Health Insurance (Pathology Services Table) Regulations 2020 (Cth)
Health Insurance (Pathology Services Table) Regulations 2020
made under the
Health Insurance Act 1973
Compilation No. 9
Compilation date: 1 January 2022
Includes amendments up to: F2021L01814
Registered: 28 January 2022
About this compilation
This compilation
This is a compilation of the Health Insurance (Pathology Services Table) Regulations 2020 that shows the text of the law as amended and in force on 1 January 2022 (the compilation date).
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.
Uncommenced amendments
The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register ( The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Editorial changes
For more information about any editorial changes made in this compilation, see the endnotes.
Modifications
If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.
Self‑repealing provisions
If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
Contents
1............................ Name............................................................................................................. 1
3............................ Authority....................................................................................................... 1
4............................ Pathology services table................................................................................ 1
Schedule 1—Pathology services table 2
Part 1—Preliminary 2
Division 1.1—Interpretation 2
1.1.1...................... Dictionary..................................................................................................... 2
1.1.2...................... Methodology for services............................................................................. 2
1.1.3...................... References in this Schedule to items include items determined under section 3C of the Act 2
Division 1.2—General application provisions 3
1.2.1...................... Restriction on items—precedence................................................................. 3
1.2.2...................... When services rendered following multiple requests are taken to have been rendered following a single request...................................................................................................................... 3
1.2.3...................... Services to which clause 1.2.2 does not apply—general............................... 3
1.2.4...................... Services to which clause 1.2.2 does not apply—haematology...................... 4
1.2.5...................... Services to which clause 1.2.2 does not apply—chemical............................. 4
1.2.6...................... Referral of designated tests by one pathology practitioner to another............ 5
1.2.7...................... Items not to be split except as stated in clause 1.2.6...................................... 6
1.2.8...................... Services in certain sets of services to be treated as individual services.......... 6
1.2.9...................... Sets of services for the purposes of clause 1.2.8........................................... 7
1.2.10.................... Satisfying requirements in descriptions of services....................................... 8
1.2.11.................... Restriction on items—services rendered with autologous injections of blood or blood products 8
1.2.12.................... Restriction on items—services rendered with harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells....................................................................... 8
1.2.13.................... Restriction on items 66551, 73812 and 73826—timing................................ 8
Division 1.3—Patient episodes 9
1.3.1...................... Meaning of patient episode........................................................................... 9
1.3.2...................... When later services are taken to be part of an earlier patient episode............. 9
Part 2—Services and fees 11
Division 2.1—Group P1: haematology 11
2.1.1...................... Restriction on items 65090 and 65093—services for patients in hospital... 11
2.1.2...................... Items in Group P1....................................................................................... 11
Division 2.2—Group P2: chemical 16
2.2.1...................... Inclusion of measurement of creatinine in services..................................... 16
2.2.2...................... Restriction on vitamins testing items—timing............................................. 16
2.2.3...................... Restriction on metals testing items—timing................................................ 16
2.2.4...................... Items in Group P2....................................................................................... 16
Division 2.3—Group P3: microbiology 27
2.3.1...................... Restriction on certain items—antigen detection services rendered as pathologist‑determinable services 27
2.3.2...................... Fee for certain items in a single patient episode—investigation for hepatitis serology 27
2.3.3...................... Restriction on certain items—timing........................................................... 27
2.3.4...................... Items in Group P3....................................................................................... 27
Division 2.4—Group P4: immunology 35
2.4.1...................... Restriction on item 71148—HLA‑B27 typing services rendered as pathologist‑determinable services 35
2.4.2...................... Items in Group P4....................................................................................... 35
Division 2.5—Group P5: tissue pathology 42
2.5.1...................... Restrictions on items—services performed using material submitted for a Group P6 service 42
2.5.2...................... Restrictions on items—certain biopsy examinations performed in a single patient episode 42
2.5.3...................... Restrictions on items—certain histopathological examinations performed on specimens from a single patient episode........................................................................................................ 42
2.5.4...................... Restriction on items—certain services in Groups P5 and P6 performed in a single patient episode 42
2.5.5...................... Restrictions on items 72858 and 72859...................................................... 42
2.5.5A................... Application of item 72860........................................................................... 43
2.5.6...................... Items in Group P5....................................................................................... 43
Division 2.6—Group P6: cytology 47
