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Determinations/Health as made
This instrument introduces 19 new Medicare Benefits Schedule items for cardiac diagnostic imaging services from 1 August 2020.
Administered by: Health
Registered 16 Jul 2020
Table of contents.

Commonwealth Coat of Arms of Australia

 

Health Insurance (Section 3C Diagnostic Imaging Services – Cardiac Services) Determination 2020

I, Andrew Simpson, delegate of the Minister for Health, make the following determination.

Dated   14 July 2020  

 

 

 

 

 

Andrew Simpson

Assistant Secretary

MBS Reviews Unit

Medical Benefits Division

Health Financing Group

Department of Health

 

 

 

 

 

  

  


Contents

1.  Name....................................................................................................................................... 1

2.  Commencement....................................................................................................................... 1

3.  Authority................................................................................................................................. 1

4.  Definitions............................................................................................................................... 1

5.  Treatment of relevant services................................................................................................. 2

6.  Application of provisions of the diagnostic imaging services table......................................... 2

Schedule 1 – relevant services                                                                                      4

Division 1.1 – Services and fees – ultrasound services                                           4

Division 1.2 – Services and fees – nuclear imaging services                                 14

 


1.  Name

              This instrument is the Health Insurance (Section 3C Diagnostic Imaging Services – Cardiac Services) Determination 2020.

2.  Commencement

(1)          Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  The whole of this instrument

1 August 2020

 

                Note:        This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

(2)       Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3.  Authority

                   This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.

4.  Definitions

 (1)    In this instrument:

Act means the Health Insurance Act 1973.

diagnostic imaging services table means the table prescribed under subsection 4AA(1) of the Act.

general medical services table means the table prescribed under subsection 4(1) of the Act.

Modified Monash 3 area has the meaning given by clause 7.1.1 of the general medical services table.

Modified Monash 4 area has the meaning given by clause 7.1.1 of the general medical services table.

Modified Monash 5 area has the meaning given by clause 7.1.1 of the general medical services table.

Modified Monash 6 area has the meaning given by clause 7.1.1 of the general medical services table.

Modified Monash 7 area has the meaning given by clause 7.1.1 of the general medical services table.

(R) has the meaning given by clause 1.2.15 of the diagnostic imaging services table.

relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.

Schedule means a Schedule to this instrument.

Note: The following terms are defined in subsection 3(1) of the Act:

·         clinically relevant service;

·         item;

·         professional service.

 (2)   Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

 

5.  Treatment of relevant services

 

For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:

(a)                    it were both a professional service and a diagnostic imaging service; and

(b)                   there were an item in the diagnostic imaging services table that:

                                                              i.      related to the service; and

                                                            ii.      specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

6.  Application of provisions of the diagnostic imaging services table

(1)          Clause 1.1.1 of diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.1.1.

(2)          Clause 1.2.1 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.1.

(3)          Clause 1.2.2 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.2.

(4)          Clause 1.2.3 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.3.

(5)          Clause 1.2.4 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.4.

(6)          Clause 1.2.5 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.5.

(7)          Clause 1.2.6 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.6.

(8)          Clause 1.2.7 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.7.

(9)          Clause 1.2.8 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.8.

(10)      Clause 1.2.9 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.9.

(11)      Clause 1.2.10 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.10.

(12)      Clause 1.2.11 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.11.

(13)      Clause 1.2.12 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.12.

(14)      Clause 1.2.13 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.13.

(15)      Clause 1.2.14 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.14.

(16)      Clause 1.2.16 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.16.

(17)      Clause 1.2.17 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.17.

(18)      Clause 1.2.18 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.18.

(19)      Clause 1.2.21 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.21.

(20)      Clause 1.2.22 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.22.

(21)      Clause 1.2.23 of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this Determination were also specified in clause 1.2.23.

(22)      Clause 2.1.1 of the diagnostic imaging services table shall have effect as if items 55126, 55127, 55128, 55129, 55132, 55133, 55134, 55137, 55141, 55143, 55145 and 55146 were also specified in clause 2.1.1.

