Division Division 1.2 - Health Insurance (Section 3C Diagnostic Imaging Services – Cardiac Services) Determination 2020 - Services and fees — nuclear imaging services

Division 1.2Services and fees — nuclear imaging services

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Division 1.2 – Services and fees – nuclear imaging services

1.2.1 Application of nuclear imaging items

(1) For any particular patient, item 61324, 61329, 61345, 61349, 61357, 61394, 61398, 61406, 61410 or 61414 applies if one or more of the following is applicable:

(a) if the patient displays one or more of the following symptoms of typical or atypical angina:

(i) constricting discomfort in the:

a. front of the chest; or

b. neck; or

c. shoulders; or

d. jaw; or

e. arms; or

(ii) the patient’s symptoms, as described in subparagraph (3)(a)(i), are precipitated by physical exertion; or

(iii) the patient’s symptoms, as described in subparagraph (3)(a)(i), are relieved by rest or glyceryl trinitrate within 5 minutes or less; or

(b) if the patient has known coronary artery disease, and displays one or more symptoms that are suggestive of ischaemia:

(i) which are not adequately controlled with medical therapy; or

(ii) which have evolved since the last functional study; or

(i) assessment indicates that resting 12 lead electrocardiogram changes are consistent with coronary artery disease or ischaemia, in a patient that is without known coronary artery disease; or

(ii) coronary artery disease related lesions, of uncertain functional significance, which have previously been identified on computed tomography coronary angiography or invasive coronary angiography; or

(iii) an assessment by a specialist or consultant physician indicates that the patient has possible painless myocardial ischaemia, which includes undue exertional dyspnoea of uncertain aetiology; or

(iv) a pre-operative assessment of a patient with functional capacity of less than 4 metabolic equivalents, confirming that surgery is intermediate to high risk, and the patient has at least one of following conditions:

a. ischaemic heart disease or previous myocardial infarction; or

b. heart failure; or

c. stroke or transient ischaemic attack; or

d. renal dysfunction (serum creatinine greater than 70umol/L or 2 mg/dL or a creatinine clearance of less than 60 mL/min); or

e. diabetes mellitus requiring insulin therapy; or

(v) quantification of extent and severity of myocardial ischaemia, before either percutaneous coronary intervention or coronary bypass surgery, to ensure the criteria for intervention are met; or

(vi) assessment of relative amounts of ischaemic viable myocardium and non-viable (infarcted) myocardium, in patients with previous myocardial infarction; or

