Medicare Benefits Schedule - Note IN.1.5

Indications

When requesting this service the provider should  adhere to the National Heart Foundation/Cardiac Society of Australia & New Zealand guidelines which state “An echocardiogram is usually repeated 3–6 months after commencing medical therapy in patients with heart failure and reduced ejection fraction (HFrEF) or if there is a change in clinical status, or to determine eligibility for other pharmacological treatments (e.g. switching an ACE inhibitor or angiotensin receptor blocker to an angiotensin receptor neprilysin inhibitor [ARNI], adding ivabradine) or to determine eligibility for device therapy (ICD and CRT)”

Providers

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: 55129

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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:

(a) valvular dysfunction is not the primary issue for the patient (although it may be a secondary issue); and

(b) the service is for the investigation of any of the following:

(i) symptoms or signs of cardiac failure;

(ii) suspected or known ventricular hypertrophy or dysfunction;

(iii) pulmonary hypertension;

(iv) aortic, thrombotic, embolic disease or pericardial disease (excluding isolated pericardial effusion or pericarditis);

(v) heart tumour;

(vi) structural heart disease;

(vii) other rare indications; and

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

(d) the service 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.1.5, IN.7.1, IR.1.2, IR.1.3 of explanatory notes to this Category)