Medicare Benefits Schedule - Note IN.1.4

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.1.4

Echocardiography - Primary valvular

Recommended intervals adapted from the 2014 American Heart Association/American College of Cardiology Guideline for the Management of Patients with Valvular Heart Disease.

The guidelines are available at: http://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_462851.pdf

Mild to moderate disease:

  1. Aortic stenosis should have a repeat every 3–5 years for mild disease and 1–2 years for moderate disease.
  2. Other valvular disease should NOT have repeat imaging more frequently than every 3 years for mild disease and every 1–2 years for moderate disease.

Severe disease:

  1. should be monitored in line with the guidelines.

Provider

Providers of this item number should meet the Level 1 requirements described in the CSANZ Guidelines for Training and Performance in Adult Echocardiography or equivalent. https://www.csanz.edu.au/wp-content/uploads/2015/04/Adult-Echo_2015-February.pdf

Results

Discussions of the results, findings or interpretation of a study are reasonably expected to be part of a formal report. Discussion of these findings with a patient does not constitute a consult. Similarly, discussion(s) during the course of a study or to determine the safety or appropriateness of the study is part of the service and should not be claimed as a consult.

 

Related Items: 55127 55128


Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

55127

55127 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Repeat serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, for the investigation of known valvular dysfunction, if:

(a)     the service involves all of the following, where possible:

(i)    assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

(ii)   assessment of right ventricular structure and function with quantitative assessment; and

(iii)  assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)  assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)   assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)  assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

(vii) assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

(b)    the service is requested by a specialist or consultant physician; and

(c)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146),  or an item in Subgroup 2 (except items 55118 and 55130), or an item in Subgroup 3 applies (R)

Fee: $234.15 Benefit: 75% = $175.65 85% = $199.05

(See para IN.0.19, IN.1.4, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55128

55128 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Repeat serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, for the investigation of known valvular dysfunction, if:

(a)     the service involves all of the following, where possible:

(i)      assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

(ii)     assessment of right ventricular structure and function with quantitative assessment; and

(iii)    assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)    assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)     assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)    assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

(vii)   assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

(b)    the service is requested by a medical practitioner (other than a specialist or consultant physician) at, or from, a practice location in:

(i)      a Modified Monash 3 area; or

(ii)     a Modified Monash 4 area; or

(iii)    a Modified Monash 5 area; or

(iv)    a Modified Monash 6 area; or

(v)     a Modified Monash 7 area; and

(c)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146), or an item in Subgroup 2 (except items 55118 and 55130) or an item in Subgroup 3 applies (R)

 

Fee: $234.15 Benefit: 75% = $175.65 85% = $199.05

(See para IN.0.19, IN.1.4, IR.1.2, IR.1.3 of explanatory notes to this Category)


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  • 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