Health Insurance (Pathology Services Table) Regulations 2003
Statutory Rules 2003 No. 256 as amended
made under the
Health Insurance Act 1973
This compilation was prepared on 1 September 2004
taking into account amendments up to SR 2004 No. 268
This document has been split into two volumes
Volume 1 contains Rr. 1–5 and Schedule 1
(Part 1 (item 1A), Part 2 (items 1–24) and Part 3),
Volume 2 contains Schedule 1 (Parts 4 and 5) and the Notes
Each volume has its own Table of Contents
Prepared by the Office of Legislative Drafting,
Attorney-General’s Department, Canberra
Contents
1 Name of Regulations [see Note 1]
2 Commencement
3 Health Insurance (Pathology Services Table) Regulations 2002 — repeal
4 Definitions
5 Pathology services table
Schedule 1 Table of pathology services
Part 1 Prescription of table
1A Prescription of table
Part 2 Rules of interpretation
1 Interpretation of table
2 Precedence of items
3 Circumstances in which services rendered following 2 requests to be taken to have been rendered following 1 request
4 Services to which rule 3 does not apply
5 Item taken to refer only to the first service of a particular kind
6 Certain items not to apply to a service referred by one pathology practitioner to another
7 Items not to be split
8 Creatinine ratios — Group P2 (Chemical)
9 Thyroid function testing
10 Meaning of serial examinations or cultures
11 Investigation for hepatitis serology
12 Tests in Group P4 (Immunology) relating to antibodies
13 Tests on biopsy material — Group P5 (Tissue pathology) and Group P6 (Cytology)
14 Items in Groups P10 (Patient episode initiation) and P11 (Specimen referred) not to apply in certain circumstances
15 Application of an item in Group P11 (Specimen referred) to a service excludes certain other items
16 Circumstances in which an item in Group P11 (Specimen referred) does not apply
17 Abbreviations
18 Certain pathology services to be treated as 1 service
19 Hepatitis C viral RNA testing
20 Haemochromatosis testing
21 Serum B12 and red cell folate testing
22 Nutritional and toxicity metals testing
23 Antineutrophil cytoplasmic antibody tests
24 Satisfying requirements described in pathology service
Part 3 Services and fees
1 Name of Regulations [see Note 1]
These Regulations are the Health Insurance (Pathology Services Table) Regulations 2003.
2 Commencement
These Regulations commence on 1 November 2003.
3 Health Insurance (Pathology Services Table) Regulations 2002 — repeal
The following Statutory Rules are repealed:
2002 No. 245
2003 No. 70.
4 Definitions
In these Regulations:
Act means the Health Insurance Act 1973.
this table means these Regulations.
5 Pathology services table
The table of pathology services set out in Schedule 1 is prescribed for subsection 4A (1) of the Act.
Schedule 1 Table of pathology services
(regulation 5)
Part 1 Prescription of table
1A Prescription of table
For section 4A of the Act, these Regulations prescribe a table of pathology services that sets out:
(a) in Part 2 — rules for interpretation of the table; and
(b) in Part 3:
(i) items of pathology services; and
(ii) the amount of fees applicable for each item; and
(c) in Parts 4 and 5 — additional supporting information.
Part 2 Rules of interpretation
1 Interpretation of table
(1) In this table:
item means:
(a) an item mentioned, by number, in column 1 of:
(i) Part 3; or
(ii) Part 3 of the diagnostic imaging services table; or
(iii) Part 3 of the general medical services table; and
(b) in a reference immediately followed by a number — the item so numbered.
patient episode means:
(a) a pathology service or pathology services (other than a pathology service to which paragraph (b) refers) provided for a single patient whose need for the service or services was determined under section 16A of the Act:
(i) on the same day; or
(ii) if more than 1 test is performed on the 1 specimen within 14 days — on the same or different days;
whether the services:
(iii) are requested by 1 or more practitioners; or
(iv) are described in a single item or in more than 1 item; or
(v) are rendered by 1 approved pathology practitioner or more than 1 approved pathology practitioner; or
(vi) are rendered on the same or different days; or
(b) a pathology service to which rule 4 refers that is provided in the circumstances set out in that rule that relate to the service.
recognised pathologist means a medical practitioner recognised as a specialist in pathology by a determination under section 3D or subsection 61 (3) of the Act.
serial examinations means a series of examinations requested on 1 occasion whether or not:
(a) the materials are received on different days by the approved pathology practitioner; or
(b) the examinations or cultures were requested on 1 or more request forms by the treating practitioner.
(2) In these rules, a reference to a request to an approved pathology practitioner includes a reference to a request for a pathologist-determinable service to which subsection 16A (6) of the Act applies.
(3) A reference to a Group in the table includes every item in the Group and a reference to a Subgroup in the table includes every item in the Subgroup.
2 Precedence of items
(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 subrule (3), if:
(a) subrule (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 pathology service that is described in another item, the other item does not apply to the service in addition to the first-mentioned item, whether or not the services described in the 2 items are requested separately.
Application of items 74990 and 74991
(4) Despite subrules (1), (2) and (3):
(a) if the pathology service described in item 74991 is provided to a person, either that item or item 74990, but not both those items, applies to the service; and
(b) if item 74990 or 74991 applies to a pathology service, the fee specified in that item applies in addition to the fee specified in any other item in this table that applies to the service.
(5) For items 74990 and 74991:
bulk-billed, in relation to a pathology service, means:
(a) a medicare benefit is payable to a person in respect of 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 provided, his or her right to the payment of the medicare benefit; and
(ii) the practitioner accepts the assignment in full payment of his or her fee for the service provided.
Commonwealth concession card holder means a person who is a concessional beneficiary within the meaning given by subsection 84 (1) of the National Health Act 1953.
unreferred service means a pathology service that:
(a) is provided to a person by, or on behalf of, a medical practitioner, being a medical practitioner who is not a consultant physician, or specialist, in any speciality (other than a medical practitioner who is, for the purposes of the Act, both a general practitioner and a consultant physician, or specialist, in a particular speciality); and
(b) has not been referred to the medical practitioner by another medical practitioner or person with referring rights.
(6) For item 74991:
ASGC means the document titled Australian Standard Geographical Classification (ASGC) 2002, published by the Australian Bureau of Statistics, as in force on 1 July 2002.
practice location, in relation to the provision of a pathology service, means the place of practice in respect of which the practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Commission.
regional, rural or remote area means an area classified as RRMAs 3-7 under the Rural, Remote and Metropolitan Areas Classification.
Rural, Remote and Metropolitan Areas Classification has the meaning given by subrule 3 (1) of Part 2 of Schedule 1 to the general medical services table.
SLA means a Statistical Local Area specified in the ASGC.
SSD means a Statistical Subdivision specified in the ASGC.
3 Circumstances in which services rendered following 2 requests to be taken to have been rendered following 1 request
(1) In subrule (2), service includes assay, estimation and test.
(2) Two or more pathology services (other than services to which, under rule 4, this rule does not apply) rendered for a patient following 2 or more requests are taken to have been rendered following a single request if:
(a) the services are listed in the same item; and
(ab) that item is not item 74990 or 74991; and
(b) 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.
4 Services to which rule 3 does not apply
(1) Rule 3 does not apply to a pathology service described in item 66500, 66503, 66506, 66509, 66512, 66515 or 66584 if:
(a) the service is rendered in relation to a single specimen taken on each of not more than 4 occasions in a period of 24 hours; and
(b) the service is rendered to a patient in a hospital unit where:
(i) the presence of 1 nurse is required for each group of not more than 4 patients; and
(ii) the condition of the patients is continuously observed in relevant respects; and
(c) in order to render the service, an approved pathology practitioner who is a recognised pathologist has to arrange for a member of the laboratory staff of the approved pathology authority concerned to undertake duties in respect of the service that are in addition to the usual duties of the staff member; and
(d) the account for the service is endorsed ‘Rule 3 Exemption’.
(2) Rule 3 does not apply to any of the following pathology services:
(a) estimation of prothrombin time (INR) for a patient undergoing anticoagulant therapy;
(b) quantitative estimation of lithium for a patient undergoing lithium therapy;
(c) a service described in item 65070 in relation to a patient undergoing chemotherapy for neoplastic disease or immunosuppressant therapy;
(d) a service described in item 65070 in relation to
clozaril, ticlopidine hydrochloride, methotrexate, gold, sulphasalazine or penicillamine therapy of a patient;
(e) a service described in any of items 66500 to 66515, in relation to methotrexate or leflunomide therapy of a patient;
(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;
(g) quantitative estimation of albumin and calcium in relation to therapy of a patient with vitamin D, its metabolites or analogues;
if:
(h) under a request for a service, other than a request for a service described in paragraph (a), no more than 6 tests are requested; and
(i) the tests are performed within 6 months of the request; and
(j) the account for the service is endorsed ‘Rule 3 Exemption’.
5 Item taken to refer only to the first service of a particular kind
(1) For an item in Group P1 (Haematology):
(a) if pathology services of a kind referred to in item 65090 or 65093 are rendered for a patient during a period when the patient is in hospital, the item applies only to the first pathology service of that kind rendered for the patient during the period; and
(b) if:
(i) tests (except tests mentioned in item 65099, 65102, 65105 or 65108) are carried out in relation to a patient episode; and
(ii) specimen material from the patient episode is stored; and
(iii) in response to a request made within 14 days of the patient episode, further tests (except tests mentioned in item 65099, 65102, 65105 or 65108) are carried out on the stored material;
the later tests and the earlier tests are taken to be part of 1 patient episode.
(2) Items 65102 and 65108 apply only if a minimum of 6 units are issued for a patient’s care in any 1 day.
(3) For items 65099 and 65102:
compatibility tests by crossmatch means that, in addition to all the tests described in paragraphs (a) and (b) of the item, donor red cells from each unit must have been tested directly against the serum of the patient by 1 or more accepted crossmatching techniques.
6 Certain items not to apply to a service referred by one pathology practitioner to another
(1) In this rule:
designated pathology service means a pathology service in respect of tests relating to a single patient episode that are:
(a) tests of the kind described in item 66695; or
(b) tests of the kind described in item 66722; or
(c) tests of the kind described in item 66800; or
(d) tests of the kind described in item 66812; or
(e) tests of the kind described in item 69384.
