Mater Pathology

Rule 3 Exemption

Rule 3 of the Pathology Services Table limits the benefits payable for pathology items during a single patient episode. Exemptions to this rule have been granted for certain specified tests in certain clinical circumstances. The exemption is referred to as ‘Rule 3 Exemption’.

Mater Pathology has produced the following user-friendly guide to tests covered by the Rule 3 Exemption to assist practitioners in its appropriate application in Out Patients.

In these instances, the request form must be endorsed ‘Rule 3 Exemption’ for the request to be valid. This request is then valid for the earlier of six months or the test frequency limit.

Patient Condition/Therapy Tests Eligible for Rule 3 Exemption Test Frequency
Anticoagulant (Warfarin) therapy INR Unlimited tests up to 6 months of request
Cancer patients receiving Bisphosphate infusions Calcium, phosphate, magnesium, urea, creatinine and electrolytes Up to 6 tests within 6 months of request
  • Chemotherapy for neoplastic disease
  • Clozaril therapy
  • Gold therapy
  • Immunosuppressant therapy
  • Penicillamine therapy
  • Sulphasalazine therapy
  • Ticlopidine hydrochloride therapy
FBC, ESR
Chronic renal failure of a patient in a dialysis program conducted by a recognised hospital Urea, creatinine and electrolytes
Cis-platinum therapy Urea, creatinine and electrolytes
Cyclosporin therapy Urea, creatinine and electrolytes
Leflunomide therapy E/LFT (or part thereof)
Lithium therapy Lithium
Methotrexate therapy FBC, ESR, E/LFT (or part thereof)
Vitamin D (metabolites or analogues) therapy Calcium and albumin

Procedure for requesting Rule 3 Exemption tests

  1. Request the pathology test in the normal way with the usual request form.
  2. Specify the number of and frequency of the test.
  3. Clearly endorse the form by writing ‘Rule 3 Exemption’.
  4. Tests not listed as eligible for Rule 3 Exemption should be requested on a separate request form.

Tests eligible for Rule 3 Exemption will be carried forward and performed on subsequent episodes.

The information in this guide has been derived from the Medicare Benefits Schedule, 1 May 2010 (Rule 4 (2), p 631).