Pathology services for health professionals

Providing and claiming pathology services under Medicare.

From 1 July 2018, applicants will need to provide additional information and complete a separate application for each ACC location. Read more about ACCs. From mid-September 2018, you will be able to apply, renew, or cancel your ACC through a new self-service function in HPOS. We’ll provide more information on this page soon.

About

We manage applications and claims for pathology service providers under Medicare.

The Department of Health develops Medicare policy and also has some general information about pathology services for health professionals and customers on their website.

Eligibility

Eligible pathology services

Pathology services eligible for Medicare benefits are listed in the Pathology Services table (category 6) of the Medicare Benefits Schedule (MBS).

Some pathology tests don’t qualify for a Medicare benefit.The patient must pay the full test fee. Examples include elective cosmetic surgery, insurance testing, and some genetic tests.

Read more about pathology services in the Medicare Benefits Schedule on the MBS Online website.

Requests for pathology services

A pathology service is a referred service, meaning the treating practitioner must decide if a pathology service is clinically relevant before making the request. If a service is not clinically relevant, we can’t pay a Medicare benefit. The fee and payment are a private matter between the practitioner and the patient.

For pathology services to be eligible for Medicare benefits, a request must meet certain conditions.

There’s no official form for a pathology request. The requesting practitioner can use their own stationery, or pre-printed forms supplied by a pathology company.  Pathology requests can be sent electronically between third parties.

Read more about referring and requesting services under Medicare

Apply

You need to know

You must be approved to provide pathology services under Medicare. Use the application form that best suits your situation when seeking approval from us. There are 4 types:

  • pathology authority (owner of a laboratory or collection centre)
  • pathology practitioner (examining specimens collected)
  • pathology laboratory (premises where specimens are examined), or
  • specimen collection centre (premises where specimens are collected).

You need to complete all questions on the form and have your signature witnessed, where required. We’ll return any incomplete applications and you’ll need to re-apply.

Pathology approval periods are set in law. You should allow enough time for us to receive, assess and approve your application.  We can only backdate approval periods from late applications under special circumstances.

To request a backdated approval, you need to provide:

  • a new application
  • the fee
  • a letter of request telling us why your application was delayed

We’ll consider the circumstances and respond to you.

Contact us if you need help with your application.

Approved Pathology Authorities (APAs)

For us to consider approval as an APA, you must:

  • own a pathology laboratory (APL) that intends to claim Medicare benefits, and
  • meet the requirements in the Approved Pathology Authority Undertaking 

To apply:

Once approved:

  • we’ll send you a unique APA number with your approval dates (12 months)
  • you’ll need to renew your approval before expiry using the Approved Pathology Authority Application form and pay the renewal fee. We’ll send you an invitation to renew about 8 weeks before the expiry date

If you've bought or merged with another APA, or partially acquired some of the business, you must tell us in writing by sending the Approved Pathology Authority acquisition or merger advice form.

Approved Pathology Practitioners (APPs)

For us to consider approval as an APP, you must:

  • have medical practitioner registration with the Australian Health Practitioner Regulation Agency (AHPRA)
  • have a Medicare provider number at the location/s Accredited Pathology Laboratory (APL) where you intend to provide services, and
  • meet the requirements in the Approved Pathology Practitioner Undertaking. When claiming, make sure the address of your Medicare provider number is the same as the registered address of the associated APL

To apply:

Once approved:

  • we’ll let you know the dates you’re approved for (12 months)
  • you’ll need to renew your approval before expiry using the Approved Pathology Practitioner form and pay the renewal fee. We’ll send you a reminder to renew about 10 weeks before the approval expiry date

Accredited Pathology Laboratories (APLs)

Laboratory quality standards are set by the National Pathology Accreditation Advisory Council (NPACC). New laboratory approvals are initially granted for 6 months. On renewal APLs are granted approval for up to 3 years.

Any change of laboratory location or ownership requires a new NATA assessment and APL application.

For us to consider approval as an APL:

To apply:

To renew:

Check the NATA website for a list of all accredited Australian Medical Testing laboratories.

Approved Collection Centres (ACCs)

Read more about the new requirements for ACCs below. From mid-September 2018, you will be able to apply, renew, or cancel your ACC through a new self-service function in HPOS. We’ll provide more information on this page soon.

