Q&A Session – 30 September 2025
Q: Why can I not claim for a TOE performed during an insertion of Impella (microaxial blood pump) insertion?
🔍 Scope: This issue relates to another frequently encountered question – imaging and real-time image-guided procedures under the MBS, particularly where imaging is considered part of the core service rather than a separate billable item.
🩺 Background:
- Following revisions to certain ICU-related MBS items, real-time ultrasound guidance (item 55054) for vascular access (arterial and central venous cannulation, VA and VV ECMO cannulation) is no longer claimable.
- The rationale is that imaging is now standard of care, meaning it is an expected component of the procedure, not an additional service.
- For other ICU procedures where ultrasound is not routinely required but may be used in complex cases, real-time ultrasound guidance remains claimable – please read our article Navigating the Maze – Common Items for ICU Procedures Explained.
🚫 Impella-specific rule:
- The MBS item descriptor for Impella insertion (microaxial blood pump) – item 38376 goes further and explicitly prohibits additional claiming for any imaging used during the procedure.
- This includes all imaging modalities used for guidance or confirmation.
❌ Imaging that cannot be claimed with insertion of Impella:
- Real-time ultrasound guidance (including vascular access)
- Transthoracic echocardiography (TTE)
- Transoesophageal echocardiography (TOE)
- Image Intensifier (II) / fluoroscopy
⚠️ Important compliance point: Even when imaging is clinically essential for safe Impella insertion, it is considered integral to the procedure and is not separately billable under the MBS.
👉 More info: Read our ICU procedures article and follow the Navigating the Maze series for upcoming articles and a deeper dive into ultrasound, echocardiography, and imaging rules in Intensive Care billing.
More info: 👉 Read our related blogs and watch the full Q&A video for further discussion:
Disclaimer
This blog is provided for educational and general informational purposes only and does not constitute legal, medical, or financial advice. While every effort has been made to ensure accuracy, billing requirements under the Medicare Benefits Schedule (MBS) are complex and subject to change. Clinicians should always consult the official MBS, relevant hospital policies, or seek independent professional advice before making billing decisions. While we use reasonable effort to ensure that our overview articles are accurate, current and complete, we do not represent, warrant, or guarantee (to the maximum extent permitted by law) their accuracy, currency, or completeness or imply that they are applicable to your individual situation. ClaimLogic accepts no liability arising from actions taken based on the content of this article.
