Medicare Benefits Schedule - Item 63399

MRI–scan of cardiovascular system for the assessment of myocardial structure and function, if the service is requested by a consultant physician who has assessed the patient, and the request for the scan indicates:

1. the patient has suspected myocarditis after receiving a mRNA COVID-19 vaccine; and
2. the patient had symptom onset within 21 days of a mRNA COVID-19 vaccine administration; and
3. the results from the following examinations are inconclusive to form a diagnosis of myocarditis:
   (i) echocardiogram; and
   (ii) troponin; and
   (iii) chest X-ray.

Applicable not more than once in a patient’s lifetime (R) (Contrast)

Bulk bill incentive

(Anaes.)

Fee: $904.70 Benefit: 75% = $678.55 85% = $806.00

(See para IN.5.3 of explanatory notes to this Category)

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Item 63399 has been introduced temporarily to diagnose myocarditis that may occur after vaccination with the mRNA COVID-19 vaccines Comirnaty (Pfizer) and Spikevax (Moderna).

The Medical Services Advisory Committee (MSAC) recommended a temporary item to allow time for a full health technology assessment on the use of cardiac MRI in diagnosing myocarditis more broadly to be considered.

Item 63399 is for use in patients where:

• the patient has suspected myocarditis after receiving a mRNA COVID-19 vaccine; and
• the patient had symptom onset within 21 days of a mRNA COVID-19 vaccine administration; and
• myocarditis cannot be definitively diagnosed using conventional imaging and other diagnostic tests.

The item can be used once in a patient's lifetime after the first vaccine dose, second vaccine dose or booster dose.

The item commenced on 1 January 2022 and will be available until 31 December 2024, pending a full assessment by the MSAC.

This service is able to be performed on both partially and fully Medicare-eligible MRIs.

Related Items: 63399