(2) This rule applies in respect of a designated pathology service where:
(a) an approved pathology practitioner (practitioner A) in an approved pathology authority:
(i) has been requested to render the designated pathology service; and
(ii) is unable, because of the lack of facilities in, or expertise or experience of the staff of, the laboratory of the authority, to render 1 or more (but not all) of the tests included in the service; and
(iii) requests an approved pathology practitioner (practitioner B) in another approved pathology authority to render the test or tests that practitioner A is unable to render; and
(iv) renders each test included in the service, other than the test or tests in respect of which the request mentioned in subparagraph (iii) is made; and
(b) the tests mentioned in subparagraph (a) (iv) that practitioner A renders are not tests constituting a service described in item 66710, 66734, 66806, 66815 or 69399.
(3) If this rule applies in respect of a designated pathology service:
(a) item 66695, 66698, 66701, 66704, 66707, 66722, 66725, 66728, 66731, 66800, 66803, 66812, 69384, 69387, 69390, 69393 or 69396 (as the case requires) applies in respect of the test or tests rendered by practitioner A; and
(b) where practitioner B renders a service under a request referred to in subparagraph (2) (a) (iii) — subject to subrule (4), the amount specified in item 66713, 66737, 66809, 66818 or 69402 (as the case requires) is payable for each test that the service comprises.
(4) For paragraph (3) (b), the maximum number of tests to which item 66713, 66737, 66809, 66818 or 69402 applies is:
(a) for item 66809:
3 – X; and
(b) for item 66818:
2 – X; and
(c) for item 66713, 66737 or 69402:
6 – X;
where X is the number of tests rendered by practitioner A in relation to the designated pathology service in respect of which the request mentioned in that paragraph is made.
(5) Items in Group P10 (Patient episode initiation) do not apply to the second-mentioned approved pathology practitioner in subrule (2).
7 Items not to be split
Except as stated in rule 6, the amount specified in an item is payable only to 1 approved pathology practitioner in respect of a single patient episode.
8 Creatinine ratios — Group P2 (Chemical)
A pathology service mentioned in an item in Group P2 (Chemical) (except item 66500) that:
(a) involves the measurement of a substance in urine; and
(b) requires calculation of a substance/creatinine ratio;
is taken to include the measurement of creatinine necessary for the calculation.
9 Thyroid function testing
(1) For item 66719:
abnormal level of TSH means a level of TSH that is outside the normal reference range in respect of the particular method of assay used to determine the level.
(2) Except where paragraph (a) of item 66719 is satisfied, the amount specified in the item is not payable for a pathology service described in the item unless the pathologist who renders the service has a written statement from the medical practitioner who requested the service that satisfies subrule (3).
(3) The written statement from the medical practitioner must indicate:
(a) that the tests are required for a particular purpose, being a purpose specified in paragraph (b) of item 66719; or
(b) that the medical practitioner who requested the tests suspects the patient has pituitary dysfunction; or
(c) that the patient is on drugs that interfere with thyroid hormone metabolism or function.
10 Meaning of serial examinations or cultures
For an item in Group P3 (Microbiology):
(a) serial examinations or cultures means a series of examinations or cultures requested on 1 occasion whether or not:
(i) the materials are received on different days by the approved pathology practitioner; or
(ii) the examinations or cultures were requested on 1 or more request forms by the treating practitioner; and
(b) if:
(i) tests are carried out in relation to a patient episode; and
(ii) specimen material from the patient episode is stored; and
(iii) in response to a request made within 14 days of the patient episode, further tests are carried out on the stored material;
the later tests and the earlier tests are taken to be part of 1 patient episode.
11 Investigation for hepatitis serology
(1) The fee applying in a single patient episode that includes any of items 69475, 69478 and 69481 is the fee specified for 1 only of those items.
(2) Item 69478 applies to a service in relation to which:
(a) a practitioner requests 2 tests for immune status or viral carriage; or
(b) the clinical notes indicate that the service is required for:
(i) pre-operative assessment; or
(ii) post-exposure to blood or other body fluids assessment; or
(iii) assessment before blood or tissue donation.
(3) Item 69481 applies to a service in relation to a patient who displays 1 or more of the characteristics of acute or chronic hepatitis.
12 Tests in Group P4 (Immunology) relating to antibodies
For items in Group P4 (Immunology), in items 71119, 71121, 71123 and 71125, if:
(a) tests are carried out in relation to a patient episode; and
(b) specimen material from the patient episode is stored; and
(c) in response to a request made within 14 days of the patient episode, further tests are carried out on the stored material;
the later tests and the earlier tests are taken to be part of 1 patient episode.
13 Tests on biopsy material — Group P5 (Tissue pathology) and Group P6 (Cytology)
(1) For items in Group P5 (Tissue pathology):
biopsy material means all tissue (other than a bone marrow biopsy) received by an approved pathology practitioner:
(a) from a medical procedure, or group of medical procedures, performed on a patient at the same time; or
(b) after being expelled spontaneously from a patient.
cytology means microscopic examination of 1 or more stained preparations of cells separated naturally or artificially from their normal environment by methods recognised as adequate to demonstrate their structure to a degree sufficient to enable an opinion to be formed about whether they are likely to be normal, abnormal but benign, or abnormal and malignant but, in accordance with customary laboratory practice, does not include examination of a blood film and a bone marrow aspirate.
separately identified specimen means an individual specimen collected, identified so that it is clearly distinguished from any other specimen, and sent for testing by or on behalf of the treating practitioner responsible for the procedure in which the specimen was taken.
(2) For Groups P5 and P6 of the pathology services table, services in Group P6 include any services described in Group P5 on the material submitted for a test in Group P6.
(3) For subrule (2), any sample submitted for cytology from which a cell block is prepared does not qualify for a Group P5 item.
(4) If more than 1 of the services mentioned in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 are performed in a single patient episode, only the fee for the item performed having the highest specified fee is applicable to the services.
(5) If more than 1 histopathological examinations are performed on separate specimens, of different complexity levels, from a single patient episode, only the fee for the examination having the highest specified fee is applicable to the examinations.
(6) In items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 a reference to a complexity level is a reference to the level given to a specimen type mentioned in Part 5 of this table.
(7) If:
(a) more than 1 of the services mentioned in items 72846, 72847 and 72848; or
(b) more than 1 of the services mentioned in items 73059, 73060 and 73061;
are performed in a single patient episode, only the fee for the item performed having the higher or highest specified fee applies to the services.
14 Items in Groups P10 (Patient episode initiation) and P11 (Specimen referred) not to apply in certain circumstances
(1) For this rule and items in Groups P10 (Patient episode initiation) and P11 (Specimen referred):
approved collection centre has the same meaning as in Part IIA of the Act.
institution means a place at which residential accommodation or day care is, or both residential accommodation and day care are, made available to:
(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 care facility; or
(l) accommodation for aged persons that is attached to a residential care facility or situated within a residential care facility complex.
prescribed laboratory means a laboratory operated by:
(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.
residential care facility means a facility in which residential care, within the meaning of section 41-3 of the Aged Care Act 1997, is provided.
specimen collection centre has the same meaning as in Part IIA of the Act.
treating practitioner has the same meaning as in paragraph 16A (1) (a) of the Act.
(2) If a service described in an item in Group P10 is rendered by, or on behalf of, an approved pathology practitioner who is a recognised pathologist, the relevant one of those items does not apply to the service if:
(a) the service is rendered upon a request made in the course of an out-patient service at a recognised hospital; or
(b) the service is rendered upon a request made for a patient who is a private patient in a recognised hospital when the request is made; or
(c) the pathology equipment of a recognised hospital, or a prescribed laboratory, is used rendering the service; or
(d) a member of the staff of a recognised hospital, or a prescribed laboratory, participates in the service in the course of the member’s employment with the hospital or laboratory.
(3) An item in Group P10 or P11 does not apply to a pathology service to which subsection 16A (7) of the Act applies.
(4) An item in Group P10 or P11 does not apply to a pathology service unless at least 1 item in Groups P1 to P8 also applies to the service.
(5) Subject to subrule (7), if 1 item in Group P10 applies to a patient episode, no other item in the Group applies to the patient episode.
(6) An item in Group P11 applies only to the approved pathology practitioner or approved pathology authority to whom the specimen mentioned in the item was referred.
(7) If, in respect of the same patient episode:
(a) services referred to in 1 or more items in Group P5 and 1 or more of Groups P1, P2, P3, P4, P6, P7 and P8 are rendered by an approved pathology practitioner in the laboratory of another approved pathology authority; or
(b) services referred to in 1 or more items in Group P6 and 1 or more of Groups P1, P2, P3, P4, P5, P7 and P8 are rendered by an approved pathology practitioner in the laboratory of another approved pathology authority;
the fee specified in the applicable item in Group P10 applies to both approved pathology practitioners.
(8) If more than one specimen is collected from a person on the same day for the provision of pathology services:
(a) in accordance with more than 1 request; and
(b) in or by a single approved pathology authority;
the fee specified in the applicable item in Group P10 applies once only to the services.
(9) The fee specified in item 73921 applies only once in respect of a single patient episode.
15 Application of an item in Group P11 (Specimen referred) to a service excludes certain other items
If item 73921 applies to a patient episode, none of the items in Group P10 applies to any pathology service rendered by the approved pathology authority or approved pathology practitioner who claimed item 73921 in respect of the patient episode.
16 Circumstances in which an item in Group P11 (Specimen referred) does not apply
(1) An item in Group P11 does not apply to a referral if:
(a) a service in respect of the same patient episode has been carried out by the referring approved pathology authority; and
(b) the approved pathology authority to which the referral is made is related to the referring approved pathology authority.
(2) An approved pathology authority is related to another approved pathology authority for subrule (1) 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 related corporations 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.
(3) An item in Group P11 does not apply to a referral if the following common tests are referred either singly or in combination (except if the following items are referred in combination with other items not similarly specified): 65060, 65070, 65120, 66500, 66503, 66506, 66509, 66512, 66515, 66536, 66596, 69300, 69303, 69333 or 73527.
17 Abbreviations
(1) The abbreviations in Part 4 may be used to identify particular pathology services or groups of pathology services.
(2) The names of services or drugs not listed in Part 4 must be written in full.
