The 1 November 2023 Medicare Benefits Schedule (MBS) files are available on the November 2023 Downloads page.
Summary of Change for 1 November 2023
From 1 November 2023, there will be changes to the Medicare Benefits Schedule (MBS). The changes include administrative changes, additional indexation of fees in line with the 2023/24 Budget and an increase in greatest permissible gap due to annual indexation. Further policy changes include the implementation of several measures from the 2023-24 Budget.
The changes will affect:
From 1 November 2023, an additional indexation factor of 0.5 per cent will be applied to:
- most of the general medical services items;
- most diagnostic imaging services (but excluding nuclear imaging services); and
- pathology items in Group P12 (74990, 74991, 75861, 75962, 75863 and 75864).
Greatest Permissible Gap
On 1 November 2023, the Greatest Permissible Gap (GPG) amount will be indexed in line with the consumer price index (September quarter).
From 1 November 2023, the GPG will be set at $98.70, which means that all out-of-hospital Medicare services which have an MBS fee of $658.35 or more will attract a benefit that is greater than 85% of the MBS fee.
Bulk-billing and Level E Consultation items
From 1 November 2023, seven existing bulk-billing incentive (BBI) items will be amended and 13 new BBI items will be added to the MBS. The new items are: 75870, 75871, 75872, 75873, 75874, 75875, 75876, 75880, 75881, 75882, 75883, 75884 and 75885.
New MBS items will also be introduced to the general medical services table (GMST), which provide services to patients requiring a consultation of 60 minutes or more (also known as level E consultation items) with existing 40 minute or more consultation items (also known as level D consultation items) being amended to include a maximum attendance time.
Other changes to general medical services
From 1 November 2023, the following changes will be made to the MBS:
- A minimum service time will be introduced to general practitioner consultation items, with items 23, 24, 5020, 5023 and 5028 applying to a consultation service lasting at least six minutes and less than 20 minutes;
- New telehealth items 91920, 91923 and 91926 will be introduced for general practice attendance items lasting 60 minutes or more;
- New phone items 91900, 91903, 91906, 91910, 91913 and 91916 will be introduced for longer general practice attendances, where the patient is registered under MyMedicare with the billing practice;
- Amendments to telehealth items 91800, 91805 and 91808 to introduce appropriate minimum and maximum consultation times;
- New items 38372, 38373, 38374 and 38375 will be introduced for the insertion, replacement or removal of a leadless permanent pacemaker;
- All groups and subgroups, excluding subgroup 10 of Group A7, of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 will be incorporated into the GMST;
- Amendments to otolaryngology items 11340, 11341 and 11343 to allow services under these items to be provided by persons other than medical practitioners; and
- Amendment to seven plastic and reconstructive surgery items 45571, 45794, 45797, 46108, 46116, 46120 and 46122 to better align with contemporary clinical practice.
From 1 November 2023, the following changes will be made to pathology services:
- Introduce pathology items 73437, 73438 and 73439, which allow testing for genetic variants in patients with non-squamous non-small cell lung carcinoma to be performed as a pathologist-determinable service;
- A fee increase for item 73418 for genetic testing for cardiac arrhythmias;
- New items 73440, 73441, 73442, 73443 and 73444 will be introduced for genetic testing for childhood hearing loss;
- New items 73445, 73446, 73447 and 73448 will be introduced for gene panel testing for haematological malignancies;
- New items 73451 and 73452 will be introduced for genetic testing to determine carrier status of cystic fibrosis, spinal muscular atrophy, and fragile X syndrome in patients who are planning pregnancy or already pregnant, and their reproductive partner;
- New items 73453, 73454 and 73455 will be introduced for reproductive carrier testing for specific genetic variants that cause nine severe conditions commonly found in the Ashkenazi Jewish population, with testing available to individuals of reproductive age who identify as being of Ashkenazi Jewish decent;
- New items 73456, 73457, 73458, 73459, 73460, 73461 and 73462 will introduced for the diagnosis of mitochondrial disease in patients who are suspected of having either acute or chronic diseases, and the cascade testing of their biological relatives;
- Amendment to the schedule fee for item 73418 from $400.00 to $1,200.00;
- New item 66585 will be introduced for the quantification of N-terminal pro B-type natriuretic peptide (NT-proBNP) or B-type natriuretic peptide (BNP) in patients with systemic sclerosis, to assess the risk of pulmonary arterial hypertensions;
- Amendments to prostate specific antigen testing items 66655, 66656, 66659 and 66660 and introduction of new item 66654 for testing patients with a first degree relative diagnosed with prostate cancer as a ‘high risk’ patient;
- New items 71202 and 73310 will be introduced for the detection of measurable residual disease (MRD) in patients with acute lymphoblastic leukaemia using flow cytometry and next-generation sequencing methods;
- New item 73306 will be introduced for the EndoPredict brand gene expression profiling test, which is a genetic test that looks at expression levels of several genes that can be involved in breast cancer;
- Pathology item 73343 will be incorporated into the PST; and
- Amendments to item 73296 and 73297 to expand the eligible patient population which ca access testing of genes associated with breast, ovarian, fallopian tube or primary peritoneal cancer.
From 1 November 2023, the following information will be made to the diagnostic imaging services table:
- Amendment to item descriptors for items 61321, 61325, 61324, 61329, 61345, 61357, 61394, 61398, 61406, 61414, 61349 and 61410 to remove references to ceased item numbers; and
- Amendment to the schedule fee for adrenal study item 61485 from $999.20 to $3,364.00 to cover the cost of the radiopharmaceutical administered as part of the service.
- Health Insurance Legislation Amendment (2023 Measures No. 3) Regulations 2023
- Health Insurance (Section 3C Cleft Lip and Cleft Palate Services) Amendment Determination 2023
- Health Insurance (Section 3C Co-Dependant Pathology) Amendment (No. 2) Determination 2023
- Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Amendment (General Practice) Determination 2023
- Health Insurance Legislation Amendment (Indexation No. 2) Determination 2023
- Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Amendment (No. 1) Determination 2023
- Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Amendment (No. 2) Determination 2023
- Health Insurance (Pathologist-determinable) Amendment (No. 2) Determination 2023
- Health Insurance Legislation (Section 3C Pathology – 17p chromosomal deletion testing) Revocation Determination 2023