Medicare Benefits Schedule - Note DR.1.1

Items 11716, 11717, 11723 or 11735 do not apply to a service unless:

(i)  the patient is referred to a specialist or consultant physician by a referring practitioner; or
(ii) the service is requested by a requesting practitioner.

Admitted patient

Item 11716, 11717, 11723 or 11735 do not apply to a service if the patient is an admitted patient.

An “admitted patient” includes an episode of hospital treatment and an episode of hospital-substitute treatment where a benefit is paid from a private health insurer.

Referred services

For referred services to which items 11716, 11717, 11723 or 11735 apply, the specialist or consultant physician who renders the service must:

(i)   manage the ongoing care of the patient; or
(ii)  perform an attendance to determine that testing is necessary, where the need for the test has not otherwise been scheduled; or
(iii) perform an attendance immediately after the test has been performed, at which clinical management decisions are discussed with the patient.

A service is taken to be referred if the specialist or consultant physician who renders the service to which items 11716, 11717, 11723 or 11735 applies is the patient’s treating practitioner, determines the need for a cardiac investigation that has not otherwise been scheduled, or performs a scheduled test but also provides an attendance where clinical management decisions are discussed with the patient.  Services in all other circumstances are considered to be requested.

Requested services

(i)   for requested services, items 11716, 11717, 11723 or 11735 do not apply to a service if the rendering specialist or consultant physician has performed a service to which an attendance applies for the same patient on the same day.

(ii)  definition of 'requesting practitioner' when applied to items 11716, 11717, 11723 or 11735 is as follows:

1. a medical practitioner (other than a specialist or consultant physician) requests that a specialist or consultant physician provide the service.
2. a specialist or consultant physician requests that a separate specialist or consultant physician provide the service.

Related Items: 11716 11717 11723 11735

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Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Continuous ambulatory electrocardiogram recording for 12 or more hours, by a specialist or consultant physician, if the service:

(a) is indicated for the evaluation of any of the following:

(i) syncope;

(ii) pre‑syncopal episodes;

(iii) palpitations where episodes are occurring more than once a week;

(iv) another asymptomatic arrhythmia is suspected with an expected frequency of greater than once a week;

(v) surveillance following cardiac surgical procedures that have an established risk of causing dysrhythmia; and

(b) utilises a system capable of superimposition and full disclosure printout of at least 12 hours of recorded electrocardiogram data (including resting electrocardiogram and the recording of parameters) and microprocessor based scanning analysis; and

(c) includes interpretation and report; and

(d) is not provided in association with ambulatory blood pressure monitoring; and

(e) is not associated with a service to which item 11704, 11705, 11707, 11714, 11717, 11723, 11735, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable only once in any 4 week period

Note: this services does not apply if the patient is being provided with the service as part of an episode of:

1. hospital treatment; or
2. hospital‑substitute treatment.

Fee: $184.40 Benefit: 85% = $156.75

(See para DN.1.28, DR.1.1 of explanatory notes to this Category)

Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Ambulatory electrocardiogram monitoring, by a specialist or consultant physician, if the service:

(a) utilises a patient activated, single or multiple event memory recording device that:

(i) is connected continuously to the patient for between 7 and 30 days; and

(ii) is capable of recording for at least 20 seconds prior to each activation and for 15 seconds after each activation; and

(b) includes transmission, analysis, interpretation and reporting (including the indication for the investigation); and

(c) is for the investigation of recurrent episodes of:

1. unexplained syncope; or
2. palpitation; or
3. other symptoms where a cardiac rhythm disturbance is suspected and where infrequent episodes have occurred; and

(d) is not associated with a service to which item 11716, 11723, 11735, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable only once in any 3 month period

Note: the service does not apply if the patient is being provided with the service as part of an episode of:

1. hospital treatment; or
2. hospital‑substitute treatment.

Fee: $108.35 Benefit: 85% = $92.10

(See para DN.1.26, DR.1.1 of explanatory notes to this Category)

Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Ambulatory electrocardiogram monitoring, by a specialist or consultant physician, if the service:

(a) utilises a patient activated, single or multiple event recording, on a memory recording device that:

(i) is connected continuously to the patient for up to 7 days; and

(ii) is capable of recording for at least 20 seconds prior to each activation and for 15 seconds after each activation; and

(b) includes transmission, analysis, interpretation and formal report (including the indication for the investigation); and

(c) is for the investigation of recurrent episodes of:

(i) unexplained syncope; or

(ii) palpitation; or

(iii) other symptoms where a cardiac rhythm disturbance is suspected and where infrequent episodes have occurred; and

(d) is not associated with a service to which item 11716, 11717, 11735, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable only once in any 3 month period

Note: The service does not apply if the patient is an admitted patient.

Fee: $57.20 Benefit: 85% = $48.65

(See para DN.1.26, DR.1.1 of explanatory notes to this Category)

Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Continuous ambulatory electrocardiogram recording for 7 days, by a specialist or consultant physician, if the service:

(a) utilises intelligent microprocessor based monitoring, with patient triggered recording and symptom reporting capability, real time analysis of electrocardiograms and alerts and daily or live data uploads; and

(b) is for the investigation of:

(i) episodes of suspected intermittent cardiac arrhythmia or episodes of syncope; or

(ii) suspected intermittent cardiac arrhythmia in a patient who has had a previous cerebrovascular accident, is at risk of cerebrovascular accident or has had one or more previous transient ischemic attacks; and

(c) includes interpretation and report; and

(d) is not a service:

(i) provided in association with ambulatory blood pressure monitoring; or

(ii) associated with a service to which item 11716, 11717, 11723, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable not more than 4 times in any 12 month period

Note: The service does not apply if the patient is an admitted patient.

Fee: $140.80 Benefit: 85% = $119.70

(See para DN.1.26, DR.1.1 of explanatory notes to this Category)