Health Insurance (1993-1994 Pathology Services Table) Regulations
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TABLE OF PROVISIONS
Regulation Page
Commencement 1
Citation 1
Repeal of Health Insurance (1992-1993 Pathology Services Table) Regulations 2
Pathology services table 2
SCHEDULE
TABLE OF PATHOLOGY SERVICES 3
PART 1—RULES OF INTERPRETATION 3
PART 2—SERVICES AND FEES 13
PART 3—ABBREVIATIONS 37
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Statutory Rules 1993 No. 2701
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Health Insurance (1993-1994 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 28 October 1993.
BILL HAYDEN
Governor-General
By His Excellency’s Command,
GRAHAM RICHARDSON
Minister for Health
____________
Commencement
These Regulations commence on 1 November 1993.
Citation
These Regulations may be cited as the Health Insurance (1993-1994 Pathology Services Table) Regulations.
Repeal of Health Insurance (1992-1993 Pathology Services Table) Regulations
Statutory Rules 1992 No. 336 and 1993 No. 125 are repealed.
Pathology services table
The table of pathology services in the Schedule is prescribed for the purposes of subsection 4a (2) of the Health Insurance Act 1973.
SCHEDULE Regulation 4
TABLE OF PATHOLOGY SERVICES
PART 1—RULES OF INTERPRETATION
(1) In this table, unless the contrary intention appears:
“approved pathology authority” has the same meaning as in Division 4A of Part IIa of the Act;
“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 item, 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 by 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.
(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.
(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) Subject to subrule (3), 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) If an item is expressed to include a pathology service that is specified in another item, the other item does not apply to the service in addition to the first-mentioned item.
(1) In subrule (2), “service” includes assay, estimation and test.
(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 fructosamine or lithium; or
(b) the quantitative estimation of 1 or more fractions of neonatal bilirubin specified in item 66365;
if:
(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 if, under a request for a service, no more than 6 tests are requested and the tests are performed within 6 months of the request:
(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.
(2a) Rule 3 does not apply to a pathology service:
(a) to which item 66217 applies; and
(b) for which a specimen is collected on each of 3 days for the purpose of making a valid estimation.
(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”.
If:
(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:
The requesting practitioner 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.
For the purposes of items 65001 to 66200 (inclusive):
(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, 66389, 66403 or 69241.
(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 comprising 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).
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 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.
For the purposes of items 69201 to 71000 (inclusive):
(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.
For the purposes of items 71001 to 72800 (inclusive):
(a) in items 71119, 71121, 71123 and 71125, 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.
For the purposes of items 72801 to 73040 (inclusive):
(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.
For the purposes of items 73041 to 73280 (inclusive), “serial examinations” means examinations requested on 1 occasion whether or not:
(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.
(1) For the purposes of this rule and items 73901 to 73921 (inclusive):
“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 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) Subject to subrule (6), 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 applies only to the approved pathology practitioner or approved pathology authority to whom the specimen mentioned in the item was referred.
(6) If, in respect of the same patient episode:
(a) services referred to in 1 or more items:
(i) in Group P5; and
(ii) in one of Groups P1, P2, P3, P4, P6, P7 and P8; or
(b) services referred to in 1 or more items:
(i) in Group P6; and
(ii) in one of Groups P1, P2, P3, P4, P5, P7 and P8;
are rendered by an approved pathology practitioner in each of 2 approved pathology authorities, the applicable amount specified in an item in Group P10 is payable to both approved pathology practitioners.
(7) If more than one specimen is collected from a person on the same day for the provision of pathology services:
(a) in accordance with more than one request; and
(b) in or by a single approved pathology authority;
only a single amount specified in the applicable item in Group P10 is payable for the services.
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.
11b. (1) Item 73921 does not apply to a referral if:
(a) a service in respect of the same patient episode has been carried out by the referring approved pathology authority; and
(b) the approved pathology authority to which the referral is made is related to the referring approved pathology authority.
(2) An approved pathology authority is related to another approved pathology authority for the purposes of subclause (1) if:
(a) both approved pathology authorities are employed (including employed under contract) by the same person, whether or not that person is also an approved pathology authority; or
(b) either of the approved pathology authorities is employed (including employed under contract) by the other; or
(c) if both of the approved pathology authorities are corporations—the approved pathology authorities are related corporations within the meaning of the Corporations Law; or
(d) the approved pathology authorities are partners (whether or not either or both of the approved pathology authorities are individuals and whether or not other persons are in partnership with either or both of the approved pathology authorities).
The abbreviations in Part 3 of this table may be used to identify particular pathology services or groups of pathology services.
