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Category 5 - DIAGNOSTIC IMAGING SERVICES
IR.1.2
Echocardiography and attendance requirements
1. For any particular patient, a service associated with an attendance item listed in Part 2 of the general medical services table does not apply if a service to which item 55126, 55127, 55128, 55129, 55132, 55133, 55134, 55137, 55141, 55143, 55145 or 55146 applies is provided on the same day; unless:
- the attendance service is provided after the service where clinical management decisions are made; or
- the decision to perform the service on the same day was made during the attendance service subject to clinical assessment.
Related Items: 55126 55127 55128 55129 55132 55133 55134 55137 55141 55143 55145 55146
Related Items
Category 5 - DIAGNOSTIC IMAGING SERVICES
55126 - Additional Information
Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2
Initial 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 any of the following:
(i) symptoms or signs of cardiac failure;
(ii) suspected or known ventricular hypertrophy or dysfunction;
(iii) pulmonary hypertension;
(iv) valvular, aortic, pericardial, thrombotic or embolic disease;
(v) heart tumour;
(vi) symptoms or signs of congenital heart disease;
(vii) other rare indications; and
(b) 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
Applicable not more than once in a 24 month period (R)
Fee: $258.70 Benefit: 75% = $194.05 85% = $219.90
(See para IN.0.19, IN.1.3, IN.7.1, IR.1.2, IR.1.3 of explanatory notes to this Category)
Category 5 - DIAGNOSTIC IMAGING SERVICES
55127 - Additional Information
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)
Category 5 - DIAGNOSTIC IMAGING SERVICES
55128 - Additional Information
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)
Category 5 - DIAGNOSTIC IMAGING SERVICES
55129 - Additional Information
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)
Category 5 - DIAGNOSTIC IMAGING SERVICES
55132 - Additional Information
Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2
Serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media, if the service:
(a) is for the investigation of a patient who:
(i) is under 17 years of age; or
(ii) has complex congenital heart disease; and
(b) is performed by a specialist or consultant physician practising in the speciality of cardiology; 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.1.6, IN.7.1, IR.1.2, IR.1.3 of explanatory notes to this Category)
Category 5 - DIAGNOSTIC IMAGING SERVICES
55133 - Additional Information
Note: the service only applies if the patient meets one or more of the following and the requirements of Note: IR.1.2
Frequent repetition 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 a patient who:
(i) has an isolated pericardial effusion or pericarditis; or
(ii) has a normal baseline study, and has commenced medication for non‑cardiac purposes that has cardiotoxic side effects and is a pharmaceutical benefit (within the meaning of Part VII of the National Health Act 1953) for the writing of a prescription for the supply of which under that Part an echocardiogram is required; and
(b) 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: $232.80 Benefit: 75% = $174.60 85% = $197.90
(See para IN.0.19, IN.1.7, IN.7.1, IR.1.2, IR.1.3 of explanatory notes to this Category)
Category 5 - DIAGNOSTIC IMAGING SERVICES
55134 - Additional Information
Note: the service only applies if the patient meets one or more of the following and the requirements of Note: IR.1.2
Repeat 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, for the investigation of rare cardiac pathologies, if the service:
(a) is requested by a specialist or consultant physician; and
(b) 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.1.8, IN.7.1, IR.1.2, IR.1.3 of explanatory notes to this Category)
Category 5 - DIAGNOSTIC IMAGING SERVICES
55137 - Additional Information
Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2
Serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media, if the service:
(a) is for the investigation of a fetus with suspected or confirmed:
(i) complex congenital heart disease; or
(ii) functional heart disease; or
(iii) fetal cardiac arrhythmia; or
(iv) cardiac structural abnormality requiring confirmation; and
(b) is performed by a specialist or consultant physician practising in the speciality of cardiology with advanced training and expertise in fetal cardiac imaging; and
(c) is not associated with a service to which:
(i) an item in Subgroup 2 applies (except items 55118 and 55130); or
(ii) an item in Subgroup 3 applies (R)
Fee: $258.70 Benefit: 75% = $194.05 85% = $219.90
(See para IN.0.19, IN.1.9, IR.1.2, IR.1.3 of explanatory notes to this Category)
Category 5 - DIAGNOSTIC IMAGING SERVICES
55141 - Additional Information
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)
Category 5 - DIAGNOSTIC IMAGING SERVICES
55143 - Additional Information
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)
Category 5 - DIAGNOSTIC IMAGING SERVICES
55145 - Additional Information
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)
Category 5 - DIAGNOSTIC IMAGING SERVICES
55146 - Additional Information
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)
Legend
- Assist - Addition/Deletion of (Assist.)
- Amend - Amended Description
- Anaes - Anaesthetic Values Amended
- Emsn - EMSN Change
- Fee - Fee Amended
- Renum - Item Number Change (renumbered)
- New - New Item
- NewMin - New Item (previous Ministerial Determination)
- Qfe - QFE Change