Medicare Benefits Schedule - Note PN.1.1

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

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Human chorionic gonadotrophin (HCG), quantitation in serum by 1 or more methods (except by latex, membrane, strip or other pregnancy test kit) for diagnosis of threatened abortion, or follow up of abortion or diagnosis of ectopic pregnancy, including any services performed in item 73527 - 1 test

Fee: $29.35 Benefit: 75% = $22.05 85% = $24.95

(See para PN.0.33, PN.1.1 of explanatory notes to this Category)

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 not been previously alloimmunised against RhD

Fee: $150.40 Benefit: 75% = $112.80 85% = $127.85

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

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)

Culture and (if performed) microscopy to detect pathogenic micro-organisms from nasal swabs, throat swabs, eye swabs and ear swabs (excluding swabs taken for epidemiological surveillance), including (if performed):

(a)    pathogen identification and antibiotic susceptibility testing; or

(b)    a service described in item 69300;

specimens from 1 or more sites

Fee: $22.00 Benefit: 75% = $16.50 85% = $18.70

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

Microscopy and culture to detect pathogenic micro-organisms from skin or other superficial sites, including (if performed):

(a)    pathogen identification and antibiotic susceptibility testing; or

(b)    a service described in items 69300, 69303, 69312, 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)

Microscopy and culture to detect dermatophytes and other fungi causing cutaneous disease from skin scrapings, skin biopsies, hair and nails (excluding swab specimens) and including (if performed):

(a)    the detection of antigens not elsewhere specified in this Schedule; or

(b)    a service described in items 69300, 69303, 69306, 69312, 69318;

1 or more tests on 1 or more specimens

Fee: $48.15 Benefit: 75% = $36.15 85% = $40.95

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

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)

Detection of Chlamydia trachomatis by any method - 1 test (Item is subject to rule 26)

Fee: $28.65 Benefit: 75% = $21.50 85% = $24.40

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

1 test described in item 69494 and a test described in 69316.  (Item is subject to rule 26)

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

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

Microscopy (with appropriate stains) and culture for mycobacteria - 1 specimen of sputum, urine, or other body fluid or 1 operative or biopsy specimen, including (if performed):

(a)    microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or

(b)    pathogen identification and antibiotic susceptibility testing;

including a service described in item 69300

Fee: $43.00 Benefit: 75% = $32.25 85% = $36.55

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

Quantitation of 1 antibody to microbial antigens not elsewhere described in the Schedule - 1 test

(This fee applies where a laboratory performs the only antibody test specified on the request form or performs 1 test and refers the rest to the laboratory of a separate APA)

(Item is subject to rule 6)

Fee: $15.65 Benefit: 75% = $11.75 85% = $13.35

(See para PN.0.18, PN.1.1 of explanatory notes to this Category)

2 tests described in item 69384

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 2 estimations specified on the request form or performs 2 of the antibody estimations specified on the request form and refers the remainder to the laboratory of a separate APA)

(Item is subject to rule 6)

Fee: $29.00 Benefit: 75% = $21.75 85% = $24.65

(See para PN.0.18, PN.1.1 of explanatory notes to this Category)

3 tests described in item 69384

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 3 estimations specified on the request form or performs 3 of the antibody estimations specified on the request form and refers the remainder to the laboratory of a separate APA)

(Item is subject to rule 6)

Fee: $42.35 Benefit: 75% = $31.80 85% = $36.00

(See para PN.0.18, PN.1.1 of explanatory notes to this Category)

4 tests described in item 69384

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 4 estimations specified on the request form or performs 4 of the antibody estimations specified on the request form and refers the remainder to the laboratory of a separate APA)

(Item is subject to rule 6)

Fee: $55.70 Benefit: 75% = $41.80 85% = $47.35

(See para PN.0.18, PN.1.1 of explanatory notes to this Category)

5 or more tests described in item 69384

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 5 estimations specified on the request form or performs 5 of the antibody tests specified on the request form and refers the remainder to the laboratory of a separate APA)

(Item is subject to rule 6)

Fee: $69.10 Benefit: 75% = $51.85 85% = $58.75

(See para PN.0.18, PN.1.1 of explanatory notes to this Category)

A test described in item 69384, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test

(Item is subject to rules 6 and 18)

Fee: $15.65 Benefit: 75% = $11.75 85% = $13.35

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

A test described in item 69384, other than that described in 69400, if rendered by a receiving APP - each test to a maximum of 4 tests

(Item is subject to rule 6, 18 and 18A)

Fee: $13.35 Benefit: 75% = $10.05 85% = $11.35

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

Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:

(a)    the determination of 1 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and

(b)    (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481

Fee: $15.65 Benefit: 75% = $11.75 85% = $13.35

(See para PN.0.18, PN.1.1 of explanatory notes to this Category)

Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:

(a)    the determination of 2 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and

(b)    (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481

Fee: $29.00 Benefit: 75% = $21.75 85% = $24.65

(See para PN.0.18, PN.1.1 of explanatory notes to this Category)

Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:

(a)    the determination of 3 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and