18 Certain pathology services to be treated as 1 service
(1) In this rule:
general practitioner means a medical practitioner who:
(a) is not a consultant physician in any specialty; and
(b) is not a specialist in any specialty.
set of pathology services means a group of pathology services:
(a) that consists of services that are described in at least 4 different items; and
(b) all of which are requested in a single patient episode; and
(c) each of which relates to a patient who is not an admitted patient of a hospital; and
(d) none of which is referred to:
(i) in item 66713, 66737, 66809, 66818, 69402, 69484, 73053 or 73055; or
(ii) in an item in Group P10 (Patient episode initiation), Group P11 (Specimen referred) or Group P12 (Management of bulk-billed services).
(2) If a general practitioner requests a set of pathology services, the pathology services in the set are to be treated as individual pathology services in accordance with this rule.
(3) If the fee specified in 1 item that describes any of the services in the set of pathology services is higher than the fees specified in the other items that describe the services in the set:
(a) the pathology service described in the first-mentioned item is to be treated as 1 pathology service; and
(b) either:
(i) the pathology service in the set that is described in the item that specifies the second-highest fee is to be treated as 1 pathology service; or
(ii) if 2 or more items that describe any of those services specify the second-highest fee — the pathology service described in the item that specifies the second-highest fee, and has the lowest item number, is to be treated as 1 pathology service; and
(c) the pathology services in the set, other than the services that are to be treated as 1 pathology service under paragraphs (a) and (b), are to be treated as 1 pathology service.
(4) If the fees specified in 2 or more items that describe any of the services in the set of pathology services are the same, and higher than the fees specified in the other items that describe the services in the set:
(a) the pathology service in the set that is described in the item that specifies the highest fee, and has the lowest item number, is to be treated as 1 pathology service; and
(b) the pathology service in the set that is described in the item that specifies the highest fee, and has the second‑lowest item number, is to be treated as 1 pathology service; and
(c) the pathology services in the set, other than the services that are to be treated as 1 pathology service under paragraphs (a) and (b), are to be treated as 1 pathology service.
(5) If pathology services are to be treated as 1 pathology service under paragraph (3) (c) or (4) (c), the fee for the 1 pathology service is the highest fee specified in any of the items that describe the pathology services that are to be treated as the 1 pathology service.
19 Hepatitis C viral RNA testing
For items 69442, 69444 and 69445:
Hepatitis C sero-positive, for a patient, means 2 different assays of Hepatitis C antibodies are positive.
serological status is uncertain, for a patient, means any result where 2 different assays of Hepatitis C antibodies are inconclusive.
20 Haemochromatosis testing
For item 66794:
elevated serum ferritin, for a patient, means a level of ferritin above the normal reference range in respect of the particular method of assay used to determine the level.
21 Serum B12 and red cell folate testing
(1) Items 66599 and 66602 do not apply to more than 3 patient episodes that include a service described in item 66599 or 66602, or any combination of those items, in a 12 month period.
(2) Item 66599 does not apply to a service described in that item if the service was provided as part of the same patient episode as a service described in item 66602.
22 Nutritional and toxicity metals testing
(1) For this rule:
metal toxicity testing group means items 66672 and 66673.
nutritional metals testing group means items 66669 and 66670.
(2) An item in the nutritional metals testing group or the metal toxicity testing group does not apply in relation to a service performed if medicare benefits are paid or payable for tests that are performed for the same patient in 3 patient episodes requested within 6 months before the request for that service, under any of:
(a) that item; or
(b) the other item in the same group; or
(c) an item in the other group.
23 Antineutrophil cytoplasmic antibody tests
For subsection 16A (3) of the Act, a request for an antineutrophil cytoplasmic antibody immunofluorescence test is taken to include a request for an antineutrophil proteinase 3 antibody test and an antimyeloperoxidase antibody test if:
(a) the immunofluorescence test performed as a result of the request is abnormal; or
(b) a previous immunofluorescence test was abnormal; or
(c) those antibodies have been previously detected.
24 Satisfying requirements described in pathology service
Unless the contrary intention appears, a requirement contained in the description of a pathology service in Part 3 is satisfied if:
(a) in the case of 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) in the case of a requirement for laboratory test results, the results are:
(i) included in the request for the service; or
(ii) obtained from another laboratory test performed in the same patient episode; or
(iii) included in results from an earlier laboratory test that have been kept by the approved pathology authority.
Part 3 Services and fees
Item | Pathology service | Fee ($) | |||||
Group P1 — Haematology | |||||||
65060 | Haemoglobin, erythrocyte sedimentation rate, blood viscosity — 1 or more tests | 7.95 | |||||
65066 | Examination of: (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 | 10.55 | |||||
65070 | Erythrocyte count, haematocrit, haemoglobin, calculation or measurement of red cell index or indices, platelet count, leucocyte count and manual or instrument generated differential count (not being a service where haemoglobin only is requested) — 1 or more instrument-generated set of results from a single sample and (if performed): (a) a morphological assessment of a blood film; and (b) any service in item 65060 or 65072 | 17.20 | |||||
65072 | Examination for reticulocytes including a reticulocyte count by any method — 1 or more tests in any patient episode | 10.30 | |||||
65075 | Haemolysis or metabolic enzymes — assessment by 1 or more of the following tests: (a) erythrocyte autohaemolysis test; (b) erythrocyte osmotic fragility test; (c) sugar water test; (d) G‑6‑P D (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 | 52.90 | |||||
65078 | Tests for the diagnosis of thalassaemia when indicated on the basis of an abnormal full blood examination or by the clinical need for family studies, consisting of haemoglobin electrophoresis or chromatography and at least 2 of: (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 | 91.75 | |||||
65081 | Tests for the investigation of haemoglobinopathy (including S, C, D, E), other than thalassaemia, when indicated on the basis of an abnormal full blood examination or by the clinical need for family studies, consisting of haemoglobin electrophoresis or chromatography and at least 1 of: (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 | 98.25 | |||||
65084 | Bone marrow trephine biopsy — histopathological examination of sections of bone marrow and examination of aspirated material (including clot sections where necessary), including (if performed): (a) special stains or immunohistochemical techniques (if any); and (b) any test described in item 65060, 65066 or 65070 | 168.75 | |||||
65087 | Bone marrow — examination of aspirated material (including clot sections where necessary), including (if performed): (a) special stains or immunohistochemical techniques (if any); and (b) any test described in item 65060, 65066 or 65070 | 84.55 | |||||
65090 | Blood grouping (including back‑grouping if performed) — ABO and Rh (D antigen) | 11.25 | |||||
65093 | Blood grouping — Rh phenotypes, Kell system, Duffy system, M and N factors or any other blood group system — 1 or more systems, including item 65090 (if performed) | 22.35 | |||||
65096 | Blood grouping (including back‑grouping if performed), and examination of serum for Rh and other blood group antibodies, including: (a) identification and quantitation of any antibodies detected; and (b) (if performed) any test described in item 65060 or 65070 | 41.65 | |||||
65099 | Compatibility tests by crossmatch — all tests performed on any one 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 (Item is subject to rule 5) | 113.40 | |||||
65102 | Compatibility tests by crossmatch — all tests performed on any one 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 (Item is subject to rule 5) | 170.10 | |||||
65105 | Compatibility testing using at least a 3 cell panel and issue of red cells for transfusion — all tests performed on any one 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 (Item is subject to rule 5) | 113.40 | |||||
65108 | Compatibility testing using at least a 3 cell panel and issue of red cells for transfusion — all tests performed on any one 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 (Item is subject to rule 5) | 170.10 | |||||
65111 | Examination of serum for blood group antibodies (including identification and, if necessary, quantitation of any antibodies detected) | 23.60 | |||||
65114 | 1 or more of the following tests: (a) direct Coombs (antiglobulin) test; (b) qualitative or quantitative test for cold agglutinins or heterophil antibodies | 9.25 | |||||
65117 | 1 or more of the following tests: (a) spectroscopic examination of blood for chemically altered haemoglobins; (b) detection of methaemalbumin (Schumm’s test) | 20.60 | |||||
65120 | Prothrombin time (including INR where appropriate), activated partial thromboplastin time, thrombin time (including test for the presence of heparin), test for factor XIII deficiency (qualitative), Echis test, Stypven test, reptilase time, fibrinogen, or 1 of fibrinogen degradation products, fibrin monomer or D‑dimer — 1 test | 14.05 | |||||
65123 | 2 tests described in item 65120 | 20.60 | |||||
65126 | 3 tests described in item 65120 | 28.35 | |||||
65129 | 4 or more tests described in item 65120 | 36.10 | |||||
65132 | Test for the presence of antithrombin III deficiency, protein C deficiency, protein S deficiency, lupus anticoagulant, activated protein C resistance, if the request for the test specifically identifies that the patient has a history of venous thromboembolism — quantitation by 1 or more techniques — 1 test | 25.75 | |||||
65133 | 2 tests described in item 65132 | 49.50 | |||||
65134 | 3 tests described in item 65132 | 73.20 | |||||
65135 | 4 tests described in item 65132 | 96.90 | |||||
65136 | 5 tests described in item 65132 | 120.65 | |||||
65137 | Test for the presence of lupus anticoagulant, not being a service connected with a service to which item 65132, 65133, 65134, 65135 or 65136 applies | 25.75 | |||||
65142 | Confirmation or clarification of an abnormal or indeterminate result of a test mentioned in item 65132, by testing a specimen collected on a different day — 1 or more tests | 25.75 | |||||
65144 | Platelet aggregation in response to ADP, collagen, 5HT, ristocetin or other substances; or heparin, low molecular weight heparins, heparinoid or other drugs — 1 or more tests | 57.55 | |||||
