CTHIn ForceLegislation
Health Insurance (Section 3C General Medical Services –Transcatheter Aortic Valve Implantation) Determination 2018
Schedule 1relevant services
Start here
Get a plain-English read of Schedule 1
Turn the raw legal text into a practical explanation grounded in Health Insurance (Section 3C General Medical Services –Transcatheter Aortic Valve Implantation) Determination 2018.
Schedule 1 – relevant services
<table cellspacing="0" cellpadding="0" style="width:100.02%; border-collapse:collapse"><thead><tr><td colspan="4" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Group A33 – Transcatheter Aortic Valve Implantation Case Conference</span></p></td></tr><tr><td colspan="2" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Item</span></p></td><td style="width:62.7%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Service</span></p></td><td style="width:23.46%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-left:29.7pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Fee ($)</span></p></td></tr></thead><tbody><tr><td colspan="2" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>6080</span></p></td><td style="width:62.7%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p class="tabletext" style="margin-top:0pt; margin-bottom:14pt; line-height:12pt; background-color:#ffffff"><span style="font-size:10pt">Coordination of a TAVI Case Conference by a TAVI Practitioner where the TAVI Case Conference has a duration of 10 minutes or more.</span></p><p class="tabletext" style="margin-top:14pt; margin-bottom:0pt; line-height:12pt; background-color:#ffffff"><span style="font-size:10pt">(Not payable more than once per patient in a five year period.)</span></p></td><td style="width:23.46%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-left:29.7pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>53.80</span></p></td></tr><tr><td colspan="2" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:115%; font-size:10pt"><span>6081</span></p></td><td style="width:62.7%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p class="tabletext" style="margin-top:0pt; margin-bottom:14pt; line-height:12pt; background-color:#ffffff"><span style="font-size:10pt">Attendance at a TAVI Case Conference by a specialist or consultant physician who does not also perform the service described in item 6080 for the same case conference where the TAVI Case Conference has a duration of 10 minutes or more.</span></p><p class="tabletext" style="margin-top:14pt; margin-bottom:0pt; line-height:12pt; background-color:#ffffff"><span style="font-size:10pt">(Not payable more than twice per patient in a five year period.)</span></p></td><td style="width:23.46%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-left:29.7pt; margin-bottom:3pt; page-break-after:avoid; line-height:115%; font-size:10pt"><span>40.15</span></p></td></tr><tr><td colspan="4" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold"></span></p><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Group T8 – Surgical Operations</span></p></td></tr><tr><td colspan="4" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Subgroup 6 – Cardio</span><span style="font-size:10pt; font-weight:bold">‑</span><span style="font-size:10pt; font-weight:bold">Thoracic</span></p></td></tr><tr><td colspan="2" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Item</span></p></td><td style="width:62.7%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Service</span></p></td><td style="width:23.46%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-left:29.7pt; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Fee ($)</span></p></td></tr><tr><td style="width:13.28%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12.65pt"><a id="_Toc15291130"><span style="font-size:10pt">38495</span></a></p></td><td colspan="2" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-bottom:4pt; line-height:12pt; background-color:#ffffff"><span style="font-size:10pt">TAVI, for the treatment of symptomatic severe aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, if:</span></p><p style="margin-left:24.3pt; margin-bottom:4pt; text-indent:-17.85pt"><span style="font-size:10pt">(a) the TAVI Patient is at high risk for surgery; and</span></p><p style="margin-left:24.3pt; margin-bottom:4pt; text-indent:-17.85pt"><span style="font-size:10pt">(b) the service:</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(i) is performed by a TAVI Practitioner in a TAVI Hospital; and</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(ii) includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient; and</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(iii) includes valvuloplasty, if required;</span></p><p style="margin-bottom:4pt; line-height:12pt; background-color:#ffffff"><span style="font-size:10pt">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.)