New Medicare Benefits Schedule (MBS) item for prostate biopsy guided by magnetic resonance imaging (MRI) factsheet

Factsheet - New item for MRI-guided prostate biopsy (PDF 291 KB)
Factsheet - New Item for MRI-guided prostate biopsy (DOC 88 KB)


What are the changes?
From 1 May 2020, Medicare rebates will be available for a new item for prostate biopsy when guided by MRI.

The new item (37226) is for needle biopsy of the prostate or prostatic bed, using prostatic magnetic resonance imaging techniques, where 1 or more prostatic specimens are obtained. The fee for this service is $285.35.

This biopsy item will be able to be provided by specialists and consultant physicians. The new item will be in the General Medical Services Table (GMST).

Why are the changes being made?
The listing of this service was recommended by the Medical Services Advisory Committee (MSAC) Executive in June 2018. Further information on the role of MSAC can be found on the MSAC website www.msac.gov.au.

What does this mean for providers and requestors?
While a corresponding prostate MRI item is not currently listed on the MBS, this change is intended to provide an alternative to prostate biopsy under ultrasound guidance (item 37219). The new item will provide medical practitioners flexibility to choose the most appropriate imaging modality to guide a prostate biopsy.

How will these changes affect patients?
This change will allow a Medicare rebate to be paid for patients who receive a prostate biopsy under MRI-guidance, and reduce patient out-of-pocket costs.

Where can I find more information?
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 [date] 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.