Medicare Benefits Schedule - Note TN.8.135

Items 38495 (high-risk), 38514 (intermediate-risk) and 38522 (low-risk with native calcific aortic stenosis) apply only to a service for Transcatheter Aortic Valve Implantation (TAVI) for the treatment of symptomatic severe aortic stenosis (items 38495 & 38514) and Transcatheter Aortic Valve Implantation (TAVI) for the treatment of symptomatic severe native calcific aortic stenosis, that is to be provided in a TAVI Hospital by a TAVI Practitioner on a TAVI patient.

TAVI Hospital

For items 38495, 38514 and 38522 a TAVI Hospital means a hospital, as defined by subsection 121-5(5) of the Private Health Insurance Act 2007, that is clinically accepted as being a suitable hospital in which the service described in items 38495, 38514 or 38522 may be performed.

The Transcatheter Aortic Valve Implantation - Rules for the Accreditation of TAVI Practitioners developed by Cardiac Accreditation Services Limited provides guidance on what are considered by the sector as minimum requirements that must be met in order to be a clinically acceptable facility that is suitable for TAVI procedures to be performed at. 

Transcatheter Aortic Valve Implantation - Rules for the Accreditation of TAVI Practitioners can be accessed via www.tavi.org.au. 

TAVI Practitioner

For items 38495, 38514 and 38522 a TAVI Practitioner is either a cardiothoracic surgeon or interventional cardiologist who is accredited by Cardiac Accreditation Services Limited. 

Accreditation by Cardiac Accreditation Services Limited must be valid prior to the service being undertaken in order for benefits to be payable under items 38495, 38514 and 38522.  

The process for accreditation and re-accreditation is outlined in the Transcatheter Aortic Valve Implantation - Rules for the Accreditation of TAVI Practitioners, issued by Cardiac Accreditation Services Limited, and is available on the Cardiac Accreditation Services Limited website, www.tavi.org.au. 

Cardiac Accreditation Services Limited is a national body comprising representatives from the Australian & New Zealand Society of Cardiac & Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). 

TAVI Patient

A TAVI Patient means a patient who, as a result of a TAVI Case Conference, has been assessed as having one of the following:

1. an unacceptably high risk for surgical aortic valve replacement and is recommended as being suitable to receive the service described in item 38495; or
2. has been assessed as having an intermediate risk for surgical aortic valve replacement and is recommended as being suitable to receive the service described in item 38514; or
3. has been assessed as having a low risk for surgical aortic valve replacement (with native calcific aortic stenosis) and is recommended as being suitable to receive the service described in item 38522

A TAVI Case Conference is a process by which:

(a)    there is a team of 3 or more participants, where:

        (i)     the first participant is a cardiothoracic surgeon; and

        (ii)    the second participant is an interventional cardiologist; and

        (iii)   the third participant is a specialist or consultant physician who does not perform a service described in items 38495, 38514 or 38522 for the patient being assessed; and

        (iv)   either the first or the second participant is also a TAVI Practitioner; and

(b)    the team assesses a patient’s risk and technical suitability to receive the service described in item 38495, item 38514 or item 38522, taking into account matters such as:

        (i)      the patient’s risk and technical suitability for a surgical aortic valve replacement; and

        (ii)     the patient’s cognitive function and frailty; and

(c)    the result of the assessment is that the team makes a recommendation about whether or not the patient is suitable to receive the service described in item 38495, 38514 or 38522; and

(d)    the particulars of the assessment and recommendation are recorded in writing.

While benefits are payable for an eligible TAVI Case Conference under Items 6080 and 6081, a claim for these services does not have to be made in order for a benefit to be paid under items 38495, 38514 or 38522.  Item 38495, item 38514 or item 38522 are only payable once per patient in a five year period. E.g. if a patient has received a rebate for item 38495 then they cannot receive a rebate for items 38495, 38514 or 38522 for 5 years. 

Related Items: 6080 6081 38495 38514 38522

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Coordination of a TAVI Case Conference by a TAVI Practitioner where the TAVI Case Conference has a duration of 10 minutes or more.

(Not payable more than once per patient in a five year period.)

Fee: $56.05 Benefit: 75% = $42.05 85% = $47.65

(See para AN.33.1, TN.8.135 of explanatory notes to this Category)

Attendance at a TAVI Case Conference by a specialist or consultant physician who does not also perform the service described in item 6080 for the same case conference where the TAVI Case Conference has a duration of 10 minutes or more.

(Not payable more than twice per patient in a five year period.)

Fee: $41.80 Benefit: 75% = $31.35 85% = $35.55

(See para AN.33.1, TN.8.135 of explanatory notes to this Category)

Multiple Operation Rule

TAVI, for the treatment of symptomatic severe aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, if:

(a) the TAVI Patient is at high risk for surgery; and

(b) the service:

        (i) is performed by a TAVI Practitioner in a TAVI Hospital; and

        (ii) includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient; and

        (iii) includes valvuloplasty, if required;

not being a service which has been rendered within 5 years of a service to which this item or item 38514 or 38522 applies (H) 

(Anaes.) (Assist.)

Fee: $1,576.45 Benefit: 75% = $1,182.35

(See para AN.33.1, TN.8.135, TN.8.278 of explanatory notes to this Category)

Multiple Operation Rule

TAVI, for the treatment of symptomatic severe aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, if:

(a) the TAVI Patient is at intermediate risk for surgery; and

(b) the service:

       (i) is performed by a TAVI Practitioner in a TAVI Hospital; and

       (ii) includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient; and

       (iii) includes valvuloplasty, if required;

not being a service which has been rendered within 5 years of a service to which this item or item 38495 or 38522 applies (H)

(Anaes.) (Assist.)

Fee: $1,576.45 Benefit: 75% = $1,182.35

(See para AN.33.1, TN.8.135, TN.8.278 of explanatory notes to this Category)

Multiple Operation Rule

TAVI, for the treatment of symptomatic severe native calcific aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, if:

(a) the TAVI Patient is at low risk for surgery; and

(b) the service:

      (i) is performed by a TAVI Practitioner in a TAVI Hospital; and

      (ii) includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient; and

      (iii) includes valvuloplasty, if required;

not being a service which has been rendered within 5 years of a service to which this item or item 38495 or 38514 applies (H)

(Anaes.) (Assist.)

Fee: $1,576.45 Benefit: 75% = $1,182.35

(See para AN.33.1, TN.8.135, TN.8.278 of explanatory notes to this Category)