Change to Botulinum Toxin Injection Item 18365 Factsheet

Factsheet - Botulinum Toxin Injection Item 18365 (PDF 183 KB)
Factsheet - Botulinum Toxin Injection Item 18365 (DOC 92 KB)


· From 1 August 2020, MBS item 18365 for the injection of botulinum toxin for the treatment of moderate to severe spasticity of the upper limb following stroke will allow for the treatment of spasticity of the upper limb following acute events, including stroke.

· These changes are relevant to all practitioners who currently treat patients for upper limb spasticity following an acute event, as outlined in the related Pharmaceutical Benefits Scheme (PBS) listings. Practitioners include neurologists, orthopaedic surgeons, rehabilitation specialists, plastic surgeons and geriatricians.

· Eligible providers who currently use MBS item 18360 for the injection of botulinum toxin to treat moderate to severe focal spasticity of the upper limb following an acute event other than stroke are requested to claim the service under the amended item 18365.

What are the changes?
From 1 August 2020, MBS item 18365 will allow for the treatment of moderate to severe spasticity of the upper limb following an acute event. The change is that:

· Item 18365 – The term ‘acute event’ will replace the term ‘stroke’, to enable the item to be claimed for a broader range of pathologies.

Why are the changes being made?
· The change will ensure alignment with the associated PBS Section 100 Authority Required (streamlined) listing for Botulinum Toxin Type A Purified Neurotoxin Complex (Botox®), Clostridium Botulinum Type A Toxin-Haemagglutinin Complex (Dysport®) or incobotulinumtoxin A (Xeomin®), which will allow their use for the treatment of moderate to severe spasticity of the upper limb following an acute event other than stroke.

· The change will expand the scope of MBS item 18365 to allow the item to cover patients with a broader range of pathologies.

· The change will provide greater clarity around the circumstances to which the item will apply and help to streamline the MBS, reducing its complexity.

The amendment of this service was recommended by the Medical Services Advisory Committee (MSAC) Executive in December 2019 following recommendations to the PBS listing for the medicines by the Pharmaceutical Benefits Advisory Committee (PBAC).

What does this mean for practitioners?
Practitioners should familiarise themselves with the updated descriptor for item 18365 to ensure the services they provide meet the relevant requirements.

Practitioners should note that item 18360 is no longer the most appropriate item to claim for the administration of botulinum toxin for the treatment of moderate to severe focal spasticity, where it affects the upper limb. Practitioners should adjust their practice to claim 18365, where spasticity of the upper limb has occurred as a result of an acute event, including a stroke.

How will this change affect patients?
Eligible patients will continue to access Medicare rebates for clinically relevant services under items 18360 and 18365. MBS item 18365 is being expanded to allow the item to cover patients with a broader range of pathologies.

How will the changes be monitored and reviewed?
The Department of Health regularly reviews the usage of new and amended MBS items in consultation with the profession. All MBS items may be subject to compliance processes and activities, including random and targeted audits which may require a provider to submit information about the services claimed.

Where can I find more information?
The full item descriptor and information on other changes to the MBS can be found on the MBS Online website at www.mbsonline.gov.au. You can also subscribe to future MBS updates by visiting MBS Online and clicking ‘Subscribe’.

The full PBS listings can be found on the PBS Online website at www.pbs.gov.au.

The Department of Health provides an email advice service for providers seeking advice on interpretation of the MBS items and rules and the Health Insurance Act and associated regulations. If you have a query relating exclusively to interpretation of the Schedule, you should email askMBS@health.gov.au.

Subscribe to ‘News for Health Professionals’ on the Services Australia website and you will receive regular news highlights.

If you are seeking advice in relation to Medicare billing, claiming, payments, or obtaining a provider number, please go to the Health Professionals page on the Services Australia website or contact the Services Australia on the Provider Enquiry Line – 13 21 50.

The data file for software vendors is available and can be accessed via the MBS Online website under the August 2020 Downloads page.

Please note that the information provided is a general guide only. It is ultimately the responsibility of treating practitioners to use their professional judgment to determine the most clinically appropriate services to provide, and then to ensure that any services billed to Medicare fully meet the eligibility requirements outlined in the legislation.

This sheet is current as of the Last updated date shown above, and does not account for MBS changes since that date.