Medicare Benefits Schedule - Note PN.7.12

Testing for pathogenic or likely pathogenic gene variants associated with neuromuscular disorders (item 73434) should include, but is not limited to, any one of the following genes: DMPK, CNBP, HTT, PABPN1, C9orf72, AR, SMN1, PRNP, MTND1, MT-ND4, MT-ND4L, MT-ND6, MT-TK, MT-L1, MT-ATP6, FXN, ATN1; or all five of the following genes: ATXN1, ATXN2, ATXN3, CACNA1A, ATXN7.

Related Items: 73434

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Detection of pathogenic or likely pathogenic gene variants, requested by a specialist or consultant physician, for any of the following:

(a) a patient with a suspected neuromuscular disorder;

(b) a relative of a patient with a pathogenic or likely pathogenic germline gene variant associated with a neuromuscular disorder (confirmed by laboratory findings);

(c) the reproductive partner of a patient with a recessive pathogenic or likely pathogenic germline gene variant associated with a neuromuscular disorder (confirmed by laboratory findings)

Applicable once per gene per lifetime

Fee: $392.00 Benefit: 75% = $294.00 85% = $333.20

(See para PN.7.11, PN.7.12 of explanatory notes to this Category)