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This instrument is the Health Insurance (Section 4BA ‑ Pathologist‑Determinable Services) Determination 2025.
This instrument is the Health Insurance (Section 4BA ‑ Pathologist‑Determinable Services) Determination 2025.
This instrument is made under section 4BA of the Health Insurance Act 1973.
A number of expressions used in this instrument are defined in interpretation section of the Health Insurance Act 1973, including the following:
approved pathology practitioner;
pathology service;
pathology services table;
accredited pathology laboratory
In this instrument:
Act means the Health Insurance Act 1973.
necessary has the meaning given by paragraph 16A(12)(b) of the Act.
recognised pathologist means a medical practitioner recognised as a specialist in pathology for the purposes of the Act.
Unless the contrary intention appears, in this Determination a reference to a provision of the Act or regulations made under the Act 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.
For the purposes of section 4BA of the Act, a pathology service is a pathologist‑determinable service if:
the service is described in an item in the pathology services table; and
the service is rendered, by or on behalf of, an approved pathology practitioner to a patient of that practitioner.
For the purposes of section 4BA of the Act, a pathology service is a pathologist‑determinable service if:
the service is rendered, by or on behalf of, an approved pathology practitioner; and
the approved pathology practitioner considers the service to be necessary, on the basis of information learned from another service:
that was rendered to the patient by, or on behalf of, that practitioner; and
the request for which complied with paragraph 16A(4)(a) or (b) of the Act; and
the service 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:
Services rendered where a different service was originally requested items of the pathology services table | ||
|---|---|---|
Item | Column 1 Pathology service | Column 2 Originally requested service |
1 | 72846, 72847, 72848, 72849, 72850, 72851, 72852, 73319, 73329, 73331, 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, 73389, 73436, 73429, 73437, 73438, 73439 | 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 |
6 | 73411, 73412, 73413 | 73410 |
7 | 66842 | 66839 |
8 | 69499, 69500 | 69475, 69478, 69481, 69484, 69405, 69408, 69411, 69413, 69415 |
Items 73319, 73329, 73331, 73332, 73336, 73337, 73341, 73342, 73344, 73436, 73437, 73438 and 73439 are specified in the Health Insurance (Section 3C Co‑Dependent Pathology Services) Determination 2018.
For the purposes of section 4BA of the Act, a pathology service that is described in items 69316, 69317, 69319, 69494, 69495, 69496, 69497 or 69498 of the pathology services table is a pathologist‑determinable service if it is:
rendered, by or on behalf of, an approved pathology practitioner who is a recognised pathologist; and
a service that the approved pathology practitioner determines to be necessary on the basis of:
information provided by a treating practitioner in relation to a pathology service described 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
the nature or appearance of the pathology specimen collected for a pathology service described 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
information learned from a pathology service described 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.
For the purposes of section 4BA of the Act, a pathology service that is described in item 72860 of the Health Insurance (Section 3C Co‑Dependent Pathology Services) Determination 2018 is a pathologist‑determinable service if it is:
an initial service that is described in an item in Group P5 (other than item 72860), Group P6 or Group 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
following the initial service, the treating practitioner determines that a service described in an item in Group P7 (the subsequent Group P7 service) is necessary; and
following a request from the treating practitioner, an approved pathology practitioner at the accredited pathology laboratory, where the initial service was rendered, determines the accredited pathology laboratory is 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
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.