Health Insurance (Section 4BA - Pathologist-Determinable Services) Determination 2025
8Services described in items 69316, 69317, 69319, 69494, 69495, 69496, 69497 and 69498
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8 Services described in items 69316, 69317, 69319, 69494, 69495, 69496, 69497 and 69498
For the purposes of section 4BA of the Act, a pathology service that is described in items 69316, 69317, 69319, 69494, 69495, 69496, 69497 or 69498 of the pathology services table is a pathologist-determinable service if it is: (a) rendered, by or on behalf of, an approved pathology practitioner who is a recognised pathologist; and (b) a service that the approved pathology practitioner determines to be necessary on the basis of: (i) information provided by a treating practitioner in relation to a pathology service described in items 69303, 69306, 69312, 69318, 69321 or 69345 of the pathology services table, that was rendered to the patient by, or on behalf of, the approved pathology practitioner pursuant to a request that complied with paragraph 16A(4)(a) or (b) of the Act; or (ii) the nature or appearance of the pathology specimen collected for a pathology service described in items 69303, 69306, 69312, 69318, 69321 or 69345 of the pathology services table, that was rendered to the patient by, or on behalf of, the approved pathology practitioner pursuant to a request that complied with paragraph 16A(4)(a) or (b) of the Act; or (iii) information learned from a pathology service described in items 69303, 69306, 69312, 69318, 69321 or 69345 of the pathology services table, that was rendered to the patient by, or on behalf of, the approved pathology practitioner pursuant to a request that complied with paragraph 16A(4)(a) or (b) of the Act.