Change to the MBS fee for capsule endoscopy

Capsule endoscopy MBS fee change - Factsheet (PDF 150 KB)
Capsule endoscopy MBS fee change - Factsheet (DOC 513 KB)


What are the changes?

From 1 November 2018, changes to capsule endoscopy (MBS items 11820 and 11823) will see a reduction in the MBS fee to $1,229.35, to better reflect the current cost of providing the service. This change is subject to parliamentary scrutiny.

Why are the changes being made?

These changes are the result of collaboration between the independent MBS Review Taskforce (the Taskforce) and the Medical Services Advisory Committee (MSAC) following a comprehensive review of capsule endoscopy services.

The Gastroenterology Clinical Committee of the Taskforce reviewed capsule endoscopy services and recommended a fee review by the MSAC due to significant variations in service volumes between and within states and territories that could not be explained on clinical grounds alone.

A complete copy of the Gastroenterology Clinical Committee's final report can be found at the Gastroenterology Clinical Committee website.

What does this mean for providers?

Providers can continue access Medicare items for these services. The MBS fee has been reduced to better reflect the current cost of providing capsule endoscopy services in Australia.

What does this mean for patients?

Patients will continue to receive this Medicare rebateable service. The rebate the patient will receive for the service however will be reduced.

When will this change be 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.

Significant variation from forecasted expenditure may warrant review and amendment of fees, and incorrect use of MBS items can result in penalties including the health professional being asked to repay monies that have been incorrectly received.

Where can I find more information?

The full item descriptor and information on other changes to the MBS can be found at the MBS Online website or by calling the Department of Human Services on 132 150.

More information about the Taskforce and associated Committees is available at MBS Reviews Taskforce website.