Breast, orientated wide local excision for carcinoma with margin assessment
7
Breast tissue—all specimens not otherwise specified
4
Bronchus, biopsy
4
Carotid body—neoplasm
5
Cholesteatoma
3
Digits, amputation—not traumatic
4
Digits, amputation—traumatic
2
Ear, middle and inner—not cholesteatoma
4
Endocrine neoplasm—not otherwise specified
5
Extremity, amputation—not otherwise specified
4
Extremity, amputation or disarticulation—neoplasm
6
Eye, conjunctiva—biopsy or pterygium
3
Eye, cornea
4
Eye, enucleation or exenteration—all lesions
6
Eye—not otherwise specified
4
Fallopian tube, biopsy
4
Fallopian tube, ectopic pregnancy
4
Fallopian tube, sterilization
2
Fetus with dissection
6
Foreskin—new born
2
Foreskin—not new born
3
Gallbladder
3
Gallbladder and porta hepatis‑radical resection
6
Ganglion cyst, all sites
3
Gum or oral mucosa, biopsy
4
Heart—not otherwise specified
5
Heart valve
4
Hernia sac
2
Hydrocele sac
2
Jaw, upper or lower, including bone—radical resection for neoplasm
6
Joint and periarticular tissue, without bone—all specimens
3
Joint tissue, including bone—all specimens
4
Kidney, biopsy including transplant
5
Kidney, nephrectomy transplant
5
Kidney, partial or total nephrectomy—not neoplasm
4
Kidney, partial or total nephrectomy or nephroureterectomy—neoplasm
6
Large bowel, colostomy—stoma
3
Large bowel (including rectum), biopsy—all sites
4
Large bowel (including rectum), biopsy, for confirmation or exclusion of Hirschsprung’s Disease
5
Large bowel (including rectum), polyp
4
Large bowel (including rectum), segmental resection—neoplasm
6
Large bowel (including rectum), submucosal resection—neoplasm
5
Large bowel, segmental resection—colon, not neoplasm
5
Larynx, biopsy
4
Larynx, partial or total resection
5
Larynx, resection with nodes or pharynx or both
6
Lip biopsy—all specimens not mentioned
3
Lip wedge resection or local excision with orientation
4
Liver—all specimens not otherwise specified
5
Liver, hydatid cyst or resection for trauma
4
Liver, total or subtotal hepatectomy—neoplasm
6
Lung, needle or transbronchial biopsy
4
Lung, resection—neoplasm
6
Lung segment, lobar or total resection
6
Lung, wedge biopsy
5
Lymph node, biopsy—all sites
4
Lymph node, biopsy, for lymphoma or lymphoproliferative disorder
5
Lymph nodes, regional resection—all sites
5
Mediastinum mass
5
Muscle, biopsy
6
Nasopharynx or oropharynx, biopsy
4
Nerve, biopsy neuropathy
5
Nerve, neurectomy or removal of neoplasm
4
Nerve—not otherwise specified
3
Nose, mucosal biopsy
4
Nose or sinuses, polyps
3
Odontogenic neoplasm
5
Odontogenic or dental cyst
4
Oesophagus, biopsy
4
Oesophagus, diverticulum
3
Oesophagus, partial or total resection
6
Oesophagus, submucosal resection—neoplasm
5
Omentum, biopsy
4
Ovary with or without tube—neoplasm
5
Ovary with or without tube—not neoplasm
4
Pancreas, biopsy
5
Pancreas, cyst
4
Pancreas, subtotal or total with or without splenectomy
6
Parathyroid gland(s)
4
Penisectomy—simple
4
Penisectomy with node dissection
5
Peritoneum, biopsy
4
Pituitary neoplasm
4
Placenta—not third trimester
4
Placenta—third trimester, abnormal pregnancy or delivery
4
Pleura or pericardium, biopsy or tissue
4
Products of conception, spontaneous or missed abortion
4
Products of conception, termination of pregnancy
3
Prostate—all types of specimen not otherwise specified
4
Prostate, radical prostatectomy or cystoprostatectomy for carcinoma
7
Prostate, radical resection
6
Retroperitoneum, neoplasm
5
Salivary gland—all specimens not otherwise specified
4
Salivary gland, Mucocele
3
Salivary gland, neoplasm—all sites
5
Sinus, paranasal, biopsy
4
Sinus, paranasal, resection—neoplasm
6
Skin—all specimens not otherwise specified including all neoplasms and cysts
3
