Medicare Benefits Schedule - Note PN.1.2

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 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. 

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

• Previous - Note PN.1.1
• Next - Note PN.1.3

Examination of complexity level 2 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 or more separately identified specimens

(Item is subject to rule 13)

Fee: $71.50 Benefit: 75% = $53.65 85% = $60.80

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

Examination of complexicity level 7 biopsy material with multiple tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 or more separately identified specimens.

(Item is subject to rule 13)

Fee: $466.85 Benefit: 75% = $350.15 85% = $396.85

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

Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 antibodies except those listed in 72848

(Item is subject to rule 13)

Fee: $59.60 Benefit: 75% = $44.70 85% = $50.70

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

Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 4-6 antibodies

(Item is subject to rule 13)

Fee: $89.40 Benefit: 75% = $67.05 85% = $76.00

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

Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 of the following antibodies - oestrogen, progesterone and c-erb-B2 (HER2)

(Item is subject to rule 13)

Fee: $74.50 Benefit: 75% = $55.90 85% = $63.35

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

Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 7-10 antibodies

(Item is subject to rule 13)

Fee: $104.30 Benefit: 75% = $78.25 85% = $88.70

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

Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 11 or more antibodies

(Item is subject to rule 13)

Fee: $119.20 Benefit: 75% = $89.40 85% = $101.35

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

Electron microscopic examination of biopsy material - 1 separately identified specimen

(Item is subject to rule 13)

Fee: $565.00 Benefit: 75% = $423.75 85% = $480.25

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

Electron microscopic examination of biopsy material - 2 or more separately identified specimens

(Item is subject to rule 13)

Fee: $753.00 Benefit: 75% = $564.75 85% = $650.60

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

Retrieval and review of one or more archived formalin fixed paraffin embedded blocks to determine the appropriate samples for the purpose of conducting genetic testing, other than:

(a) a service associated with a service to which item 72858 or 72859 applies; or

(b) a service associated with, and rendered in the same patient episode as, a service to which an item in Group P5, P6, P10 or P11 applies

Applicable not more than once in a patient episode

Fee: $85.00 Benefit: 75% = $63.75 85% = $72.25

(See para PN.1.2, PR.5.1 of explanatory notes to this Category)

Detection of mutation of the FMR1 gene where:

(a) the patient exhibits intellectual disability, ataxia, neurodegeneration, or premature ovarian failure consistent with an FMRI mutation; or

(b) the patient has a relative with a FMR1 mutation

1 or more tests

Fee: $101.30 Benefit: 75% = $76.00 85% = $86.15

(See para PN.0.23, PN.1.2, PN.7.16 of explanatory notes to this Category)

Detection of mutation of the FMR1 gene by Southern Blot analysis where the results in item 73300 are inconclusive

Fee: $202.65 Benefit: 75% = $152.00 85% = $172.30

(See para PN.0.23, PN.1.2, PN.7.16 of explanatory notes to this Category)

Detection of HLA-B27 by nucleic acid amplification

includes a service described in 71147 unless the service in item 73320 is rendered as a pathologist determinable service.

(Item is subject to rule 27)

Fee: $40.55 Benefit: 75% = $30.45 85% = $34.50

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

An in situ hybridization (ISH) test of tumour tissue from a patient with breast cancer requested by, or on the advice of, a specialist or consultant physician who manages the treatment of the patient to determine if the requirements relating to human epidermal growth factor receptor 2 (HER2) gene amplification for access to trastuzumab under the Pharmaceutical Benefits Scheme (PBS) or the Herceptin Program are fulfilled.

Fee: $315.40 Benefit: 75% = $236.55 85% = $268.10

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

A test of tumour tissue from a patient with stage III or stage IV metastatic cutaneous melanoma, requested by, or on behalf of, a specialist or consultant physician, to determine if the requirements relating to BRAF V600 mutation status for access to dabrafenib, vemurafenib or encorafenib under the Pharmaceutical Benefits Scheme are fulfilled.