New ACC approvals are granted for a 6 month period. For ACCs renewing or subject to merger or acquisition, approved applications are granted for a 12 month period.

For us to consider approval as an ACC you must:

  • be a current APA before you apply to operate an ACC
  • own a Category G Lab (or have entered into an agreement with another APA to use their Category G lab) or own a Category S lab
  • meet the Guidelines for Approved Pathology Collection Centres developed by the Royal College of Pathologists of Australia (RCPA) and the National Pathology Accreditation Advisory Council (NPAAC)
  • submit an application for each ACC location
  • pay the tax and provide proof of payment with your application
  • provide supporting documents showing the APA connection to the premises used by the ACC

You must also include copies of these supporting documents with your ACC application:

  • where the APA is a lessee or sub-lessee – the signed lease or sub-lease for the premises, or
  • where the lease or sub-lease over the premises has been assigned to the APA – the signed lease, sub-lease or assignment of lease for the premises, or
  • where the APA is the owner of the premises – proof of ownership of the premises (for example, a rates notice), and
  • the floor plan of the premises or, if the premises are part of a larger facility, the floor plan for that facility

The floor plan must clearly identify:

  • the name of the ACC
  • the physical address of the premises
  • if the premises are used exclusively as an ACC – the area occupied by the premises (m2)

If the premises are part of a larger facility the floor plan must clearly identify (in m2):

  • the area for exclusive use by the ACC and the size of that area
  • the area for exclusive use by other occupants of that facility and the size of that area
  • each common area used by the ACC and one or more other occupants of the facility, and the size of each of those areas
  • the total size of the facility
If your application is for the acquisition or merger of an APA, you must show us the APA’s connection to the ACC premises and a floor plan. You must do this within 30 days of signing the new lease agreement. Tell us by sending the Approved Pathology Authority acquisition or merger advice form.

To apply or renew:

To cancel:

Check the Approved Collection Centre Register for a list of ACCs.

Application Fees/Taxes and Payment

Current application fees/taxes are:
APA $1,500
APP $500
APL

$2,500 Category GX (General)

$2,000 Category GY (General)

$1,500 Category B (Branch)

$750 Category M (Medical) and S (Specialised)

New ACC $500
Renewal ACC $1,000

Fees or taxes will be refunded if we don't grant approvals.

You can pay your fees or taxes by bank transfer, cheque or money order.

Bank transfer

BSB: 092 009
Account Number: 120 260
Account Name: DHS Medicare Official Administered Payments Other Health Programs

Reference:

  • Payment for APA:
    • APA name or APA number if renewing
  • Payment for APP:
    • APP name or APP number if renewing
  • Payment for APL:
    • APA number and APL suburb or APL number if renewing
  • Payment for ACC:
    • APA number and ACC suburb or ACC number if renewing
Cheques or money orders

Cheques or money orders can be made payable to the Department of Human Services ABN 75 174 030 967. Post to us.

The effective payment date is when we receive payment, not when the cheque or money order is drawn, dated or posted.

Late payments

You must pay ACC tax at the time of application.

You must pay APP, APA and APL fees within 14 days of application.

We may cancel your application if you don’t pay on time and you may lose eligibilty for Medicare benefits.

Manage

Keeping your details up to date

It’s your responsibility to make sure your details are up to date and accurate.  Legal requirements for when you need to tell us about details of any changes are on the application forms.   

Telling us about any changes will help ensure you stay eligible for Medicare benefits.

How to update us:

Billing your patients

Bulk billing

Pathology service providers can bulk bill and accept the Medicare benefit as full payment for their pathology service. There is no out-of-pocket expenses for the patient. Read more about bulk bill payments to health professionals.

Private billing

Where the service is not bulk billed, you must give your patient an itemised account, so they can lodge a claim for a Medicare benefit.

The itemised account must contain certain information. Read more about private billing for health professionals.

You must tell your patient if there is an out-of-pocket expense before providing the service.

Lodging a claim with us

Pathology service providers

We offer a range of online business solutions that can save you time and paperwork and help you get payments faster. Read more about doing business online.

Patients

Your patients can claim their Medicare benefits in several ways. They can read more about Medicare claiming.

Page last updated: 4 July 2018