65147 | Quantitation of anti‑Xa activity when monitoring is required for a patient receiving a low molecular weight heparin or heparinoid — 1 test | 38.55 | |||||
65150 | Quantitation of von Willebrand factor antigen, von Willebrand factor activity (ristocetin cofactor assay), von Willebrand factor collagen binding activity, factor II, factor V, factor VII, factor VIII, factor IX, factor X, factor XI, factor XII, factor XIII, Fletcher factor, Fitzgerald factor, circulating coagulation factor inhibitors other than by Bethesda assay — 1 test | 72.15 | |||||
65153 | 2 tests described in item 65150 | 144.35 | |||||
65156 | 3 or more tests described in item 65150 | 216.50 | |||||
65159 | Quantitation of circulating coagulation factor inhibitors by Bethesda assay — 1 test | 72.15 | |||||
65162 | Examination of a maternal blood film for the presence of fetal red blood cells (Kleihauer test) | 10.55 | |||||
65165 | Detection and quantitation of fetal red blood cells in the maternal circulation by detection of red cell antigens using flow cytometric methods including (if performed) any test described in item 65070 or 65162 | 35.05 | |||||
65168 | Characterisation of the genotype of a patient for factor V Leiden gene mutation, or detection of other relevant mutations in the investigation of proven venous thrombosis or pulmonary embolism — 1 or more tests | 37.10 | |||||
65171 | Test for the presence of antithrombin III deficiency, protein C deficiency, protein S deficiency or activated protein C resistance in a first degree relative of a person who has a proven deficiency mentioned in this item — 1 or more tests | 25.75 | |||||
65174 | Characterisation of the genotype of a person who is a first degree relative of a person who has been proven to have 1 or more abnormal genotypes under item 65168 — 1 or more tests | 37.10 | |||||
65200 | Characterisation of gene rearrangement by nucleic acid amplification in the diagnosis and monitoring of patients with laboratory evidence of: (a) acute myeloid leukaemia; or (b) acute promyelocytic leukaemia; or (c) acute lymphoid leukaemia; or (d) chronic myeloid leukaemia; each test to a maximum of 4 tests in a 12 month period | 235.00 | |||||
Group P2 — Chemical | |||||||
66500 | Quantitation in serum, plasma, urine or other body fluid (except amniotic fluid), by any method, except reagent tablet or reagent strip, (with or without reflectance meter) of acetoacetate, acid phosphatase, alanine aminotransferase, albumin, alkaline phosphatase, ammonia, amylase, aspartate aminotransferase, beta-hydroxybutyrate, bicarbonate, bilirubin (total), bilirubin (any fractions), C-reactive protein, calcium (total or corrected for albumin), chloride, creatine kinase, creatinine, gamma glutamyl transferase, globulin, glucose, lactate, lactate dehydrogenase, lipase, magnesium, phosphate, potassium, pyruvate, sodium, total cholesterol, total protein, triglycerides, urate or urea — 1 test | 9.75 | |||||
66503 | 2 tests described in item 66500 | 11.75 | |||||
66506 | 3 tests described in item 66500 | 13.75 | |||||
66509 | 4 tests described in item 66500 | 15.75 | |||||
66512 | 5 tests described in item 66500 | 17.80 | |||||
66515 | 6 or more tests described in item 66500 | 19.80 | |||||
66518 | Investigation of cardiac or skeletal muscle damage by measurement of creatine kinase isoenzymes (by any method), troponin or myoglobin in plasma or serum — tests on only 1 specimen, in a 24 hour period | 20.40 | |||||
66519 | Investigation of cardiac or skeletal muscle damage by measurement of creatine kinase isoenzymes (by any method), troponin or myoglobin in plasma or serum — tests on 2 or more specimens, in a 24 hour period | 40.85 | |||||
66536 | Quantitation of HDL cholesterol | 11.25 | |||||
66539 | Electrophoresis of serum for demonstration of lipoprotein subclasses, if the cholesterol is >6.5 mmol/L and triglyceride >4.0 mmol/L or in the diagnosis of types III and IV hyperlipidaema — each patient episode to a maximum of 2 patient episodes in a 12 month period | 31.15 | |||||
66542 | Oral glucose tolerance test for the diagnosis of diabetes mellitus, that includes: (a) administration of glucose; and (b) at least 2 measurements of blood glucose; and (c) (if performed) any test described in item 66695 | 19.30 | |||||
66545 | Oral glucose challenge test in pregnancy for the detection of gestational diabetes that includes: (a) administration of glucose; and (b) 1 or 2 measurements of blood glucose; and (c) (if performed) any test in item 66695 | 16.10 | |||||
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 | 20.30 | |||||
66551 | Quantitation of glycosylated haemoglobin performed in the management of established diabetes — each test to a maximum of 4 tests in a 12 month period | 17.10 | |||||
66554 | Quantitation of glycosylated haemoglobin performed in the management of pre-existing diabetes where the patient is pregnant — each test to a maximum of 6 tests in a 12 month period which includes the whole pregnancy, including a service in item 66551 (if performed) | 17.10 | |||||
66557 | Quantitation of fructosamine performed in the management of established diabetes — each test to a maximum of 4 tests in a 12 month period | 9.85 | |||||
66560 | Microalbumin — quantitation in urine | 20.50 | |||||
66563 | Osmolality, estimation by osmometer, in serum or in urine — 1 or more tests | 25.10 | |||||
66566 | Quantitation of: (a) blood gases (including pO2, oxygen saturation and pCO2); and (b) bicarbonate and pH; including any other measurement (eg haemoglobin, potassium or ionised calcium) or calculation performed on the same specimen — 1 or more tests on 1 specimen | 34.30 | |||||
66569 | Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 2 specimens performed on any 1 day | 43.35 | |||||
66572 | Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 3 specimens performed on any 1 day | 52.45 | |||||
66575 | Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 4 specimens performed on any 1 day | 61.50 | |||||
66578 | Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 5 specimens performed on any 1 day | 70.55 | |||||
66581 | Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 6 or more specimens performed on any 1 day | 79.65 | |||||
66584 | Quantitation of ionised calcium (except if performed as part of item 66566) — 1 test | 9.85 | |||||
66587 | Urine acidification test for the diagnosis of renal tubular acidosis including the administration of an acid load, and pH measurements on 4 or more urine specimens and at least 1 blood specimen | 48.35 | |||||
66590 | Calculus, analysis of 1 or more | 31.15 | |||||
66593 | Ferritin — quantitation, except if requested as part of iron studies | 18.35 | |||||
66596 | Iron studies, consisting of quantitation of: (a) serum iron; and (b) transferrin or iron binding capacity; and (c) ferritin | 33.10 | |||||
66599 | Serum B12 or red cell folate and, if required, serum folate (Item is subject to rule 21) | 24.05 | |||||
66602 | Serum B12 and red cell folate and, if required, serum folate (Item is subject to rule 21) | 43.75 | |||||
66605 | Vitamins — quantitation of vitamins A, B1, B2, B3, B6, C and E in blood, urine or other body fluid — 1 or more tests within a 6 month period | 31.15 | |||||
66608 | Vitamin D or D fractions — 1 or more tests | 43.00 | |||||
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 | 42.25 | |||||
66626 | Detection or quantitation or both (not including the detection of nicotine and metabolites in smoking withdrawal programs) 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; but excluding the surveillance of sports people and athletes for performance improving substances; including all tests on blood, urine or other body fluid — each patient episode, to a maximum of 36 episodes in a 12 month period | 24.55 | |||||
66629 | Beta-2-microglobulin — quantitation in serum, urine or other body fluids — 1 or more tests | 20.50 | |||||
66632 | Caeruloplasmin, haptoglobins, or prealbumin — quantitation in serum, urine or other body fluids — 1 or more tests | 20.50 | |||||
66635 | Alpha‑1‑antitrypsin — quantitation in serum, urine or other body fluid — 1 or more tests | 20.50 | |||||
66638 | Isoelectric focussing or similar methods for determination of alpha‑1‑antitrypsin phenotype in serum — 1 or more tests | 29.70 | |||||
66641 | Electrophoresis of serum or other body fluid to demonstrate: (a) the isoenzymes of lactate dehydrogenase; or (b) the isoenzymes of alkaline phosphatase; including the preliminary quantitation of total relevant enzyme activity — 1 or more tests | 29.70 | |||||
66644 | C-1 esterase inhibitor — quantitation | 20.50 | |||||
66647 | C-1 esterase inhibitor — functional assay | 45.90 | |||||
66650 | Alpha‑fetoprotein, CA‑15.3 antigen (CA15.3), CA‑19.9 antigen (CA19.9), CA‑125 antigen (C125), cancer associated serum antigen (CASA), carcinoembryonic antigen (CEA), human chorionic gonadotrophin (HCG), mammary serum antigen (MSA), thyroglobulin in serum or other body fluid, in the monitoring of malignancy or in the detection or monitoring of gestational trophoblastic disease or a hepatic or germ cell tumour — quantitation — 1 test | 24.75 | |||||
66653 | 2 or more tests described in item 66650 | 45.35 | |||||
66655 | Prostate specific antigen (PSA) quantitation — 1 patient episode in a 12 month period | 20.50 | |||||
66656 | Prostate specific antigen (PSA) quantitation in the monitoring of previously diagnosed prostatic disease (including a test to which item 66655 applies) | 20.50 | |||||
66659 | Prostate specific antigen (PSA), quantitation of 2 or more fractions of PSA and any derived index in the follow up of a PSA result that lies in the equivocal range of the particular method of assay used to determine the level — 1 test (including a test to which item 66656 applies) in a 12 month period | 37.80 | |||||
66662 | Quantitation of hormone receptors on proven primary breast or ovarian carcinoma or a metastasis from a breast or ovarian carcinoma or a subsequent lesion in the breast — 1 or more tests | 81.35 | |||||
66665 | Lead quantitation in blood or urine (other than for occupational health screening purposes) to a maximum of 3 tests in a 6 month period — each test | 31.15 | |||||
66667 | Quantitation of serum zinc in a patient receiving intravenous alimentation — each test | 31.15 | |||||
66669 | Quantitation of copper, manganese, selenium, or zinc (except if item 66667 applies), in blood, urine or other body fluid or tissue — 1 test, to a maximum of 3 patient episodes, in a 6 month period (Item is subject to rule 22) | 31.15 | |||||
66670 | Quantitation of copper, manganese, selenium, or zinc (except if item 66667 applies), in blood, urine or other body fluid or tissue — 2 or more tests, to a maximum of 3 patient episodes, in a 6 month period (Item is subject to rule 22) | 53.35 | |||||
66671 | Quantitation of serum aluminium in a patient in a renal dialysis program — each test | 37.55 | |||||
66672 | Quantitation of aluminium (except if item 66671 applies), arsenic, beryllium, cadmium, chromium, gold, mercury, nickel, or strontium, in blood, urine or other body fluid or tissue — 1 test, to a maximum of 3 patient episodes, in a 6 month period (Item is subject to rule 22) | 31.15 | |||||
66673 | 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, to a maximum of 3 patient episodes, in a 6 month period (Item is subject to rule 22) | 53.35 | |||||
