Health Insurance (Pathology Services Table) Regulations 2004
13Tests on biopsy material — Group P5 (Tissue pathology) and Group P6 (Cytology)
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13 Tests on biopsy material — Group P5 (Tissue pathology) and Group P6 (Cytology)
(1) For items in Group P5 (Tissue pathology):
biopsy material means all tissue (other than a bone marrow biopsy) received by an approved pathology practitioner:
(a) from a medical procedure, or group of medical procedures, performed on a patient at the same time; or
(b) after being expelled spontaneously from a patient.
cytology means microscopic examination of 1 or more stained preparations of cells separated naturally or artificially from their normal environment by methods recognised as adequate to demonstrate their structure to a degree sufficient to enable an opinion to be formed about whether they are likely to be normal, abnormal but benign, or abnormal and malignant but, in accordance with customary laboratory practice, does not include examination of a blood film and a bone marrow aspirate.
separately identified specimen means an individual specimen collected, identified so that it is clearly distinguished from any other specimen, and sent for testing by or on behalf of the treating practitioner responsible for the procedure in which the specimen was taken.
(2) For Groups P5 and P6 of the pathology services table, services in Group P6 include any services described in Group P5 on the material submitted for a test in Group P6.
(3) For subrule (2), any sample submitted for cytology from which a cell block is prepared does not qualify for a Group P5 item.
(4) If more than 1 of the services mentioned in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 are performed in a single patient episode, only the fee for the item performed having the highest specified fee is applicable to the services.
(5) If more than 1 histopathological examinations are performed on separate specimens, of different complexity levels, from a single patient episode, only the fee for the examination having the highest specified fee is applicable to the examinations.
(6) In items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 a reference to a complexity level is a reference to the level given to a specimen type mentioned in Part 5 of this table.
(7) If:
(a) more than 1 of the services mentioned in items 72846, 72847 and 72848; or
(b) more than 1 of the services mentioned in items 73059, 73060 and 73061;
are performed in a single patient episode, only the fee for the item performed having the higher or highest specified fee applies to the services.