Medicare Benefits Schedule - Note TN.8.60

The fees for the insertion of a pacemaker (Items  38350, 38353 and 38356) cover the testing of cardiac conduction or conduction threshold, etc related to the pacemaker and pacemaker function. 

Accordingly, additional benefits are not payable for such routine testing under Item 38209 or 38212 (Cardiac electrophysiological studies).

Related Items: 38209 38212 38350 38353 38356

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Multiple Operation Rule

CARDIAC ELECTROPHYSIOLOGICAL STUDY  up to and including 3 catheter investigation of any 1 or more of  syncope, atrioventricular conduction, sinus node function or simple ventricular tachycardia studies, not being a service associated with a service to which item 38212 or 38213 applies

(Anaes.)

Fee: $903.75 Benefit: 75% = $677.85 85% = $810.55

(See para TN.8.60 of explanatory notes to this Category)

Multiple Operation Rule

Cardiac electrophysiological study for:

(a) the investigation of supraventricular tachycardia involving 4 or more catheters; or

(b) complex tachycardia inductions; or

(c) multiple catheter mapping; or

(d) acute intravenous anti‑arrhythmic drug testing with pre and post drug inductions; or

(e) catheter ablation to intentionally induce complete atrioventricular block; or

(f) intraoperative mapping;

other than a service associated with a service to which item 38209 or 38213 applies

(Anaes.)

Fee: $1,503.15 Benefit: 75% = $1,127.40 85% = $1,409.95

(See para TN.8.60 of explanatory notes to this Category)

Multiple Operation Rule

SINGLE CHAMBER PERMANENT TRANSVENOUS ELECTRODE, insertion, removal or replacement of, including cardiac electrophysiological services where used for pacemaker implantation

(Anaes.)

Fee: $699.50 Benefit: 75% = $524.65

(See para TN.8.60 of explanatory notes to this Category)

Multiple Operation Rule

PERMANENT CARDIAC PACEMAKER, insertion, removal or replacement of, not for cardiac resynchronisation therapy, including cardiac electrophysiological services where used for pacemaker implantation

(Anaes.)

Fee: $279.75 Benefit: 75% = $209.85

(See para TN.8.60 of explanatory notes to this Category)

Multiple Operation Rule

DUAL CHAMBER PERMANENT TRANSVENOUS ELECTRODES, insertion, removal or replacement of, including cardiac electrophysiological services where used for pacemaker implantation

(Anaes.)

Fee: $917.05 Benefit: 75% = $687.80

(See para TN.8.60 of explanatory notes to this Category)