2.6.1...................... Restriction on items in Group P6—fee for services performed in a single patient episode 47
2.6.2...................... Items in Group P6....................................................................................... 47
Division 2.7—Group P7: genetics 51
2.7.1A................... Restriction on item 73287—conjunction with item 73388.......................... 51
2.7.1B.................... Restriction on item 73290—conjunction with item 73391.......................... 51
2.7.1...................... Restriction on items 73320 and 73321 (HLA‑B27 detection)—services rendered as pathologist‑determinable services....................................................................................................... 51
2.7.2...................... Restriction on items 73339 and 73340 (relating to RET gene mutations).... 51
2.7.3...................... Restriction on items 73345 to 73350 (relating to cystic fibrosis)—testing methodology 51
2.7.3A................... Items 73384 to 73387 (relating to pre‑implantation genetic testing)—patient eligibility 51
2.7.4...................... Items in Group P7....................................................................................... 52
Division 2.8—Group P8: infertility and pregnancy tests 68
2.8.1...................... Items in Group P8....................................................................................... 68
Division 2.9—Group P9: simple basic pathology tests 69
2.9.1...................... Items in Group P9....................................................................................... 69
Division 2.10—Group P10: patient episode initiation 70
2.10.1.................... Restrictions on items in Group P10—circumstances.................................. 70
2.10.2.................... Items in Group P10..................................................................................... 71
Division 2.11—Group P11: specimen referred 74
2.11.1.................... Restriction on items in Group P11—circumstances.................................... 74
2.11.2.................... Restriction on items in Group P10—patient episodes including a service to which item 73940 applies 74
2.11.3.................... Restrictions on items in Group P11—referrals........................................... 74
2.11.4.................... Items in Group P11..................................................................................... 75
Division 2.12—Group P12: management of bulk‑billed services 76
2.12.1.................... Application of items 74990, 74991, 75861, 75862, 75863 and 75864....... 76
2.12.2.................... Items in Group P12..................................................................................... 76
Division 2.13—Group P13: bulk‑billing incentive 78
2.13.1.................... Items in Group P13..................................................................................... 78
Division 2.14—Indexation of fees 79
2.14.1.................... Indexation—1 July 2021............................................................................. 79
Part 3—Complexity levels for tissue pathology items 80
3.1......................... Complexity levels........................................................................................ 80
Part 4—Dictionary 86
4.1......................... Dictionary................................................................................................... 86
Endnotes89
Endnote 1—About the endnotes 89
Endnote 2—Abbreviation key 90
Endnote 3—Legislation history 91
Endnote 4—Amendment history 93
1 Name
This instrument is the Health Insurance (Pathology Services Table) Regulations 2020.
3 Authority
This instrument is made under the Health Insurance Act 1973.
4 Pathology services table
For the purposes of section 4A of the Health Insurance Act 1973, Schedule 1 is prescribed as a table of pathology services.
Schedule 1—Pathology services table
Note: See section 4.
Part 1—Preliminary
Division 1.1—Interpretation
1.1.1 Dictionary
The Dictionary in Part 4 defines certain words and expressions that are used in this Schedule, and includes references to certain words and expressions that are defined elsewhere in this Schedule.
1.1.2 Methodology for services
If the description of a pathology service in an item in this Schedule does not include the methodology for the service, the methodology by which the service may be carried out includes assay, estimation and test.
Note: A pathology service is deemed to include any necessary interpretation, analysis or reporting—see subsection 3(5A) of the Act.
1.1.3 References in this Schedule to items include items determined under section 3C of the Act
A reference in this Schedule to an item includes a reference to an item relating to a health service that, under a determination in force under subsection 3C(1) of the Act, is treated as if there were an item in the table that relates to the service.
Division 1.2—General application provisions
1.2.1 Restriction on items—precedence
(1) If a service is described:
(a) in an item in general terms; and
(b) in another item in specific terms;
only the item that describes the service in specific terms applies to the service.
(2) Subject to subclause (3), if:
(a) subclause (1) does not apply; and
(b) a service is described in 2 or more items;
only the item that provides the lower or lowest fee for the service applies to the service.
(3) If an item is expressed to include a service that is described in another item, the other item does not apply to the service in addition to the first‑mentioned item, whether or not the services described in the 2 items are requested separately.
1.2.2 When services rendered following multiple requests are taken to have been rendered following a single request
Two or more pathology services (other than services to which, under clause 1.2.3, 1.2.4 or 1.2.5, this clause does not apply) rendered for a patient following 2 or more requests are taken to have been rendered following a single request if:
(a) the services are listed in the same item; and
(b) that item is not item 74990, 74991, 75861, 75862, 75863 or 75864; and
(c) the patient’s need for the services was determined under subsection 16A(1) of the Act on the same day even if the services are rendered by an approved pathology practitioner on more than 1 day.
1.2.3 Services to which clause 1.2.2 does not apply—general
(1) Clause 1.2.2 does not apply to a pathology service described in subclause (2) if:
(a) under a request for a service, other than a request for a service described in paragraph (2)(a), no more than 6 tests are requested; and
(b) the tests are performed within 6 months of the request; and
(c) the pathology provider of the service writes on the account for the service that the service has a “rule 3 exemption”.
