Medicare Benefits Schedule - Note TN.8.17

The following are guidelines for appropriate minimum standards for the performance of GI endoscopy in relation to (a) cleaning, disinfection and sterilisation procedures, and (b) anaesthetic and resuscitation equipment.

These guidelines are based on the advice of the Gastroenterological Society of Australia, the Sections of HPB and Upper GI and of Colon and Rectal Surgery of the Royal Australasian College of Surgeons, and the Colorectal Surgical Society of Australia.

Cleaning, disinfection and sterilisation procedures
Endoscopic procedures should be performed in facilities where endoscope and accessory reprocessing protocols follow procedures outlined in:

1. Infection Control in Endoscopy, Gastroenterological Society of Australia and Gastroenterological Nurses College of Australia , 2011;
2. Australian Guidelines for the Prevention and Control of Infection in Healthcare (NHMRC, 2010);
3. Australian Standard AS 4187 2014 (and Amendments), Standards Association of Australia. 

Anaesthetic and resuscitation equipment
Where the patient is anaesthetised, anaesthetic equipment, administration and monitoring, and post-operative and resuscitation facilities should conform to the standards outlined in 'Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures' (PS09), Australian & New Zealand College of Anaesthetists, Gastroenterological Society of Australia and Royal Australasian College of Surgeons.

Single operator, single use peroral cholangiopancreatoscopy (POCPS) item 30665

For the purposes of item 30665 a treatment cycle, for a patient, means a series of treatments for the patient that:

(a)  begins on the day of the initial failed attempt at biliary stone removal via endoscopic retrograde cholangiopancreatography (ERCP) extraction techniques; and
(b)  ends at the conclusion of the aftercare period for the procedure, being either the lithotripsy procedure or a definitive surgical management procedure, that has resulted in removal of the biliary stones.

Conjoint Committee

For the purposes of Items 32023, 30664 and 30665 the procedure is to be performed by a surgeon or gastroenterologist with ERCP training recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy.

Related Items: 30473 30475 30478 30479 30481 30484 30485 30490 30491 30494 30680 30682 30684 30686 30687 30688 30690 30692 30694 32023 32084 32087 32094 32095 32106 32222 32223 32224 32225 32226 32227 32228 32229 32232

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Multiple Operation Rule

Endoscopic insertion of stent or stents for large bowel obstruction, stricture or stenosis, including colonoscopy and any image intensification, where the obstruction is due to:

a) a pre-diagnosed colorectal cancer, or cancer of an organ adjacent to the bowel; or

b) an unknown diagnosis

(Anaes.)

Fee: $632.70 Benefit: 75% = $474.55

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

Sigmoidoscopy or colonoscopy up to the hepatic flexure, with or without biopsy, other than a service associated with a service to which any of items 32222 to 32228 applies.

(Anaes.)

Fee: $126.90 Benefit: 75% = $95.20 85% = $107.90

(See para TN.8.17, TN.8.134 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon up to the hepatic flexure by sigmoidoscopy or colonoscopy for the removal of one or more polyps, other than a service associated with a service to which any of items 32222 to 32228 applies (Anaes.)

(Anaes.)

Fee: $233.20 Benefit: 75% = $174.90 85% = $198.25

(See para TN.8.17, TN.8.134 of explanatory notes to this Category)

Multiple Operation Rule

ENDOSCOPIC DILATATION OF COLORECTAL STRICTURES including colonoscopy

(Anaes.)

Fee: $628.65 Benefit: 75% = $471.50

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

ENDOSCOPIC EXAMINATION of SMALL BOWEL with flexible endoscope passed by stoma, with or without biopsies

(Anaes.)

Fee: $145.60 Benefit: 75% = $109.20 85% = $123.80

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

Anterolateral intraperitoneal rectal tumour, per anal excision of, using rectoscopy digital viewing system and pneumorectum, if:
(a) clinically appropriate; and
(b) removal requires dissection within the peritoneal cavity;
excluding use of a colonoscope as the operating platform and not being a service associated with a service to which item 32024, 32025 or 32232 applies 

(Anaes.) (Assist.)

Fee: $1,554.55 Benefit: 75% = $1,165.95 85% = $1,455.85

(See para TN.8.17, TN.8.31 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient:

(a) following a positive faecal occult blood test; or

(b) who has symptoms consistent with pathology of the colonic mucosa; or

(c) who has anaemia or iron deficiency; or

(d) for whom diagnostic imaging has shown an abnormality of the colon; or

(e) who is undergoing the first examination following surgery for colorectal cancer; or

(f) who is undergoing pre‑operative evaluation; or

(g) for whom a repeat colonoscopy is required due to inadequate bowel preparation for the patient’s previous colonoscopy; or

(h) for the management of inflammatory bowel disease;

other than a service associated with a service to which item 32230 applies

Applicable once on a day under a single episode of anaesthesia or other sedation

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70 85% = $323.80

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient:

(a) who has had a colonoscopy that revealed:

(i) one to 4 adenomas, each of which was less than 10 mm in diameter, had no villous features and had no high grade dysplasia; or

