Medicare Benefits Schedule - Item 38374

Leadless permanent cardiac pacemaker, single‑chamber ventricular, percutaneous retrieval of, if:

(a) the service is performed by a specialist or consultant physician who has undertaken training to perform the service; and

(b) if the service is performed at least 4 weeks after the pacemaker was inserted—the service is performed in a facility where cardiothoracic surgery is available and a thoracotomy can be performed immediately and without transfer; and

(c) if the service is performed by an interventional cardiologist at least 4 weeks after the pacemaker was inserted—a cardiothoracic surgeon is in attendance during the service

(H)

Multiple Operation Rule

(Anaes.)

Fee: $879.95 Benefit: 75% = $660.00

(See para TN.8.214 of explanatory notes to this Category)

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International guidelines for chronic lead extraction state that delays from injury to open access to the heart of more than 5–10 minutes are often associated with a fatal outcome. Preparations for this procedure should provide for this rare but life threatening circumstance.

Claiming guide chronic lead extraction:

When the service to which item 38358 applies is provided to a patient by an accredited interventional cardiologist the following claiming will apply:

• Item 38358 is to be claimed by the accredited interventional cardiologist; and
• Item 90300 is to be claimed by the standby cardiothoracic surgeon.

When the service to which item 38358 applies is provided to a patient by an accredited cardiothoracic surgeon the following claiming will apply:

• Item 38358 is to be claimed by the accredited cardiothoracic surgeon only

Claiming guide leadless pacemaker extraction (for an interventional cardiologist):

When the service to which item 38374 or 38375 applies is provided to a patient by an accredited interventional cardiologist the following claiming will apply:

• Item 38374 is to be claimed by the accredited interventional cardiologist; and
• Item 90300 is to be claimed by the standby cardiothoracic surgeon.

When the service to which item 38375 applies is provided to a patient by an accredited cardiothoracic surgeon the following claiming will apply:

• Item 38375 is to be claimed by the accredited cardiothoracic surgeon only

Claiming guide TAVI intermediate risk (38514) or TAVI low risk (38522):

When the service to which item 38514 or 38522 applies is provided to a patient by an accredited interventional cardiologist the following claiming will apply:

• Item 38514 or 38522 is to be claimed by the accredited interventional cardiologist; and
• Item 90300 is to be claimed by the standby cardiothoracic surgeon.

When the service to which item 38514 or 38522 applies is provided to a patient by an accredited cardiothoracic surgeon the following claiming will apply:

• Item 38514 or 38522 is to be claimed by the accredited cardiothoracic surgeon only

Related Items: 38358 38373 38374 38514 38522 90300