Summary of Item Changes
New Items
111 117 120 6080 6081 12320 12322 16407 16408 16530 16531 16533 16534 35414 38276 38495 40701 40702 40704 40705 40707 40708
73296 73297 80001 80011 80021 80101 80111 80121 80126 80136 80146 80151 80161 80171
Ceased Items
12309 12318 12323 16525 16633 16636 30009 30013 30041 30048 30067 30074 30102 30106 30110 30265 30282 30476 30487 30493 30620 30634
30638 30675 35512 35516 35526 35617 35639 35676 35683 35687 35712 35716 36658 36660 36662 37622 41665 41788 41792 41796 41800 41819
41820 61616
Amended Descriptors
105 11204 11205 11820 12306 12312 12315 12321 16401 16406 16508 16509 16515 16518 16519 16520 16522 16527 16528 16590 16591 16606
20560 20855 20946 20958 30042 30075 30107 30473 30475 30478 30479 30621 30631 30635 30640 30642 30688 30690 30692 30694 32084 32087
35618 35640 35643 35644 35713 35717 41668 41674 41789 41793 41801 41831 46495 46498 46500 46501 46502 46503 50950 50952 51306 51309
51312 61620 61622 61628 61632 80000 80010 80020 80100 80110 80120 80125 80135 80145 80150 80160 80170
Fee Amended
16515 16520 16527 16528 16590 30475
Provider Type Amended
30010 30014 30042 30049 30068 30075 30103 30107 30111 30266 30283 30621 30635 30641 30676 35513 35517 35527 35618 35640 35677 35684
35688 35713 35717 35730 37623 41668 41789 41793 41797 41801 42705
New Item effective 16 November 2017
31591
Amended Benefit effective 16 November 2017
31584
Increase in Maximum Patient Gap
The maximum patient gap between the Medicare Benefits Schedule (MBS) fee and the benefits payable for out-of-hospital services increases to $81.70 as at 1 November 2017. The 85% benefit level will apply for all fees up to $544.70, after which, benefits are calculated at the Schedule fee less $81.70.
Blocking Claiming of MBS Items for Subsequent Attendances with Any Item in Group T8 (Surgical Operations) That Has an MBS Fee of $300 or More
This change amends subsequent attendance items 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6019, 6052, and 16404. The amendment blocks the claiming of these items if they are performed on the same day as any Group T8 item (30001-50952) that has a schedule fee of $300 or more. Three new attendance items (111, 117 and 120) have been listed for the use in extenuating circumstances. Refer to corresponding explanatory notes for further details.
New listing of Transcatheter Aortic Valve Implantation (TAVI)
In March 2016, the Medical Services Advisory Committee (MSAC) recommended the listing of MBS items for transcatheter aortic valve implantation (TAVI) and associated services for use in patients who are symptomatic with severe aortic stenosis, and who are deemed to be at high risk for surgical aortic valve replacement or who would otherwise be inoperable. A new item (38495) has been introduced for the performance of TAVI. Item 38495 applies to a service that is provided in a TAVI Hospital by a TAVI Practitioner, on a patient who has been assessed as suitable to receive the procedure. The new items 6080 and 6081 apply in relation to a TAVI Case Conference, which is a process undertaken by a number of medical practitioners to assess and make recommendations regarding a patient’s suitability to receive the service described in item 38495. Item 20560 for the management of anaesthesia has been amended to include the percutaneous insertion of a valvular prosthesis.
Aftercare changes
This change amends the rules that exist around aftercare arrangements. MBS rebates will now be available for GP consultations performed during an aftercare period, where the operation was performed by another practitioner. Refer to corresponding explanatory notes for further details.
Electroretinography 11204 and Electrooculography 11205 ophthalmology items
This change amends relevant electroretinography (11204) and electrooculography (11205) ophthalmology items to exclude their use by general practitioners and clarify that these services can only be performed by a specialist or consultant physician. Items 11204 and 11205 are highly specialised and should be performed by ophthalmologists in specific conditions, including in shielded rooms.
Gastroenterology items - amendments and deletions
Items 11820, 30473, 30475, 30478, 30479, 30688, 30690, 30692, 30694, 32084, 32087 and 41831 have been amended to clarify the intent of the item, to consolidate with other services and/or to specify co-claiming restrictions. Refer to corresponding explanatory notes for further details.
Items 30476, 30487, 30493, 41819, 41820 have been deleted as these services have been replaced and/or consolidated in other items or are no longer reflective of contemporary clinical practice.
Deletion of Quantitative Computed Tomography (QCT) items 12309 and 12318
The MBS QCT items 12309 and 12318 are removed from the MBS following review under MBS Review Taskforce processes, on the basis that QCT provides lower value care in comparison to Dual Energy X-ray Absorptiometry (DEXA), which is the superior test for bone densitometry.
New time restricted bone densitometry items for patients aged 70 years or over
Following review under MBS Review Taskforce processes, two new time-restricted MBS items (12320 and 12322) are introduced for bone mineral density testing (bone densitometry) for people aged 70 years or over. Patients 70 years or over continue to be eligible for an initial screening study using the new item 12320. New item 12320 also applies for patients with a bone mineral density t-score equal to or greater than -1.5, who will be eligible for repeat testing every five years. New item 12322 applies for patients with a bone mineral density t-score less than -1.5 and greater than -2.5, who will be eligible for repeat testing every two years. The current MBS item (item 12323) for people aged 70 years or over will be removed from the MBS.
