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Determinations/Health as amended, taking into account amendments up to Health Insurance (Pathologist-determinable Services) Amendment Determination (No. 2) 2020
Administered by: Health
Registered 02 Jun 2020
Start Date 01 May 2020
Table of contents.

 

Commonwealth Coat of Arms of Australia

Health Insurance (Pathologist-determinable Services) Determination 2015

made under section 4BA of the

Health Insurance Act 1973

Compilation No. 5

Compilation date:                              1 May 2020

Includes amendments up to:           Health Insurance (Pathologist-determinable Services) Amendment Determination (No. 2) 2020

Registered:                                         2 June 2020

 

About this compilation

This compilation

This is a compilation of the Health Insurance (Pathologist-determinable Services) Determination 2015 that shows the text of the law as amended and in force on 1 May 2020 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

  

  

  



1.       Name of Determination

This Determination is the Health Insurance (Pathologist-determinable Services) Determination 2015.

4.       Interpretation

(1)     In this Determination:

Act means the Health Insurance Act 1973.

Recognised pathologist means a medical practitioner recognised as a specialist in pathology for the purposes of the Act.

Pathology services table means the table prescribed under subsection 4A(1) of the Act.

(2)    Unless the contrary intention appears, in this Determination a reference to a provision of the Act or regulations made under the Act or the National Health Act 1953 or regulations made under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

5.       Pathologist-determinable services

Pursuant to section 4BA of the Act, the following classes of pathology services are pathologist-determinable services:

(a)      a pathology service that:

                          (i)    is mentioned in an item in the pathology services table; and

                         (ii)    is rendered, by or on behalf of, an approved pathology practitioner to a patient of that practitioner;

(b)     a pathology service that:

                          (i)    is rendered, by or on behalf of, an approved pathology practitioner; and

                         (ii)    the approved pathology practitioner considers to be necessary, on the basis of information learned from another service:

                                   (A)     that was rendered to the patient by, or on behalf of, that practitioner; and

                                   (B)     the request for which complied with paragraph 16A (4) (a) or (b) of the Act; and

                        (iii)    is an item in the pathology services table that is mentioned in column 1 in the following table and, in relation to which, the pathology service originally requested was an item in the pathology services table that is mentioned in column 2 of the following table for that item of the table:

Item

Column 1

Pathology service

Column 2

Originally requested service

1

72846, 72847, 72848, 72849, 72850, 72851, 72852, 73332, 73336, 73337, 73341, 73342, 73344, 73364, 73365, 73366, 73367, 73368, 73369, 73370, 73371, 73372, 73373, 73374, 73375, 73376, 73377, 73378, 73379, 73380, 73381, 73382, 73383

72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836, 72838

2

73059, 73060, 73061

73045, 73047, 73049, 73051

3

73305

73300

4

73320

71147

5

66839

66838

Note: Items 72860, 73332, 73336, 73337, 73341, 73342 and 73344 are specified in a determination made under subsection 3C(1) of the Act.

(c)     a pathology service that is mentioned in items 69316, 69317, 69319, 69494, 69495, 69496, 69497 or 69498 of the pathology services table and:

                          (i)    is rendered, by or on behalf of, an approved pathology practitioner who is a recognised pathologist; and

                         (ii)    is a service that the approved pathology practitioner determines to be necessary on the basis of:

(A)   information provided by a treating practitioner in relation to a pathology service mentioned 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

(B)   the nature or appearance of the pathology specimen collected for a pathology service mentioned 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

(C)   information learned from a pathology service mentioned 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.

(d)     a pathology service that is mentioned in item 72860, which is specified in a determination made under subsection 3C(1) of the Act and:

(i)                 An initial service that is described in an item in Group P5 (other than item 72860), P6 or 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

(ii)               Following the initial service, the treating practitioner determines that a service described in an item in Group P7 (the subsequent P7 service) is clinically necessary; and

(iii)             following a request from the treating practitioner, the pathologist who rendered the initial service, determines they are 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

(iv)             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.


Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

 

Endnote 2—Abbreviation key

 

o = order(s)

ad = added or inserted

Ord = Ordinance

am = amended

orig = original

amdt = amendment

par = paragraph(s)/subparagraph(s)

c = clause(s)

    /sub‑subparagraph(s)

C[x] = Compilation No. x

pres = present

Ch = Chapter(s)

prev = previous

def = definition(s)

(prev…) = previously

Dict = Dictionary

Pt = Part(s)

disallowed = disallowed by Parliament

r = regulation(s)/rule(s)

Div = Division(s)

 

exp = expires/expired or ceases/ceased to have

reloc = relocated

    effect

renum = renumbered

F = Federal Register of Legislation

rep = repealed

gaz = gazette

rs = repealed and substituted

LA = Legislation Act 2003

s = section(s)/subsection(s)

LIA = Legislative Instruments Act 2003

Sch = Schedule(s)

(md) = misdescribed amendment can be given

Sdiv = Subdivision(s)

    effect

SLI = Select Legislative Instrument

(md not incorp) = misdescribed amendment

SR = Statutory Rules

    cannot be given effect

Sub‑Ch = Sub‑Chapter(s)

mod = modified/modification

SubPt = Subpart(s)

No. = Number(s)

underlining = whole or part not

 

    commenced or to be commenced

 

Endnote 3—Legislation history

 

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (Pathologist-determinable Services) Determination 2015

17 December 2015 (F2015L02063)

1 January 2016

 

Health Insurance Legislation Amendment (2018 Measures No. 1) Instrument 2018

24 September 2018 (F2018L01333)

1 October 2018

Health Insurance (Pathologist-determinable Services) Amendment Determination 2018

17 December 2018 (F2018L01777)

1 January 2019 (s 2(1) item 1)

Health Insurance (Pathologist-determinable Services) Amendment Determination 2019

21 March 2019 (F2019L00338)

1 April 2019 (s 2(1) item 1)

Health Insurance (Pathologist-determinable Services) Amendment Determination 2020

12 March 2020 (F2020L00251)

13 March 2020 (s 2(1) item 1)

Health Insurance (Pathologist-determinable Services) Amendment Determination (No. 2) 2020

29 Apr 2020 (F2020L00519)

1 May 2020 (s 2(1) item 1)

 

Endnote 4—Amendment history

 

Provision affected

How affected

s 2.............................................

rep LA s 48D

s 3.............................................

rep LA s 48C

s 4.............................................

am F2018L01333

s 5.............................................

am F2018L01777; F2019L00338; F2020L00251; F2020L00519