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Health Insurance (Pathology Services Table) Regulations 2020
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Administered by
Department of Health and Aged Care
This item is authorised by the following title:
Health Insurance Act 1973
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F2024C00578 (C14)
01 July 2024
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1 Name
3 Authority
4 Pathology services table
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Schedule 1—Pathology services table
Part 1—Preliminary
Division 1.1—Interpretation
1.1.1 Dictionary
1.1.2 Methodology for services
1.1.3 References in this Schedule to items include items determined under section 3C of the Act
Division 1.2—General application provisions
1.2.1 Restriction on items—precedence
1.2.2 When services rendered following multiple requests are taken to have been rendered following a single request
1.2.3 Services to which clause 1.2.2 does not apply—general
1.2.4 Services to which clause 1.2.2 does not apply—haematology
1.2.5 Services to which clause 1.2.2 does not apply—chemical
1.2.6 Referral of designated tests by one pathology practitioner to another
1.2.7 Items not to be split except as stated in clause 1.2.6
1.2.8 Services in certain sets of services to be treated as individual services
1.2.9 Sets of services for the purposes of clause 1.2.8
1.2.10 Satisfying requirements in descriptions of services
1.2.11 Restriction on items—services rendered with autologous injections of blood or blood products
1.2.12 Restriction on items—services rendered with harvesting, storage, in vitro processing or injection of non haematopoietic stem cells
1.2.13 Restriction on items 66551, 73812 and 73826—timing
Division 1.3—Patient episodes
1.3.1 Meaning of patient episode
1.3.2 When later services are taken to be part of an earlier patient episode
Part 2—Services and fees
Division 2.1—Group P1: haematology
2.1.1 Restriction on items 65090 and 65093—services for patients in hospital
2.1.2 Items in Group P1
Division 2.2—Group P2: chemical
2.2.1 Inclusion of measurement of creatinine in services
2.2.2 Restriction on vitamins testing items—timing
2.2.3 Restriction on metals testing items—timing
2.2.4 Items in Group P2
Division 2.3—Group P3: microbiology
2.3.1 Restriction on certain items—antigen detection services rendered as pathologist determinable services
2.3.2 Fee for certain items in a single patient episode—investigation for hepatitis serology
2.3.3 Restriction on certain items—timing
2.3.4 Items in Group P3
Division 2.4—Group P4: immunology
2.4.1 Restriction on item 71148—HLA B27 typing services rendered as pathologist determinable services
2.4.2 Items in Group P4
Division 2.5—Group P5: tissue pathology
2.5.1 Restrictions on items—services performed using material submitted for a Group P6 service
2.5.2 Restrictions on items—certain biopsy examinations performed in a single patient episode
2.5.3 Restrictions on items—certain histopathological examinations performed on specimens from a single patient episode
2.5.4 Restriction on items—certain services in Groups P5 and P6 performed in a single patient episode
2.5.5 Restrictions on items 72858 and 72859
2.5.5A Application of item 72860
2.5.6 Items in Group P5
Division 2.6—Group P6: cytology
2.6.1 Restriction on items in Group P6—fee for services performed in a single patient episode
2.6.2 Items in Group P6
Division 2.7—Group P7: genetics
2.7.1A Restriction on item 73287—conjunction with item 73388
2.7.1B Restriction on item 73290—conjunction with item 73391
2.7.1 Restriction on items 73320 and 73321 (HLA B27 detection)—services rendered as pathologist determinable services
2.7.2 Restriction on items 73339 and 73340 (relating to RET gene mutations)
2.7.3 Restriction on items 73345 to 73350 (relating to cystic fibrosis)—testing methodology
2.7.3A Items 73384 to 73387 (relating to pre implantation genetic testing)—patient eligibility
2.7.4 Items in Group P7
Division 2.8—Group P8: infertility and pregnancy tests
2.8.1 Items in Group P8
Division 2.9—Group P9: simple basic pathology tests
2.9.1 Items in Group P9
Division 2.10—Group P10: patient episode initiation
2.10.1 Restrictions on items in Group P10—circumstances
2.10.2 Items in Group P10
Division 2.11—Group P11: specimen referred
2.11.1 Restriction on items in Group P11—circumstances
2.11.2 Restriction on items in Group P10—patient episodes including a service to which item 73940 applies
2.11.3 Restrictions on items in Group P11—referrals
2.11.4 Items in Group P11
Division 2.12—Group P12: management of bulk billed services
2.12.1 Application of items 74990, 74991, 75861, 75862, 75863 and 75864
2.12.2 Items in Group P12
Division 2.13—Group P13: bulk billing incentive
2.13.1 Items in Group P13
Division 2.14—Indexation of fees
2.14.1 Indexation—1 July 2024
Part 3—Complexity levels for tissue pathology items
3.1 Complexity levels
Part 4—Dictionary
4.1 Dictionary
Endnotes
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history