Medicare Benefits Schedule - Note IN.4.2

Item indication

A service provided under new item 61325 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. This item allows the use of an initial rest study followed by redistribution study, later the same day, with or without 24 hour imaging, with thallous chloride-201 (Tl-201).

Claiming

This item can be claimed twice in a 24 month period, however it would be expected that the item would be claimed twice in a 24 hour period to reflect the requirements of the study.

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: 61325

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Bulk bill incentive

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:

(i) an initial rest study followed by a redistribution study on the same day; and

(ii) a thallous chloride‑201 (Tl‑201) 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, 61321, 61329, 61345, 61398 or 61406 applies; and

(e) if the patient is 17 years or older:

(i) a service to which item 61321, 61329, 61345, 61398 or 61406 applies has not been provided to the patient in the previous 24 months; and

(ii) the service is applicable only twice each 24 months (R)

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

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