{"id":"F2021L01269","name":"Health Insurance (Prescribed Pathology Services) Determination 2021","slug":"health-insurance-prescribed-pathology-services-determination-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440988,"registerId":"F2021L01269-fast-fetch-1775956428344","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Health Insurance (Prescribed Pathology Services) Determination 2021","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![Commonwealth Coat of Arms of Australia](image.001.jpeg)\n\n \n\nHealth Insurance (Prescribed Pathology Services) Determination 2021\n\nI, GREG HUNT, Minister for Health and Aged Care, make this determination under section 4BB of the Health Insurance Act 1973\n\nDated     25 August 2021 \n\n \n\n \n\n \n\n \n\n \n\n \n\nGreg Hunt\n\nMinister for Health and Aged Care\n\n \n\n \n\n \n\n \n\n \n\n \n\nContents\n\n1.  Name \n\n2.  Commencement\n\n3.  Authority\n\n4.  Repeal \n\n5.  Definitions\n\n6.  Prescribed pathology services\n\n7.  Prescribed pathology services rendered by participating nurse practitioners\n\n \n\n1.  Name\n\n This instrument is the Health Insurance (Prescribed Pathology Services) Determination 2021.\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whole of this instrument 1 November 2021\n\n\n Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.\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 section 4BB of the Health Insurance Act 1973.\n\n4.  Repeal\n\n        The Health Insurance (Prescribed Pathology Services) Determination 2011 is repealed.\n\n5.  Definitions\n\n (1) In this instrument:\n\nAct means the Health Insurance Act 1973.\n\nparticipating nurse practitioner has the meaning given by subsection 3(1) of the Act.\n\npathology services table means the table prescribed under section 4A of the Act.\n\n \n\n6.  Prescribed pathology services\n\n For paragraph 4BB(a) of the Act, a pathology service specified in an item in Group P9 of the pathology services table is a prescribed pathology service for the purposes of that Act.\n\n \n\n \n\n7.  Prescribed pathology services rendered by participating nurse practitioners\n\nSubsection 16A(7A) of the Act applies to a pathology service mentioned in any of items 73826 to 73837 if the service is rendered by a participating nurse practitioner.\n\n \n","sortOrder":0}],"analysis":{"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":2,"scope_assessment":{"changed":false,"description":"The legislation maintains its original narrow purpose: specifying which pathology services are prescribed for Medicare purposes and which can be rendered by nurse practitioners. The 2021 version is a straightforward re-enactment with updated dates and the addition of nurse practitioner provisions (items 73826-73837), which appears to be an incremental expansion rather than scope creep."},"complexity_factors":["Very short instrument (only 7 sections, approximately 1 page)","Minimal defined terms (only 3 definitions in section 5)","No nested exceptions or conditional logic","Single cross-reference to the Health Insurance Act 1973 (section 4BB)","Simple structure: name, commencement, authority, repeal, definitions, substantive provisions","No transitional provisions, schedules, or intricate machinery provisions"],"plain_english_summary":"This 2021 determination updates which pathology services Medicare covers, repealing the 2011 rules and defining \"prescribed pathology services\" as tests listed in Group P9. It also expands ordering authority by allowing participating nurse practitioners to request items 73826–73837 with Medicare coverage.\n\nThe change affects patients, pathology labs, nurse practitioners and other clinicians by clarifying billing rules, ensuring payment for listed tests, and widening nurse practitioners’ role in ordering covered pathology services."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"The instrument repeals the Health Insurance (Prescribed Pathology Services) Determination 2011 and reissues prescriptions: it designates Group P9 services as prescribed and applies subsection 16A(7A) to items 73826–73837 when rendered by participating nurse practitioners. The text itself does not set out how this differs from the 2011 instrument; assessing substantive expansion or contraction of scope requires comparison with the repealed instrument."},"complexity_factors":["Short instrument with limited clauses and clear operative effect (designation, commencement, repeal)","Relies on cross-references to the Health Insurance Act (notably section 4BB, section 4A, and subsection 16A(7A))","Depends on an external ‘pathology services table’ and Group P9 (requires checking that table to see exact services)","Specifies a tight list of MBS item numbers (73826–73837) tied to practitioner eligibility (participating nurse practitioners)","Repeal of the 2011 Determination introduces a requirement to compare instruments externally to assess prior coverage","Operational impact depends on administrative processes for Medicare claiming and provider eligibility (participating status)"],"plain_english_summary":"This determination declares pathology services listed in Group P9 of the Health Insurance Act’s pathology services table to be “prescribed” and specifies that MBS items 73826–73837, when provided by a “participating nurse practitioner”, fall within subsection 16A(7A) for Medicare benefits. It commences on 1 November 2021 and repeals the 2011 Determination. It affects pathology providers, participating nurse practitioners and patients by changing which services qualify for Commonwealth subsidy; providers submit claims and the Commonwealth pays applicable benefits."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-prescribed-pathology-services-determination-2021","history":"/api/acts/health-insurance-prescribed-pathology-services-determination-2021/history","analysis":"/api/acts/health-insurance-prescribed-pathology-services-determination-2021/analysis","conflicts":"/api/acts/health-insurance-prescribed-pathology-services-determination-2021/conflicts","importantCases":"/api/acts/health-insurance-prescribed-pathology-services-determination-2021/important-cases","documents":"/api/acts/health-insurance-prescribed-pathology-services-determination-2021/documents"}}