66674 | Quantitation of: (a) faecal fat; or (b) breath hydrogen in response to loading with disaccharides; 1 or more tests within a 28 day period | 40.65 | |||||
66677 | Test for tryptic activity in faeces in the investigation of diarrhoea of longer than 4 weeks duration in children under 6 years old | 11.35 | |||||
66680 | Quantitation of disaccharidases and other enzymes in intestinal tissue — 1 or more tests | 75.75 | |||||
66683 | Enzymes — quantitation in solid tissue or tissues other than blood elements or intestinal tissue — 1 or more tests | 75.75 | |||||
66686 | Performance of 1 or more of the following procedures: (a) growth hormone suppression by glucose loading; (b) growth hormone stimulation by exercise; (c) dexamethasone suppression test; (d) sweat collection by iontophoresis for chloride analysis; (e) pharmacological stimulation of growth hormone | 51.55 | |||||
66689 | Personal performance by a recognised pathologist of 1 of the following procedures: (a) gonadotrophin releasing hormone stimulation test; (b) synacthen stimulation test; (c) glucagon stimulation test with C‑peptide measurement; (d) pentagastrin or calcium stimulation of thyrocalcitonin release; (e) secretin or calcium stimulation of gastrin release; (f) insulin hypoglycaemia; (g) arginine infusion; (h) thyrotrophin releasing hormone (TRH) test | 82.50 | |||||
66692 | Personal performance by a recognised pathologist of 2 or more tests described in item 66689 | 144.35 | |||||
66695 | Quantitation of hormones and hormone binding proteins — ACTH, aldosterone, androstenedione, C‑peptide, calcitonin, cortisol, cyclic AMP, DHEAS, 11-deoxycortisol, dihydrotestosterone, FSH, gastrin, glucagon, growth hormone, hydroxyprogesterone, insulin, LH, oestradiol, oestrone, progesterone, prolactin, PTH, renin, sex hormone binding globulin, somatomedin C(IGF –1), free or total testosterone, urine steroid fraction or fractions, vasoactive intestinal peptide, vasopressin (antidiuretic hormone) — 1 test | 30.70 | |||||
66698 | 2 tests described in item 66695 (Item is subject to rule 6) | 43.80 | |||||
66701 | 3 tests described in item 66695 (Item is subject to rule 6) | 57.20 | |||||
66704 | 4 tests described in item 66695 (Item is subject to rule 6) | 70.60 | |||||
66707 | 5 tests described in item 66695 (Item is subject to rule 6) | 84.05 | |||||
66710 | 6 or more tests described in item 66695 (Item is subject to rule 6) | 97.45 | |||||
66713 | Tests described in item 66695, if rendered under a request referred to in subparagraph 6 (2) (a) (iii) of Part 2 — each test to a maximum of 5 tests (Item is subject to rule 6) | 13.40 | |||||
66716 | TSH quantitation | 25.45 | |||||
66719 | Thyroid function tests (comprising the service described in item 66716 and 1 or more of the following tests — estimation of free thyroxine index, free thyroxine, free T3, total T3, thyroxine binding globulin) for a patient, if at least 1 of the following conditions is satisfied: (a) the patient has an abnormal level of TSH; (b) the tests are performed: (i) for the purpose of monitoring thyroid disease in the patient; or (ii) to investigate the sick euthyroid syndrome if the patient is an admitted patient; or (iii) to investigate dementia or psychiatric illness of the patient; or (iv) to investigate amenorrhoea or infertility of the patient; (c) the medical practitioner who requested the tests suspects the patient has a pituitary dysfunction; (d) the patient is on drugs that interfere with thyroid hormone metabolism or function (Item is subject to rule 9) | 35.45 | |||||
66722 | TSH quantitation described in item 66716 and 1 test described in item 66695 (Item is subject to rule 6) | 38.55 | |||||
66725 | TSH quantitation described in item 66716 and 2 tests described in item 66695 (Item is subject to rule 6) | 51.95 | |||||
66728 | TSH quantitation described in item 66716 and 3 tests described in item 66695 (Item is subject to rule 6) | 65.35 | |||||
66731 | TSH quantitation described in item 66716 and 4 tests described in item 66695 (Item is subject to rule 6) | 78.75 | |||||
66734 | TSH quantitation described in item 66716 and 5 tests described in item 66695 (Item is subject to rule 6) | 92.15 | |||||
66737 | Tests described in items 66716 and 66695, if rendered under a request mentioned in subparagraph 6 (2) (a) (iii) of Part 2 — each test to a maximum of 5 tests (Item is subject to rule 6) | 13.40 | |||||
66743 | Quantitation of alpha-fetoprotein in serum or other body fluids during pregnancy except if requested as part of item 66750 or 66751 | 20.50 | |||||
66749 | Amniotic fluid, spectrophotometric examination of, and quantitation of: (a) lecithin/sphingomyelin ratio; or (b) palmitic acid, phosphatidylglycerol or lamellar body phospholipid; or (c) bilirubin, including correction for haemoglobin; 1 or more tests | 33.50 | |||||
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); | 40.45 | |||||
| (e) unconjugated oestriol (uE3); (f) alpha-fetoprotein (AFP); including (if performed) a service described in item 73527 or 73529 — 1 patient episode in a pregnancy |
| |||||
66751 | Quantitation, in pregnancy, of any 3 or more tests described in item 66750 | 56.20 | |||||
66752 | Quantitation of citrate, oxalate, total free fatty acids or amino acids including cysteine, homocysteine, cystine and hydroxyproline (except if performed as part of item 66773 or 66776) — 1 test | 25.10 | |||||
66755 | 2 or more tests described in item 66752 | 39.50 | |||||
66758 | Quantitation of angiotensin converting enzyme, or cholinesterase — 1 or more tests | 25.10 | |||||
66761 | Test for reducing substances in faeces by any method (except reagent strip or dipstick) | 13.40 | |||||
66764 | Examination for faecal occult blood (including tests for haemoglobin and its derivatives in the faeces) by: (a) an immunological method; and (b) a chemical method (except reagent strip or dip stick); with a maximum of 3 examinations on specimens collected on separate days in a 28 day period — 1 examination by both methods | 9.05 | |||||
66767 | 2 examinations by both methods described in item 66764 performed on separately collected and identified specimens | 18.15 | |||||
66770 | 3 examinations by both methods described in item 66764 performed on separately collected and identified specimens | 27.20 | |||||
66773 | Quantitation of products of collagen breakdown for the monitoring of patients with proven low bone mineral density, and if performed, a service described in item 66752 — 1 or more tests | 25.10 | |||||
66776 | Quantitation of products of collagen breakdown for the monitoring of patients with metabolic bone disease or Paget’s disease of bone, and if performed, a service described in item 66752 — 1 or more tests | 25.10 | |||||
66779 | Adrenaline, noradrenaline, dopamine, histamine, hydroxyindoleacetic acid (5HIAA), hydroxymethoxymandelic acid (HMMA), homovanillic acid (HVA), metanephrines, methoxyhydroxyphenylethylene glycol (MHPG), phenylacetic acid (PAA) or serotonin — quantitation — 1 or more tests | 40.65 | |||||
66782 | Porphyrins or porphyrins precursors — detection in plasma, red cells, urine or faeces — 1 or more tests | 13.40 | |||||
66785 | Porphyrins or porphyrins precursors — quantitation in plasma, red cells, urine or faeces — 1 test | 40.65 | |||||
66788 | Porphyrins or porphyrins precursors — quantitation in plasma, red cells, urine or faeces — 2 or more tests | 67.00 | |||||
66791 | Porphyrin biosynthetic enzymes — measurement of activity in blood cells or other tissues — 1 or more tests | 75.75 | |||||
66794 | Detection of the C282Y genetic mutation of the HFE gene and, if performed, detection of other mutations for haemochromatosis where: (a) the patient has an elevated transferrin saturation or elevated serum ferritin on testing of repeated specimens; or (b) the patient has a first degree relative with haemochromatosis; or (c) the patient has a first degree relative with homozygosity for the C282Y genetic mutation, or with compound heterozygosity for recognised genetic mutations for haemochromatosis (Item is subject to rule 20) | 37.10 | |||||
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, phenabarbitone, phenytoin, primidone, procainamide, quinidine, salicylate, theophyline, tobramicin, valproate or vancomycin — 1 test (Item is subject to rule 6) | 18.45 | |||||
66803 | 2 tests described in item 66800 (Item is subject to rule 6) | 31.05 | |||||
66806 | 3 tests described in item 66800 (Item is subject to rule 6) | 43.60 | |||||
66809 | Tests described in item 66800, if rendered under a request referred to in subparagraph 6 (2) (a) (iii) of Part 2 — each test to a maximum of 2 tests | 12.60 | |||||
66812 | Quantitation, not elsewhere described in this table by any method or methods, in blood, urine or other body fluid, of a drug being used therapeutically by the patient from whom the specimen was taken — 1 test (Item is subject to rule 6) | 35.45 | |||||
66815 | 2 tests described in item 66812 (Item is subject to rule 6) | 60.60 | |||||
66818 | Tests described in item 66812, if rendered under a request referred to in subparagraph 6 (2) (a) (iii) of Part 2 — each test to a maximum of 1 test (Item is subject to rule 6) | 25.15 | |||||
Group P3 — Microbiology | |||||||
69300 | Microscopy of wet film material other than blood, from 1 or more sites, obtained directly from a patient (not cultures) including: (a) differential cell count (if performed); or (b) examination for dermatophytes; or (c) dark ground illumination; or (d) stained preparation or preparations using any relevant stain or stains; 1 or more tests | 12.60 | |||||
69303 | Culture and (if performed) microscopy to detect pathogenic micro‑organisms (including fungi but excluding viruses) 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) the detection of antigens not elsewhere described in this table; or (c) a service described in item 69300; specimens from 1 or more sites | 22.15 | |||||
69306 | Microscopy and culture to detect pathogenic micro-organisms (including fungi but excluding viruses) from skin or other superficial sites, including (if performed): (a) the detection of antigens not elsewhere specified in this table; or (b) pathogen identification and antibiotic susceptibility testing; or (c) a service described in items 69300, 69303, 69312, 69318 and 73810; 1 or more tests on 1 or more specimens | 34.00 | |||||
69309 | Microscopy and culture to detect dermatophytes and other fungi causing cutaneous disease, from skin scrapings, skin biopsies, hair and nails (excluding swab specimens) and including (if performed): (a) the detection of antigens not elsewhere specified in this table; or (b) a service described in items 69300, 69303, 69306, 69312, 69318 and 73810; 1 or more tests on 1 or more specimens | 48.45 | |||||
69312 | Microscopy and culture to detect pathogenic micro‑organisms (including fungi but excluding viruses) from urethra, vagina, cervix or rectum (except for faecal pathogens), including (if performed): (a) the detection of antigens not elsewhere specified in this table; or (b) pathogen identification and antibiotic susceptibility testing; or (c) a service described in items 69300, 69303, 69306 and 69318; 1 or more tests on 1 or more specimens | 34.00 | |||||
