Medicare Benefits Schedule - Note PN.0.27

Genomic testing methods for future re-analysis

Items 73416 and 73392

The rapidly expanding field of genomic medicine has resulted in recognition of an increasing number of genetic causes of cardiac diseases. Use of genomic testing methods that permit reanalysis of existing data for variants in newly described clinically relevant genes are recommended/encouraged.

Related Items: 73392 73416

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Characterisation of pathogenic or likely pathogenic germline gene variants, requested by a specialist or consultant physician:

(a) in at least the following genes:

(i) MYBPC3;

(ii) MYH7;

(iii) TNNI3;

(iv) TNNT2;

(v) TPM1;

(vi) ACTC1;

(vii) MYL2;

(viii) MYL3;

(ix) PRKAG2;

(x) LAMP2;

(xi) GLA;

(xii) LMNA;

(xiii) SCN5A;

(xiv) TTN;

(xv) RBM20;

(xvi) PLN;

(xvii) DSP;

(xviii) DSC2;

(xix) DSG2;

(xx) JUP;

(xxi) PKP2;

(xxii) TMEM43; and

(b) for a patient for whom clinical history, family history or laboratory findings suggest there is a high probability of one or more of the following heritable cardiomyopathies in the patient:

(i) hypertrophic cardiomyopathy;

(ii) dilated cardiomyopathy;

(iii) arrhythmogenic cardiomyopathy

Applicable once per lifetime

Fee: $1,200.00 Benefit: 75% = $900.00 85% = $1,097.60

(See para PN.0.23, PN.0.27 of explanatory notes to this Category)

Detection of germline gene variants, including copy number variation, requested by a specialist or consultant physician:

(a) in at least the following genes:

(i) KCNQ1;

(ii) KCNH2;

(iii) SCN5A;

(iv) KCNE1;

(v) KCNE2;

(vi) KCNJ2;

(vii) CACNA1C;

(viii) RYR2;

(ix) CASQ2;

(x) CAV3;

(xi) SCN4B;

(xii) AKAP9;

(xiii) SNTA1;

(xiv) KCNJ5;

(xv) ALG10;

(xvi) CALM1;

(xvii) CALM2;

(xviii) ANK2;

(xix) TECRL;

(xx) TRDN; and

(b) for a patient for whom clinical or family history criteria is suggestive of inherited cardiac arrhythmias or channelopathies that place the patient at greater than 10% risk of having a pathogenic variant

Applicable once per lifetime

Fee: $1,200.00 Benefit: 75% = $900.00 85% = $1,097.60

(See para PN.0.23, PN.0.27 of explanatory notes to this Category)