(b)    (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481

Fee: $42.35 Benefit: 75% = $31.80 85% = $36.00

(See para PN.0.18, PN.1.1 of explanatory notes to this Category)

Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:

(a)    the determination of 4 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and

(b)    (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481

Fee: $55.70 Benefit: 75% = $41.80 85% = $47.35

(See para PN.0.18, PN.1.1 of explanatory notes to this Category)

Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:

(a)    the determination of all 5 of the following - rubella immune status, specific syphilis serology, carriage of

    Hepatitis B, Hepatitis C antibody, HIV antibody and

(b)    (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481

Fee: $69.10 Benefit: 75% = $51.85 85% = $58.75

(See para PN.0.18, PN.1.1 of explanatory notes to this Category)

Haemoglobin, erythrocyte sedimentation rate, blood viscosity - 1 or more tests

Fee: $8.05 Benefit: 75% = $6.05 85% = $6.85

(See para PN.0.33, PN.1.1 of explanatory notes to this Category)

Erythrocyte count, haematocrit, haemoglobin, calculation or measurement of red cell index or indices, platelet count, leucocyte count and manual or instrument generated differential count - not being a service where haemoglobin only is requested - one or more instrument generated sets of results from a single sample; and (if performed)

(a)     a morphological assessment of a blood film;

(b)     any service in item 65060 or 65072

Fee: $17.35 Benefit: 75% = $13.05 85% = $14.75

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

Blood grouping (including back-grouping if performed) - ABO and Rh (D antigen)

Fee: $11.40 Benefit: 75% = $8.55 85% = $9.70

(See para PN.0.33, PN.1.1 of explanatory notes to this Category)

Blood grouping - Rh phenotypes, Kell system, Duffy system, M and N factors or any other blood group system - 1 or more systems, including item 65090 (if performed)

Fee: $22.55 Benefit: 75% = $16.95 85% = $19.20

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

Blood grouping (including back-grouping if performed), and examination of serum for Rh and other blood group antibodies, including:

(a)    identification and quantitation of any antibodies detected; and

(b)    (if performed) any test described in item 65060 or 65070

Fee: $42.00 Benefit: 75% = $31.50 85% = $35.70

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

Compatibility tests by crossmatch - all tests performed on any 1 day for up to 6 units, including:

(a)    direct testing of donor red cells from each unit against the serum of the patient by one or more accepted crossmatching techniques; and

(b)    all grouping checks of the patient and donor; and

(c)    examination for antibodies, and if necessary identification of any antibodies detected; and

(d)    (if performed) any tests described in item 65060, 65070, 65090 or 65096

(Item is subject to rule 5)

Fee: $111.50 Benefit: 75% = $83.65 85% = $94.80

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

1 or more of the following tests:

(a)    direct Coombs (antiglobulin) test;

(b)    qualitative or quantitative test for cold agglutinins or heterophil antibodies

Fee: $9.30 Benefit: 75% = $7.00 85% = $7.95

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

73070

A test, including partial genotyping, for oncogenic human papillomavirus that may be associated with cervical pre‑cancer or cancer:

(a) performed on a liquid based cervical specimen; and

(b) for an asymptomatic patient who is at least 24 years and 9 months of age

For any particular patient, once only in a 57 month period

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

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

A test, including partial genotyping, for oncogenic human papillomavirus that may be associated with cervical pre‑cancer or cancer, if performed:

(a) on a self‑collected vaginal specimen; and

(b) for an asymptomatic patient who is at least 24 years and 9 months of age

For any particular patient, applicable once in 57 months

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

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

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)

Cytology of a liquid‑based cervical or vaginal vault specimen, where the stained cells are examined microscopically or by automated image analysis by or on behalf of a pathologist, if:

(a) the cytology is associated with the detection of oncogenic human papillomavirus infection by:

(i) a test to which item 73070, 73071, 73074 or 73075 applies; or

(ii) a test to which item 73072 applies for a patient mentioned in paragraph (a) or (b) of that item; or

(b) the cytology is associated with a test to which item 73072 applies for a patient mentioned in paragraph (c), (d), (e) or (f) of that item; or

(c) the cytology is associated with a test to which item 73074 applies; or

(d) the test is a repeat of a test to which this item applies, if the specimen collected for the previous test is unsatisfactory; or

(e) the cytology is for the follow‑up management of a patient treated for endometrial adenocarcinoma

Fee: $47.10 Benefit: 75% = $35.35 85% = $40.05

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

Detection performed by a participating nurse practitioner of:

(a) chlamydia trachomatis (CT) and neisseria gonorrhoeae (NG) via molecular point-of-care testing for the diagnosis of CT or NG infection; and

(b) trichomonas vaginalis (TV) via molecular point-of-care testing for the diagnosis of TV infection

Fee: $117.65 Benefit: 85% = $100.05

(See para PN.1.1, PR.9.6 of explanatory notes to this Category)

Quantitation of glycated haemoglobin (HbA1c) performed by a participating nurse practitioner in the management of established diabetes when performed:

   (a)  as a point‑of‑care test;

   (b)  by a nurse practitioner who works in a general practice that is accredited to the Royal Australian College of General Practitioners Standards for point-of-care testing under the National General Practice Accreditation Scheme; and

