Medicare Benefits Schedule - Note PN.2.1

Form of Request 

A treating practitioner may request a pathology service either orally or in writing but oral requests must be confirmed in writing within fourteen days from the day when the oral request was made. 

Pathology request forms and combined pathology request/offer to assign forms which are prepared by the pathologists and distributed to requesting practitioners on or after 1 August 2012 must include the minimum information detailed under PN.2.2. 

All written requests for pathology services should contain the following particulars: 

(i) a description of the individual pathology services, or recognised groups of pathology tests to be rendered (see PN.0.28 and PN.0.31). The description must be sufficient to enable the item in which the service is specified to be identified; 

(ii) the date of request; 

(iii) the name of the requesting practitioner and their practice address or provider number; 

(iv) the patient's name and address; 

(v) details of the hospital status of the patient, as follows (for benefit rate assessment). That is, whether the patient was or will be, at the time of the service and when the specimen is obtained: 

(a) a private patient in a private hospital, or approved day hospital facility; 

(b) a private patient in a recognised hospital; 

(c) a public patient in a recognised hospital; 

(d) an outpatient of a recognised hospital; 

Offence Not to Confirm an Oral Request 

A requesting practitioner who, without reasonable excuse, does not confirm in writing an oral request within fourteen days of making the oral request is guilty of an offence under the Health Insurance Act 1973 punishable, upon conviction, by a fine not exceeding $1,100 (10 Penalty Units in accordance with the Crimes Act 1914), and the request is deemed never to have been made. 

Services Australia has developed a Health Practitioner Guideline to substantiate that a valid request existed (pathology or diagnostic imaging) which is located on the Services Australia website.

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