Medicare Benefits Schedule - Note DN.1.16

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Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

DN.1.16

Administration of Thyrotropin Alfa-rch for the Detection of Recurrent Well-differentiated Thyroid Cancer - (Item 12201)

Thyrotropin alfa-rch is a diagnostic agent that allows patients to remain on thyroid hormone therapy while being assessed for recurrent cancer.  This item was introduced following an assessment by the Medical Services Advisory Committee (MSAC) of the available evidence relating to the safety, effectiveness and cost-effectiveness of thyrotropin alfa-rch.  MSAC found that the use of thyrotropin alfa-rch is associated with a lower diagnostic accuracy than when the patient has withdrawn from thyroid hormone therapy.  Accordingly, benefits are payable under the item only for patients in whom thyroid hormone therapy withdrawal is medically contraindicated and where concurrent whole body study using radioactive iodine and serum thyroglobulin are undertaken.  Services provided to patients who do not demonstrate the indications set out in item 12201 do not attract benefits under the item.

"Severe psychiatric illness" is defined as patients with a severe pre-existing psychiatric illness who are currently under specialist psychiatric care.

The item includes the cost of supplying thyrotropin alfa-rch and the equivalent of a subsequent specialist attendance.  "Administration" means an attendance by the specialist or consultant physician (the administering practitioner) that includes:

-           an assessment that the patient meets the criteria prescribed by the item;

             the supply of thyrotropin alfa-rch;

-           ensuring that thyrotropin alfa-rch is injected (either by the administering practitioner or by another practitioner) in two doses at 24 hour intervals, with the second dose being administered 72 hours prior to whole body study with radioactive iodine and serum thyroglobulin test; and

-           arranging the whole body radioactive iodine study and the serum thyroglobulin test.

Where thyrotropin alfa-rch is injected by the administering practitioner, benefits are not payable for an attendance on the day the second dose is administered.  Where thyrotropin alfa-rch is injected by: a general practitioner - benefits are payable under a Level A consultation (item 3); other practitioners - benefits are payable under item 52.

Related Items: 12201


Related Items

Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

12201

12201 - Additional Information

Item Start Date:
01-May-2004
Description Start Date:
01-May-2004
Schedule Fee Start Date:
01-Nov-2012

Administration, by a specialist or consultant physician in the practice of his or her specialty, of thyrotropin alfa-rch (recombinant human thyroid-stimulating hormone), and arranging services to which both items 61426 and 66650 apply,


for the detection of recurrent well-differentiated thyroid cancer in a patient who:


(a)    has had a total thyroidectomy and one ablative dose of radioactive iodine; and

(b)    is maintained on thyroid hormone therapy; and

(c)    is at risk of recurrence; and

(d)        on at least one previous whole body scan or serum thyroglobulin test when withdrawn from thyroid hormone therapy did not have evidence of well differentiated thyroid cancer; and


    (i)    withdrawal from thyroid hormone therapy resulted in severe psychiatric disturbances when hypothyroid; or

    (ii)    withdrawal is medically contraindicated because the patient has:

        -    unstable coronary artery disease; or

        -    hypopituitarism ; or

        -    a high risk of relapse or exacerbation of a previous severe psychiatric illness


payable once only in any twelve month period.

Fee: $2,392.90 Benefit: 75% = $1,794.70 85% = $2,311.20

(See para DN.1.16 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