{"id":"F2018L00377","name":"Health Insurance (Permitted Benefits – Pathology Services) Determination 2018","slug":"health-insurance-permitted-benefits-pathology-services-determination-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":99949,"registerId":"commonwealth-F2018L00377-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Health Insurance (Permitted Benefits – Pathology Services) Determination 2018","content":"![](image.001.png)\n\nHealth Insurance (Permitted Benefits — Pathology Services) Determination 2018\n\nHealth Insurance Act 1973\n\nI, DAVID WEISS, delegate of the Minister for Health, make this Determination under section 23DZZIG of the Health Insurance Act 1973.\n\nDated 21 March 2018\n\nDAVID WEISS  \nFirst Assistant Secretary  \nMedical Benefits Division  \nHealth Financing Group\n\nDepartment of Health\n\n1 Name\n\nThis instrument is the Health Insurance (Permitted Benefits – Pathology Services) Determination 2018.\n\n2 Authority\n\nThis instrument is made under section 23DZZIG of the Health Insurance Act 1973.\n\n3 Commencement\n\nThis instrument commences on the day after it is registered.\n\n4 Repeal\n\nThe Health Insurance (Permitted benefits – pathology services) Determination 2008 is repealed.\n\n5 Definitions\n\nIn this instrument:\n\n> Act means the Health Insurance Act 1973.\n\n> hospital treatment has the meaning given by section 121‑5 of the Private Health Insurance Act 2007.\n\n> Note Accredited pathology laboratory, approved pathology practitioner, hospital and pathology service are defined in subsection 3 (1) of the Act. Provider and requester are defined in subsection 23DZZID (1) of the Act.\n\n6 Permitted benefits for pathology services\n\n(1) For section 23DZZIG of the Act, a benefit mentioned in Schedule 1 is a permitted benefit if:\n\n(a) a beneficiary who is, or is connected to, a requester of a kind of pathology service, asks for, or accepts, the benefit from a provider, or a person connected to a provider, of a kind of pathology service; or\n\n(b) a provider, or a person connected to a provider, of a kind of pathology service offers or provides the benefit to a beneficiary who is, or is connected to, a requester of a kind of pathology service.\n\n(2) However, a benefit is not a permitted benefit if:\n\n(a) it is related to the number, kind or value of requests for pathology services made by a requester to a particular provider; or\n\n(b) taken with other benefits of the same kind, it exceeds the number that would usually be needed by the beneficiary’s practice.\n\nSchedule 1 Permitted benefits\n\n(section 6)\n\n    1 Items related to pathology that help the requester to make requests or view pathology reports if they can only be used for purposes connected with pathology\n\nExample\n\nRequesting software\n\n    2 The provision of the following staff at premises of the beneficiary:\n\n(a) an approved pathology practitioner, or a person rendering services on behalf of an approved pathology practitioner, stationed at the premises for the sole purpose of providing preliminary analysis or advice in relation to specimens collected during any of the following procedures performed at the premises:\n\n(i) a procedure performed by fine needle aspiration;\n\n(ii) bone marrow aspiration or trephine;\n\n(iii) frozen section examination;\n\n(b) for premises that are a hospital — staff stationed at the hospital to collect pathology specimens from a person who is in attendance at the hospital for the purpose of receiving hospital treatment\n\n    3 The provision of the following equipment at premises of the beneficiary:\n\n(a) equipment stationed at the premises for the sole purpose of providing preliminary analysis in relation to specimens collected during any of the following procedures performed at the premises:\n\n(i) a procedure performed by fine needle aspiration;\n\n(ii) bone marrow aspiration or trephine;\n\n(iii) frozen section examination;\n\n(b) for premises that are a hospital — equipment stationed at the hospital for use in relation to the rendering of services relating to pathology to a person who is in attendance at the hospital for the purpose of receiving hospital treatment\n\n    4 Educational material about pathology, including material that may be given to patients\n    5 Education sessions on pathology for the beneficiary if:\n\n(a) the primary objective of the session is to provide relevant information about pathology; and\n\n(b) the venue is appropriate for the educational purpose of the session; and\n\n(c) any hospitality given is secondary to the educational purpose of the session; and\n\n(d) the cost of any hospitality is reasonable having regard to the venue and the conduct of the session; and\n\n(e) no travel or accommodation costs of the beneficiary are paid by the provider of the benefit; and\n\n(f) the session does not include, and is not held with, a sporting event or other entertainment\n\nExamples of topics for educational material or sessions\n\n1 Appropriate requesting of pathology tests\n\n2 Understanding results and reports for areas of pathology and for particular tests\n\n3 Specimen collection, identification and transport procedures\n\n    6 Gifts or hospitality if:\n\n(a) they are a non‑cash benefit that is not convertible to cash; and\n\n(b) they are given infrequently and only in relation to a significant occasion; and\n\n(c) they are not given as inducement, consideration or reward for the beneficiary requesting pathology services from a particular provider; and\n\n(d) the cost of the gift or hospitality is reasonable in the circumstances\n\nExamples\n\n1 Flowers given because of the death of a family member of the beneficiary\n\n2 Hospitality given for Christmas parties\n\n    7 Pathology request forms and other forms (paper or electronic), telephone result pads, stock request pads, promotional publications and promotional items, including material promoting the quality, convenience and cost to patients of