who has a proven deficiency mentioned in this item—one or more tests

25.35

65175

A test for the presence of antithrombin III deficiency, protein C deficiency, protein S deficiency, lupus anticoagulant, activated protein C resistance, if the request for the test specifically identifies that the patient has a history of venous thromboembolism—quantitation by one or more techniques—one test

25.35

65176

Two tests described in item 65175

48.65

65177

Three tests described in item 65175

71.95

65178

Four tests described in item 65175

95.20

65179

Five tests described in item 65175

118.50

65180

A test described in item 65175, if rendered by a receiving APP, if no tests in the item have been rendered by the referring APP—one test

25.35

65181

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

23.30

Division 2.2Group P2: chemical2.2.1Creatinine ratios

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

  1. (a)

    involves the measurement of a substance in urine; and

  2. (b)

    requires calculation of a substance/creatinine ratio;

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

2.2.2Services to which clause 1.2 does not apply

Clause 1.2 does not apply to a pathology service described in item 66500, 66503, 66506, 66509, 66512, 66584 or 66800 if:

  1. (a)

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

  2. (b)

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

  3. (c)

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

  4. (d)

    the pathology provider of the service writes on the account for the service that the service has a “rule 3 exemption”.

2.2.3Limitation on certain items
  1. (1)

    For any particular patient, items 66605 and 66606 are applicable not more than twice (in total for both items) in 12 months.

  2. (2)

    For any particular patient, items 66607 and 66610 are applicable not more than twice (in total for both items) in 12 months.

2.2.4Thyroid function testing
  1. (1)

    For item 66719:

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

  1. (2)

    Unless paragraph (a) of item 66719 is satisfied, the item is not applicable to 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).

  2. (3)

    The written statement from the medical practitioner must indicate:

    1. (a)

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

    2. (b)

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

    3. (c)

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

2.2.5Metals testing
  1. (1)

    This clause applies to items 66819, 66820, 66821, 66822, 66825, 66826, 66827, 66828, 66831 and 66832 (metals testing items).

  2. (2)

    For any particular patient, a metals testing item is not applicable if, in the 6 months before the service mentioned in the item was requested, there have been 3 patient episodes for the patient in relation to which any metals testing item applied.

Group P2—Chemical

Column 1

Item

Column 2

Pathology service

Colum 3

Fee ($)

66500

Quantitation in serum, plasma, urine or other body fluid (except amniotic fluid), by any method, except reagent tablet or reagent strip, (with or without reflectance meter) of acid phosphatase, alanine aminotransferase, albumin, alkaline phosphatase, ammonia, amylase, aspartate aminotransferase, bicarbonate, bilirubin (total), bilirubin (any fractions), C‑reactive protein, calcium (total or corrected for albumin), chloride, creatine kinase, creatinine, gamma glutamyl transferase, globulin, glucose, lactate dehydrogenase, lipase, magnesium, phosphate, potassium, sodium, total cholesterol, total protein, triglycerides, urate or urea—one test

9.70

66503

Two tests described in item 66500

11.65

66506

Three tests described in item 66500

13.65

66509

Four tests described in item 66500

15.65

66512

Five or more tests described in item 66500

17.70

66517

Quantitation of bile acids in blood in pregnancy

For any particular patient, applicable not more than 3 times in a pregnancy

19.65

66518

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

20.05

66519

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

40.15

66536

Quantitation of HDL cholesterol

11.05

66539

Electrophoresis of serum for demonstration of lipoprotein subclasses:

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

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

For any particular patient, applicable not more than twice in 12 months

30.60

66542

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

(a) administration of glucose; and

(b) at least 2 measurements of blood glucose; and

(c) (if performed) any test described in item 66695

18.95

66545

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

(a) administration of glucose; and

(b) one or 2 measurements of blood glucose; and

(c) (if performed) any test in item 66695

15.80

66548

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

(a) administration of glucose; and

(b) at least 3 measurements of blood glucose; and

(c) (if performed) any test in item 66695

19.90

66551

Quantitation of glycosylated haemoglobin performed in the management of established diabetes

For any particular patient, applicable not more than 4 times in 12 months

16.80

66554

Quantitation of glycosylated haemoglobin performed in the management of pre‑existing diabetes if the patient is pregnant—including a service in item 66551 (if performed)

For any particular patient, applicable not more than 6 times in 12 months

16.80

66557

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

9.70

66560

Microalbumin—quantitation in urine

20.10

66563

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

24.70

66566

Quantitation of:

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

(b) bicarbonate and pH;

including any other measurement (e.g. haemoglobin, lactate, potassium or ionised calcium) or calculation performed on the same specimen—one or more tests on one specimen

33.70

66569

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

42.60

66572

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

51.55

66575

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

60.45

66578

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

69.35

66581

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

78.25

66584

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

9.70

66587

Urine acidification test for the diagnosis of renal tubular acidosis including the administration of an acid load, and pH measurements on 4 or more urine specimens and at least one blood specimen

47.55

66590

Calculus, analysis of one or more

30.60

66593

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

18.00

66596

Iron studies, consisting of quantitation of:

(a) serum iron; and

(b) transferrin or iron binding capacity; and

(c) ferritin

32.55

66605

Vitamins—quantitation of vitamin B1, B2, B3, B6 or C in blood, urine or other body fluid—one or more tests

30.60

66606

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

30.60

66607

Vitamins—quantitation of vitamin A or E in blood, urine or other body fluid—one or more tests

75.75

66610

A test described in item 66607 if rendered by a receiving APP—one or more tests

75.75

66623

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

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

(b) ingested or absorbed toxic chemicals;

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

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

(d) the monitoring of patients participating in a drug abuse treatment program

41.50

66626

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

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

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

For any particular patient, applicable not more than 36 times in 12 months

24.10

66629

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

20.10

66632

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

20.10

66635

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

20.10

66638

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

49.05

66639

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

29.20

66641

Electrophoresis of serum or other body fluid to demonstrate:

(a) the isoenzymes of lactate dehydrogenase; or

(b) the isoenzymes of alkaline phosphatase;