Fee: $230.95 Benefit: 75% = $173.25 85% = $196.35

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

A test of tumour tissue from a patient with a new diagnosis of non‑small cell lung cancer, shown to have non-squamous histology or histology not otherwise specified, requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a)   to determine if requirements relating to epidermal growth factor receptor (EGFR) gene status for access to an immunotherapy listed under the Pharmaceutical Benefits Scheme (PBS) are fulfilled; and

(b)   not associated with a service to which item 73437 or 73438 applies

Fee: $397.35 Benefit: 75% = $298.05 85% = $337.75

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)

An in situ hybridisation (ISH) test of tumour tissue from a patient with metastatic adenocarcinoma of the stomach or gastro-oesophageal junction, with documented evidence of human epidermal growth factor receptor 2 (HER2) overexpression by immunohistochemical (IHC) examination giving a staining intensity score of 2+ or 3+ on the same tumour tissue sample, requested by, or on the advice of, a specialist or consultant physician who manages the treatment of the patient to determine if the requirements relating to HER2 gene amplification for access to trastuzumab under the Pharmaceutical Benefits Scheme are fulfilled.

Fee: $315.40 Benefit: 75% = $236.55 85% = $268.10

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

Fluorescence in situ hybridization (FISH) test of tumour tissue from a patient with a new diagnosis of locally advanced or metastatic non-small cell lung cancer, which is of non-squamous histology or histology not otherwise specified, with documented evidence of ROS proto-oncogene 1 (ROS1) immunoreactivity by immunohistochemical (IHC) examination giving a staining intensity score of 2+ or 3+; and with documented absence of both activating mutations of the epidermal growth factor receptor (EGFR) gene and anaplastic lymphoma kinase (ALK) immunoreactivity by IHC, requested by a specialist or consultant physician, if the test is:

(a)   to determine if requirements relating to ROS1 gene arrangement status for access to an immunotherapy listed under the Pharmaceutical Benefits Scheme (PBS) are fulfilled: and

(b)   not associated with a service to which item 73437 or 73439 applies

Fee: $400.00 Benefit: 75% = $300.00 85% = $340.00

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)

Analysis of tumour tissue, requested by a specialist or consultant physician, that:

(a) is for:

(i) the characterisation of MYC gene rearrangement; and

(ii) if the results of the characterisation mentioned in subparagraph (i) are positive—the characterisation of either or both of BCL2 gene rearrangement and BCL6 gene rearrangement; and

(b) is for a patient:

(i) for whom MYC immunohistochemistry is non-negative; and

(ii) with clinical or laboratory evidence, including morphological features, of diffuse large B-cell lymphoma or high grade B-cell lymphoma; and

(c) is not performed in conjunction with item 73365

Applicable only once per lifetime

Fee: $400.00 Benefit: 75% = $300.00 85% = $340.00

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

Analysis of tumour tissue, requested by a specialist or consultant physician, that:

(a) is for the characterisation of either or both of the following:

(i) TFE3 gene rearrangement;

(ii) TFEB gene rearrangement; and

(b) is for a patient with clinical or laboratory evidence, including morphological features, of renal cell carcinoma

Applicable only once per lifetime

Fee: $400.00 Benefit: 75% = $300.00 85% = $340.00

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

Analysis of products of conception from a patient with suspected hydatidiform mole for the characterisation of ploidy status

Applicable once per pregnancy

Fee: $340.00 Benefit: 75% = $255.00 85% = $289.00

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

Deletion testing of HBA1 and HBA2 for:

(a) the diagnosis of alpha thalassaemia in a patient of reproductive age:

(i) who has abnormal red cell indices; and

(ii) for whom thalassaemia screening was suggestive of thalassaemia; and

(iii) who does not have a concurrent iron deficiency (or who, irrespective of iron status, is pregnant); and

(iv) who has no historic normal cell indices; or

(b) the determination of carrier status in a person:

(i) who is a reproductive partner of a person with alpha thalassaemia; and

(ii) who has abnormal red cell indices; and

(iii) who does not have a concurrent iron deficiency; or

(c) the determination of carrier status in a person:

