Medicare Benefits Schedule - Note TN.8.17

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Category 3 - THERAPEUTIC PROCEDURES

TN.8.17

Gastrointestinal Endoscopic Procedures - (Items 30473 to 30481, 30484, 30485, 30490 to 30494, 30680 to 32023, 32084 to 32095, 32103, 32104 and 32106)

The following are guidelines for appropriate minimum standards for the performance of GI endoscopy in relation to (a) cleaning, disinfection and sterilisation procedures, and (b) anaesthetic and resuscitation equipment.

 These guidelines are based on the advice of the Gastroenterological Society of Australia, the Sections of HPB and Upper GI and of Colon and Rectal Surgery of the Royal Australasian College of Surgeons, and the Colorectal Surgical Society of Australia.

 Cleaning, disinfection and sterilisation procedures
Endoscopic procedures should be performed in facilities where endoscope and accessory reprocessing protocols follow procedures outlined in:

  1. Infection Control in Endoscopy, Gastroenterological Society of Australia and Gastroenterological Nurses College of Australia , 2011;
  2. Australian Guidelines for the Prevention and Control of Infection in Healthcare (NHMRC, 2010);
  3. Australian Standard AS 4187 2014 (and Amendments), Standards Association of Australia. 

Anaesthetic and resuscitation equipment
Where the patient is anaesthetised, anaesthetic equipment, administration and monitoring, and post-operative and resuscitation facilities should conform to the standards outlined in 'Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures' (PS09), Australian & New Zealand College of Anaesthetists, Gastroenterological Society of Australia and Royal Australasian College of Surgeons.

Conjoint Committee

For the purposes of Item 32023, the procedure is to be performed by a colorectal surgeon or gastroenterologist with endoscopic training who is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy.

 

Related Items: 30473 30475 30478 30479 30481 30484 30485 30490 30491 30494 30680 30682 30684 30686 30687 30688 30690 30692 30694 32023 32084 32087 32088 32089 32090 32093 32094 32095 32103 32104 32106


Related Items

Category 3 - THERAPEUTIC PROCEDURES

30473

30473 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Oesophagoscopy (not being a service to which item 41816 or 41822 applies), gastroscopy, duodenoscopy or panendoscopy (1 or more such procedures), with or without biopsy, not being a service associated with a service to which item 30478 or 30479 applies.

(Anaes.)

Fee: $179.95 Benefit: 75% = $135.00 85% = $153.00

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30475

30475 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Endoscopic dilatation of stricture of upper gastrointestinal tract (including the use of imaging intensification where clinically indicated)

(Anaes.)

Fee: $354.55 Benefit: 75% = $265.95 85% = $301.40

(See para TN.8.17, TN.8.133 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30478

30478 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Oesophagoscopy (other than a service to which item 41816, 41822 or 41825 applies), gastroscopy, duodenoscopy, panendoscopy or push enteroscopy, one or more such procedures, if:

(a) the procedures are performed using one or more of the following endoscopic procedures:

(i) polypectomy;

(ii) sclerosing or adrenalin injections;

(iii) banding;

(iv) endoscopic clips;

(v) haemostatic powders;

(vi) diathermy;

(vii) argon plasma coagulation; and

 

(b) the procedures are for the treatment of one or more of the following:

(i) upper gastrointestinal tract bleeding;

(ii) polyps;

(iii) removal of foreign body;

(iv) oesophageal or gastric varices;

(v) peptic ulcers;

(vi) neoplasia;

(vii) benign vascular lesions;

(viii) strictures of the gastrointestinal tract;

(ix) tumorous overgrowth through or over oesophageal stents;

 

other than a service associated with a service to which item 30473 or 30479 applies

(Anaes.)

Fee: $249.50 Benefit: 75% = $187.15 85% = $212.10

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30479

30479 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Endoscopy with laser therapy, for the treatment of one or more of the following:

(a) neoplasia;

(b) benign vascular lesions;

(c) strictures of the gastrointestinal tract;

(d) tumorous overgrowth through or over oesophageal stents;

(e) peptic ulcers;

(f) angiodysplasia;

(g) gastric antral vascular ectasia;

(h) post-polypectomy bleeding;

 

other than a service associated with a service to which item 30473 or 30478 applies

(Anaes.)

