Health Insurance (Pathology Services Table) Regulations 2007
18Certain pathology services to be treated as 1 service
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18 Certain pathology services to be treated as 1 service
(1) In this rule:
general practitioner has the meaning given by subrule 18A (1).
set of pathology services has the meaning given by subrule 18A (2).
(2) If a general practitioner requests a set of pathology services, the pathology services in the set are to be treated as individual pathology services in accordance with this rule.
(3) If the fee mentioned in 1 item that describes any of the services in the set of pathology services is higher than the fees mentioned in the other items that describe the services in the set:
(a) the pathology service described in the first‑mentioned item is to be treated as 1 pathology service; and
(b) either:
(i) the pathology service in the set that is described in the item that mentions the second‑highest fee is to be treated as 1 pathology service; or
(ii) if 2 or more items that describe any of those services mentions the second‑highest fee — the pathology service described in the item that mentions the second‑highest fee, and has the lowest item number, is to be treated as 1 pathology service; and
(c) the pathology services in the set, other than the services that are to be treated as 1 pathology service under paragraphs (a) and (b), are to be treated as 1 pathology service.
(4) If the fees mentioned in 2 or more items that describe any of the services in the set of pathology services are the same, and higher than the fees mentioned in the other items that describe the services in the set:
(a) the pathology service in the set that is described in the item that mentions the highest fee, and has the lowest item number, is to be treated as 1 pathology service; and
(b) the pathology service in the set that is described in the item that mentions the highest fee, and has the second‑lowest item number, is to be treated as 1 pathology service; and
(c) the pathology services in the set, other than the services that are to be treated as 1 pathology service under paragraphs (a) and (b), are to be treated as 1 pathology service.
(5) If pathology services are to be treated as 1 pathology service under paragraph (3) (c) or (4) (c), the fee for the 1 pathology service is the highest fee mentioned in any of the items that describe the pathology services that are to be treated as the 1 pathology service.