Medicare Benefits Schedule - Note DN.1.21

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Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

DN.1.21

Fraction of Exhaled Nitric Oxide (Item 11507) and Cardiopulmonary Exercise Testing (Item 11508)

Services billed to item 11507 should meet the following quality standards: 

  • An Official ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications: Am J Respir Crit Care Med Vol 184. pp 602–615, 2011 DOI: 10.1164/rccm.912011ST.
  • ATS/ERS Recommendations for Standardized Procedures for the Online and Offline Measurement of Exhaled Lower Respiratory Nitric Oxide and Nasal Nitric Oxide, 2005: Am J Respir Crit Care Med Vol 171. pp 912–930, 2005 DOI: 10.1164/rccm.200406-710ST
    Fewer than three traces will be accepted as billable under item 11507 if three reproducible loops are difficult to achieve for clinical reasons. The clinical reason(s) for not achieving three reproducible loops must be documented.

Services billed to item 11508 should meet the following quality standards:  

  • ATS/ACCP Statement on Cardiopulmonary Exercise Testing: Am J Respir Crit Care Med Vol 167. pp 211–277, 2003 DOI: 10.1164/rccm.167.2.211.

Related Items: 11507 11508


Related Items

Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

11507

11507 - Additional Information

Item Start Date:
01-Nov-2018
Description Start Date:
01-Nov-2018
Schedule Fee Start Date:
01-Nov-2018

Measurement of spirometry:

(a) that includes continuous measurement of the relationship between flow and volume during expiration or during expiration and inspiration, performed before and after inhalation of a bronchodilator; and

(b) fractional exhaled nitric oxide (FeNO) concentration in exhaled breath;

if:

(c) the measurement is performed:

(i) under the supervision of a specialist or consultant physician; and

(ii) with continuous attendance by a respiratory scientist; and

(iii) in a respiratory laboratory equipped to perform complex lung function tests; and

(d) a permanently recorded tracing and written report is provided; and

(e) 3 or more spirometry recordings are performed unless difficult to achieve for clinical reasons;

each occasion at which one or more such tests are performed

Not applicable to a service associated with a service to which item 11503, 11512 or 22018 applies

Fee: $100.20 Benefit: 75% = $75.15 85% = $85.20

(See para DN.1.21 of explanatory notes to this Category)

Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

11508

11508 - Additional Information

Item Start Date:
01-Nov-2018
Description Start Date:
01-Nov-2018
Schedule Fee Start Date:
01-Nov-2018

Maximal symptom‑limited incremental exercise test using a calibrated cycle ergometer or treadmill, if:

(a) the test is performed for the evaluation of:

(i) breathlessness of uncertain cause from tests performed at rest; or

(ii) breathlessness out of proportion with impairment due to known conditions; or

(iii) functional status and prognosis in a patient with significant cardiac or pulmonary disease for whom complex procedures such as organ transplantation are considered; or

(iv) anaesthetic and peri‑operative risks in a patient undergoing major surgery who is assessed as substantially above average risk after standard evaluation; and

(b) the test has been requested by a specialist or consultant physician following professional attendance on the patient by the specialist or consultant physician; and

(c) a respiratory scientist and a medical practitioner are in constant attendance during the test; and

(d) the test is performed in a respiratory laboratory equipped with airway management and defibrillator equipment; and

(e) there is continuous measurement of at least the following:

(i) work rate;

(ii) pulse oximetry;

(iii) respired oxygen and carbon dioxide partial pressures and respired volumes;

(iv) ECG;

(v) heart rate and blood pressure; and

(f) interpretation and preparation of a permanent report is provided by a consultant respiratory physician who is also responsible for the supervision of technical staff and quality assurance

Fee: $290.80 Benefit: 75% = $218.10 85% = $247.20

(See para DN.1.21 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