3 or more procedures to which item 65001 applies, including any calculation or measurement of erythrocyte or other indices
7.65
65005
Examination of blood film, with or without 5 part differential cell count, or 5 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 phosphatase, nitroblue tetrazolium, periodic acid Schiff, Sudan Black stains, or Kleihauer test for HbF on blood film, including any services specified in item 65027
10.10
65007
Full blood examination consisting of items 65003 and 65005
17.50
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—1 or more procedures
23.30
65011
Tests for the diagnosis of haemoglobinopathy consisting of haemoglobin electrophoresis and 2 of the following—examination for HbH, quantitation of HbA2 or HbF—including any services specified in items 65001, 65003, 65005 and 65007
36.30
65013
Histopathological examination of sections of bone marrow trephine biopsy including, where indicated, examination of marrow smears and any special stains and immunochemical techniques, including any services specified in items 65001, 65003, 65005, 65007 and 65015
111.50
65015
Bone marrow examination of aspirated material including any special stains, immunochemical techniques and clot sections where necessary, including any services specified in items 65001, 65003, 65005 and 65007
80.95
65017
Blood grouping, including back-grouping when performed—ABO and Rh (D antigen)
9.80
65019
Blood grouping—Rh phenotypes, Kell system, Duffy system, M and N factors or any other blood group system—1 or more systems, including any services specified in item 65017
19.50
65021
Blood grouping, including back-grouping when performed, and examination of serum for Rh and other blood group antibodies, including identification and quantitative estimation of any antibodies detected, and including any services specified in items 65001, 65003, 65005 and 65007
36.30
65023
Compatibility testing, including all necessary grouping checks of patient and donor, examination for antibodies, identification and, if necessary, quantitative estimation of any antibodies detected and any services specified in items 65001, 65003, 65005, 65007, 65017 and 65021 including all testing performed on any 1 day
88.60
65025
Examination of serum for blood group antibodies including identification and, if necessary, quantitative estimation of any antibodies detected
16.05
65027
Direct Coombs test, qualitative or quantitative test for cold agglutinins, or heterophile antibodies, qualitative spectroscopic examination of blood for abnormal haemoglobins, qualitative test for red cell porphyrins and detection of metalbumin (Schumm’s test) including those services specified in items 65005 and 65007—1 or more tests
8.85
65029
Skin bleeding time, coagulation time, prothrombin time, activated partial thromboplastin time, thrombin time (including test for presence of an inhibitor and serial tests for fibrinolysis), test for factor XIII deficiency, fibrinogen, or 1 of: fibrinogen degradation products, fibrin monomer or D-dimer—1 estimation
12.25
65031
2 estimations specified in item 65029
16.20
65033
3 estimations specified in item 65029
20.15
65035
4 or more estimations specified in item 65029
24.10
65037
Quantitative assay, by 1 or more techniques, of plasminogen, antithrombin III, Protein C, Protein S, heparin cofactor II, euglobulin clot lysis time and test for lupus anticoagulant—1 estimation
24.05
65039
4 or more estimations specified in item 65037
76.40
65041
Platelet aggregation in response to ADP, collagen, 5HT, ristocetin or similar substance—1 or more estimations
48.10
65043
Heparin assay, only when monitoring a patient on subcutaneous heparin or low molecular weight heparin —1 or more estimations
32.10
65045
Quantitative assay of:Von Willebrand’s factor antigen (factor VIII related antigen), Von Willebrand’s factor (ristocetin cofactor), factor II, factor V, factor VII, factor VIII, factor IX, factor X, factor XI, factor XII, factor XIII, Fletcher factor, Fitzgerald factor, Passovy factor—1 estimation
32.05
65047
2 estimations as specified in item 65045
46.20
65049
3 or more estimations as specified in item 65045
60.35
GROUP P2—CHEMICAL
66201
Quantitative estimation in serum, plasma, urine or other body fluid, by any method except by reagent strip with or without reflectance meter or electrophoresis, of:—alanine aminotransferase, albumin, alkaline phosphatase, amylase, aspartate aminotransferase, bicarbonate, bilirubin (total and any fractions), calcium (total, dialysed or ionised), chloride, creatine kinase, creatine kinase isoenzymes (when not performed as specified in item 66245), creatinine, fructosamine, gamma glutamyl transpeptidase, globulin, glucose, lactate dehydrogenase, lipase, lithium, magnesium, phosphate, potassium, total protein, sodium, urate, urea—1 estimation
9.90
66203
2 estimations specified in item 66201
11.95
66205
3 estimations specified in item 66201
14.00
66207
4 estimations specified in item 66201
16.05
66209
5 estimations specified in item 66201
18.10
66211
6 or more estimations specified in item 66201
20.15
66213
Qualitative estimation by any method, except by reagent strip or dip-stick of the following urine constituents:bilirubin, cystine (cysteine), haemoglobin, melanin (melanogen), myoglobin, porphobilinogen, porphyrins, urobilinogen or pH measurement of body fluids other than urine (excepting urine acidification test), or cryoglobulins or cryofibrinogen in plasma—1 or more estimations
9.60
66215
