Medicare Benefits Schedule - Note TN.8.132

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Transcatheter occlusion of left atrial appendage for stroke prevention (item 38276)

Eligibility requirements for Item 38276

This item is intended for use in patients where an independent medical practitioner has documented an absolute and permanent contraindication to oral coagulation. The medical practitioner who has documented this contraindication should not have been involved in any decision to provide the service or the actual provision of the service, and is not engaged in the same or a similar group of practitioners.

The following list provides examples of the conditions for which this item is intended:

  1. A previous major bleeding complication experienced whilst undergoing treatment with oral anticoagulation therapy without remedial cause, or
  2. History of intracranial, intraocular, spinal, retroperitoneal or atraumatic intra-articular bleeding, or
  3. Chronic, irreversible, recurrent gastrointestinal bleeding of any cause (eg, radiation proctitis, gut angiodysplasia, hereditary haemorrhagic telangiectasia, gastric antral vascular ectasia (GAVE), portal hypertensive gastropathy, refractory radiation proctitis, obscure source), or
  4. Life-long spontaneous impairment of haemostasis, or
  5. A vascular abnormality predisposing to potentially life threatening haemorrhage, or
  6. Irreversible hepatic disease with coagulopathy and increased bleeding risk (Child Pugh B and C), or
  7. Receiving concomitant medications with strong inhibitors of both CYP3A4 and P-glycoprotein (P-gp), or
  8. Severe renal impairment defined as creatinine clearance (CrCL) < 15 ml/min or undergoing dialysis and where warfarin is inappropriate, or
  9. Known hypersensitivity to the direct oral anticoagulant (DOAC) or to any of the excipients.

This item is not intended for use in patients with a relative contraindication to oral anticoagulation.



Related Items: 38276

Related Items



38276 - Additional Information

Item Start Date:
Description Updated:
Schedule Fee Updated:

Transcatheter occlusion of left atrial appendage, and cardiac catheterisation performed by the same practitioner, for stroke prevention in a patient who has non‑valvular atrial fibrillation, if:

(a) the patient is at increased risk of thromboembolism demonstrated by:

(i) a prior stroke (whether of an ischaemic or unknown type), transient ischaemic attack or non‑central nervous system systemic embolism; or

(ii) at least 2 of the following risk factors:

(A) an age of 65 years or more;

(B) hypertension;

(C) diabetes mellitus;

(D) heart failure or left ventricular ejection fraction of 35% or less (or both);

(E) vascular disease (prior myocardial infarction, peripheral artery disease or aortic plaque); and

(b) the patient has an absolute and permanent contraindication to oral anticoagulation (confirmed by written documentation that is provided by a medical practitioner, independent of the practitioner rendering the service); and

(c) the service is not associated with a service to which item 38200, 38203, 38206 or 38254 applies


(Anaes.) (Assist.)

Fee: $999.15 Benefit: 75% = $749.40

(See para TN.8.132 of explanatory notes to this Category)


  • 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