Document ID: chunk:federal_register_of_legislation:C2025C00156:section:16a:p1
Version: federal_register_of_legislation:C2025C00156
Segment Type: section
Provision Reference: s 16A (pt 1/5)
Character Range: 119963–122809

16A  Medicare benefits in relation to pathology services
 (1) A medicare benefit is not payable in respect of a pathology service that has been rendered in relation to a person unless:
 (a) the service (whether a pathologist‑determinable service or not) was determined to be necessary by a practitioner (in this section referred to as the treating practitioner) whose patient the person was; or
 (aa) the service (whether a pathologist‑determinable service or not) was:
 (i) determined to be necessary by a participating midwife (in this section also referred to as the treating practitioner), acting in his or her capacity as a participating midwife, whose patient the person was; and
 (ii) a service of a kind specified in regulations made for the purposes of this subparagraph; or
 (ab) the service (whether a pathologist‑determinable service or not) was:
 (i) determined to be necessary by a participating nurse practitioner (in this section also referred to as the treating practitioner), acting in his or her capacity as a participating nurse practitioner, whose patient the person was; and
 (ii) a service of a kind specified in regulations made for the purposes of this subparagraph; or
 (b) the service was:
 (i) a pathologist‑determinable service rendered by or on behalf of an approved pathology practitioner; and
 (ii) determined to be necessary by that approved pathology practitioner.
 (2) A medicare benefit is not payable in respect of a pathology service (other than a prescribed pathology service to which subsection (7) or (7A) applies) unless:
 (a) the service was rendered by or on behalf of an approved pathology practitioner;
 (b) the service was rendered in an accredited pathology laboratory and was a service of a kind in respect of which the laboratory was accredited;
 (c) the proprietor of the laboratory was an approved pathology authority;
 (ca) there was no other proprietor of the laboratory; and
 (d) either:
 (i) the approved pathology practitioner by whom or on whose behalf the service was rendered was the proprietor of the laboratory; or
 (ii) the service was rendered in the laboratory under an agreement (whether by way of contract of employment or otherwise) between:
 (A) the approved pathology practitioner by whom or on whose behalf the pathology service was rendered; and
 (B) the proprietor of the laboratory.
 (3) A medicare benefit is not payable in respect of a pathology service (other than a pathologist‑determinable service to which subsection (6) applies) that has been rendered by or on behalf of an approved pathology practitioner unless:
 (a) the service was rendered pursuant to a request made by the treating practitioner and, if an approved pathology practitioner was specified on the request, the service was conducted by that practitioner; or
 (b) the service was rendered pursuant to