Quantitative estimation of cryoglobulins or cryofibrinogen after a positive result for cryoglobulin is obtained in any service specified in item 66213 (including provision of that service)—1 or more estimations
14.50
66217
Qualitative estimation by any method except by reagent strip or dip-stick of the following faecal constituents—haemoglobin, porphyrins, reducing substances—each estimation, to a maximum of 3 estimations, taken on separate days
6.40
66219
Immunological detection of human haemoglobin in faeces, including any additional services specified in item 66217—1 estimation in any 28 day period
12.20
66223
Osmolality, estimation by osmometer, in serum or in urine—1 or more estimations
24.05
66225
Quantitative estimation of blood gases including tests performed from pO2, oxygen saturation, pCO2, bicarbonate, pH, and any other measurement (eg. haemoglobin, potassium) or calculation performed on the same specimen—1 or more estimations on 1 specimen
32.85
66227
Estimation of blood gases as specified in item 66225 on each specimen in excess of 1 to a maximum of 6 specimens within any 1 day
8.70
66229
Calculus, analysis of 1 or more
29.80
66231
Drug or chemical assays—including all qualitative and quantitative tests on blood, urine or other body fluid for a drug or drugs of abuse, including illegal drugs and legally available drugs taken other than in appropriate dosage, ingested or absorbed toxic chemicals including any services specified in items 66235, 66237 and 66239, but excluding the surveillance of sports people and athletes for performance improving substances or the monitoring of patients participating in a drug abuse treatment program
40.50
66235
Drug assay—quantitative estimation on blood or other body fluid by any method or methods of a drug being used therapeutically for the patient from whom the specimen was taken and not elsewhere specified in the Schedule—1 estimation
20.20
66237
2 estimations specified in item 66235
28.30
66239
3 or more estimations specified in item 66235
36.40
66241
Estimations specified in any of items 66235 to 66239 (inclusive), if the number of estimations relating to the same patient episode does not exceed 3—each estimation to a maximum of 2 estimations
8.10
66243
Amniotic fluid, spectrophotometric examination of, estimation of lecithin/sphingomyelin ratio, palmitic acid, phosphatidylglycerol or lamellar body phospholipid—1 or more examinations or estimations
32.10
66245
Electrophoresis, quantitative or qualitative, of serum, urine or other body fluid to demonstrate protein classes or presence and amount of paraprotein, or the isoenzymes of lactate dehydrogenase, alkaline phosphatase and creatine kinase or lipoprotein electrophoresis (only when the cholesterol is >6.5 mmol/l and triglyceride >3.0 mmol/l or in the diagnosis of types III and IV hyperlipidaemia), including the preliminary quantitation of total protein, albumin and globulin or of total relevant enzyme activity—1 examination to a maximum of 2 examinations in any 12 month period
29.80
66247
Electrophoresis, quantitative or qualitative, of concurrently collected, or collected within a 28 day period, serum, urine or other body fluid to demonstrate protein classes or presence and amount of paraprotein, including the preliminary quantitation of total protein, albumin and globulin, or of total relevant enzyme activity—2 or more examinations
44.30
66255
Alpha-1-acid glycoprotein, alpha-1-antitrypsin, alpha-2-macroglobulin, quantitative estimation in serum, urine or other body fluid—1 or more estimations
19.65
66257
C-1 esterase inhibitor, quantitative estimation
19.65
66258
C-1 esterase inhibitor, functional assay
43.95
66261
CA-125 antigen, CA-15.3 antigen, CA-19.9 antigen, carcinoembryonic antigen (CEA), mammary serum antigen, mucin-like carcinoma associated antigen (1 or more fractions), neuron-specific enolase, thyroglobulin in serum or other body fluid, in the monitoring or confirmation of malignancy, quantitative estimation—1 estimation
19.65
66262
2 or more estimations specified in item 66261
36.20
66263
Iron studies consisting of quantitative analysis of iron, transferrin or iron binding capacity and ferritin
38.20
66265
Serum B12, serum folate—1 or more estimations within any 28 day period
24.05
66267
Red cell folate and serum B12 and, if required, serum folate, to a maximum of 3 estimations in any 12 month period
43.90
66269
Vitamins , quantitative estimation in blood, urine or other body fluid, by direct or indirect means, of vitamins A, B1, B2, B3, B6, C, and E—1 or more estimations within any 6 month period
29.80
66271
Vitamin D or D fractions—1 or more estimations
29.80
66277
Aluminium (except if item 66325 applies), arsenic, beryllium, cadmium, copper, chromium, gold, manganese, mercury, nickel, selenium, strontium, in blood, urine or other body fluid or tissue—1 or more estimations in any 6 month period
34.90
66279
Blood lead estimation, other than for occupational health screening purposes, to a maximum of 3 estimations in any 6 month period—each estimation
29.80
66281
Porphyrins (1 or more fractions), catecholamines (1 or more fractions), hydroxymethoxymandelic acid (HMMA), homovanillic acid (HVA), metanephrines, methoxyhydroxyphenylethylene glycol (MHPG), phenylacetic acid (PAA)—quantitative including any qualitative estimations—1 or more estimations
38.95
66283
Faecal fat, breath hydrogen measurements in response to loading with disaccharides—1 or more quantitative estimations within any 28 day period
38.95
66285
Solid tissue or tissues excluding blood elements—assay of 1 or 2 enzymes
38.95
66287
Assay of 3 to 5 enzymes as specified in item 66285
72.55
66289
