Minor changes to sleep study items 12205 and 12207 factsheet

Minor changes to sleep study items (PDF 262 KB)
Minor changes to sleep study items (DOC 92 KB)

Item descriptors and explanatory notes (PDF 326 KB)
Item descriptors and explanatory notes (DOC 20 KB)

What are the changes?
On 1 November 2019, some minor changes will be made to sleep study items 12205 and 12207. The changes are:

· Item 12205 – The intent of the associated MBS Explanatory Note for this item will be reflected in the item descriptor itself.

· Item 12207 – The term ‘cardio-respiratory failure’ will be changed to ‘respiratory failure’.

Why are the changes being made?
These changes aim to provide greater clarity around circumstances to which the items will apply, as well as ensure funding is provided to patients with a clinical need.

What does this mean for practitioners?
Eligible practitioners can continue to access items 12205 and 12207. While there will be no changes the way these items are administered, practitioners should familiarise themselves with the updated item descriptors to ensure the services they provide meet the relevant requirements.

How will these changes affect patients?
These changes are not anticipated to affect patient access to these services. Eligible patients can continue to access rebates for clinically relevant services under items 12205 and 12207.

Who was consulted on the changes?
The changes to item 12205 and 12207 were progressed in consultation with relevant professional groups, including the Australasian Sleep Association.

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?
Further information on about item changes which came into effect for sleep studies on 1 November 2018 is available here.

The full item descriptor(s) 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 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 Department of Human Services 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 Department of Human Services website or contact the Department of Human Services on the Provider Enquiry Line – 13 21 50.

The data file for software vendors is expected to become available on 1 November 2019 and can be accessed via the MBS Online website under the 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.