(2) For the purposes of subclause (1), the pathology services are:
(a) estimation of prothrombin time (INR) for a patient undergoing anticoagulant therapy; and
(b) quantitative estimation of lithium for a patient undergoing lithium therapy; and
(c) a service described in item 65070 in relation to a patient undergoing chemotherapy for neoplastic disease or immunosuppressant therapy; and
(d) a service described in item 65070 in relation to clozaril, ticlopidine hydrochloride, methotrexate, gold, sulphasalazine or penicillamine therapy of a patient; and
(e) a service described in any of items 66500 to 66512, in relation to methotrexate or leflunomide therapy of a patient; and
(f) quantitative estimation of urea, creatinine and electrolytes in relation to:
(i) cis‑platinum or cyclosporin therapy of a patient; or
(ii) chronic renal failure of a patient being treated in a dialysis program conducted by a recognised hospital; and
(g) quantitative estimation of albumin and calcium in relation to therapy of a patient with vitamin D, its metabolites or analogues; and
(h) quantitative estimation of calcium, phosphate, magnesium, urea, creatinine and electrolytes for a cancer patient receiving bisphosphonate infusions.
1.2.4 Services to which clause 1.2.2 does not apply—haematology
(1) Clause 1.2.2 does not apply to a pathology service described in item 65060, 65070, 65120, 65123, 65126, 65129, 65150, 65153 or 65156 if:
(a) the service is rendered in relation to one or more specimens taken on any of not more than 6 occasions in 24 hours; and
(b) the service is rendered to an inpatient of a hospital; and
(c) the service is rendered in relation to each specimen as soon as possible after the specimen is taken; and
(d) the pathology provider of the service writes on the account for the service that the service has a “rule 3 exemption”.
(2) Clause 1.2.2 does not apply to a pathology service described in item 65109 or 65110 if:
(a) the service is rendered:
(i) for a service described in item 65109—on one of not more than 5 occasions in 24 hours; and
(ii) for a service described in item 65110—on one of not more than 2 occasions in 24 hours; and
(b) the service was requested on a separate occasion to any other occasions on which the service was requested in that period; and
(c) the pathology provider of the service writes on the account for the service that the service has a “rule 3 exemption”.
1.2.5 Services to which clause 1.2.2 does not apply—chemical
Clause 1.2.2 does not apply to a pathology service described in item 66500, 66503, 66506, 66509, 66512, 66584 or 66800 if:
(a) the service is rendered in relation to one or more specimens taken on any of not more than 6 occasions in 24 hours; and
(b) the service is rendered to an inpatient of a hospital; and
(c) the service is rendered in relation to each specimen as soon as possible after the specimen is taken; and
(d) the pathology provider of the service writes on the account for the service that the service has a “rule 3 exemption”.
1.2.6 Referral of designated tests by one pathology practitioner to another
(1) Designated test means a pathology test relating to a patient episode that is a test of a kind mentioned in item 65150, 65175, 66650, 66695, 66711, 66722, 66785, 66800, 66812, 66819, 66825, 69384, 69494, 71089, 71153 or 77165.
(2) This clause applies if one or more designated tests are referred by a referring APP to a receiving APP in another approved pathology authority.
(3) If a referring APP has rendered one or more designated tests:
(a) 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
(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.
(4) If a referring APP has not rendered a designated test:
(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
(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:
(a) for item 66652, 66715, 66790, 66817, 66821 or 66827—2 less the number of designated tests rendered by a referring APP;
(b) for item 65158, 66805, 69498 or 71092—3 less the number of designated tests rendered by a referring APP;
(c) for item 71156 or 71170—4 less the number of designated tests rendered by a referring APP;
(d) for item 65181 or 66724—5 less the number of designated tests rendered by a referring APP.
(6) For the purposes of paragraph (4)(b), the maximum number of designated tests to which the relevant item applies is as follows:
(a) for item 66652, 66715, 66790, 66817, 66821 or 66827—1;
(b) for item 65158, 66805, 69498 or 71092—2;
(c) for item 71156 or 71170—3;
(d) for item 65181 or 66724—4.
(7) Items in Group P10 (Patient episode initiation) do not apply to a receiving APP in subclause (2).
1.2.7 Items not to be split except as stated in clause 1.2.6
Except as stated in clause 1.2.6, an item applies only to one approved pathology practitioner for a single patient episode.
1.2.8 Services in certain sets of services to be treated as individual services
(1) If a medical practitioner (other than a specialist or consultant physician), participating midwife or participating nurse practitioner requests a set of pathology services to which clause 1.2.9 applies, the pathology services in the set are to be treated as individual pathology services in accordance with this clause.
(2) If the fee mentioned in an item that describes any of the services in the set is higher than the fees mentioned in the other items that describe the services in the set:
(a) the pathology service described in the first‑mentioned item is to be treated as one pathology service; and
(b) either:
(i) the pathology service in the set that is described in the item that mentions the second‑highest fee is to be treated as one pathology service; or
(ii) if 2 or more items that describe any of those services mentions the second‑highest fee—the pathology service described in the item that mentions the second‑highest fee, and has the lowest item number, is to be treated as one pathology service; and
(c) the pathology services in the set, other than the services that are to be treated as one pathology service under paragraphs (a) and (b), are to be treated as one pathology service.
(3) If the fees mentioned in 2 or more items that describe any of the services in the set are the same, and higher than the fees mentioned in the other items that describe the services in the set:
(a) the pathology service in the set that is described in the item that mentions the highest fee, and has the lowest item number, is to be treated as one pathology service; and
(b) the pathology service in the set that is described in the item that mentions the highest fee, and has the second‑lowest item number, is to be treated as one pathology service; and
(c) the pathology services in the set, other than the services that are to be treated as one pathology service under paragraphs (a) and (b), are to be treated as one pathology service.
