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HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATION 2015 (SLI NO 85 OF 2015) - NOTES

 

Select Legislative Instrument No. 85, 2015

I, General the Honourable Sir Peter Cosgrove AK MC (Ret'd), Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulation.

Dated 17 June 2015

Peter Cosgrove

Governor-General

By His Excellency's Command

Sussan Ley

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...................................................................................... 2

Division 1.2--General application provisions                                                 3

1.2.1...... Precedence of items............................................................................. 3

1.2.2...... Circumstances in which services rendered following 2 requests to be taken to have been rendered following one request............................................................................................................ 3

1.2.3...... Services to which clause 1.2.2 does not apply.................................... 4

1.2.4...... Referral of designated tests by one pathology practitioner to another.. 5

1.2.5...... Items not to be split............................................................................. 6

1.2.6...... Certain pathology services to be treated as one service....................... 6

1.2.7...... Meaning of set of pathology services.................................................. 8

1.2.8...... Satisfying requirements described in pathology service...................... 9

1.2.9...... Application of items--services provided with autologous injections of blood or blood products            10

Part 2--Services and fees                                                                                                11

Division 2.1--Group P1: haematology                                                             11

2.1.1...... Services to which clause 1.2.2 does not apply.................................. 11

2.1.2...... Item taken to refer only to the first service of a particular kind.......... 11

Division 2.2--Group P2: chemical                                                                      18

2.2.1...... Creatinine ratios................................................................................ 18

2.2.2...... Services to which clause 1.2.2 does not apply.................................. 18

2.2.3...... Limitation on certain items................................................................ 18

2.2.5...... Thyroid function testing.................................................................... 19

2.2.6...... Limitation on certain items................................................................ 19

2.2.7...... Nutritional and toxicity metals testing............................................... 19

Division 2.3--Group P3: microbiology                                                             33

2.3.1...... Meaning of serial examinations or cultures..................................... 33

2.3.2...... Antigen detection.............................................................................. 33

2.3.3...... Investigation for hepatitis serology................................................... 33

2.3.4...... Limitation on certain items................................................................ 34

2.3.5...... Hepatitis C viral RNA testing........................................................... 34

Division 2.4--Group P4: immunology                                                               44

2.4.1...... Limitation on certain items................................................................ 44

2.4.2...... Tests in Group P4 relating to antibodies........................................... 44

2.4.3...... HLA-B27 typing............................................................................... 44

2.4.4...... Antineutrophil cytoplasmic antibody tests......................................... 44

Division 2.5--Group P5: tissue pathology                                                      52

2.5.1...... Tests on biopsy material.................................................................... 52

Division 2.6--Group P6: cytology                                                                       56

2.6.1...... Tests on biopsy material.................................................................... 56

Division 2.7--Group P7: genetics                                                                        60

2.7.1...... Haemochromatosis testing................................................................ 60

2.7.2...... HLA-B27 typing............................................................................... 60

2.7.3...... Limitation on items 73339 and 73340............................................... 60

Division 2.8--Group P8: infertility and pregnancy tests                        66

2.8.1...... Limitation on item 73523.................................................................. 66

Division 2.9--Group P9: simple basic pathology tests                             67

Division 2.10--Group P10: patient episode initiation                               68

2.10.1.... Items in Group P10 not to apply in certain circumstances................. 68

Division 2.11--Group P11: specimen referred                                             74

2.11.1.... Items in Group P11 not to apply in certain circumstances................. 74

2.11.2.... Application of an item in Group P11 to a service excludes certain other items         74

2.11.3.... Circumstances in which an item in Group P11 does not apply......... 74

Division 2.12--Group P12: management of bulk-billed services        76

2.12.1.... Application of items 74990 and 74991............................................. 76

Division 2.13--Group P13: bulk billing incentive for episodes consisting of a P10 service        80

Part 3--Abbreviations                                                                                                      82

Part 4--Complexity levels for histopathology items                                     113

Part 5--Dictionary                                                                                                            120

Schedule 2--Repeals                                                                                                        124

Health Insurance (Pathology Services Table) Regulation 2014                    124

 


 

 



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