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Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
These Regulations prescribe the 1992–93 pathology services table under the Health Insurance Act 1973, listing individual pathology items, the fee for each, and detailed billing rules about when tests are bundled, repeated, referred or exempted. They affect approved pathology practitioners, approved pathology authorities, recognised pathologists, treating practitioners and patients by determining which laboratory services attract a Health Insurance Act benefit and how those services must be billed (patient‑episode aggregation, exemptions, referral and initiation fees).
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Direct links to the current provisions in Health Insurance (1992-1993 Pathology Services Table) Regulations.
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
Statutory Rules 1992 No. 3361
__________________
Health Insurance (1992-1993 Pathology Services Table) Regulations
I, The Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.
Dated 20 October 1992.
BILL HAYDEN
Governor-General
By His Excellency’s Command,
B. HOWE
Minister of State for Health, Housing
and Community Services
____________
Citation
Commencement
Repeal
Pathology services table
SCHEDULE
TABLE OF PATHOLOGY SERVICES
RULES OF INTERPRETATION
“patient episode” means:
(a) a pathology service to which rule 3a refers that is provided in the circumstances described in that rule that relate to the service; and
(b) except in the case of a pathology service to which paragraph (a) refers—a pathology service or pathology services, whether specified in a single item or in more than 1 items, provided for a single patient whose need for the service or services was determined under subsection 16a (1) of the Act on the same day, whether rendered by an approved pathology practitioner or more than 1 approved pathology practitioner on the same day or on different days;
“recognised pathologist” means a medical practitioner recognised as a specialist in pathology under a determination under subsection 61 (3) of the Act;
“the Act” means the Health Insurance Act 1973.
(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.
SCHEDULE—continued
(3) Unless the contrary intention appears, a reference in this table by number to an item that is not included in this table is a reference to the correspondingly numbered item in the general medical services table or the diagnostic imaging services table, as each case requires.
(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) If:
(a) a service is described in 2 or more items; and
(b) subrule (1) does not apply;
only the item that provides the lower or lowest fee for the service applies to the service.
(2) Subject to rule 3a, 2 or more pathology services 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
(b) the patient’s need for the services was determined under subsection 16a (1) of the Act on the same day even if they are rendered by an approved pathology practitioner on more than one day.
3a. (1) Rule 3 does not apply to:
(a) a pathology service specified in item 66201, other than an estimation of cholesterol, fructosamine, lithium or triglycerides; or
(b) the quantitative estimation of 1 or more fractions of neonatal bilirubin specified in item 66273;
if:
SCHEDULE—continued
(c) 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
(d) 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
(e) 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.
(2) Rule 3 does not apply to any of the following pathology services rendered in relation to a single specimen taken on each of not more than 6 occasions in a period of 6 months:
(a) estimation of prothrombin time in respect of a patient undergoing anticoagulant therapy;
(b) quantitative estimation of lithium in respect of a patient undergoing lithium therapy;
(c) a service specified in item 65007 in relation to a patient undergoing chemotherapy for neoplastic disease or immunosuppressant therapy;
(d) a service specified in item 65007 in relation to methotrexate, gold or penicillamine therapy of a patient;
(e) a service specified in item 66201 in relation to methotrexate therapy of a patient;
(f) quantitative estimation of urea, creatinine and electrolytes in relation to:
(i) cis-platinum therapy of a patient; or
(ii) chronic renal failure of a patient being treated in a dialysis program conducted by a recognised hospital.
(3) This rule does not apply in relation to a pathology service unless the account for fees in respect of the service is endorsed with the words “Rule 3 Exemption”.
SCHEDULE—continued
(a) a pathology service to which an item of the table applies is rendered for a patient in accordance with a request; and
(b) another pathology service is rendered for the patient in accordance with the request; and
(c) an item of the table:
(i) applies to the other service; and
(ii) is referred to in the item mentioned in paragraph (a);
the other service is treated as if it were part of the service referred to in paragraph (a).
Example:
Dr Proctor requests an extended blood grouping test (covered by item 65019) and the test includes a basic blood grouping test (covered by item 65017). Item 65017 is referred to in item 65019. Benefit is payable under item 65019 for the extended blood grouping test but benefit is not payable separately under item 65017 for the basic blood grouping test.
(a) if pathology services of a kind referred to in item 65017 or 65019 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 that period; and
(b) tests (except the tests mentioned in item 65023) carried out on material stored from a previous patient episode in response to a later request are treated as part of that previous patient episode if the second request is made within 14 days of that previous patient episode.