Assay of 6 or more enzymes as specified in item 66285
96.25
66291
Thyroid function tests, including thyrotrophin (TSH) and at least 1 or more of the following tests—free thyroxine index, free thyroxine, free T3, total T3, thyroxine binding globulin
40.50
66293
Thyrotrophin releasing hormone (TRH) test, including provision and administration of TRH and all necessary estimations of hormones
48.10
66295
Growth hormone suppression by glucose loading, growth hormone stimulation by exercise, dexamethasone suppression test, L-dopa stimulation of growth hormone, where physically performed by a recognised pathologist—1 or more procedures
11.45
66297
Gonadotrophin releasing hormone stimulation test, synacthen stimulation test, glucagon stimulation test with C-peptide measurement, pentagastrin stimulation of thyrocalcitonin release, secretin stimulation of gastrin release, insulin hypoglycaemia, arginine infusion, where physically performed by a recognised pathologist—1 procedure
38.20
66299
2 or more tests specified in item 66297
61.10
66315
Hormone receptor assay on proven primary breast or ovarian carcinoma or a metastasis from a breast or ovarian carcinoma or a subsequent lesion in the breast—1 or more assays
77.90
66317
HDL cholesterol or apolipoprotein B/A1 ratio, estimation of, in patients with serum cholesterol >5.5 mmol/1 or those on prescribed lipid lowering drugs or with a fasting serum triglyceride level >2.0 mmol/1—each episode to a maximum of 4 episodes in any 12 month period
12.20
66319
Glycosylated haemoglobin only when performed in the management of established diabetes—each estimation to a maximum of 4 estimations in any 12 month period
16.40
66321
Quantitative estimation in the 2nd trimester of pregnancy of alpha fetoprotein, human chorionic gonadotrophin and oestriol and any other substance to detect foetal abnormality, including any service specified in 1 or more of items 66353, 66373, 73527 or 73529—1 patient episode in that pregnancy
53.80
66323
Estimation of tryptic activity in faeces for the investigation of diarrhoea of greater than 4 weeks duration in children less than 6 years of age
10.85
66325
Estimation of serum aluminium in a patient in a renal dialysis program—each estimation
34.90
66331
Quantitative estimation in serum, plasma, urine or other body fluid of cholesterol or triglycerides or both, except by reagent strip with or without reflectance meter or electrophoresis
11.75
66335
Services specified in item 66331 and 1 estimation specified in item 66201
14.00
66337
Services specified in item 66331 and 2 estimations specified in item 66201
16.05
66339
Services specified in item 66331 and 3 estimations specified in item 66201
18.10
66341
Services specified in item 66331 and 4 or more estimations specified in item 66201
20.15
66343
Drug assays, including all qualitative and quantitative estimations on blood, urine or other body fluid for a drug, or drugs, of abuse or a therapeutic drug, on a sample collected from a patient participating in a drug abuse treatment program, or being treated for drug effects or under a court order or parole board supervision, but excluding the detection of nicotine and metabolites in smoking withdrawal programs—each assay to a maximum of 21 assays in any 12 month period
20.25
66353
Alpha fetoprotein (where not requested as part of item 66321)—quantitative estimation in serum or other body fluids
19.65
66355
Ferritin (where not requested as part of iron studies)—quantitative estimation
19.65
66357
Prostate specific antigen, prostatic acid phosphatase, in the monitoring or confirmation of malignancy—quantitative estimation—1 estimation
19.65
66359
2 estimations specified in item 66357
36.20
66361
Beta-2-microglobulin, caeruloplasmin, haptoglobulins, microalbumin in proven diabetes mellitus, prealbumin—quantitative estimation in serum, urine or other body fluids—1 estimation
19.65
66363
2 or more estimations specified in item 66361
36.20
66365
Neonatal bilirubin (1 or more fractions)—quantitative estimation
TSH (where not requested as part of thyroid function test or in association with other hormones or hormone binding proteins specified in item 66377)—quantitative estimation
31.15
66373
Human placental lactogen, oestriol (where not requested as part of item 66321)—quantitative estimation by any method—1 estimation
31.15
66375
2 estimations specified in item 66373
42.05
66377
Hormones and hormone binding proteins, quantitative estimation by any method, of—androstenedione, DHEAS, dihydrotestosterone, FSH, hydroxyprogesterone, LH, oestradiol, oestrone, progesterone, prolactin, sex hormone binding globulin, free or total testosterone, TSH (where it is not requested on its own or as part of a thyroid function test)—1 estimation
31.15
66379
2 estimations specified in item 66377
42.05
66381
3 estimations specified in item 66377
52.95
66383
4 estimations specified in item 66377
63.85
66385
5 estimations specified in item 66377
74.75
66387
6 or more estimations specified in item 66377
85.65
66389
Estimations specified in any of items 66377 to 66387 (inclusive), if the number of estimations relating to the same patient episode does not exceed 6—each estimation to a maximum of 5 estimations
10.90
66391
Hormones and hormone binding proteins, quantitative estimation by any method, of: ACTH, aldosterone, C-peptide, calcitonin, cortisol, cyclic AMP, 11-deoxycortisol, gastrin, glucagon, growth hormone, insulin, PTH, renin, somatomedin C(IgF1), urine steroid fraction or fractions, vasoactive intestinal peptide, vasopressin (anti-diuretic hormone)—1 estimation