69315 | Microscopy and culture to detect pathogenic micro‑organisms and the detection of chlamydia from urethra, vagina, cervix or rectum and including (if performed): (a) the detection of microbial antigens; or (b) pathogen identification and antibiotic susceptibility testing; or (c) a service described in item 69300, 69303, 69306, 69312, 69318, 69363, 69369, 69370, 69372, 69375 or 73810; 1 or more tests on 1 or more specimens | 62.70 | |||||
69318 | Microscopy and culture to detect pathogenic micro‑organisms (including fungi but excluding viruses) from specimens of sputum (except when part of items 69324, 69327 and 69330), including (if performed): (a) the detection of antigens (from any type of specimen) not elsewhere specified in this table, including item 69372; or (b) pathogen identification and antibiotic susceptibility testing; or | 34.00 | |||||
| (c) a service described in items 69300, 69303, 69306 and 69312; 1 or more tests on 1 or more specimens |
| |||||
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 (including fungi but excluding viruses) 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) the detection of antigens not elsewhere specified in this table; or (c) a service described in item 69300, 69303, 69306, 69312 or 69318; specimens from 1 or more sites | 48.45 | |||||
69324 | Microscopy (with appropriate stains) and culture for mycobacteria — 1 specimen of sputum, urine or other body fluid or 1 operative or biopsy specimen, including (if performed): (a) microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or (b) pathogen identification and antibiotic susceptibility testing; including a service mentioned in item 69300 | 43.30 | |||||
69327 | Microscopy (with appropriate stains) and culture for mycobacteria — 2 specimens of sputum, urine or other body fluids or operative or biopsy specimens, including (if performed): (a) microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or (b) pathogen identification and antibiotic susceptibility testing; including a service described in item 69300 | 85.55 | |||||
69330 | Microscopy (with appropriate stains) and culture for mycobacteria — 3 specimens of sputum, urine or other body fluids or operative or biopsy specimens, including (if performed): (a) microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or (b) pathogen identification and antibiotic susceptibility testing; including a service described in item 69300 | 128.85 | |||||
69333 | Urine examination (including serial examination) by any means other than simple culture by dip slide, including: (a) cell count; and (b) culture; and (c) colony count; and (d) (if performed) identification of cultured pathogens; and (e) (if performed) examination for pH, specific gravity, blood, albumin, urobilinogen, sugar, acetone or bile salts | 20.70 | |||||
69336 | Microscopy of faeces for ova, cysts and parasites using concentration techniques including the use of fixed stains or antigen detection for cryptosporidia and giardia, including (if performed) a service mentioned in item 69300 — not more than 1 examination in a 7 day period | 33.65 | |||||
69339 | Microscopy of faeces for ova, cysts and parasites using concentration techniques examined after examination described in item 69336 performed on a separately collected and identified specimen collected within 7 days of the examination described in item 69336 — not more than 1 examination in a 7 day period | 19.25 | |||||
69345 | Culture and (if performed) microscopy without concentration techniques of faeces for faecal pathogens, using at least 2 selective or enrichment media and culture in at least 2 different atmospheres including (if performed): (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 1 examination in a 7 day period | 53.25 | |||||
69354 | Blood culture for pathogenic micro-organisms (other than viruses), including sub-cultures and (if performed): (a) identification of any cultured pathogen; and (b) necessary antibiotic susceptibility testing; to a maximum of 3 sets of cultures — 1 set of cultures | 30.95 | |||||
69357 | 2 sets of cultures described in item 69354 | 61.85 | |||||
69360 | 3 sets of cultures described in item 69354 | 92.80 | |||||
69363 | Detection of Clostridium difficile or Clostridium difficile toxin (except if a service described in item 69345, 69369, 69370, 69372, 69373 or 69375 has been performed) — 1 or more tests | 28.85 | |||||
69369 | Detection of chlamydia by any method in specimens from 1 or more sites | 28.85 | |||||
69370 | Detection of chlamydia by any method and Neisseria gonorrhoeae by nucleic acid amplification techniques in specimens from 1 or more sites | 36.10 | |||||
69372 | Detection of microbial antigens or nucleic acids (not elsewhere described in this table) — 1 or more tests | 28.85 | |||||
69373 | Detection of a virus or microbial antigen or nucleic acid from a respiratory tract specimen — 1 test | 28.85 | |||||
69374 | 2 or more tests described in item 69373 | 36.10 | |||||
69375 | Examination for Herpes simplex virus, varicella zoster virus or cytomegalovirus by culture or by detection of microbial antigen or nucleic acid, including a service described in item 69363, 69369, 69370, 69372 or 69373 (if performed) — 1 test | 28.85 | |||||
69376 | 2 or more tests described in item 69375 | 36.10 | |||||
69378 | Quantitation of HIV viral RNA load in plasma or serum in the monitoring of a HIV sero-positive patient not on antiretroviral therapy — 1 or more assays on 1 or more specimens in any 1 patient episode | 181.45 | |||||
69381 | Quantitation of HIV viral RNA load in plasma or serum in the monitoring of antiretroviral therapy in a HIV sero-positive patient — 1 or more assays on 1 or more specimens in any 1 patient episode | 181.45 | |||||
69382 | Quantitation of HIV viral RNA load in cerebrospinal fluid in a HIV sero‑positive patient — 1 or more assays on 1 or more specimens in any 1 patient episode | 181.45 | |||||
69384 | Quantitation of 1 antibody to microbial or exogenous antigens not elsewhere described in this table — 1 test (Item is subject to rule 6) | 15.75 | |||||
69387 | 2 tests described in item 69384 (Item is subject to rule 6) | 28.85 | |||||
69390 | 3 tests described in item 69384 (Item is subject to rule 6) | 43.30 | |||||
69393 | 4 tests described in item 69384 (Item is subject to rule 6) | 57.75 | |||||
69396 | 5 tests described in item 69384 (Item is subject to rule 6) | 72.15 | |||||
69399 | 6 or more tests described in item 69384 | 86.60 | |||||
69402 | Tests described in item 69384, if rendered under a request referred to in subparagraph 6 (2) (a) (iii) of Part 2 — each test to a maximum of 5 tests (Item is subject to rule 6) | 14.45 | |||||
69405 | Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of 1 of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody; and (b) (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481 | 15.75 | |||||
69408 | Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of 2 of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody; and (b) (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481 | 28.00 | |||||
69411 | Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of 3 of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody; and (b) (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481 | 39.35 | |||||
69413 | Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: (a) the determination of all of the following — rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody; and (b) (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481 | 50.65 | |||||
69442 | Quantitation of HCV RNA load in plasma or serum in the pretreatment evaluation or the assessment of efficacy of antiviral therapy of a patient with chronic HCV hepatitis — where the test is requested by or on the advice of the specialist or consultant physician who manages the treatment of the patient with chronic HCV hepatitis (including a service in item 69444 or 69445) — not more than 2 tests in a 12 month period | 181.45 | |||||
69443 | Nucleic acid amplification and determination of hepatitis C virus (HCV) genotype if: (a) the patient is HCV RNA positive and is being evaluated for antiviral therapy of chronic HCV hepatitis; and (b) the request for the test is made by, or on the advice of, the specialist or consultant physician managing the treatment of the patient Not more than 1 episode in a 12 month period | 206.20 | |||||
69444 | Detection of Hepatitis C viral RNA if at least 1 of the following criteria is satisfied: (a) the patient is Hepatitis C seropositive; (b) the patient’s serological status is uncertain after testing; (c) the test is performed for the purpose of: (i) determining the Hepatitis C status of an immunosuppressed or immunocompromised patient; or (ii) the detection of acute Hepatitis C prior to seroconversion where considered necessary for the clinical management of the patient Not more than 1 patient episode in a 12 month period (Item is subject to rule 19) | 92.80 | |||||
69445 | Detection of Hepatitis C viral RNA in a patient undertaking antiviral therapy for chronic HCV hepatitis (including a service described in item 69444) — not more than 4 patient episodes in a 12 month period (Item is subject to rule 19) | 92.80 | |||||
69471 | Test of cell‑mediated immunity in blood for the detection of active tuberculosis or atypical mycobacterial infection in an immunosuppressed or immunocompromised patient — 1 test | 35.15 | |||||
69472 | Detection of antibodies to Epstein Barr Virus using specific serology — 1 test | 15.75 | |||||
69474 | Detection of antibodies to Epstein Barr Virus using specific serology — 2 or more tests | 28.85 | |||||
69475 | Detection of hepatitis antigens or antibodies to determine immune status or viral carriage following exposure or vaccination to Hepatitis A, Hepatitis B, Hepatitis C or Hepatitis D — 1 test, including: (a) Hepatitis A antibody test; or (b) Hepatitis B antibody or antigen test; or (c) Hepatitis C antibody test; or (d) Hepatitis D antibody test in a patient who is Hepatitis B surface antigen positive (Item is subject to rule 11) | 15.75 | |||||
69478 | Detection of hepatitis antigens or antibodies to determine immune status or viral carriage following exposure or vaccination to Hepatitis A, Hepatitis B, Hepatitis C or Hepatitis D — 2 tests, including: (a) Hepatitis A antibody test; or (b) Hepatitis B surface or core antibody test; or (c) Hepatitis B surface antigen test; or (d) Hepatitis B ‘e’ antibody or ‘e’ antigen test; or (e) Hepatitis C antibody test; or (f) Hepatitis D antibody test in a patient who is Hepatitis B surface antigen positive (Item is subject to rule 11) | 29.45 | |||||
69481 | Investigation of infectious causes of acute or chronic hepatitis — 3 tests, including: (a) Hepatitis A antibody test; or (b) Hepatitis B core antibody test; or (c) Hepatitis B ‘e’ antibody or ‘e’ antigen test; or (d) Hepatitis B surface antibody or surface antigen test; or (e) Hepatitis C antibody test; or (f) Hepatitis D antibody test in a patient who is Hepatitis B surface antigen positive (Item is subject to rule 11) | 40.80 | |||||
69484 | Supplementary test for Hepatitis B surface antigen or Hepatitis C antibody using a different assay on a specimen that yielded a reactive result on initial testing | 17.20 | |||||
Group P4 — Immunology | |||||||
71057 | Electrophoresis, quantitative and qualitative, of serum, urine or other body fluid all collected within 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 — 1 specimen type | 36.30 | |||||
