Health Insurance (Section 3C General Medical Services – Transcatheter Aortic Valve Implantation) Determination 2018
I, MICHAEL RYAN, delegate of the Minister for Health, make this Determination.
MICHAEL RYAN
Acting Assistant Secretary
MBS Policy and Specialist Services Branch
Medical Benefits Division
Health Financing Group
Department of Health
This Determination is the Health Insurance (Section 3C General Medical Services –Transcatheter Aortic Valve Implantation) Determination 2018.
This Determination commences on 1 January 2019.
This Determination is made under subsection 3C(1) of the Health Insurance Act 1973.
The Health Insurance (Section 3C General Medical Services – Transcatheter Aortic Valve Implantation) Determination 2017 is repealed.
(1) In this Determination:
Act means the Health Insurance Act 1973.
Attendance means undertaking all of the following activities in relation to a TAVI Case Conference:
(a) retaining a record of the day the conference was held, and the times the conference started and ended;
(b) retaining a record of the names of the participants;
(c) provision of expertise to inform the recommendation resulting from the case conference;
(d) retaining a record of the recommendation resulting from the conference.
Coordination means undertaking all of the following activities in relation to a TAVI Case Conference:
(a) ensuring that the patient is aware of the purpose and nature of the patient’s TAVI Case Conference and has consented to their TAVI Case Conference;
(b) recording the day the conference was held, and the times the conference started and ended;
(c) recording the names of the participants of the conference;
(d) provision of expertise to inform the recommendation resulting from the case conference;
(e) recording minutes of the TAVI Case Conference including the recommendation resulting from the conference;
(f) ensuring that the patient is aware of the recommendation.
relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.
Schedule means a Schedule to this Determination.
TAVI means Transcatheter Aortic Valve Implantation.
TAVI Case Conference means a process by which:
(a) there is a team of 3 or more participants, where:
(i) the first participant is a cardiothoracic surgeon; and
(ii) the second participant is an interventional cardiologist; and
(iii) the third participant is a specialist or consultant physician who does not perform a service described in Item 38495 for the patient being assessed; and
(iv) either the first or the second participant is also a TAVI Practitioner; and
(b) the team assesses a patient’s risk and technical suitability to receive the service described in Item 38495, taking into account matters such as:
(i) the patient’s risk and technical suitability for a surgical aortic valve replacement; and
(ii) the patient’s cognitive function and frailty; and
(c) the result of the assessment is that the team makes a recommendation about whether or not the patient is suitable to receive the service described in Item 38495; and
(d) the particulars of the assessment and recommendation are recorded in writing.
TAVI Hospital means a hospital, as defined by subsection 121-5(5) of the Private Health Insurance Act 2007, that is clinically accepted as being a suitable hospital in which the service described in Item 38495 may be performed.
TAVI Patient means a patient who, as a result of a TAVI Case Conference, has been assessed as having an unacceptably high risk for surgical aortic valve replacement and is recommended as being suitable to receive the service described in item 38495.
TAVI Practitioner means a cardiothoracic surgeon or interventional cardiologist who is accredited by the Cardiac Accreditation Services Limited.
Note: The following terms are defined in subsection 3(1) of the Act:
(2) Unless the contrary intention appears, a reference in this Determination to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.
For subsection 3C(1) of the Act a relevant service specified in Schedule 1 to this Determination, provided in accordance with this Determination and as a clinically relevant service, is to be treated, for the relevant provisions, 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 that:
(i) related to the service; and
(ii) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.
Medicare benefit is not payable if the service described in item 38495 is provided at the same time as, or in connection with, the provision of a pain pump for post‑surgical pain management.
Group A33 – Transcatheter Aortic Valve Implantation Case Conference | ||
Item | Service | Fee ($) |
6080 | Coordination of a TAVI Case Conference by a TAVI Practitioner where the TAVI Case Conference has a duration of 10 minutes or more. (Not payable more than once per patient in a five year period.) | 50.90 |
6081 | Attendance at a TAVI Case Conference by a specialist or consultant physician who does not also perform the service described in item 6080 for the same case conference where the TAVI Case Conference has a duration of 10 minutes or more. (Not payable more than twice per patient in a five year period.) | 37.95 |
Group T8 – Surgical Operations | ||
Subgroup 6 – Cardio-Thoracic | ||
Item | Service | Fee ($) |
38495 | TAVI, for the treatment of symptomatic severe aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, in a TAVI Hospital on a TAVI Patient by a TAVI Practitioner – includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient. (Anaes.) (Assist.) (Not payable more than once per patient in a five year period.) | 1,432.20 |