(23)      Clause 2.1.2 of the diagnostic imaging services table shall have effect as if items 55126, 55127, 55128, 55129, 55132, 55133, 55134, 55137, 55141, 55143, 55145 and 55146 were also specified in clause 2.1.2.

(24)      Clause 2.4.1 of the diagnostic imaging services table shall have effect as if items 61321, 61324, 61325, 61329, 61345, 61349 and 61357 were also specified in clause 2.4.1.

 

Schedule 1 – relevant services

Division 1.1 – Services and fees – ultrasound services

1.1.1      Application of ultrasound items

(1)   For the purpose of subclause 1.1.1(2), if one or more services in paragraph (a) is rendered with one or more services in paragraph (b) for the same patient on the same day by the same medical practitioner, the fees that are set out in the items, other than the item with the highest fee, are reduced by 40%.

 

(2)   The items applicable to the multiple services fee reduction rule are:

(a)      a service to which one or more of items 55126, 55127, 55128, 55129, 55132, 55133, 55134 or 55137 apply; and

(b)     a service to which one or more of items 55141, 55143, 55145 or 55146 apply.

 

(3)   For any particular patient, item 55141, 55143, 55145 or 55146 applies if one or more of the following is applicable:

(a)    if the patient displays one or more of the following symptoms of typical or atypical angina:

(i)            constricting discomfort in the:

a.         front of the chest; or

b.        neck; or

c.         shoulders; or

d.        jaw; or

e.         arms; or

(ii)          the patient’s symptoms, as described in subparagraph (3)(a)(i), are precipitated by physical exertion; or

(iii)        the patient’s symptoms, as described in subparagraph (3)(a)(i), are relieved by rest or glyceryl trinitrate within 5 minutes or less; or

(b)   if the patient has known coronary artery disease and displays one or more symptoms that are suggestive of ischaemia:

(i)            which are not adequately controlled with medical therapy; or

(ii)          have evolved since the last functional study; or

(c)    if the patient qualifies for one or more of the following indications:

(i)                  assessment of myocardial ischaemia with exercise is required if a patient with congenital heart lesions has undergone surgery and reversal of ischemia is considered possible; or

(ii)                assessment indicates that resting 12 lead electrocardiogram changes are consistent with coronary artery disease or ischaemia, in a patient that is without known coronary artery disease; or

(iii)             coronary artery disease related lesions, of uncertain functional significance, which have previously been identified on computed tomography coronary angiography or invasive coronary angiography; or

(iv)             assessment indicates that the patient has potential non-coronary artery disease, which includes undue exertional dyspnoea of uncertain aetiology; or

(v)               a pre-operative assessment of a patient with functional capacity of less than 4 metabolic equivalents confirming that surgery is intermediate to high risk, and the patient has at least one of following conditions:

a.       ischaemic heart disease or previous myocardial infarction; or

b.      heart failure; or

c.       stroke or transient ischaemic attack; or

d.      renal dysfunction (serum creatinine greater than 170umol/L or 2 mg/dL or a creatinine clearance of less than 60 mL/min); or

e.       diabetes mellitus requiring insulin therapy: or

(vi)             assessment before cardiac surgery or catheter-based interventions is required to:

a.       increase the cardiac output to assess the severity of aortic stenosis; or

b.      determine whether valve regurgitation worsens with exercise and/or correlates with functional capacity; or

c.       correlate functional capacity with the ischaemic threshold; or

(vii)           for patients where silent myocardial ischaemia is suspected, or due to the patient’s cognitive capacity or expressive language impairment, it is not possible to accurately assess symptom frequency based on medical history.

 

(4)   For any particular patient, the request for a service to be provided under item 55141, 55143, 55145 or 55146 must identify the symptom/s or clinical indications/s, as outlined in subclause 1.1.1(3).