pathology services if:\n\n(a) it has no resale value for the beneficiary; and\n\n(b) it is clearly identified as coming from the provider of the pathology service\n\n    8 The following equipment that is necessary for the collection, identification or temporary storage of pathology specimens:\n\n(a) a refrigerator if:\n\n(i) it is necessary to preserve specimens awaiting transport; and\n\n(ii) it is labelled as the property of the provider of the benefit and used exclusively for pathology purposes; and\n\n(iii) it is used only for purposes connected with pathology services;\n\n(b) insulated containers or other specimen transport containers for transporting specimens must be labelled as the property of the provider of the benefit;\n\n(c) specimen pick‑up receptacles (e.g. night boxes) must be labelled as the property of the provider of the benefit\n\n    9 Goods mentioned in an item in the following table used for the collection of pathology specimens for testing or, if other uses are possible, when supplied by an accredited pathology laboratory to referrers, will only be used for collection purposes.\n\n| Item | Goods                                                                                                                                                                                  |\n| ---- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| 1    | Needle barrel holders                                                                                                                                                                  |\n| 2    | Vacutainer or equivalent tubes for collection                                                                                                                                          |\n| 3    | Syringes (5 ml or larger)                                                                                                                                                              |\n| 4    | 21 or 23 gauge needles                                                                                                                                                                 |\n| 5    | Individual alcohol wipes (for example, alcowipes)                                                                                                                                      |\n| 6    | Spreaders for blood films                                                                                                                                                              |\n| 7    | Small test tube racks                                                                                                                                                                  |\n| 8    | Spray fixative                                                                                                                                                                         |\n| 9    | Cervix spatulas                                                                                                                                                                        |\n| 10   | Cyto brush                                                                                                                                                                             |\n| 11   | Direct to vial kits                                                                                                                                                                    |\n| 12   | Slides and slide carriers or holders                                                                                                                                                   |\n| 13   | Formalin or other fixative                                                                                                                                                             |\n| 14   | Appropriate containers and media for specimens                                                                                                                                         |\n| 15   | Punch biopsy instruments                                                                                                                                                               |\n| 16   | Microbiological or virology swabs and transport media                                                                                                                                  |\n| 17   | Urine containers                                                                                                                                                                       |\n| 18   | Faeces containers                                                                                                                                                                      |\n| 19   | Paediatric urine collection kits                                                                                                                                                       |\n| 20   | Chlamydia specific collection and transport receptacles                                                                                                                                |\n| 21   | Tuberculosis specific collection receptacles                                                                                                                                           |\n| 22   | Blood culture bottles                                                                                                                                                                  |\n| 23   | Petri dishes                                                                                                                                                                           |\n| 24   | Specimen biohazard bags and rubber bands                                                                                                                                               |\n| 25   | Appropriate containers and media for urine, sputum and other body fluid cytology and cytology samples collected directly from tissues by the procedure of Fine Needle Aspiration (FNA) |\n| 26   | Timed urine collection containers                                                                                                                                                      |\n| 27   | Faecal fat collection containers                                                                                                                                                       |\n| 28   | Glucose drinks for a glucose tolerance test (GTT)                                                                                                                                      |\n| 29   | Centrifuges if:(a) they are labelled as the property of the provider of the benefit; and(b) they are necessary to ensure that specimens are not damaged                                |\n| 30   | Disposable vaginal speculums                                                                                                                                                           |","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the Health Insurance (Permitted benefits – pathology services) Determination 2008 (s.4) and substitutes a new list of permitted benefits and conditions (Schedule 1). The source shows replacement of the prior instrument but does not detail textual differences; therefore the Determination alters the operative instrument and establishes a revised scope of permitted pathology benefits."},"complexity_factors":["Cross‑references to the Health Insurance Act for defined terms (see s.5: definitions and note referencing subsection 3(1) and subsection 23DZZID(1))","Conditional test for permitted benefits in s.6(1) and exclusion criteria in s.6(2) (ties to requester connection and prohibition of benefits related to request volume)","Detailed, itemised Schedule 1 with item‑specific qualifying conditions (e.g. education session criteria in Schedule 1 item 5(a)–(f))","Operational labelling and exclusive‑use requirements for equipment and containers (Schedule 1 items 8 and 9, including centrifuge labelling and use limits)","Large enumerated list of specimen collection goods (Schedule 1 item 9) that requires practical compliance by providers and referrers","Limits on hospitality/gifts frequency and purpose that require judgement about ‘reasonable’ cost and ‘infrequent’ occurrence (Schedule 1 item 6)","Repeal and replacement of an earlier Determination (s.4) requiring comparison for transitional or scope implications","Enforcement relies on statutory permitted‑benefit tests rather than precise monetary thresholds, creating interpretive discretion for administrators and practitioners"],"plain_english_summary":"This Determination replaces the 2008 instrument and specifies which non‑cash benefits pathology providers may give to requesters (or people connected to them) without being excluded under the Health Insurance Act. It lists permitted items—software, certain on‑site staff/equipment, educational materials and sessions, modest gifts, and specimen collection supplies—and sets conditions that rule out benefits tied to request volumes or that exceed a practitioner’s normal needs.\n\nProviders supply and label the benefits; beneficiaries may accept them only if the conditions are met. The rules change provider incentives, create record and labelling requirements, and impose compliance tests that affect referral and supply practices."},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a straightforward remake of the 2008 Determination (which it explicitly repeals). The scope remains tightly focused on defining permitted benefits for pathology services to ensure compliance with prohibition on inducements while allowing practical support for patient care. No significant scope creep detected."},"complexity_factors":["Moderate cross-referencing to the Health Insurance Act 1973 (section 23DZZIG) and Private Health Insurance Act 2007 (for 'hospital treatment' definition)","Multiple defined terms sourced from external legislation (Act, hospital treatment, plus note referencing 5 additional defined terms from other sections)","Conditional logic with nested requirements—particularly items 5 and 6 which have 6 and 4 sub-conditions respectively","Specific exclusions in section 6(2) that override the general permission","Detailed tabular schedule with 30 specific items of medical equipment, each with specific use restrictions","Multiple 'sole purpose' and 'exclusive use' restrictions creating narrow operational boundaries"],"plain_english_summary":"This law creates narrow exceptions to anti‑kickback rules for pathology providers, allowing certain gifts, equipment, services and educational support to doctors and hospitals who request tests so long as they support patient care. Permitted items include IT/software, onsite staff for specimen procedures, limited lab‑owned collection equipment and fridges, educational materials/events, and modest infrequent gifts. Key limits: benefits must not depend on referral volume, must be proportionate to need, and exclude travel, accommodation, entertainment, or rewards for referrals."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-permitted-benefits-pathology-services-determination-2018","history":"/api/acts/health-insurance-permitted-benefits-pathology-services-determination-2018/history","analysis":"/api/acts/health-insurance-permitted-benefits-pathology-services-determination-2018/analysis","conflicts":"/api/acts/health-insurance-permitted-benefits-pathology-services-determination-2018/conflicts","importantCases":"/api/acts/health-insurance-permitted-benefits-pathology-services-determination-2018/important-cases","documents":"/api/acts/health-insurance-permitted-benefits-pathology-services-determination-2018/documents"}}