71058 | Examination as described in item 71057 of 2 or more specimen types | 51.40 | |||||
71059 | Electrophoresis and immunofixation, immunoelectrophoresis or isoelectric focussing of: (a) urine for detection of Bence Jones proteins; or (b) serum, plasma or other body fluid; and characterisation, if detected, of a paraprotein or cryoglobulin not previously characterised — examination of 1 specimen type (eg serum, urine or CSF) | 29.70 | |||||
71060 | Examination as described in item 71059 of 2 or more specimen types | 44.80 | |||||
71062 | Electrophoresis and immunofixation or immunoelectrophoresis or isoelectric focussing of CSF for the detection of oligoclonal bands and including if required electrophoresis of the patient’s serum for comparison purposes — 1 or more tests | 44.80 | |||||
71064 | Detection and quantitation of cryoglobulins or cryofibrinogen — 1 or more tests | 21.10 | |||||
71066 | Quantitation of total immunoglobulin A (by any method) in serum, urine, or other body fluid — 1 test | 14.80 | |||||
71068 | Quantitation of total immunoglobulin G (by any method) in serum, urine, or other body fluid — 1 test | 14.80 | |||||
71069 | 2 tests described in item 71066, 71068, 71072 or 71074 | 23.15 | |||||
71071 | 3 or more tests described in item 71066, 71068, 71072 or 71074 | 31.50 | |||||
71072 | Quantitation of total immunoglobulin M (by any method) in serum, urine, or other body fluid — 1 test | 14.80 | |||||
71073 | Quantitation of all 4 immunoglobulin G subclasses — each patient episode | 108.00 | |||||
71074 | Quantitation of total immunoglobulin D (by any method) in serum, urine, or other body fluid — 1 test | 14.80 | |||||
71075 | Quantitation of immunoglobulin E (total), with a maximum of 2 patient episodes in any 12 month period — each patient episode | 23.40 | |||||
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, with a maximum of 6 patient episodes in a 12 month period — each patient episode | 27.55 | |||||
71079 | Detection of specific immunoglobulin G or E antibodies to single or multiple potential allergens, with a maximum of 4 patient episodes in a 12 month period — each patient episode | 27.30 | |||||
71081 | Quantitation of total haemolytic complement | 41.25 | |||||
71083 | Quantitation of complement components C3 and C4 or properdin factor B — 1 test | 20.50 | |||||
71085 | 2 tests described in item 71083 | 29.45 | |||||
71087 | 3 or more tests described in item 71083 | 38.35 | |||||
71089 | Quantitation of complement components or breakdown products of complement proteins not elsewhere described in an item in this table — 1 test | 29.65 | |||||
71091 | 2 tests described in item 71089 | 53.70 | |||||
71093 | 3 or more tests described in item 71089 | 77.80 | |||||
71095 | Quantitation of serum or plasma eosinophil cationic protein, or both, to a maximum of 3 assays in 1 year, for monitoring the response to therapy in corticosteroid treated asthma, in a child aged less than 12 years | 41.25 | |||||
71097 | Antinuclear antibodies — detection in serum or other body fluids, including quantitation if required | 24.85 | |||||
71099 | Double-stranded DNA antibodies — quantitation by 1 or more methods other than the Crithidia method | 27.00 | |||||
71101 | Antibodies to 1 or more extractable nuclear antigens — detection in serum or other body fluids | 17.70 | |||||
71103 | Characterisation of an antibody detected in a service described in item 71101 (including that service) | 52.95 | |||||
71106 | Rheumatoid factor — detection by any technique in serum or other body fluids, including quantitation if required | 11.50 | |||||
71109 | Antibodies to tissue antigens (acetylcholine receptor, adrenal cortex, cardiolipin, 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, including quantitation if required, of 1 antibody | 35.15 | |||||
71113 | Detection of 2 antibodies described in item 71109 | 48.25 | |||||
71115 | Detection of 3 antibodies described in item 71109 | 61.35 | |||||
71117 | Detection of 4 or more antibodies described in item 71109 | 74.45 | |||||
71119 | Antibodies to tissue antigens not elsewhere specified in this table — detection, including quantitation if required, of 1 antibody | 17.65 | |||||
71121 | Detection of 2 antibodies specified in item 71119 | 21.15 | |||||
71123 | Detection of 3 antibodies specified in item 71119 | 24.65 | |||||
71125 | Detection of 4 or more antibodies specified in item 71119 | 28.15 | |||||
71127 | Functional tests for lymphocytes — quantitation other than by microscopy of: (a) proliferation induced by 1 or more mitogens; or (b) proliferation induced by 1 or more antigens; or | 179.45 | |||||
| (c) estimation of 1 or more mixed lymphocyte reactions; including a test described in item 65066 or 65070 (if performed), up to a maximum of 2 patient episodes in a 12 month period — each patient episode |
| |||||
71129 | 2 tests described in item 71127 | 221.65 | |||||
71131 | 3 or more tests described in item 71127 | 263.90 | |||||
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 | 10.55 | |||||
71134 | Investigation of recurrent infection, by quantitative assessment, of oxidative pathways by flow cytometric techniques, including a test described in item 71133 (if performed) | 105.85 | |||||
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), up to a maximum of 2 patient episodes in a 12 month period — each patient episode | 211.60 | |||||
71137 | Quantitation of cell-mediated immunity by multiple antigen delayed type hypersensitivity intradermal skin testing using a minimum of 7 antigens, up to a maximum of 2 patient episodes in a 12 month period — each patient episode | 30.80 | |||||
71139 | Characterisation of 3 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations, including a total lymphocyte count or total leucocyte count by any method, on 1 or more specimens of blood, CSF or serous fluid | 105.85 | |||||
71141 | Characterisation of 3 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations on 1 or more disaggregated tissue specimens | 200.85 | |||||
71143 | Characterisation of 6 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations for the diagnosis (but not monitoring) of an immunological or haematological malignancy, including a service described in 1 or both of items 71139 and 71141 (if performed), on a specimen of blood, CSF, serous fluid or disaggregated tissue | 264.55 | |||||
71145 | Characterisation of 6 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations for the diagnosis (but not monitoring) of an immunological or haematological malignancy, including a service described in 1 or more of items 71139, 71141 and 71143 (if performed) on 2 or more specimens of disaggregated tissues or 1 specimen of disaggregated tissue and 1 or more specimens of blood, CSF or serous fluid | 431.95 | |||||
71146 | Enumeration of CD34+ cells, only for the purposes of autologous or directed allogeneic haemopoietic stem cell transplantation, including a total white cell count | 105.85 | |||||
71147 | HLA-B27 typing | 41.25 | |||||
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 | 110.15 | |||||
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 | 120.95 | |||||
71153 | Testing, for assessment or diagnosis of systemic inflammatory disease or vasculitis, for the presence of an antibody by 1 of the following tests: (a) antineutrophil cytoplasmic antibody (ANCA) immunofluorescence test; (b) antineutrophil proteinase 3 antibody (PR3 ANCA) test; (c) antimyeloperoxidase antibody (MPO ANCA) test; (d) antiglomerular basement membrane antibody (GBM ANCA) test (Item is subject to rule 23) | 35.15 | |||||
71155 | Testing for the presence of 2 antibodies by tests mentioned in item 71153 (Item is subject to rule 23) | 48.25 | |||||
71157 | Testing for the presence of 3 antibodies by tests mentioned in item 71153 (Item is subject to rule 23) | 61.35 | |||||
71159 | Testing for the presence of 4 antibodies by tests mentioned in item 71153 (Item is subject to rule 23) | 74.45 | |||||
71163 | Detection of 1 of the following antibodies (of 1 or more class or isotype) in the assessment or diagnosis of coeliac disease or other gluten hypersensitivity syndromes, including a service described in item 71066 (if performed): (a) antibodies to gliadin; (b) antibodies to endomysium; (c) antibodies to tissue transglutaminase 1 test | 25.15 | |||||
71164 | 2 or more tests mentioned in item 71163, including a service described in item 71066 (if performed) | 40.60 | |||||
Group P5 — Tissue pathology | |||||||
72813 | Examination of complexity level 2 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 1 or more separately identified specimens (Item is subject to rule 13) | 72.15 | |||||
72816 | Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 1 separately identified specimen (Item is subject to rule 13) | 87.10 | |||||
72817 | Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 2 to 4 separately identified specimens (Item is subject to rule 13) | 97.45 | |||||
72818 | Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 5 or more separately identified specimens (Item is subject to rule 13) | 107.75 | |||||
72823 | Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 1 separately identified specimen (Item is subject to rule 13) | 97.95 | |||||
72824 | Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 2 to 4 separately identified specimens (Item is subject to rule 13) | 142.30 | |||||
72825 | Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 5 to 7 separately identified specimens (Item is subject to rule 13) | 181.45 | |||||
72826 | Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 8 or more separately identified specimens (Item is subject to rule 13) | 195.90 | |||||
72830 | Examination of complexity level 5 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 1 or more separately identified specimens (Item is subject to rule 13) | 190.75 | |||||
72836 | Examination of complexity level 6 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions — 1 or more separately identified specimens (Item is subject to rule 13) | 293.85 | |||||
72844 | Enzyme histochemistry of skeletal muscle for investigation of primary degenerative or metabolic muscle diseases or of muscle abnormalities secondary to disease of the central or peripheral nervous system — 1 or more tests | 30.95 | |||||
72846 | Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen — 1 to 3 antibodies except those mentioned in item 72848 (Item is subject to rule 13) | 43.30 | |||||
72847 | Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen — 4 or more antibodies (Item is subject to rule 13) | 57.75 | |||||
72848 | Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen — 1 to 3 of the following antibodies: (a) oestrogen; (b) progesterone; (c) c-erb-B2 (HER2) (Item is subject to rule 13) | 51.55 | |||||
72851 | Electron microscopic examination of biopsy material — 1 separately identified specimen (Item is subject to rule 13) | 185.60 | |||||
72852 | Electron microscopic examination of biopsy material — 2 or more separately identified specimens (Item is subject to rule 13) | 247.45 | |||||
72855 | Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear — 1 separately identified specimen (Item is subject to rule 13) | 185.60 | |||||
72856 | Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear — 2 to 4 separately identified specimens (Item is subject to rule 13) | 247.45 | |||||
