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