Expansion of eligible population for MBS item 11219 (optical coherence tomography – OCT)

Expansion of OCT - Factsheet (PDF 157 KB)
Expansion of OCT - Factsheet (DOC 514 KB)

What are the changes?
From 1 November 2018, changes will be made to MBS item 11219. The item descriptor will be expanded to allow optical coherence tomography (OCT) to be used for the diagnosis of all ocular conditions, for initial access to PBS listed intra-ocular medication.

Why are the changes being made?
The Medical Services Advisory Committee (MSAC) Executive considered a proposal from the Department of Health to amend the current OCT MBS item in March 2018. The current descriptor specifies eligible ocular conditions for access to specific associated PBS-listed medication. The MSAC Executive considered this was reasonable as OCT is now standard care and has largely replaced use of fluorescein angiography.

What does this mean for providers?
Eligible providers will be able to access MBS item 11219 for the diagnosis of ocular conditions for which a medication is listed on the Pharmaceutical Benefits Scheme for intraocular administration. This represents an expanded eligible patient population from 1 November 2018.

What does this mean for patients?
Eligible patients may now receive Medicare rebates when undergoing OCT to determine diagnosis of ocular conditions for which a medication is listed on the Pharmaceutical Benefits Scheme for intraocular administration. The current schedule fee and restriction of one service per patient per year will remain.

When will this change be reviewed?
The Department of Health will continue to review the change in consultation with the profession.

All changes to the MBS 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

Amended Item
(Draft wording of items to be finalised through regulatory amendments)