Patient Episode Initiation (PEI) item changes - 1 May 2012

Page last updated: 26 April 2012

1 May 2012 Change to Patient Episode Initiation (PEI) Fee Items for Tissue Pathology Items 72838, 72827 and 728282


The Health Insurance (Patient Episode Initiation) Determination 2011 (No. 1) was registered on the Federal Register of Legislative Instruments (FRLI) on 5 December 2011 to rectify the omission of tissue pathology items 72838, 72827 and 72828 from the item descriptors for the specific tissue pathology PEIs 73924, 73925, 73926 and 73927 or the bulk billing initiative items 74993, 74994, and 74999. The new items and other changes were retrospective for claims that have not been processed and benefits paid prior to this date.

This Determination provided legal authority for benefits to be paid pending the correction of the Health Insurance (Pathology Services Table) Regulations 2011. The Health Insurance (Pathology Services Table) Amendment Regulation 2012 (No. 1) registered on FRLI on 20 April 2012 revised the descriptors for PEI items 73924, 73925, 73926 and 73927 to include the tissue pathology items 72838, 72827 and 72828 from 1 May 2012.

The Health Insurance (Patient Episode Initiation) Determination 2011 (No. 1) will be revoked as at 1 May 2012. As the amendments to the PEI items in the Pathology Services Table take effect prospectively from 1 May 2012 and the 3C Determination creating items 73914 - 73919 is revoked from 1 May 2012, this will not mean that a person who received a relevant pathology service 72827 on e.g. 1 December 2010 will not be able to claim the associated PEI item. When the patient received the service on 1 December 2010 he or she was legally entitled to a Medicare benefit for the service, and the revocation of the 3C Determination will not retrospectively remove that entitlement.

Therefore, any PEI claimed in relation to items 72827, 72828 and 72838 for services performed on or after 1 May 2012 should be claimed against the following revised PEI items.

PEI association with items 72827, 72828 and 72838 from 1 May 2012
PEIPayable per patient episode when associated withBulk billing incentive item from 1/05/2012
73924 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 for an in-patient of a hospital 74994
73925 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 for a private in-patient of a public hospital; or
an in-patient of a private hospital and the service is provided by a public pathology laboratory
74999
73926 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 for private laboratory 74993
73927 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 for public laboratory 74999


Claims for the PEIs associated with items 72827, 72828 and 72838 where the service was performed between 1 November 2008 and 30 April 2012 should be claimed against the following PEI items.

PEI association with items 72827, 72828 and 72838 from 1 November 2008 to 30 April 2012
PEI Payable per patient episode when associated with Bulk billing incentive item from 1/11/09
73914 72827, 72828, 72838 for an in-patient of a private hospital 74994
73916 72827, 72828, 72838 for a private in-patient of a public hospital
or
an in-patient of a private hospital and the service is provided by a public pathology laboratory
74999
73918 72827, 72828, 72838 for private laboratory 74993
73919 72827, 72828, 72838 for public laboratory 74999


Any claims for the PEIs associated with item 72838 where the service was performed between 1 November 2007 and 31 October 2008 should be claimed against the following PEI items.

PEI association with item 72838 from 1 November 2007 until 31 October 2008
PEI
Conditions
73902 In-patient of a private hospital
73904 Private in-patient of a public hospital
or
In-patient of a private hospital and the service is provided by a public pathology laboratory
73906 Patient is not an admitted patient of a private or public hospital and the service is provided in a private pathology laboratory
73908 Patient is not an admitted patient of a private or public hospital and the service is provided in a public pathology laboratory