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Information for Pathology Providers

Fact Sheet

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From 1 November 2010, eligible midwives and eligible nurse practitioners who are working in a collaborative arrangement with a medical practitioner can request specific Medicare Benefits Schedule (MBS) pathology services within their scope of practice.

What pathology services can a midwife and nurse practitioner request?

Eligible nurse practitioners can request MBS pathology services in the range 65060 to 73529 inclusive.
Eligible midwives can request the following services as described in the Pathology Services Table

MBS Pathology Services that a Midwife Can request
65060 - Haemoglobin, erythrocyte sedimentation rate, blood viscosity - 1 or more tests
65070 - 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 set 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
65090 - Blood grouping (including back-grouping if performed) - ABO and Rh (D antigen)
65093 - 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)
65096 - 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
65099 - Compatibility tests by crossmatch - all tests performed on any one day for up to 6 units, including: (a) all grouping checks of the patient and donor; and (b) examination for antibodies, and if necessary identification of any antibodies detected; and (c) (if performed) any tests described in item 65060, 65070, 65090 or 65096
65114 -1 or more of the following tests: (a) direct Coombs (antiglobulin) test; (b) qualitative or quantitative test for cold agglutinins or heterophil antibodies
66500 - 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
66503 - 2 tests described in item 66500
66506 - 3 tests described in item 66500
66509 - 4 tests described in item 66500
66512 - 5 or more tests described in item 66500
66545 - 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
66548 - 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)
66566 - 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
66743 - Quantitation of alpha-fetoprotein in serum or other body fluids during pregnancy except if requested as part of items 66750 or 66751
66750 - Quantitation, in pregnancy, of any two of the following - 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) - to detect foetal abnormality, including a service described in 1 or more of items 73527 and 73529 (if performed) -
66751 - Quantitation, in pregnancy, of any three or more tests described in 66750
69303 - 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
69306 - 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
69309 - 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 Table; or (b) a service described in items 69300, 69303, 69306, 69312, 69318; 1 or more tests on 1 or more specimens
69312 - 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
69316 - Detection of Chlamydia trachomatis by any method - 1 test (Item is subject to rule 26)
69317 - 1 test described in item 69494 and a test described in 69316. (Item is subject to rule 26)
69324 - 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 mentioned in item 69300
69384 - 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)
69387 - 2 tests described in item 69384
69390 - 3 tests described in item 69384
69393 - 4 tests described in item 69384
69396 - 5 or more tests described in item 69384
69400 – A test described in 69384, if rendered by a receiving APP where no tests have been rendered by the referring APP – 1 test
69401 - A test described in 69384, other than that described in 69400, if rendered by a receiving APP – each test to a maximum of 4 tests.
69405 - 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: the determination of 1 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
69408 - 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: the determination of 2 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
69411 - 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: the determination of 3 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
69413 - 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: the determination of 4 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
69415 - 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: the determination of all 5 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitus B, Hepatitus C antibody, HIV antibody and (if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
73053 - Cytology of a smear from cervix where the smear is prepared by direct application of the specimen to a slide, excluding the use of liquid based slide preparation techniques, and the stained smear is microscopically examined by or on behalf of a pathologist - each examination (a) for the detection of precancerous or cancerous changes in women with no symptoms, signs or recent history suggestive of cervical neoplasia, or (b) if a further specimen is taken due to an unsatisfactory smear taken for the purposes of paragraph (a); or (c) if there is inadequate information provided to use item 73055;
73529 - 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 followup of abortion or diagnosis of ectopic pregnancy, including any services performed in item 73527 - 1 test

How do the new arrangements affect episode coning?

Episode coning applies in the same way it is applied for general practitioners. That is, the Medicare benefits payable in a patient episode for a set of pathology services, containing more than three items, ordered by a nurse practitioner or midwife for a non-hospitalised patient, will be equivalent to the sum of the benefits for the three items with the highest Schedule fees.

How do the new arrangements affect bulk billing incentives?

The current bulk billing incentives for pathologists will apply to services requested by eligible nurse practitioners and midwives, who have a Medicare provider number.

How do the new arrangements affect patient episode initiation fees (PEIs)?

PEIs apply to all episodes where a nurse practitioner or midwife requests pathology tests. Under section 16A(1)(aa)(i) and (1)(ab)(i) of the Health Insurance Act 1973, midwives and nurse practitioners are respectively defined as the “treating practitioner”.
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