Medicare Benefits Schedule - Note IR.4.1

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IR.4.1

Stress myocardial perfusion studies - Indications and requirements of use

1. For any particular patient, item 61311, 61324, 61329, 61332, 61345, 61349, 61357, 61365, 61377, 61380, 61394, 61398, 61406, 61410, 61414 or 61418 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. which have evolved since the last functional study; or
  3. if the patient qualifies for one or more of the following indications:
    1. 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
    2. coronary artery disease related lesions, of uncertain functional significance, which have previously been identified on computed tomography coronary angiography or invasive coronary angiography; or
    3. an assessment by a specialist or consultant physician indicates that the patient has possible painless myocardial ischaemia, which includes undue exertional dyspnoea of uncertain aetiology; or
    4. 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 70umol/L or 2 mg/dL or a creatinine clearance of less than 60 mL/min); or
      5. diabetes mellitus requiring insulin therapy: or
    5. quantification of extent and severity of myocardial ischaemia, before either percutaneous coronary intervention or coronary bypass surgery, to ensure the criteria for intervention are met; or
    6. assessment of relative amounts of ischaemic viable myocardium and non-viable (infarcted) myocardium, in patients with previous myocardial infarction; or
    7. assessment of myocardial ischaemia with exercise is required, if a patient with congenital heart lesions has undergone surgery and ischemia is considered possible; or
    8. assessment of myocardial perfusion in a person who is under 17 years old with coronary anomalies, before and after cardiac surgery for congenital heart disease, or where there is a probable or confirmed coronary artery abnormality; or
    9. for patients where myocardial perfusion abnormality is suspected but 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 61311, 61332, 61324, 61329, 61345, 61349, 61357, 61365, 61377, 61380, 61394, 61398, 61406, 61410, 61414 or 61418 must identify the symptom/s or clinical indications/s, as outlined in subclause 1.2.1(1).
 

3. For any particular patient, item 61311, 61324, 61329, 61332, 61345, 61349, 61357, 61365, 61377, 61380, 61394, 61398, 61406, 61410 61414 or 61418 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 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. 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 61311, 61324, 61329, 61332, 61345, 61349, 61357, 61365, 61377, 61380, 61394, 61398, 61406, 61410, 61414 or 61418 applies is provided in 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.

5. Limitations of items 61311, 61321, 61324, 61329, 61332, 61345, 61357, 61365, 61377, 61380, 61394, 61398, 61406, 61414 or 61418

  1. Item 61321, 61324, 61329, 61345, 61357, 61394, 61398, 61406 or 61414 are applicable not more than once in any 24 month period if the patient is 17 years old or older.
  2. Item 61311 does not apply to a service provided to a patient who is 17 years old or older if in the previous 24 months, a service associated with:

        (i)  a service to which item 61332, 61377 or 61380 applies has been provided to the patient; or
        (ii) a service to which item 61324, 61349, 61357, 61365, 61394, 61398, 61406, 61410, 61414 or 61418 of the diagnostic imaging services table applies has been provided to the patient

  3. Item 61332 does not apply to a service provided to a patient who is 17 years old or older if in the previous 24 months, a service associated with:
        (i)  a service to which item 61311, 61377, 61380 or 61422 applies has been provided to the patient; or
        (ii) a service to which item 61329, 61345, 61349, 61365, 61410 or 61418 of the diagnostic imaging services table applies has been provided to the patient.

  4. Item 61365 does not apply to a service provided to a patient if in the previous 12 months, a service associated with a service to which item 61349, 61410 or 61418 of the diagnostic imaging services table applies has been provided to the patient.  

  5. Item 61377 does not apply to a service provided to a patient who is 17 years old or older if in the previous 24 months, a service associated with:
         (i) a service to which item 61311, 61332 or 61380 applies has been provided to the patient; or
        (ii) to which item 61329, 61345, 61349, 61365, 61394, 61410, 61414 or 61418 of the diagnostic imaging services table applies has been provided to the patient.

  6. Item 61380 does not apply to a service provided to a patient who is 17 years old or older if in the previous 24 months, a service associated with:
        (i)  a service to which item 61311, 61332, 61337 or 61422 applies has been provided to the patient; or
        (ii) a service to which item 61349, 61365, 61398, 61406, 61410 or 61418 of the diagnostic imaging services table applies has been provided to the patient.

  7. Item 61418 does not apply to a service provided to a patient if in the previous 12 months, a service associated with a service to which item 61349, 61365 or 61410 of the diagnostic imaging services table applies has been provided to the patient.

  8. Item 61422 does not apply to a service provided to a patient who is 17 years old or older if in the previous 24 months, a service associated with:
         (i) a service to which item 61332 or 61380 applies has been provided to the patient; or
        (ii) a service to which item 61321, 61325, 61329, 61345, 61349, 61365, 61410 or 61418 of the diagnostic imaging services table has been provided to the table.

  9. An item in Part 2 of the general medical services table does not apply to a service (the attendance service) provided to a patient on a day if either of the following is provided to the patient on the same day:
         (i) a myocardial perfusion study service to which item 61311, 61332, 61365,  61377, 61380, 61418 or 61422 of the diagnostic imaging services table applies.



     

 

Related Items: 61311 61321 61324 61329 61332 61345 61349 61357 61394 61398 61406 61410 61414


Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

61311

61311 - Additional Information

Item Start Date:
14-Sep-2019
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.4.1

Single stress myocardial perfusion study, with PET if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

  1. the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;
  2. the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;
  3. the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting ECG, continuous ECG monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61394, 61398, 61380, 61406, 61414 or 61422 applies

Applicable not more than once in 24 months (R)    

Item 61311 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: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

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

61324

61324 - Additional Information

Item Start Date:
01-Aug-2020
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.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting ECG, continuous ECG monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

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

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61325, 61329, 61332, 61377, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61329

61329 - 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.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61332, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61332

61332 - Additional Information

Item Start Date:
14-Sep-2019
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.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with PET, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

  1. the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;
  2. the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;
  3. the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61345, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies

Applicable not more than once in 24 months (R)

Item 61332 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: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61345

61345 - 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.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

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

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies (R); and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61349

61349 - 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.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) both:

(i) a service has been provided to the patient in the previous 24 months to which this item, or item 61311, 61324, 61329, 61332, 61337, 61345, 61357, 61365, 61380, 61394, 61398, 61406, 61410, 61414 or 61418, applies; and

(ii) the patient has subsequently undergone a revascularisation procedure; and

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

(c) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

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

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61365, 61410 or 61418 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61365, 61410 or 61418, applies has not been provided to the patient in the previous 12 months (R)

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61357

61357 - 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.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which items 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61377, 61380, 61394, 61398, 61406, or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61394

61394 - Additional Information

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

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

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

(f) 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, 61398, 61406, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61398, 61406 or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61398

61398 - Additional Information

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

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the services is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(f) 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, 61406, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61406

61406 - Additional Information

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

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

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

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61377, 61345, 61357, 61380, 61394, 61398, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61410

61410 - Additional Information

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

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) both:

(i) a service has been provided to the patient in the previous 24 months to which this item, or item 61311, 61324, 61329, 61332, 61345, 61349, 61357, 61365, 61377, 61380, 61394, 61398, 61406, 61414 or 61418, applies; and

(ii) the patient has subsequently undergone a revascularisation procedure; and

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

(c) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(d) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730 or 61418 applies; and

(f) if the patient is 17 years or older—a service to which item 61349, 61365 or 61418 applies has not been provided to the patient in the previous 12 months

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61414

61414 - Additional Information

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

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(f) 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 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61398 or 61406, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 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