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

29.20

66642

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

29.20

66644

C‑1 esterase inhibitor—quantitation

20.15

66647

C‑1 esterase inhibitor—functional assay

45.10

66650

Alpha‑fetoprotein, CA‑15.3 antigen (CA15.3), CA‑19.9 antigen (CA19.9), CA‑125 antigen (C125), cancer associated serum antigen (CASA), carcinoembryonic antigen (CEA), human chorionic gonadotrophin (HCG), neuron specific enolase (NSE) thyroglobulin in serum or other body fluid, in the monitoring of malignancy or in the detection or monitoring of gestational trophoblastic disease or a hepatic or germ cell tumour—quantitation—one test

24.35

66651

A test described in item 66650, if rendered by a receiving APP, if no tests in the item have been rendered by the referring APP—one test

24.35

66652

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

20.30

66653

Two or more tests described in item 66650

44.60

66655

Prostate specific antigen—quantitation

For any particular patient, applicable not more than once in 12 months

20.15

66656

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

20.15

66659

Prostate specific antigen (PSA), quantitation of 2 or more fractions of PSA and any derived index, including, if performed, a test described in item 66656, in the follow up of a PSA result that lies at or above the age‑related median but below the age‑related, method‑specific 97.5% reference limit

For any particular patient, applicable not more than once in 12 months

37.30

66660

Prostate specific antigen (PSA), quantitation of 2 or more fractions of PSA and any derived index, including, if performed, a test described in item 66656, in the follow up of a PSA result that lies at or above the age‑related, method‑specific 97.5% reference limit, but below 10 µg/L

For any particular patient, applicable not more than 4 times in 12 months

37.30

66662

Quantitation of hormone receptors on proven primary breast or ovarian carcinoma or a metastasis from a breast or ovarian carcinoma or a subsequent lesion in the breast—one or more tests

79.95

66663

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

79.95

66665

Lead quantitation in blood or urine (other than for occupational health screening purposes) to a maximum of 3 tests in 6 months—each test

30.60

66666

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

30.60

66667

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

30.60

66671

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

36.90

66674

Quantitation of:

(a) faecal fat; or

(b) breath hydrogen in response to loading with disaccharides;

one or more tests within 28 days

39.95

66677

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

11.15

66680

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

74.45

66683

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

74.45

66686

Performance of one or more of the following procedures:

(a) growth hormone suppression by glucose loading;

(b) growth hormone stimulation by exercise;

(c) dexamethasone suppression test;

(d) sweat collection by iontophoresis for chloride analysis;

(e) pharmacological stimulation of growth hormone

50.65

66695

Quantitation in blood or urine of hormones and hormone binding proteins—ACTH, aldosterone, androstenedione, C‑peptide, calcitonin, cortisol, DHEAS, 11‑deoxycortisol, dihydrotestosterone, FSH, gastrin, glucagon, growth hormone, hydroxyprogesterone, insulin, LH, oestradiol, oestrone, progesterone, prolactin, PTH, renin, sex hormone binding globulin, somatomedin C(IGF –1), free or total testosterone, urine steroid fraction or fractions, vasoactive intestinal peptide—one test

30.50

66696

A test described in item 66695, if rendered by a receiving APP, if no tests in the item have been rendered by the referring APP

30.50

66697

A test described in item 66695, if rendered by a receiving APP, if one or more tests in the item have been rendered by the referring APP—each test to a maximum of 4 tests

13.20

66698

Two tests described in item 66695

43.70

66701

Three tests described in item 66695

56.90

66704

Four tests described in item 66695

70.15

66707

Five or more tests described in item 66695

83.35

66711

Quantitation in saliva of cortisol in:

(a) the investigation of Cushing’s syndrome; or

(b) the management of children with congenital adrenal hyperplasia;

one test

30.15

66712

Two tests described in item 66711

43.05

66714

A test described in item 66711, if rendered by a receiving APP, if no tests in the item have been rendered by the referring APP

30.15

66715

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

12.85

66716

TSH quantitation

25.05

66719

Thyroid function tests (comprising the service described in item 66716 and one or more of the following tests—free thyroxine, free T3, for a patient, if at least one of the following conditions is satisfied:

(a) the patient has an abnormal level of TSH;

(b) the tests are performed:

(i) for the purpose of monitoring thyroid disease in the patient; or

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

(iii) to investigate dementia or psychiatric illness of the patient; or

(iv) to investigate amenorrhoea or infertility of the patient;

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

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

34.80

66722

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

37.90

66723

A test described in item 66722, if rendered by a receiving APP, if no tests in the item have been rendered by the referring APP—one test

37.90

66724

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

13.15

66725

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

51.05

66728

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

64.20

66731

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

77.40

66734

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

90.55

66743

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

20.10

66749

Amniotic fluid, spectrophotometric examination of, and quantitation of:

(a) lecithin/sphingomyelin ratio; or

(b) palmitic acid, phosphatidylglycerol or lamellar body phospholipid; or

(c) bilirubin, including correction for haemoglobin;

one or more tests

32.95

66750

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

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

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

(c) free beta human chorionic gonadotrophin (free beta HCG);

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

(e) unconjugated oestriol (uE3);

(f) alpha‑fetoprotein (AFP);

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

For any particular patient, applicable not more than once in a pregnancy

39.75

66751

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

For any particular patient, applicable not more than once in a pregnancy

55.25

66752

Quantitation of acetoacetate, beta‑hydroxybutyrate, citrate, oxalate, total free fatty acids, cysteine, homocysteine, cystine, lactate, pyruvate or other amino acids and hydroxyproline (except if performed as part of item 66773 or 66776)—one test

24.70

66755

Two or more tests described in item 66752

38.85

66756

Quantitation of 10 or more amino acids for the diagnosis of inborn errors of metabolism—up to 4 tests in 12 months on specimens of plasma, CSF and urine

98.30

66757

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

98.30

66758

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

24.70

66761

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

13.15

66764

Examination for faecal occult blood (including tests for haemoglobin and its derivatives in the faeces except by reagent strip or dip stick methods) with a maximum of 3 examinations on specimens collected on separate days in a 28 day period

8.90

66767

Two examinations described in item 66764 performed on separately collected and identified specimens

17.85

66770

Three examinations described in item 66764 performed on separately collected and identified specimens

26.70

66773

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

24.65

66776

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

24.65

66779

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

39.95

66780

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

39.95

66782

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

13.15

66783

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

13.15

66785

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

39.95

66788

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

65.85

66789

A test described in item 66785 if rendered by a receiving APP, if no tests in the item have been rendered by the referring APP—one test

