Medicare Benefits Schedule - Note TN.8.63

Items 38365 and 38368 apply only to patients who meet the criteria listed in the item descriptor, and to patients who do not meet the criteria listed in the descriptor but have previously had a CRT device and transvenous left ventricular electrode inserted and who prior to its insertion met the criteria and now need the device replaced.

Related Items: 38365 38368

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Multiple Operation Rule

Insertion, removal or replacement of permanent cardiac synchronisation device, if the patient:

(a) has all of the following:

(i) chronic heart failure, classified as New York Heart Association class III or IV (despite optimised medical therapy);

(ii) left ventricular ejection fraction of less than 35%;

(iii) QRS duration of greater than or equal to 130 ms; or

(b) has all of the following:

(i) chronic heart failure, classified as New York Heart Association class II (despite optimised medical therapy);

(ii) left ventricular ejection fraction of less than 35%;

(iii) QRS duration of greater than or equal to 150 ms;

other than a service associated with a service to which item 38212 applies (H)

(Anaes.) (Assist.)

Fee: $281.15 Benefit: 75% = $210.90

(See para TN.8.63 of explanatory notes to this Category)

Multiple Operation Rule

Insertion, removal or replacement of permanent transvenous left ventricular electrode, through the coronary sinus, for the purpose of cardiac resynchronisation therapy, including right heart catheterisation and any associated venograms, if the patient:

(a) has all of the following:

(i) chronic heart failure, classified as New York Heart Association class III or IV (despite optimised medical therapy);

(ii) left ventricular ejection fraction of less than 35%;

(iii) QRS duration of greater than or equal to 130 ms; or

(b) has all of the following:

(i) chronic heart failure, classified as New York Heart Association class II (despite optimised medical therapy);

(ii) left ventricular ejection fraction of less than 35%;

(iii) QRS duration of greater than or equal to 150 ms;

other than a service associated with a service to which item 35200, 38200 or 38212 applies (H)

(Anaes.) (Assist.)

Fee: $1,347.90 Benefit: 75% = $1,010.95

(See para TN.8.63 of explanatory notes to this Category)