Health Insurance (Pathology Services Table) Regulations 2010

1.2.5 Items not to be split

Except as stated in clause 1.2.4 the amount mentioned in an item is payable only to 1 approved pathology practitioner for a single patient episode.

1.2.6 Certain pathology services to be treated as 1 service

(1) In this clause:

general practitioner has the meaning given by subclause 1.2.7 (1).

set of pathology services has the meaning given by subclause 1.2.7 (2).

(2) If a general practitioner, participating midwife or participating nurse practitioner requests a set of pathology services, the pathology services in the set are to be treated as individual pathology services in accordance with this clause.

(3) If the fee mentioned in 1 item that describes any of the services in the set of pathology services is higher than the fees mentioned in the other items that describe the services in the set:

(a) the pathology service described in the first mentioned item is to be treated as 1 pathology service; and

(b) either:

(i) the pathology service in the set that is described in the item that mentions the second highest fee is to be treated as 1 pathology service; or

(ii) if 2 or more items that describe any of those services mentions the second highest fee — the pathology service described in the item that mentions the second highest fee, and has the lowest item number, is to be treated as 1 pathology service; and

(c) the pathology services in the set, other than the services that are to be treated as 1 pathology service under paragraphs (a) and (b), are to be treated as 1 pathology service.

(4) If the fees mentioned in 2 or more items that describe any of the services in the set of pathology services are the same, and higher than the fees mentioned in the other items that describe the services in the set:

(a) the pathology service in the set that is described in the item that mentions the highest fee, and has the lowest item number, is to be treated as 1 pathology service; and

(b) the pathology service in the set that is described in the item that mentions the highest fee, and has the second lowest item number, is to be treated as 1 pathology service; and

(c) the pathology services in the set, other than the services that are to be treated as 1 pathology service under paragraphs (a) and (b), are to be treated as 1 pathology service.

(5) If pathology services are to be treated as 1 pathology service under paragraph (3) (c) or (4) (c), the fee for the 1 pathology service is the highest fee mentioned in any of the items that describe the pathology services that are to be treated as the 1 pathology service.