Pathology under Medicare

About the Australian Government’s objective to ensure access to high quality, clinically relevant, cost-effective pathology services, by publishing current pathology standards, professional discourse and trends.

Page last updated: 20 April 2015

Accreditation

The National Pathology Accreditation Advisory Council (NPAAC) is responsible for developing and maintaining the accreditation standards that pathology laboratories must meet to be eligible for Medicare. The Accreditation section of Pathology under Medicare contains a range of information about pathology accreditation including:
    • current accreditation standards
    • best practice guidelines
    • ongoing NPAAC communiqués
    • NPAAC membership
    • NPAAC documents for public consultation.

Pathology Services Table (PST)

The PST lists the pathology tests for which Medicare benefits are payable and the fees and conditions associated with their use. See Category 6, MBS Online.

Quality Use of Pathology Program (QUPP)

The Quality Use of Pathology Program (QUPP) is a national grants program that promotes innovative approaches to improving the delivery of pathology services.

Legislation relating to pathology and diagnostic imaging

The Health Insurance Act 1973 underpins the provision of pathology services in Australia. This Act includes the Health Insurance Regulations 1975 and the Health Insurance (Pathology Services Table) Regulations both of which are also contained in the updated Medicare Benefits Schedule (MBS).

Strengthening Compliance - Pathology Approved Collection Centres

As part of the 2017 Budget the Government announced its commitment to strengthening compliance under the Prohibited Practices Provisions of the Health Insurance Act 1973 (the Act) as they relate to Approved Collection Centres (ACCs).

Changes to the laws prohibiting inappropriate commercial relationships between requesters and providers of pathology services came into effect on 1 March 2008.

Rent or other benefits may, in certain circumstances, breach the prohibited practices provisions of the Health Insurance Act 1973. Those provisions prohibit the offer or acceptance of benefits that would be reasonably likely to induce a requester of pathology services to request those services from a provider.

Inappropriate Practice

Indications of suspected inappropriate practices may include:
  • extremes in rent paid
  • inducements associated with rental agreements
  • inducements offered to providers of pathology services or requestors of these services
  • vacant or unused rented space for the use of pathology services within 60 days of the lease agreement.
Concerns which relate to the use or occupation of pathology approved collection premises can be raised with the department by:

Pathology FAQ

The Pathology Frequently Asked Questions provides plain English explanations of how the pathology system works while helping consumers to plan for pathology service fees, gaps and benefits.

Contacts

For information about eligibility, claims and services please contact the Department of Human Services.

Contact methodDetails
Patient telephone132011
Provider telephone132150
EmailaskMBS
Web siteDepartment of Human Services
Other web siteMBS Online