Medicare Benefits Schedule - Note DN.1.15

Capsule endoscopy is primarily used to view the small bowel, which cannot be viewed by upper gastrointestinal endoscopy and colonoscopy.  

Capsule endoscopy imaging must be kept in a manner that facilitates retrieval on the basis of the patient's name and date of service. Records must be retained for a period of 2 years commencing on the day on which the service was rendered.

The Conjoint Committee comprises representatives from the Gastroenterological Society of Australia (GESA), the Royal Australasian College of Physicians (RACP) and the Royal Australasian College of Surgeons (RACS). For the purposes of Items 11820 and 11823, specialists or consultant physicians performing this procedure must have endoscopic training recognised by The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy, and the Department of Human Services notified of that recognition. 

Related Items: 11820 11823

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Capsule endoscopy to investigate an episode of obscure gastrointestinal bleeding, using a capsule endoscopy device (including administration of the capsule, associated endoscopy procedure if required for placement, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered) if:

(a) the service is provided to a patient who:

(i) has overt gastrointestinal bleeding; or

(ii) has gastrointestinal bleeding that is recurrent or persistent, and iron deficiency anaemia that is not due to coeliac disease, and, if the patient also has menorrhagia, has had the menorrhagia considered and managed; and

(b)    an upper gastrointestinal endoscopy and a colonoscopy have been performed on the patient and have not identified the cause of the
   bleeding; and

(c)  the service has not been provided to the same patient on more than 2 occasions in the preceding 12 months; and

(d)  the service is performed by a specialist or consultant physician with endoscopic training that is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and

(e)   the service is not associated with a service to which item 30680, 30682, 30684 or 30686 applies

Fee: $1,353.15 Benefit: 75% = $1,014.90 85% = $1,254.45

(See para DN.1.15 of explanatory notes to this Category)

Capsule endoscopy to conduct small bowel surveillance of a patient diagnosed with Peutz-Jeghers Syndrome, using a

capsule endoscopy device approved by the Therapeutic Goods Administration (including administration of the capsule, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered) if:

(a) the service is performed by a specialist or consultant physician with endoscopic training that is recognised by

the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and

(b) the item is performed only once in any 2 year period; and

(c) the service is not associated with balloon enteroscopy.

Fee: $1,353.15 Benefit: 75% = $1,014.90 85% = $1,254.45

(See para DN.1.15 of explanatory notes to this Category)