Medicare Benefits Schedule - Note TN.8.67

Items 38470 to 38766 and 38817 to 38818 must be performed using open exposure or minimally invasive surgery which excludes percutaneous and transcatheter techniques unless otherwise stated in the item.

Related Items: 38477 38485 38487 38490 38493 38508 38509 38512 38515 38518 38550 38553 38556 38568 38571 38572 38600 38603 38609 38612 38615 38618 38621 38624 38627 38637 38653 38670 38673 38677 38700 38703 38706 38709 38715 38718 38721 38724 38727 38730 38733 38736 38739 38742 38745 38748 38751 38754 38757 38760 38766 38817

• Previous - Note TN.8.64
• Next - Note TN.8.70

Multiple Operation Rule

Repair or replacement of ascending thoracic aorta:

(a) including:

(i) cardiopulmonary bypass; and

(ii) retrograde cardioplegia (if performed); and

(b) not including valve replacement or repair or implantation of coronary arteries;

other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,559.25 Benefit: 75% = $1,919.45

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Repair or replacement of ascending thoracic aorta:

(a) including:

(i) aortic valve replacement or repair; and

(i) cardiopulmonary bypass; and

(ii) retrograde cardioplegia (if performed); and

(b) not including implantation of coronary arteries;

other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $3,222.10 Benefit: 75% = $2,416.60

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Repair or replacement of ascending thoracic aorta, including:

(a) aortic valve replacement or repair; and

(b) implantation of coronary arteries; and

(c) cardiopulmonary bypass; and

(d) retrograde cardioplegia (if performed);

other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38603, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $3,536.95 Benefit: 75% = $2,652.75

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Repair or replacement of descending thoracic aorta, without shunt or cardiopulmonary bypass, by open exposure, percutaneous or endovascular means, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,122.30 Benefit: 75% = $1,591.75

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Repair or replacement of descending thoracic aorta, with shunt or cardiopulmonary bypass, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,419.25 Benefit: 75% = $1,814.45

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Operative management of acute rupture or dissection, if the service:

(a) is performed in conjunction with a service to which item 38550, 38553, 38554, 38555, 38556, 38557, 38558, 38568, 38571, 38706 or 38709 applies; and

(b) is not associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38603, 38816, 38828 or 45503 applies

(H)

(Anaes.) (Assist.)

Fee: $2,263.80 Benefit: 75% = $1,697.85

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Patent diseased coronary artery bypass vein graft or grafts, dissection, disconnection and oversewing of, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $631.75 Benefit: 75% = $473.85

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Open heart surgery, other than a service:

(a) to which another item in this Group applies; or

(b) associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,288.80 Benefit: 75% = $1,716.60

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Thoracotomy, thoracoscopy or sternotomy, by any procedure:

(a) including any division of adhesions if the time taken to divide the adhesions exceeds 30 minutes; and

(b) other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18258, 18260, 33824, 38815, 38816, 38818, 38828 or 45503 applies

(H) 

(Anaes.) (Assist.)

Fee: $1,716.40 Benefit: 75% = $1,287.30

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Division of accessory pathway, isolation procedure, procedure on atrioventricular node or perinodal tissues involving one atrial chamber only, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,390.70 Benefit: 75% = $1,793.05

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Division of accessory pathway, isolation procedure, procedure on atrioventricular node or perinodal tissues involving both atrial chambers and including curative surgery for atrial fibrillation, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $3,044.00 Benefit: 75% = $2,283.00

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Ventricular arrhythmia with mapping and muscle ablation, with or without aneurysmeotomy, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $3,267.35 Benefit: 75% = $2,450.55

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Valve annuloplasty with insertion of ring, other than:

(a) a service to which item 38516 or 38517 applies; or

(b) a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies

(H)

(Anaes.) (Assist.)

Fee: $2,282.30 Benefit: 75% = $1,711.75

(See para TN.8.67, TN.8.213 of explanatory notes to this Category)

Multiple Operation Rule

MITRAL ANNULUS, reconstruction of, after decalcification, when performed in association with valve surgery

(Anaes.) (Assist.)