39.95

66790

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

25.90

66791

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

74.45

66792

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

74.45

66800

Quantitation in blood, urine or other body fluid by any method (except reagent tablet or reagent strip) of any of the following used therapeutically by the patient from whom the specimen was taken: amikacin, carbamazepine, digoxin, disopyramide, ethanol, ethosuximide, gentamicin, lignocaine, lithium, netilmicin, paracetamol, phenobarbitone, phenytoin, primidone, procainamide, quinidine, salicylate, theophylline, tobramycin, valproate or vancomycin—one test

18.15

66803

Two tests described in item 66800

30.50

66804

A test described in item 66800 if rendered by a receiving APP, if no tests in the item have been rendered by the referring APP—one test

18.15

66805

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

12.35

66806

Three tests described in item 66800

41.85

66812

Quantitation, not elsewhere described in this table by any method or methods, in blood, urine or other body fluid, of a drug being used therapeutically by the patient from whom the specimen was taken—one test

34.80

66815

Two tests described in item 66812

59.55

66816

A test described in item 66812 if rendered by a receiving APP, if no tests in the item have been rendered by the referring APP—one test

34.80

66817

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

24.75

66819

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

30.60

66820

A test described in item 66819 if rendered by a receiving APP, if no tests in the item have been rendered by the referring APP—one test

30.60

66821

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

21.80

66822

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

52.45

66825

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

30.60

66826

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

30.60

66827

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

21.80

66828

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

52.45

66830

Quantitation of BNP or NT‑proBNP for the diagnosis of heart failure in patients presenting with dyspnoea in a hospital emergency department

For any particular patient, applicable not more than 6 times in 12 months

58.50

66831

Quantitation of copper or iron in liver tissue biopsy

30.95

66832

A test described in item 66831 if rendered by a receiving APP

30.95

66833

25‑hydroxyvitamin D, quantification in serum, for the investigation of a patient who:

(a) has signs or symptoms of osteoporosis or osteomalacia; or

(b) has increased alkaline phosphatase and otherwise normal liver function tests; or

(c) has hyperparathyroidism, hypo‑ or hypercalcaemia, or hypophosphataemia; or

(d) is suffering from malabsorption (for example, because the patient has cystic fibrosis, short bowel syndrome, inflammatory bowel disease or untreated coeliac disease, or has had bariatric surgery); or

(e) has deeply pigmented skin, or chronic and severe lack of sun exposure for cultural, medical, occupational or residential reasons; or

(f) is taking medication known to decrease 25OH‑D levels (for example, anticonvulsants); or

(g) has chronic renal failure or is a renal transplant recipient; or

(h) is less than 16 years of age and has signs or symptoms of rickets; or

(i) is an infant whose mother has established vitamin D deficiency; or

(j) is an exclusively breastfed baby and has at least one other risk factor mentioned in a paragraph in this item; or

(k) has a sibling who is less than 16 years of age and has vitamin D deficiency

30.05

66834

A test described in item 66833 if rendered by a receiving APP

30.05

66835

1, 25‑dihydroxyvitamin D—quantification in serum, if the request for the test is made by, or on advice of, the specialist or consultant physician managing the treatment of the patient

39.05

66836

1, 25‑dihydroxyvitamin D—quantification in serum, if:

(a) a patient has hypercalcaemia; and

(b) the request for the test is made by a medical practitioner (other than a specialist or consultant physician) managing the treatment of the patient

39.05

66837

A test described in item 66835 or 66836 if rendered by a receiving APP

39.05

66838

Serum vitamin B12 test

For any particular patient, applicable not more than once in 12 months

23.60

66839

Quantification of vitamin B12 markers such as holoTranscobalamin or methylmalonic acid, if initial serum vitamin B12 result is low or equivocal

42.95

66840

Serum folate test and, if required, red cell folate test for a patient at risk of folate deficiency, including patients with malabsorption conditions, macrocytic anaemia or coeliac disease

23.60

66841

Quantitation of HbA1c (glycated haemoglobin) performed for the diagnosis of diabetes in asymptomatic patients at high risk

For any particular patient, applicable not more than once in 12 months

16.80

66900

Carbon‑labelled urea breath test using oral C‑13 or C‑14 urea, including the measurement of exhaled 13 CO2 or 14 CO2, (except if item 12533 of the general medical services table applies) for:

(a) the confirmation of Helicobacter pylori colonisation; or

(b) the monitoring of the success of eradication of Helicobacter pylori

77.65

Division 2.3Group P3: microbiology2.3.1Meaning of serial examinations or cultures

For an item in Group P3 (Microbiology):

serial examinations or cultures means:

  1. (a)

    a series of examinations or cultures requested on one occasion whether or not:

    1. (i)

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

    2. (ii)

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

  2. (b)

    if:

    1. (i)

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

    2. (ii)

      specimen material from the patient episode is stored; and

    3. (iii)

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

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

2.3.2Antigen detection

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

2.3.3Investigation for hepatitis serology

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

2.3.4Limitation on certain items
  1. (1)

    For any particular patient, items 69445 and 69451 are applicable not more than 4 times (in total for both items) in 12 months.

  2. (2)

    For any particular patient, items 69488 and 69489 are applicable not more than twice (in total for both items) in 12 months.

  3. (3)

    For any particular patient, items 69491 and 69492 are applicable not more than once (in total for both items) in 12 months.

  4. (4)

    For any particular patient, items 69499 and 69500 are applicable not more than once (in total for both items) in 12 months.

