Pathology services for health professionals

Providing and claiming pathology services under Medicare.

From 1 December 2018, all new and renewing ACCs not located with a category GX or GY Accredited Pathology Laboratory will also need to pay a tax amount of $2,000 for an approval period of 2 years
From 1 July 2018, applicants must provide additional information and complete a separate application for each Approved Collection Centre (ACC). Read more about ACCs.

From 1 December 2018, you can apply, renew, or cancel your ACC through a new self-service function in HPOS. Read more about how HPOS will make it easier to manage your ACCs and what you need to do to get ready for the change.

About

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

The Department of Health develops Medicare policy. There is 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 MBS on MBS Online.

Requests for pathology services

A pathology service is a referred service. This means 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 need to apply for approval to provide pathology services under Medicare.

Pathology approval periods are set in law. You should allow enough time for us to receive, assess and approve your application.

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.

There are different applications for different circumstances.

Read more about the specific criteria you have to meet for:

Backdated approval

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 is late

We’ll consider the circumstances and respond to you.

Contact us if you need help with your application.

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

Tax payments and application fees don’t attract GST.

We’ll refund fees or taxes if we don't grant approvals.

For manually submitted applications, you can pay your fees or taxes by bank transfer, cheque or money order.

For HPOS submitted applications, use the bank account details quoted in your payment invoice.

Bank transfer

BSB: 092 009
Account number: 120 260
Account name: DHS Medicare Official Administered Payments Other Health Programs

Reference:

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

You can make cheques or money orders payable to the Department of Human Services, ABN 75 174 030 967. Then post to us.

The effective payment date is when we receive payment. It's not when you draw, date or post the cheque or money order.

Late payments

We do not accept late payments. You must pay:

  • ACC tax at the time of application
  • APP and APA within 14 days of application
  • APL before it expires

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

Manage

Keep your details up-to-date

Tell us about any changes to ensure you keep getting Medicare benefits.

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

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 are no out-of-pocket expenses for the patient. Read more about bulk bill payments to health professionals.

Private billing

If the service isn’t 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 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: 8 October 2018