Statutory Rules 1992 No. 2731
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Health Insurance (1992 Pathology Services Table) Regulations 2 (Amendment)
I, THE GOVERNOR-GENERAL of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.
Dated 19 August 1992.
BILL HAYDEN
Governor-General
By His Excellency’s Command,
PETER STAPLES
Minister of State for Aged, Family and Health Services
for and on behalf of the
Minister of State for Health, Housing and Community Services
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1. Commencement
1.1 These Regulations commence on 1 September 1992.
2. Amendment
2.1 The Health Insurance (1992 Pathology Services Table) Regulations are amended as set out in these Regulations.
3. Schedule (Table of pathology services)
3.1 Rule 1 (definition of “patient episode”):
Omit the definition, substitute:
“’patient episode’ means:
(a) a pathology service to which rule 3a refers that is provided in the circumstances described in that rule that relate to the service; and
(b) except in the case of a pathology service to which paragraph (a) refers‒a pathology service or pathology services, whether specified in a single item or in more than 1 items, provided for a single patient whose need for the service or services was determined under subsection 16a (1) of the Act on the same day, whether rendered by an approved pathology practitioner or more than 1 approved pathology practitioner on the same day or on different days;”.
3.2 Rule 1:
Add at the end:
“(3)Unless the contrary intention appears, a reference in this table by number to an item that is not included in this table is a reference to the correspondingly numbered item in the general medical services table or the diagnostic imaging services table, as each case requires.”.
3.3 Subrule 3 (2):
Before “2 or more”, insert “Subject to rule 3A,”.
3.4 After rule 3, insert:
“3a. (1) Rule 3 does not apply to:
(a) a pathology service specified in item 66201, other than an estimation of cholesterol, fructosamine, lithium or triglycerides; or
(b) the quantitative estimation of 1 or more fractions of neonatal bilirubin specified in item 66273;
if:
(c) the service is rendered in relation to a single specimen taken on each of not more than 4 occasions in a period of 24 hours; and
(d) the service is rendered to a patient in a hospital unit where:
(i) the presence of 1 nurse is required for each group of not more than 4 patients; and
(ii) the condition of the patients is continuously observed in relevant respects; and
(e) in order to render the service, an approved pathology practitioner who is a recognised pathologist has to arrange for a member of the laboratory staff of the approved pathology authority concerned to undertake duties in respect of the service that are in addition to the usual duties of the staff member.
“(2)Rule 3 does not apply to any of the following pathology services rendered in relation to a single specimen taken on each of not more than 6 occasions in a period of 6 months:
(a) estimation of prothrombin time in respect of a patient undergoing anticoagulant therapy;
(b) quantitative estimation of lithium in respect of a patient undergoing lithium therapy;
(c) a service specified in item 65007 in relation to a patient undergoing chemotherapy for neoplastic disease or immunosuppressant therapy;
(d) a service specified in item 65007 in relation to methotrexate, gold or penicillamine therapy of a patient;
(e) a service specified in item 66201 in relation to methotrexate therapy of a patient;
(f) quantitative estimation of urea, creatinine and electrolytes in relation to:
(i) cis-platinum therapy of a patient; or
(ii) chronic renal failure of a patient being treated in a dialysis program conducted by a recognised hospital.
“(3)This rule does not apply in relation to a pathology service unless the account for fees in respect of the service is endorsed with the words “Rule 3 Exemption””.
3.5 After rule 5, insert:
“5A. (1) In this rule:
‘designated pathology service’ means a pathology service specified in item 66241, 66313 or 69241.
“(2) Subject to subrule (3), if an approved pathology practitioner in an approved pathology authority:
(a) has been requested to render a pathology service that specifies 2 or more estimations comprised in a designated pathology service; and
(b) is unable to perform 1 or more, but not all, of the estimations because of the lack of facilities in, or expertise or experience of the staff of, the laboratory of the authority in relation to that estimation or those estimations; and
(c) requests an approved pathology practitioner in another approved pathology authority to render 1 or more, but not all, of the estimations;
the service rendered by the second-mentioned practitioner is taken to be the designated pathology service.
“(3)Items 73901 to 73917 (inclusive) do not apply to the second-mentioned approved pathology practitioner in subrule (2).”.
3.6 After rule 12, insert:
“SERVICES AND FEES”.
3.7 After item 66213, insert:
“66215 Quantitative estimation of cryoglobulins or cryofibrinogen after a positive result for cryoglobulin is obtained in any service specified in item 66213 (including provision of that service)─1 or more estimations 14.00”.
3.8 After item 66239, insert:
“66241 Estimations specified in any of items 66235 to 66239 (inclusive), if the number of estimations relating to the same patient episode does not exceed 3─each estimation to a maximum of 2 estimations 7.70”.
