Medicare Benefits Schedule - Note TN.8.61

The fee for implantation of the loop recorder (item 38285) covers the initial programming and testing of the device for satisfactory rhythm capture. Benefits are payable only once per day. 

The term "recurrent" refers to more than one episode of syncope, where events occur at intervals of 1 week or longer. The term "other available cardiac investigations" includes the following:

• a complete history and physical examination that excludes a primary neurological cause of syncope and does not exclude a cardiac cause;
• electrocardiography (ECG) (items 11704, 11705, 11707, 11714);
• echocardiography (items 55126, 55127, 55128, 55129, 55132, 55133, 55134);
• continuous ECG recording or ambulatory ECG monitoring (items 11716, 11717, 11723, 11735);
• up-right tilt table test (item 11724); and
• cardiac electrophysiological study, unless there is reasonable medical reason to waive this requirement (item 38209).

Related Items: 38285

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Multiple Operation Rule

Insertion of implantable ECG loop recorder, by a specialist or consultant physician, for the diagnosis of a primary disorder, including initial programming and testing, if:

(a) the patient has recurrent unexplained syncope and does not have a structural heart defect associated with a high risk of sudden cardiac death; and

(b) a diagnosis has not been achieved through all other available cardiac investigations; and

(c) a neurogenic cause is not suspected

(Anaes.)

Fee: $169.80 Benefit: 75% = $127.35 85% = $144.35

(See para TN.8.61, TN.8.211 of explanatory notes to this Category)