Group P3—Microbiology

Column 1

Item

Column 2

Pathology service

Column 3

Fee ($)

69300

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

(a) differential cell count; or

(b) examination for dermatophytes; or

(c) dark ground illumination; or

(d) stained preparation or preparations using any relevant stain or stains;

one or more tests

12.50

69303

Culture and (if performed) microscopy to detect pathogenic micro‑organisms from nasal swabs, throat swabs, eye swabs and ear swabs (except swabs taken for epidemiological surveillance), including (if performed):

(a) pathogen identification and antibiotic susceptibility testing; or

(b) a service described in item 69300;

specimens from one or more sites

22.00

69306

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

(a) pathogen identification and antibiotic susceptibility testing; or

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

one or more tests on one or more specimens

33.75

69309

Microscopy and culture to detect dermatophytes and other fungi causing cutaneous disease, from skin scrapings, skin biopsies, hair and nails (excluding swab specimens) and including (if performed):

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

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

one or more tests on one or more specimens

48.15

69312

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

(a) pathogen identification and antibiotic susceptibility testing; or

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

one or more tests on one or more specimens

33.75

69316

Detection of Chlamydia trachomatis by any method—one test

28.65

69317

This item applies if:

(a) one test described in item 69316 is performed; and

(b) one test described in item 69494 is performed

35.85

69318

Microscopy and culture to detect pathogenic micro‑organisms from specimens of sputum (except when part of items 69324, 69327 and 69330), including (if performed):

(a) pathogen identification and antibiotic susceptibility testing; or

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

one or more tests on one or more specimens

33.75

69319

This item applies if:

(a) one test described in item 69316 is performed; and

(b) 2 tests described in item 69494 are performed

42.95

69321

Microscopy and culture of post‑operative wounds, aspirates of body cavities, synovial fluid, CSF or operative or biopsy specimens, for the presence of pathogenic micro‑organisms involving aerobic and anaerobic cultures and the use of different culture media, and including (if performed):

(a) pathogen identification and antibiotic susceptibility testing; or

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

specimens from one or more sites

48.15

69324

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

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

(b) pathogen identification and antibiotic susceptibility testing;

including a service mentioned in item 69300

43.00

69325

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

43.00

69327

Microscopy (with appropriate stains) and culture for mycobacteria—2 specimens of sputum, urine or other body fluids or operative or biopsy specimens, including (if performed):

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

(b) pathogen identification and antibiotic susceptibility testing;

including a service described in item 69300

85.00

69328

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

85.00

69330

Microscopy (with appropriate stains) and culture for mycobacteria—3 specimens of sputum, urine or other body fluids or operative or biopsy specimens, including (if performed):

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

(b) pathogen identification and antibiotic susceptibility testing;

including a service described in item 69300

128.00

69331

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

128.00

69333

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

(a) cell count; and

(b) culture; and

(c) colony count; and

(d) (if performed) stained preparations; and

(e) (if performed) identification of cultured pathogens; and

(f) (if performed) antibiotic susceptibility testing; and

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

20.55

69336

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

(a) a concentration technique; and

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

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

For any particular patient, applicable not more than once in 7 days

33.45

69339

Microscopy of faeces for ova, cysts and parasites using concentration techniques examined after examination described in item 69336 performed on a separately collected and identified specimen collected within 7 days of the examination described in item 69336—not more than one examination in 7 days

19.10

69345

Culture and (if performed) microscopy without concentration techniques of faeces for faecal pathogens, using at least 2 selective or enrichment media and culture in at least 2 different atmospheres including (if performed):

(a) pathogen identification and antibiotic susceptibility testing; and

(b) the detection of clostridial toxins; and

(c) a service described in item 69300;

not more than one examination in 7 days

52.90

69354

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

(a) identification of any cultured pathogen; and

(b) necessary antibiotic susceptibility testing;

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

30.75

69357

Two sets of cultures described in item 69354

61.45

69360

Three sets of cultures described in item 69354

92.20

69363

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

28.65

69378

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

180.25

69379

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

180.25

69380

Genotypic testing for HIV antiretroviral resistance in a patient with confirmed HIV infection if the patient’s viral load is greater than 1,000 copies per ml at any of the following times:

(a) at presentation;

(b) before antiretroviral therapy;

(c) when treatment with combination antiretroviral agents fails;

maximum of 2 tests in 12 months

770.30

69381

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

180.25

69382

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

180.25

69383

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

180.25

69384

Quantitation of one antibody to microbial antigens not elsewhere described in this table—one test

15.65

69387

Two tests described in item 69384

29.00

69390

Three tests described in item 69384

42.35

69393

Four tests described in item 69384

55.70

69396

Five or more tests described in item 69384

69.10

69400

A test described in item 69384 if rendered by a receiving APP, if no tests in the item have been rendered by the referring APP—one test

15.65

69401

A test described in item 69384 if a referring APP has performed a test or tests described in item 69384—each test to a maximum of 4 tests

13.35

69405

Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:

(a) the determination of one of the following: rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody; and

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

15.65

69408

Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:

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

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

29.00

69411

Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:

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

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

42.35

69413

Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:

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

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

55.70

69415

Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:

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

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

69.10

69445

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

92.20

69451

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

92.20

69471

Test of cell‑mediated immune response in blood for the detection of latent tuberculosis by interferon gamma release assay (IGRA) in the following people:

(a) a person who has been exposed to a confirmed case of active tuberculosis;

(b) a person who is infected with human immunodeficiency virus;

(c) a person who is to commence, or has commenced, tumour necrosis factor (TNF) inhibitor therapy;

(d) a person who is to commence, or has commenced, renal dialysis;

(e) a person with silicosis;

(f) a person who is, or is about to become, immunosuppressed because of a disease, or a medical treatment, not mentioned in paragraphs (a) to (e)

34.90

69472

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

15.65

69474

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

28.65

69475

Detection of hepatitis antigens or antibodies to determine immune status or viral carriage following exposure or vaccination to Hepatitis A, Hepatitis B, Hepatitis C or Hepatitis D—one test

15.65

69478

Two tests described in item 69475

29.25

69481

Investigation of infectious causes of acute or chronic hepatitis—3 tests described in item 69475

40.55

69482

Quantitation of hepatitis B viral DNA in patients who are hepatitis B surface antigen positive and have chronic hepatitis B but are not receiving antiviral therapy—one test

For any particular patient, applicable not more than once in 12 months

152.10

69483

Quantitation of hepatitis B viral DNA in patients who:

(a) are hepatitis B surface antigen positive; and

(b) have chronic hepatitis B; and

(c) are receiving antiviral therapy;

one test

For any particular patient, applicable not more than 4 times in 12 months

152.10

69484

Supplementary test for hepatitis B surface antigen or hepatitis C antibody using a different assay on a specimen that yielded a reactive result on initial testing

17.10

69488

Quantitation of HCV RNA load in plasma or serum in:

(a) the pre‑treatment evaluation, of a patient with chronic HCV hepatitis, for antiviral therapy; or

(b) the assessment of efficacy of antiviral therapy for such a patient;

