Medicare Benefits Schedule - Item 73337

A test of tumour tissue from a patient with a new diagnosis of non‑small cell lung cancer, shown to have non-squamous histology or histology not otherwise specified, requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a)   to determine if requirements relating to epidermal growth factor receptor (EGFR) gene 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)

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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 or biomarker testing items 73437 to 73439 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 to 72838 or cytology items 73045 to 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: 69303 69306 69312 69318 69321 69345 69494 69495 69496 71147 72813 72838 72846 72847 72848 72849 72850 72851 72852 72860 73045 73051 73059 73060 73061 73300 73305 73320 73332 73336 73337 73342 73344 73364 73383 73389 73410 73411 73412 73413 73429 73436 73437 73438 73439

Prior to requesting or performing these tests, the requesting practitioner or pathologist should consider if the patient has already received equivalent testing under the same or another methodology in the same new diagnosis of non-small cell lung cancer (NSCLC).
Repeat testing by multiple methods in the same new diagnosis of NSCLC should only be performed if it is clinically relevant.

Items 73337, 73341, 73344 and 73436 support sequential single-gene testing for biomarkers in patients with NSCLC.

Item 73437 supports use of one next generation sequencing (NGS) panel for testing of all biomarkers supported under items 73337, 73341, 73344 and 73436.

Items 73438 and 73439 support sequential use of two NGS panels for testing of all biomarkers supported under 73337 and 73436, and 73341 and 73344 respectively.

Related Items: 73337 73341 73344 73436 73437 73438 73439