From 1 July 2025, changes to Medicare funding for Vitamin B12 tests have come into effect.
We remain committed to bulk billing for the majority of pathology tests, where bulk billing is available. We have, however, introduced some private billing for certain tests.
We bulk bill Total Vitamin B12 wherever Medicare eligibility is met. Clear clinical notes on the request form help us apply the correct Medicare item and minimise any out-of-pocket costs.
Active B12 (holotranscobalamin)
- An upfront fee applies to all Active B12 requests: $75 (non concession) or $20.10 (approved concession).
- After payment, patients may be eligible to claim a $20.10 Medicare rebate depending on Medicare’s criteria.
Total B12 (Item 66838) and Medicare eligibility
Frequency rule: Medicare generally allows one Total B12 (Item 66838) within an 11month period.
If the request form has no clinical notes
- We bulk bill one Total B12 (Item 66838) per 11 months.
- If a patient has already had a Total B12 within the last 11 months, the test is not Medicare eligible and an out-of-pocket fee applies: $60 (non concession) or $20.10 (approved concession). No Medicare rebate is available for this scenario.
- If we can’t confirm eligibility at collection, we’ll obtain financial consent and may issue an invoice later if ineligibility is confirmed.
If clinical notes indicate Medicare criteria are met
When clinical notes support Medicare eligibility, the test is bulk billed (typically under Item 66842). Where clinically justified, repeat testing within 11 months can also be bulk billed if sufficient notes are provided.
If Vitamin B12 result is low or borderline
Where clinically indicated, we may perform a homocysteine test on the same episode at no additional cost to the patient.
Concession cards we accept
DVA Gold Card, Pensioner Concession Card and Health Care Card.
Medicare Eligibility Criteria - 66838
- Quantification of either or both of total vitamin B12 and holotranscobalamin
- Applicable not more than once in 11 months
Medicare Eligibility Criteria - 66842
Quantification of one or more of total vitamin B12, holotranscobalamin, methylmalonic acid or homocysteine for a patient:
a) who:
(i) is still experiencing symptoms of vitamin B12 deficiency 3 to 6 months after a service described in item 66838 or 66839 was rendered for the patient; or
(ii) obtained inconclusive results from a service described in item 66839; or
b) to whom one or more of the following applies:
(i) the patient has a diet low in vitamin B12;
(ii) the patient has a family history of vitamin B12 deficiency or an autoimmune condition;
(iii) the patient has previously had abdominal or pelvic radiotherapy;
(iv) the patient has previously had surgery involving the gastrointestinal tract;
(v) the patient uses, or has a recent history of using, recreational nitrous oxide;
(vi) the patient requires monitoring of vitamin B12 treatment;
(vii) the patient uses vitamin B12-antagonistic medicines;
(viii) the patient has one or more clinical conditions with a recognised risk of vitamin B12 deficiency
