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HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATIONS 2017 (F2017L00677) - NOTES

Greg Hunt

Minister for Health

 

 

 

 

  

  

  


Contents

1............ Name............................................................................................................................. 1

2............ Commencement............................................................................................................. 1

3............ Authority....................................................................................................................... 1

4............ Schedules...................................................................................................................... 1

5............ Pathology services table................................................................................................ 1

6............ Dictionary...................................................................................................................... 1

Schedule 1--Pathology services table                                                                                  2

Part 1--Preliminary                                                                                                                                        2

Division 1.1--Interpretation                                                                                                               2

1.1.1...... Abbreviations for services and drugs--Part 3............................................................... 2

Division 1.2--General application provisions                                                                           2

1.2.1...... Precedence of items....................................................................................................... 2

1.2.2...... Circumstances in which services rendered following 2 requests to be taken to have been rendered following one request...................................................................................................................................... 2

1.2.3...... Services to which clause 1.2.2 does not apply............................................................... 3

1.2.4...... Referral of designated tests by one pathology practitioner to another............................ 3

1.2.5...... Items not to be split....................................................................................................... 4

1.2.6...... Certain pathology services to be treated as one service.................................................. 4

1.2.7...... Meaning of set of pathology services............................................................................ 5

1.2.8...... Satisfying requirements described in pathology service................................................ 6

1.2.9...... Application of items--services provided with autologous injections of blood or blood products            7

Part 2--Services and fees                                                                                                                            8

Division 2.1--Group P1: haematology                                                                                          8

2.1.1...... Services to which clause 1.2.2 does not apply............................................................... 8

2.1.2...... Item taken to refer only to the first service of a particular kind...................................... 8

Division 2.2--Group P2: chemical                                                                                                 13

2.2.1...... Creatinine ratios........................................................................................................... 13

2.2.2...... Services to which clause 1.2.2 does not apply............................................................. 13

2.2.3...... Limitation on certain items........................................................................................... 13

2.2.5...... Thyroid function testing.............................................................................................. 14

2.2.6...... Limitation on certain items........................................................................................... 14

2.2.7...... Nutritional and toxicity metals testing.......................................................................... 14

Division 2.3--Group P3: microbiology                                                                                       23

2.3.1...... Meaning of serial examinations or cultures................................................................. 23

2.3.2...... Antigen detection......................................................................................................... 24

2.3.3...... Investigation for hepatitis serology.............................................................................. 24

2.3.4...... Limitation on certain items........................................................................................... 24

2.3.5...... Hepatitis C viral RNA testing...................................................................................... 24

Division 2.4--Group P4: immunology                                                                                         31

2.4.1...... Limitation on certain items........................................................................................... 31

2.4.2...... Tests in Group P4 relating to antibodies...................................................................... 31

2.4.3...... HLA-B27 typing......................................................................................................... 31

2.4.4...... Antineutrophil cytoplasmic antibody tests................................................................... 31

Division 2.5--Group P5: tissue pathology                                                                                 36

2.5.1...... Tests on biopsy material.............................................................................................. 36

2.5.2...... Limitations on items 72858 and 72859........................................................................ 37

Division 2.6--Group P6: cytology                                                                                                 40

2.6.1...... Tests on biopsy material.............................................................................................. 40

Division 2.7--Group P7: genetics                                                                                                  42

2.7.1...... Haemochromatosis testing........................................................................................... 42

2.7.2...... HLA-B27 typing......................................................................................................... 43

2.7.3...... Limitation on items 73339 and 73340......................................................................... 43

Division 2.8--Group P8: infertility and pregnancy tests                                                   46

2.8.1...... Limitation on item 73523............................................................................................. 46

Division 2.9--Group P9: simple basic pathology tests                                                        47

Division 2.10--Group P10: patient episode initiation                                                         47

2.10.1.... Items in Group P10 not to apply in certain circumstances........................................... 47

Division 2.11--Group P11: specimen referred                                                                       52

2.11.1.... Items in Group P11 not to apply in certain circumstances........................................... 52

2.11.2.... Application of an item in Group P11 to a service excludes certain other items............ 52

2.11.3.... Circumstances in which an item in Group P11 does not apply.................................... 52

Division 2.12--Group P12: management of bulk-billed services                                  53

2.12.1.... Application of items 74990 and 74991........................................................................ 53

Division 2.13--Group P13: bulk-billing incentive                                                                 56

Part 3--Abbreviations for services and drugs                                                                             57

3.1......... Abbreviations.............................................................................................................. 57

Part 4--Complexity levels for histopathology items                                                                  81

4.1......... Complexity levels........................................................................................................ 81

Part 5--Dictionary                                                                                                                                         87

5.1......... Dictionary.................................................................................................................... 87

Schedule 2--Repeals                                                                                                                                     91

Health Insurance (Pathology Services Table) Regulation 2016                                                91

 




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