Medicare Benefits Schedule - Note PN.0.24

Additional Bulk Billing Payment for Pathology Services - (Item 74990, 74991, 75861, 75862, 75863 and 75864)

The Additional Bulk Billing Payment for Pathology Services operates in the same way as the equivalent items for unreferred medical services (see note MN.1.1), apart from the following differences:

• Item 74990 and 74991 can only be used in conjunction with items in the Pathology Services Table of the MBS
• Item 74990 and 74991 applies to unreferred pathology services performed by a medical practitioner which are included in Group P9 of  the Pathology Services Table, and unreferred pathology services provided by category M laboratories
• Item 74990 and item 74991 applies to pathology services self determined by general practitioners and specialists with dual qualifications acting in their capacity as general practitioners.

Specialists and consultant physicians who provide pathology services are not able to claim the Additional Bulk Billing Payment unless, for the purposes of the Health Insurance Act 1973, the medical practitioner is also a general practitioner and the service provided by the medical practitioner has not been referred to that practitioner by another medical practitioner or person with referring rights.

The pathology rules (see note PN.0.33) have been amended to exclude the Additional Bulk Billing Payment items from the Multiple Services Rule and the Coning Rule.

Item 74991 can only be used where the service is provided at, or from, a practice location that is in a MMM 2 area under the Modified Monash Model classification system

Item 75861 can only be used where the service is provided at, or from, a practice location that is in a MMM 3 or 4 area under the Modified Monash Model classification system

Item 75862 can only be used where the service is provided at, or from, a practice location that is in a MMM 5 area under the Modified Monash Model classification system

Item 75863 can only be used where the service is provided at, or from, a practice location that is in a MMM 6 area under the Modified Monash Model classification system

Item 75864 can only be used where the service is provided at, or from, a practice location that is in an MMM 7 area under the Modified Monash Model classification system.

Related Items: 74990 74991 75861 75862 75863 75864

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A pathology service to which an item in this table (other than this item or item 74991, 75861, 75862, 75863 or 75864) applies if:

(a)    the service is an unreferred service; and

(b)    the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder;    and

(c)    the person is not an admitted patient of a hospital; and

(d)    the service is bulk-billed in respect of the fees for:

    (i)    this item; and

    (ii)    the other item in this table applying to the service

Fee: $7.60 Benefit: 85% = $6.50

(See para PN.0.24, PN.0.33 of explanatory notes to this Category)

A pathology service to which an item in this table (other than this item or items 74990, 75861, 75862, 75863 or 75864) applies if:

(a)    the service is an unreferred service; and

(b)    the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c)    the person is not an admitted patient of a hospital; and

(d)    the service is bulk-billed in respect of the fees for:

    (i)    this item; and

    (ii)    the other item in this table applying to the service; and

(e) the service is provided at, or from, a practice location in a Modified Monash 2 area.

Fee: $11.50 Benefit: 85% = $9.80

(See para PN.0.24, PN.0.33 of explanatory notes to this Category)

A pathology service to which an item in this table (other than this item or item 74990, 74991, 75862, 75863 or 75864) applies if:

(a) the service is an unreferred service; and

(b) the service is rendered to a person who is under the age of 16 or is a concessional beneficiary; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulk-billed in respect of the fees for:

     (i)    this item; and

     (ii)   the other item in this Schedule applying to the service; and

(e) the service is rendered at, or from, a practice location in:

      (i)   a Modified Monash 3 area; or

      (ii) a Modified Monash 4 area

Fee: $12.20 Benefit: 85% = $10.40

(See para PN.0.24, PN.0.33 of explanatory notes to this Category)

A pathology service to which an item in this Schedule (other than this item or item 74990, 74991, 75861, 75863, or 75864) applies if:

(a) the service is an unreferred service; and

(b) the service is rendered to a person who is under the age of 16 or is a concessional beneficiary; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulk-billed in relation to the fees for:

     (i)    this item; and

     (ii)    the other item in this Schedule applying to the service; and

(e)  the service is rendered at, or from, a practice location in a Modified Monash 5 area

Fee: $12.95 Benefit: 85% = $11.05

(See para PN.0.24, PN.0.33 of explanatory notes to this Category)

A pathology service to which an item in this Schedule (other than this item or item 74990, 74991, 75861, 75862 or 75864) applies if:

(a) the service is an unreferred service; and

(b) the service is rendered to a person who is under the age of 16 or is a concessional beneficiary; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulk-billed in respect of the fees for:

     (i)    this item; and

     (ii)   the other item in this Schedule applying to the service; and

(e) the service is rendered at, or from, a practice location in a Modified Monash 6 area

Fee: $13.75 Benefit: 85% = $11.70

(See para PN.0.24, PN.0.33 of explanatory notes to this Category)

A pathology service to which an item in this Schedule (other than this item or item 74990, 74991, 75861, 75862 or 75863) applies if:

(a) the service is an unreferred service; and

(b) the service is rendered to a person who is under the age of 16 or is a concessional beneficiary; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulk-billed in relation to the fees for:

     (i)   this item; and

     (ii)  the other item in this Schedule applying to the service; and

(e) the service is rendered at, or from, a practice location in a Modified Monash 7 area

Fee: $15.05 Benefit: 85% = $12.80

(See para PN.0.24, PN.0.33 of explanatory notes to this Category)