Medicare Benefits Schedule - Item 38272

Atrial septal defect or patent foramen closure:

(a) for congenital heart disease in a patient with documented evidence of right heart overload or paradoxical embolism; and

(b) using a septal occluder or similar device, by transcatheter approach; and

(c) including right or left heart catheterisation (or both);

other than a service associated with a service to which item 38200, 38203, 38206 or 38254 applies

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $1,039.30 Benefit: 75% = $779.50 85% = $936.90

(See para TN.8.221 of explanatory notes to this Category)

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Claiming Guidance

This item may be claimed without evidence of right heart overload in highly rare paediatric conditions such as abnormal development of the right heart. Additionally, in patients under 16 years old, risk of paradoxical embolism is sufficient.

Related Items: 38272