(4) If pathology services are to be treated as one pathology service under paragraph (2)(c) or (3)(c), the fee for the one pathology service is the highest fee mentioned in any of the items that describe the pathology services that are to be treated as the one pathology service.
1.2.9 Sets of services for the purposes of clause 1.2.8
(1) This clause applies to a set of pathology services if:
(a) the set consists of services that are described in at least 4 different items, other than an item mentioned in subclause (2); and
(b) all of the services in the set are requested in a single patient episode; and
(c) each of the services in the set relates to a patient who is not an admitted patient of a hospital; and
(d) none of the services in the set is referred to in item 66900, 69484, 73070, 73071, 73072, 73073, 73074, 73075 or 73076.
(2) For the purposes of paragraph (1)(a), the items are as follows:
(a) an item in Group P10 (Patient episode initiation), Group P11 (Specimen referred), Group P12 (Management of bulk‑billed services) or Group P13 (Bulk‑billing incentive);
(b) if a service is requested by an approved pathology practitioner of an approved pathology authority and rendered by another approved pathology practitioner of an approved pathology authority that is not related to the approved pathology authority of the first‑mentioned approved pathology practitioner—item 65079, 65082, 65157, 65158, 65166, 65180, 65181, 66606, 66610, 66639, 66642, 66651, 66652, 66663, 66666, 66696, 66697, 66714, 66715, 66723, 66724, 66780, 66783, 66789, 66790, 66792, 66804, 66805, 66816, 66817, 66820, 66821, 66826, 66827, 66832, 66834, 66837, 69325, 69328, 69331, 69379, 69383, 69400, 69401, 69451, 69489, 69492, 69497, 69498, 69500, 71076, 71090, 71092, 71096, 71148, 71154, 71156, 71169, 71170, 73309, 73312, 73315, 73318, 73321 or 73324.
(3) For the purposes of paragraph (2)(b), an approved pathology authority is related to another approved pathology authority if:
(a) both approved pathology authorities are employed (including employed under contract) by the same person, whether or not the person is also an approved pathology authority; or
(b) either of the approved pathology authorities is employed (including employed under contract) by the other; or
(c) both approved pathology authorities are corporations and are connected entities within the meaning of the Corporations Act 2001; or
(d) the approved pathology authorities are partners (whether or not either or both of the approved pathology authorities are individuals and whether or not other persons are in partnership with either or both of the approved pathology authorities); or
(e) both approved pathology authorities are operated by the Commonwealth or an authority of the Commonwealth; or
(f) both approved pathology authorities are operated by the same State or internal Territory or an authority of the same State or internal Territory.
1.2.10 Satisfying requirements in descriptions of services
A requirement contained in the description of a pathology service in Part 2 is satisfied if:
(a) for a requirement for information—the information:
(i) is included in the request for the service; or
(ii) was supplied in writing on an earlier occasion to the approved pathology authority that rendered the service, and has been kept by the approved pathology authority; or
(b) for a requirement for laboratory test results—the results are:
(i) included in the request for the service; or
(ii) obtained from another laboratory test performed in the same patient episode; or
(iii) included in results from an earlier laboratory test that have been kept by the approved pathology authority.
1.2.11 Restriction on items—services rendered with autologous injections of blood or blood products
An item in this Schedule does not apply to a service described in the item if the service is rendered to a patient at the same time as, or in connection with, an injection of blood or a blood product that is autologous.
1.2.12 Restriction on items—services rendered with harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells
An item in this Schedule does not apply to a service described in the item if the service is rendered 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.
1.2.13 Restriction on items 66551, 73812 and 73826—timing
For any particular patient, item 66551 is applicable not more than 4 times in 12 months, either individually or in combination with a service to which item 73812 or 73826 applies.
Division 1.3—Patient episodes
1.3.1 Meaning of patient episode
In this Schedule:
patient episode means:
(a) one or more pathology services (other than a pathology service to which paragraph (b) refers) rendered for a single patient whose need for the services was determined under section 16A of the Act:
(i) on the same day; or
(ii) if more than one test is performed on the one specimen within 14 days—on the same or different days;
whether the services:
(iii) are requested by one or more practitioners, participating midwives or participating nurse practitioners; or
(iv) are described in a single item or in more than one item; or
(v) are rendered by one approved pathology practitioner or more than one approved pathology practitioner; or
(vi) are rendered on the same or different days; or
(b) a pathology service to which clause 1.2.3, 1.2.4 or 1.2.5 refers that is rendered in the circumstances, set out in the clause, that relate to the service.
1.3.2 When later services are taken to be part of an earlier patient episode
Group P1 services
(1) If:
(a) a patient episode for a patient includes one or more services described in items in Group P1 (except items 65099, 65102, 65105 and 65108); and
(b) specimen material from the patient episode is stored; and
(c) in response to a request made within 14 days of the initiation of the patient episode, one or more further services described in items in Group P1 (except items 65099, 65102, 65105 and 65108) are rendered using the stored material;
the services mentioned in paragraph (c) are taken to be part of the patient episode mentioned in paragraph (a).