3.9 Items 66251 and 66253:
Omit the items, substitute:
“66255 Alpha-1-acid glycoprotein, alpha-1-antitrypsin, alpha-2-macroglobulin, quantitative estimation in serum, urine or other body fluid─1 or more estimations 19.00
66257 C-1 esterase inhibitor, quantitative estimation 19.00
66258 C-1 esterase inhibitor, functional assay 42.50
66259 Alpha-fetoprotein, beta-2-microglobulin, caeruloplasmin, ferritin (except when part of item 66263), haptoglobulins, microalbumin in proven diabetes mellitus, prealbumin, prostate specific antigen, prostatic acid phosphatase, transferrin (except when part of item 66263), quantitative estimation in serum, urine or other body fluid─1 estimation 19.00
66260 2 or more estimations as specified in item 66259 35.00
66261 CA-125 antigen, CA-15.3 antigen, CA-19.9 antigen, carcinoembryonic antigen (CEA), mammary serum antigen, mucin-like carcinoma associated antigen (1 or more fractions), neuron-specific enolase, thyroglobulin in serum or other body fluid, in the monitoring or confirmation of malignancy, quantitative estimation─1 estimation 19.00”.
3.10 Item 66277:
Omit the item, substitute:
“66277 Aluminium (except if item 66325 applies), arsenic, beryllium, cadmium, copper, chromium, gold, manganese, mercury, nickel, selenium, strontium, in blood, urine or other body fluid or tissue─1 or more estimations in any 6 month period 33.00”.
3.11 After item 66311, insert:
“66313 Estimations specified in any of items 66301 to 66311 (inclusive), if the number of estimations relating to the same patient episode does not exceed 6─each estimation to a maximum of 5 estimations 10.60”.
3.12 Item 66321:
Omit the item, substitute:
“66321 Quantitative estimation in the second trimester of a pregnancy of alpha-fetoprotein, human chorionic gonadotrophin and oestriol and any other substance to detect foetal abnormality, including any service specified in one or more of items 66259, 66301, 73527 or 73529─1 patient episode in that pregnancy 52.00
66323 Estimation of tryptic activity in faeces for the investigation of diarrhoea of greater than 4 weeks duration in children less than 6 years of age 10.50
66325 Estimation of serum aluminium in a patient in a renal dialysis program‒each estimation 33.00”.
3.13 Item 69227:
Omit the item.
3.14 After item 69239, insert:
“69241 Estimations specified in any of items 69229 to 69239 (inclusive), if the number of estimations relating to the same patient episode does not exceed 6─each estimation to a maximum of 5 estimations 7.00”.
3.15 After item 69251, insert:
“69253 All microbiological serology during a pregnancy, which must include the determination of 1 of the following─rubella immune status, specific syphilis serology or hepatitis B surface antigen─including any service specified in one or more of items 69229, 69243 or 69245, except in the investigation of a clinically apparent intercurrent microbial illness during that pregnancy 13.30
69255 All microbiological serology during a pregnancy, which must include the determination of 2 of the following─rubella immune status, specific syphilis serology or hepatitis B surface antigen and including any service specified in one or more of items 69229, 69243 or 69245, except in the investigation of a clinically apparent intercurrent microbial illness during that pregnancy 20.30
69257 All microbiological serology during a pregnancy, which must include the determination of all 3 of the following─rubella immune status, specific syphilis serology and hepatitis B surface antigen─including any service specified in one or more of items 69229, 69243 or 69245, except in the investigation of a clinically apparent intercurrent microbial illness during that pregnancy 27.00”.