31.15
66393
2 estimations specified in item 66391
42.05
66395
3 estimations specified in item 66391
52.95
66397
4 estimations specified in item 66391
63.85
66399
5 estimations specified in item 66391
74.75
66401
6 or more estimations specified in item 66391
85.65
66403
Estimations specified in any of items 66391 to 66401 (inclusive), if the number of estimations relating to the same patient episode does not exceed 6—each estimation to a maximum of 5 estimations
10.90
GROUP P3—MICROBIOLOGY
69201
Microscopic examination of material other than blood, from 1 or more sites, obtained directly from a patient and excluding material from cultures—wet film, including differential cell count if performed, examination for dermatophytes or dark ground illumination, or stained preparation or preparations using any relevant stain or stains—1 or more examinations
7.25
69203
Microscopic examination of faeces for parasites using concentration techniques including the use of appropriate stains, to a maximum of 3 estimations taken on separate days including any services specified in item 69201—each estimation
12.20
69205
The cultural examination and microscopical examination when indicated (including the detection of antigens not elsewhere specified in the Schedule) to determine the presence of pathogenic micro-organisms, including fungi but excluding viruses, from nasal swabs, throat swabs, eye swabs and ear swabs, including pathogen identification and antibiotic sensitivity testing, including any services specified in item 69201—1 or more sites
19.10
69207
Microscopical and cultural examination (including the detection of antigens not elsewhere specified in the Schedule) to determine the presence of pathogenic micro-organisms, including fungi but excluding viruses, from the following sites: skin or other superficial sites, urethra, vagina, cervix or rectum (except for faecal pathogens), or specimens of sputum (except when part of item 69213), including pathogenic identification and antibiotic sensitivity testing, including any services specified in items 69201, 69205 and 73810—1 or more examinations on 1 or more specimens
27.90
69209
Microscopical and cultural examination (including the detection of antigens not elsewhere specified in the Schedule) of postoperative wounds, aspirations of body cavities, synovial fluid, CSF and operative or biopsy specimens for the presence of pathogenic micro-organisms, including fungi but excluding viruses, involving aerobic and anaerobic culture and the use of different culture media and including pathogen identification and antibiotic sensitivity testing, including any services specified in items 69201, 69205 and 69207—1 or more sites
37.80
69211
Cultural examination (including the detection of clostridial toxins or antigens not elsewhere specified in the Schedule) of faeces to determine the presence or absence of faecal pathogens, involving the use of at least 2 selective or enrichment media as well as culture in at least 2 different atmospheres and includes pathogen identification and antibiotic sensitivity testing, including any services specified in item 69201, to a maximum of 3 specimens in any 7 day period—each examination
45.85
69213
Microscopy with appropriate stains and cultural examinations of 3 specimens of sputum, urine or other bodily fluids for mycobacteria and any other bacterial pathogens, including pathogen identification and antibiotic sensitivity testing and including any services specified in item 69201
64.15
69215
Blood culture to determine the presence or absence of pathogenic micro-organisms excluding viruses, including serial cultures and sub-cultures, any relevant cultural methods and any tests necessary to identify any cultured pathogen and necessary antibiotic sensitivity testing —each set of cultures to a maximum of 3 sets
16.80
69217
Urine examination including serial examination, with cell count, relevant stained preparations, culture, colony count by any method, identification of any cultured pathogens, antibiotic sensitivity testing when necessary, and with any relevant general examination for pH, specific gravity, blood, albumin, urobilinogen, sugar, acetone or bile salts (simple culture by dip slide is excluded from this item)
20.30
69219
Direct detection of the antigens of Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, Group B streptococcus (in CSF and urine specimens only), RSV, cryptococcal antigens and Varicella zoster or detection of Clostridium difficile toxin except where item 69211 has been performed—1 or more estimations
16.05
69221
Direct detection of Chlamydia from clinical material, not cultures—1 or more estimations
9.60
69223
Direct detection of herpes simplex virus from clinical material, not cultures—1 or more estimations
9.60
69229
Antibodies to microbial or exogenous antigens not elsewhere specified in the Schedule—estimation of 1 antibody
13.75
69231
2 estimations specified in item 69229
21.05
69233
3 estimations specified in item 69229
28.35
69235
4 estimations specified in item 69229
35.65
69237
5 estimations specified in item 69229
42.95
69239
6 or more estimations specified in item 69229
50.25
69241
Estimations specified in any of items 69229 to 69239 (inclusive), if the number of estimations relating to the same patient episode does not exceed 6—each estimation to a maximum of 5 estimations
7.30
69243
Hepatitis B surface antigen test
13.60
69245
Hepatitis B serology to define the immune status of an individual, including at least hepatitis B surface antibody or hepatitis B core antibody tests, including services specified in items 69243, 69247 and 69249
