Health Insurance (Section 4BA - Pathologist-Determinable Services) Determination 2025
9A service described in item 72860
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9 A service described in item 72860
For the purposes of section 4BA of the Act, a pathology service that is described in item 72860 of the Health Insurance (Section 3C Co-Dependent Pathology Services) Determination 2018 is a pathologist-determinable service if it is: (a) an initial service that is described in an item in Group P5 (other than item 72860), Group P6 or Group P7 of the pathology services table was rendered in a patient episode for 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; and (b) following the initial service, the treating practitioner determines that a service described in an item in Group P7 (the subsequent Group P7 service) is clinically necessary; and (c) following a request from the treating practitioner, an approved pathology practitioner at the accredited pathology laboratory, where the initial service was rendered, determines the accredited pathology laboratory is unable to perform the subsequent P7 service and consequently determines a service described under item 72860 is required to select appropriate tissue samples for referral to a different accredited pathology laboratory for performance of the subsequent P7 service; and (d) the subsequent P7 service and a service under item 72860 are rendered in a different accredited pathology laboratory, by or on behalf of, an approved pathology practitioner who is a recognised pathologist.
Schedule 1—Repeals
Health Insurance (Pathologist-determinable Services) Determination 2015
1 The whole of the instrument
Repeal the instrument.