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Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
What this legislation does
This regulation establishes the Pathology Services Table for Australia's national health insurance scheme (Medicare) for the 1990-91 financial year. It sets out exactly which laboratory tests are subsidised by the government, how much doctors and laboratories get paid for each test, and the rules for claiming these benefits.
Key points:
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Direct links to the current provisions in Health Insurance (1990-91 Pathology Services Table) Regulations.
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
Statutory Rules 1990 No. 3431
–––––––
Health Insurance (1990-91 Pathology
Services Table) Regulations
I, THE GOVERNOR-GENERAL of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby make the following Regulations under the Health Insurance Act 1973.
Dated 25 October 1990.
BILL HAYDEN
Governor-General
By His Excellency’s Command,
B. HOWE
Minister of State for Community Services
and Health
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Citation
Commencement
Repeal
Pathology services table
PATHOLOGY SERVICES TABLE
RULES OF INTERPRETATION
“Division” means a Division of the list of services and fees in this table;
“item” means an item in that list;
“recognised pathologist” means a medical practitioner who under a determination under section 61, is recognised for the purposes of this Act as a specialist in the specialty of pathology.
(a) rendered following a request made in the course of the provision of an out-patient service at a recognised hospital; or
(b) rendered following a request made in respect of a person who was, at the time when the request was made, a private patient in a recognised hospital; or
(c) in the rendering of which:
(i) any pathology equipment of a recognised hospital, or a laboratory included in a prescribed class of laboratories, is used; or
(ii) any member of the staff of a recognised hospital, or a laboratory included in a prescribed class of laboratories, participates in the course of that member’s employment with that hospital or laboratory.
(a) to which an item that includes the symbol “(SP)” relates; or
(b) to which subsection 16a (7) applies.
(a) laboratories operated by the Commonwealth;
(b) laboratories operated by a State or an authority of a State;
(c) laboratories operated by the Northern Territory;
(d) laboratories operated by the Australian Capital Territory;
(e) laboratories operated by an Australian tertiary education institution.
(a) each pathology service is rendered to the same person; and
(b) each pathology service is listed in the same item; and
(c) the determinations of the necessity for the pathology services were made on the same day.
In rule 5, “service” includes an assay, estimation and test.
A reference in these rules to a request made to an approved pathology practitioner includes a reference to a request that is taken for the purposes of section 16a, to have been made to that approved pathology practitioner.
If:
(a) a pathology service (in this rule called the “first pathology service”) is rendered following a request; and
(b) an item of the table applies to that pathology service; and
(c) another pathology service (in this rule called the “second pathology service”) is rendered following the request; and
(d) the second pathology service is of a kind referred to in the item referred to in paragraph (b);
the second pathology service is treated as if it were subsumed within the first pathology service.
Example: Dr Proctor requests an extended blood grouping test (covered by item 1192) and the test includes a basic blood grouping test (covered by item 1187). Item 1187 is referred to in item 1192. Benefit is payble under item 1192 for the extended blood grouping test but benefit is not payable separately under item 1187 for the basic blood grouping test.
(a) if pathology services of a kind referred to in item 1187, 1188, 1192 or 1193 are rendered to a person during a period of hospitalisation, the item applies only to the first pathology service of that kind rendered to the person during that person’s hospitalisation; and
(b) tests performed on material stored from a previous patient episode (except tests specified in item 1198 of 1199) in response to a later request are treated as being part or that previous patient episode if the second request is made within 14 days of that previous patient episode.
(a) if a pathology service involving the measurement of any substance in urine requires a 24 hour urine collection or
calculation of a substance/creatinine ratio, that pathology service is treated as including any estimation of creatinine in other fluids necessary for calculation; and
(b) tests performed on material stored from a previous patient episode in response to a subsequent request are treated as being part of that previous patient episode if the second request occurs within 14 days of that previous patient episode.
(a) serial examinations or cultures means examinations or cultures requested on the 1 occasion regardless of whether the materials are received on different days by the approved pathology practitioner and regardless of whether the examinations or cultures were requested on 1 or more request forms by the treating practitioner; and
(b) tests performed on material that has been stored from a previous patient episode in response to a later request are treated as being part of that previous patient episode if the further request occurs within 14 days of that previous patient episode.