 

(5)   For any particular patient, item 55141, 55143, 55145 or 55146 applies to a service if:

(a)    the diagnostic imaging procedure is performed on premises equipped with resuscitation equipment, which includes a defibrillator; and

(b)   the diagnostic imaging procedure is performed by a person trained in exercise testing and cardiopulmonary resuscitation who is in personal attendance during the procedure; and

(c)    a second person trained in exercise testing and cardiopulmonary resuscitation is located at the diagnostic imaging premise where the procedure is performed and is immediately available to respond at the time the exercise test is performed on the patient, if required; and

(d)   one of the persons mentioned in paragraphs (b) and (c) must be a medical practitioner.

 

(6)   For any particular patient, item 55143 applies to a service if:

(a)    the service is for an exercise stress echocardiography and includes all of the following:

(i)                 two-dimensional recordings before exercise (baseline) from at least 2 acoustic windows; and

(ii)               matching recordings at or immediately after peak exercise, which include at least parasternal short and long axis views, and apical 4-chamber and 2 chamber views; and

(iii)             recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(iv)              resting electrocardiogram and continuous multi-channel electrocardiogram monitoring and recording during stress; and

(v)               blood pressure monitoring and the recording of other parameters (including heart rate); or

(b)   the service is for a pharmacological stress echocardiography and includes all of the following:

(i)                  two-dimensional recordings before drug infusion (baseline) from at least 2 acoustic windows; and

(ii)                matching recordings at least twice during drug infusion, including a recording at the peak drug dose, which include at least parasternal short and long axis views, and apical 4-chamber and 2 chamber views; and

(iii)              recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(iv)              resting electrocardiogram and continuous multi-channel electrocardiogram monitoring and recording during stress; and

(v)                blood pressure monitoring and the recording of other parameters (including heart rate).

 

(7)   For any particular patient, a service associated with an attendance item listed in Part 2 of the general medical services table does not apply if a service to which item 55126, 55127, 55128, 55129, 55132, 55133, 55134, 55137, 55141, 55143, 55145 or 55146 applies is provided on the same day; unless:

(a)    the attendance service is provided after the service where clinical management decisions are made; or

(b)   the decision to perform the service on the same day was made during the attendance service subject to clinical assessment.

 

1.1.2      Limitation of ultrasound items 55141, 55143, 55145 and 55146

(1)   For any particular patient, a service under item 55141, 55143, 55145 and 55146 does not apply if:

(a)    the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or

(b)   the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or

(c)    results of a previous imaging service indicate that a stress echocardiography service would not provide adequate information.

 

Group I1 - Ultrasound

Subgroup 7 – Transthoracic Echocardiogram and Stress Echocardiogram

Column 1

Item

Column 2

Description

Column 3

Fee ($)

55126

Initial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media:

(a)     for the investigation of any of the following:

(i)              symptoms or signs of cardiac failure; or

(ii)            suspected or known ventricular hypertrophy or dysfunction; or

(iii)           pulmonary hypertension; or

(iv)          valvular, aortic, pericardial, thrombotic or embolic disease; or

(v)            heart tumour; or

(vi)          symptoms or signs of congenital heart disease; or

(vii)         other rare indications; and

(b)     if the service involves all of the following, where possible:

(i)              assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

(ii)            assessment of right ventricular structure and function with quantitative assessment; and

(iii)           assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)          assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)            assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)          assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

(vii)         assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

(c)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146) or an item in Subgroup 2 (except items 55118 and 55130) applies; and

(d)    cannot be claimed within 24 months if a service associated with a service to which item 55127, 55128, 55129, 55132, 55133 or 55134 is provided

For any particular patient, applicable not more than once in 24 months (R)

234.15

55127

Repeat serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, for the investigation of known valvular dysfunction, if:

(a)     the service involves all of the following, where possible:

(i)              assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

(ii)            assessment of right ventricular structure and function with quantitative assessment; and

(iii)           assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)          assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)            assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)          assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

(vii)         assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

(b)     the service is requested by a specialist or consultant physician; and

(c)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146) or an item in Subgroup 2 (except items 55118 and 55130) applies (R)

