Medicare Benefits Schedule - Item 38326

Use of optical coherence tomography (OCT) during transluminal insertion of stents, to optimise procedural strategy, appropriate stent size and assessment of stent apposition, if:

(a) the patient is documented with:

  (i) one or more lesions located at a bifurcation; and

  (ii) a planned side branch at least 2.5 mm in diameter by angiographic visual estimation; or

(b) the patient is documented with stent thrombosis; or

(c) both:

   (i) the patient is documented with one or more lesions at least 28mm in length; and

   (ii) either of the following apply:

      (A) a service to which this item applies is not performed in association with a service to which item 38325 applies because of paragraph (b) of that item;

      (B) a service to which this item applies is not performed, in relation to a lesion, in association with a service to which item 38325 applies because of paragraph (a) of that item, performed in relation to the same lesion;

if performed in association with a service to which item 38307, 38308, 38310, 38311, 38313, 38314, 38316, 38317, 38319, 38320, 38322 or 38323 applies

Applicable once per episode of care (for one or more lesions) (H)

Multiple Operation Rule

Fee: $553.15 Benefit: 75% = $414.90

(See para TR.8.8 of explanatory notes to this Category)

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1. For lesions at least 28mm in length, including lesions in the left main artery, item 38326 cannot be claimed in association with a service provided under item 38325 for the same occasion of service.
2. For left main coronary artery biurfication lesions item 38326 is claimable.
3. For left main coronary artery lesions (other than the biurfication) it is not permissible to claim item 38326. For these types of lesions it is only permissible to claim item 38325.

Related Items: 38325 38326