Medicare Benefits Schedule - Item 11823

Capsule endoscopy to conduct small bowel surveillance of a patient diagnosed with Peutz-Jeghers Syndrome, using a

capsule endoscopy device approved by the Therapeutic Goods Administration (including administration of the capsule, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered) if:

(a) the service is performed by a specialist or consultant physician with endoscopic training that is recognised by

the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and

(b) the item is performed only once in any 2 year period; and

(c) the service is not associated with balloon enteroscopy.

Fee: $1,400.50 Benefit: 75% = $1,050.40 85% = $1,301.80

(See para DN.1.15 of explanatory notes to this Category)

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Capsule endoscopy is primarily used to view the small bowel, which cannot be viewed by upper gastrointestinal endoscopy and colonoscopy.  

Capsule endoscopy imaging must be kept in a manner that facilitates retrieval on the basis of the patient's name and date of service. Records must be retained for a period of 2 years commencing on the day on which the service was rendered.

The Conjoint Committee comprises representatives from the Gastroenterological Society of Australia (GESA), the Royal Australasian College of Physicians (RACP) and the Royal Australasian College of Surgeons (RACS). For the purposes of Items 11820 and 11823, specialists or consultant physicians performing this procedure must have endoscopic training recognised by The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy, and the Department of Human Services notified of that recognition. 

Related Items: 11820 11823