Medicare Benefits Schedule - Note IN.1.10

Functional studies include stress echocardiograms and nuclear myocardial perfusion studies

Indications

Assessment before cardiac surgery or catheter-based interventions to ensure the criteria for intervention are met could include assessment of the severity of aortic stenosis in patients with impaired left ventricular function or obtaining objective evidence of the correlation between functional capacity and ischaemic threshold.

A calcium score of zero is normal in adults and clinician judgement should be applied for scores of 0–10 (does not apply to persons under 17 years).

Providers

Appropriately trained means a provider that meets the level 2 requirements for stress echocardiography as described in the Cardiac Society of Australia & New Zealand Guidelines for Training and Performance in Adult Echocardiography or CSANZ Guidelines for Training and Performance in Paediatric Echocardiography, or an equivalent training standard.

This available at: https://www.csanz.edu.au/wp-content/uploads/2015/04/Adult-Echo_2015-February.pdf

A complete echocardiogram refers to services performed under items 55126, 55127, 55128, 55129, 55132, 55134 and 55137.

In most cases, stress echocardiography and myocardial perfusion studies provide equivalent information. Consideration should be given to the radiation burden of any test that is requested when determining the appropriate modality for a patient, and the patient should be fully informed and involved in this decision.

Results

Discussions of the results, findings or interpretation of a study are reasonably expected to be part of a formal report. Discussion of these findings with a patient does not constitute a consult. Similarly, discussion(s) during the course of a study or to determine the safety or appropriateness of the study is part of the service and should not be claimed as a consult.

Related Items: 55141 55143 55145 55146

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Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2 and does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55143, 55145 or 55146 applies has been provided to the patient.

Exercise stress echocardiography focused study, other than a service associated with a service to which:

(a) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(b) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Fee: $461.15 Benefit: 75% = $345.90 85% = $392.00

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1, IR.1.1 and IR.1.2 

Repeat pharmacological or exercise stress echocardiography if:

(a) a service to which item 55141, 55145, 55146, or this item, applies has been performed on the patient in the previous 24 months; and

(b) the patient has symptoms of ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) the service is requested by a specialist or a consultant physician; and

(d) the service is not associated with a service to which:

(i) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(ii) an item in Subgroup 3 applies

Applicable not more than once in a 12 month period (R)

Fee: $461.15 Benefit: 75% = $345.90 85% = $392.00

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2

Pharmacological stress echocardiography, other than a service associated with a service to which:

(a) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(b) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Note: this item does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55141, 55143 or 55146 applies has been provided to the patient.

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

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2

Pharmacological stress echocardiography if:

(a) a service to which item 55141 applies has been performed on the patient in the previous 4 weeks, and the test has failed due to an inadequate heart rate response; and

(b) the service is not associated with a service to which:

(i) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(ii) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Note: this item does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55143 or 55145 applies has been provided to the patient.

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

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 of explanatory notes to this Category)