Medicare Benefits Schedule - Note IN.4.3

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.4.3

Myocardial Perfusion Study Items

Stress Myocardial Perfusion Study Items (61311, 61324, 61329, 61332, 61345, 61349, 61357, 61365, 61377, 61380, 61394, 61398, 61406, 61410, 61414 and 61418)

Functional studies include stress echocardiograms and nuclear myocardial perfusion studies.

In most cases, stress echocardiography and myocardial perfusion studies provide equivalent information. Consideration should be given to the radiation burden of any test that is requested when determining the appropriate modality for a patient, the patient should be fully informed and involved in this decision.

A calcium score of zero is normal in adults and clinician judgement should be applied for scores of 0–10 (does not apply to persons under 17 years).

Results

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: 61311 61324 61329 61332 61345 61349 61357 61365 61377 61380 61394 61398 61406 61410 61414 61418


Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

61311

61311 - Additional Information

Item Start Date:
14-Sep-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with PET if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

  1. the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;
  2. the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;
  3. the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting ECG, continuous ECG monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61394, 61398, 61380, 61406, 61414 or 61422 applies

Applicable not more than once in 24 months (R)    

Item 61311 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61324

61324 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting ECG, continuous ECG monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a specialist or consultant physician; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61325, 61329, 61332, 61377, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61329

61329 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61332, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61332

61332 - Additional Information

Item Start Date:
14-Sep-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with PET, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

  1. the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;
  2. the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;
  3. the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61345, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies

Applicable not more than once in 24 months (R)

Item 61332 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61345

61345 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a specialist or consultant physician; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies (R); and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61349

61349 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) both:

(i) a service has been provided to the patient in the previous 24 months to which this item, or item 61311, 61324, 61329, 61332, 61337, 61345, 61357, 61365, 61380, 61394, 61398, 61406, 61410, 61414 or 61418, applies; and

(ii) the patient has subsequently undergone a revascularisation procedure; and

(b) the patient has one or more symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(d) the service is requested by a specialist or a consultant physician; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61365, 61410 or 61418 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61365, 61410 or 61418, applies has not been provided to the patient in the previous 12 months (R)

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61357

61357 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which items 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61377, 61380, 61394, 61398, 61406, or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61365

61365 - Additional Information

Item Start Date:
01-Dec-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with PET, if:

(a) in the previous 24 months, the patient has had a service performed to which item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61414 applies and has subsequently undergone a revascularisation procedure; and

(b) the patient has one or more symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) at least one of the following applies:

  1. the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;
  2. the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;
  3. the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(d) the service is requested by a specialist or a consultant physician; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61349, 61410 or 61418 applies

Applicable not more than once in 12 months (R)

Item 61365 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61377

61377 - Additional Information

Item Start Date:
01-Dec-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with PET, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422 applies

Applicable not more than once in 24 months (R)

Item 61377 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61380

61380 - Additional Information

Item Start Date:
01-Dec-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with PET, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the services is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61394, 61398, 61406, 61414 or 61422 applies

Applicable not more than once in 24 months (R)

Item 61380 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61394

61394 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a specialist or consultant physician; and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61398, 61406, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61398, 61406 or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61398

61398 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the services is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61406, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61406

61406 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a specialist or consultant physician; and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61377, 61345, 61357, 61380, 61394, 61398, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61410

61410 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) both:

(i) a service has been provided to the patient in the previous 24 months to which this item, or item 61311, 61324, 61329, 61332, 61345, 61349, 61357, 61365, 61377, 61380, 61394, 61398, 61406, 61414 or 61418, applies; and

(ii) the patient has subsequently undergone a revascularisation procedure; and

(b) the patient has one or more symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(d) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730 or 61418 applies; and

(f) if the patient is 17 years or older—a service to which item 61349, 61365 or 61418 applies has not been provided to the patient in the previous 12 months

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61414

61414 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61398 or 61406, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61418

61418 - Additional Information

Item Start Date:
01-Dec-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with PET, if:

(a) in the previous 24 months, the patient has had a service performed to which item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61414 applies, and has subsequently undergone a revascularisation procedure; and

(b) the patient has one or more symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(d) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(e) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61349, 61365 or 61410 applies

Applicable not more than once in 12 months (R)

Item 61418 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)


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