IMPORTANT CHANGES – SUMMARY
MEDICARE ELIGIBILTY FOR CARDIAC TESTING
- A rebate is no longer available for ‘routine’ pre-operative testing
- A rebate is available if there is a clinical indication.
- If you require a cardiologist report for an ECG performed at your office please fax to Western Cardiology ((08) 9388 2601) or email to our practice manager email@example.com
- 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:
- 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.
- 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.
- There are published time restrictions on repeat studies. We are available to assist you to adapt to these changes over the coming months.
- 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 – please contact us to discuss when this situation arises.
Note we will be checking with patients ahead of the booking date to ensure eligibility where possible and inform you if there are concerns that the patient may not attract a rebate.
Once again please do not hesitate to contact Western Cardiology if you have any queries or concerns.
Dr Paul Stobie
Chairperson, Western Cardiology