Medicare Benefits Schedule - Note TN.8.296

Item 42504 provides for a standalone procedure for the implantation of micro-bypass glaucoma surgery device or devices into the suprachoroidal space or trabecular meshwork for the treatment of glaucoma patients if conservative therapies have failed, are likely to fail, or are contraindicated.

Item 42705 can provide for the implantation of a micro-bypass glaucoma surgery device or devices into the suprachoroidal space or trabecular meshwork, however 42504 is for a standalone procedure.

The suprachoroidal and supraciliary spaces are contiguous and are potential spaces opened by surgery to allow drainage of aqueous humour, and the terms are used interchangeably.

Related Items: 42504 42705

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Multiple Operation Rule

Implantation of a micro-bypass glaucoma surgery device or devices into the suprachoroidal space or the trabecular meshwork, if conservative therapies have failed, are likely to fail, or are contraindicated (H)

(Anaes.)

Fee: $350.85 Benefit: 75% = $263.15

(See para TN.8.296 of explanatory notes to this Category)

Multiple Operation Rule

Lens extraction and insertion of intraocular lens, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye, performed in association with insertion of a micro-bypass glaucoma surgery device or devices into the suprachoroidal space or trabecular meshwork, in a patient diagnosed with open angle glaucoma who is not adequately responsive to topical anti‑glaucoma medications or who is intolerant of anti‑glaucoma medication (H)

(Anaes.)

Fee: $1,062.90 Benefit: 75% = $797.20

(See para TN.8.296 of explanatory notes to this Category)