Extension of SARS-CoV-2 (COVID-19) Laboratory Testing Items

From 1 January 2022 until 30 June 2022, the Australian Government has extended the temporary Medicare Benefits Schedule (MBS) items 69479 and 69480 for polymerase chain reaction (PCR) testing for COVID-19.

From 1 January 2022, the MBS item (69501) for COVID-19 screening of asymptomatic essential workers will cease.

A reduced schedule fee for MBS items 69479 and 69480 will apply from 1 January 2022, reflecting a reduction in the cost of providing COVID-19 tests.

A request from a medical or nurse practitioner is a requirement for MBS items 69479 and 69480. Rebates must only be claimed where a patient’s treating practitioner determines that the test is necessary for the clinical management of their patient.

All COVID-19 PCR tests undertaken for public health screening purposes, for example, asymptomatic screening, workplace testing, or testing for travel interstate, will continue to be provided free-of-charge through state and territory public health testing sites. Public health testing sites can be found via the relevant state and territory health department websites.

From 1 January 2022, COVID-19 tests performed for patients admitted in-hospital with private health insurance coverage may be charged at a fee higher than the MBS rebate. To be eligible for an MBS rebate, pathology providers will only be permitted to charge no more than 100 per cent of the MBS fee. Patients will continue to not incur out-of-pocket expenses, with private health insurers to cover the gap between the Medicare rebate and the fee charged.

Out-of-hospital claims for MBS items 69479 and 69480 in any other settings must be directly billed to Medicare and cannot incur any additional cost over the MBS rebate (i.e. the services must be bulk-billed).

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