(i) who is a reproductive partner of a person with alpha thalassaemia and heterozygous 2‑gene deletion; and

(ii) who has normal red cell indices

Fee: $100.00 Benefit: 75% = $75.00 85% = $85.00

(See para PN.1.2, PN.7.5 of explanatory notes to this Category)

Sequencing of HBA1 or HBA2, if the results of deletion testing described in item 73410 were inconclusive and a less common or rare variant is suspected, either:

(a) for the diagnosis of alpha thalassaemia in a patient of reproductive age; or

(b) for the determination of carrier status in a reproductive partner of a person with alpha thalassaemia

Applicable once per gene per lifetime

Fee: $400.00 Benefit: 75% = $300.00 85% = $340.00

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

Deletion testing of HBA1 and HBA2, if the results of deletion testing described in item 73410 were inconclusive and a large deletion variant is suspected, either:

(a) for the diagnosis of alpha thalassaemia in a patient of reproductive age; or

(b) for the determination of carrier status in a reproductive partner of a person with alpha thalassaemia

Fee: $250.00 Benefit: 75% = $187.50 85% = $212.50

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

Non‑deletion testing of HBA1 and HBA2 using techniques other than sequencing, if the results of deletion testing described in item 73410 were inconclusive, either:

(a) for the diagnosis of alpha thalassaemia in a patient of reproductive age ; or

(b) for the determination of carrier status in a reproductive partner of a person with alpha thalassaemia

Fee: $250.00 Benefit: 75% = $187.50 85% = $212.50

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

Genetic testing (including characterisation of single nucleotide variants, structural variants, fusions and copy number alterations) in a gene panel, requested by a specialist or consultant physician, for a patient with clinical or laboratory evidence of a glioma, glioneuronal tumour or glioblastoma, to aid diagnosis and classification of the relevant tumour, including assessments of at least the following kinds:

(a) IDH1, IDH2—variant testing;

(b) 1p/19q—co‑deletion assessment;

(c) H3F3A—variant status;

(d) TERT—promoter variant status;

(e) EGFR—amplification;

(f) CDKN2A/B—deletion;

(g) BRAF—variants

Applicable to one test per diagnostic episode

Fee: $887.90 Benefit: 75% = $665.95 85% = $785.50

(See para PN.1.2, PN.7.10 of explanatory notes to this Category)

A test of tumour tissue from a patient with a new diagnosis of locally advanced or metastatic non-small cell lung cancer requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a)   to determine if the requirements relating to MET proto-oncogene, receptor tyrosine kinase (MET) exon 14 skipping alterations (METex14sk) status for access to an immunotherapy listed under the Pharmaceutical Benefits Scheme (PBS) are fulfilled: and

(b)   not associated with a service to which item 73437 or 73438 applies

Fee: $397.35 Benefit: 75% = $298.05 85% = $337.75

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)

A nucleic acid-based multi-gene panel test of tumour tissue from a patient with a new diagnosis of non-small cell lung cancer requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a)  to detect variants in at least EGFR, BRAF, KRAS and MET exon 14 to determine access to specific therapies relevant to these variants listed on the Pharmaceutical Benefits Scheme (PBS); and

(b)  to detect the fusion status of at least ALK, ROS1, RET, NTRK1, NTRK2 and NTRK3; and

          (i)   to determine access to specific therapies relevant to these variants listed on the PBS; or

         (ii)   determine if the requirements relating to EGFR, ALK and ROS1 status for access immunotherapies listed on the PBS are fulfilled; and

(c)  not associated with a service to which item 73438, 73439, 73337, 73341, 73344, 73436 or 73351 applies

Fee: $1,247.00 Benefit: 75% = $935.25 85% = $1,144.60

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)

A DNA-based multi-gene panel test of tumour tissue from a patient with a new diagnosis of non-small cell lung cancer requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a)   to detect variants in at least EGFR, BRAF, KRAS and MET exon 14; and

(b)   to determine access to specific therapies relevant to these variants listed on the Pharmaceutical Benefits Scheme (PBS); or