(ii) one or 2 sessile serrated lesions, each of which was less than 10 mm in diameter, and without dysplasia; or

(b) who has a moderate risk of colorectal cancer due to family history; or

(c) who has a history of colorectal cancer and has had an initial post‑operative colonoscopy that did not reveal any adenomas or colorectal cancer;

other than a service associated with a service to which item 32230 applies

Applicable once in any 5 year period

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70 85% = $323.80

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a moderate risk of colorectal cancer due to:

(a) a history of adenomas, including an adenoma that:

(i) was 10 mm or greater in diameter; or

(ii) had villous features; or

(iii) had high grade dysplasia; or

(b) having had a previous colonoscopy that revealed:

(i) 5 to 9 adenomas, each of which was less than 10 mm in diameter, had no villous features and had no high grade dysplasia; or

(ii) one or 2 sessile serrated lesions, each of which was 10 mm or greater in diameter or had dysplasia; or

(iii) a hyperplastic polyp that was 10 mm or greater in diameter; or

(iv) 3 or more sessile serrated lesions, each of which was less than 10 mm in diameter and had no dysplasia; or

(v) one or 2 traditional serrated adenomas, of any size;

other than a service associated with a service to which item 32230 applies

Applicable once in any 3 year period

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70 85% = $323.80

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a high risk of colorectal cancer due to having had a previous colonoscopy that:

(a) revealed 10 or more adenomas; or

(b) included a piecemeal, or possibly incomplete, excision of a large, sessile polyp;

other than a service associated with a service to which item 32230 applies

Applicable 4 times in any 12 month period

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70 85% = $323.80

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a high risk of colorectal cancer due to:

(a) having either:

(i) a known or suspected familial condition, such as familial adenomatous polyposis, Lynch syndrome or serrated polyposis syndrome; or

(ii) a genetic mutation associated with hereditary colorectal cancer; or

(b) having had a previous colonoscopy that revealed:

(i) 5 or more sessile serrated lesions, each of which was less than 10 mm in diameter and had no dysplasia; or

(ii) 3 or more sessile serrated lesions, one or more of which was 10 mm or greater in diameter or had dysplasia; or

(iii) 3 or more traditional serrated adenomas, of any size;

other than a service associated with a service to which item 32230 applies

Applicable once in any 12 month period

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70 85% = $323.80

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy:

(a) for the treatment of bleeding, including one or more of the following:

    (i) radiation proctitis;

    (ii) angioectasia;

    (iii) post‑polypectomy bleeding; or

(b) for the treatment of colonic strictures with balloon dilatation

Applicable only once on a day under a single episode of anaesthesia or other sedation

(Anaes.)

Fee: $534.45 Benefit: 75% = $400.85 85% = $454.30

(See para TN.8.2, TN.8.17, TN.8.152 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, other than:

(a) a service to which item 32222, 32223, 32224, 32225 or 32226 applies; or

(b) a service associated with a service to which item 32230 applies

Applicable once

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70 85% = $323.80

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Removal of one or more polyps during colonoscopy, in association with a service to which item 32222, 32223, 32224, 32225, 32226, or 32228 applies

(Anaes.)

Fee: $307.25 Benefit: 75% = $230.45 85% = $261.20

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Rectal tumour, per anal excision of, using a rectoscopy digital viewing system and pneumorectum if clinically appropriate and excluding use of a colonoscope as the operating platform, not being a service associated with a service to which item 32024, 32025 or 32106 applies (H)

(Anaes.) (Assist.)

Fee: $1,029.30 Benefit: 75% = $772.00

(See para TN.8.17, TN.8.31 of explanatory notes to this Category)

Multiple Operation Rule

Oesophagoscopy (not being a service associated with a service to which item 41822 applies), gastroscopy, duodenoscopy or panendoscopy (1 or more such procedures), with or without biopsy, not being a service associated with a service to which item 30478 or 30479 applies.

(Anaes.)

Fee: $201.75 Benefit: 75% = $151.35 85% = $171.50

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic dilatation of stricture of upper gastrointestinal tract (including the use of imaging intensification where clinically indicated)

(Anaes.)

Fee: $397.55 Benefit: 75% = $298.20 85% = $337.95

(See para TN.8.17, TN.8.133 of explanatory notes to this Category)

Multiple Operation Rule

Oesophagoscopy (other than a service associated with a service to which item 41822 or 41825 applies), gastroscopy, duodenoscopy, panendoscopy or push enteroscopy, one or more such procedures, if:

(a) the procedures are performed using one or more of the following endoscopic procedures:

(i) polypectomy;

(ii) sclerosing or adrenalin injections;

(iii) banding;

(iv) endoscopic clips;

(v) haemostatic powders;

(vi) diathermy;

(vii) argon plasma coagulation; and

(b) the procedures are for the treatment of one or more of the following:

(i) upper gastrointestinal tract bleeding;

(ii) polyps;

(iii) removal of foreign body;

(iv) oesophageal or gastric varices;

(v) peptic ulcers;

(vi) neoplasia;

(vii) benign vascular lesions;

(viii) strictures of the gastrointestinal tract;

(ix) tumorous overgrowth through or over oesophageal stents;

other than a service associated with a service to which item 30473 or 30479 applies

(Anaes.)

