View Associated Notes
Category 3 - THERAPEUTIC PROCEDURES
13761 - Additional Information
Extracorporeal photopheresis for the treatment of chronic graft‑versus‑host disease, if:
(a) the person is:
(i) has received allogeneic haematopoietic stem cell transplantation; and
(ii) has been diagnosed with chronic graft versus host disease following the transplantation; and
(iii) steroid treatment is clinically unsuitable as the disease is steroid refractory or the person is steroid‑dependent or steroid‑intolerant; and
(b) the person has not previously received extracorporeal photopheresis treatment; and
(c) the service is delivered using an integrated, closed extracorporeal photopheresis system; and
(d) the service is provided in combination with the use of methoxsalen that is listed on the Pharmaceutical Benefits Scheme; and
(e) the service is provided by, or on behalf of, a specialist or consultant physician who:
(i) is practising in the speciality of haematology or oncology; and
(ii) has experience with allogeneic bone marrow transplantation.
Applicable once per treatment session
Fee: $2,089.40 Benefit: 75% = $1,567.05 85% = $1,990.70
(See para TN.1.29 of explanatory notes to this Category)
Associated Notes
Category 3 - THERAPEUTIC PROCEDURES
TN.1.29
Extracorporeal Photopheresis (ECP) for Chronic Graft Versus Host Disease (cGVHD)
For the purpose of administering MBS item 13761 the phrase ‘treatment cycle’ usually refers to a 12-week time period and item 13762 usually refers to a 6-week time period. A ‘treatment session’ is an attendance for ECP, which occurs two or three times per week.
A cycle of treatment funded under item 13762 can be preceded by a cycle funded by either item 13761 or by item 13762, provided at least a partial organ response occurs. A response, for the purposes of administering MBS item 13762, is defined as attaining a complete or partial response in at least one organ according to National Institutes of Health (NIH) criteria. A response only needs to be demonstrated after the first 12 weeks of treatment.
Patient Requirements
For the purpose of administering MBS item 13761 and item 13762, steroid-refractory or steroid-dependent disease is defined as one of the following:
- A lack of response or disease progression after a minimum of prednisone 1 mg/kg/day or equivalent for at least 1 week, OR
- Disease persistence without improvement despite continued treatment with prednisone at > 0.5 mg/kg/day or 1 mg/kg every day or equivalent other day for at least 4 weeks, OR
- Increase to prednisolone dose to > 0.25 mg/kg/day or equivalent after 2 unsuccessful attempts to taper the dose.
Legend
- Assist - Addition/Deletion of (Assist.)
- Amend - Amended Description
- Anaes - Anaesthetic Values Amended
- Emsn - EMSN Change
- Fee - Fee Amended
- Renum - Item Number Change (renumbered)
- New - New Item
- NewMin - New Item (previous Ministerial Determination)
- Qfe - QFE Change