Medicare Benefits Schedule - Note IR.1.2

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IR.1.2

Echocardiography and attendance requirements

1. For any particular patient, a service associated with an attendance item listed in Part 2 of the general medical services table does not apply if a service to which item 55126, 55127, 55128, 55129, 55132, 55133, 55134, 55137, 55141, 55143, 55145 or 55146 applies is provided on the same day; unless:

  1. the attendance service is provided after the service where clinical management decisions are made; or
  2. the decision to perform the service on the same day was made during the attendance service subject to clinical assessment.

Related Items: 55126 55127 55128 55129 55132 55133 55134 55137 55141 55143 55145 55146


Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

55126

55126 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
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.1.2

Initial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media:

(a)     for the investigation of any of the following:

         (i)   symptoms or signs of cardiac failure; or

         (ii)   suspected or known ventricular hypertrophy or dysfunction; or

         (iii)  pulmonary hypertension; or

 (iv)  valvular, aortic, pericardial, thrombotic or embolic disease; or

         (v)   heart tumour; or

         (vi)  symptoms or signs of congenital heart disease; or

         (vii) other rare indications; and

(b)     if the service involves all of the following, where possible:

         (i)    assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

         (ii)    assessment of right ventricular structure and function with quantitative assessment; and

         (iii)   assessment of left and right atrial structure including quantification of atrial sizes; and

         (iv)   assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

         (v)    assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

         (vi)   assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

         (vii)   assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

(c)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146),  or an item in Subgroup 2 (except items 55118 and 55130), or an item in Subgroup 3 applies; and

(d)    cannot be claimed within 24 months if a service associated with a service to which item 55127, 55128, 55129, 55132, 55133 or 55134 is provided

For any particular patient, applicable not more than once in 24 months (R)

Fee: $234.15 Benefit: 75% = $175.65 85% = $199.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55127

55127 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
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.1.2

Repeat serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, for the investigation of known valvular dysfunction, if:

(a)     the service involves all of the following, where possible:

(i)    assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

(ii)   assessment of right ventricular structure and function with quantitative assessment; and

(iii)  assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)  assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)   assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)  assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

(vii) assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

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

(c)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146),  or an item in Subgroup 2 (except items 55118 and 55130), or an item in Subgroup 3 applies (R)

Fee: $234.15 Benefit: 75% = $175.65 85% = $199.05

(See para IN.0.19, IN.1.4, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55128

55128 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
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.1.2

Repeat serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, for the investigation of known valvular dysfunction, if:

(a)     the service involves all of the following, where possible:

(i)      assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

(ii)     assessment of right ventricular structure and function with quantitative assessment; and

(iii)    assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)    assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)     assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)    assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

(vii)   assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

(b)    the service is requested by a medical practitioner (other than a specialist or consultant physician) at, or from, a practice location in:

(i)      a Modified Monash 3 area; or

(ii)     a Modified Monash 4 area; or

(iii)    a Modified Monash 5 area; or

(iv)    a Modified Monash 6 area; or

(v)     a Modified Monash 7 area; and

(c)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146), or an item in Subgroup 2 (except items 55118 and 55130) or an item in Subgroup 3 applies (R)

 

Fee: $234.15 Benefit: 75% = $175.65 85% = $199.05

(See para IN.0.19, IN.1.4, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55129

55129 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
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.1.2

Repeat serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, excluding valvular dysfunction (when valvular dysfunction is the primary condition):

(a)     for the investigation of any of the following:

(i)     symptoms or signs of cardiac failure; or

(ii)    suspected or known ventricular hypertrophy or dysfunction; or

(iii)   pulmonary hypertension; or

(iv)   aortic, thrombotic, embolic disease or pericardial disease (excluding isolated pericardial effusion or pericarditis); or

(v)    heart tumour; or

(vi)   structural heart disease; or

(vii)   other rare indications; and

(b)    if the service involves all of the following, where possible:

(i)      assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and  

(ii)     assessment of right ventricular structure and function with quantitative assessment; and

(iii)     assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)     assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)      assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)      assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation if present; and