234.15

55128

Repeat serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, for the investigation of known valvular dysfunction, if:

(a)     the service involves all of the following, where possible:

(i)             assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

(ii)            assessment of right ventricular structure and function with quantitative assessment; and

(iii)          assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)          assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)           assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)          assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

(vii)        assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

(b)     the service is requested by a medical practitioner (other than a specialist or consultant physician) at, or from, a practice location in:

(i)                  a Modified Monash 3 area; or

(ii)                 a Modified Monash 4 area; or

(iii)               a Modified Monash 5 area; or

(iv)               a Modified Monash 6 area; or

(v)                a Modified Monash 7 area; and

(c)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146) or an item in Subgroup 2 (except items 55118 and 55130) applies (R)

234.15

55129

Repeat serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, excluding valvular dysfunction (when valvular dysfunction is the primary condition):

(a)     for the investigation of any of the following:

(i)              symptoms or signs of cardiac failure; or

(ii)            suspected or known ventricular hypertrophy or dysfunction; or

(iii)           pulmonary hypertension; or

(iv)          aortic, thrombotic, embolic disease or pericardial disease (excluding isolated pericardial effusion or pericarditis); or

(v)            heart tumour; or

(vi)          structural heart disease; or

(vii)         other rare indications; and

(b)     if the service involves all of the following, where possible:

(i)              assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and  

(ii)            assessment of right ventricular structure and function with quantitative assessment; and

(iii)           assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)          assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)            assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)          assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation if present; and

(vii)         assessment of additional haemodynamic parameters including the assessment of pulmonary pressures when possible; and

(c)     the service is requested by a specialist or consultant physician; and

(d)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146) or an item in Subgroup 2 (except items 55118 and 55130) applies (R)

234.15

55132

Serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media, for the investigation of a patient who is under 17 years of age, or a patient of any age with complex congenital heart disease, if:

(a)     the service involves the all of the following, where possible:

(i)              assessment of ventricular structure and function including quantification of systolic function (if the ventricular configuration allows accurate quantification) using at least one of M-mode, 2-dimensional or 3-dimensional imaging; and

(ii)            assessment of diastolic function; and

(iii)           assessment of atrial structure including quantification of atrial sizes; and

(iv)          assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)            assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)          assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using relevant Doppler techniques with quantification; and

(vii)         subxiphoid views where recommended for congenital heart lesions; and

(viii)       additional haemodynamic parameters relevant to the clinical condition under review; and

(b)     the service is performed by a specialist or consultant physician practising in the speciality of cardiology; and

(c)     the service is requested by a specialist or consultant physician; and

(d)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146) or an item in Subgroup 2 (except items 55118 and 55130) applies (R)

234.15

55133

Frequent repetition serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media:

(a)   for the investigation of a patient:

(i)             with isolated pericardial effusion or pericarditis; or

(ii)            who has commenced medication for non-cardiac purposes that have cardiotoxic side effects, and if the patient has a normal baseline study which requires echocardiograms to comply with the requirements of the Pharmaceutical Benefits Scheme; and

(b)    the service involves all of the following, where possible:

(i)             assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

(ii)            assessment of right ventricular structure and function with quantitative assessment; and

(iii)          assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)          assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)           assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)          assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

(vii)        assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

(c)    not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146)  or an item in Subgroup 2 (except items 55118 and 55130) applies (R)

210.75

55134

Repeat real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, for rare cardiac pathologies, if:

(a)     the service involves all of the following, where possible:

(i)              assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

(ii)            assessment of right ventricular structure and function with quantitative assessment; and

(iii)           assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)          assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)            assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)          assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

(vii)        assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

(b)     the service is requested by a specialist or consultant physician; and

(c)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146) or an item in Subgroup 2 (except items 55118 and 55130) applies (R)

234.15

55137

Serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media:

(a)     for the investigation of a fetus with suspected or confirmed of one or more of the following:

