Medicare Benefits Schedule - Note IN.2.2

Time restriction and claiming guidance for item 57360

Benefits are not payable for item 57360 more than once in a 5 year period following a service to which itself or 57364 applies that detected no obstructive coronary artery disease unless the patient meets the eligibility criteria for selective invasive coronary angiography (items 38244, 38247, 38248 or 38249).  The criteria for these items are set out in explanatory notes TR8.2 and TR8.3. 

The 5 year frequency restriction on the claiming of this item does not apply if obstructive coronary artery disease was detected as part of the previous service.

The 5 year frequency restriction does not apply if no obstructive coronary disease was detected at the previous service AND the patient meets the criteria for item 38244, 38247, 38248 or 38249.

Item 57360 can be claimed if the patient has known obstructive coronary disease.

Related Items: 57360

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Bulk bill incentive

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

(a) the request is made by a specialist or consultant physician; and

(b) the patient has stable or acute symptoms consistent with coronary ischaemia; and

(c) the patient is at low to intermediate risk of an acute coronary event, including having no significant cardiac biomarker elevation and no electrocardiogram changes indicating acute ischaemia (R) 

Note:  See explanatory note IN.2.2 for claiming restrictions for this item.

(Anaes.)

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

(See para IN.0.19, IN.2.2 of explanatory notes to this Category)