Medicare Benefits Schedule - Item 73075

A test, including partial genotyping, for oncogenic human papillomavirus, if:

(a) the test is a repeat of a test to which item 73070, 73071, 73072, 73074 or this item applies; and

(b) the specimen collected for the previous test is unsatisfactory

Fee: $35.85 Benefit: 75% = $26.90 85% = $30.50

(See para PN.0.22, PN.1.1 of explanatory notes to this Category)

• Previous - Item 73074
• Next - Item 73076

It is the responsibility of the treating healthcare practitioner to determine if the sample is being collected as part of the routine screening program under 73070 or 73071 or represents a sample falling under 73072 or 73074 or 73075 or 73076, and to indicate this on the request form.  Unless a co-test is specifically requested, requiring the pathology laboratory to perform both a human papillomavirus (HPV) test and a liquid-based cytology (LBC) test on the same specimen, for a clinician-collected sample, the pathology laboratory will by default perform a HPV test and then only undertake reflex LBC testing if oncogenic HPV (any type) is detected.  The pathology laboratory will issue the HPV test result, the LBC test result and overall screening risk rating as a combined report as prescribed by the National Pathology Accreditation Advisory Council (NPAAC) Requirements for Laboratories reporting tests for the National Cervical Screening Program (NPAAC Requirements).

The test used for detecting oncogenic HPV must allow partial HPV genotyping to identify HPV16, HPV18 with or without HPV45 as well as meet the criteria for a population-based screening test as prescribed by the NPAAC Requirements.

When used together, the self-collection device and the HPV test must meet the NPAAC Requirements, including the HPV test must be a polymerase chain reaction (PCR) test.

73070 applies to a HPV test on a cervical specimen for primary screening purposes and collected by a healthcare practitioner (or an accredited test provider under the supervision of a healthcare practitioner).

73071 applies to HPV tests for primary screening purposes requested by a healthcare practitioner (or an accredited test provider under the supervision of a healthcare practitioner) on a self-collected vaginal specimen.

Tests for both 73070 and 73071 must be from an asymptomatic patient as part of routine five yearly screening recommended by the National Cervical Screening Program.  The Health Insurance Act 1973 excludes payment of Medicare Benefits for health screening services except where Ministerial directions have been issued to enable benefits to be paid, this includes HPV testing that is performed in accordance with the policy of the National Cervical Screening Program (available at https://www.health.gov.au/initiatives-and-programs/national-cervical-screening-program).  This policy provides for a screening interval of five years for an asymptomatic patient commencing at 24 years and 9 months of age and for a patient aged between 70 to 74 years of age to cease cervical screening if the last test result is normal (i.e. low risk).  A patient aged 75 years of age or older who has never had a cervical screening test or has not had one in the previous five years, may request a cervical screening test and be screened.

In accordance with the national policy for the National Cervical Screening Program, where oncogenic HPV (any type) is detected from a sample collected by a healthcare practitioner (73070), the pathology laboratory will conduct reflex LBC automatically under 73076 (a) without requiring an additional request by the treating healthcare professional.

Where oncogenic HPV (non 16/18) is detected from a self-collected vaginal sample (73071), the participant will need to return to their healthcare practitioner for the collection of a cervical sample for LBC. The healthcare practitioner collected liquid based sample from the cervix that follows, can be claimed under 73076 (a) with a further request by the treating healthcare practitioner.

