5Treatment of transcatheter mitral valve services

5 Treatment of transcatheter mitral valve services

(1) A health service (the service) described in an item of the table in subsection (5) is to be treated, in the circumstances specified in subsection (2) and for the purposes of the provisions specified in subsection (3), as if: (a) it were both a professional service and a medical service; and (b) there were an item in the general medical services table in the location mentioned in subsection (4), corresponding to the item of the table in subsection (5) that describes the service, that: (i) related to the service; and (ii) specified a fee for the service, in relation to each State, that corresponds to the fee set out in the item of the table in subsection (5) that describes the service. (2) For the purposes of subsection (1), the circumstances are that the service is provided as a clinically relevant service. (3) For the purposes of subsection (1), the provisions of the following that relate to professional services, medical services or items are specified: (a) the Act and regulations made under the Act; (b) the National Health Act 1953 and regulations made under that Act. (4) For the purposes of paragraph (1)(b), the location is: (a) for items 6082 and 6084—Part 2 of the general medical services table (which deals with attendances); and (b) for items 38461 and 38463—Subgroup 6 of Group T8 of Part 5 of the general medical services table (which deals with cardio‑thoracic surgical operations). (5) For the purposes of subsection (1), the health services are as follows.

<table cellspacing="0" cellpadding="0" style="width:100%; 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"><p class="TableHeading"><span>Transcatheter mitral valve services</span></p></td></tr></thead><tbody><tr><td style="width:13.36%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 1</span></p><p class="TableHeading"><span>Item</span></p></td><td style="width:71.22%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 2</span></p><p class="TableHeading"><span>Description</span></p></td><td style="width:15.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="TableHeading"><span>Column 3</span></p><p class="TableHeading"><span>Fee ($)</span></p></td></tr><tr><td style="width:13.36%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>6082</span></p></td><td style="width:71.22%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>Attendance at a TMVr suitability case conference, by a cardiothoracic surgeon or an interventional cardiologist, to coordinate the conference, if:</span></p><p class="Tablea"><span>(a) the attendance lasts at least 10 minutes; and</span></p><p class="Tablea"><span>(b) the surgeon or cardiologist is accredited by the TMVr accreditation committee to perform the service</span></p><p class="Tablea"><span>Applicable once each 5 years</span></p></td><td style="width:15.42%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext" style="text-align:right"><span>52.95</span></p></td></tr><tr><td style="width:13.36%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>6084</span></p></td><td style="width:71.22%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>Attendance at a TMVr suitability case conference, by a specialist or consultant physician, other than to coordinate the conference, if the attendance lasts at least 10 minutes</span></p><p class="Tabletext"><span>Applicable once each 5 years</span></p></td><td style="width:15.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext" style="text-align:right"><span>39.50</span></p></td></tr><tr><td style="width:13.36%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>38461</span></p></td><td style="width:71.22%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>TMVr, by transvenous or transeptal techniques, for permanent coaptation of mitral valve leaflets using one or more tissue approximation implants, including intra</span><span>‑</span><span>operative diagnostic imaging, if:</span></p><p class="Tabletext"><span>(a) the patient has each of the following risk factors:</span></p><p class="Tablei"><span></span><span>(i) moderate to severe, or severe, symptomatic degenerative (primary) mitral valve</span><span style="font-style:italic"> </span><span>regurgitation (grade 3+ or 4+);</span></p><p class="Tablei"><span></span><span>(ii) left ventricular ejection fraction of 20% or more;</span></p><p class="Tablei"><span></span><span>(iii) symptoms of mild, moderate or severe chronic heart failure (New York Heart Association class II, III or IV); and</span></p><p class="Tablea"><span>(b) as a result of a TMVr suitability case conference, the patient has been:</span></p><p class="Tablei"><span>(i) assessed as having an unacceptably high risk for surgical mitral valve replacement; and</span></p><p class="Tablei"><span>(ii) recommended as being suitable for the service; and</span></p><p class="Tablea"><span>(c) the service is performed:</span></p><p class="Tablei"><span>(i) by a cardiothoracic surgeon, or an interventional cardiologist, accredited by the TMVr accreditation committee to perform the service; and</span></p><p class="Tablei"><span>(ii) via transfemoral venous delivery, unless transfemoral venous delivery is contraindicated or not feasible; and</span></p><p class="Tablei"><span>(iii) in a hospital that is accredited by the TMVr accreditation committee as a suitable hospital for the service; and</span></p><p class="Tablea"><span>(d) a service to which this item, or item</span><span> </span><span>38463, applies has not been provided to the patient in the previous 5 years</span></p><p class="Tabletext"><span>(H) (Anaes.) (Assist.)</span></p></td><td style="width:15.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext" style="text-align:right"><span>1,490.25</span></p></td></tr><tr><td style="width:13.36%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>38463</span></p></td><td style="width:71.22%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext"><span>TMVr, by transvenous or transeptal techniques, for permanent coaptation of mitral valve leaflets using one or more Mitraclips™, including intra</span><span>‑</span><span>operative diagnostic imaging, if:</span></p><p class="Tabletext"><span>(a) the patient has each of the following risk factors:</span></p><p class="Tablei"><span></span><span>(i) moderate to severe, or severe, symptomatic functional (secondary) mitral valve regurgitation (grade 3+ or 4+);</span></p><p class="Tablei"><span></span><span>(ii) left ventricular ejection fraction of 20% to 50%;</span></p><p class="Tablei"><span>(iii) left ventricular end systolic diameter of not more than 70mm;</span></p><p class="Tablei"><span></span><span>(iv) symptoms of mild, moderate or severe chronic heart failure (New York Heart Association class II, III or IV) that persist despite maximally tolerated guideline directed medical therapy; and</span></p><p class="Tablea"><span>(b) as a result of a TMVr suitability case conference, the patient has been:</span></p><p class="Tablei"><span>(i) assessed as having an unacceptably high risk for surgical mitral valve replacement; and</span></p><p class="Tablei"><span>(ii) recommended as being suitable for the service; and</span></p><p class="Tablea"><span>(c) the service is performed:</span></p><p class="Tablei"><span>(i) by a cardiothoracic surgeon, or an interventional cardiologist, accredited by the TMVr accreditation committee to perform the service; and</span></p><p class="Tablei"><span>(ii) via transfemoral venous delivery, unless transfemoral venous delivery is contraindicated or not feasible; and</span></p><p class="Tablei"><span>(iii) in a hospital that is accredited by the TMVr accreditation committee as a suitable hospital for the service; and</span></p><p class="Tablea"><span>(d) a service to which this item, or item</span><span> </span><span>38461, applies has not been provided to the patient in the previous 5 years</span></p><p class="Tabletext"><span>(H) (Anaes.) (Assist.)</span></p></td><td style="width:15.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p class="Tabletext" style="text-align:right"><span>1,490.25</span></p></td></tr></tbody></table>