Site Map Contact Us Useful Links

Fee Information

Histopathology And Cytology

Within 2 days of a specimen being referred to Adelaide Pathology we will issue an account for the request.

The information that we receive on the request form is vital in determining how we initially invoice the service. Providing us with as much information as possible on the patient request form can be of great assistance in the billing procedure and enable us to bill correctly in the first instance.

Below is a diagram of the appropriate fields to be completed to ensure appropriate billing:

On Private accounts, which are issued to patients who do not have concessions, we offer a $10.00 discount providing the account is finalised in full within 14 days. Generally gaps apply to private outpatients only as we have arrangements with all Major Health Funds.

Thus in the event of patients requiring surgery in a private hospital or a day surgery facility, there are no out of pocket expenses for most privately insured patients.

As displayed in the following fee tables, our fees are just above the schedule fee for private outpatients but well short of the AMA fee.

Histopathology Fee Table
Cytology Fee Table

We are of course happy to bulkbill cases that you select as appropriate and it has been our policy to accept the Medicare cheque only (MBO) for pensioners if they are able to quote their pension number to us. We charge schedule fee rather than our normal fee for Commonwealth Health Care and Senior cardholders, which results in a significantly lower gap. For further information on our billing policies/criteria please refer to the APP Billing Policy

Billing guidelines followed by accounts staff

1.	Private request form for an outpatient, no signature required: Privately charged invoice. Can also be medical benefits if pension card holder
2.	Bulkbill request form for in/outpatient signed: Bulkbilled (claimed directly from Medicare)
3.	Bulkbill request form without signature in/outpatient: Medical Benefits Only (Sent to patient and Medicare cheque accepted as full payment)
4.	Private/Bulkbill request form in/outpatient, DVA patient: With pathology cover will be billed directly to DVA (no signature required)
5.	Private request form inpatient, uninsured (no signature required): Privately charged At doctors request can be bulkbilled Can also be medical benefits if pension card holder
6.	Private request form inpatient with private health cover: Simplified billing (sent directly to health fund, if we have contract)
7.	Private request form, in/outpatient, but states is on pension: Medical Benifits Only
8.	Private request form, in/outpatient, but states has health care card or seniors card: Charged schedule fee

How fees are determined

Histological Specimens

The fees for histological specimens are determined based on complexity levels, which in turn are reflected by the type of specimen received.

For example: a Vasectomy specimen is level 2. A skin excision for benign or malignant neoplasm, a cholecystectomy, and an appendicectomy are level 3. A GE biopsy, an endometrial curette, and an unorientated breast biopsy are level 4. A regional lymph node dissection, a thyroidectomy specimen, and a colectomy for non-neoplastic disease are level 5. Finally most cancer resections are set at complexity level 6.

Frozen Sections

Currently there is no difference in the charge for a frozen section if the specimen is sent into the laboratory or if the pathologist travels to the private hospital and examines the specimen onsite. There is a basic fee for a single frozen section, and an increased fee for evaluation of multiple specimens (i.e. multiple lymph nodes or margins)

Cytological Specimens

General cytological specimens such as bronchial washings and brushings, body cavity fluids (pericardial, plural and peritoneal) and urine will incur a similar charge (bfcy). Smears from different sites (SMCY) are associated with a different charge code. There is also a separate charge code for a series of 3 urines, or sputum samples to assess for malignancy.

FNA Biopsies

There are two charge codes for fine needle aspirations. The first applies to cases where you perform the aspiration as the referring clinician and send the prepared slides to the laboratory (FNA). The second (FNAP) applies to fine needle aspirations performed by the pathologist on palpable lesions, or when a fine needle aspiration is performed under radiological guidance, and the pathologist travels to the radiology practice to assess the specimen adequacy.

Note: Additional charges apply to all extra tests which incur an additional item number. These include immunofluorescence and immunohistochemistry and Her2 and ER/PR testing.

Clinical Pathology

Adelaide Pathology Partners charges the scheduled fee for all tests performed in the clinical pathology laboratory. These fees are all charged according to the medical benefits schedule item number for each test.

If the tests are charged privately as an outpatient Medicare pays 85% of the schedule fee, and there will be a gap payable for the remainder. For all most all in hospital tests the patients will not receive an account as we have agreements with all Major Health Funds.

If the test is performed on an outpatient basis, and the patient signs a bulk billed request form we will bill Medicare direct.

As with histology and cytology we will bill all DVA patients direct to the department of veteran affairs.

All patients who are pensioners will be charged at medical benefits only.