Patient Episode Initiation (PEI) Fees for Tissue Pathology Item 72838, 72827 and 72828

Page last updated: 08 December 2011

PDF version of Patient Episode Initiation (PEI) Fees for Tissue Pathology Item 72838, 72827 and 72828 article

New PEI items have been listed on the Pathology Services Table of the Medicare Benefits Schedule for tissue pathology items 72838, 72827 and 72828. In error these items were not included in the item descriptors for the specific tissue pathology PEIs, 73924, 73925, 73926 and 73927 or the bulk billing initiative items, 74993, 74994, and 74999. This omission resulted in claims for these items being rejected by Medicare from 30 October 2011 when claimed in association with tissue pathology items 72838, 72827 and 72828.

The Health Insurance (Patient Episode Initiation) Determination 2011 (No. 1) that was registered on the Federal Register of Legislative Instruments on 5 December 2011 has rectified this omission. The new items and other changes are retrospective for claims that have not been processed and benefits paid prior to this date.

The following table reflects the new PEI items to be claimed in association with the tissue pathology items and the period for which they are applicable.

PEI association with items 72827, 72828 and 72838 from 1 November 2008.

PEIPayable per patient episode when associated withBulk billing incentive item from 1/11/09
7391472827, 72828, 72838 for an in-patient of a private hospital74994
7391672827, 72828, 72838 for a private in-patient of a public hospital
or
an in-patient of a private hospital and the service is provided by a public pathology laboratory
74999
7391872827, 72828, 72838 for private laboratory74993
7391972827, 72828, 72838 for public laboratory74999


PEI association with item 72838 from 1 November 2007 until 31 October 2008
PEI
Conditions
73902In-patient of a private hospital
73904Private in-patient of a public hospital
or
In-patient of a private hospital and the service is provided by a public pathology laboratory
73906Patient is not an admitted patient of a private or public hospital and the service is provided in a private pathology laboratory
73908Patient is not an admitted patient of a private or public hospital and the service is provided in a public pathology laboratory

These changes will be available in PDF and RTF format from the 1 Janaury 2012 MBS Downloads page from 16 December 2011.