Skin, biopsy—blistering skin diseases
4
Skin, biopsy—inflammatory dermatosis
4
Skin, biopsy—investigation of alopecia where serial horizontal sections are taken, except for male pattern baldness
5
Skin, biopsy—investigation of lymphoproliferative disorder
5
Skin, eyelid, wedge resection
4
Skin, local resection—orientation
4
Skin, resection of malignant melanoma or melanoma in situ
5
Small bowel—all specimens not otherwise specified
5
Small bowel—biopsy, all sites
4
Small bowel, diverticulum
3
Small bowel, resection—neoplasm
6
Small bowel, submucosal resection—neoplasm
5
Soft tissue, infiltrative lesion—extensive resections at least 5 cm in maximal dimension
6
Soft tissue, lipoma and variants
3
Soft tissue, neoplasm, not lipoma—all specimens
5
Soft tissue—not otherwise specified
4
Spleen
5
Stomach—all specimens not otherwise specified
4
Stomach, endoscopic biopsy or endoscopic polypectomy
4
Stomach, resection, neoplasm—all specimens
6
Stomach, submucosal resection—neoplasm
5
Tendon or tendon sheath, giant cell neoplasm
4
Tendon or tendon sheath—not otherwise specified
3
Testis and adjacent structures, castration
2
Testis and adjacent structures, neoplasm with or without nodes
5
Testis and adjacent structures—not otherwise specified
3
Testis and adjacent structures, vas deferens sterilization
2
Testis, biopsy
5
Thymus—not otherwise specified
5
Thyroglossal duct—all lesions
4
Thyroid—all specimens
5
Tissue or organ—all specimens not otherwise specified
3
Tissue or organ not otherwise specified, abscess
3
Tissue or organ not otherwise specified, haematoma
3
Tissue or organ not otherwise specified, malignant neoplasm with regional nodes
6
Tissue or organ not otherwise specified, neoplasm local
4
Tissue or organ not otherwise specified, pilonidal cyst or sinus
3
Tissue or organ not otherwise specified, thrombus or embolus
3
Tissue or organ not otherwise specified, veins varicosity
3
Tongue, biopsy
4
Tongue or tonsil, neoplasm local
5
Tongue or tonsil, neoplasm with nodes
6
Tonsil, biopsy—excluding resection of whole organ
4
Tonsil or adenoids or both
2
Trachea, biopsy
4
Ureter, biopsy
4
Ureter, resection
5
Urethra, biopsy
4
Urethra, resection
5
Urinary bladder—all specimens not otherwise specified
4
Urinary bladder, partial or total with or without prostatectomy
6
Urinary bladder, transurethral resection of neoplasm
5
Uterus and/or cervix—all specimens not otherwise specified
4
Uterus, cervix cone, biopsy (including LEEP or LLETZ biopsy)
5
Uterus, cervix, curettings or biopsy
4
Uterus, endocervix, polyp
3
Uterus, endometrium, polyp
3
Uterus, with or without adnexa, malignant neoplasm—all specimen types not otherwise specified
6
Uterus with or without adnexa, neoplasm, Wertheim’s or pelvic clearance
6
Vagina, biopsy
4
Vaginal mucosa, incidental
3
Vagina, radical resection
6
Vulva or labia, biopsy
4
Vulval, subtotal or total with or without nodes
6
Dictionary
abnormal level of TSH for item 66719—see clause 2.2.5 of Schedule 1.
Act means the Health Insurance Act 1973.
approved collection centre for Group P10—see clause 2.10.1 of Schedule 1.
ASGC for item 74991—see clause 2.12.1 of Schedule 1.
biopsy material for Group P5—see clause 2.5.1 of Schedule 1.
bulk‑billed for items 74990 and 74991—see clause 2.12.1 of Schedule 1.
Commonwealth concession card holder for items 74990 and 74991—see clause 2.12.1 of Schedule 1.
compatibility tests by crossmatch for items 65099 and 65102—see clause 2.1.2 of Schedule 1.
cytology for Group P5—see clause 2.5.1 of Schedule 1.
designated test—see clause 1.2.4 of Schedule 1.
elevated serum ferritin for items 73317 and 73318—see clause 2.7.1 of Schedule 1.
general practitioner—see clause 1.2.7 of Schedule 1.
Group, for a Group in the table, means every item in the Group.