   (c)  using a method and instrument certified by the National Glycohemoglobin Standardization Program (NGSP), if the instrument has a total coefficient variation less than 3.0% at 48 mmol/mol (6.5%)

Applicable not more than 3 times per 12 months per patient

Fee: $11.80 Benefit: 75% = $8.85 85% = $10.05

(See para PN.1.1, PR.9.3 of explanatory notes to this Category)

Semen examination for presence of spermatozoa by a participating nurse practitioner

Fee: $6.90 Benefit: 85% = $5.90

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

Leucocyte count, erythrocyte sedimentation rate, examination of blood film (including differential leucocyte count), haemoglobin, haematocrit or erythrocyte count by a participating nurse practitioner  - 1 test

Fee: $4.55 Benefit: 85% = $3.90

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

2 tests described in item 73829 by a participating nurse practitioner

Fee: $6.35 Benefit: 85% = $5.40

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

3 or more tests described in item 73829 by a participating nurse practitioner

Fee: $8.15 Benefit: 85% = $6.95

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

Microscopy of urine, excluding dipstick testing by a participating nurse practitioner.

Fee: $4.55 Benefit: 85% = $3.90

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

Pregnancy test by 1 or more immunochemical methods by a participating nurse practitioner

Fee: $10.15 Benefit: 85% = $8.65

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

Microscopy for wet film other than urine, including any relevant stain by a participating nurse practitioner

Fee: $6.90 Benefit: 85% = $5.90

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

Microscopy of Gram-stained film, including (if performed) a service described in item 73832 or 73834 by a participating nurse practitioner

Fee: $8.65 Benefit: 85% = $7.40

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

Chemical tests for occult blood in faeces by reagent stick, strip, tablet or similar method by a participating nurse practitioner

Fee: $2.35 Benefit: 85% = $2.00

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

Microscopy for fungi in skin, hair or nails by a participating nurse practitioner  - 1 or more sites

Fee: $6.90 Benefit: 85% = $5.90

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

Quantitation in serum, plasma, urine or other body fluid (except amniotic fluid), by any method except reagent tablet or reagent strip (with or without reflectance meter) of: acid phosphatase, alanine aminotransferase, albumin, alkaline phosphatase, ammonia, amylase, aspartate aminotransferase, bicarbonate, bilirubin (total), bilirubin (any fractions), C-reactive protein, calcium (total or corrected for albumin), chloride, creatine kinase, creatinine, gamma glutamyl transferase, globulin, glucose, lactate dehydrogenase, lipase, magnesium, phosphate, potassium, sodium, total protein, total cholesterol, triglycerides, urate or urea - 1 test

Fee: $9.70 Benefit: 75% = $7.30 85% = $8.25

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

2 tests described in item 66500

Fee: $11.65 Benefit: 75% = $8.75 85% = $9.95

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

3 tests described in item 66500

Fee: $13.65 Benefit: 75% = $10.25 85% = $11.65

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

4 tests described in item 66500

Fee: $15.65 Benefit: 75% = $11.75 85% = $13.35

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

5 or more tests described in item 66500

Fee: $17.70 Benefit: 75% = $13.30 85% = $15.05

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

Oral glucose challenge test in pregnancy for the detection of gestational diabetes that includes:

(a)    administration of glucose; and

(b)    1 or 2 measurements of blood glucose; and

(c)    (if performed) any test in item 66695

Fee: $15.80 Benefit: 75% = $11.85 85% = $13.45

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

Oral glucose tolerance test in pregnancy for the diagnosis of gestational diabetes that includes:

(a)    administration of glucose; and

(b)    at least 3 measurements of blood glucose; and

(c)    any test in item 66695 (if performed)

Fee: $19.90 Benefit: 75% = $14.95 85% = $16.95

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

Quantitation of:

(a)    blood gases (including pO₂, oxygen saturation and pCO₂) ; and

(b)    bicarbonate and pH;

including any other measurement (eg. haemoglobin, lactate, potassium or ionised calcium) or calculation performed on the same specimen - 1 or more tests on 1 specimen

Fee: $33.70 Benefit: 75% = $25.30 85% = $28.65

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

Quantitation of alpha-fetoprotein in serum or other body fluids during pregnancy except if requested as part of items 66750 or 66751

Fee: $20.10 Benefit: 75% = $15.10 85% = $17.10

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

Quantitation, in pregnancy, of any 2 of the following to detect foetal abnormality - total human chorionic gonadotrophin (total HCG), free alpha human chorionic gonadotrophin (free alpha HCG), free beta human chorionic gonadotrophin (free beta HCG), pregnancy associated plasma protein A (PAPP-A), unconjugated oestriol (uE₃), alpha-fetoprotein (AFP) - including (if performed) a service described in item 73527 or 73529  - Applicable not more than once in a pregnancy

Fee: $39.75 Benefit: 75% = $29.85 85% = $33.80

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

Quantitation, in pregnancy, of any three or more tests described in 66750

(Item is subject to rule 25)

Fee: $55.25 Benefit: 75% = $41.45 85% = $47.00

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