Providing and claiming pathology services under Medicare.
We manage applications and claims for pathology service providers under Medicare.
Eligible pathology services
Pathology services eligible for Medicare benefits are 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. We can only pay a Medicare benefit if the treating practitioner decides the pathology service is clinically relevant. If it’s not, the fee and payment are a private matter between the practitioner and the patient.
To be eligible for Medicare benefits, a request must meet certain conditions.
There’s no official form for a pathology request. The requester can use their own stationery, or pre-printed forms supplied by a pathology company.
Read more about referring and requesting services under Medicare.
You need to know
You must apply for approval to provide pathology services under Medicare.
Approval periods are set in law.
You must meet certain criteria and supply all the information we ask for. Please give us enough time to get, assess and approve your application. You’ll need to re-apply if you miss something.
Find out how to apply for:
- Approved Pathology Authorities (APA) - if you own a laboratory or collection centre
- Approved Pathology Practitioners (APP) - if you examine collected specimens
- Accredited Pathology Laboratories (APL) - a premises that examines specimens
- Approved Collection Centres (ACC) - premises where specimens are collected.
If you apply late, we can only backdate approval periods 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 let you know the outcome.
Contact us if you need help with your application.
Pay by bank transfer (manual applications only)
BSB: 092 009
Account number: 120 260
Account name: DHS Medicare Official Administered Payments Other Health Programs
Payment reference: Name and APA, APP, APL or ACC number plus the APL suburb.
You can make cheques or money orders payable to the Department of Human Services, ABN 75 174 030 967. Then post to us.
If you use the Pathology self-service function in HPOS pay by bank transfer – you’ll see the details on your screen.
If you use file upload, pay as per manual application.
Fee/Tax - GST doesn’t apply
$2,500 Category GX (General)
$2,000 Category GY (General)
$1,500 Category B (Branch)
$750 Category M (Medical) and S (Specialised)
The payment date is when we get paid. It's not when you draw, date or post the cheque or money order. We don’t 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 eligibility for Medicare benefits.
We’ll refund fees or taxes if we don't grant approval.
Keep your details up-to-date
Tell us about any changes so you can keep getting Medicare benefits.
It’s your responsibility to make sure your details are up-to-date. Legal requirements for when you need to tell us are on the application forms.
How to update us:
- complete the ‘amendment’ section of the application form, where available, and use the form upload function in HPOS
- email us
- write to us.
Billing your patients
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.
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’s an out-of-pocket expense before providing the service.
Lodging a claim with us
Pathology service providers
Save time and get your payments faster online. Read more about doing business online.
Patients can claim Medicare benefits in several ways. Read more about Medicare claiming.