Medicare Benefits Schedule - Note PN.0.28

As stated at PN.3.2, details that must be recorded on accounts, receipts or assignment forms of an Approved Pathology Practitioner/Authority include a description of the pathology service that is of sufficient detail to identify the specific service rendered. The lists of abbreviations for group tests are contained in PN.0.31.  The abbreviations are provided to allow users to identify and refer to particular pathology services, or particular groups of pathology services, more accurately and conveniently. 

The above requirements may be used for billing purposes but treating practitioners requesting pathology services are encouraged to use the approved abbreviations. In this regard treating practitioners should note that:

-                  pathology services cannot be self determined by a rendering pathologist responding to a request. This places the onus for medical necessity on the treating practitioner who, in normal circumstances would, if he or she was unclear in deciding the appropriate test for a clinical situation, consult a pathologist for assistance; and

-                  Approved Pathology Practitioners/Authorities undertake not to issue accounts etc unless the pathology service was rendered in response to an unambiguous request.

Related Items: 65129

• Previous - Note PN.0.27
• Next - Note PN.0.29

4 or more tests described in item 65120

Fee: $35.50 Benefit: 75% = $26.65 85% = $30.20

(See para PN.0.28 of explanatory notes to this Category)