72857 | Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear — 5 or more separately identified specimens (Item is subject to rule 13) | 288.70 | |||||
Group P6 — Cytology | |||||||
73043 | Cytology (including serial examinations) of nipple discharge or smears from skin, lip, mouth, nose or anus for detection of precancerous or cancerous changes — 1 or more tests | 23.00 | |||||
73045 | Cytology (including serial examinations) for malignancy (other than an examination mentioned in item 73053), including any Group P5 service (if performed), 1 or more tests on: (a) specimens resulting from washings or brushings from sites not specified in item 73043; or (b) a single specimen of sputum or urine; or (c) 1 or more specimens of other body fluids | 48.95 | |||||
73047 | Cytology of a series of 3 sputum or urine specimens for malignant cells | 95.35 | |||||
73049 | Cytology of material obtained directly from a patient by fine needle aspiration of solid tissue, or tissues | 69.60 | |||||
73051 | Cytology of material obtained directly from a patient by fine needle aspiration of solid tissue, or tissues, if: (a) the aspiration is performed by a recognised pathologist; or (b) a recognised pathologist attends the aspiration and performs a cytological examination during the attendance | 171.50 | |||||
73053 | Cytology of a smear from cervix, where the smear is prepared by direct application of the specimen to a slide, excluding the use of liquid based slide preparation techniques, and the stained smear is microscopically examined by or on behalf of a pathologist — each examination: (a) for the detection of precancerous or cancerous changes in women with no symptoms, signs or recent history suggestive of cervical neoplasia; or (b) if a further specimen is taken due to an unsatisfactory smear taken for the purposes of paragraph (a); or (c) if there is inadequate information provided to use item 73055 | 19.60 | |||||
73055 | Cytology of a smear from cervix, not associated with item 73053, where the smear is prepared by direct application of the specimen to a slide, excluding the use of liquid based slide preparation techniques, and the stained smear is microscopically examined by or on behalf of a pathologist — each test: (a) for the management of previously detected abnormalities including precancerous or cancerous conditions; or (b) for the investigation of women with symptoms, signs or recent history suggestive of cervical neoplasia | 19.60 | |||||
73057 | Cytology of a smear from vagina, not associated with item 73053 or 73055, and not to monitor hormone replacement therapy, where the smear is prepared by direct application of the specimen to a slide, excluding the use of liquid based slide preparation techniques, and the stained smear is microscopically examined by or on behalf of a pathologist — each test | 19.60 | |||||
73059 | Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049 and 73051 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen — 1 to 3 antibodies except those mentioned in item 73061 (Item is subject to rule 13) | 43.30 | |||||
73060 | Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049 and 73051 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen — 4 or more antibodies (Item is subject to rule 13) | 57.75 | |||||
73061 | Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049 and 73051 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen — 1 to 3 of the following antibodies: (a) oestrogen; (b) progesterone; (c) c-erb-B2 (HER2) (Item is subject to rule 13) | 51.55 | |||||
Group P7 — Genetics | |||||||
73287 | Chromosome studies, including preparation, count, karyotyping and identification by banding techniques of 1 or more of any tissue or fluid except blood — 1 or more tests | 401.45 | |||||
73289 | Chromosome studies, including preparation, count, karyotyping and identification by banding techniques of blood — 1 or more tests | 365.20 | |||||
73300 | Detection of genetic mutation of the FMR1 gene by nucleic acid amplification (NAA) where: (a) the patient exhibits 1 or more of the clinical features of fragile X (A) syndrome, including intellectual disabilities; or (b) the patient has a relative with a fragile X (A) mutation 1 or more tests | 103.10 | |||||
73305 | Detection of genetic mutation of the FMR1 gene by Southern Blot, if the results of a service performed in item 73300 are inconclusive | 206.20 | |||||
Group P8 — Infertility and pregnancy tests | |||||||
73521 | Semen examination for presence of spermatozoa or examination of cervical mucus for spermatozoa (Huhner’s test) | 9.80 | |||||
73523 | Semen examination (other than post-vasectomy semen examination), including: (a) measurement of volume, sperm count and motility; and (b) examination of stained preparations; and (c) morphology; and (d) (if performed) differential count and 1 or more chemical tests; no more than 4 patient episodes in a 12 month period — each patient episode | 42.50 | |||||
73525 | Sperm antibodies — sperm-penetrating ability — 1 or more tests | 28.85 | |||||
73527 | Human chorionic gonadotrophin (HCG) — detection in serum or urine by 1 or more methods for diagnosis of pregnancy — 1 or more tests | 10.20 | |||||
73529 | Human chorionic gonadotrophin (HCG), quantitation in serum by 1 or more methods (except by latex, membrane, strip or other pregnancy test kit) for diagnosis of threatened abortion, or follow up of abortion or diagnosis of ectopic pregnancy, including any services performed in item 73527 — 1 test | 29.15 | |||||
Group P9 — Simple basic pathology tests | |||||||
73801 | Semen examination for presence of spermatozoa | 6.95 | |||||
73802 | Leucocyte count, erythrocyte sedimentation rate, examination of blood film (including differential leucocyte count), haemoglobin, haematocrit or erythrocyte count — 1 test | 4.60 | |||||
73803 | 2 tests described in item 73802 | 6.40 | |||||
73804 | 3 or more tests described in item 73802 | 8.20 | |||||
73805 | Microscopy of urine, whether stained or not, or catalase test | 4.60 | |||||
73806 | Pregnancy test by 1 or more immunochemical methods | 10.20 | |||||
73807 | Microscopy for wet film other than urine, including any relevant stain | 6.95 | |||||
73808 | Microscopy of Gram-stained film, including (if performed) a service described in item 73805 or 73807 | 8.70 | |||||
73809 | Chemical tests for occult blood in faeces by reagent stick, strip, tablet or similar method | 2.35 | |||||
73810 | Microscopy for fungi in skin, hair or nails — 1 or more sites | 6.95 | |||||
73811 | Mantoux test | 11.30 | |||||
Group P10 — Patient episode initiation | |||||||
73901 | Initiation of a patient episode that consists only of a service described in item 73053, 73055 or 73057 from a person who is not in a recognised hospital or a prescribed laboratory | 8.25 | |||||
73903 | Initiation of a patient episode that consists only of 1 or more services described in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 from a person who is an in-patient of a hospital other than a recognised hospital | 14.75 | |||||
73905 | Initiation of a patient episode that consists only of 1 or more services described in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 from a person who is not an in-patient of a private hospital and not a patient of a recognised hospital | 8.25 | |||||
73907 | Initiation of a patient episode by collection of a specimen for a service (other than a service described in any of items 73901, 73903, 73905 or in Group P9) if the specimen is collected: (a) until 30 November 2001 — in a licensed collection centre (within the meaning of Part IIA of the Act); or (b) after that date — in an approved collection centre | 17.40 | |||||
73909 | Initiation of a patient episode by collection of a specimen for a service (other than a service described in any of items 73901, 73903, 73905 or in Group P9) if the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person who is an in-patient of a hospital other than a recognised hospital | 17.70 | |||||
73910 | Initiation of a patient episode by collection of a specimen for a service (other than a service described in any of items 73901, 73903, 73905 or in Group P9) if the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person in the place where the person was residing | 10.30 | |||||
73912 | Initiation of a patient episode by collection of a specimen for a service (other than a service described in any of items 73901, 73903, 73905 or in Group P9) if the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person in a residential care facility or institution | 17.70 | |||||
73913 | Initiation of a patient episode by collection of a specimen for a service (other than a service described in any of items 73901, 73903, 73905, 73907 or items in Group P9) if the specimen is collected from the person by the person | 9.80 | |||||
73915 | Initiation of a patient episode by collection of a specimen for a service (other than a service described in any of items 73901, 73903, 73905 or items in Group P9) if the specimen is collected by or on behalf of the treating practitioner | 9.80 | |||||
Group P11 — Specimen referred | |||||||
73921 | Receipt of a specimen by an approved pathology practitioner of an approved pathology authority from another approved pathology practitioner of a different approved pathology authority or another approved pathology authority (Item is subject to rules 14, 15 and 16) | 10.30 | |||||
Group P12 — Management of bulk-billed services | |||||||
74990 | A pathology service to which an item in this table (other than this item or item 74991) applies if: (a) the service is an unreferred service; and (b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and (c) the person is not an admitted patient of a hospital or day‑hospital facility; and (d) the service is bulk-billed in respect of the fees for: (i) this item; and (ii) the other item in this table applying to the service | 5.85 | |||||
74991 | A pathology service to which an item in this table (other than this item or item 74990) applies if: (a) the service is an unreferred service; and (b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and (c) the person is not an admitted patient of a hospital or day‑hospital facility; and | 8.80 | |||||
| (d) the service is bulk-billed in respect of the fees for: (i) this item; and (ii) the other item in this table applying to the service; and |
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| (e) the service is provided at, or from, a practice location in: (i) a regional, rural or remote area; or (ii) Tasmania; or (iii) a geographical area included in any of the following SSD spatial units: (A) Beaudesert Shire Part A (B) Belconnen (C) Darwin City (D) Eastern Outer Melbourne (E) East Metropolitan (F) Frankston City (G) Gosford-Wyong (H) Greater Geelong City Part A (I) Gungahlin-Hall (J) Ipswich City (Part in BSD) (K) Litchfield Shire (L) Melton-Wyndham (M) Mornington Peninsula Shire (N) Newcastle (O) North Canberra (P) Palmerston-East Arm (Q) Pine Rivers Shire (R) Queanbeyan (S) South Canberra (T) South Eastern Outer Melbourne (U) Southern Adelaide (V) South West Metropolitan (W) Thuringowa City Part A (X) Townsville City Part A (Y) Tuggeranong (Z) Weston Creek-Stromlo (ZA) Woden Valley (ZB) Yarra Ranges Shire Part A; or; or (iv) the geographical area included in the SLA spatial unit of Palm Island (AC) |
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