Pathology and diagnostic imaging services in public hospital emergency departments

Information to help you understand your legal obligations when billing under Medicare for pathology and diagnostic imaging services provided to emergency department patients in public hospitals.

Page last updated: 18 January 2017

Eligibility

    • under the Health Insurance Act 1973, we can't pay a Medicare benefit for a professional service funded under an arrangement with the Australian Government or a state or territory government
    • pathology and diagnostic imaging services for public patients in public hospital emergency departments are funded by an arrangement with the Australian Government. Such services are not eligible for Medicare benefits
    • an eligible patient presenting at a public hospital emergency department will be treated as a public patient. Once a medical practitioner has made a clinical decision to admit a patient to the hospital, services can only be billed to Medicare after the patient, or person with authority on their behalf, has agreed in writing to be treated as a private patient
    • when you bill under Medicare for services you provide to a patient in a public hospital, make sure you understand and meet the requirements of the Medicare Benefits Schedule (MBS). These include:
      • the patient is an admitted patient
      • the patient elected to be treated as a private patient
      • the patient is eligible for a Medicare benefit
      • the service is eligible and not already funded by other means
      • any necessary referral is valid for Medicare purposes, and
      • the MBS item number is correctly billed for the service you provided

For more information

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