{"id":"F2026L00272","name":"Health Insurance (Eligible Pathology Laboratories) Determination 2026","slug":"health-insurance-eligible-pathology-laboratories-determination-2026","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443203,"registerId":"F2026L00272-fast-fetch-1775958103874","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Health Insurance (Eligible Pathology Laboratories) Determination 2026","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n![Commonwealth Coat of Arms of Australia](image.001.jpeg)\n\n \n\nHealth Insurance (Eligible Pathology Laboratories) Determination 2026\n\nI, Mark Butler, Minister for Health and Ageing, make the following determination.\n\n \n\nDated         16 March 2026\n\nMark Butler  \n\nMinister for Health and Ageing\n\n \n\n \n\n \n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Schedules\n\n5 Definitions\n\n6 Categories of eligible pathology laboratories........................2\n\nSchedule 1—Repeals 3\n\nHealth Insurance (Eligible Pathology Laboratories) Determination 2015 3\n\n \n\n \n\n1  Name\n\n  This instrument is the Health Insurance (Eligible Pathology Laboratories) Determination 2026.\n\n2  Commencement\n\n (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.\n\n \n\n- Commencement information\n- Column 1 Column 2 Column 3\n- Provisions Commencement Date/Details\n- 1. The whole of this instrument 1 April 2026. 1 April 2026\n\n\nNote: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.\n\n (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.\n\n3  Authority\n\n  This instrument is made under subsection 23DBA(1) of the Health Insurance Act 1973.\n\n4.  Schedules\n\n  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.\n\n5  Definitions\n\n  In this instrument:\n\nAct means the Health Insurance Act 1973.\n\nCategory GX (General) means the category of that name set out in section 17 of in the Health Insurance (Accredited Pathology Laboratories – Approval) Principles 2017, as in force from time to time.\n\nCategory GY (General) means the category of that name set out in section 17 of the Health Insurance (Accredited Pathology Laboratories – Approval) Principles 2017, as in force from time to time.\n\nCategory S (Specialised) means the category of that name set out in section 17 of the Health Insurance (Accredited Pathology Laboratories – Approval) Principles 2017, as in force from time to time.\n\nNote 1 Unless the contrary intention appears, expressions used in this determination have the same meanings as in the Act—see section 13 of the Legislation Act 2003. The  term  accredited pathology laboratory is defined in subsection 3(1) of the Act.\n\n6.  Categories of eligible pathology laboratories\n\n (1) For the purpose of the definition of eligible pathology laboratory in subsection 23DA(1) of the Act, the following categories are prescribed:\n\n1.    accredited pathology laboratories allocated Category GX (General) in the approval given under section 23DN of the Act relating to the laboratory;\n2.    accredited pathology laboratories allocated Category GY (General) in the approval given under section 23DN of the Act relating to the laboratory;\n3.    accredited pathology laboratories allocated Category S (Specialised) in the approval given under section 23DN of the Act relating to the laboratory.\n\n\n \n\n\n\n\nSchedule 1—Repeals\n\nHealth Insurance (Eligible Pathology Laboratories) Determination 2015\n\n1  The whole of the instrument\n\nRepeal the instrument\n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":2,"scope_assessment":{"changed":false,"description":"The legislation maintains its original narrow purpose: specifying which categories of accredited pathology laboratories are eligible for Medicare purposes. It is a direct replacement of the 2015 Determination with no expansion of scope."},"complexity_factors":["Very short instrument (only 6 substantive sections plus a repeal schedule)","Minimal defined terms (only 4 definitions, 3 of which simply cross-reference another instrument)","No nested exceptions or conditional logic—just a straightforward list of three categories","Single operational provision (section 6) that does one thing: prescribe categories for a definition in the parent Act","Heavy reliance on external documents (the 2017 Principles and the 1973 Act) for actual substantive content"],"plain_english_summary":"This instrument updates which pathology laboratories can claim Medicare rebates, replacing the 2015 rules with new 2026 criteria. It recognizes three eligible lab categories (GX, GY and S) as defined in the Health Insurance (Accredited Pathology Laboratories – Approval) Principles 2017.\n\nIt affects pathology labs seeking to bill Medicare, patients relying on rebate‑eligible testing, and the Department of Health/Medicare by setting the gatekeeper list for public funding and repealing the old 2015 rules."},"flash_summary":{"complexity_score":2,"scope_assessment":{"changed":false,"description":"The instrument prescribes that accredited laboratories holding Category GX, GY or S (per the Approval Principles 2017) are \"eligible pathology laboratories\" for subsection 23DA(1). It also repeals the 2015 Determination (Schedule 1). The text itself does not expand or narrow eligibility beyond prescribing these three categories; any substantive scope change would depend on differences between this and the repealed 2015 instrument or changes in the Approval Principles 2017."},"complexity_factors":["Direct cross-references to the Health Insurance Act 1973 (authority under subsection 23DBA(1)) (see section 3).","Reliance on definitions and category definitions located in an external instrument: Health Insurance (Accredited Pathology Laboratories – Approval) Principles 2017, section 17 (see section 5 and section 6).","Reference to approval allocated under section 23DN of the Act to determine eligibility (see section 6).","Repeal of an earlier instrument (Health Insurance (Eligible Pathology Laboratories) Determination 2015) which requires checking prior instrument for differences (Schedule 1).","Simple commencement mechanics (single date) reduce administrative timing complexity (see section 2)."],"plain_english_summary":"This Determination says that, for Medicare purposes, an \"eligible pathology laboratory\" is any accredited laboratory assigned Category GX, GY or S under the Accredited Pathology Laboratories – Approval Principles 2017. It starts 1 April 2026 and repeals the 2015 Determination.\n\nIt affects accredited pathology labs and Medicare payments: a lab must hold one of those categories in its section 23DN approval to be eligible to bill Medicare. The decision shifts compliance onto labs to obtain and maintain the specified approval categories."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-eligible-pathology-laboratories-determination-2026","history":"/api/acts/health-insurance-eligible-pathology-laboratories-determination-2026/history","analysis":"/api/acts/health-insurance-eligible-pathology-laboratories-determination-2026/analysis","conflicts":"/api/acts/health-insurance-eligible-pathology-laboratories-determination-2026/conflicts","importantCases":"/api/acts/health-insurance-eligible-pathology-laboratories-determination-2026/important-cases","documents":"/api/acts/health-insurance-eligible-pathology-laboratories-determination-2026/documents"}}