18.35
69247
All serological tests performed for the identification of the agent causing acute hepatitis, which must include hepatitis B surface antigen, hepatitis B core antibody and hepatitis A IgM antibody tests and those services specified in items 69243, 69245 and 69249
36.30
69249
All tests performed in the follow-up of a patient with proven hepatitis B, including hepatitis B surface antigen and either hepatitis B antigen or hepatitis B surface antibody tests, including services specified in items 69243 and 69245
26.35
69251
Antibiotics or antimicrobial chemotherapeutic agents, concentration in serum, urine or other body fluid, by direct quantitative measurement of the agent—1 or more estimations
24.05
69253
All microbiological serology during a pregnancy, which must include the determination of 1 of the following—rubella immune status, specific syphilis serology or hepatitis B surface antigen, including any service specified in 1 or more of items 69229, 69243 or 69245, except in the investigation of a clinically apparent intercurrent microbial illness during that pregnancy
13.75
69255
All microbiological serology during a pregnancy, which must include the determination of 2 of the following—rubella immune status, specific syphilis serology or hepatitis B surface antigen and including any service specified in 1 or more of items 69229, 69243 or 69245, except in the investigation of a clinically apparent intercurrent microbial illness during that pregnancy
21.00
69257
All microbiological serology during a pregnancy, which must include the determination of all 3 of the following—rubella immune status, specific syphilis serology and hepatitis B surface antigen, including any service specified in 1 or more of items 69229, 69243 or 69245, except in the investigation of a clinically apparent intercurrent microbial illness during that pregnancy
27.90
69261
Examination for chlamydia by culture or by the demonstration of chlamydial nucleic acid using a DNA probe in material collected directly from a patient, including a service specified in item 69221, 69223 or 69263
17.80
69263
Examination for herpes simplex virus of one or more types in material collected directly from a patient by culture, including a service specified in item 69221, 69223 or 69261
27.80
69265
Determination of antibodies to hepatitis C
13.75
GROUP P4—IMMUNOLOGY
71061
Examination for, and characterisation of, a paraprotein or cryoglobulin not previously characterised on serum, urine or other body fluid by immunoelectrophoresis or immunofixation—1 or more procedures
28.45
71063
Examination for, and characterisation of, a paraprotein not previously characterised, by immunoelectrophoresis or immunofixation on serum and urine collected concurrently—2 or more procedures
42.90
71065
Examination of CSF and serum concurrently for the presence of oligoclonal proteins—2 or more procedures
42.90
71067
Immunoglobulins A, G, M or D, quantitative estimation by any method in serum, urine or other body fluid—1 estimation
14.65
71069
2 estimations as specified in item 71067
23.15
71071
3 or more estimations as specified in item 71067
31.65
71073
Immunoglobulin G subclasses, quantitative estimation of all 4 subclasses with a maximum of 2 patient episodes in any 12 month period—each patient episode
103.45
71075
Immunoglobulin E (total), quantitative estimation with a maximum of 2 patient episodes in any 12 month period—each patient episode
26.35
71077
Immunoglobulin E (total), quantitative estimation in the follow-up of a patient with proven immunoglobulin E secreting myeloma, proven congenital immunodeficiency or proven allergic bronchopulmonary aspergillosis, with a maximum of 6 patient episodes in any 12 month period—each patient episode
26.35
71079
Estimation of specific immunoglobulin G or E antibodies to single or multiple potential allergens, with a maximum of 4 patient episodes in any 12 month period—each patient episode
23.80
71081
Total haemolytic complement, quantitative estimation
Complement components or breakdown products of complement proteins not elsewhere specified in an item in this Schedule, quantitative estimation—1 estimation
28.40
71091
2 estimations as specified in item 71089
51.45
71093
3 or more estimations as specified in item 71089
74.50
71097
Antinuclear antibodies, detection in serum or other body fluids, including quantitation if required
24.80
71099
Double-stranded DNA antibodies, quantitative estimation by 1 or more methods other than the Crithidia method
25.85
71101
Antibodies to 1 or more extractable nuclear antigens, detection in serum or other body fluids
16.95
71103
Antibodies to 1 or more extractable nuclear antigens, characterisation after a positive result is obtained by a service specified in item 71101, including that service
50.70
71105
Rheumatoid factor, detection by any technique
8.50
71107
Quantitation of rheumatoid factor if detected during a service specified in item 71105, including that service
Estimation of 2 antibodies specified in item 71109
46.20
71115
Estimation of 3 antibodies specified in item 71109
58.75
71117
Estimation of 4 antibodies specified in item 71109
71.30
71119
Antibodies to tissue antigens not elsewhere specified in an item in this Schedule, qualitative or quantitative—estimation of 1 antibody
16.90
71121
Estimation of 2 antibodies specified in item 71119
20.25
71123
Estimation of 3 antibodies specified in item 71119
23.60
71125
Estimation of 4 or more antibodies specified in item 71119
26.95
71127