Fee: $930.85 Benefit: 75% = $698.15

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

MITRAL VALVE, open valvotomy of

(Anaes.) (Assist.)

Fee: $1,960.50 Benefit: 75% = $1,470.40

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Reconstruction and re-implantation of sub-valvular structures, if performed in conjunction with a service to which item 38499 applies (H)

(Anaes.) (Assist.)

Fee: $631.75 Benefit: 75% = $473.85

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

OPERATIVE MANAGEMENT of acute infective endocarditis, in association with heart valve surgery

(Anaes.) (Assist.)

Fee: $2,230.10 Benefit: 75% = $1,672.60

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Repair or reconstruction of left ventricular aneurysm, including plication, resection and primary and patch repairs, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,185.55 Benefit: 75% = $1,639.20

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Repair of ischaemic ventricular septal rupture,, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,721.20 Benefit: 75% = $2,040.90

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

CENTRAL CANNULATION for cardiopulmonary bypass excluding post-operative management, not being a service associated with a service to which another item in this Subgroup applies

(Anaes.) (Assist.)

Fee: $1,745.25 Benefit: 75% = $1,308.95

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Peripheral cannulation for cardiopulmonary bypass, excluding post-operative management, other than a service:

(a) in which peripheral cannulation is used in preference to central cannulation for valve or coronary bypass procedures; or

(b) associated with a service to which item 38555 or 38572 applies

(H)

(Anaes.) (Assist.)

Fee: $1,091.85 Benefit: 75% = $818.90

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Insertion of intra-aortic balloon pump, by arteriotomy, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $545.85 Benefit: 75% = $409.40

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Removal of intra-aortic balloon pump, with closure of artery by direct suture, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 338816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $611.95 Benefit: 75% = $459.00

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Insertion of a left or right ventricular assist device, for use as:

(a) a bridge to cardiac transplantation in patients with refractory heart failure who are:

    (i) currently on a heart transplant waiting list, or

    (ii) expected to be suitable candidates for cardiac transplantation following a period of support on the ventricular assist device; or

(b) acute post cardiotomy support for failure to wean from cardiopulmonary transplantation; or

(c) cardio-respiratory support for acute cardiac failure which is likely to recover with short term support of less than 6 weeks;

other than a service associated with a service to which:

(d) item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies; or

(e) another item in this Schedule applies if the service described in the item is for the use of a ventricular assist device as destination therapy in the management of a patient with heart failure who is not expected to be a suitable candidate for cardiac transplantation

(H)

(Anaes.) (Assist.)

Fee: $1,745.25 Benefit: 75% = $1,308.95

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Insertion of a left and right ventricular assist device, for use as:

(a) a bridge to cardiac transplantation in patients with refractory heart failure who are:

    (i) currently on a heart transplant waiting list, or

    (ii) expected to be suitable candidates for cardiac transplantation following a period of support on the ventricular assist device; or

(b) acute post cardiotomy support for failure to wean from cardiopulmonary transplantation; or

(c) cardio-respiratory support for acute cardiac failure which is likely to recover with short term support of less than 6 weeks;

other than a service associated with a service to which:

(d) item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies; or

(e) another item in this Schedule applies if the service described in the item is for the use of a ventricular assist device as destination therapy in the management of a patient with heart failure who is not expected to be a suitable candidate for cardiac transplantation

(H) 

(Anaes.) (Assist.)

Fee: $2,175.40 Benefit: 75% = $1,631.55

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Left or right ventricular assist device, removal of, as an independent procedure, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38627, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $868.45 Benefit: 75% = $651.35

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Left and right ventricular assist device, removal of, as an independent procedure, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38627, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $975.90 Benefit: 75% = $731.95

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Extra-corporeal membrane oxygenation, bypass or ventricular assist device cannulae, adjustment and re-positioning of, by open operation, in patients supported by these devices, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38627, 38816, 38828 or 45503 applies

(H)

(Anaes.) (Assist.)

