Medicare Benefits Schedule - Note DN.1.26

Discussions of the results, findings or interpretation of a study are reasonably expected to be part of a formal report. Discussion of these findings with a patient does not constitute a consult. Similarly, discussion(s) during the course of a study or to determine the safety or appropriateness of the study is part of the service and should not be claimed as a consult.

Related Items: 11717 11723 11735

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Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Ambulatory electrocardiogram monitoring, by a specialist or consultant physician, if the service:

(a) utilises a patient activated, single or multiple event memory recording device that:

(i) is connected continuously to the patient for between 7 and 30 days; and

(ii) is capable of recording for at least 20 seconds prior to each activation and for 15 seconds after each activation; and

(b) includes transmission, analysis, interpretation and reporting (including the indication for the investigation); and

(c) is for the investigation of recurrent episodes of:

1. unexplained syncope; or
2. palpitation; or
3. other symptoms where a cardiac rhythm disturbance is suspected and where infrequent episodes have occurred; and

(d) is not associated with a service to which item 11716, 11723, 11735, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable only once in any 3 month period

Note: the service does not apply if the patient is being provided with the service as part of an episode of:

1. hospital treatment; or
2. hospital‑substitute treatment.

Fee: $108.35 Benefit: 85% = $92.10

(See para DN.1.26, DR.1.1 of explanatory notes to this Category)

Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Ambulatory electrocardiogram monitoring, by a specialist or consultant physician, if the service:

(a) utilises a patient activated, single or multiple event recording, on a memory recording device that:

(i) is connected continuously to the patient for up to 7 days; and

(ii) is capable of recording for at least 20 seconds prior to each activation and for 15 seconds after each activation; and

(b) includes transmission, analysis, interpretation and formal report (including the indication for the investigation); and

(c) is for the investigation of recurrent episodes of:

(i) unexplained syncope; or

(ii) palpitation; or

(iii) other symptoms where a cardiac rhythm disturbance is suspected and where infrequent episodes have occurred; and

(d) is not associated with a service to which item 11716, 11717, 11735, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable only once in any 3 month period

Note: The service does not apply if the patient is an admitted patient.

Fee: $57.20 Benefit: 85% = $48.65

(See para DN.1.26, DR.1.1 of explanatory notes to this Category)

Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Continuous ambulatory electrocardiogram recording for 7 days, by a specialist or consultant physician, if the service:

(a) utilises intelligent microprocessor based monitoring, with patient triggered recording and symptom reporting capability, real time analysis of electrocardiograms and alerts and daily or live data uploads; and

(b) is for the investigation of:

(i) episodes of suspected intermittent cardiac arrhythmia or episodes of syncope; or

(ii) suspected intermittent cardiac arrhythmia in a patient who has had a previous cerebrovascular accident, is at risk of cerebrovascular accident or has had one or more previous transient ischemic attacks; and

(c) includes interpretation and report; and

(d) is not a service:

(i) provided in association with ambulatory blood pressure monitoring; or

(ii) associated with a service to which item 11716, 11717, 11723, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable not more than 4 times in any 12 month period

Note: The service does not apply if the patient is an admitted patient.

Fee: $140.80 Benefit: 85% = $119.70

(See para DN.1.26, DR.1.1 of explanatory notes to this Category)