1. Name of Determination

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

2. Commencement

This Determination commences on 1 January 2016.

3. Revocation

This Determination revokes the Health Insurance (Pathologist-determinable Services) Determination 2006 (No. 3)

4. Interpretation

(1) In this Determination:

Act means the Health Insurance Act 1973.

Regulations means the Health Insurance Regulations 1975.

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, 73332, 73336, 73337, 73342	72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836, 72838
2	73059, 73060, 73061	73045, 73047, 73049, 73051
3	72851, 72852	72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836, 72838
4	73305	73300
5	73320	71147
6	66839	66838

(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.

Contents

1. Name of Determination

2. Commencement

3. Revocation

4. Interpretation

5. Pathologist-determinable services