5a. (1) In this rule:
“designated pathology service” means a pathology service specified in item 66241, 66313 or 69241.
SCHEDULE—continued
(2) Subject to subrule (3), if an approved pathology practitioner in an approved pathology authority:
(a) has been requested to render a pathology service that specified 2 or more estimations comprised in a designated pathology service; and
(b) is unable to perform 1 or more, but not all, of the estimations because of the lack of facilities in, or expertise or experience of the staff of, the laboratory of the authority in relation to that estimation or those estimations; and
(c) requests an approved pathology practitioner in another approved pathology authority to render 1 or more, but not all, of the estimations;
the service rendered by the second-mentioned practitioner is taken to be the designated pathology service.
(3) Items 73901 to 73917 (inclusive) do not apply to the second-mentioned approved pathology practitioner in subrule (2).
(a) if a pathology service involving the measurement of a substance in urine requires a 24 hour urine collection, or calculation of a substance/creatinine ratio, the service is treated as including any estimation of creatinine in other fluids necessary for the calculation; and
(b) tests carried out on material stored from a previous patient episode in response to a later request are treated as part of that previous patient episode if the second request is made within 14 days of that previous patient episode.
(a) “serial examinations or cultures” means 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
SCHEDULE—continued
(b) tests carried out on material stored from a previous patient episode in response to a later request are treated as part of that previous patient episode if the second request occurs within 14 days of that previous patient episode.
(a) in items 71025, 71027, 71029 and 71031, the estimation of a single antibody includes qualitative and quantitative assays for that antibody; and
(b) tests carried out on material stored from a previous patient episode in response to a later request are treated as part of that previous patient episode if the second request occurs within 14 days of that previous patient episode.
(a) “biopsy material” means all tissue received by the approved pathology practitioner from an operation, or a group of operations, performed on a patient at the same time, other than a bone marrow biopsy; and
(b) if:
(i) a pathology service that is the examination of biopsy material is rendered under any of those items; and
(ii) a further pathology service mentioned in any of those items is also rendered using that biopsy material;
those pathology services are treated as 1 pathology service.
(a) the materials are received on different days by the approved pathology practitioner; or
(b) the examinations were requested on 1 or more request forms by the treating practitioner.
SCHEDULE—continued
“approved pathology authority” has the same meaning as in Division 4a of Part IIa of the Act;
“institution” means a place (other than a hospital, a nursing home or accommodation for aged persons that is attached to a nursing home or situated within a nursing home complex) 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.
“licensed collection centre” has the same meaning as in Part IIa of the Act;
“prescribed laboratory” means a laboratory operated by:
(a) the Commonwealth; or
(b) a State; or
(c) an authority of a State or Territory; or
(d) the Northern Territory; or
(e) the Australian Capital Territory; or
(f) an Australian tertiary education institution.
“specimen collection centre” has the same meaning as in Part IIA of the Act;
“temporary 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.
SCHEDULE—continued
(2) A service mentioned in items 73901 to 73921 (inclusive) applies to a pathology service when rendered by, or on behalf of, an approved pathology practitioner who is a recognised pathologist unless:
(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 was made; or
(c) the pathology equipment of a recognised hospital, or prescribed laboratory, is used rendering the service; or
(d) a member of the staff of a recognised hospital, or prescribed laboratory, participates in the service in the course of the member’s employment with the hospital or laboratory.
(3) A service mentioned in items 73901 to 73921 (inclusive) does not apply to a pathology service:
(a) to which subsection 16a (7) of the Act applies; or
(b) unless at least one of items 65001 to 73529 (inclusive) also applies to that service.
(4) If one item of items 73901 to 73917 (inclusive) applies to a patient episode, none of the remainder of those items applies to that patient episode.
(5) Item 73921:
(a) applies only to the approved pathology practitioner or approved pathology authority to whom the specimen mentioned in the item was referred; and
11a. If item 73921 applies to a patient episode, none of items 73901 to 73917 (inclusive) applies to any pathology service rendered by the approved pathology authority or the approved pathology provider in respect of that patient episode.
SCHEDULE—continued
SERVICES AND FEES
GROUP P1—HAEMATOLOGY
| 65001 | 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 | $5.60 |
|---|---|---|
| 65003 | 3 or more procedures to which item 65001 applies, including any calculation or measurement of erythrocyte or other indices |
This is an opening excerpt, not the complete document.