Health Insurance (Section 3C Pathology Services – Archival Tissue Retrieval) Amendment Determination 2020 (Cth)

Health Insurance (Section 3C Pathology Services – Archival Tissue Retrieval) Amendment Determination 2020

I, Renaye Lucchese, delegate of the Minister for Health, make the following Determination.

Dated   30 April 2020 

Renaye Lucchese

Assistant Secretary

Diagnostic Imaging and Pathology Branch

Medical Benefits Division

Health Financing Group

Department of Health

Contents

1  Name........................................................................................................................................ 1

2  Commencement........................................................................................................................ 1

3  Authority.................................................................................................................................. 1

4  Schedules................................................................................................................................. 1

Schedule 1— Amendments................................................................................................... 2

1  Name

This instrument is the Health Insurance (Section 3C Pathology Services – Archival Tissue Retrieval) Amendment Determination 2020.

2  Commencement

(1)       Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

Commencement information
Column 1	Column 2	Column 3
Provisions	Commencement	Date/Details
1.  The whole of this instrument	1 May 2020

Note:        This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

(2)       Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3  Authority

This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.

4  Schedules

Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule 1— Amendments

Health Insurance (Section 3C Pathology Services – Archival Tissue Retrieval) Determination 2019

1 Section 6 (below the heading)

Repeal the section, substitute:

(1)       Item 72860 applies to a service (the relevant service) for a patient if:

(a)     a service (the initial service) described in an item in Group P5 (other than item 72860), or a service described in an item in Group P6 or P7 of the pathology services table, was rendered in a patient episode (the initial patient episode) for the patient; and

(b)       tissue material was collected for the initial service; and

(c)       the tissue material was biopsy material, or samples submitted for cytology, from which a tissue block was prepared; and

(d)       the tissue material was archived in a formalin fixed paraffin embedded block; and

(e)       following the initial service, the treating practitioner determines that a service described in an item in Group P7 (the subsequent P7 service) is clinically necessary for the patient; and

(f)      that subsequent P7 service is rendered in another patient episode (the subsequent patient episode) for the patient; and

(g)      the relevant service is also rendered in the subsequent patient episode.

2 Section 7 (below the heading)

Repeal the section, substitute:

(1)        Item 72860 does not apply to the relevant service if:

(a)   it is rendered in the accredited pathology laboratory in which the subsequent P7 service is rendered; or

(b)   it is rendered in association with a service to which item 72858 or 72859 applies; or

(c)   it is rendered in association with, and in the same patient episode as, a service to which an item in Group P5, P6, P10 or P11 applies.

(2)        For any particular patient, item 72860 is applicable for a maximum of one retrieval and review of an archived formalin fixed paraffin embedded block per subsequent patient episode.

3 Schedule 1 (below the heading)

Repeal and substitute:

Group P5—Tissue pathology
Item	Service	Fee ($)
72860	Retrieval and review of one or more archived formalin fixed paraffin embedded block(s) to determine the appropriate sample(s) for the purpose of conducting genetic testing	85.00