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Pathology services for health professionals

Providing and claiming pathology services under Medicare.

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 consumers 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 and 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 and 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 get an approval backdated, you need to provide:

  • a new application
  • the fee
  • a letter of request detailing 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)

To get approval as an APA you must:

  • own a pathology laboratory (APL) that intends to claim Medicare benefits
  • meet the requirements in the Approved Pathology Authority Undertaking. This is a legal declaration and part of the application form

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)

To get approval as an APP you must:

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 lab 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.

To get 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)

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

To get 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)

To apply:

To renew:

To cancel:

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

Application Fees and Payment

Current application fees are:
APA $1500
APP $500
New ACC $500 No fees are payable if the ACC is co-located with a Category GX or GY lab
Renewal ACC $1000
APL

$2500 Category GX (General)

$2000 Category GY (General)

$1500 Category B (Branch)

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

Fees will be refunded for any approvals not granted.

You can pay your fees 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 fees 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 your fee on time and you may lose your Medicare benefits.

Manage

Keeping your details up to date

It’s your responsibility to make sure your details are up to date and accurate.  Legislative requirements regarding the timeframes for which you must provide details of any changes to your details are outlined on the application forms.   

This 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: 16 May 2018