Medicare Benefits Schedule - Note PN.0.27

Patients who are found to have any form of affected allele should be referred for post-test genetic counselling as there may be implications for other family members. Appropriate genetic counselling should be provided to the patient either by the specialist treating practitioner, a genetic counselling service or a clinical geneticist on referral.

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Detection of germline BRCA1 or BRCA2 pathogenic or likely pathogenic gene variants, in a patient with advanced (FIGO III-IV) high-grade serous or high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer for whom testing of tumour tissue is not feasible, requested by a specialist or consultant physician, to determine eligibility for olaparib under the Pharmaceutical Benefits Scheme (PBS)

Maximum of one test per patient’s lifetime

Fee: $1,200.00 Benefit: 75% = $900.00 85% = $1,112.10

(See para PN.0.27 of explanatory notes to this Category)

Characterisation of germline gene variants:

(a) including copy number variation in:

(i) BRCA1 genes; and

(ii) BRCA2 genes; and

(iii) one or more of the genes STK11, PTEN, CDH1, PALB2 and TP53; and

(b) in a patient:

(i) with breast, ovarian, fallopian tube or primary peritoneal cancer; and

(ii) for whom clinical and family history criteria (as assessed, by the specialist or consultant physician who requests the service, using a quantitative algorithm) place the patient at greater than 10% risk of having a pathogenic or likely pathogenic gene variation identified in one or more of the genes specified in subparagraphs (a)(i), (ii) and (iii);

requested by a specialist or consultant physician

Fee: $1,200.00 Benefit: 75% = $900.00 85% = $1,112.10

(See para PN.0.27 of explanatory notes to this Category)

Detection of germline BRCA1 or BRCA2 pathogenic or likely pathogenic gene variants, in a patient with metastatic castration‑resistant prostate cancer, for whom testing of tumour tissue is not clinically feasible, requested by a specialist or consultant physician, to determine eligibility for olaparib under the Pharmaceutical Benefits Scheme.

Applicable once per lifetime

Fee: $1,000.00 Benefit: 75% = $750.00 85% = $912.10

(See para PN.0.27 of explanatory notes to this Category)

Detection of germline mutations of the von Hippel-Lindau (VHL) gene:

(a)    in a patient who has a clinical diagnosis of VHL syndrome and:

(i)    a family history of VHL syndrome and one of the following:

(A)     haemangioblastoma (retinal or central nervous system);

(B)     phaeochromocytoma;

(C)     renal cell carcinoma; or

(i)    2 or more haemangioblastomas; or

(ii)    one haemangioblastoma and a tumour or a cyst of:

(A)     the adrenal gland; or

(B)     the kidney; or

(C)    the pancreas; or

(D)     the epididymis; or

(E)     a broad ligament (other than epididymal and single renal cysts, which are common in the general population); or

(a)    in a patient presenting with one or more of the following clinical features suggestive of VHL syndrome:

    (i)    haemangioblastomas of the brain, spinal cord, or retina;

    (ii)    phaeochromocytoma;

    (iii)    functional extra-adrenal paraganglioma

Fee: $600.00 Benefit: 75% = $450.00 85% = $512.10

(See para PN.0.27 of explanatory notes to this Category)