Hepatitis C sero‑positive for items 69499 and 69500—see clause 2.3.5 of Schedule 1.
item means:
(a) an item mentioned, by number, in column 1 of a table in:
(i) Schedule 1; or
(ii) Schedule 1 to the diagnostic imaging services table; or
(iii) Schedule 1 to the general medical services table; and
(b) in a reference immediately followed by a number—the item so numbered.
institution for Group P10—see clause 2.10.1 of Schedule 1.
metal toxicity testing group—see clause 2.2.7 of Schedule 1.
nutritional metals testing group—see clause 2.2.7 of Schedule 1.
patient episode means:
(a) a pathology service or pathology services (other than a pathology service to which paragraph (b) refers) provided for a single patient whose need for the service or services was determined under section 16A of the Act:
(i) on the same day; or
(ii) if more than one test is performed on the one specimen within 14 days—on the same or different days;
whether the services:
(iii) are requested by one or more practitioners, participating midwives or participating nurse practitioners; or
(iv) are described in a single item or in more than one item; or
(v) are rendered by one approved pathology practitioner or more than one approved pathology practitioner; or
(vi) are rendered on the same or different days; or
(b) a pathology service to which clause 1.2.3, 2.1.1 or 2.2.2 refers that is provided in the circumstances, set out in the clause, that relate to the service.
practice location for item 74991—see clause 2.12.1 of Schedule 1.
prescribed laboratory for Group P10—see clause 2.10.1 of Schedule 1.
receiving APP, for a patient episode, means an approved pathology practitioner in an approved pathology authority who:
(a) receives a request from a referring APP to render a designated test or tests; and
(b) renders each test included in the designated test that the referring APP has not performed.
recognised pathologist means:
(a) a medical practitioner recognised as a specialist in pathology under subsection 3D (1) of the Act; or
(b) a medical practitioner in relation to whom there is in force a determination under paragraph 3DB (4) (a) or subsection 3E (1) of the Act that the practitioner is recognised as a specialist in pathology.
referring APP, for a patient episode, means an approved pathology practitioner in an approved pathology authority who:
(a) has received a request to render one or more designated tests; and
(b) is unable, because of the lack of facilities in, or expertise or experience of the staff of, the laboratory of the authority, to render one or more of the tests included in the designated test; and
(c) requests a receiving APP in another approved pathology authority to render:
(i) the test or tests that the approved pathology practitioner is unable to render; or
(ii) all of the tests that are included in the designated test; and
(d) renders each test included in the designated test, other than the test or tests for which the request mentioned in paragraph (c) is made.
request, received by an approved pathology practitioner, includes a request for a pathologist‑determinable service to which subsection 16A (6) of the Act applies.
residential care facility for Group P10—see clause 2.10.1 of Schedule 1.
rule 3 exemption means the exemption that has effect because of the operation of clause 1.2.2 of Schedule 1.
Rural, Remote and Metropolitan Areas Classification for item 74991—see clause 2.12.1 of Schedule 1.
separately identified specimen for Group P5—see clause 2.5.1 of Schedule 1.
serial examinations means a series of examinations requested on one occasion whether or not:
(a) the materials are received on different days by the approved pathology practitioner; or
(b) the examinations or cultures were requested on one or more request forms by the treating practitioner.
serial examinations or cultures for Group P3—see clause 2.3.1 of Schedule 1.
serological status is uncertain for items 69499 and 69500—see clause 2.3.5 of Schedule 1.
set of pathology services—see clause 1.2.7 of Schedule 1.
SLA for item 74991—see clause 2.12.1 of Schedule 1.
specimen collection centre for Group P10—see clause 2.10.1 of Schedule 1.
SSD for item 74991—see clause 2.12.1 of Schedule 1.
Subgroup, for a Subgroup in the table, means every item in the Subgroup.
treating practitioner for Group P10—see clause 2.10.1 of Schedule 1.
unreferred service for items 74990 and 74991—see clause 2.12.1 of Schedule 1.
Notes to the Health Insurance (Pathology Services Table) Regulation 2012
Note 1
Note: The Health Insurance (Pathology Services Table) Regulation 2012 (in force under the Health Insurance Act 1973) as shown in this compilation comprise Select Legislative Instrument 2012 No. 246 amended as indicated in the Tables below.
Note: > Note: Table of Instruments
Year andNumber
Date of FRLI registration
Date ofcommencement
Application, saving ortransitional provisions
2012 No. 246
26 Oct 2012 (see F2012L02094)
1 Nov 2012
2012 No. 254
23 Nov 2012 (see F2012L02242)
1 Dec 2012
—
2012 No. 297
11 Dec 2012 (see F2012L02413)
1 Jan 2013
—
Note: > Note: Table of Amendments
Part Part 4 - Health Insurance (Pathology Services Table) Regulation 2012 - Complexity levels for histopathology items | Zoe