(c)   to determine if the requirements relating to EGFR status for access to immunotherapies listed on the PBS are fulfilled; and

(d)   not associated with a service to which item 73437, 73337, 73436 or 73351 applies

Fee: $682.35 Benefit: 75% = $511.80 85% = $580.00

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)

A nucleic acid-based multi-gene panel test of tumour tissue from a patient with a new diagnosis of non-small cell lung cancer and with documented absence of activating variants of the EGFR gene, KRAS, BRAF and MET exon14, requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a)   to determine the fusion status of at least ALK, ROS1, RET, NTRK1, NTRK2, and NTRK3 to determine access to specific therapies relevant to these variants listed on the Pharmaceutical Benefits Scheme (PBS) are fulfilled; or

(b)   to determine if the requirements relating to ALK and ROS1 status for access to immunotherapies listed on the PBS are fulfilled; and

(c)   not associated with a service to which item 73437, 73341, 73344 or 73351 applies

Fee: $682.35 Benefit: 75% = $511.80 85% = $580.00

(See para PN.1.2, PN.7.15 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.1.2 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.1.2 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.1.2 of explanatory notes to this Category)

Microscopy and culture to detect pathogenic micro-organisms from specimens of sputum (except when part of items 69324, 69327 and 69330), including (if performed):

(a)     pathogen identification and antibiotic susceptibility testing; or

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

1 or more tests on 1 or more specimens

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

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

Microscopy and culture of post-operative wounds, aspirates of body cavities, synovial fluid, CSF or operative or biopsy specimens, for the presence of pathogenic micro-organisms involving aerobic and anaerobic cultures and the use of different culture media, and including (if performed):

(a)    pathogen identification and antibiotic susceptibility testing; or

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

specimens from 1 or more sites

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

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

Culture and (if performed) microscopy without concentration techniques of faeces for faecal pathogens, using at least 2 selective or enrichment media and culture in at least 2 different atmospheres including (if performed):

(a)    pathogen identification and antibiotic susceptibility testing; and

(b)    the detection of clostridial toxins; and

(c)    a service described in item 69300;

- 1 examination in any 7 day period

Fee: $52.90 Benefit: 75% = $39.70 85% = $45.00

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

Detection of a virus or microbial antigen or microbial nucleic acid (not elsewhere specified)

1 test

(Item is subject to rule 6 and 26)

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

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

2 tests described in 69494

(Item is subject to rule 6 and 26)

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

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

3 or more tests described in 69494

(Item is subject to rule 6 and 26)

Fee: $43.05 Benefit: 75% = $32.30 85% = $36.60

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

HLA-B27 typing

(Item is subject to rule 27)

Fee: $40.55 Benefit: 75% = $30.45 85% = $34.50

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

Cytology (including serial examinations) for malignancy (other than an examination mentioned in item 73076); and including any Group P5 service, if performed on:

(a)    specimens resulting from washings or brushings from sites not specified in item 73043; or

(b)    a single specimen of sputum or urine; or

(c)    1 or more specimens of other body fluids;

1 or more tests

Fee: $48.60 Benefit: 75% = $36.45 85% = $41.35

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

Cytology of material obtained directly from a patient at one identified site by fine needle aspiration of solid tissue or tissues if a recognized pathologist:

(a)    performs the aspiration; or

(b)    attends the aspiration and performs cytological examination during the attendance

Fee: $170.35 Benefit: 75% = $127.80 85% = $144.80

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

Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049, 73051, 73062, 73063, 73066 and 73067 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 antibodies except those listed in 73061

(Item is subject to rule 13)

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

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

Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049, 73051, 73062, 73063, 73066 and 73067  for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 4 to 6  antibodies

(Item is subject to rule 13)

Fee: $57.35 Benefit: 75% = $43.05 85% = $48.75

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

Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049, 73051, 73062, 73063, 73066 and 73067 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 of the following antibodies - oestrogen, progesterone and c-erb-B2 (HER2)

(Item is subject to rule 13)

Fee: $51.20 Benefit: 75% = $38.40 85% = $43.55

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