Fee: $483.70 Benefit: 75% = $362.80 85% = $411.15

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30481

30481 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-May-2018
Schedule Fee Start Date:
01-Jul-2019

PERCUTANEOUS GASTROSTOMY (initial procedure):

(a) including any associated imaging services; and

(b) excluding the insertion of a device for the purpose of facilitating weight loss

(Anaes.)

Fee: $362.70 Benefit: 75% = $272.05 85% = $308.30

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30484

30484 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-Nov-1992
Schedule Fee Start Date:
01-Jul-2019

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

(Anaes.)

Fee: $370.75 Benefit: 75% = $278.10 85% = $315.15

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30485

30485 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-Nov-1992
Schedule Fee Start Date:
01-Jul-2019

ENDOSCOPIC SPHINCTEROTOMY with or without extraction of stones from common bile duct

(Anaes.)

Fee: $572.30 Benefit: 75% = $429.25 85% = $488.90

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30490

30490 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-Nov-1992
Schedule Fee Start Date:
01-Jul-2019

OESOPHAGEAL PROSTHESIS, insertion of, including endoscopy and dilatation

(Anaes.)

Fee: $534.80 Benefit: 75% = $401.10 85% = $454.60

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30491

30491 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-Nov-1992
Schedule Fee Start Date:
01-Jul-2019

BILE DUCT, ENDOSCOPIC STENTING OF (including endoscopy and dilatation)

(Anaes.)

Fee: $564.25 Benefit: 75% = $423.20 85% = $480.85

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30494

30494 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-Nov-1992
Schedule Fee Start Date:
01-Jul-2019

ENDOSCOPIC BILIARY DILATATION

(Anaes.)

Fee: $427.25 Benefit: 75% = $320.45

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30680

30680 - Additional Information

Item Start Date:
01-Jul-2007
Description Start Date:
01-Mar-2014
Schedule Fee Start Date:
01-Jul-2019

Balloon enteroscopy, examination of the small bowel (oral approach), with or without biopsy, WITHOUT intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup  (with the exception of item 30682 or 30686)


The patient to whom the service is provided must:

(i)    have recurrent or persistent bleeding; and

(ii)    be anaemic or have active bleeding; and

(iii)    have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify     the cause of     the bleeding.

(Anaes.)

Fee: $1,188.70 Benefit: 75% = $891.55 85% = $1,105.30

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30682

30682 - Additional Information

Item Start Date:
01-Jul-2007
Description Start Date:
01-Mar-2014
Schedule Fee Start Date:
01-Jul-2019

Balloon enteroscopy, examination of the small bowel (anal approach), with or without biopsy, WITHOUT intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30680 or 30684)


The patient to whom the service is provided must:

(i)    have recurrent or persistent bleeding; and

(ii)    be anaemic or have active bleeding; and

(iii)    have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of      the bleeding.

    

(Anaes.)

Fee: $1,188.70 Benefit: 75% = $891.55 85% = $1,105.30

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30684

30684 - Additional Information

Item Start Date:
01-Jul-2007
Description Start Date:
01-Mar-2014
Schedule Fee Start Date:
01-Jul-2019

Balloon enteroscopy, examination of the small bowel (oral approach), with or without biopsy, WITH 1 or more of the following procedures (snare polypectomy, removal of foreign body, diathermy, heater probe, laser coagulation or argon plasma coagulation), for diagnosis and management of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30682 or 30686)


The patient to whom the service is provided must:

(i)    have recurrent or persistent bleeding; and

(ii)    be anaemic or have active bleeding; and

(iii)    have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of     the bleeding.

    

(Anaes.)