Changes to obstetric items
The changes to Obstetrics items implement the recommendations of the Medicare Benefits Schedule Review Taskforce. Amendments have been made to a number of obstetrics items, including to add a requirement for a mental health assessment to be undertaken at particular periods during pregnancy and the postpartum period, and to increase fees to acknowledge the time and complexity required to undertake certain services. Six new obstetrics items for pregnancy complications (16533 and 16534); postnatal care (16407 and 16408); and the management of second trimester fetal loss (16530 and 16531) have been introduced. Items 16525; 16633; and 16636 have been deleted.
G (general practitioner) and S (specialist) item changes
The MBS items for some procedural services had different fees for GPs and specialists. Amendments have been made to a number of specialist items, allowing these items to now be claimed by GPs. This change has resulted in a number of GP-specific items becoming redundant and therefore removed from the schedule. This change also increases the MBS rebate for selected procedures performed by GPs.
Mechanical thrombectomy
One new item (35414) has been listed for the treatment of acute ischaemic stroke due to a large vessel occlusion, which is identified by diagnostic imaging. The service involves use of a device to remove blood clots with the aim of restoring blood flow to minimise damage to the brain from stroke. This listing was supported by the Medical Services Advisory Committee (MSAC Application 1428).
Removal of sacral nerve items 36658, 36660 and 36662
Items 36658, 36660 and 36662 have been removed from the MBS. These items were originally introduced for the removal and replacement of leads and sacral nerve pulse generators that were implanted prior to 1998 (for patients with urinary dysfunctions). There are now alternative items (36663-36668) that relate to the removal and replacement of leads at any time, so items 36658, 36660 and 36662 are no longer required.
Transcatheter occlusion of left atrial appendage – for stroke prevention
Item 38276 has been listed as a new medical service for the percutaneous insertion of a left atrial appendage closure device to occlude the left atrial appendage (LAA) in patients with non-valvular atrial fibrillation. The procedure aims at preventing stroke and systemic thromboembolism by closing off the LAA permanently to avoid the formation and migration of emboli to the brain. This listing was supported by the Medical Services Advisory Committee (MSAC application 1347.1). Refer to corresponding explanatory notes for further details.
Vagus nerve stimulation therapy
Six new items (40701, 40702, 40704, 40705, 40707 and 40708) have been added for the management of refractory generalised epilepsy or the treatment of refractory focal epilepsy not suitable for resective epilepsy surgery. This listing was supported by the Medical Services Advisory Committee (MSAC Application 1358.1).
Changes to Ear, Nose and Throat Items 41674, 41789, 41793 and 41801
Item 41674 has been amended to remove the inclusion of MBS coverage for cauterisation of the pharynx, as this is no longer considered appropriate clinical practice.
Items 41789 and 41793 for tonsillectomy and 41801 for adenoidectomy have been amended to clarify that each item covers the service of injection of local anaesthetic and examination of the post nasal space to prevent inappropriate billing.
Microwave tissue ablation for primary liver tumour
Items 50950 and 50952 have been amended to include microwave tissue ablation as an alternative treatment to radio frequency ablation for the treatment of unresectable malignant primary liver tumours.
Changes to item descriptors for spinal x-ray services
The requesting of MBS three (item 58121 and 58127) and four region (58120 and 58126) spinal x-ray items has been restricted to medical practitioners, physiotherapists and osteopaths only following review under MBS Review Taskforce processes. Chiropractors are no longer able to request these items.
The MBS one region spinal x-ray items (58100, 58102, 58103, 58105, 58106, 58109, 58111 and 58117); and MBS two region spinal x-ray items (58112 and 58123) are amended so that allied health practitioners cannot request more than one of any of the one and two region spinal x-ray services, for the same patient, on the same day.
Changes to item description for PET for lymphoma items
Items 61620, 61622, 61628 & 61632 have been amended removing the restriction for indolent non-Hodgkin lymphoma. Item 61616 has been removed as the service is covered by item 61620. The item descriptors have also been amended to reflect the appropriate ICD-10 classification for Hodgkin lymphoma. This listing was supported by the Medical Services Advisory Committee (MSAC Application 1406).
New genetic testing items
From 1 November 2017, two new Medicare funded pathology services (73296 and 73297) will provide diagnostic genetic testing for heritable mutations predisposing to breast or ovarian cancer in clinically affected individuals to estimate their relative risk of a new primary cancer, and of predictive genetic testing of the family members of those affected individuals who are shown to have such a mutation.
New Telehealth MBS items for psychological services
The purpose for the change is to expand Medicare eligibility for video consultations to include psychological services in rural and remote areas. The new telehealth MBS items for psychological video conference services will be made available to people residing in Modified Monash Model (MMM) regions four to seven, which include regional, remote and very remote locations.
Medicare rebates are available for up to 10 individual allied mental health services in a calendar year. From 1 November 2017, up to seven of these services may be provided via video conference.