(including a service described in item 69445 or 69499)

180.25

69489

A test described in item 69488 if the test is performed by a receiving APP

180.25

69491

Nucleic acid amplification and determination of hepatitis C virus (HCV) genotype, if the patient is HCV RNA positive and is being evaluated for antiviral therapy of chronic HCV hepatitis

204.80

69492

A service described in item 69491 if the test is performed by a receiving APP

204.80

69494

Detection of a virus, microbial antigen or microbial nucleic acid (not elsewhere described in this table)—one test

28.65

69495

Two tests described in item 69494

35.85

69496

Three or more tests described in item 69494

43.05

69497

This item applies to a test described in item 69494 if:

(a) a referring APP has not performed the test described in item 69494; and

(b) a receiving APP performs the test described in item 69494;

one test

28.65

69498

This item applies to a test described in item 69494 if:

(a) a referring APP has performed the test or tests described in item 69494; and

(b) a receiving APP has performed the test or tests described in item 69494;

one test

7.20

69499

Detection of hepatitis C viral RNA if:

(a) 2 different assays of Hepatitis C antibodies in the patient are positive or inconclusive; or

(b) 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 if considered necessary for the clinical management of the patient

92.20

69500

A test described in item 69499 if the test is performed by a receiving APP

92.20

Division 2.4Group P4: immunology2.4.1Tests in Group P4 relating to antibodies

For items 71119, 71121, 71123 and 71125, if:

  1. (a)

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

  2. (b)

    specimen material from the patient episode is stored; and

  3. (c)

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

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

2.4.2HLA‑B27 typing

If a pathology service mentioned in item 71148 is rendered as a pathologist‑determinable service, the item is not applicable to the pathology service unless the recognised pathologist who renders the service records, in writing:

  1. (a)

    the reasons for rendering the service; and

  2. (b)

    the result of the pathology service mentioned in item 71147.

2.4.3Antineutrophil cytoplasmic antibody tests

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

  1. (a)

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

  2. (b)

    a previous immunofluorescence test was abnormal; or

  3. (c)

    those antibodies have been previously detected.

Group P4—Immunology

Column 1

Item

Column 2

Pathology service

Column 3

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

(b) presence and amount of paraprotein;

including the preliminary quantitation of total protein, albumin and globulin—one specimen type

32.90

71058

Examination as described in item 71057—2 or more specimen types

50.50

71059

Immunofixation, immunoelectrophoresis or isoelectric focusing of:

(a) urine for detection of Bence Jones proteins; or

(b) serum, plasma, or other body fluid;

and characterisation of a paraprotein or cryoglobulin—examination of one specimen type (e.g. serum, urine or CSF)

35.65

71060

Examination as described in item 71059 of 2 or more specimen types

44.05

71062

Electrophoresis and immunofixation or immunoelectrophoresis or isoelectric focusing of CSF for the detection of oligoclonal bands and including if required electrophoresis of the patient’s serum for comparison purposes—one or more tests

44.05

71064

Detection and quantitation of cryoglobulins or cryofibrinogen—one or more tests

20.75

71066

Quantitation of total immunoglobulin A (by any method) in serum, urine, or other body fluid—one test

14.55

71068

Quantitation of total immunoglobulin G (by any method) in serum, urine, or other body fluid—one test

14.55

71069

Two tests described in item 71066, 71068, 71072 or 71074

22.75

71071

Three or more tests described in item 71066, 71068, 71072 or 71074

30.95

71072

Quantitation of total immunoglobulin M (by any method) in serum, urine, or other body fluid—one test

14.55

71073

Quantitation of all 4 immunoglobulin G subclasses

106.15

71074

Quantitation of total immunoglobulin D (by any method) in serum, urine, or other body fluid—one test

14.55

71075

Quantitation of immunoglobulin E (total)—one test

For any particular patient, applicable not more than twice in 12 months

23.00

71076

A test described in item 71073 if the test is performed by a receiving APP—one test

106.15

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—one test

For any particular patient, applicable not more than 6 times in 12 months

27.05

71079

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

For any particular patient, applicable not more than 4 times in 12 months

26.80

71081

Quantitation of total haemolytic complement

40.55

71083

Quantitation of complement components C3 and C4 or properdin factor B—one test

20.15

71085

Two tests described in item 71083

28.95

71087

Three or more tests described in item 71083

37.70

71089

Quantitation of complement components or breakdown products of complement proteins not elsewhere described in an item in this table—one test

29.15

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

(b) a receiving APP performs the test described in item 71089;

one test

29.15

71091

Two tests described in item 71089

52.85

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;

one test

23.70

71093

Three or more tests described in item 71089

76.45

71095

Quantitation of serum or plasma eosinophil cationic protein, or both, to a maximum of 3 assays in 12 months, for monitoring the response to therapy in corticosteroid treated asthma, in a child aged less than 12 years

40.55

71096

A test described in item 71095 if the quantitation is performed by a receiving APP

40.55

71097

Antinuclear antibodies—detection in serum or other body fluids, including quantitation if required

24.45

71099

Double‑stranded DNA antibodies—quantitation by one or more methods other than the Crithidia method

26.50

71101

Antibodies to one or more extractable nuclear antigens—detection in serum or other body fluids

17.40

71103

Characterisation of an antibody detected in a service described in item 71101 (including that service)

52.05

71106

Rheumatoid factor—detection by any technique in serum or other body fluids, including quantitation if required

11.30

71119

Antibodies to tissue antigens not elsewhere specified in this table—detection of one antibody, including quantitation if required

17.35

71121

Detection of 2 antibodies specified in item 71119

20.80

71123

Detection of 3 antibodies specified in item 71119

24.25

71125

Detection of 4 or more antibodies specified in item 71119

27.65

71127

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

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

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

(c) estimation of one or more mixed lymphocyte reactions;

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

For any particular patient, applicable not more than twice in 12 months

176.35

71129

Two tests described in item 71127

217.85

71131

Three or more tests described in item 71127

259.35

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

10.40

71134

Investigation of recurrent infection, by quantitative assessment, of oxidative pathways by flow cytometric techniques, including a test described in item 71133 (if performed)

104.05

71135

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

(a) chemotaxis;

(b) phagocytosis;

(c) oxidative metabolism;

(d) bactericidal activity;

