Health Insurance (Section 4BA - Pathologist-Determinable Services) Determination 2025
7Services rendered where a different service was originally requested
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7 Services rendered where a different service was originally requested
For the purposes of section 4BA of the Act, a pathology service is a pathologist-determinable service if: (a) the service is rendered, by or on behalf of, an approved pathology practitioner; and (b) the approved pathology practitioner considers the service to be necessary, on the basis of information learned from another service: (i) that was rendered to the patient by, or on behalf of, that practitioner; and (ii) the request for which complied with paragraph 16A(4)(a) or (b) of the Act; and (c) the service is an item in the pathology services table that is mentioned in column 1 in the following table and, in relation to which, the pathology service originally requested was an item in the pathology services table that is mentioned in column 2 of the following table for that item of the table:
<table cellspacing="0" cellpadding="0" style="width:339.95pt; margin-left:71.15pt; border-collapse:collapse"><tbody><tr><td colspan="3" style="width:329.15pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:middle; background-color:#ffffff"><p class="paragraph" style="margin-left:8.4pt; text-indent:-8.4pt"><span style="font-weight:bold">Services rendered where a different service was originally requested items of the pathology services table</span></p></td></tr><tr><td style="width:24.4pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph"><span style="font-weight:bold">Item</span></p></td><td style="width:138pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-left:31.35pt; text-indent:-31.35pt"><span style="font-weight:bold">Column 1</span></p><p class="paragraph"><span style="font-weight:bold">Pathology service</span></p></td><td style="width:145.15pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph"><span style="font-weight:bold">Column 2</span></p><p class="paragraph" style="margin-left:0pt; text-indent:0pt"><span style="font-weight:bold">Originally requested service</span></p></td></tr><tr><td style="width:24.4pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph"><span>1</span></p></td><td style="width:138pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:7.75pt; margin-left:0pt; text-indent:0pt"><span>72846, 72847, 72848, 72849, 72850, 72851, 72852, 73319, 73332, 73336, 73337, 73341, 73342, 73344, 73364, 73365, 73366, 73367, 73368, 73369, 73370, 73371, 73372, 73373, 73374, 73375, 73376, 73377, 73378, 73379, 73380, 73381, 73382, 73383, 73389, 73436, 73429, 73437, 73438, 73439</span></p></td><td style="width:145.15pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:15.75pt; margin-left:0pt; text-indent:0pt"><span>72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836, 72838</span></p></td></tr><tr><td style="width:24.4pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph"><span>2</span></p></td><td style="width:138pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:7.75pt"><span>73059, 73060, 73061</span></p></td><td style="width:145.15pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:15.75pt; margin-left:0pt; text-indent:0pt"><span>73045, 73047, 73049, 73051</span></p></td></tr><tr><td style="width:24.4pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph"><span>3</span></p></td><td style="width:138pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:7.75pt"><span>73305</span></p></td><td style="width:145.15pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:15.75pt; margin-left:0pt; text-indent:0pt"><span>73300</span></p></td></tr><tr><td style="width:24.4pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph"><span>4</span></p></td><td style="width:138pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:7.75pt"><span>73320</span></p></td><td style="width:145.15pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:15.75pt; margin-left:0pt; text-indent:0pt"><span>71147</span></p></td></tr><tr><td style="width:24.4pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph"><span>5</span></p></td><td style="width:138pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:7.75pt"><span>66839</span></p></td><td style="width:145.15pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:15.75pt; margin-left:0pt; text-indent:0pt"><span>66838</span></p></td></tr><tr><td style="width:24.4pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph"><span>6</span></p></td><td style="width:138pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:7.75pt"><span>73411, 73412, 73413</span></p></td><td style="width:145.15pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:15.75pt; margin-left:0pt; text-indent:0pt"><span>73410</span></p></td></tr><tr><td style="width:24.4pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph"><span>7</span></p></td><td style="width:138pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:7.75pt"><span>66842</span></p></td><td style="width:145.15pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top; background-color:#ffffff"><p class="paragraph" style="margin-right:15.75pt; margin-left:0pt; text-indent:0pt"><span>66839</span></p></td></tr></tbody></table>