73072 applies to HPV tests where the specimen has been collected in accordance with the National Cervical Screening Program: Guidelines for the Management of Screen Detected Abnormalities, Screening in Specific Populations and Investigation of Abnormal Vaginal Bleeding (NCSP Clinical Guidelines) which provides for:

(a)           a HPV test performed on a patient within a specific population suggestive of a higher risk of pre-cancerous or cancerous cervical changes. HPV tests carried out in specific populations under Item 73072 should be in accordance with the NCSP Clinical Guidelines including:

(i)            screening with a primary HPV test every 3 years for an immune-deficient patient; or

(ii)           a single HPV test between 20 and 24 years of age could be considered by healthcare practitioners on a case-by-case basis for a patient who experienced first sexual activity at a young age (less than 14 years of age) and who has not received the HPV vaccine before sexual debut; or

(b)           a HPV test performed for the follow up management of previously detected oncogenic HPV infection; or

(c)           a co-test (HPV+LBC) for the investigation of symptoms of cervical cancer, most commonly abnormal vaginal bleeding; or

(d)           annual HPV tests for the management of a patient following treatment of high grade squamous intraepithelial lesions (HSIL) of the cervix as part of a ‘test of cure’ process performed at 12 months after treatment and annually thereafter, until HPV tests are negative on two separate consecutive occasions, at which point the patient can return to routine five yearly screening; or

(e)           a co-test (HPV+LBC) for the follow up management of glandular abnormalities; or

(f)            a co-test (HPV+LBC) for screening a patient exposed to diethylstilbestrol (DES) in utero and daughters of patients exposed to DES in utero, if requested; or

(g)           a co-test (HPV+LBC) for a patient previously treated for a genital tract malignancy.

A co-test requires both HPV and LBC tests to be performed irrespective of the HPV test result and so must be performed on a clinician collected cervical sample. In cases where a co-test is indicated but a self-collected sample has been received, a HPV test may be performed and may be claimed under 73072 (but the lab report will indicate that LBC is required). In other HPV tests, LBC is only required if oncogenic HPV (any type) is detected; where oncogenic HPV (any type) has been detected in a liquid based sample from the cervix by a healthcare professional, the pathology laboratory will conduct LBC automatically without requiring an additional request. It is the intention of the National Cervical Screening Program where a co-test is requested or oncogenic HPV has previously been detected under this item, the LBC can be claimed under 73076 without requiring an additional request by the treating healthcare professional.

73074 applies to a HPV test on a vaginal vault specimen from a patient with past history of total hysterectomy, in accordance with the NCSP Clinical Guidelines which provides for:

(a)           a HPV test for a patient who has no evidence of cervical pathology but the patient has never been screened or their screening history is not available, performed at 12 months following a total hysterectomy and annually thereafter until a patient has two negative HPV tests (i.e. oncogenic HPV is not detected on two separate consecutive occasions at which point they can be advised that no further testing is required; or

(b)           a HPV test for a patient who has had a total hysterectomy, performed at 12 months following a total hysterectomy and annually thereafter if LSIL or HSIL is identified in the cervix at the time of total hysterectomy, regardless of screening history. Once the person has tested negative for oncogenic HPV on 2 consecutive occasions they can be advised that no further testing is required.

(c)           Co-testing (HPV+LBC) for a patient who has had a total hysterectomy, performed at 12 months after treatment and annually thereafter if the total hysterectomy was after adenocarcinoma in situ (AIS) or if adenocarcinoma in situ is identified in the hysterectomy sample. Once the person has tested negative on both tests (HPV and LBC) for 2 consecutive occasions, they do not need further testing.

73075 applies to HPV tests repeated due to an unsatisfactory HPV test under 73070 or 73071 or 73072 or 73074. 

73076 applies to a liquid-based cytology (LBC) test on a cervical or vaginal vault specimen:

(a)           as part of a reflex test following detection of oncogenic HPV described in the national policy and NCSP Clinical Guidelines associated with items 73070 or 73071 or 73072 (a) or (b) or (d) or 73074 or 73075; or

(b)           as part of a co-test described in the national policy and NCSP Clinical Guidelines under 73072 (c) or (d) or (e) or (f) or 73074; or

(c)           where the previous specimen collected is unsatisfactory; or

(d)           for the follow up management of a patient with a past history of total hysterectomy for endometrial adenocarcinoma.

Related Items: 73070 73071 73072 73074 73075 73076

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