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

For any particular patient, applicable not more than twice in 12 months

207.95

71137

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

For any particular patient, applicable not more than twice in 12 months

30.25

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 one or more specimens of blood, CSF or serous fluid

104.05

71141

Characterisation of 3 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations on one or more disaggregated tissue specimens

197.35

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 one or both of items 71139 and 71141 (if performed), on a specimen of blood, CSF, serous fluid or disaggregated tissue

260.00

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 one or more of items 71139, 71141 and 71143 (if performed) on 2 or more specimens of disaggregated tissues or one specimen of disaggregated tissue and one or more specimens of blood, CSF or serous fluid

424.50

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

104.05

71147

HLA‑B27 typing

40.55

71148

A test described in item 71147 if a receiving APP performs the test

40.55

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

108.25

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

118.85

71153

Testing, for assessment or diagnosis of systemic inflammatory disease or vasculitis, for the presence of an antibody by one 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;

(d) antiglomerular basement membrane antibody (GBM ANCA) test

34.55

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

(b) a receiving APP performs the test described in item 71153;

one test

34.55

71155

Testing for the presence of 2 antibodies by tests mentioned in item 71153

47.45

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;

one test

12.85

71157

Testing for the presence of 3 antibodies by tests mentioned in item 71153

60.30

71159

Testing for the presence of 4 antibodies by tests mentioned in item 71153

73.15

71163

Detection of one of the following antibodies (of one 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;

one test

24.75

71164

Two or more tests mentioned in item 71163, including a service described in item 71066 (if performed)

39.90

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, thyroglobulin, thyroid microsome or thyroid stimulating hormone receptor)—detection of one antibody, including quantitation if required

34.55

71166

Detection of 2 antibodies described in item 71165

47.45

71167

Detection of 3 antibodies described in item 71165

60.30

71168

Detection of 4 or more antibodies described in item 71165

73.15

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

34.55

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

2.11.3Circumstances in which an item in Group P11 does not apply
  1. (1)

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

    1. (a)

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

    2. (b)

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

  2. (2)

    An approved pathology authority is related to another approved pathology authority for the purposes of subclause (1) if:

    1. (a)

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

    2. (b)

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

    3. (c)

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

    4. (d)

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

    5. (e)

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

    6. (f)

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

  3. (3)

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

Group P11—Specimen referred

Column 1

Item

Column 2

Pathology service

Column 3

Fee ($)

73940

Receipt of a specimen by an approved pathology practitioner of an approved pathology authority from another approved pathology practitioner of another approved pathology authority

10.25

Division 2.12Group P12: management of bulk‑billed services2.12.1Application of items 74990 and 74991
  1. (1)

    Despite clause 1.1:

    1. (a)

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

    2. (b)

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

  2. (2)

    For items 74990 and 74991:

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

unreferred servicemeans a pathology service that:

  1. (a)

    is provided to a person by, or on behalf of, a medical practitioner who is:

    1. (i)

      not a specialist or consultant physician; or

    2. (ii)

      both a specialist or consultant physician and a general practitioner; and

  2. (b)

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

  1. (3)

    For item 74991:

eligible areahas the meaning given by clause 2.34.1 of the general medical services table.

practice location, for the provision of a pathology service, means the place of practice for which the practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Chief Executive Medicare.

Group P12—Management of bulk‑billed services

Column 1

Item

Column 2

Pathology service

Column 3

Fee ($)

74990

A pathology service to which an item in this table (other than this item or item 74991) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under 16 years or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulk‑billed in respect of the fees for:

(i) this item; and

(ii) the other item in this table applying to the service

14.10

74991

A pathology service to which an item in this table (other than this item or item 74990) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under 16 years or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulk‑billed in respect of the fees for:

(i) this item; and

(ii) the other item in this table applying to the service; and

(e) the service is provided at, or from, a practice location in an eligible area

21.30

Division 2.13Group P13: bulk‑billing incentive

Note: The payments mentioned in column 3 of Group P13 are additional payments for bulk‑billing a patient episode consisting of a pathology service to which a Group P10 item described in column 2 applies or a pathology service to which a Group P11 item described in column 2 applies.

Group P13—Bulk‑billing incentive

Column 1

Item

Column 2

Pathology service

Column 3

Fee ($)

74992

A patient episode that:

(a) consists of a pathology service to which item 73920 applies; and

(b) is bulk‑billed

1.60

74993

A patient episode that:

(a) consists of a pathology service to which item 73922 or 73926 applies; and

(b) is bulk‑billed

3.75

74994

A patient episode that:

(a) consists of a pathology service to which item 73924 applies; and

(b) is bulk‑billed

3.25

74995

A patient episode that:

(a) consists of a pathology service to which item 73899, 73900, 73928, 73930 or 73936 applies; and

(b) is bulk‑billed

4.00

74996

A patient episode that:

(a) consists of a pathology service to which item 73932 or 73940 applies; and

(b) is bulk‑billed

3.70

74997

A patient episode that:

(a) consists of a pathology service item 73934 applies; and

(b) is bulk‑billed

3.30

74998

A patient episode that:

(a) consists of a pathology service to which item 73938 applies; and

(b) is bulk‑billed

2.00

74999

A patient episode that:

(a) consists of a pathology service to which item 73923, 73925, 73927, 73929, 73931, 73933, 73935, 73937 or 73939 applies; and

(b) is bulk‑billed

1.60

Part 3Complexity levels for histopathology items3.1Complexity levels

For the purposes of subclause 2.5.2(4), this Part sets out complexity levels for specimen types.

