Medicare Benefits Schedule - Note IN.2.1

Heart rate during CTCA should be less than 65 beats per minute wherever possible, and sublingual glyceryl trinitrate (GTN) should be administered immediately prior to scanning where clinically appropriate.

The presence of coronary calcium alone does not preclude CTCA.

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 separate consultation. 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 separate consultation.

Indication (b)(iv) of the item recognises the increasing role of CTCA as an alternative to selective coronary angiography (invasive) in the assessment of the coronary arteries (including bypass grafts).

The service only applies if the patient meets the requirements of Notes: TR.8.3 (item 38247), TR.8.2 (item 38249) or item 38252 if subclause (iv) of the item applies.

Related Items: 38247 38249 38252 57364

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Multiple Operation Rule

Note: (acute coronary syndrome - graft) the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: TR.8.2 and TR.8.5

Selective coronary and graft angiography:

(a) for a patient who is eligible for the service under clause 5.10.17A; and

(b) with placement of one or more catheters and injection of opaque material into the native coronary arteries; and

(c) if free coronary grafts attached to the aorta or direct internal mammary artery grafts are present—with placement of one or more catheters and injection of opaque material into those grafts (irrespective of the number of grafts); and

(d) with or without left heart catheterisation, left ventriculography or aortography; and

(e) including all associated imaging;

other than a service associated with a service to which item 38200, 38203, 38206, 38244, 38248, 38249, 38251 or 38252 applies

(Anaes.)

Fee: $1,559.20 Benefit: 75% = $1,169.40 85% = $1,460.50

(See para IN.2.1, TN.8.215, TN.8.216, TR.8.2, TR.8.5 of explanatory notes to this Category)

Multiple Operation Rule

Note: (stable coronary syndrome - graft) the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: TR.8.3 and TR.8.5

Selective coronary and graft angiography:

(a) for a patient who is eligible for the service under clause 5.10.17B; and

(b) as part of the management of the patient; and

(c) with placement of one or more catheters and injection of opaque material into native coronary arteries; and

(d) if free coronary grafts attached to the aorta or direct internal mammary artery grafts are present—with placement of one or more catheters and injection of opaque material into those grafts (irrespective of the number of grafts); and

(e) with or without left heart catheterisation, left ventriculography or aortography; and

(f) including all associated imaging;

other than a service associated with a service to which item 38200, 38203, 38206, 38244, 38247, 38248, 38251 or 38252 applies—applicable once each 3 months

(Anaes.)

Fee: $1,559.20 Benefit: 75% = $1,169.40 85% = $1,460.50

(See para IN.2.1, TN.8.215, TN.8.216, TR.8.3, TR.8.5, TR.8.6 of explanatory notes to this Category)

Multiple Operation Rule

Note: (pre-operative assessment - graft) the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: TR.8.5

Selective coronary and graft angiography:

(a) for a symptomatic patient with valvular or other non-coronary structural heart disease; and

(b) as part of the management of the patient for:

(i) pre-operative assessment for planning non-coronary cardiac surgery, including by transcatheter approaches; or

(ii) evaluation of valvular heart disease or other non-coronary structural heart disease where clinical impression is discordant with non-invasive assessment; and

(c) with placement of one or more catheters and injection of opaque material into the native coronary arteries; and

(d) if free coronary grafts attached to the aorta or direct internal mammary artery grafts are present—with placement of one or more catheters and injection of opaque material into those grafts (irrespective of the number of grafts); and

(e) with or without left heart catheterisation, left ventriculography or aortography; and

(f) including all associated imaging;

other than a service associated with a service to which item 38200, 38203, 38206, 38244, 38247, 38248, 38249 or 38251 applies—applicable once each 12 months

(Anaes.)

Fee: $1,559.20 Benefit: 75% = $1,169.40 85% = $1,460.50

(See para IN.2.1, TN.8.215, TN.8.216, TR.8.5 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: TR.8.3 (item 38247), TR.8.2 (item 38249) or item 38252 if subclause (iv) applies.

Computed tomography of the coronary arteries performed on a minimum of a 64 slice (or equivalent) scanner, if:

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

(b) at least one of the following apply to the patient:

(i) the patient has stable symptoms and newly recognised left ventricular systolic dysfunction of unknown aetiology;

(ii) the patient requires exclusion of coronary artery anomaly or fistula;

(iii) the patient will be undergoing non-coronary cardiac surgery;

(iv) the patient meets the criteria to be eligible for a service to which item 38247, 38249 or 38252 applies, but as an alternative to selective coronary angiography will require an assessment of the patency of one or more bypass grafts

(R) 

(Anaes.)

Fee: $758.30 Benefit: 75% = $568.75 85% = $659.60

(See para IN.0.19, IN.2.1, TR.8.2, TR.8.3, TR.8.6 of explanatory notes to this Category)