Group P3 services
(2) If:
(a) a patient episode for a patient includes one or more services described in items in Group P3; and
(b) specimen material from the patient episode is stored; and
(c) in response to a request made within 14 days of the initiation of the patient episode, one or more further services described in items in Group P3 are rendered using the stored material;
the services mentioned in paragraph (c) are taken to be part of the patient episode mentioned in paragraph (a).
Group P4 services—tests relating to antibodies
(3) If:
(a) a patient episode includes one or more services described in item 71119, 71121, 71123 or 71125; and
(b) specimen material from the patient episode is stored; and
(c) in response to a request made within 14 days of the initiation of the patient episode, one or more further services described in item 71119, 71121, 71123 or 71125 are rendered using the stored material;
the services mentioned in paragraph (c) are taken to be part of the patient episode mentioned in paragraph (a).
Part 2—Services and fees
Division 2.1—Group P1: haematology
2.1.1 Restriction on items 65090 and 65093—services for patients in hospital
If pathology services of a kind described 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.
2.1.2 Items in Group P1
This clause sets out items in Group P1.
| 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 sets 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) direct testing of donor red cells from each unit against the serum of the patient by one or more accepted crossmatching techniques; and (b) all grouping checks of the patient and donor; and (c) examination for antibodies and, if necessary, identification of any antibodies detected; and (d) (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) direct testing of donor red cells from each unit against the serum of the patient by one or more accepted crossmatching techniques; and (b) all grouping checks of the patient and donor; and (c) examination for antibodies and, if necessary, identification of any antibodies detected; and (d) (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 described in the item have been rendered by the referring APP—one test | 23.30 |
Division 2.2—Group P2: chemical
2.2.1 Inclusion of measurement of creatinine in services
A pathology service described in an item in Group P2 (except item 66500) that:
(a) involves the measurement of a substance in urine; and
(b) requires calculation of a substance/creatinine ratio;
is taken to include the measurement of creatinine necessary for the calculation.
2.2.2 Restriction on vitamins testing items—timing
(1) For any particular patient, items 66605 and 66606 are applicable not more than twice (in total for both items) in 12 months.
(2) For any particular patient, items 66607 and 66610 are applicable not more than twice (in total for both items) in 12 months.
2.2.3 Restriction on metals testing items—timing
(1) This clause applies to items 66819, 66820, 66821, 66822, 66825, 66826, 66827, 66828, 66831 and 66832 (each of which is a metals testing item).
(2) For any particular patient, a metals testing item does not apply if, in the 6 months before the service described in the item was requested, there have been 3 patient episodes for the patient in relation to which any metals testing item applied.
2.2.4 Items in Group P2
This clause sets out items in Group P2.
| 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 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 |
| 66522 | Faecal calprotectin test for the diagnosis of inflammatory bowel disease, if all the following apply: (a) the patient is under 50 years of age; (b) the patient has gastrointestinal symptoms suggestive of inflammatory or functional bowel disease of more than 6 weeks’ duration; (c) infectious causes have been excluded; (d) the likelihood of malignancy has been assessed as low; (e) no relevant clinical alarms are present | 75.00 |
| 66523 | Faecal calprotectin test for the diagnosis of inflammatory bowel disease, if all the following apply: (a) the results of a service to which item 66522 applies were inconclusive for the patient (that is, the results showed a faecal calprotectin level of more than 50 μg/g but not more than 100 μg/g); (b) the patient has ongoing gastrointestinal symptoms suggestive of inflammatory or functional bowel disease; (c) the service is requested by a specialist or consultant physician practising as a specialist gastroenterologist; (d) the request indicates that an endoscopic examination is not initially required; (e) no relevant clinical alarms are present | 75.00 |
| 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 | 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 either or both of a test for free thyroxine and a test for free T3) for a patient, if: (a) the patient has a level of TSH that is outside the normal reference range for the particular method of assay used to determine the level; or (b) the request from the requesting medical practitioner indicates that 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; or (c) the request from the requesting medical practitioner indicates that the medical practitioner suspects the patient has a pituitary dysfunction; or (d) the request from the requesting medical practitioner indicates that 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 Applicable not more than once in a pregnancy | 39.75 |
| 66751 | Quantitation, in pregnancy, of any 3 or more tests described in item 66750 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 Schedule 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 13CO2 or 14CO2, (except if item 12533 applies) for: (a) the confirmation of Helicobacter pylori colonisation; or (b) the monitoring of the success of eradication of Helicobacter pylori Note: Item 12533 is in the general medical services table. | 77.65 |
Division 2.3—Group P3: microbiology
2.3.1 Restriction on certain items—antigen detection services rendered as pathologist‑determinable services
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 does not apply to the service unless the recognised pathologist who renders the service records, in writing, the reasons for rendering the service.
2.3.2 Fee for certain items in a single patient episode—investigation 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.
