Document ID: chunk:federal_register_of_legislation:F2025C00158:clause:4_1:p30
Version: federal_register_of_legislation:F2025C00158
Segment Type: clause
Provision Reference: sch 4 cl 1 (pt 30/191)
Character Range: 9796301–9809947

severe LH deficiency; AND
                                                                                                                                                                                                                               Patient must be considered appropriate for treatment with the combination product after titration of FSH and LH after at least one cycle of treatment; AND
                                                                                                                                                                                                                               Patient must be receiving medical treatment as described in items 13200, 13201, 13202 or 13203 of the Medicare Benefits Schedule.
C5251               P5251          CN5251           Lutropin alfa                                                                                                                                                              Stimulation of follicular development                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Compliance with Authority Required procedures - Streamlined Authority Code 5251
                                                                                                                                                                                                                               Patient must have severe LH deficiency; AND
                                                                                                                                                                                                                               Patient must be receiving medical treatment as described in items 13200, 13201, 13202 or 13203 of the Medicare Benefits Schedule.
C5253               P5253          CN5253           Levodopa with carbidopa                                                                                                                                                    Parkinson disease
                                                                                                                                                                                                                               The condition must be one in which fluctuations in motor function are not adequately controlled by frequent dosing with conventional formulations of levodopa with decarboxylase inhibitor.
C5255               P5255          CN5255           Calcitriol                                                                                                                                                                 Hypoparathyroidism                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Compliance with Authority Required procedures - Streamlined Authority Code 5255

C5259               P5259          CN5259           Sumatriptan                                                                                                                                                                Migraine attack
                                                                                                                                                                                                                               The condition must have usually failed to respond to analgesics in the past.
C5266               P5266          CN5266           Desmopressin                                                                                                                                                               Cranial diabetes insipidus                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Compliance with Authority Required procedures - Streamlined Authority Code 5266

C5267               P5267          CN5267           Desmopressin                                                                                                                                                               Primary nocturnal enuresis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Compliance with Authority Required procedures - Streamlined Authority Code 5267
                                                                                                                                                                                                                               Patient must be 6 years of age or older;
                                                                                                                                                                                                                               Patient must be one in whom an enuresis alarm is contraindicated.
                                                                                                                                                                                                                               The reason that an enuresis alarm is contraindicated must be documented in the patient's medical records when treatment is initiated
C5268               P5268          CN5268           Dicloxacillin                                                                                                                                                              Serious staphylococcal infection

C5288               P5288          CN5288           Levodopa with carbidopa and entacapone                                                                                                                                     Parkinson disease
                                                                                                                                                                                                                               Patient must be being treated with levodopa decarboxylase inhibitor combinations; AND
                                                                                                                                                                                                                               Patient must be experiencing fluctuations in motor function due to end-of-dose effect.
C5289               P5289          CN5289           Levonorgestrel                                                                                                                                                             Idiopathic menorrhagia
                                                                                                                                                                                                                               The treatment must be in a patient where oral treatments are contraindicated.
C5291               P5291          CN5291           Pamidronic acid                                                                                                                                                            Bone metastases                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Compliance with Authority Required procedures - Streamlined Authority Code 5291
                                                                                                                                                                                                                               The condition must be due to breast cancer.
C5295               P5295          CN5295           Desmopressin                                                                                                                                                               Primary nocturnal enuresis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Compliance with Authority Required procedures - Streamlined Authority Code 5295
                                                                                                                                                                                                                               Patient must be 6 years of age or older;
                                                                                                                                                                                                                               Patient must be one in whom an enuresis alarm is contraindicated.
                                                                                                                                                                                                                               The reason that an enuresis alarm is contraindicated must be documented in the patient's medical records when treatment is initiated
C5296               P5296          CN5296           Thyrotropin alfa                                                                                                                                                           Ablation of thyroid remnant tissue
                                                                                                                                                                                                                               Patient must have undergone a thyroidectomy; AND
                                                                                                                                                                                                                               The treatment must be in combination with radioactive iodine; AND
                                                                                                                                                                                                                               Patient must not have a known metastatic disease.
C5297               P5297          CN5297           Flucloxacillin                                                                                                                                                             Serious staphylococcal infection

C5298               P5298          CN5298           Flucloxacillin                                                                                                                                                             Serious staphylococcal infection

C5323               P5323          CN5323           Amino acid formula with vitamins and minerals without lysine and low in tryptophan                                                                                         Proven glutaric aciduria type 1

C5324               P5324          CN5324