Fee: $1,462.90 Benefit: 75% = $1,097.20 85% = $1,379.50

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30686

30686 - Additional Information

Item Start Date:
01-Jul-2007
Description Start Date:
01-Mar-2014
Schedule Fee Start Date:
01-Jul-2019

Balloon enteroscopy, examination of the small bowel (anal approach), with or without biopsy, WITH 1 or more of the following procedures (snare polypectomy, removal of foreign body, diathermy, heater probe, laser coagulation or argon plasma coagulation), for diagnosis and management of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30680 or 30684)


The patient to whom the service is provided must:

(i)    have recurrent or persistent bleeding; and

(ii)    be anaemic or have active bleeding; and

(iii)    have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of     the bleeding.

(Anaes.)

Fee: $1,462.90 Benefit: 75% = $1,097.20 85% = $1,379.50

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30687

30687 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Nov-2012
Schedule Fee Start Date:
01-Jul-2019

ENDOSCOPY with RADIOFREQUENCY ABLATION of mucosal metaplasia for the treatment of Barrett's Oesophagus in a single course of treatment, following diagnosis of high grade dysplasia confirmed by histological examination

(Anaes.)

Fee: $483.70 Benefit: 75% = $362.80 85% = $411.15

(See para TN.8.17, TN.8.20 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30688

30688 - Additional Information

Item Start Date:
01-Jul-2007
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis.

(Anaes.)

Fee: $370.75 Benefit: 75% = $278.10 85% = $315.15

(See para TN.8.17, TN.8.21 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30690

30690 - Additional Information

Item Start Date:
01-Jul-2007
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy,  with fine needle aspiration, including aspiration of the locoregional lymph nodes if performed, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis.

(Anaes.)

Fee: $572.30 Benefit: 75% = $429.25 85% = $488.90

(See para TN.8.17, TN.8.21 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30692

30692 - Additional Information

Item Start Date:
01-Jul-2007
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis.

(Anaes.)

Fee: $370.75 Benefit: 75% = $278.10 85% = $315.15

(See para TN.8.17, TN.8.21 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30694

30694 - Additional Information

Item Start Date:
01-Jul-2007
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy,  with fine needle aspiration, for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours,  not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis.

(Anaes.)

Fee: $572.30 Benefit: 75% = $429.25 85% = $488.90

(See para TN.8.17, TN.8.21 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32023

32023 - Additional Information

Item Start Date:
01-Mar-2013
Description Start Date:
01-Mar-2013
Schedule Fee Start Date:
01-Jul-2019

Endoscopic insertion of stent or stents for large bowel obstruction, stricture or stenosis, including colonoscopy and any image intensification, where the obstruction is due to:

a) a pre-diagnosed colorectal cancer, or cancer of an organ adjacent to the bowel; or

b) an unknown diagnosis

(Anaes.)

Fee: $564.25 Benefit: 75% = $423.20

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32084

32084 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Flexible fibreoptic sigmoidoscopy or fibreoptic colonoscopy up to the hepatic flexure, with or without biopsy, other than a service associated with a service to which item 32090 or 32093 applies.

 

 

(Anaes.)

Fee: $113.15 Benefit: 75% = $84.90 85% = $96.20

(See para TN.8.17, TN.8.134 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32087

32087 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Endoscopic examination of the colon up to the hepatic flexure by flexible fibreoptic sigmoidoscopy or fibreoptic colonoscopy for the removal of 1 or more polyps or the treatment of radiation proctitis, angiodysplasia or post-polypectomy bleeding by argon plasma coagulation, one or more of, other than a service associated with a service to which item 32090 or 32093 applies

 

 

(Anaes.)

Fee: $208.00 Benefit: 75% = $156.00 85% = $176.80

(See para TN.8.17, TN.8.134 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32088

32088 - Additional Information

Item Start Date:
01-May-2016
Description Start Date:
01-May-2016
Schedule Fee Start Date:
01-Jul-2019

FIBREOPTIC COLONOSCOPY examination of the colon beyond the hepatic flexure WITH or WITHOUT BIOPSY, following a positive faecal occult blood test for a participant registered on the National Bowel Cancer Screening Program.

(Anaes.)

