Medicare Benefits Schedule - Note TN.8.280

MBS item 31536 is for the preoperative insertion of a hookwire (or a similar device) into the breast or axilla to mark the site of a lesion, when the insertion is not associated with a breast biopsy. The hookwire (or similar device) is to be inserted under imaging which is billed under a separate MBS item.

MBS item 31537 is for the insertion of a marker clip (or tissue marker) into the breast and/or axilla, to mark the site of lesion that has been totally or almost removed at biopsy and requires localisation.

In accordance with accepted clinical practice guidelines, marker clips (or tissue markers) are not required for every biopsy and the particular occasions where they should be inserted are listed in MBS item 31537 (a) – (f). Please note the requirement at d) includes where neoadjuvant therapy may occur prior to future interventions on the breast and there is potential lack of lesion conspicuity following completion of neoadjuvant therapy.

For further information practitioners could refer to the accepted clinical guidance for the use of marker clips that is provided by BreastScreen Australia and Assessment Services.

Related Items: 31500 31503 31506 31509 31515 31536 31537

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Multiple Operation Rule

BREAST, BENIGN LESION up to and including 50mm in diameter, including simple cyst, fibroadenoma or fibrocystic disease, open surgical biopsy or excision of, with or without frozen section histology

(Anaes.)

Fee: $286.20 Benefit: 75% = $214.65 85% = $243.30

(See para TN.8.25, TN.8.280 of explanatory notes to this Category)

Multiple Operation Rule

BREAST, BENIGN LESION more than 50mm in diameter, excision of

(Anaes.) (Assist.)

Fee: $381.65 Benefit: 75% = $286.25 85% = $324.45

(See para TN.8.25, TN.8.280 of explanatory notes to this Category)

Multiple Operation Rule

BREAST, ABNORMALITY detected by mammography or ultrasound where guidewire or other localisation procedure is performed, excision biopsy of

(Anaes.) (Assist.)

Fee: $429.40 Benefit: 75% = $322.05

(See para TN.8.25, TN.8.280 of explanatory notes to this Category)

Multiple Operation Rule

BREAST, MALIGNANT TUMOUR, open surgical biopsy of, with or without frozen section histology

(Anaes.)

Fee: $381.65 Benefit: 75% = $286.25 85% = $324.45

(See para TN.8.25, TN.8.280 of explanatory notes to this Category)

Multiple Operation Rule

BREAST, TUMOUR SITE, re-excision of following open biopsy or incomplete excision of malignant tumour

(Anaes.) (Assist.)

Fee: $480.10 Benefit: 75% = $360.10

(See para TN.8.25, TN.8.280 of explanatory notes to this Category)

Multiple Operation Rule

Breast, preoperative localisation of lesion of, by hookwire or similar device, using interventional imaging techniques, but not including imaging (Anaes.)

(Anaes.)

Fee: $208.50 Benefit: 75% = $156.40 85% = $177.25

(See para TN.8.280 of explanatory notes to this Category)

Multiple Operation Rule

Insertion of a marker clip into a breast, including axilla, following a breast biopsy and using imaging (but not including the associated imaging), if additional surgery, neoadjuvant systemic therapy, follow up imaging or radiation may be required and the insertion is for any of the following reasons:

(a) to mark the site of a lesion that has been totally or almost completely removed;

(b) to confirm biopsy site if multiple lesions are present;

(c) to confirm biopsy site of an ill-defined lesion;

(d) future surgery or preoperative localisation is considered to be potentially difficult due to lesion conspicuity;

(e) preoperative localisation is likely to be carried out using a modality different from the biopsy modality;

(f) for correlation across modalities for diagnostic reasons

(Anaes.)

Fee: $208.50 Benefit: 75% = $156.40 85% = $177.25

(See para TN.8.280 of explanatory notes to this Category)