(i)                   complex congenital heart disease; or

(ii)                 functional heart disease; or

(iii)                fetal cardiac arrhythmia; or

(iv)               cardiac structural abnormality requiring confirmation; and

(b)     the service involves the assessment all of the following, where possible:

(i)                   ventricular structure and function; and

(ii)                 atrial structure; and

(iii)                vascular connections of the heart including the great vessels and systemic venous structures; and

(iv)               pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(v)                 all present valves including structural assessment and measurement of blood flow velocities across the valves using relevant Doppler techniques with quantification; and

(c)     the service is performed by a specialist or consultant physician practising in the speciality of cardiology with advanced training and expertise in fetal cardiac imaging; and

(d)     not being a service associated with a service to which another item in this Subgroup (except items 55141, 55143, 55145 and 55146) or an item in Subgroup 2 (except items 55118 and 55130) applies (R)

234.15

55141

Exercise stress echocardiography focused study if;

(a)     the service involves all of the following:

(i)       two-dimensional recordings before exercise (baseline) from at least 2 acoustic windows; and

(ii)     matching recordings at or immediately after peak exercise, which include at least parasternal short and long axis views, and apical 4-chamber and 2 chamber views; and

(iii)    recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(iv)   resting electrocardiogram and continuous multi-channel electrocardiogram monitoring and recording during stress; and

(v)     blood pressure monitoring and the recording of other parameters (including heart rate); and

(b)     cannot be claimed if a service associated with a service to which item 55143, 55145 or 55146 applies is provided in the previous 24 months; and

(c)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 or 11730 applies

For any particular patient, applicable not more than once in 24 months (R)

417.45

55143

Repeat pharmacological or exercise stress echocardiography if:

(a)     the patient has had a service associated with a service to which item 55141, 55145 or 55146 applies provided in the previous 24 months; and

(b)     the patient has symptoms of ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c)     the service is requested by a specialist or a consultant physician; and

(d)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 or 11730 applies

For any particular patient, applicable not more than once in 12 months (R)

417.45

55145

Pharmacological stress echocardiography if:

(a)     the service involves all of the following:

(i)       two-dimensional recordings before drug infusion (baseline) from at least 2 acoustic windows; and

(ii)     matching recordings at least twice during drug infusion, including a recording at the peak drug dose, which include at least parasternal short and long axis views, and apical 4-chamber and 2 chamber views; and

(iii)    recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(iv)   resting electrocardiogram and continuous multi-channel electrocardiogram monitoring and recording during stress; and

(v)     blood pressure monitoring and the recording of other parameters (including heart rate); and

(b)     a service to which item 55141, 55146 or 55143 applies has not been provided in the previous 24 months; and

(c)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 or 11730 applies

For any particular patient, applicable not more than once in 24 months (R)

483.85

55146

Pharmacological stress echocardiography if:

(a)     the service involves all of the following:

(i)       two-dimensional recordings before drug infusion (baseline) from at least 2 acoustic windows; and

(ii)     matching recordings at least twice during drug infusion, including a recording at the peak drug dose, which include at least parasternal short and long axis views, and apical 4-chamber and 2 chamber views; and

(iii)    recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(iv)   resting electrocardiogram and continuous multi-channel electrocardiogram monitoring and recording during stress; and

(v)     blood pressure monitoring and the recording of other parameters (including heart rate); and

(b)     the patient has had a service performed under item 55141 in the previous 4 weeks and the test has failed due to an inadequate heart rate response; and

(c)     a service to which item 55143 or 55145 applies has not been provided in the previous 24 months; and

(d)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 or 11730 applies

For any particular patient, applicable not more than once in 24 months (R)

483.85


 

Division 1.2 – Services and fees – nuclear imaging services

1.2.1 Application of nuclear imaging items

(1)   For any particular patient, item 61324, 61329, 61345, 61349 or 61357 applies if one or more of the following is applicable:

(a)    if the patient displays one or more of the following symptoms of typical or atypical angina:

