MEDICARE BILLING REVIEW IN LINE WITH NEW MBS ITEM NUMBERS FOR CARDIAC TESTS
Cardiac testing came into the spotlight in August 2020, when Medicare decided to review and change the traditional mode of investigative testing from a General Practitioners and Cardiologists perspective. The changes have been recommended by the MBS review task force in an effort to ensure that patients receive appropriate ‘evidence based care’ and reduce cost to the health care system related to ‘low value testing’.
Changes have been made to the Medicare eligibility criteria for all routine cardiac testing. From the billing assessment, the following changes have been implemented, with the options and referral for Medicare eligibility for Cardiac Testing:
Electrocardiograph (ECG)
• A rebate is no longer available for ‘routine’ pre-operative testing.
• A rebate is available if there is a clinical indication.
Holter Monitor
• The main change is the publication of listed eligibility criteria on the Medicare website
• A patient can be referred for a Holter monitor, with Medicare subsidy, if they have the following clinical indications:
• Syncope
• Pre-syncope
• Palpitations (frequency greater than once per week)
• Another asymptomatic arrhythmia – for example, screening for atrial fibrillation in a stroke patient
• Surveillance following cardiac surgical procedures – for example, post cardiac ablation of atrial fibrillation
• A Medicare subsidy is available once only in a 4 week period.
• For longer duration monitoring, within that time frame patients could be referred for an event monitor.
Exercise Stress Testing
• There are listed eligibility criteria on the Medicare website.
• Eligible indications include investigation for:
• Symptoms consistent with cardiac ischaemia. This could include chest pain, chest tightness or exertional dyspnoea.
• Cardiac disease that may be exacerbated by exercise – for example valvular disease, cardiomyopathy or arrhythmias.
• Suspicion of heritable arrhythmia.
• Patients are not eligible for a rebate if the test is for:
• Medical screening or work purposes.
• If the patient is asymptomatic and has a normal cardiac examination – this means a patient can no longer have ‘routine’ follow up stress testing for coronary artery disease without a change in symptoms.
• If the patient has an expected poor functional capacity or abnormal ECG that will limit interpretation of the test.
Echocardiography
• The allowable indications for GP referred echocardiography are for investigation of:
• Symptoms or signs of heart failure
• Suspected or known ventricular hypertrophy or dysfunction – for example and abnormal ECG or a patient with hypertension
• Pulmonary hypertension
• Valvular, pericardial, thrombotic or embolic disease
• Cardiac tumour
• Symptoms or signs of congenital heart disease
• Other ‘rare’ indications
• This list covers most current indications for echocardiography and therefore initially, it is expected that there will be little impact on patient care.
Stress echocardiography
• A patient is eligible for a GP or specialist referred stress echo if the following apply:
• Symptoms suggestive of or concerning for ischaemia.
• Ongoing symptoms or a change in symptoms for a patient with known coronary artery disease.
• If assessment for coronary disease identifies a lesion of uncertain functional significance – for example on CTCA or CT calcium score
• Pre-operative assessment in certain patients considered to be high risk.
• Assessment prior to intervention for structural heart disease.
• Some other less frequent indications
• The above criteria cover most of the common indications for referring a patient to undergo stress echocardiography.
• The major impact is on repeat testing – which is limited to 2 years (including other types of functional testing such as exercise ECG or myocardial perfusion scanning).
• In appropriate circumstances the restriction is reduced to 12 months if referred by a cardiologist
Source: Quick Reference-Guide-Changes-CI-ECG-MPS.pdf (mbsonline.gov.au)
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