Medicare Benefits Schedule - Item 69312

Microscopy and culture to detect pathogenic micro-organisms from urethra, vagina, cervix or rectum (except for faecal pathogens), including (if performed):

(a)    pathogen identification and antibiotic susceptibility testing; or

(b)     a service described in items 69300, 69303, 69306 and 69318;

1 or more tests on 1 or more specimens

Fee: $33.75 Benefit: 75% = $25.35 85% = $28.70

(See para PN.1.1, PN.1.2 of explanatory notes to this Category)

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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

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 73319, 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. 

(g)        that is specified in item 66839, rendered in the same patient episode as a service to which item 66838 applies if the result of that service is inconclusive or abnormal

(h)        that is specified in item 66842, where the patient obtained inconclusive results from a service described in item 66839

Related Items: 66838 66839 66842 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 73319 73320 73332 73336 73337 73342 73344 73364 73383 73389 73410 73411 73412 73413 73429 73436 73437 73438 73439