Fee: $339.70 Benefit: 75% = $254.80 85% = $288.75

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32089

32089 - Additional Information

Item Start Date:
01-May-2016
Description Start Date:
01-May-2016
Schedule Fee Start Date:
01-Jul-2019

Endoscopic examination of the colon beyond the hepatic flexure by FIBREOPTIC COLONOSCOPY for the REMOVAL OF 1 OR MORE POLYPS, following a positive faecal occult blood test for a participant registered on the National Bowel Cancer Screening Program.

(Anaes.)

Fee: $476.70 Benefit: 75% = $357.55 85% = $405.20

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32090

32090 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Dec-1991
Schedule Fee Start Date:
01-Jul-2019

FIBREOPTIC COLONOSCOPY  examination of colon beyond the hepatic flexure WITH or WITHOUT BIOPSY

(Anaes.)

Fee: $339.70 Benefit: 75% = $254.80 85% = $288.75

(See para TN.8.17, TN.8.134 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32093

32093 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-May-2010
Schedule Fee Start Date:
01-Jul-2019


Endoscopic examination of the colon beyond the hepatic flexure by FIBREOPTIC COLONOSCOPY for the REMOVAL OF 1 OR MORE POLYPS, or the treatment of radiation proctitis, angiodysplasia or post-polypectomy bleeding by ARGON PLASMA COAGULATION, 1 or more of

(Anaes.)

Fee: $476.70 Benefit: 75% = $357.55 85% = $405.20

(See para TN.8.17, TN.8.134 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32094

32094 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-Nov-1992
Schedule Fee Start Date:
01-Jul-2019

ENDOSCOPIC DILATATION OF COLORECTAL STRICTURES including colonoscopy

(Anaes.)

Fee: $560.70 Benefit: 75% = $420.55

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32095

32095 - Additional Information

Item Start Date:
31-Oct-1992
Description Start Date:
01-Nov-1992
Schedule Fee Start Date:
01-Jul-2019

ENDOSCOPIC EXAMINATION of SMALL BOWEL with flexible endoscope passed by stoma, with or without biopsies

(Anaes.)

Fee: $129.85 Benefit: 75% = $97.40 85% = $110.40

(See para TN.8.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32103

32103 - Additional Information

Item Start Date:
01-May-2004
Description Start Date:
01-Nov-2012
Schedule Fee Start Date:
01-Jul-2019

RECTAL TUMOUR, of less than 4 cm in diameter, per anal excision of, using rectoscopy incorporating either 3 dimensional or 2 dimensional optic viewing systems, if removal is unable to be performed during colonoscopy or by local excision, other than a service associated with a service to which item 32024, 32025, 32104 or 32106 applies

(Anaes.) (Assist.)

Fee: $784.65 Benefit: 75% = $588.50

(See para TN.8.17, TN.8.31 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32104

32104 - Additional Information

Item Start Date:
01-May-2004
Description Start Date:
01-Nov-2012
Schedule Fee Start Date:
01-Jul-2019

RECTAL TUMOUR, of 4 cm or greater in diameter, per anal excision of, using rectoscopy incorporating either 3 dimensional or 2 dimensional optic viewing systems, if removal is unable to be performed during colonoscopy or by local excision, other than a service associated with a service to which item 32024, 32025, 32103 or 32106 applies

(Anaes.) (Assist.)

Fee: $1,015.65 Benefit: 75% = $761.75

(See para TN.8.17, TN.8.31 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32106

32106 - Additional Information

Item Start Date:
01-May-2004
Description Start Date:
01-Nov-2012
Schedule Fee Start Date:
01-Jul-2019

ANTEROLATERAL INTRAPERITONEAL RECTAL TUMOUR, per anal excision of, using rectoscopy incorporating either 3 dimensional or 2 dimensional optic viewing systems, if removal is unable to be performed during colonoscopy and if removal requires dissection within the peritoneal cavity, other than a service associated with a service to which item 32024, 32025, 32103 or 32104 applies

(Anaes.) (Assist.)

Fee: $1,386.45 Benefit: 75% = $1,039.85 85% = $1,303.05

(See para TN.8.17, TN.8.31 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