Medicare Benefits Schedule - Note PN.1.2

Satisfying requirements described in pathology service 

Unless the contrary intention appears, a requirement contained in the description of a pathology service in Part 2 is satisfied if: 

(a)        for a requirement for information - the information:

(i)         is included in the request for the service; or

(ii)        was supplied in writing on an earlier occasion to the approved pathology authority that rendered the service, and has been kept by the approved pathology authority; or

(b)        for a requirement for laboratory test results - the results are:

(i)         included in the request for the service; or

(ii)        obtained from another laboratory test performed in the same patient episode; or

(iii)       included in results from an earlier laboratory test that have been kept by the approved pathology authority. 

Services Where Request Not Required 

A pathologist-determinable service is a pathology service: 

(a)        that is rendered by or on behalf of an approved pathology practitioner for a person who is a patient of that approved pathology practitioner who has determined that the service is necessary.

(b)        that is specified in item 73332, 73336, 73337, 73389, 73341, 73342, 73344, 73436, 73429 or only one immunohistochemistry items 72846, 72847, 72848, 72849, 72850 and 72860 or electronmicroscopy items 72851 and 72852 or immunocytochemistry items 73059, 73060 or 73061, and 73364 to 73383 and is considered necessary by the approved pathology practitioner as a consequence of information resulting from a pathology service contained in tissue examination items 72813 - 72838 or cytology items 73045 - 73051 respectively. 

Please note: a written request is required for a service contained in items 72813 to 72838 and items 73045 to 73051. 

(c)        that is specified in one of the antigen detection items 69494, 69495 or 69496 is considered necessary by the approved pathology practitioner as a consequence of information provided by the requesting practitioner or by the nature or appearance of the specimen or as a consequence of information resulting from a pathology service contained in items 69303, 69306, 69312, 69318, 69321 and 69345.  

Please note: a written request is required for a service contained in items 69303, 69306, 69312, 69318, 69321 and 69345. 

(d)        that is specified in item 73320, HLA-B27 typing by nucleic acid amplification, and is considered necessary by the approved pathology practitioner because the results of HLA-B27 typing described in item 71147 are unsatisfactory. 

(e)         that is specified in item 73305, detection of mutation of the FMRI gene by Southern Blot analysis where the results in item 73300 are inconclusive.

(f)  that is specified in alpha thalassaemia genetic testing items 73411, 73412 or 73413 and is considered necessary by the approved pathology practitioner because the results of testing described in item 73410 were inconclusive. 

Related Items: 73342 73344 73389 73436

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An in situ hybridisation (ISH) test of tumour tissue from a patient with metastatic adenocarcinoma of the stomach or gastro-oesophageal junction, with documented evidence of human epidermal growth factor receptor 2 (HER2) overexpression by immunohistochemical (IHC) examination giving a staining intensity score of 2+ or 3+ on the same tumour tissue sample, requested by, or on the advice of, a specialist or consultant physician who manages the treatment of the patient to determine if the requirements relating to HER2 gene amplification for access to trastuzumab under the Pharmaceutical Benefits Scheme are fulfilled.

Fee: $315.40 Benefit: 75% = $236.55 85% = $268.10

(See para PN.1.2 of explanatory notes to this Category)

Fluorescence in situ hybridization (FISH) test of tumour tissue from a patient with a new diagnosis of locally advanced or metastatic non-small cell lung cancer, which is of non-squamous histology or histology not otherwise specified, with documented evidence of ROS proto-oncogene 1 (ROS1) immunoreactivity by immunohistochemical (IHC) examination giving a staining intensity score of 2+ or 3+; and with documented absence of both activating mutations of the epidermal growth factor receptor (EGFR) gene and anaplastic lymphoma kinase (ALK) immunoreactivity by IHC, requested by a specialist or consultant physician, if the test is:

(a)   to determine if requirements relating to ROS1 gene arrangement status for access to an immunotherapy listed under the Pharmaceutical Benefits Scheme (PBS) are fulfilled: and

(b)   not associated with a service to which item 73437 or 73439 applies

Fee: $400.00 Benefit: 75% = $300.00 85% = $340.00

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)

Analysis of products of conception from a patient with suspected hydatidiform mole for the characterisation of ploidy status

Applicable once per pregnancy

Fee: $340.00 Benefit: 75% = $255.00 85% = $289.00

(See para PN.1.2 of explanatory notes to this Category)

A test of tumour tissue from a patient with a new diagnosis of locally advanced or metastatic non-small cell lung cancer requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a)   to determine if the requirements relating to MET proto-oncogene, receptor tyrosine kinase (MET) exon 14 skipping alterations (METex14sk) status for access to an immunotherapy listed under the Pharmaceutical Benefits Scheme (PBS) are fulfilled: and

(b)   not associated with a service to which item 73437 or 73438 applies

Fee: $397.35 Benefit: 75% = $298.05 85% = $337.75

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)