(vii)     assessment of additional haemodynamic parameters including the assessment of pulmonary pressures when possible; and

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

(d)    not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146), or an item in Subgroup 2 (except items 55118 and 55130) or an item in Subgroup 3 applies (R)

Fee: $234.15 Benefit: 75% = $175.65 85% = $199.05

(See para IN.0.19, IN.1.5, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55132

55132 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
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.1.2

Serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media, for the investigation of a patient who is under 17 years of age, or a patient of any age with complex congenital heart disease, if:

(a)     the service involves the all of the following, where possible:

(i)    assessment of ventricular structure and function including quantification of systolic function (if the ventricular configuration allows accurate quantification) using at least one of M-mode, 2-dimensional or 3-dimensional imaging; and

(ii)    assessment of diastolic function; and

(iii)   assessment of atrial structure including quantification of atrial sizes; and

(iv)   assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)    assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)   assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using relevant Doppler techniques with quantification; and

(vii)   subxiphoid views where recommended for congenital heart lesions; and

(viii)  additional haemodynamic parameters relevant to the clinical condition under review; and

(b)    the service is performed by a specialist or consultant physician practising in the speciality of cardiology; and

(c)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146), or an item in Subgroup 2 (except items 55118 and 55130) or an item in Subgroup 3 applies (R)

 

Fee: $234.15 Benefit: 75% = $175.65 85% = $199.05

(See para IN.0.19, IN.1.6, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55133

55133 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets one or more of the following and the requirements of Note: IR.1.2

Frequent repetition serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media:

(a)   for the investigation of a patient:

(i)   with isolated pericardial effusion or pericarditis; or

(ii)  who has commenced medication for non-cardiac purposes that have cardiotoxic side effects, and if the patient has a normal baseline study which requires echocardiograms to comply with the requirements of the Pharmaceutical Benefits Scheme; and

(b)   the service involves all of the following, where possible:

(i)    assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

(ii)   assessment of right ventricular structure and function with quantitative assessment; and

(iii)  assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)  assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)   assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)  assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

(vii) assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

(c)    not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146), or an item in Subgroup 2 (except items 55118 and 55130) or an item in Subgroup 3 applies (R)

Fee: $210.75 Benefit: 75% = $158.10 85% = $179.15

(See para IN.0.19, IN.1.7, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55134

55134 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets one or more of the following and the requirements of Note: IR.1.2

Repeat real time echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, for rare cardiac pathologies, if:

(a)     the service involves all of the following, where possible:

(i)     assessment of left ventricular structure and function including quantification of systolic function using M-mode, 2-dimensional or 3-dimensional imaging and diastolic function; and

(ii)    assessment of right ventricular structure and function with quantitative assessment; and

(iii)   assessment of left and right atrial structure including quantification of atrial sizes; and

(iv)   assessment of vascular connections of the heart including the great vessels and systemic venous structures; and

(v)    assessment of pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(vi)   assessment of all present valves including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation; and

(vii)  assessment of additional haemodynamic parameters including the assessment of pulmonary pressures; and

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

(c)     not being a service associated with a service to which another item in this Subgroup (except items 55137, 55141, 55143, 55145 and 55146), or an item in Subgroup 2 (except items 55118 and 55130) or an item in Subgroup 3 applies (R)

Fee: $234.15 Benefit: 75% = $175.65 85% = $199.05

(See para IN.0.19, IN.1.8, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55137

55137 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
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.1.2

Serial real time echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media:

(a)     for the investigation of a fetus with suspected or confirmed of one or more of the following:

(i)      complex congenital heart disease; or

(ii)     functional heart disease; or

(iii)    fetal cardiac arrhythmia; or

(iv)    cardiac structural abnormality requiring confirmation; and

(b)    the service involves the assessment all of the following, where possible:

(i)       ventricular structure and function; and

(ii)      atrial structure; and

(iii)      vascular connections of the heart including the great vessels and systemic venous structures; and

(iv)      pericardium and assessment of any haemodynamic consequences of pericardial abnormalities; and

(v)       all present valves including structural assessment and measurement of blood flow velocities across the valves using relevant Doppler techniques with quantification; and

