Medicare Benefits Schedule - Note TN.8.278

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Category 3 - THERAPEUTIC PROCEDURES

TN.8.278

Balloon valvuloplasty co-claiming restriction with Transcatheter Aortic Valve Implantation (TAVI) items

The services performed under TAVI items (38495, 38514 and 38522) are complete medical services and include balloon valvuloplasty as part of the TAVI procedural service. MBS item 38270 for balloon valvuloplasty cannot be co-claimed with the TAVI items for the same occasion of service.

Accompanying text is required for claims where a TAVI item and item 38270 are performed on the same day at separate occasions. Suitable texts could include "separate attendances" or "10 AM and 3PM".

Providers are legally responsible for services billed under their provider number or their own name. This includes any incorrect billing of services that result in overpayment of Medicare benefits, regardless of who does the billing or receives the benefit.

Related Items: 38270 38495 38514 38522


Related Items

Category 3 - THERAPEUTIC PROCEDURES

38270

38270 - Additional Information

Item Start Date:
01-May-1997
Description Updated:
01-Nov-2004
Schedule Fee Updated:
01-Nov-2023

BALLOON VALVULOPLASTY OR ISOLATED ATRIAL SEPTOSTOMY, including cardiac catheterisations before and after balloon dilatation

(Anaes.) (Assist.)

Fee: $1,004.15 Benefit: 75% = $753.15 85% = $905.45

(See para TN.8.278 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

38495

38495 - Additional Information

Item Start Date:
01-Nov-2017
Description Updated:
01-Jan-2024
Schedule Fee Updated:
01-Nov-2023

TAVI, for the treatment of symptomatic severe aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, if:

(a) the TAVI Patient is at high risk for surgery; and

(b) the service:

        (i) is performed by a TAVI Practitioner in a TAVI Hospital; and

        (ii) includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient; and

        (iii) includes valvuloplasty, if required;

not being a service which has been rendered within 5 years of a service to which this item or item 38514 or 38522 applies (H) 

(Anaes.) (Assist.)

Fee: $1,576.45 Benefit: 75% = $1,182.35

(See para AN.33.1, TN.8.135, TN.8.278 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

38514

38514 - Additional Information

Item Start Date:
01-Mar-2022
Description Updated:
01-Jan-2024
Schedule Fee Updated:
01-Nov-2023

TAVI, for the treatment of symptomatic severe aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, if:

(a) the TAVI Patient is at intermediate risk for surgery; and

(b) the service:

       (i) is performed by a TAVI Practitioner in a TAVI Hospital; and

       (ii) includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient; and

       (iii) includes valvuloplasty, if required;

not being a service which has been rendered within 5 years of a service to which this item or item 38495 or 38522 applies (H)

(Anaes.) (Assist.)

Fee: $1,576.45 Benefit: 75% = $1,182.35

(See para AN.33.1, TN.8.135, TN.8.278 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

38522

38522 - Additional Information

Item Start Date:
01-Jul-2022
Description Updated:
01-Jan-2024
Schedule Fee Updated:
01-Nov-2023

TAVI, for the treatment of symptomatic severe native calcific aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, if:

(a) the TAVI Patient is at low risk for surgery; and

(b) the service:

      (i) is performed by a TAVI Practitioner in a TAVI Hospital; and

      (ii) includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient; and

      (iii) includes valvuloplasty, if required;

not being a service which has been rendered within 5 years of a service to which this item or item 38495 or 38514 applies (H)

(Anaes.) (Assist.)

Fee: $1,576.45 Benefit: 75% = $1,182.35

(See para AN.33.1, TN.8.135, TN.8.278 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