Medicare Benefits Schedule - Note IN.1.4

Recommended intervals adapted from the 2014 American Heart Association/American College of Cardiology Guideline for the Management of Patients with Valvular Heart Disease.

The guidelines are available at: http://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_462851.pdf

Mild to moderate disease:

1. Aortic stenosis should have a repeat every 3–5 years for mild disease and 1–2 years for moderate disease.
2. Other valvular disease should NOT have repeat imaging more frequently than every 3 years for mild disease and every 1–2 years for moderate disease.

Severe disease:

1. should be monitored in line with the guidelines.

Provider

Providers of this item number should meet the Level 1 requirements described in the CSANZ Guidelines for Training and Performance in Adult Echocardiography or equivalent. https://www.csanz.edu.au/wp-content/uploads/2015/04/Adult-Echo_2015-February.pdf

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: 55127 55128

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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.1.2

Repeat serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of known valvular dysfunction; and

(b) is requested by a specialist or consultant physician; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $258.70 Benefit: 75% = $194.05 85% = $219.90

(See para IN.0.19, IN.1.4, IN.7.1, 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.1.2

Repeat serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of known valvular dysfunction; and

(b) is requested by a medical practitioner (other than a specialist or consultant physician) at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $258.70 Benefit: 75% = $194.05 85% = $219.90

(See para IN.0.19, IN.1.4, IN.7.1, IR.1.2, IR.1.3 of explanatory notes to this Category)