Fee: $762.80 Benefit: 75% = $572.10

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Cardiac tumour, excision of, involving the wall of the atrium or inter-atrial septum, without patch or conduit reconstruction, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,175.00 Benefit: 75% = $1,631.25

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Cardiac tumour, excision of, involving the wall of the atrium or inter-atrial septum, requiring reconstruction with patch or conduit, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,448.10 Benefit: 75% = $1,836.10

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Cardiac tumour arising from ventricular myocardium, partial thickness excision of, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,290.20 Benefit: 75% = $1,717.65

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Patent ductus arteriosus, shunt, collateral or other single large vessel, division or ligation of, without cardiopulmonary bypass, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $1,215.95 Benefit: 75% = $912.00

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Patent ductus arteriosus, shunt, collateral or other single large vessel, division or ligation of, with cardiopulmonary bypass, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,199.45 Benefit: 75% = $1,649.60

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Aorta, anastomosis or repair of, without cardiopulmonary bypass, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,076.10 Benefit: 75% = $1,557.10

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Anastomosis or repair of aorta, with cardiopulmonary bypass, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,447.45 Benefit: 75% = $1,835.60

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Main Pulmonary Artery, banding, debanding or repair of, without cardiopulmonary bypass, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $1,943.90 Benefit: 75% = $1,457.95

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Banding, debanding or repair of main pulmonary artery, with cardiopulmonary bypass, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,458.75 Benefit: 75% = $1,844.10

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Vena Cava, anastomosis or repair of, without cardiopulmonary bypass, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $1,704.15 Benefit: 75% = $1,278.15

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Vena cava, anastomosis or repair of, with cardiopulmonary bypass, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,479.40 Benefit: 75% = $1,859.55

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Anastomosis or repair of intrathoracic vessels, without cardiopulmonary bypass, performed as a primary procedure, other than a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38700, 38703, 38706, 38709, 38715, 38718, 38721, 38724, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $1,704.15 Benefit: 75% = $1,278.15

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Anastomosis or repair of intrathoracic vessels, with cardiopulmonary bypass, performed as a primary procedure, other than a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38700, 38703, 38706, 38709, 38715, 38718, 38721, 38724, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,431.75 Benefit: 75% = $1,823.85

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Systemic pulmonary or Cavo-pulmonary shunt, creation of, without cardiopulmonary bypass, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $1,704.15 Benefit: 75% = $1,278.15

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Systemic pulmonary or Cavo-pulmonary shunt, creation of, with cardiopulmonary bypass, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,431.75 Benefit: 75% = $1,823.85

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Atrial septectomy, with or without cardiopulmonary bypass, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,229.75 Benefit: 75% = $1,672.35

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Atrial septal defect, closure by open exposure and direct suture or patch, for congenital heart disease in a patient with documented evidence of right heart overload or paradoxical embolism, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,192.05 Benefit: 75% = $1,644.05

(See para TN.8.67, TN.8.210 of explanatory notes to this Category)

Multiple Operation Rule

Intra-atrial baffle, insertion of, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,431.75 Benefit: 75% = $1,823.85

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Ventricular septectomy, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,431.75 Benefit: 75% = $1,823.85

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Ventricular septal defect, closure by direct suture or patch, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,431.75 Benefit: 75% = $1,823.85

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Intraventricular baffle or conduit, insertion of, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $3,044.00 Benefit: 75% = $2,283.00

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Extracardiac conduit, insertion of, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,431.75 Benefit: 75% = $1,823.85

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Extracardiac conduit, replacement of, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,431.75 Benefit: 75% = $1,823.85

(See para TN.8.67 of explanatory notes to this Category)

Multiple Operation Rule

Ventricular augmentation, right or left, for congenital heart disease, other than a service associated with a service to which item 11704, 11705, 11707, 11714, 18260, 33824, 38816, 38828 or 45503 applies (H)

(Anaes.) (Assist.)

Fee: $2,431.75 Benefit: 75% = $1,823.85

(See para TN.8.67 of explanatory notes to this Category)