(i)          constricting discomfort in the:

a.             front of the chest; or

b.             neck; or

c.             shoulders; or

d.             jaw; or

e.             arms; or

(ii)        the patient’s symptoms, as described in subparagraph (3)(a)(i), are precipitated by physical exertion; or

(iii)      the patient’s symptoms, as described in subparagraph (3)(a)(i), are relieved by rest or glyceryl trinitrate within 5 minutes or less; or

(b)   if the patient has known coronary artery disease, and displays one or more symptoms that are suggestive of ischaemia:

(i)            which are not adequately controlled with medical therapy; or

(ii)          which have evolved since the last functional study; or

(c)    if the patient qualifies for one or more of the following indications:

(i)            assessment indicates that resting 12 lead electrocardiogram changes are consistent with coronary artery disease or ischaemia, in a patient that is without known coronary artery disease; or

(ii)          coronary artery disease related lesions, of uncertain functional significance, which have previously been identified on computed tomography coronary angiography or invasive coronary angiography; or

(iii)        an assessment by a specialist or consultant physician indicates that the patient has possible painless myocardial ischaemia, which includes undue exertional dyspnoea of uncertain aetiology; or

(iv)        a pre-operative assessment of a patient with functional capacity of less than 4 metabolic equivalents, confirming that surgery is intermediate to high risk, and the patient has at least one of following conditions:

a.         ischaemic heart disease or previous myocardial infarction; or

b.        heart failure; or

c.         stroke or transient ischaemic attack; or

d.        renal dysfunction (serum creatinine greater than 70umol/L or 2 mg/dL or a creatinine clearance of less than 60 mL/min); or

e.         diabetes mellitus requiring insulin therapy: or

(v)          quantification of extent and severity of myocardial ischaemia, before either percutaneous coronary intervention or coronary bypass surgery, to ensure the criteria for intervention are met; or

(vi)        assessment of relative amounts of ischaemic viable myocardium and non-viable (infarcted) myocardium, in patients with previous myocardial infarction; or

(vii)      assessment of myocardial ischaemia with exercise is required, if a patient with congenital heart lesions has undergone surgery and reversal of ischemia is considered possible; or

(viii)    assessment of myocardial perfusion in a person who is under 17 years old with coronary anomalies, before and after cardiac surgery for congenital heart disease, or where there is a probable or confirmed coronary artery abnormality; or

(ix)        for patients where myocardial perfusion abnormality is suspected but due to the patient’s cognitive capacity or expressive language impairment, it is not possible to accurately assess symptom frequency based on medical history.

 

(2)   For any particular patient, the request for a service to be provided under item 61324, 61329, 61345, 61349 or 61357 must identify the symptom/s or clinical indications/s, as outlined in subclause 1.2.1(1).

 

(3)   For any particular patient, item 61324, 61329, 61345, 61349 or 61357 applies to a service if:

(a)    the diagnostic imaging procedure is performed on premises equipped with resuscitation equipment, which includes a defibrillator; and

(b)   the diagnostic imaging procedure is performed by a person trained in cardiopulmonary resuscitation who is in personal attendance during the procedure; and

(c)    a second person trained in exercise testing and cardiopulmonary resuscitation is located at the diagnostic imaging premise where the procedure is performed and is immediately available to respond at the time the exercise test is performed on the patient, if required; and

(d)   one of the persons mentioned in paragraphs (b) and (c) must be a medical practitioner.

 

(4)   For any particular patient, a service associated with an attendance item listed in Part 2 of the general medical services table does not apply if a service to which item 61321, 61324, 61325, 61329, 61345, 61349 or 61357 applies is provided in the same day; unless:

(a)    the attendance service is provided after the service where clinical management decisions are made; or

(b)   the decision to perform the service on the same day was made during the attendance service subject to clinical assessment.

 

1.2.2      Limitation of items 61321, 61324, 61325, 61329, 61345 and 61357

(1)   Item 61321, 61324, 61329, 61345 or 61357 are applicable not more than once in any 24 month period if the patient is 17 years old or older.

(2)   Item 61325 is applicable not more than twice in any 24 month period if the patient is 17 years old or older.

