Medicare Benefits Schedule - Item 73421

Non-invasive prenatal testing of blood from an RhD negative pregnant patient for the detection of the RHD gene from fetal DNA circulating in maternal blood, if the patient has been previously alloimmunised against RhD

Fee: $550.00 Benefit: 75% = $412.50 85% = $467.50

(See para PN.1.1, PN.7.21 of explanatory notes to this Category)

• Previous - Item 73420
• Next - Item 73422

Basic Requirements 

Determination of Necessity of Service

The treating practitioner must determine that the pathology service is necessary. 

Request for Service

The service may only be provided:

(i)               in response to a request from the treating practitioner, including a participating midwife or a participating nurse practitioner, or from another Approved Pathology Practitioner and the request must be in writing (or, if oral, confirmed in writing within fourteen days); or

(ii)              if determined to be necessary by an Approved Pathology Practitioner who is treating the patient.  

Services requested by participating midwives and participating nurse practitioners:

(i)            A participating midwife can request the following services:

Items 65060, 65070, 65090 to 65099 (inclusive), 65114, 66500 to 66512 (inclusive), 66545, 66548, 66566, 66743, 66750, 66751, 69303 to 69317 (inclusive), 69324, 69384 to 69415 (inclusive), 73070, 73071, 73075, 73076, 73420, 73421 and 73529.

(ii)            A participating nurse practitioner can request items in the range 65060 to 73529 (inclusive), and 73825 to 73837 (inclusive).

Provision of Service

The following conditions relate to provision of services:   

(i)               the service has to be provided by or on behalf of an Approved Pathology Practitioner;

(ii)              the service has to be provided in a pathology laboratory accredited for that kind of service;

(iii)             the proprietor of the laboratory where the service is performed must be an Approved Pathology Authority;

(iv)             the Approved Pathology Practitioner providing the service must either be the proprietor of the laboratory or party to an agreement, either by way of contract of employment or otherwise, with the proprietor of the laboratory in which the service is provided; and

(v)              no benefit will be payable for services provided by an Approved Pathology Practitioner on behalf of an Approved Pathology Authority if they are not performed in the laboratories of that particular Approved Pathology Authority. 

Therapeutic Goods Act 1989

For any service listed in the MBS to be eligible for a Medicare benefit, the service must be rendered in accordance with the provisions of the relevant Commonwealth and State and Territory laws. Approved Pathology Practitioners have the responsibility to ensure that the supply of medicines or medical devices used in the provision of pathology services is strictly in accordance with the provisions of the Therapeutic Goods Act 1989.

Related Items: 65060 65070 65090 65093 65096 65099 65114 66500 66503 66506 66509 66512 66545 66548 66566 66743 66750 66751 69303 69306 69309 69312 69316 69317 69324 69384 69387 69390 69393 69396 69400 69401 69405 69408 69411 69413 69415 73070 73071 73075 73076 73420 73421 73529 73825 73826 73828 73829 73830 73831 73832 73833 73834 73835 73836 73837

An alternative test methodology to that used for Item 73420 is recommended to minimise the risk of false negative results in alloimmunised patients, such as using a more sensitive method, confirming the presence of cell-free fetal DNA, or repeat testing of negative results on a second sample. When repeat testing is used to reduce the risk of false negative results, item 73421 should only be billed once.

Related Items: 73421