Medicare Benefits Schedule - Note DN.1.31

The formal report is separate to any letter and entails interpretation of the trace commenting on the significance of the trace findings and their relationship to clinical decision making for the patient in their clinical context, in addition to any measurements taken or automatically generated.

Related Items: 11704 11705

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Twelve‑lead electrocardiography, trace and formal report, by a specialist or a consultant physician, if the service:

(a) is requested by a requesting practitioner; and

(b) is not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies.

Note: the following are also requirements of the service:

1. a formal report is completed; and
2. a copy of the formal report is provided to the requesting practitioner; and
3. the service is not provided to the patient as part of an episode of hospital treatment or hospital-substitute treatment; and
4. is not provided in association with an attendance item (Part 2 of the schedule); and
5. the specialist or consultant physician who renders the service does not have a financial relationship with the requesting practitioner.

Fee: $34.40 Benefit: 85% = $29.25

(See para DN.1.31, DR.1.4 of explanatory notes to this Category)

Twelve‑lead electrocardiography, formal report only, by a specialist or a consultant physician, if the service:

(a) is requested by a requesting practitioner; and

(b) is not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable not more than twice on the same day

Note: the following are also requirements of the service:

1. a formal report is completed; and
2. a copy of the formal report is provided to the requesting practitioner; and
3. the specialist or consultant physician who renders the service does not have a financial relationship with the requesting practitioner.

Fee: $20.25 Benefit: 75% = $15.20 85% = $17.25

(See para DN.1.31, DR.1.4 of explanatory notes to this Category)