<table cellspacing="0" cellpadding="0" style="width:99.94%; border-collapse:collapse"><thead><tr><td colspan="3" style="border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Group I4 – Nuclear Medicine Imaging</td></tr><tr><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Subgroup 1 – Nuclear Medicine – Non-PET</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Column 1Item</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Column 2Description</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Column 3Fee ($)</td></tr></thead><tbody><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61321</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Single rest myocardial perfusion study for the assessment of extent and severity of viable and non-viable myocardium – with single photon emission tomography, which can include planar imaging, when performed on a patient who has left ventricular systolic dysfunction and probable or confirmed coronary artery disease, if:(a) using a single rest technetium-99m (Tc-99m) protocol; and(b) the service is requested by a specialist or a consultant physician; and(c) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61325, 61329, 61345, 61398 or 61406 applies (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">329.00</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61324</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Single stress myocardial perfusion study – with single photon emission tomography, which can include planar imaging, if:(a) the patient has symptoms of cardiac ischaemia where at least one of the following applies:(i) the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or(ii) the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or(iii) the patient has had a failed stress echocardiography provided under a service to which items 55141, 55143, 55145 or 55146 applies; and(b) the service includes resting ECG, continuous ECG monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and(c) the service is requested by a specialist or consultant physician; and(d) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61325, 61329, 61345, 61357, 61394, 61398, 61406 or 61414 applies (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">653.05</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61325</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Single rest myocardial perfusion study for the assessment of extent and severity of viable and non-viable myocardium – with single photon emission tomography, which can include planar imaging, when performed on a patient with left ventricular systolic dysfunction and probable or confirmed coronary artery disease, if:(a) using an initial rest study followed by redistribution study on the same day; and(b) using a thallous chloride-201 (Tl-201) protocol; and(c) the service is requested by a specialist or a consultant physician; and(d) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61329, 61345, 61398 or 61406 applies (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">329.00</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61329</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Combined stress and rest, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion – with single photon emission tomography, which can include planar imaging, if:(a) the patient has symptoms of cardiac ischaemia where at least one of the following applies:(i) the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or(ii) the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or(iii) the patient has had a failed stress echocardiography provided under a service to which item 55141, 55143, 55145 or 55146 applies; and(b) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and(c) the service is requested by a medical practitioner (other than a specialist or consultant physician); and(d) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61345, 61357, 61394, 61398, 61406 or 61414 applies (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">982.05</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61345</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Combined stress and rest, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion – with single photon emission tomography, which can include planar imaging, if:(a) the patient has symptoms of cardiac ischaemia where at least one of the following applies:(i) the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or(ii) the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or(iii) the patient has had a failed stress echocardiography provided under a service to which item 55141, 55143, 55145 or 55146 applies; and(b) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and(c) the service is requested by a specialist or consultant physician; and(d) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61329, 61357, 61394, 61398, 61406 or 61414 applies (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">982.05</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61349</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Repeat combined stress and rest, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion—with single photon emission tomography, which can include planar imaging, if:(a) in the previous 24 months, the patient has had a single stress or combined rest and stress myocardial perfusion study performed under item 61324, 61329, 61345, 61357, 61394, 61398, 61406 or 61414 and has undergone a revascularisation procedure; and(b) the patient has one or more of the following symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy, where at least one of the following applies;(i) the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or(ii) the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or(iii) the patient has had a failed stress echocardiography provided under service to which item 55141, 55143, 55145 or 55146 applies; and(c) the service is requested by a specialist or a consultant physician; and(d) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 11730 or 61410 applies; andFor any particular patient, applicable not more than once in 12 months (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">982.05</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61357</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Single stress myocardial perfusion study – with single photon emission tomography, which can include planar imaging, if:(a) the patient has symptoms of cardiac ischaemia where at least one of the following applies:(i) the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or(ii) the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or(iii) the patient has had a failed stress echocardiography provided under a service to which items 55141, 55143, 55145 or 55146 applies; and(b) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and(c) the service is requested by a medical practitioner (other than a specialist or consultant physician); and(d) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61329, 61345, 61394, 61398, 61406 or 61414 applies (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">653.05</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61394</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Single stress myocardial perfusion study – with single photon emission tomography, which can include planar imaging, if:(a) the patient has symptoms of cardiac ischaemia; and(b) the service is provided at, or from, a practice location in:(i) a Modified Monash 3 area; or(ii) a Modified Monash 4 area; or(iii) a Modified Monash 5 area; or(iv) a Modified Monash 6 area; or(v) a Modified Monash 7 area; and(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and(e) the service is requested by a specialist or consultant physician; and(f) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61325, 61329, 61345, 61357, 61394, 61398, 61406 or 61414 applies (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">653.05</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61398</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Combined stress and rest, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion – with single photon emission tomography, which can include planar imaging, if:(a) the patient has symptoms of cardiac ischaemia; and(b) the service is provided at, or from, a practice location in:(i) a Modified Monash 3 area; or(ii) a Modified Monash 4 area; or(iii) a Modified Monash 5 area; or(iv) a Modified Monash 6 area; or(v) a Modified Monash 7 area; and(c) a stress echocardiography service is not available in the Modified Monash area where the services is provided; and(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and(f) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61329, 61345, 61357, 61394, 61398, 61406 or 61414 applies (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">982.05</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61406</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Combined stress and rest, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion – with single photon emission tomography, which can include planar imaging, if:(a) the patient has symptoms of cardiac ischaemia; and(b) the service is provided at, or from, a practice location in:(i) a Modified Monash 3 area; or(ii) a Modified Monash 4 area; or(iii) a Modified Monash 5 area; or(iv) a Modified Monash 6 area; or(v) a Modified Monash 7 area; and(c) a stress echocardiography service is not available in the Modified Monash area where the services is provided; and(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and(e) the service is requested by a specialist or consultant physician; and(d) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61329, 61345, 61357, 61394, 61398, 61406 or 61414 applies (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">982.05</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61410</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Repeat combined stress and rest, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion—with single photon emission tomography, which can include planar imaging, if:(a) in the previous 24 months, the patient has had a single stress or combined rest and stress myocardial perfusion study performed under item 61324, 61329, 61345, 61357, 61394, 61398, 61406 or 61414 and has undergone a revascularisation procedure; and(b) the patient has one or more symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and(c) the service is provided at, or from, a practice location in:(i) a Modified Monash 3 area; or(ii) a Modified Monash 4 area; or(iii) a Modified Monash 5 area; or(iv) a Modified Monash 6 area; or(v) a Modified Monash 7 area; and(d) a stress echocardiography service is not available in the Modified Monash area where the services is provided; and(e) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 or 11730 appliesFor any particular patient, applicable not more than once in 12 months (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">982.05</td></tr><tr><td style="width:14.2%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">61414</td><td style="width:71.62%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">Single stress myocardial perfusion study – with single photon emission tomography, which can include planar imaging, if:(a) the patient has symptoms of cardiac ischaemia; and(b) the service is provided at, or from, a practice location in:(i) a Modified Monash 3 area; or(ii) a Modified Monash 4 area; or(iii) a Modified Monash 5 area; or(iv) a Modified Monash 6 area; or(v) a Modified Monash 7 area; and(c) a stress echocardiography service is not available in the Modified Monash area where the services is provided; and(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and(f) not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61329, 61345, 61357, 61394, 61398, 61406 or 61414 applies (R)</td><td style="width:14.18%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top">653.05</td></tr></tbody></table>