(c)     the service is performed by a specialist or consultant physician practising in the speciality of cardiology with advanced training and expertise in fetal cardiac imaging; and

(d)    not being a service associated with a service to which another item in this Subgroup (except items 55141, 55143, 55145 and 55146), or an item in Subgroup 2 (except items 55118 and 55130) or an item in Subgroup 3 applies (R)

Fee: $234.15 Benefit: 75% = $175.65 85% = $199.05

(See para IN.0.19, IN.1.9, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55141

55141 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
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.0.1 and IR.1.2

Exercise stress echocardiography focused study if;

(a)     the service involves all of the following:

(i)      two-dimensional recordings before exercise (baseline) from at least 2 acoustic windows; and

(ii)    matching recordings at or immediately after peak exercise, which include at least parasternal short and long axis views, and apical 4-chamber and 2 chamber views; and

(iii)  recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(iv)   resting electrocardiogram and continuous multi-channel electrocardiogram monitoring and recording during stress; and

(v)    blood pressure monitoring and the recording of other parameters (including heart rate); and

(b)    cannot be claimed if a service associated with a service to which item 55143, 55145 or 55146 applies is provided in the previous 24 months; and

(c)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 or 11730 applies; and

(d)    not being a service associated with a service to which an item in Subgroup 3 applies


For any particular patient, applicable not more than once in 24 months (R)

 

Fee: $417.45 Benefit: 75% = $313.10 85% = $354.85

(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-Aug-2020
Description Updated:
15-Sep-2020
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.0.1, IR.1.1 and IR.1.2 

Repeat pharmacological or exercise stress echocardiography if:

(a)     the patient has had a service associated with a service to which item 55141, 55145 or 55146 applies provided 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)    not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 or 11730 applies; and

(e)    not being a service associated with a service to which an item in Subgroup 3 applies 

For any particular patient, applicable not more than once in 12 months (R)

Fee: $417.45 Benefit: 75% = $313.10 85% = $354.85

(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-Aug-2020
Description Updated:
15-Sep-2020
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.0.1 and IR.1.2

Pharmacological stress echocardiography if:

(a)     the service involves all of the following:

(i)      two-dimensional recordings before drug infusion (baseline) from at least 2 acoustic windows; and

(ii)    matching recordings at least twice during drug infusion, including a recording at the peak drug dose, which include at least parasternal short and long axis views, and apical 4-chamber and 2 chamber views; and

(iii)  recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(iv)   resting electrocardiogram and continuous multi-channel electrocardiogram monitoring and recording during stress; and

(v)    blood pressure monitoring and the recording of other parameters (including heart rate); and

(b)    a service to which item 55141, 55146 or 55143 applies has not been provided in the previous 24 months; and

(c)     not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 or 11730 applies; and 

(d)    not being a service associated with a service to which an item in Subgroup 3 applies 

For any particular patient, applicable not more than once in 24 months (R)

Fee: $483.85 Benefit: 75% = $362.90 85% = $411.30

(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-Aug-2020
Description Updated:
15-Sep-2020
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.0.1 and IR.1.2

Pharmacological stress echocardiography if:

(a)     the service involves all of the following:

(i)      two-dimensional recordings before drug infusion (baseline) from at least 2 acoustic windows; and

(ii)    matching recordings at least twice during drug infusion, including a recording at the peak drug dose, which include at least parasternal short and long axis views, and apical 4-chamber and 2 chamber views; and

(iii)  recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(iv)   resting electrocardiogram and continuous multi-channel electrocardiogram monitoring and recording during stress; and

(v)    blood pressure monitoring and the recording of other parameters (including heart rate); and

(b)    the patient has had a service performed under item 55141 in the previous 4 weeks and the test has failed due to an inadequate heart rate response; and

(c)     a service to which item 55143 or 55145 applies has not been provided in the previous 24 months; and

(d)    not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 or 11730 applies; and 

(e)    not being a service associated with a service to which an item in Subgroup 3 applies 

For any particular patient, applicable not more than once in 24 months (R)

Fee: $483.85 Benefit: 75% = $362.90 85% = $411.30

(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