Complexity levels for histopathology items

Column 1

Specimen type

Column 2

Complexity level

Adrenal resection, neoplasm

5

Adrenal resection, not neoplasm

4

Anus, all specimens not otherwise specified

3

Anus, neoplasm, biopsy

4

Anus, neoplasm, radical resection

6

Anus, submucosal resection—neoplasm

5

Appendix

3

Artery, all specimens not otherwise specified

3

Artery, biopsy

4

Bartholin’s gland—cyst

3

Bile duct, resection—all specimens

6

Bone—all specimens not otherwise specified

4

Bone, biopsy, curettings or fragments—lesion

5

Bone, biopsy or curettings quantitation—metabolic disease

6

Bone, femoral head

4

Bone marrow, biopsy

4

Bone, resection, neoplasm—all sites and types

6

Brain neoplasm, resection—cerebello‑pontine angle

4

Brain or meninges, biopsy—all lesions

5

Brain or meninges, not neoplasm—temporal lobe

6

Brain or meninges, resection—neoplasm (intracranial)

5

Brain or meninges, resection—not neoplasm

4

Branchial cleft, cyst

4

Breast, excision biopsy, guidewire localisation—non‑palpable lesion

6

Breast, excision biopsy, or radical resection, malignant neoplasm or atypical proliferative disease—all specimen types

6

Breast, incision biopsy or needle biopsy, malignant neoplasm—all specimen types

4

Breast, microdochectomy

6

Breast, orientated wide local excision for carcinoma with margin assessment

7

Breast tissue—all specimens not otherwise specified

4

Bronchus, biopsy

4

Carotid body—neoplasm

5

Cholesteatoma

3

Digits, amputation—not traumatic

4

Digits, amputation—traumatic

2

Ear, middle and inner—not cholesteatoma

4

Endocrine neoplasm—not otherwise specified

5

Extremity, amputation—not otherwise specified

4

Extremity, amputation or disarticulation—neoplasm

6

Eye, conjunctiva—biopsy or pterygium

3

Eye, cornea

4

Eye, enucleation or exenteration—all lesions

6

Eye—not otherwise specified

4

Fallopian tube, biopsy

4

Fallopian tube, ectopic pregnancy

4

Fallopian tube, sterilisation

2

Fetus with dissection

6

Foreskin—new born

2

Foreskin—not new born

3

Gallbladder

3

Gallbladder and porta hepatis‑radical resection

6

Ganglion cyst, all sites

3

Gum or oral mucosa, biopsy

4

Heart—not otherwise specified

5

Heart valve

4

Hernia sac

2

Hydrocele sac

2

Jaw, upper or lower, including bone—radical resection for neoplasm

6

Joint and periarticular tissue, without bone—all specimens

3

Joint tissue, including bone—all specimens

4

Kidney, biopsy including transplant

5

Kidney, nephrectomy transplant

5

Kidney, partial or total nephrectomy—not neoplasm

4

Kidney, partial or total nephrectomy or nephroureterectomy—neoplasm

6

Large bowel, colostomy—stoma

3

Large bowel (including rectum), biopsy—all sites

4

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

5

Large bowel (including rectum), polyp

4

Large bowel (including rectum), segmental resection—neoplasm

6

Large bowel (including rectum), submucosal resection—neoplasm

5

Large bowel, segmental resection—colon, not neoplasm

5

Larynx, biopsy

4

Larynx, partial or total resection

5

Larynx, resection with nodes or pharynx or both

6

Lip biopsy—all specimens not mentioned

3

Lip wedge resection or local excision with orientation

4

Liver—all specimens not otherwise specified

5

Liver, hydatid cyst or resection for trauma

4

Liver, total or subtotal hepatectomy—neoplasm

6

Lung, needle or transbronchial biopsy

4

Lung, resection—neoplasm

6

Lung segment, lobar or total resection

6

Lung, wedge biopsy

5

Lymph node, biopsy—all sites

4

Lymph node, biopsy, for lymphoma or lymphoproliferative disorder

5

Lymph nodes, regional resection—all sites

5

Mediastinum mass

5

Muscle, biopsy

6

Nasopharynx or oropharynx, biopsy

4

Nerve, biopsy neuropathy

5

Nerve, neurectomy or removal of neoplasm

4

Nerve—not otherwise specified

3

Nose, mucosal biopsy

4

Nose or sinuses, polyps

3

Odontogenic neoplasm

5

Odontogenic or dental cyst

4

Oesophagus, biopsy

4

Oesophagus, diverticulum

3

Oesophagus, partial or total resection

6

Oesophagus, submucosal resection—neoplasm

5

Omentum, biopsy

4

Ovary with or without tube—neoplasm

5

Ovary with or without tube—not neoplasm

4

Pancreas, biopsy

5

Pancreas, cyst

4

Pancreas, subtotal or total with or without splenectomy

6

Parathyroid gland(s)

4

Penisectomy—simple

4

Penisectomy with node dissection

5

Peritoneum, biopsy

4

Pituitary neoplasm

4

Placenta—not third trimester

4

Placenta—third trimester, abnormal pregnancy or delivery

4

Pleura or pericardium, biopsy or tissue

4

Products of conception, spontaneous or missed abortion

4

Products of conception, termination of pregnancy

3

Prostate—all types of specimen not otherwise specified

4

Prostate, radical prostatectomy or cystoprostatectomy for carcinoma

7

Prostate, radical resection

6

Retroperitoneum, neoplasm

5

Salivary gland—all specimens not otherwise specified

4

Salivary gland, Mucocele

3

Salivary gland, neoplasm—all sites

5

Sinus, paranasal, biopsy

4

Sinus, paranasal, resection—neoplasm

6

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

3

Skin, biopsy—blistering skin diseases

4

Skin, biopsy—inflammatory dermatosis

4

Skin, biopsy—investigation of alopecia if serial horizontal sections are taken, except for male pattern baldness

5

Skin, biopsy—investigation of lymphoproliferative disorder

5

Skin, eyelid, wedge resection

4

Skin, local resection—orientation

4

Skin, resection of malignant melanoma or melanoma in situ

5

Small bowel—all specimens not otherwise specified

5

Small bowel—biopsy, all sites

4

Small bowel, diverticulum

3

Small bowel, resection—neoplasm

6

Small bowel, submucosal resection—neoplasm

5

Soft tissue, infiltrative lesion—extensive resections at least 5 cm in maximal dimension

