Medicare Benefits Schedule - Item 13207

Biopsy of an embryo, from a patient who is eligible for a service described in item 73384 under clause 2.7.3A of the pathology services table (see PR.7.1), for the purpose of providing a sample for pre-implantation genetic testing—applicable to one or more tests performed in one assisted reproductive treatment cycle

Fee: $125.90 Benefit: 75% = $94.45 85% = $107.05

(See para PR.7.1 of explanatory notes to this Category)

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A patient is eligible for a service described in any of items 73384 to 73387 only if:

(a)  the patient or the patient’s reproductive partner:

1. has an identified gene variant which places the patient at risk of having a pregnancy affected by a Mendelian or mitochondrial disorder; or
2. is at risk of an autosomal dominant disorder which places the patient at risk of having a child who develops the autosomal dominant disorder; or
3. has a chromosome re‑arrangement or copy number variant which places the patient at risk of having a pregnancy affected by a chromosome disorder; and

(b)  there is no curative treatment for the disorder and there is severe limitation of quality of life despite contemporary management of the disorder; and

(c)  the patient has previously had a consultation, with a specialist or consultant physician practising as a clinical geneticist, that included a discussion about the disorder.

Related Items: 13207 73384 73385 73386 73387