Functional tests for lymphocytes—estimation of proliferation induced by 1 or more mitogens, estimation of proliferation induced by 1 or more antigens or estimation of 1 or more mixed lymphocyte reactions, other than quantitation by microscopy, including a test specified in item 65005, with a maximum of 2 patient episodes in any 12 month period—each patient episode
171.85
71129
2 estimations specified in item 71127
212.30
71131
3 or more estimations specified in item 71127
252.75
71135
Determination of neutrophil function—comprising at least 2 of neutrophil chemotaxis, neutrophil phagocytosis, neutrophil oxidative metabolism, neutrophil bactericidal activity—including any test specified in item 65005 (other than nitroblue tetrazolium reduction slide test), with a maximum of 2 patient episodes in any 12 month period—each patient episode
202.70
71137
Determination of cell mediated immunity by multiple antigen delayed type hypersensitivity intradermal skin testing using a minimum of 7 antigens, with a maximum of 2 patient episodes in any 12 month period—each patient episode
29.50
71139
Characterisation of 3 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations on 1 or more specimens of blood, CSF or serous fluid
101.35
71141
Characterisation of 3 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations on 1 or more disaggregated tissue specimens
222.35
71143
Characterisation (not monitoring) of 6 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations in an immunological or haematological malignancy, including any service specified in 1 or more of items 71139 or 71141, on a specimen of blood, CSF, serous fluid or disaggregated tissue
253.40
71145
Characterisation (not monitoring) of 6 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations in an immunological or haematological malignancy, including any service specified in 1 or more of items 71139, 71141 or 71143, on 2 or more specimens of disaggregated tissues or 1 specimen of disaggregated tissue and 1 or more specimens of blood, CSF or serous fluid
413.70
71147
HLA-B27 typing
33.60
71149
Complete tissue typing for 4 HLA-A and HLA-B Class I antigens (including any separation of leucocytes), including any service specified in item 71147
105.50
71151
Tissue typing for HLA-DR, HLA-DP and HLA-DQ Class II antigens (including any separation of leucocytes)—phenotyping or genotyping of 2 or more antigens
115.85
GROUP P5—HISTOPATHOLOGY
72801
Histopathology examination of biopsy material including all tissue processing, staining and professional opinion or opinions
78.05
72803
Immediate frozen section diagnosis of biopsy material, including any other histopathology examination
126.80
72805
Immunohistochemical investigation of biopsy material by 1 or more of immunofluorescent, immunoperoxidase or other labelled antibody techniques including any other histopathology examination
96.25
72807
Electron microscopy of biopsy material including any other histopathology examination
102.35
GROUP P6—CYTOPATHOLOGY
73043
Cytological examination including serial examinations of smears from skin, nipple discharge, lip, mouth, nose or anus for detection of precancerous or cancerous changes—1 or more examinations
14.80
73045
Cytological examination, other than an examination mentioned in item 73053, for malignancy, including serial examinations and histological services performed on the resulting specimens from washings or brushings from sites not specified in item 73043, or performed on a single specimen of sputum or urine or on 1 or more specimens of other body fluids—1 or more examinations
29.00
73047
Cytological examination including examination of a series of 3 sputum or urine specimens for malignant cells
60.35
73049
Cytological examination of material obtained from a patient by fine needle aspiration of solid tissue or tissues
36.30
73051
Cytological examination of material obtained from a patient by fine needle aspiration of solid tissue or tissues where the aspiration is performed by a recognised pathologist; or where a recognised pathologist attends the aspiration and performs cytological examination during the attendance
68.00
73053
Routine cytological examination of smears from cervix for detection of precancerous or cancerous changes in women with no symptoms, signs or recent history suggestive of cervical neoplasia and smears repeated due to an unsatisfactory routine smear—each examination
12.40
73055
Cytological examination of smears from cervix in association with the management of previously detected abnormalities including precancerous or cancerous conditions, or the investigation of women with symptoms, signs or recent history suggestive of cervical neoplasia, not associated with item 73053—each examination
12.40
73057
Cytological examination of smears from vagina, not associated with items 73053 or 73055—each examination
12.40
GROUP P7—CYTOGENETICS
73287
Chromosome studies, including preparation, count, karyotyping and identification by banding techniques or by fragile X-site determination of one or more of amniotic fluid, bone marrow, skin and any other tissue or fluid except blood—1 or more estimations
323.50
73289
Chromosome studies, including preparation, count, karyotyping and identification by banding techniques or by fragile X-site determination of blood—1 or more estimations
293.15
GROUP P8—INFERTILITY AND PREGNANCY TESTS
73521
Semen examination for presence of spermatozoa or examination of cervical mucus for spermatozoa (Huhner’s test)
6.70
73523