2.3.3 Restriction on certain items—timing
(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) For any particular patient, items 69488 and 69489 are applicable not more than twice (in total for both items) in 12 months.
(3) For any particular patient, items 69491 and 69492 are applicable not more than once (in total for both items) in 12 months.
(4) For any particular patient, items 69499 and 69500 are applicable not more than once (in total for both items) in 12 months.
2.3.4 Items in Group P3
This clause sets out items in Group P3.
| 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 Schedule; 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 or more 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 described 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 examinations) 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 described 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 Schedule—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 Schedule)—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 2.4—Group P4: immunology
2.4.1 Restriction on item 71148—HLA‑B27 typing services rendered as pathologist‑determinable services
If a service described in item 71148 is rendered as a pathologist‑determinable service, the item does not apply to the service unless the recognised pathologist who renders the service records, in writing:
(a) the reasons for rendering the service; and
(b) the result of the pathology service described in item 71147.
2.4.2 Items in Group P4
This clause sets out items in Group P4.
| 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 Schedule—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 Schedule—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: (a) by one of the following tests: (i) antineutrophil cytoplasmic antibody (ANCA) immunofluorescence test; (ii) antineutrophil proteinase 3 antibody (PR3 ANCA) test; (iii) antimyeloperoxidase antibody (MPO ANCA) test; (iv) antiglomerular basement membrane antibody (GBM ANCA) test; or (b) by either or both of the tests mentioned in subparagraphs (a)(ii) and (iii), if a test mentioned in subparagraph (a)(i) was requested and: (i) the result is abnormal; or (ii) a test mentioned in subparagraph (a)(i) has previously been carried out and the result was abnormal; or (iii) either or both of the antibodies mentioned in subparagraphs (a)(ii) and (iii) have been previously detected | 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 (b) a receiving APP performs the test or tests described in item 71165; one test | 12.85 |
| 71175 | A test, requested by a specialist or consultant physician, to diagnose neuromyelitis optica spectrum disorder (NMOSD) or myelin oligodendrocyte glycoprotein antibody‑related demyelination (MARD), by the detection of one or more antibodies, for a patient: (a) suspected of having NMOSD or MARD; and (b) with any of the following: (i) recurrent, bilateral or severe optic neuritis; (ii) recurrent longitudinal extensive transverse myelitis (LETM); (iii) area postrema syndrome (unexplained hiccups, nausea or vomiting); (iv) acute brainstem syndrome; (v) symptomatic narcolepsy or acute diencephalic clinical syndrome with typical NMOSD magnetic resonance imaging lesions; (vi) symptomatic cerebral syndrome with typical NMOSD magnetic resonance imaging lesions; (vii) monophasic neuromyelitis optica (no recurrence, and simultaneous or closely related optic neuritis and LETM within 30 days of each other); (viii) acute disseminated encephalomyelitis; (ix) aseptic meningitis and encephalomyelitis; (x) poor recovery from multiple sclerosis relapses Applicable not more than 4 times in 12 months | 50.00 |
| 71180 | Antibody to cardiolipin or beta‑2 glycoprotein I—detection, including quantitation if required; one antibody specificity (IgG or IgM) | 34.55 |
| 71183 | Detection of 2 antibodies described in item 71180 | 47.45 |
| 71186 | Detection of 3 or more antibodies described in item 71180 | 60.30 |
| 71189 | Detection of specific IgG antibodies to one or more respiratory disease allergens not elsewhere specified | 15.50 |
| 71192 | Two items described in item 71189 | 28.35 |
| 71195 | Three or more items described in item 71189 | 40.05 |
| 71198 | Estimation of serum tryptase for the evaluation of unexplained acute hypotension or suspected anaphylactic event, assessment of risk in stinging insect anaphylaxis, exclusion of mastocytosis, monitoring of known mastocytosis | 40.55 |
| 71200 | Detection and quantitation, if present, of free kappa and lambda light chains in serum for the diagnosis or monitoring of amyloidosis, myeloma or plasma cell dyscrasias | 59.60 |
| 71203 | Determination of HLAB5701 status by flow cytometry or cytotoxity assay prior to the initiation of Abacavir therapy including item 73323 (if performed) | 40.55 |
2.13.1 Items in Group P13
This clause sets out items in Group P13.
| 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 |
Division 2.14—Indexation of fees
2.14.1 Indexation—1 July 2021
(1) On 1 July 2021 (the indexation day), the amount of a fee for an item in Group P12 is replaced by the amount worked out using the following formula:
Note: The indexed fees could in 2021 be viewed on the Department of Health’s MBS Online website ( (2) An amount worked out under subclause (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).
Part 3—Complexity levels for tissue pathology items
3.1 Complexity levels
The following table specifies complexity levels for specimen types.
Complexity levels for tissue pathology 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 4—Dictionary
4.1 Dictionary
Note 1: All references in this clause to a provision are references to a provision in this Schedule, unless otherwise indicated.
Note 2: A number of expressions used in this Schedule are defined in the Act, including pathologist‑determinable service.
