Medicare Benefits Schedule - Note PN.2.8

Please note that pathology providers who bill item 66839 must claim this within the same episode as item 66838 where initial vitamin B12 result is inconclusive or abnormal.

Lethargy/tiredness alone is not an appropriate indication for vitamin B12 testing. Presence of other symptoms of, or risk factors for, vitamin B12 deficiency along with lethargy/tiredness may indicate vitamin B12 testing is appropriate. Other symptoms may include (but are not limited to):

• abnormal findings on a blood count, such as anaemia or macrocytosis
• cognitive difficulties such as difficulty concentrating or short-term memory loss (sometimes described as 'brain fog'), which can also be symptoms of delirium or dementia
• eyesight problems related to optic nerve dysfunction:
  • blurred vision
  • optic atrophy
  • visual field loss (scotoma)
• glossitis
• neurological or mobility problems related to peripheral neuropathy, or to central nervous system disease including myelopathy (spinal cord disease):
  • balance issues and falls caused by impaired proprioception (the ability to sense movement, action and location) and linked to sensory ataxia (which may have been caused by spinal cord damage)
  • impaired gait
  • pins and needles or numbness (paraesthesia)
• symptoms or signs of anaemia that suggest iron treatment is not working properly during pregnancy or breastfeeding

Clinical conditions with a recognised risk of vitamin B12 deficiency include but are not limited to:

• Malabsorption disorders, including coeliac disease
• Gastrointestinal disorders, including atrophic gastritis
• Autoimmune conditions, including type 1 diabetes.

Related Items: 66838 66839

• Previous - Note PN.2.7
• Next - Note PN.3.1

Quantification of either or both of total vitamin B12 and holotranscobalamin

Applicable not more than once in 11 months

Fee: $23.60 Benefit: 75% = $17.70 85% = $20.10

(See para PN.1.2, PN.2.8 of explanatory notes to this Category)

Quantification of methylmalonic acid or homocysteine, rendered in the same patient episode as a service to which item 66838 applies if the result of that service is inconclusive or abnormal

Applicable not more than once in 11 months

Fee: $42.95 Benefit: 75% = $32.25 85% = $36.55

(See para PN.1.2, PN.2.8 of explanatory notes to this Category)