Medicare Benefits Schedule - Note IR.0.1

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IR.0.1

Stress echocardiography indications and requirements of use

1. For any particular patient, item 55141, 55143, 55145 or 55146 applies if one or more of the following is applicable:

  1. if the patient displays one or more of the following symptoms of typical or atypical angina:
    1. constricting discomfort in the:
      1. front of the chest; or
      2. neck; or
      3. shoulders; or
      4. jaw; or
      5. arms; or
    2. the patient’s symptoms, as described in subparagraph (3)(a)(i), are precipitated by physical exertion; or
    3. the patient’s symptoms, as described in subparagraph (3)(a)(i), are relieved by rest or glyceryl trinitrate within 5 minutes or less; or
  2. if the patient has known coronary artery disease and displays one or more symptoms that are suggestive of ischaemia:
    1. which are not adequately controlled with medical therapy; or
    2. have evolved since the last functional study; or
  3. if the patient qualifies for one or more of the following indications:
    1. assessment of myocardial ischaemia with exercise is required if a patient with congenital heart lesions has undergone surgery and reversal of ischemia is considered possible; or
    2. assessment indicates that resting 12 lead electrocardiogram changes are consistent with coronary artery disease or ischaemia, in a patient that is without known coronary artery disease; or
    3. coronary artery disease related lesions, of uncertain functional significance, which have previously been identified on computed tomography coronary angiography or invasive coronary angiography; or
    4. assessment by a specialist or consultant physician indicates that the patient has potential non-coronary artery disease, where a stress echocardiography study is likely to assist the diagnosis; or
    5. assessment indicates that the patient has undue exertional dyspnoea of uncertain aetiology; or
    6. a pre-operative assessment of a patient with functional capacity of less than 4 metabolic equivalents confirming that surgery is intermediate to high risk, and the patient has at least one of following conditions:
      1. ischaemic heart disease or previous myocardial infarction; or
      2. heart failure; or
      3. stroke or transient ischaemic attack; or
      4. renal dysfunction (serum creatinine greater than 170umol/L or 2 mg/dL or a creatinine clearance of less than 60 mL/min); or
      5. diabetes mellitus requiring insulin therapy: or
    7. assessment before cardiac surgery or catheter-based interventions is required to:
      1. increase the cardiac output to assess the severity of aortic stenosis; or
      2. determine whether valve regurgitation worsens with exercise and/or correlates with functional capacity; or
      3. correlate functional capacity with the ischaemic threshold; or
    8. for patients where silent myocardial ischaemia is suspected, or due to the patient’s cognitive capacity or expressive language impairment, it is not possible to accurately assess symptom frequency based on medical history.

 
2. For any particular patient, the request for a service to be provided under item 55141, 55143, 55145 or 55146 must identify the symptom/s or clinical indications/s, as outlined in subclause 1.1.1(3).
 

3. For any particular patient, item 55141, 55143, 55145 or 55146 applies to a service if:

  1. the diagnostic imaging procedure is performed on premises equipped with resuscitation equipment, which includes a defibrillator; and
  2. the diagnostic imaging procedure is performed by a person trained in exercise testing and cardiopulmonary resuscitation who is in personal attendance during the procedure; and
  3. a second person trained in exercise testing and cardiopulmonary resuscitation is located at the diagnostic imaging premise where the procedure is performed and is immediately available to respond at the time the exercise test is performed on the patient, if required; and
  4. one of the persons mentioned in paragraphs (b) and (c) must be a medical practitioner.

 
4. Limitation of ultrasound items 55141, 55143, 55145 and 55146

  1. For any particular patient, a service under item 55141, 55143, 55145 and 55146 does not apply if:
    1. the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or
    2. the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or
    3. results of a previous imaging service indicate that a stress echocardiography service would not provide adequate information.

Related Items: 55141 55143 55145 55146


Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

55141

55141 - Additional Information

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

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2

Exercise stress echocardiography focused study, other than a service associated with a service to which:

(a) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(b) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)


 

 

Fee: $421.20 Benefit: 75% = $315.90 85% = $358.05

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55143

55143 - Additional Information

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

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1, IR.1.1 and IR.1.2 

Repeat pharmacological or exercise stress echocardiography if:

(a) a service to which item 55141, 55145, 55146, or this item, applies has been performed on the patient in the previous 24 months; and

(b) the patient has symptoms of ischaemia that have evolved and are not adequately controlled with optimal medical therapy; 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:

(i) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(ii) an item in Subgroup 3 applies

Applicable not more than once in a 12 month period (R)

Fee: $421.20 Benefit: 75% = $315.90 85% = $358.05

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55145

55145 - Additional Information

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

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2

Pharmacological stress echocardiography, other than a service associated with a service to which:

(a) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(b) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Note: this item does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55141, 55143 or 55146 applies has been provided to the patient.

 

Fee: $488.20 Benefit: 75% = $366.15 85% = $415.00

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55146

55146 - Additional Information

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

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2

Pharmacological stress echocardiography if:

(a) a service to which item 55141 applies has been performed on the patient in the previous 4 weeks, and the test has failed due to an inadequate heart rate response; and

(b) the service is not associated with a service to which:

(i) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(ii) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Note: this item does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55143 or 55145 applies has been provided to the patient.

 

Fee: $488.20 Benefit: 75% = $366.15 85% = $415.00

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 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