Medicare Benefits Schedule - Note PN.7.13

MBS Items 73440 and 73441

When determining the genes to be assessed on the virtual panel, the list of phenotypically driven genes should be based on a recognised test directory.

MBS Items 73443 and 73444

Prior to requesting or performing these tests, the requesting practitioner or pathologist should consider if the patient has previously received equivalent testing. Testing should not be required more than:

• once per variant per lifetime, for item 73443
• once per gene per lifetime, for item 73444

Additional testing should only be performed if it is clinically relevant.

Related Items: 73440 73441 73443 73444

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Genomic testing and copy number variant analysis of genes known to be causative or likely causative of childhood hearing loss in a patient, if:
(a) the testing and analysis is requested by a specialist or consultant physician; and
(b) the patient has congenital or childhood onset hearing loss that presented before the patient was 18 years of age and is permanent moderate, severe, or profound (>40 dB in the worst ear over 3 frequencies) and classified as sensorineural, auditory neuropathy or mixed; and
(c) the patient is not eligible for a service to which item 73358 or 73359 applies; and
(d) the testing and analysis is not associated with a service to which item 73441 applies

Applicable once per lifetime

Fee: $1,200.00 Benefit: 75% = $900.00 85% = $1,101.30

(See para PN.0.23, PN.7.13 of explanatory notes to this Category)

Genomic testing and copy number variant analysis of relevant genes known to be causative or likely causative of childhood hearing loss in a patient, if:
(a) the testing and analysis is requested by a specialist or consultant physician; and
(b) the patient has congenital or childhood onset hearing loss that presented before the patient was 18 years of age and is permanent bilateral moderate, severe, or profound (>40 dB in the worst ear over 3 frequencies) and classified as sensorineural, auditory neuropathy or mixed; and
(c) the testing and analysis is performed using a sample from the patient and a sample from each of the patient’s biological parents; and
(d) the patient is not eligible for a service to which item 73358 or 73359 applies; and
(e) the testing and analysis is not associated with a service to which item 73440 applies

Applicable once per lifetime

Fee: $2,100.00 Benefit: 75% = $1,575.00 85% = $2,001.30

(See para PN.0.23, PN.7.13 of explanatory notes to this Category)

Characterisation of one or more familial germline gene variants known to be causative or likely causative of childhood hearing loss in a person, if:
(a) the person tested is a biological relative of a patient with a germline gene variant known to be causative or likely causative of hearing loss confirmed by laboratory findings; and
(b) the result of a previous proband testing is made available to the laboratory undertaking the characterisation

Fee: $400.00 Benefit: 75% = $300.00 85% = $340.00

(See para PN.0.23, PN.7.13 of explanatory notes to this Category)

Characterisation of all germline variants in one or more genes known to cause hearing loss in a person, if:
(a) the characterisation is requested by a specialist or consultant physician; and
(b) the characterisation is for the reproductive partner of a patient with a pathogenic or likely pathogenic recessive germline gene variant known to cause hearing loss confirmed by laboratory findings; and
(c) the result of the patient’s previous testing is made available to the laboratory undertaking the characterisation

Fee: $1,200.00 Benefit: 75% = $900.00 85% = $1,101.30

(See para PN.0.23, PN.7.13 of explanatory notes to this Category)