(a) tests performed on material that has been stored from a previous patient episode in response to a later request are treated as being part of that previous patient episode if the further request occurs within 14 days of that previous patient episode; and
(b) in items 2271, 2274, 2275, 2276, 2277, 2278, 2279 and 2280, the estimation of a single antibody includes qualitative and quantitative assays for that antibody.
(a) “biopsy material” means all tissue received by the approved pathology practitioner from any operation or group of operations performed on a patient at the same time other than a bone marrow biopsy; and
(b) if a pathology service relating to the examination of biopsy material is rendered under an item set out in Division 5 in circumstances where a further pathology service specified in an item in Division 5 is rendered also in relation to that biopsy material all those pathology services are treated as 1 pathology service under the same item appropriate to the pathology services provided.
For the purposes of Division 6, “serial examinations” means examinations requested on the same occasion regardless of whether the materials are received on different days by the approved pathology practitioner and regardless of whether the examinations were requested on 1 or more request forms by the treating practitioner.
If in these Rules provision is made for 2 or more pathology services to be treated as 1 pathology service, a reference to an appropriate item is a reference to the item that incorporates whichever of the symbols “(SP)” or “(OP)” is relevant to the rendering of that pathology service.
The lists of abbreviations at the end of the table are provided to allow users of the table to identify and refer to particular pathology services, or groups of pathology services, more accurately and efficiently.
SERVICES AND FEES
<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:10.72%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Item</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Pathology service</span></p></td><td style="width:9.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Fee</span></p></td></tr><tr style="height:1pt"><td style="width:10.72%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-style:italic">Division 1</span><span style="font-family:'Times New Roman', serif">—</span><span style="font-family:'Times New Roman', serif; font-style:italic">Haematology</span></p></td><td style="width:9.18%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:14.4pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">$</span></p></td></tr><tr style="height:1pt"><td style="width:10.72%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">1163</span></p></td><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Blood count consisting of erythrocyte count, C-reactive protein, erythrocyte sedimentation rate, blood viscosity, haematocrit, haemoglobin, platelet count, leucocyte count, reticulocyte count—1 or 2 procedures (SP)</span></p></td><td style="width:9.18%; padding-right:2pt; padding-left:2pt; vertical-align:bottom"><p style="margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">7.80</span></p></td></tr><tr style="height:1pt"><td style="width:10.72%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">1164</span></p></td><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Blood count consisting of erythrocyte count, C-reactive protein, erythrocyte sedimentation rate, blood viscosity, haematocrit, haemoglobin, platelet count, leucocyte count, reticulocyte count—1 or 2 procedures (OP)</span></p></td><td style="width:9.18%; padding-right:2pt; padding-left:2pt; vertical-align:bottom"><p style="margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">5.90</span></p></td></tr><tr style="height:1pt"><td style="width:10.72%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">1168</span></p></td><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">3 or more procedures to which item 1163 applies, including any calculation or measurement of erythrocyte or other indices (SP)</span></p></td><td style="width:9.18%; padding-right:2pt; padding-left:2pt; vertical-align:bottom"><p style="margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">10.60</span></p></td></tr><tr style="height:1pt"><td style="width:10.72%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">1169</span></p></td><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">3 or more procedures to which item 1164 applies, including any calculation or measurement of erythrocyte or other indices (OP)</span></p></td><td style="width:9.18%; padding-right:2pt; padding-left:2pt; vertical-align:bottom"><p style="margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">7.95</span></p></td></tr><tr style="height:1pt"><td style="width:10.72%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">1170</span></p></td><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Examination of blood film, with or without differential cell count, or differential cell count with or without examination of blood film, and if performed, any of these additional services—Direct Coombs test, tests for heterophile antibodies, cold agglutinins, examination of blood film by special stains to demonstrate Heinz bodies, parasites or iron, or examination of a blood film with alpha-naphthyl acetate esterase, choloroacetate esterase, neutrophil alkaline phosphotase, nitro blue tetrazolium, periodic acid Schiff, Sudan Black stains, or Kleihauer test for HbF on blood film, including any services soecified in item 1419 (SP)</span></p></td><td style="width:9.18%; padding-right:2pt; padding-left:2pt; vertical-align:bottom"><p style="margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">14.00</span></p></td></tr><tr style="height:1pt"><td style="width:10.72%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">1171</span></p></td><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font
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