Medicare Benefits Schedule - Item 18354

Search Results for Item 18354

View Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

18354

18354 - Additional Information

Item Start Date:
01-May-2003
Description Updated:
01-Nov-2014
Schedule Fee Updated:
01-Jul-2022

Group
T11 - Botulinum Toxin Injections

Botulinum Toxin Type A Purified Neurotixin Complex (Botox) or Clostridium Botulinum Type A Toxin-Haemagglutinin Complex (Dysport), injection of, for the treatment of dynamic equinus foot deformity (including equinovarus and equinovalgus) due to spasticity in an ambulant cerebral palsy patient, if:

(a)    the patient is at least 2 years of age; and

(b)    the treatment is for all or any of the muscles subserving one functional activity and supplied by one motor nerve,     with a maximum of 4 sets of injections for the patient on any one day (with a maximum of  2 sets of injections for     each lower limb), including all injections per set

(Anaes.)

Fee: $132.00 Benefit: 75% = $99.00 85% = $112.20

(See para TN.7.5, TN.11.1 of explanatory notes to this Category)


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.7.5

Regional or Field Nerve Blocks - (Items 18234 to 18298)

Items in the range 18234 - 18298 are intended to cover the injection of anaesthetic into the nerve or nerve sheath and not for the treatment of carpal tunnel or similar compression syndromes. 

Paravertebral nerve block item 18276 covers the provision of regional anaesthesia for surgical and related procedures for the management acute pain or of chronic pain related to radiculopathy. Blockade of lumbar paravertebral nerves should be claimed under 18276. Infiltration of the soft tissue of the paravertebral area for the treatment of other pain symptoms does not attract benefit under this item. Additionally, item 18276 does not cover zygo‑apophyseal joint blocks/injections. This procedure is covered under item 39013. 

Item 18292 may not be claimed for the injection of botulinum toxin, but may be claimed where a neurolytic agent (such as phenol) is used to treat the obturator nerve in patients receiving botulinum toxin injections under item 18354 for a dynamic foot deformity.

 

Related Items: 18234 18236 18238 18240 18242 18244 18248 18250 18252 18254 18256 18258 18260 18262 18264 18266 18268 18270 18272 18276 18278 18280 18282 18284 18286 18288 18292 18354 39013

Category 3 - THERAPEUTIC PROCEDURES

TN.11.1

Botulinum Toxin - (Items 18350 to 18379)

The Therapeutic Goods Administration (TGA) assesses each indication for the therapeutic use of botulinum toxin on an individual basis.  There are currently three botulinum toxin agents with TGA registration (Botox®, Dysport® and Xeomin®).  Each has undergone a separate evaluation of its safety and efficacy by the TGA as they are neither bioequivalent, nor dose equivalent.  When claiming under an item for the injection of botulinum toxin, only the botulinum toxin agent specified in the item can be used.  Benefits are not payable where an agent other than that specified in the item is used. 

The TGA assesses each indication for the therapeutic use of botulinum toxin by assessment of clinical evidence for its use in paediatric or adult patients.  Where an indication has been assessed for adult use, data has generally been assessed using patients over 12 years of age.  Paediatric indications have been assessed using data from patients under 18 years of age.  Botulinum toxin should only be administered to patients under the age of 18 where an item is for a paediatric indication, and patients over 12 years of age where the item is for an adult indication, unless otherwise specified. 

Items for the administration of botulinum toxin can only be claimed by a medical practitioner who is recognised as an eligible medical practitioner for the relevant indication under the arrangements under Section 100 of the National Health Act 1953 (the Act) relating to the use and supply of botulinum toxin.  The specialist qualifications required to administer botulinum toxin vary across the indications for which the medicine is listed on the PBS, and are detailed within the relevant PBS restrictions available at: www.pbs.gov.au/browse/section100-mf 

Item 18354 for the treatment of equinus, equinovarus or equinovalgus is limited to a maximum of 4 injections per patient on any day (2 per limb).  Accounts should be annotated with the limb which has been treated.  Item 18292 may not be claimed for the injection of botulinum toxin, but may be claimed where a neurolytic agent (such as phenol) is used, in addition to botulinum toxin injection(s), to treat the obturator nerve in patients with a dynamic foot deformity. 

Treatment under item 18375 or 18379 can only continue if the patient achieves at least a 50% reduction in urinary incontinence episodes from baseline from the start of week 6 through to the end of week 12 after the first treatment.  The term 'continue' means the patient can be retreated under item 18375 or 18379 at some point after the 12 week period (for example; 6 to 12 months after the first treatment).  This requirement is in line with the PBS listing for the supply of the medicine for this indication under Section 100 of the Act

Item 18362 for the treatment of severe primary axillary hyperhidrosis allows for a maximum number of 3 treatments per patient in a 12 month period, with no less than 4 months to elapse between treatments. 

Botulinum toxin which is not supplied and administered in accordance with the arrangements under Section 100 of the Act is not required to be provided free of charge to patients.  Where a charge is made for the botulinum toxin administered, it must be separately listed on the account and not billed to Medicare.  Since 1 September 2015, PBS patient co-payments have applied to botulinum toxin supplied and administered in accordance with the arrangements under Section 100 of the Act. 

The Department of Human Services (DHS) has developed a Health Practitioner Guideline to substantiate that a patient had a pre-existing condition at the time of the service which is located on the DHS website.

 

Related Items: 18350 18351 18353 18354 18360 18361 18362 18365 18366 18368 18369 18370 18372 18374 18375 18377 18379


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change