Medicare Benefits Schedule - Note PN.7.15

Prior to requesting or performing these tests, the requesting practitioner or pathologist should consider if the patient has already received equivalent testing under the same or another methodology in the same new diagnosis of non-small cell lung cancer (NSCLC).
Repeat testing by multiple methods in the same new diagnosis of NSCLC should only be performed if it is clinically relevant.

Items 73337, 73341, 73344 and 73436 support sequential single-gene testing for biomarkers in patients with NSCLC.

Item 73437 supports use of one next generation sequencing (NGS) panel for testing of all biomarkers supported under items 73337, 73341, 73344 and 73436.

Items 73438 and 73439 support sequential use of two NGS panels for testing of all biomarkers supported under 73337 and 73436, and 73341 and 73344 respectively.

Related Items: 73337 73341 73344 73436 73437 73438 73439

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A test of tumour tissue from a patient with a new diagnosis of non-small cell lung cancer, requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a) for epidermal growth factor receptor (EGFR) status to determine eligibility for a relevant treatment under the Pharmaceutical Benefits Scheme; and 

(b) not associated with a service to which item 73437 or 73438 applies

Fee: $397.35 Benefit: 75% = $298.05 85% = $337.75

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)

Fluorescence in situ hybridisation (FISH) test of tumour tissue from a patient with a new diagnosis of non-small cell lung cancer, requested by a specialist or consultant physician, if the test is:

(a) for ALK gene rearrangement status to determine eligibility for a relevant treatment under the Pharmaceutical Benefits Scheme; and

(b) not associated with a service to which item 73437 or 73439 applies

Fee: $400.00 Benefit: 75% = $300.00 85% = $340.00

(See para PN.7.15 of explanatory notes to this Category)

Fluorescence in situ hybridization (FISH) test of tumour tissue from a patient with a new diagnosis of non-small cell lung cancer, requested by a specialist or consultant physician, if the test is:

(a) for ROS1 gene arrangement status to determine eligibility for a relevant treatment under the Pharmaceutical Benefits Scheme; and

(b) not associated with a service to which item 73437 or 73439 applies

Fee: $400.00 Benefit: 75% = $300.00 85% = $340.00

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)

A test of tumour tissue from a patient with a new diagnosis of non-small cell lung cancer requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a)   for MET proto-oncogene, receptor tyrosine kinase (MET) exon 14 skipping alterations (METex14sk) status to determine eligibility for access to a relevant treatment under the Pharmaceutical Benefits Scheme; and

(b)   not associated with a service to which item 73437 or 73438 applies

Fee: $397.35 Benefit: 75% = $298.05 85% = $337.75

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)

A nucleic acid-based multi-gene panel test of tumour tissue from a patient with a new diagnosis of non-small cell lung cancer requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a) to detect variants in at least EGFR, BRAF, KRAS and MET exon 14 to determine eligibility for a relevant treatment under the Pharmaceutical Benefits Scheme; and

(b) to detect the fusion status of at least ALK, ROS1, RET, NTRK1, NTRK2 and NTRK3 to determine eligibility for a relevant treatment under the PBS; and

(c) not associated with a service to which item 73438, 73439, 73337, 73341, 73344, 73436 or 73351 applies

Fee: $1,247.00 Benefit: 75% = $935.25 85% = $1,142.50

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)

A DNA-based multi-gene panel test of tumour tissue from a patient with a new diagnosis of non-small cell lung cancer requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a) to detect variants in at least EGFR, BRAF, KRAS and MET exon 14; and

(b) to determine eligibility for a relevant treatment under the Pharmaceutical Benefits Scheme; and

(c) not associated with a service to which item 73437, 73337, 73436 or 73351 applies

Fee: $682.35 Benefit: 75% = $511.80 85% = $580.00

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)

A nucleic acid-based multi-gene panel test of tumour tissue from a patient with a new diagnosis of non-small cell lung cancer and with documented absence of activating variants of the EGFR gene, KRAS, BRAF and MET exon14, requested by, or on behalf of, a specialist or consultant physician, if the test is:

(a) for fusion status of at least ALK, ROS1, RET, NTRK1, NTRK2, and NTRK3 to determine eligibility for a relevant treatment under the Pharmaceutical Benefits Scheme; and

(b) not associated with a service to which item 73437, 73341, 73344 or 73351 applies

Fee: $682.35 Benefit: 75% = $511.80 85% = $580.00

(See para PN.1.2, PN.7.15 of explanatory notes to this Category)