</span></p></td><td style="width:23.46%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-left:29.75pt; margin-bottom:3pt; line-height:12.65pt"><span style="font-size:10pt">1,514.10</span></p></td></tr><tr><td style="width:13.28%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12.65pt"><span style="font-size:10pt">38514</span></p></td><td colspan="2" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:2pt; margin-bottom:4pt; line-height:normal; font-size:10pt"><span>TAVI, for the treatment of symptomatic severe aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, if:</span></p><p style="margin-left:24.3pt; margin-bottom:4pt; text-indent:-17.85pt"><span style="font-size:10pt">(a)</span><span style="font-size:10pt"> </span><span style="font-size:10pt"></span><span style="font-size:10pt">the TAVI Patient is at intermediate risk for surgery; and</span></p><p style="margin-left:24.3pt; margin-bottom:4pt; text-indent:-17.85pt"><span style="font-size:10pt">(b)</span><span style="font-size:10pt"> </span><span style="font-size:10pt"></span><span style="font-size:10pt">the service:</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(i) is performed by a TAVI Practitioner in a TAVI Hospital; and</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(ii) includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient; and</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(iii)</span><span style="font-size:10pt"> </span><span style="font-size:10pt">includes valvuloplasty, if required; and</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(iv) is performed in a facility where cardiothoracic surgery is available and a thoracotomy can be performed immediately and without transfer; and</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(v) if performed by an interventional cardiologist, a cardiothoracic surgeon is in attendance during the service;</span></p><p style="margin-bottom:4pt; line-height:12pt; background-color:#ffffff"><span style="font-size:10pt">not being a service which has been rendered within 5 years of a service to which this item or item 38495 or 38522 applies</span></p><p style="margin-bottom:4pt"><span style="font-size:10pt">(H) (Anaes.) (Assist.)</span></p></td><td style="width:23.46%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-left:29.75pt; margin-bottom:3pt; line-height:12.65pt"><span style="font-size:10pt">1,514.10</span></p></td></tr><tr><td style="width:13.28%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12.65pt"><span style="font-size:10pt">38522</span></p></td><td colspan="2" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:2pt; margin-bottom:4pt; line-height:normal; font-size:10pt"><span>TAVI, for the treatment of symptomatic severe native calcific aortic stenosis,</span><span> </span><span>performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible,</span><span> </span><span>if:</span></p><p style="margin-left:24.3pt; margin-bottom:4pt; text-indent:-17.85pt"><span style="font-size:10pt">(a)</span><span style="font-size:10pt"> </span><span style="font-size:10pt"></span><span style="font-size:10pt">the TAVI Patient is at low risk for surgery; and</span></p><p style="margin-left:24.3pt; margin-bottom:4pt; text-indent:-17.85pt"><span style="font-size:10pt">(b)</span><span style="font-size:10pt"> </span><span style="font-size:10pt"></span><span style="font-size:10pt"></span><span style="font-size:10pt">the service:</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(i) is performed by a TAVI Practitioner in a TAVI Hospital; and</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(ii) includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient; and</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(iii)</span><span style="font-size:10pt"> </span><span style="font-size:10pt">includes valvuloplasty, if required; and</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(iv) is performed in a facility where cardiothoracic surgery is available and a thoracotomy can be performed immediately and without transfer; and</span></p><p style="margin-left:45.6pt; margin-bottom:4pt; text-indent:-21.25pt"><span style="font-size:10pt">(v) if performed by an interventional cardiologist, a cardiothoracic surgeon is in attendance during the service;</span></p><p style="margin-bottom:4pt; line-height:12pt; background-color:#ffffff"><span style="font-size:10pt">not being a service which has been rendered within 5 years of a service to which this item or item 38495 or 38514 applies</span></p><p style="margin-top:2pt; margin-bottom:4pt; line-height:normal; font-size:10pt"><span>(H) (Anaes.) (Assist.)</span></p></td><td style="width:23.46%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-left:29.75pt; margin-bottom:3pt; line-height:12.65pt"><span style="font-size:10pt">1,514.10</span></p></td></tr><tr><td style="width:13.28%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-bottom:3pt; line-height:12.65pt"><span style="font-size:10pt">38523</span></p></td><td colspan="2" style="border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:2pt; margin-bottom:4pt; line-height:normal; font-size:10pt"><span>Percutaneous transcatheter delivery of dual</span><span>‑</span><span>filter cerebral embolic protection system during a TAVI procedure, for the reduction of postoperative embolic ischaemic strokes, if:</span></p><p style="margin-left:36pt; text-indent:-18pt"><span style="font-size:10pt">(a)</span><span style="width:6.9pt; text-indent:0pt; font-size:10pt; display:inline-block"> </span><span style="font-size:10pt">the service is performed upon a TAVI Patient in a TAVI Hospital; and</span></p><p style="margin-left:36pt; text-indent:-18pt"><span style="font-size:10pt">(b)</span><span style="width:6.34pt; text-indent:0pt; font-size:10pt; display:inline-block"> </span><span style="font-size:10pt">where the service is performed by the practitioner performing the TAVI procedure, the service includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient</span></p><p><span style="font-size:10pt">(H) (Anaes.) (Assist.)</span></p></td><td style="width:23.46%; border-top:1.5pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; margin-left:29.75pt; margin-bottom:3pt; line-height:12.65pt"><span style="font-size:10pt">275.20</span></p></td></tr><tr style="height:0pt"><td style="width:56.6pt"></td><td style="width:2.4pt"></td><td style="width:267.35pt"></td><td style="width:100.05pt"></td></tr></tbody></table>