Medicare Benefits Schedule - Note TN.8.21

For the purposes of these items the following definitions apply: 

Biopsy  means the removal of solid tissue by core sampling or forceps

FNA  means aspiration of cellular material from solid tissue via a small gauge needle. 

The provider should make a record of the findings of the ultrasound imaging in the patient's notes for any service claimed against items 30688 to 30694, 38416 and 38417. 

Endoscopic ultrasound  is an appropriate investigation for patients in whom there is a strong clinical suspicion of pancreatic neoplasia with negative imaging (such as CT scanning). Scenarios include, but are not restricted to:

-           A middle aged or elderly patient with a first attack of otherwise unexplained (eg negative abdominal CT) first episode of acute pancreatitis; or

-           A patient with biochemical evidence of a neuroendocrine tumour.

The procedure is not claimable for periodic surveillance of patients at increased risk of pancreatic cancer, such as chronic pancreatitis. However, EUS would be appropriate for a patient with chronic pancreatitis in whom there was a clinical suspicion of pancreatic cancer (eg: a pancreatic mass occurring on a background of chronic pancreatitis).

Related Items: 30688 30690 30692 30694 38416 38417

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Multiple Operation Rule

Endoscopic ultrasound guided fine needle aspiration biopsy or biopsies (endoscopy with ultrasound imaging) to obtain one or more specimens from either or both of the following:

(a) mediastinal masses;

(b) locoregional nodes to stage non-small cell lung carcinoma;

other than a service associated with a service to which an item in Subgroup 1 of this Group, or item 38417 or 55054, applies 

(Anaes.)

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

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

Multiple Operation Rule

Endobronchial ultrasound guided biopsy or biopsies (bronchoscopy with ultrasound imaging, with or without associated fluoroscopic imaging) to obtain one or more specimens by:

(a) transbronchial biopsy or biopsies of peripheral lung lesions; or

(b) fine needle aspirations of one or more mediastinal masses; or

(c) fine needle aspirations of locoregional nodes to stage non-small cell lung carcinoma;

other than a service associated with a service to which an item in Subgroup 1 of this Group, item 38416, 38420 or 38423, or an item in Subgroup I5 of Group I3, applies 

(Anaes.)

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

(See para TN.8.21 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)