6

Soft tissue, lipoma and variants

3

Soft tissue, neoplasm, not lipoma—all specimens

5

Soft tissue—not otherwise specified

4

Spleen

5

Stomach—all specimens not otherwise specified

4

Stomach, endoscopic biopsy or endoscopic polypectomy

4

Stomach, resection, neoplasm—all specimens

6

Stomach, submucosal resection—neoplasm

5

Tendon or tendon sheath, giant cell neoplasm

4

Tendon or tendon sheath—not otherwise specified

3

Testis and adjacent structures, castration

2

Testis and adjacent structures, neoplasm with or without nodes

5

Testis and adjacent structures—not otherwise specified

3

Testis and adjacent structures, vas deferens sterilisation

2

Testis, biopsy

5

Thymus—not otherwise specified

5

Thyroglossal duct—all lesions

4

Thyroid—all specimens

5

Tissue or organ—all specimens not otherwise specified

3

Tissue or organ not otherwise specified, abscess

3

Tissue or organ not otherwise specified, haematoma

3

Tissue or organ not otherwise specified, malignant neoplasm with regional nodes

6

Tissue or organ not otherwise specified, neoplasm local

4

Tissue or organ not otherwise specified, pilonidal cyst or sinus

3

Tissue or organ not otherwise specified, thrombus or embolus

3

Tissue or organ not otherwise specified, veins varicosity

3

Tongue, biopsy

4

Tongue or tonsil, neoplasm local

5

Tongue or tonsil, neoplasm with nodes

6

Tonsil, biopsy—excluding resection of whole organ

4

Tonsil or adenoids or both

2

Trachea, biopsy

4

Ureter, biopsy

4

Ureter, resection

5

Urethra, biopsy

4

Urethra, resection

5

Urinary bladder—all specimens not otherwise specified

4

Urinary bladder, partial or total with or without prostatectomy

6

Urinary bladder, transurethral resection of neoplasm

5

Uterus and/or cervix—all specimens not otherwise specified

4

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

5

Uterus, cervix, curettings or biopsy

4

Uterus, endocervix, polyp

3

Uterus, endometrium, polyp

3

Uterus, with or without adnexa, malignant neoplasm—all specimen types not otherwise specified

6

Uterus with or without adnexa, neoplasm, Wertheim’s or pelvic clearance

6

Vagina, biopsy

4

Vaginal mucosa, incidental

3

Vagina, radical resection

6

Vulva or labia, biopsy

4

Vulval, subtotal or total with or without nodes

6

Part 4Dictionary4.1Dictionary

Note: All references in this clause to a provision are references to a provision in this table, unless otherwise indicated.

In this table:

abnormal level of TSH, for item 66719, has the meaning given by clause 2.2.4.

Act means the Health Insurance Act 1973.

approved collection centre, for Group P10, has the meaning given by clause 2.10.1.

biopsy material, for Group P5, has the meaning given by clause 2.5.1.

bulk‑billed: a pathology service is bulk‑billed if:

  1. (a)

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

  2. (b)

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

    1. (i)

      the person assigns to the practitioner by whom, or on whose behalf, the service is provided, the person’s right to the payment of the medicare benefit; and

    2. (ii)

      the practitioner accepts the assignment in full payment of the practitioner’s fee for the service provided.

Commonwealth concession card holder, for items 74990 and 74991, has the meaning given by subclause 2.12.1(2).

compatibility tests by crossmatch, for items 65099 and 65102, has the meaning given by clause 2.1.2.

designated test, has the meaning given by clause 1.4.

elevated serum ferritin, for items 73317 and 73318, has the meaning given by clause 2.7.1.

eligible area, for item 74991, has the meaning given by subclause 2.12.1(3).

group, for a group in this table, means every item in the group.

institution, for Group P10, has the meaning given by clause 2.10.1.

patient episode means:

  1. (a)

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

    1. (i)

      on the same day; or

    2. (ii)

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

whether the services:

  1. (iii)

    are requested by one or more practitioners, participating midwives or participating nurse practitioners; or

  2. (iv)

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

  3. (v)

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

  4. (vi)

    are rendered on the same or different days; or

  1. (b)

    a pathology service to which clause 1.3, 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, has the meaning given by subclause 2.12.1(3).

prescribed laboratory, for Group P10, has the meaning given by clause 2.10.1.

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

  1. (a)

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

  2. (b)

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

recognised pathologist means:

  1. (a)

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

  2. (b)

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

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

  1. (a)

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

  2. (b)

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

  3. (c)

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

    1. (i)

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

    2. (ii)

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

  4. (d)

    renders each test included in the designated test, other than the test or tests 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 Group P10, has the meaning given by clause 2.10.1.

separately identified specimen, for Group P5, has the meaning given by clause 2.5.1.

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

  1. (a)

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

  2. (b)

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

serial examinations or cultures, for Group P3, has the meaning given by clause 2.3.1.

set of pathology services, has the meaning given by clause 1.7.

treating practitioner has the same meaning as in subsection 16A(1) of the Act.

unreferred service, for items 74990 and 74991, has the meaning given by subclause 2.12.1(3).

Endnotes

Endnote 1About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

Endnote 2Abbreviation key

ad = added or inserted

o = order(s)

am = amended

Ord = Ordinance

amdt = amendment

orig = original

c = clause(s)

par = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

/sub‑subparagraph(s)

Ch = Chapter(s)

pres = present

def = definition(s)

prev = previous

Dict = Dictionary

(prev…) = previously

disallowed = disallowed by Parliament

Pt = Part(s)

Div = Division(s)

r = regulation(s)/rule(s)

ed = editorial change

reloc = relocated

exp = expires/expired or ceases/ceased to have

renum = renumbered

effect

rep = repealed

F = Federal Register of Legislation

rs = repealed and substituted

gaz = gazette

s = section(s)/subsection(s)

LA = Legislation Act 2003

Sch = Schedule(s)

LIA = Legislative Instruments Act 2003

Sdiv = Subdivision(s)

(md) = misdescribed amendment can be given

SLI = Select Legislative Instrument

effect

SR = Statutory Rules

(md not incorp) = misdescribed amendment

Sub‑Ch = Sub‑Chapter(s)

cannot be given effect

SubPt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

commenced or to be commenced

Endnote 3Legislation history

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (Pathology Services Table) Regulations 2019

8 Apr 2019 (F2019L00568)

1 July 2019 (s 2(1) item 1)

Health Insurance Legislation Amendment (Bulk‑billing Incentive) Regulations 2020

29 Mar 2020 (F2020L00341)

Sch 1 (items 5, 6): 30 Mar 2020 (s 2(1) item 2)

—

Endnote 4Amendment history

Provision affected

How affected

s 2.............................................

rep LA s 48D

s 6.............................................

rep LA s 48C

Schedule 1

Part 2

Division 2.12

Group P12 Table.........................

am F2020L00341

Schedule 2..................................

rep LA s 48C

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