Medicare Benefits Schedule - Note PN.0.18

Prior to ordering an HIV diagnostics tests (included in items 69384, 69387, 69390, 69393, 69396, 69405, 69408, 69411, 69413, 69415) the ordering practitioner should ensure that the patient has given informed consent.  Appropriate discussion should be provided to the patient.  Further discussion may be necessary upon receipt of the test results.

Related Items: 69384 69387 69390 69393 69396 69405 69408 69411 69413 69415

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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 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 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 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 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 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 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 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 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 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 of explanatory notes to this Category)