Medicare Benefits Schedule - Note PR.5.1

Item 72860 applies to a service (the relevant service) for a patient if:

                     (a)  the relevant service is subsequent to one or more earlier patient episodes involving:

                              (i)  the rendering of services to which one or more items in Groups P5, P6 or P7 apply (other than item 72860); and

                             (ii)  the collection of tissue material (either biopsy material or samples submitted for cytology) from which a tissue block was prepared; and

                            (iii)  the archiving of the tissue material in formalin fixed paraffin embedded blocks; and

                     (b)  following the earlier patient episode or episodes, the treating practitioner determines that a service to which an item in Group P7 (which deal with genetic testing) applies is clinically necessary for the patient; and

                     (c)  the relevant service is rendered in a patient episode with services to which one or more items in Group P7 apply, but is not rendered in the same accredited pathology laboratory as those services.

Related Items: 72860

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Retrieval and review of one or more archived formalin fixed paraffin embedded blocks to determine the appropriate samples for the purpose of conducting genetic testing, other than:

(a) a service associated with a service to which item 72858 or 72859 applies; or

(b) a service associated with, and rendered in the same patient episode as, a service to which an item in Group P5, P6, P10 or P11 applies

Applicable not more than once in a patient episode

Fee: $85.00 Benefit: 75% = $63.75 85% = $72.25

(See para PR.5.1 of explanatory notes to this Category)