Fee: $279.80 Benefit: 75% = $209.85 85% = $237.85

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopy with laser therapy, for the treatment of one or more of the following:

(a) neoplasia;

(b) benign vascular lesions;

(c) strictures of the gastrointestinal tract;

(d) tumorous overgrowth through or over oesophageal stents;

(e) peptic ulcers;

(f) angiodysplasia;

(g) gastric antral vascular ectasia;

(h) post-polypectomy bleeding;

other than a service associated with a service to which item 30473 or 30478 applies

(Anaes.)

Fee: $542.35 Benefit: 75% = $406.80 85% = $461.00

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

PERCUTANEOUS GASTROSTOMY (initial procedure):

(a) including any associated imaging services; and

(b) excluding the insertion of a device for the purpose of facilitating weight loss

(Anaes.)

Fee: $406.70 Benefit: 75% = $305.05 85% = $345.70

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic retrograde cholangiopancreatography, other than a service to which item 30664 or 30665 applies

(Anaes.)

Fee: $415.75 Benefit: 75% = $311.85 85% = $353.40

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

ENDOSCOPIC SPHINCTEROTOMY with or without extraction of stones from common bile duct

(Anaes.)

Fee: $641.80 Benefit: 75% = $481.35 85% = $545.55

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

OESOPHAGEAL PROSTHESIS, insertion of, including endoscopy and dilatation

(Anaes.)

Fee: $599.70 Benefit: 75% = $449.80 85% = $509.75

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

BILE DUCT, ENDOSCOPIC STENTING OF (including endoscopy and dilatation)

(Anaes.)

Fee: $632.70 Benefit: 75% = $474.55 85% = $537.80

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

ENDOSCOPIC BILIARY DILATATION

(Anaes.)

Fee: $479.05 Benefit: 75% = $359.30

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

Balloon enteroscopy, examination of the small bowel (oral approach), with or without biopsy, WITHOUT intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup  (with the exception of item 30682 or 30686)

The patient to whom the service is provided must:

(i)    have recurrent or persistent bleeding; and

(ii)    be anaemic or have active bleeding; and

(iii)    have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify     the cause of     the bleeding.

(Anaes.)

Fee: $1,332.90 Benefit: 75% = $999.70 85% = $1,234.20

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

Balloon enteroscopy, examination of the small bowel (anal approach), with or without biopsy, WITHOUT intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30680 or 30684)

The patient to whom the service is provided must:

(i)    have recurrent or persistent bleeding; and

(ii)    be anaemic or have active bleeding; and

(iii)    have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of      the bleeding.

(Anaes.)

Fee: $1,332.90 Benefit: 75% = $999.70 85% = $1,234.20

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

Balloon enteroscopy, examination of the small bowel (oral approach), with or without biopsy, WITH 1 or more of the following procedures (snare polypectomy, removal of foreign body, diathermy, heater probe, laser coagulation or argon plasma coagulation), for diagnosis and management of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30682 or 30686)

The patient to whom the service is provided must:

(i)    have recurrent or persistent bleeding; and

(ii)    be anaemic or have active bleeding; and

(iii)    have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of     the bleeding.

(Anaes.)

Fee: $1,640.30 Benefit: 75% = $1,230.25 85% = $1,541.60

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

Balloon enteroscopy, examination of the small bowel (anal approach), with or without biopsy, WITH 1 or more of the following procedures (snare polypectomy, removal of foreign body, diathermy, heater probe, laser coagulation or argon plasma coagulation), for diagnosis and management of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30680 or 30684)

The patient to whom the service is provided must:

(i)    have recurrent or persistent bleeding; and

(ii)    be anaemic or have active bleeding; and

(iii)    have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of     the bleeding.

(Anaes.)

Fee: $1,640.30 Benefit: 75% = $1,230.25 85% = $1,541.60

(See para TN.8.17 of explanatory notes to this Category)

Multiple Operation Rule

ENDOSCOPY with RADIOFREQUENCY ABLATION of mucosal metaplasia for the treatment of Barrett's Oesophagus in a single course of treatment, following diagnosis of high grade dysplasia confirmed by histological examination

(Anaes.)

Fee: $542.35 Benefit: 75% = $406.80 85% = $461.00

(See para TN.8.17, TN.8.20 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis.

(Anaes.)

Fee: $415.75 Benefit: 75% = $311.85 85% = $353.40

(See para TN.8.17, TN.8.21 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy,  with fine needle aspiration, including aspiration of the locoregional lymph nodes if performed, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis.

(Anaes.)

Fee: $641.80 Benefit: 75% = $481.35 85% = $545.55

(See para TN.8.17, TN.8.21 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis.

(Anaes.)

Fee: $415.75 Benefit: 75% = $311.85 85% = $353.40

(See para TN.8.17, TN.8.21 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy,  with fine needle aspiration, for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours,  not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis.

(Anaes.)

Fee: $641.80 Benefit: 75% = $481.35 85% = $545.55

(See para TN.8.17, TN.8.21 of explanatory notes to this Category)