Semen examination (excluding post vasectomy semen examination), involving measurement of volume, sperm count, motility, examination of stained preparations, morphology, and, if performed, differential count and 1 or more chemical tests, with a maximum of 4 examinations in any 12 month period
27.90
73525
Sperm antibodies, sperm penetrating ability—1 or more tests
17.95
73527
Chorionic gonadotrophin (beta-HCG), qualitative estimation in serum or urine by 1 or more methods, including serial dilution if performed, for diagnosis of pregnancy —1 or more estimations
9.80
73529
Chorionic gonadotrophin (beta-HCG), qualitative (if performed) and quantitative estimation in serum by 1 or more methods for diagnosis of hydatidiform mole, HCG-secreting neoplasm, threatened abortion or follow up of abortion
27.90
GROUP P9—SIMPLE BASIC PATHOLOGY TESTS
73801
Seminal examination for presence of spermatozoa
6.40
73802
Blood count consisting of leucocyte count, erythrocyte sedimentation rate, examination of blood film (including differential leucocyte count), haemoglobin estimation, haematocrit estimation or erythrocyte count—1 procedure
4.25
73803
2 procedures specified in item 73802
5.60
73804
3 or more procedures specified in item 73802
7.65
73805
Urine—microscopical examination of, or catalase test for, bacteria and cells, whether stained or not
4.25
73806
Pregnancy test by 1 or more immunochemical methods
10.45
73807
Microscopical examination of wet film other than urine, including any relevant stain
6.40
73808
Microscopical examination of Gram stained film, including any examination specified in items 73805 and 73807
8.05
73809
Chemical tests for occult blood in faeces by reagent stick, strip, tablet or similar method
2.15
73810
Microscopical examination screening for fungi in skin, hair or nails—1 or more sites
6.40
73811
Mantoux test
10.45
GROUP P10—PATIENT EPISODE INITIATION
73901
Initiation of a patient episode which consists only of a service specified in item 73053, 73055 or 73057 from a person who is not in a recognised hospital or a prescribed laboratory
7.75
73903
Initiation of a patient episode which consists only of a service specified in item 72801 from a person who is an in-patient of a hospital other than a recognised hospital
13.95
73905
Initiation of a patient episode which consists only of a service specified in item 72801 from a person who is not an in-patient of a private hospital and not a patient of a recognised hospital
7.75
73907
Initiation of a patient episode by collection of specimen for a service other than a service specified in items 73901, 73903, 73905 and 73801 to 73811 (inclusive) where the specimen is collected in a licensed collection centre other than a temporary licensed collection centre
16.05
73909
Initiation of a patient episode by collection of specimen for a service other than a service specified in items 73901, 73903, 73905 and 73801 to 73811 (inclusive) where the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person who is an in-patient of a hospital other than a recognised hospital
16.05
73911
Initiation of a patient episode by collection of specimen for a service other than a service specified in items 73901, 73903, 73905 and 73801 to 73811 (inclusive) where the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority, from a person in the place where the person was residing or in a nursing home or institution
16.05
73913
Initiation of a patient episode by collection of specimen for a service other than a service specified in items 73901, 73903, 73905, 73907, 73917 and 73801 to 73811 (inclusive) where the specimen is collected from the person by the person
9.85
73915
Initiation of a patient episode by collection of specimen for a service other than a service specified in items 73901, 73903, 73905 and 73801 to 73811 (inclusive) where the specimen is collected by or on behalf of the treating practitioner
9.85
73917
Initiation of a patient episode by collection of specimen for a service other than a service specified in items 73901, 73903, 73905 and 73801 to 73811 (inclusive) where the specimen is collected in a temporary licensed collection centre
9.85
GROUP P11—SPECIMEN REFERRED
73921
Referral of specimen by an approved pathology practitioner of an approved pathology authority to another approved pathology practitioner of another approved pathology authority or to another approved pathology authority
9.85
PART 3—ABBREVIATIONS
A—ABBREVIATIONS FOR GROUPS OF TESTS
Group
Estimations included in group
Abbreviation
Item numbers
Cardiac Enzymes
Lactate dehydrogenase (LDH) aspartate aminotransferase (AST) and creatine kinase (CK)
CE
66205
Coagulation Studies
Prothrombin time, activated partial thrombo-plastin time and two or more of the following tests—bleeding time, thrombin clotting time, fibrinogen degradation products, fibrin monomer, D-dimer, factor XIII screening tests
COAG
65035
Electrolytes
Sodium (NA) potassium (K) chloride (CL) and bicarbonate (HCO3)
E
66207
Lipid Studies
Cholesterol (CHOL) and triglycerides (TRIG)
FATS
66331
Liver Function Tests
Alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), bilirubin (BIL), gamma glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), and protein (PROT)
LFT
66211
Syphilis Serology
Rapid plasma reagin test (RPR) or venereal disease research laboratory test (VDRL) and treponema pallidum haemagglutination test (TPHA) or fluorescent treponemal antibody-absorption test (FTA)
STS
69231
Urea, Electrolytes, Creatine
Urea, electrolytes, creatinine
U&E
66211
B—ABBREVIATIONS FOR INDIVIDUAL TESTS
Abnormal haemoglobins AH 65027
Acetoacetate ACAT 66367
Acetylcholine receptor—tissue antigens—antibodies ARA 71109