Section 15 - Health Insurance (1997-98 Pathology Services Table) Regulations - Items in Groups P10 (Patient episode initiation) and P11 (Specimen referred) not to apply in certain circumstances

15 Items in Groups P10 (Patient episode initiation) and P11 (Specimen referred) not to apply in certain circumstances

(1) For this rule and items in Groups P10 (Patient episode initiation) and P11 (Specimen referred):

institution means a place 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

(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;

but does not include:

(j) a hospital; or

(k) a nursing home; or

(l) accommodation for aged persons that is attached to a nursing home or situated within a nursing home complex;

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 internal Territory; or

(d) an Australian tertiary education institution.

specimen 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) If a service described in an item in Group P10 or P11 is rendered by, or on behalf of, an approved pathology practitioner who is a recognised pathologist, the relevant one of those items does not apply to the service if:

(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 is made; or

(d) a member of the staff of a recognised hospital, or a prescribed laboratory, participates in the service in the course of the member’s employment with the hospital or laboratory.

(3) An item in Group P10 or P11 does not apply to a pathology service to which subsection 16A (7) of the Act applies.

(4) An item in Group P10 or P11 does not apply to a pathology service unless at least one item in Groups P1 to P8 also applies to the service.

(5) Subject to subrule (7), if one item in Group P10 applies to a patient episode, no other item in the Group applies to the patient episode.

(6) An item in Group P11 applies only to the approved pathology practitioner or approved pathology authority to whom the specimen mentioned in the item was referred.

(7) If, in respect of the same patient episode:

(a) services referred to in 1 or more items in Group P5 and 1 or more of Groups P1, P2, P3, P4, P6, P7 and P8 are rendered by an approved pathology practitioner in the laboratory of another approved pathology authority; and

(b) services referred to in 1 or more items in Group P6 and 1 or more of Groups P1, P2, P3, P4, P5, P7 and P8 are rendered by another approved pathology practitioner in another approved pathology authority;

the fee specified in the applicable item in Group P10 is payable to both approved pathology practitioners.

(8) 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.

(9) The amount specified in item 73921 is payable only once in respect of a single patient episode.

15Items in Groups P10 (Patient episode initiation) and P11 (Specimen referred) not to apply in certain circumstances

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