Medicare Benefits Schedule - Note DN.1.31

The formal report is separate to any letter and entails interpretation of the trace commenting on the significance of the trace findings and their relationship to clinical decision making for the patient in their clinical context, in addition to any measurements taken or automatically generated.

Related Items: 11704 11705 11716 11717 11723 11735

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Twelve‑lead electrocardiography, trace and formal report, by a specialist or a consultant physician, if the service:

(a) is requested by a requesting practitioner; and

(b) is not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies.

Note: the following are also requirements of the service:

1. a formal report is completed; and
2. a copy of the formal report is provided to the requesting practitioner; and
3. the service is not provided to the patient as part of an episode of hospital treatment or hospital-substitute treatment; and
4. is not provided in association with an attendance item (Part 2 of the schedule); and
5. the specialist or consultant physician who renders the service does not have a financial relationship with the requesting practitioner.

Fee: $36.45 Benefit: 85% = $31.00

(See para DN.1.31, DR.1.4 of explanatory notes to this Category)

Twelve‑lead electrocardiography, formal report only, by a specialist or a consultant physician, if the service:

(a) is requested by a requesting practitioner; and

(b) is not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable not more than twice on the same day

Note: the following are also requirements of the service:

1. a formal report is completed; and
2. a copy of the formal report is provided to the requesting practitioner; and
3. the specialist or consultant physician who renders the service does not have a financial relationship with the requesting practitioner.

Fee: $21.45 Benefit: 75% = $16.10 85% = $18.25

(See para DN.1.31, DR.1.4 of explanatory notes to this Category)

Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Continuous ambulatory electrocardiogram recording for 12 or more hours, by a specialist or consultant physician, if the service:

(a) is indicated for the evaluation of any of the following:

(i) syncope;

(ii) pre‑syncopal episodes;

(iii) palpitations where episodes are occurring more than once a week;

(iv) another asymptomatic arrhythmia is suspected with an expected frequency of greater than once a week;

(v) surveillance following cardiac surgical procedures that have an established risk of causing dysrhythmia; and

(b) utilises a system capable of superimposition and full disclosure printout of at least 12 hours of recorded electrocardiogram data (including resting electrocardiogram and the recording of parameters) and microprocessor based scanning analysis; and

(c) includes interpretation and report; and

(d) is not provided in association with ambulatory blood pressure monitoring; and

(e) is not associated with a service to which item 11704, 11705, 11707, 11714, 11717, 11723, 11735, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable only once in any 4 week period

Note: this services does not apply if the patient is being provided with the service as part of an episode of:

1. hospital treatment; or
2. hospital‑substitute treatment.

Fee: $195.45 Benefit: 85% = $166.15

(See para DN.1.28, DN.1.31, DR.1.1 of explanatory notes to this Category)

Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Ambulatory electrocardiogram monitoring, by a specialist or consultant physician, if the service:

(a) utilises a patient activated, single or multiple event memory recording device that:

(i) is connected continuously to the patient for between 7 and 30 days; and

(ii) is capable of recording for at least 20 seconds prior to each activation and for 15 seconds after each activation; and

(b) includes transmission, analysis, interpretation and reporting (including the indication for the investigation); and

(c) is for the investigation of recurrent episodes of:

1. unexplained syncope; or
2. palpitation; or
3. other symptoms where a cardiac rhythm disturbance is suspected and where infrequent episodes have occurred; and

(d) is not associated with a service to which item 11716, 11723, 11735, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable only once in any 3 month period

Note: the service does not apply if the patient is being provided with the service as part of an episode of:

1. hospital treatment; or
2. hospital‑substitute treatment.

Fee: $114.85 Benefit: 85% = $97.65

(See para DN.1.26, DN.1.31, DR.1.1 of explanatory notes to this Category)

Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Ambulatory electrocardiogram monitoring, by a specialist or consultant physician, if the service:

(a) utilises a patient activated, single or multiple event recording, on a memory recording device that:

(i) is connected continuously to the patient for up to 7 days; and

(ii) is capable of recording for at least 20 seconds prior to each activation and for 15 seconds after each activation; and

(b) includes transmission, analysis, interpretation and formal report (including the indication for the investigation); and

(c) is for the investigation of recurrent episodes of:

(i) unexplained syncope; or

(ii) palpitation; or

(iii) other symptoms where a cardiac rhythm disturbance is suspected and where infrequent episodes have occurred; and

(d) is not associated with a service to which item 11716, 11717, 11735, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable only once in any 3 month period

Note: The service does not apply if the patient is an admitted patient.

Fee: $60.60 Benefit: 85% = $51.55

(See para DN.1.26, DN.1.31, DR.1.1 of explanatory notes to this Category)

Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Continuous ambulatory electrocardiogram recording for 7 days, by a specialist or consultant physician, if the service:

(a) utilises intelligent microprocessor based monitoring, with patient triggered recording and symptom reporting capability, real time analysis of electrocardiograms and alerts and daily or live data uploads; and

(b) is for the investigation of:

(i) episodes of suspected intermittent cardiac arrhythmia or episodes of syncope; or

(ii) suspected intermittent cardiac arrhythmia in a patient who has had a previous cerebrovascular accident, is at risk of cerebrovascular accident or has had one or more previous transient ischemic attacks; and

(c) includes interpretation and report; and

(d) is not a service:

(i) provided in association with ambulatory blood pressure monitoring; or

(ii) associated with a service to which item 11716, 11717, 11723, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable not more than 4 times in any 12 month period

Note: The service does not apply if the patient is an admitted patient.

Fee: $149.25 Benefit: 85% = $126.90

(See para DN.1.26, DN.1.31, DR.1.1 of explanatory notes to this Category)