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Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
This regulation is the Medicare price list and rulebook for pathology services in Australia: it names which lab tests are funded, sets the item numbers and fees, and defines billing and claiming rules labs and clinicians must follow.
It affects patients, doctors who order tests, and pathology providers because it shapes which tests are paid, how often they can be done, and how labs organise billing and service delivery.
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Direct links to the current provisions in Health Insurance (1992 Pathology Services Table) Regulations.
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
Statutory Rules 1991 No.4421
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Health Insurance (1992 Pathology Services Table) Regulations2
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 12 December 1991.
BILL HAYDEN
Governor-General
By His Excellency’s Command,
B.HOWE
Minister of State for Health, Housing and Community Services
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Citation
Commencement
Repeal
3. Statutory Rule 1991 No. 353 is repealed.
Pathology services table
SCHEDULE Regulation 4
TABLE OF PATHOLOGY SERVICES
RULES OF INTERPRETATION
1. (1) In this table, unless the contrary intention appears:
“patient episode” means a pathology service, or pathology services whether listed in 1 or more items, for a single patient whose need for which was determined under subsection 16a (1) of the Act on the same day, whether rendered by 1 or more approved pathology practitioners on 1 or more 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.
2. (1) If a service is described:
(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.
3. (1) In subrule (2), “service” includes an assay, estimation and test
(2) 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 die 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.
(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 accord 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, 65018, 65019 or 65020 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 items 65023 and 65024) 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.
6. For the purposes of items 66201 to 69200 (inclusive):
(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 earned 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
(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, 71026, 71027, 71028, 71029, 71030, 71031 and 71032, 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.
11. (1) For the purposes of this rule and items 73901 to 73921 (inclusive):
“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.
(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 outpatient 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 in 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 to which subsection 16A (7) of the Act applies.
(4) If one item of items 73901 to 73917 (inclusive) applies to a patient episode, none of the remainder of those items apply 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
(b) applies to a service even if any item in items 73901 to 73917 (inclusive) also applies to the service.
SCHEDULE- continued
| Item | Pathology service | Fee |
|---|---|---|
| $ | ||
| GROUP PI - HAEMATOLOGY | ||
| 65001 | Blood count consisting of erythrocyte count, C-reactive protein, erythrocyte sedimentation rate, blood viscosity, haematocrit, haemoglobin, platelet count, leucocyte count, reticulocyte count - one or two procedures | 5.40 |
| 65003 | Three or more procedures to which item 65001 applies, including any calculation or measurement of erythrocyte or other indices | 7.40 |
| 65005 | Examination of blood film, with or without five part differential cell count, or five part 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 specified in item 65027 | 9.70 |
| 65007 | Full blood examination consisting of items 65003 and 65005 | 16.40 |
| 65009 | Erythrocytes, qualitative or quantitative assessment of haemolysis or metabolic enzymes by - erythrocyte autohaemolysis test, erythrocyte fragility test, sugar water test, erythrocyte metabolic enzyme test, heat denaturation test, isopropanol precipitation test, acid haemolysis test, and quantitation of muramidase in serum or urine - one or more procedures | 22.50 |
| 65011 | Tests for the diagnosis of haemoglobinopathy consisting of haemoglobin electrophoresis and two of the following - examination for HbH, quantitation of HbA2 or HbF, including any services specified in items 65001, 65003, 65005 and 65007 |
This is an opening excerpt, not the complete document.