Medicare Benefits Schedule - Note TN.1.10

TN.1.10 Procedures Associated with Intensive Care - (Items 13815, 13818, 13832, 13834, 13835, 13837, 13838, 13840, 13842, 13848, 13851, 13854 and 13857)

Item 13815 covers the insertion of a central vein catheter, including under ultrasound guidance where clinically appropriate. No separate ultrasound item is payable with item 13815.

Item 13818 covers the insertion of a right heart balloon flotation catheter. Benefits are payable under this item only once per day except where a second discrete operation is performed on that day. 

Items 13832, 13834, 13835, 13837, 13838 and 13840

These items cover extracorporeal life support services in an ICU. Benefits are payable only once per calendar day for a patient, irrespective of the number of medical practitioners involved.

Items 13832 and 13840 include the use of ultrasound guidance where clinically appropriate. No separate ultrasound item is payable with these items.

Item 13839

Provides for collection of blood for diagnostic purposes by arterial puncture.

Medicare benefits are not payable for sampling by arterial puncture under item 13839 in addition to item 13870 and 13873 on the same day. 

Item 13842

This item provides for intra-arterial cannulation (including ultrasound guidance) for either or both intra-arterial pressure monitoring or blood sampling.

If a service covered by item 13842 is provided outside of an ICU, in association with, for example, an anaesthetic, benefits are payable under item 13842 in addition to item 13870 and 13873 when performed on the same day.

Where this occurs, accounts should be endorsed "performed outside of an Intensive Care Unit" against item 13842.

Item 13848

Item 13848 covers management of counterpulsation by intraaortic balloon on each day and includes initial and subsequent consultations and monitoring of parameters. Insertion of the intraaortic balloon is covered under item 38609.

Items 13851 and 13854

Items 13851 and 13854 cover the management of ventricular assist devices in an ICU. Benefits are payable only once per calendar day per patient, irrespective of the number of medical practitioners involved.

Item 13851 covers management of ventricular assist devices on the first day where the ICU admission relates to the device implantation or complication. Management on each day subsequent to the first is covered under item 13854.

Item 13857

This item covers the establishment of airway access and initiation of ventilation on a patient outside intensive care for the purpose of subsequent ventilatory support in intensive care. Benefits are not payable under item 13857 where airway access and ventilation is initiated in the context of an anaesthetic for surgery even if it is likely that following surgery the patient will be ventilated in an ICU. In such cases the appropriate anaesthetic item/s should be utilised.

Related Items: 11600 13815 13818 13832 13834 13835 13837 13838 13840 13842 13848 13851 13854 13857 13870 13876

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(Note: See para T1.8 of Explanatory Notes to this

Category for definition of an Intensive Care Unit)

MANAGEMENT of a patient in an Intensive Care Unit by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - including initial and subsequent attendances, electrocardiographic monitoring, arterial sampling and bladder catheterisation - management on the first day (H)

Fee: $398.60 Benefit: 75% = $298.95

(See para TN.1.9, TN.1.10, TN.1.11 of explanatory notes to this Category)

CENTRAL VENOUS PRESSURE, pulmonary arterial pressure, systemic arterial pressure or cardiac intracavity pressure, continuous monitoring by indwelling catheter in an intensive care unit and managed by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - once only for each type of pressure on any calendar day (up to a maximum of 4 pressures) (H)

Fee: $84.65 Benefit: 75% = $63.50

(See para TN.1.9, TN.1.10, TN.1.11 of explanatory notes to this Category)

Central vein catheterisation, including under ultrasound guidance where clinically appropriate, by percutaneous or open exposure other than a service to which item 13318 applies (Anaes.)

No separate ultrasound item is payable with this item.

(Anaes.)

Fee: $125.10 Benefit: 75% = $93.85 85% = $106.35

(See para TN.1.6, TN.1.10 of explanatory notes to this Category)

RIGHT HEART BALLOON CATHETER, insertion of, including pulmonary wedge pressure and cardiac output measurement

(Anaes.)

Fee: $125.15 Benefit: 75% = $93.90 85% = $106.40

(See para TN.1.10 of explanatory notes to this Category)

Peripheral cannulation, including under ultrasound guidance where clinically appropriate, for veno-arterial cardiopulmonary extracorporeal life support

No separate ultrasound item is payable with this item

Fee: $970.60 Benefit: 75% = $727.95 85% = $871.90

(See para TN.1.10 of explanatory notes to this Category)

Veno–arterial cardiopulmonary extracorporeal life support, management of—the first day

Fee: $543.35 Benefit: 75% = $407.55 85% = $461.85

(See para TN.1.10 of explanatory notes to this Category)

Veno–arterial cardiopulmonary extracorporeal life support, management of—each day after the first

Fee: $126.40 Benefit: 75% = $94.80 85% = $107.45

(See para TN.1.10 of explanatory notes to this Category)

Veno-venous pulmonary extracorporeal life support, management of—the first day

Fee: $543.35 Benefit: 75% = $407.55 85% = $461.85

(See para TN.1.10 of explanatory notes to this Category)

Veno-venous pulmonary extracorporeal life support, management of—each day after the first

Fee: $126.40 Benefit: 75% = $94.80 85% = $107.45

(See para TN.1.10 of explanatory notes to this Category)

Peripheral cannulation, including under ultrasound guidance where clinically appropriate, for veno-venous pulmonary extracorporeal life support
No separate ultrasound item is payable with this item

Fee: $650.30 Benefit: 75% = $487.75 85% = $552.80

(See para TN.1.10 of explanatory notes to this Category)

Intra-arterial cannulation, including under ultrasound guidance where clinically appropriate, for the purpose of intra-arterial pressure monitoring or arterial blood sampling (or both)

No separate ultrasound item is payable with this item

Fee: $102.95 Benefit: 75% = $77.25 85% = $87.55

(See para TN.1.10 of explanatory notes to this Category)

Counterpulsation by intra-aortic balloon-management including associated consultations and monitoring of parameters by means of full haemodynamic assessment and management on several occasions on a day – each day

Fee: $171.85 Benefit: 75% = $128.90 85% = $146.10

(See para TN.1.10 of explanatory notes to this Category)

Ventricular assist device, management of, for a patient admitted to an intensive care unit for implantation of the device or for complications arising from implantation or management of the device - first day

Fee: $543.35 Benefit: 75% = $407.55 85% = $461.85

(See para TN.1.10 of explanatory notes to this Category)

Ventricular assist device, management of, for a patient admitted to an intensive care unit, including management of complications arising from implantation or management of the device - each day after the first day

Fee: $126.40 Benefit: 75% = $94.80 85% = $107.45

(See para TN.1.10 of explanatory notes to this Category)

AIRWAY ACCESS, ESTABLISHMENT OF AND INITIATION OF MECHANICAL VENTILATION (other than in the context of an anaesthetic for surgery), outside an Intensive Care Unit, for the purpose of subsequent ventilatory support in an Intensive Care Unit

Fee: $161.15 Benefit: 75% = $120.90 85% = $137.00

(See para TN.1.10 of explanatory notes to this Category)

BLOOD PRESSURE MONITORING (central venous, pulmonary arterial, systemic arterial or cardiac intracavity), by indwelling catheter - once only for each type of pressure on any calendar day up to a maximum of 4 pressures (not being a service to which item 13876 applies and where not performed in association with the administration of general anaesthesia)

Fee: $76.30 Benefit: 75% = $57.25 85% = $64.90

(See para TN.1.10, TN.1.11 of explanatory notes to this Category)