 

Group I4 – Nuclear Medicine Imaging

Subgroup 1 – Nuclear Medicine – Non-PET

Column 1

Item

Column 2

Description

Column 3

Fee ($)

61321

Single rest myocardial perfusion study for the assessment of extent and severity of viable and non-viable myocardium – with single photon emission tomography and with planar imaging, when performed on a patient who has left ventricular systolic dysfunction and probable or confirmed coronary artery disease, if:

(a)     using a single rest technetium-99m (Tc-99m) protocol; and

(b)     the service is requested by a specialist or a consultant physician; and

(c)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61325, 61329 or 61345 applies (R)

329.00

61324

Single stress myocardial perfusion study – with single photon emission tomography and with planar imaging, if:

(a)     the patient has symptoms of cardiac ischaemia where at least one of the following applies:

(i)       the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or

(ii)     the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or

(iii)    the patient has had a failed stress echocardiography provided under a service to which items 55141, 55143, 55145 or 55146 applies; or

(iv)   the patient has had an assessment of undue exertional dyspnoea of uncertain aetiology; and

(b)     the service includes resting ECG, continuous ECG monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(c)     the service is requested by a specialist or consultant physician; and

(d)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61325, 61329, 61345 or 61357 applies (R)

653.05

61325

Single rest myocardial perfusion study for the assessment of extent and severity of viable and non-viable myocardium – with single photon emission tomography and with planar imaging, when performed on a patient with left ventricular systolic dysfunction and probable or confirmed coronary artery disease, if:

(a)     using an initial rest study followed by redistribution study on the same day; and

(b)     using a thallous chloride-201 (Tl-201) protocol; and

(c)     the service is requested by a specialist or a consultant physician; and

(d)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61329 or 61345 applies (R)

329.00

61329

Combined stress and rest, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion – with single photon emission tomography and with planar imaging, if:

(a)     the patient has symptoms of cardiac ischaemia where at least one of the following applies:

(i)       the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or

(ii)     the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or

(iii)    the patient has had a failed stress echocardiography provided under a service to which item 55141, 55143, 55145 or 55146 applies; and

(b)     the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(c)     the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(d)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61345 or 61357 applies (R)

982.05

61345

Combined stress and rest, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion – with single photon emission tomography and with planar imaging, if:

(a)     the patient has symptoms of cardiac ischaemia where at least one of the following applies:

(i)       the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or

(ii)     the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or

(iii)    the patient has had a failed stress echocardiography provided under a service to which item 55141, 55143, 55145 or 55146 applies; or

(iv)   the patient has had an assessment of undue exertional dyspnoea of uncertain aetiology; and

(b)     the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(c)     the service is requested by a specialist or consultant physician; and

(d)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61329 or 61357 applies (R)

982.05

61349

Repeat combined stress and rest, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion—with single photon emission tomography and with planar imaging, if:

(a)     in the previous 24 months, the patient has had a single stress or combined rest and stress myocardial perfusion study performed under item 61324, 61329, 61345 or 61357 and has undergone a revascularisation procedure; and

(b)     the patient has one or more of the following symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy, where at least one of the following applies;

(i)       the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or

(ii)     the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or

(iii)    the patient has had a failed stress echocardiography provided under service to which item 55141, 55143, 55145 or 55146 applies; or

(iv)   the patient has had an assessment of undue exertional dyspnoea of uncertain aetiology; and

(c)     the service is requested by a specialist or a consultant physician; and

(d)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 or 11730 applies; and

For any particular patient, applicable not more than once in 12 months (R)

982.05

61357

Single stress myocardial perfusion study – with single photon emission tomography and with planar imaging, if:

(a)     the patient has symptoms of cardiac ischaemia where at least one of the following applies:

(i)       the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or

(ii)     the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or

(iii)    the patient has had a failed stress echocardiography provided under a service to which items 55141, 55143, 55145 or 55146 applies; or

(b)     the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(c)     the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(d)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61329 or 61345 applies (R)

653.05