Mesh MBS Item 1 July 2018 (PDF 46 KB)
Mesh MBS Items 1 July 2018 (Word 494 KB)

From 1 July 2018, the Government is introducing changes to the MBS to address patient safety concerns regarding the use of transvaginal mesh in pelvic organ prolapse (POP) surgery.

What do the changes involve?

Changes to items for the repair of POP

The MBS currently provides rebates for a number of procedures where surgeons may or may not apply techniques involving urogynaecological mesh, including items specifically for the repair of POP.

The changes will amend MBS items for the repair of POP via vaginal approach (items 35570, 35571, 35573, and 35577) to clarify that MBS rebates will only be payable for procedures that do not employ the use of mesh. These items will continue to be available for native tissue repairs without mesh.

Items for the repair of POP via vaginal approach will continue to be available for native tissue repairs without mesh.

New items for mesh removal

The Government is supporting patient access by introducing three new items for the surgical removal of mesh/graft material in symptomatic patients. The new MBS rebates correlate with the varying levels of complexity of the procedure depending on the size, approach and complications experienced.

Why is the Government making these changes?

There has been increasing safety concerns for patients who have transvaginal mesh implants, including reports of chronic, severe and life-changing pain and complications. To address these concerns, the Government is drawing forward recommendations from the MBS Review Taskforce’s Gynaecology Clinical Committee.

The changes align with the Therapeutic Goods Administration’s recent removal of urogynaecological mesh products from the Australian Register of Therapeutic Goods, whose sole purpose is for the repair of POP by vaginal approach.

The new items will allow appropriate rebates for the surgical removal of mesh in symptomatic patients and help facilitate the collection of Medicare data on the number of women requiring mesh removal in Australia.

The changes also complement the work of the Australian Commission on Safety and Quality in Health Care on the appropriate use of mesh. For more information regarding the resources available for consumers, clinicians and health service organisations, please visit: https://www.safetyandquality.gov.au/our-work/transvaginal-mesh/resources/

The MBS Review Taskforce is finalising its remaining recommendations on MBS gynaecological services, including those for stress urinary incontinence procedures. The report will be available for consultation in line with Taskforce processes.

Changes to item descriptors and new items:

Amendments to the existing items 35570, 35571, 35573 and 35577

· include reference to ‘pelvic organ prolapse’

· replace ‘with or without mesh’ with ‘using native tissue without graft’


(additional amendments made to item 35577, see descriptor)

Changes to Pelvic Organ Prolapse Surgical Items:

Service	Item	Amended Item Descriptor
Anterior vaginal compartment repair	35570	Anterior vaginal compartment repair by vaginal approach for pelvic organ prolapse (involving repair of urethrocele and cystocele), using native tissue without graft, other than a service associated with a service to which item 35573, 35577 or 35578 applies (H) (Anaes.) (Assist.) Fee: $553.85 Benefit: 75% = $415.40
Posterior vaginal compartment repair	35571	Posterior vaginal compartment repair by vaginal approach for pelvic organ prolapse involving repair of one or more of the following: (a) perineum; (b) rectocoele; (c) enterocoele; using native tissue without graft, other than a service associated with a service to which item 35573, 35577 or 35578 applies (H) (Anaes.) (Assist.) Fee: $553.85 Benefit: 75% = $415.40
Anterior and posterior vaginal compartment repair	35573	Anterior and posterior vaginal compartment repair by vaginal approach for pelvic organ prolapse (involving anterior and posterior compartment defects), using native tissue without graft, other than a service associated with a service to which item 35577 or 35578 applies (H) (Anaes.) (Assist.) Fee: $830.90 Benefit: 75% = $623.20
Manchester (Donald Fothergill) operation	35577	Manchester (Donald Fothergill) operation for pelvic organ prolapse (includes cervical amputation, anterior and posterior native tissue vaginal wall repairs without graft) (H) (Anaes.) (Assist.) Fee: $674.50 Benefit: 75% = $505.90

New items for the surgical removal of urogynaecological mesh:

Item	Item Descriptor
35581	Vaginal procedure for excision of graft material in symptomatic patients with graft related complications, including graft related pain or discharge and bleeding related to graft exposure, less than 2cm2 in its maximum area, either singly or in multiple pieces, other than a service associated with a service to which item 35582 or 35585 applies (H) (Anaes.) (Assist.) (See para TN.8.140 of explanatory notes to this Category) Fee: $553.85 Benefit: 75%=$415.40
35582	Vaginal procedure for excision of graft material in symptomatic patients with graft related complications, including graft related pain or discharge and bleeding related to graft exposure, more than 2cm2 in its maximum area, either singly or in multiple pieces, other than a service associated with a service to which item 35581 or 35585 applies (H) (Anaes.) (Assist.) (See para TN.8.140 of explanatory notes to this Category) Fee: $830.90 Benefit: 75%=$623.20
35585	Abdominal procedure either open, laparoscopic or robotic, for removal of graft material in patients symptomatic with graft related complications, including graft related pain or discharge and bleeding related to graft exposure or where the graft has penetrated adjacent organs such as the bladder (including urethra) or bowel, including retroperitoneal dissection and mobilisation of bladder and/or bowel, other than a service associated with a service to which item 35581 or 35582 applies (H) (Anaes.) (Assist.) Fee: $1,473.20 Benefit: 75%=$1,104.90

New explanatory note for Excision of graft material (Items 35581 and 35582):

Note	Note Details
TN.8.140	For items 35581 and 35582 the size of the excised graft material must be histologically tested and confirmed.