COVID-19 Pathology

Page last updated: 01 April 2020


COVID-19 Pathology.pdf
COVID-19 Pathology.docx

Last updated – 1 April 2020
Claiming Microbiology Tests for SARS-CoV-2 (COVID-19) factsheet

Last updated: 1 April 2020

The dedicated Medicare bulk-billed pathology tests for COVID-19 were updated from 1 April 2020 to increase the Medicare rebate the Government pays for COVID-19 testing.

Claims for the new Medicare items can be submitted to Services Australia from 2 April 2020.

The changes apply to all COVID-19 testing that has occurred from 13 March 2020.

There are four new items for claiming Medicare bulk-billed pathology tests for COVID-19:


    o From 1 April 2020, new item 69479 provides a rebate for a pathology service undertaken for a private patient in a recognised (public) hospital or by a prescribed laboratory.

    o From 1 April 2020, new item 69480 provides a rebate for undertaking the pathology test for any other patient (i.e private laboratories).


      Old item 69485 has been replaced and does not apply to services provided from 1 April 2020.
The Government is increasing the Medicare rebate for all COVID-19 tests performed from 13 March 2020. To enable the higher rebate to be available for services provided between 13 March 2020 and 31 March 2020 two new supplementary Medicare items have been created so that all COVID-19 tests that are eligible for a Medicare rebate under old MBS item 69485 can also claim an additional amount under one of the new supplementary Medicare items. If the appropriate supplementary item is claimed the total rebate will be equivalent to the total rebate paid under the new COVID-19 items 69479 ($42.50 Medicare rebate) and 69480 ($85 Medicare rebate).

    o From 1 April 2020, supplementary MBS item 69476 can be claimed for a service provided under 69485 for a pathology service undertaken for a private patient in a recognised (public) hospital or by a prescribed laboratory.

    o From 1 April 2020, supplementary MBS item 69477 can be claimed for a service provided under 69485 for a pathology service undertaken for any other patient (i.e private laboratories).


Items 69476 and 69477 apply to pathology tests performed in accordance with the service described in item 69485 during the period commencing on 13 March 2020 and ending and including 31 March 2020.

What are the changes?

From 13 March 2020, Medicare Benefits Schedule (MBS) item 69485 was listed for microbiology testing for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The Government has decided to increase the Medicare rebate for the SARS-CoV-2 test, and an earlier change means it is no longer required to be rendered in conjuction with testing for other respiratory viruses under MBS items 69494, 69495 or 69496. New MBS items 69497 and 69480 may be claimed as stand-alone tests. Testing for SARS-CoV-2 in conjunction with other respiratory viruses is at the discretion of the patient’s medical practitioner.

New item 69479 provides a rebate for a pathology service undertaken for a private patient in a recognised (public) hospital or by a prescribed laboratory. New item 69480 provides a rebate for undertaking the pathology test for any other patient. An additional two new supplementary Medicare items have also been created so that SARS-CoV-2 tests provided between 13 March 2020 and 31 March 2020 can claim an additional amount equivalent to the difference between the fee for 69485 and the new fees for items 69479 and 69480. Items 69476 (public) and 69477 (private) apply to pathology tests performed in accordance with the service described in item 69485 during the period commencing on 13 March 2020 and ending 31 March 2020

Why are the changes being made?

The introduction of this item will help ensure there is adequate capacity to provide accessible and rapid laboratory testing of SARS-CoV-2, the virus which causes the disease known commonly as COVID-19.

What does this mean for providers/referrers/other stakeholders?

New MBS items 69479 and 69480 will not be subject to episode coning arrangements.

Non-Public Health Laboratory Network (PHLN) laboratories planning to provide clinical diagnostic testing and reporting for SARS-CoV-2 (item 69480) are strongly recommended to meet the following criteria to ensure quality testing is maintained across Australia:


    a) participation in the Royal College of Pathologists of Australasia Quality Assurance Program (RCPAQAP) for SARS-CoV-2 testing when available;

    b) access and utilise positive control material provided by a state or territory reference laboratory; and

    c) arrange for parallel testing to be conducted by a PHLN laboratory to validate the results - in the short term, this means referring all positive samples for confirmatory testing, and referring a subset of negative samples where a strong clinical or epidemiological suspicion exists.



How will these changes affect patients?

The test will be able to be requested by all Medical Practitioners and will only be claimable where the service has been bulk-billed.

Who was consulted on the changes?

Pathology providers and the Royal College of Pathologists of Australasia.

How will the changes be monitored and reviewed?

Item 69479 and 69480 are scheduled to be listed until 30 September 2020. Disease progression in the community and advice from the Australian Health Protection Principal Committee will determine whether the item is required for a longer time.


Where can I find more information?

The full item descriptor(s) and information on other changes to the MBS can be found on the MBS Online website at www.mbsonline.gov.au. You can also subscribe to future MBS updates by visiting MBS Online and clicking ‘Subscribe’.

The Department of Health provides an email advice service for providers seeking advice on interpretation of the MBS items and rules and the Health Insurance Act and associated regulations. If you have a query relating exclusively to interpretation of the Schedule, you should email askMBS@health.gov.au.

Subscribe to ‘News for Health Professionals’ on the Services Australia website and you will receive regular news highlights.

If you are seeking advice in relation to Medicare billing, claiming, payments, or obtaining a provider number, please go to the Health Professionals page on the Services Australia website or contact Services Australia on the Provider Enquiry Line – 13 21 50.

The data file for software vendors is expected to become available on [date] and can be accessed via the MBS Online website under the Downloads page.