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Category 6 - PATHOLOGY SERVICES
73386 - Additional Information
Genetic analysis, for a patient who is eligible for this service under clause 2.7.3A of the Pathology Services Table (see PR.7.1), of embryonic tissue from samples from 2 embryos, if:
(a) the analysis is:
(i) requested by a specialist or consultant physician; and
(ii) for the purpose of providing a pre‑implantation genetic test; and
(iii) performed on embryos that were produced in a single assisted reproductive treatment cycle; and
(b) the service is not a service to which item 73385 or 73387 applies for the same assisted reproductive treatment cycle
Applicable not more than once per assisted reproductive treatment cycle for the 2 embryos tested
Fee: $1,270.00 Benefit: 75% = $952.50 85% = $1,176.80
Category 3 - THERAPEUTIC PROCEDURES
Assisted Reproductive Technology ART Services - (Items 13200 to 13221)
Medicare benefits are not payable in respect of ANY other item in the Medicare Benefits Schedule, including Diagnostic Imaging and Pathology (with the exception of items 73384, 73385, 73386 and 73387) in lieu of or in connection with items 13200 - 13221. Specifically, Medicare benefits are not payable for these items in association with items 104, 105, 14203, 14206, 35631, 35632, 35637, 35641, pathology tests (not including pathology items 73384, 73385, 73386 and 73387) or diagnostic imaging.
A treatment cycle that is a series of treatments for the purposes of ART services is defined as beginning either on the day on which treatment by superovulatory drugs is commenced or on the first day of the patient's menstrual cycle, and ending either; not more than 30 days later, or if a service mentioned in item 13212, 13215 or 13221 is provided in connection with the series of treatments-on the day after the day on which the last of those services is provided.
The date of service in respect of treatment covered by Items 13200, 13201, 13203, 13209 and 13218 is DEEMED to be the FIRST DAY of the treatment cycle.
Items 13200, 13201, 13202 and 13203 are linked to the supply of hormones under the Section 100 (National Health Act) arrangements. Providers must notify Services Australia of Medicare card numbers of patients using hormones under this program, and hormones are only supplied for patients claiming one of these four items.
Medicare benefits are not payable for assisted reproductive services rendered in conjunction with surrogacy arrangements where surrogacy is defined as 'an arrangement whereby a woman agrees to become pregnant and to bear a child for another person or persons to whom she will transfer guardianship and custodial rights at or shortly after birth'.
NOTE: Items 14203 and 14206 are not payable for artificial insemination.
Category 6 - PATHOLOGY SERVICES
Items 73384 to 73387 (relating to pre implantation genetic testing under clause 2.7.3A of the pathology services table)—patient eligibility
A patient is eligible for a service described in any of items 73384 to 73387 only if:
(a) the patient or the patient’s reproductive partner:
- has an identified gene variant which places the patient at risk of having a pregnancy affected by a Mendelian or mitochondrial disorder; or
- is at risk of an autosomal dominant disorder which places the patient at risk of having a child who develops the autosomal dominant disorder; or
- has a chromosome re‑arrangement or copy number variant which places the patient at risk of having a pregnancy affected by a chromosome disorder; and
(b) there is no curative treatment for the disorder and there is severe limitation of quality of life despite contemporary management of the disorder; and
(c) the patient has previously had a consultation, with a specialist or consultant physician practising as a clinical geneticist, that included a discussion about the disorder.
- 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