In this Schedule:
Act means the Health Insurance Act 1973.
approved collection centre has the meaning given by subsection 23DA(1) of the Act.
biopsy material means all tissue received by an approved pathology practitioner:
(a) from a medical procedure, or set of medical procedures, performed on a patient at the same time; or
(b) after being expelled spontaneously from a patient.
bulk‑billed: a pathology service is bulk‑billed if:
(a) a medicare benefit is payable to a person in relation to the service; and
(b) under an agreement entered into under section 20A of the Act:
(i) the person assigns to the practitioner by whom, or on whose behalf, the service is rendered, the person’s right to the payment of the medicare benefit; and
(ii) the practitioner accepts the assignment in full payment of the practitioner’s fee for the service rendered.
care institution means a place at which residential accommodation, day care or both are made available to:
(a) disadvantaged children; or
(b) juvenile offenders; or
(c) aged persons; or
(d) chronically ill psychiatric patients; or
(e) homeless persons; or
(f) unemployed persons; or
(g) persons suffering from alcoholism; or
(h) persons addicted to drugs; or
(i) physically or mentally handicapped persons;
but does not include:
(j) a hospital; or
(k) a residential aged care facility; or
(l) accommodation for aged persons that is attached to a residential aged care facility or situated within a residential aged care facility complex.
complexity level, for a specimen type mentioned in an item, means the complexity level specified for the specimen type in Part 3.
concessional beneficiary has the same meaning as in Part VII of the National Health Act 1953.
designated area has the same meaning as in the general medical services table.
designated test has the meaning given by clause 1.2.6.
Modified Monash 2 area has the same meaning as in the general medical services table.
Modified Monash 3 area has the same meaning as in the general medical services table.
Modified Monash 4 area has the same meaning as in the general medical services table.
Modified Monash 5 area has the same meaning as in the general medical services table.
Modified Monash 6 area has the same meaning as in the general medical services table.
Modified Monash 7 area has the same meaning as in the general medical services table.
patient episode has the meaning given by clause 1.3.1.
practice location, for the rendering of a pathology service, means the place of practice for which the practitioner by whom, or on whose behalf, the service is rendered, has been allocated a provider number by the Chief Executive Medicare.
prescribed laboratory means a laboratory operated by:
(a) the Commonwealth; or
(b) an authority of the Commonwealth; or
(c) a State or internal Territory; or
(d) an authority of a State or internal Territory; or
(e) an Australian tertiary education institution.
receiving APP, for a patient episode, means an approved pathology practitioner in an approved pathology authority who:
(a) receives a request from a referring APP to render a designated test or tests; and
(b) renders each test included in the designated test that the referring APP has not performed.
recognised pathologist means:
(a) a medical practitioner recognised as a specialist in pathology under subsection 3D(1) of the Act; or
(b) a medical practitioner in relation to whom there is in force a determination under paragraph 3DB(4)(a) or subsection 3E(1) of the Act that the practitioner is recognised as a specialist in pathology.
referring APP, for a patient episode, means an approved pathology practitioner in an approved pathology authority who:
(a) has received a request to render one or more designated tests; and
(b) is unable, because of the lack of facilities in, or expertise or experience of the staff of, the laboratory of the authority, to render one or more of the tests included in the designated test; and
(c) requests a receiving APP in another approved pathology authority to render:
(i) the test or tests that the approved pathology practitioner is unable to render; or
(ii) all of the tests that are included in the designated test; and
(d) renders each test included in the designated test, other than the test or tests for which the request mentioned in paragraph (c) is made.
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 aged care facility has the same meaning as in the general medical services table.
separately identified specimen means an individual specimen collected, identified so that it is clearly distinguished from any other specimen, and sent for testing by or on behalf of the treating practitioner responsible for the procedure in which the specimen was collected.
serial examinations means a series of examinations requested on one occasion whether or not:
(a) the materials are received on different days by the approved pathology practitioner; or
(b) the examinations were requested on one or more request forms by the treating practitioner.
treating practitioner has the same meaning as in subsection 16A(1) of the Act.
treatment cycle has the same meaning as in the general medical services table.
unreferred service means a pathology service that:
(a) is rendered to a person by, or on behalf of, a medical practitioner who is:
(i) not a specialist or consultant physician; or
(ii) both a specialist or consultant physician and a general practitioner; and
(b) has not been referred to the medical practitioner.
Endnotes
Endnote 1—About the endnotes
The endnotes provide information about this compilation and the compiled law.
The following endnotes are included in every compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Abbreviation key—Endnote 2
The abbreviation key sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.
Editorial changes
The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.
If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.
Misdescribed amendments
A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.
If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.