3.16 Items 71001 to 71055:
Omit the items, substitute:
“71061 Examination for, and characterisation of, a paraprotein or cryoglobulin not previously characterised on serum, urine or other body fluid by immunoelectrophoresis or immunofixation─1 or more procedures 27.50
71063 Examination for, and characterisation of, a paraprotein not previously characterised, by immunoelectrophoresis or immunofixation on serum and urine collected concurrently─2 or more procedures 41.50
71065 Examination of CSF and serum concurrently for the presence of oligoclonal proteins─2 or more procedures 41.50
71067 Immunoglobulins A, G, M or D, quantitative estimation by any method in serum, urine or other body fluid─1 estimation 14.20
71069 2 estimations as specified in item 71067 24.00
71071 3 or more estimations as specified in item 71067 30.50
71073 Immunoglobulin G subclasses, quantitative estimation of all 4 subclasses with a maximum of 2 patient episodes in any 12 month period─each patient episode 100.00
71075 Immunoglobulin E (total), quantitative estimation with a maximum of 2 patient episodes in any 12 month period─each patient episode 25.50
71077 Immunoglobulin E (total), quantitative estimation in the follow up of a patient with proven immunglobulin E secreting myeloma, proven congenital immunodeficiency or proven allergic bronchopulmonary aspergillosis, with a maximum of 6 patient episodes in any 12 month period─each patient episode 25.50
71079 Estimation of specific immunoglobulin G or E antibodies to single or multiple potential allergens, with a maximum of 4 patient episodes in any 12 month period─each patient episode 23.00
71081 Total haemolytic complement, quantitative estimation 19.00
71083 Complement components C3, C4 or properdin factor B, quantitative estimation─1 estimation 19.00
71085 2 estimations as specified in item 71083 28.50
71087 3 or more estimations as specified in item 71083 35.50
71089 Complement components or breakdown products of complement proteins not elsewhere specified in an item in this Schedule, quantitative estimation─1 estimation 27.50
71091 2 estimations as specified in item 71089 50.00
71093 3 or more estimations as specified in item 71089 72.00
71097 Antinuclear antibodies, detection in serum or other body fluids, including quantitation if required 24.00
71099 Double-stranded DNA antibodies, quantitative estimation by 1 or more methods other than the Crithidia method 25.00
71101 Antibodies to 1 or more extractable nuclear antigens, detection in serum or other body fluids 16.40
71103 Antibodies to 1 or more extractable nuclear antigens, characterisation after a positive result is obtained by a service specified in item 71101, including that service 49.00
71105 Rheumatoid factor, detection of by any technique 8.20
71107 Quantitation of rheumatoid factor if detected during a service specified in item 71105, including that service 19.00
71109 Antibodies to tissue antigens (acetylcholine receptor, adrenal cortex, cardiolipin, glomerular basement membrane, heart, histone, insulin, insulin receptor, intrinsic factor, islet cell, lymphocyte, neurone, neutrophil cytoplasm, ovary, parathyroid, platelet, salivary gland, skeletal muscle, skin basement membrane and intercellular substance, thyroglobulin, thyroid microsome, thyroid stimulating hormone receptor), qualitative or quantitative─estimation of 1 antibody 32.50
71113 Estimation of 2 antibodies specified in item 71109 49.00
71115 Estimation of 3 antibodies specified in item 71109 61.00
71117 Estimation of 4 or more antibodies specified in item 71109 69.00
71119 Antibodies to tissue antigens not elsewhere specified in an item in this Schedule, qualitative or quantitative─estimation of 1 antibody 16.40
71121 Estimation of 2 antibodies specified in item 71119 19.60
71123 Estimation of 3 antibodies specified in item 71119 23.00
71125 Estimation of 4 or more antibodies specified in item 71119 26.00
71127 Functional tests for lymphocytes─estimation of proliferation induced by 1 or more mitogens, estimation of proliferation induced by 1 or more antigens or estimation of 1 or more mixed lymphocyte reactions, other than quantitation by microscopy─including a test specified in item 65005, with a maximum of 2 patient episodes in any 12 month period─each patient episode 164.00
71129 2 estimations specified in item 71127 205.00
71131 3 or more estimations specified in item 71127 245.00
71135 Determination of neutrophil function─comprising at least 2 of neutrophil chemotaxis, neutrophil phagocytosis, neutrophil oxidative metabolism, neutrophil bactericidal activity─including any test specified in item 65005 (other than Nitroblue tetrazolium reduction slide test), with a maximum of 2 patient episodes in any 12 month period─each patient episode 196.00
71137 Determination of cell mediated immunity by multiple antigen delayed type hypersensitivity intradermal skin testing using a minimum of 7 antigens, with a maximum of 2 patient episodes in any 12 month period─each patient episode 28.50
71139 Characterisation of 3 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations on 1 or more specimens of blood, CSF or serous fluid 98.00
71141 Characterisation of 3 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations on 1 or more disaggregated tissue specimens 215.00
71143 Characterisation (not monitoring) of 6 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations in an immunological or haematological malignancy, including any service specified in one or more of items 71139 or 71141, on a specimen of blood, CSF, serous fluid or disaggregated tissue 245.00
71145 Characterisation (not monitoring) of 6 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations in an immunological or haematological malignancy, including any service specified in one or more of items 71139, 71141 or 71143, on 2 or more specimens of disaggregated tissues or 1 specimen of disaggregated tissue and 1 or more specimens of blood, CSF or serous fluid 400.00
71147 HLA-B27 typing 32.50
71149 Complete tissue typing for 4 HLA-A and HLA-B Class I antigens (including any separation of leucocytes), including any service specified in item 71147 102.00
71151 Tissue typing for HLA-DR, HLA-DP and HLA-DQ Class II antigens (including any separation of leucocytes)─phenotyping or genotyping of 2 or more antigens 112.00”.
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NOTES
1. Notified in the Commonwealth of Australia Gazette on 26 August 1992.
2. Statutory Rules 1992 No. 23 as amended by 1992 No. 46.