Medicare Benefits Schedule - Item 73400

Genetic testing for at least 2 HLA variants to predict the patient’s risk of a severe drug hypersensitivity reaction to carbamazepine or oxcarbazepine, if the service is conducted before or during the initiation of treatment with carbamazepine or oxcarbazepine

Applicable once per lifetime

Fee: $139.00 Benefit: 75% = $104.25 85% = $118.15

(See para PN.7.23 of explanatory notes to this Category)

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Item 73400 Genetic testing:

• should be in line with contemporaneous clinical guidelines
• should at a minimum include the following alleles: HLA-B*15:02, HLA-A*31:01
• should be conducted prior to initiation of treatment with carbamazepine or oxcarbazepine, unless the patient requires urgent treatment before the test result is available.

Requesting physicians should note:

• Not all drug hypersensitivity reactions to carbamazepine or oxcarbazepine are linked to HLA-B*15:02, HLA-A*31:01. Thus, genetic testing cannot definitively exclude the possibility of a drug hypersensitivity event. Clinical vigilance remains necessary, even after negative results from the relevant HLA alleles testing.
• HLA-B*15:02 is of higher prevalence in patients with East Asian ancestry. An individual’s self-reported ancestry should not be used solely to predict whether the individual has the HLA-B*15:02 or HLA-A*31:01 alleles.

Related Items: 73400