Medicare Benefits Schedule - Note IN.4.1

Search Results for Note IN.4.1

View Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.4.1

Single Rest Myocardial Perfusion Study - Item 61321 and 61422

Item interpretation

A service provided under new items 61321 or 61422 is for a single rest myocardial perfusion study (MPS) for the assessment of extent and severity of viable and non-viable heart tissue (myocardium), when performed on a patient with left ventricular systolic dysfunction, using a single rest technetium-99m (Tc-99m) protocol for item 61321 or an equivalent protocol to the single rest technetium-99m (Tc-99m) protocol when technetium is not available using item 61422.

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: 61321 61422


Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

61321

61321 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
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.4.2

Single rest myocardial perfusion study for the assessment of the extent and severity of viable and non‑viable myocardium, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has left ventricular systolic dysfunction and probable or confirmed coronary artery disease; and

(b) the service uses a single rest technetium‑99m (Tc‑99m) protocol; and

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

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61325, 61329, 61332, 61345, 61380, 61398, 61406 or 61422 applies; and

(e) if the patient is 17 years or older—a service to which this item, or item 61325, 61329, 61332, 61345, 61380, 61398, 61406 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $329.00 Benefit: 75% = $246.75 85% = $279.65

(See para IN.0.19, IN.4.1, IR.4.1, IR.4.2 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61422

61422 - Additional Information

Item Start Date:
01-Dec-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.2

Single rest myocardial perfusion study for the assessment of the extent and severity of viable and non‑viable myocardium, with PET, if:

(a) the patient has left ventricular systolic dysfunction and probable or confirmed coronary artery disease; and

(b) technetium is not available and the service uses an equivalent protocol to the single rest technetium‑99m (Tc‑99m) protocol; and

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

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61414 applies

Applicable not more than once in 24 months (R)

Item 61422 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $329.00 Benefit: 75% = $246.75 85% = $279.65

(See para IN.0.19, IN.4.1, IR.4.2 of explanatory notes to this Category)


Legend

  • 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