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 and Aged Care develops Medicare policy. Read about pathology services for health professionals and customers on their website.

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 and the patient must pay the full fee. Examples include elective cosmetic surgery, insurance testing, and some genetic tests.

Read about pathology services in the MBS on MBS Online.

Requests for pathology services

A pathology service is a requested service by a health professional.

We can only pay a Medicare benefit if the treating practitioner:

  • decides the pathology service is clinically relevant
  • is eligible to request that service for the purposes of Medicare.

If 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 organisation.

Read about referring and requesting services under Medicare.

Date of service for pathology providers

When claiming Medicare for pathology services, you should report the date of service as either:

  • the date of the specimen collection
  • the date of the first specimen collection where multiple samples are taken for a single Medicare-billed test.

This is because some pathology tests are performed in multiple parts, and sometimes on different days.

There are exceptions. You can read about Claiming Medicare Benefits - Date of Service for Pathology Providers on the Department of Health and Aged Care website.

Eligibility to claim Medicare pathology services

You must apply for approval to provide pathology services under Medicare.

Approval periods are set in law. You can’t perform Medicare eligible services until we’ve provided an approval to do so. That’s why we can’t backdate initial approvals.

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:

Backdated approval

If you apply late, we can only backdate approval periods under special circumstances.

The requirements for backdating are different depending on the approval type. See the relevant page for more information.

Contact us if you need help with your application.

Payment

Manual applications

With the exception of ACCs, you don’t need to pay us until your undertaking or application has been accepted or approved in principle. We’ll notify you once it is.

We accept payment by EFT, cheque or money order for manual applications, including HPOS form upload. The EFT payment details are:

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

Payment reference:

APA applications

  • New: APA <APA Name>
  • Renewal: APA#####.

APP applications

  • New: APP <Name>
  • Renewal: APP#####.

APL applications

  • New: APA##### APL <APL Suburb>
  • Renewal: APL#####
  • Multiple: APA##### APL applications.

ACC applications

  • New: APA##### ACC <ACC Suburb>
  • Renewal: APA##### ACC#####
  • Multiple: APA##### ACC applications.

You can only submit single payments for multiple applications for the one application type.

Make cheques or money orders payable to Services Australia (ABN 75 174 030 967)

Then post to us.

HPOS applications

You need to pay by bank transfer when using the Pathology self-service function in HPOS for ACC applications. We’ll provide payment details.

Fees and tax amounts

Below are the amounts payable for each approval type.

Application typeGST doesn’t applyApproval period
APA fee$1,5001 Year
APP fee$5001 Year
APL fee$2,500 Category GX (General)
$2,000 Category GY (General)
$1,500 Category B (Branch)
$750 Category M (Medical) and S (Specialised)
Up to 3 years
ACC tax$2,0002 Years

You must pay the:

  • ACC tax - at the time of application
  • APP and APA fee - must be received within 14 days from the date your undertaking is accepted
  • APL fee - must be received before full approval is granted.

We must revoke the acceptance of your APA or APP undertaking if you don’t pay on time and you’ll lose eligibility for Medicare benefits.

APLs aren’t eligible for Medicare benefits until we’ve granted full approval.

Manage

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.

You can update some APA and ACC details online.

Other ways to update us include:

  • completing the amendment section of the relevant application form where available
  • submitting an appropriately authorised and signed letter
  • using the form upload function in HPOS.

You can also keep up to date with the latest news by subscribing to news for health professionals.

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.

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. We call this private billing.

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.

Patients

Patients can claim Medicare benefits in several ways.

Page last updated: 30 January 2024.
QC 23086