Endnote 2—Abbreviation key
ad = added or inserted o = order(s) am = amended Ord = Ordinance amdt = amendment orig = original c = clause(s) par = paragraph(s)/subparagraph(s) C[x] = Compilation No. x /sub‑subparagraph(s) Ch = Chapter(s) pres = present def = definition(s) prev = previous Dict = Dictionary (prev…) = previously disallowed = disallowed by Parliament Pt = Part(s) Div = Division(s) r = regulation(s)/rule(s) ed = editorial change reloc = relocated exp = expires/expired or ceases/ceased to have renum = renumbered effect rep = repealed F = Federal Register of Legislation rs = repealed and substituted gaz = gazette s = section(s)/subsection(s) LA = Legislation Act 2003 Sch = Schedule(s) LIA = Legislative Instruments Act 2003 Sdiv = Subdivision(s) (md) = misdescribed amendment can be given SLI = Select Legislative Instrument effect SR = Statutory Rules (md not incorp) = misdescribed amendment Sub‑Ch = Sub‑Chapter(s) cannot be given effect SubPt = Subpart(s) mod = modified/modification underlining = whole or part not No. = Number(s) commenced or to be commenced
Endnote 3—Legislation history
| Name | Registration | Commencement | Application, saving and transitional provisions |
| Health Insurance (Pathology Services Table) Regulations 2020 | 23 Apr 2020 (F2020L00460) | 1 May 2020 (s 2(1) item 1) | |
| Health Insurance Legislation Amendment (Bulk‑billing Incentive) Regulations 2020 | 29 Mar 2020 (F2020L00341) | Sch 1 (items 11, 12): 1 May 2020 (s 2(1) item 3) | — |
| Health Insurance (Pathology Services Table) Amendment (Indexation) Regulations 2020 | 16 June 2020 (F2020L00728) | 1 July 2020 (s 2(1) item 1) | — |
| Health Insurance Legislation Amendment (Bulk‑billing Incentive (No. 2)) Regulations 2020 | 23 Sept 2020 (F2020L01203) | Sch 1 (items 5, 6): 1 Oct 2020 (s 2(1) item 1) | — |
| Health Insurance Legislation Amendment (2020 Measures No. 2) Regulations 2020 | 20 Oct 2020 (F2020L01330) | Sch 1 (item 159): 1 Nov 2020 (s 2(1) item 1) | — |
| Health Legislation Amendment (Administration) Regulations 2020 | 14 Dec 2020 (F2020L01602) | Sch 1 (item 2): 15 Dec 2020 (s 2(1) item 1) | — |
| Health Insurance Legislation Amendment (2020 Measures No. 3) Regulations 2020 | 14 Dec 2020 (F2020L01608) | Sch 1 (items 65, 66, 94–96): 1 Mar 2021 (s 2(1) items 2, 4) | — |
| Health Insurance Legislation Amendment (2021 Measures No. 1) Regulations 2021 | 2 June 2021 (F2021L00681) | Sch 1 (items 6, 7): 1 July 2021 (s 2(1) item 2) | — |
| Health Insurance Legislation Amendment (2021 Measures No. 2) Regulations 2021 | 17 Sept 2021 (F2021L01281) | Sch 3: 1 Nov 2021 (s 2(1) item 1) | — |
| Health Insurance Legislation Amendment (Rural Bulk‑billing Incentive) Regulations 2021 | 9 Dec 2021 (F2021L01748) | Sch 1 (items 24–29): 1 Jan 2022 (s 2(1) item 1) | — |
| Health Insurance Legislation Amendment (2021 Measures No. 3) Regulations 2021 | 17 Dec 2021 (F2021L01814) | Sch 1 (items 25–27): 1 Jan 2022 (s 2(1) item 1) | — |
Endnote 4—Amendment history
| Provision affected | How affected |
| s 2............................................. | rep LA s 48D |
| s 4............................................. | am F2020L01602 |
| s 5............................................. | rep LA s 48C |
| Schedule 1 | |
| Part 1 | |
| Division 1.2 | |
| c 1.2.2....................................... | am F2021L01748 |
| c 1.2.13..................................... | ad F2021L01814 |
| Part 2 | |
| Division 2.2 | |
| Group P2 Table......................... | am F2021L01281; F2021L01814 |
| Division 2.3 | |
| Group P3 Table......................... | am F2020L00728 |
| Division 2.4 | |
| Group P4 Table......................... | am F2021L01281 |
| Division 2.5 | |
| c 2.5.5A.................................... | ad F2020L01608 |
| Group P5 Table......................... | am F2020L01608 |
| Division 2.7 | |
| c 2.7.1A.................................... | ad F2021L01281 |
| c 2.7.1B.................................... | ad F2021L01281 |
| c 2.7.3A.................................... | ad F2021L01281 |
| Group P7 Table......................... | am F2020L01330; F2020L01608; F2021L01281 |
| Division 2.12 | |
| c 2.12.1..................................... | rs F2021L01748 |
| c 2.12.2..................................... | am F2021L00681; F2021L01814 |
| Group P12 Table....................... | am F2020L00341; F2020L00728; F2020L01203; F2021L01748 |
| Division 2.14 | |
| Division 2.14............................ | ad F2021L00681 |
| c 2.14.1..................................... | ad F2021L00681 |
| ed C7 | |
| Part 4 | |
| c 4.1.......................................... | am F2021L01281 |
| Schedule 2................................ | rep LA s 48C |
0
0
0