From 1 November 2021 there will be a number of changes to the MBS. These changes include minor administrative and minor policy changes which were recommended by the clinician-led MBS Review Taskforce or the Medicare Benefits Schedule Advisory Committee and also incorporates five legislative instruments which are made under subsection 3C(1) of the Health Insurance Act 1973. Details of the changes are as set out below.

A number of changes to the General Medical Services Table (GMST), Diagnostic Imaging Services Table (DIST) and the Pathology Services Table (PST) will be implemented through the Health Insurance Legislation Amendment (2021 Measures No. 2) Regulations 2021.

Medical Services

Four new items (14216, 14217, 14219 and 14220) for repetitive transcranial magnetic stimulation (rTMS) therapy are being introduced onto the MBS. The new items will provide rTMS services for eligible adult patients (18 years old or older), who have not previously received a rTMS service in the public or private setting, and who have trialled at least two different classes of antidepressant medicines but have not responded to this course of treatment.

New item 30311 is being introduced for a sentinel lymph node biopsy or biopsies for intermediate thickness melanoma. Patients with malignant cutaneous melanoma primary legion greater than 1mm in depth (or at least 0.8mm depth in the presence of ulceration) will be able to receive a service under the new item.

New item 32230 is being introduced for the removal of very large (≤ 25mm) sessile colorectal polyps by an endoscopic mucosal resection. This service will provide patients with a safe, effective and cost effective service when compared with the surgical resection of colorectal polyps, which is already provided for under the MBS.

New item 35401 is being introduced for the treatment of spinal fractures by vertebroplasty.

Three new items (45534, 45535 and 45589) will be introduced for the provision of surgical treatment by autologous fat grafting. Items 45534 and 45535 will be used for the treatment of patients requiring breast construction and the correction of developmental breast disorders, and item 45589 is for the treatment of burn scars and facial defects due to craniofacial abnormalities.

New item 11607 will be introduced for ambulatory blood pressure monitoring for the diagnosis of high blood pressure.

Three thoracic medicine items (11503, 11508 and 11512) will be amended to enable appropriately trained specialists or consultant physicians to provide these services. Patients, particularly in rural and remote areas, will have better access to these diagnostic tests to ensure they are able to be treated for a range of diseases.

Item 30210 will be amended, which is for multiple injections of glucocorticoid preparations into keloid scars and other skin restrictions, to remove the age restriction for the service, which will increase access to patients of any age who have a clinical need for the service.

Item 45558 will be amended, which is for the surgical correction of bilateral breast ptosis by mastopexy, to remove the restriction for patients that have been pregnant. This change will provide access to the patient populations at greatest need of the service, including individuals who have undergone significant weight loss.

Varicose vein items 32500 and 32507 to 32529 are being amended to align the items with contemporary clinical practice, ensure appropriate patient access and prevent their use for cosmetic purposes. The amendments will also restrict the inappropriate and unsafe use of venography, fluoroscopy and angiography services with some varicose vein items.

Diagnostic Imaging Services

A new restriction to prevent co-claiming attendance items in association with a magnetic resonance imaging (MRI) item (that is, an item listed in Group I5 of the DIST) will be implemented from 1 November 2021. This change will clarify appropriate claiming arrangements for consultations rendered in association with MRI services.

Items 55065 and 55068, which are for an ultrasound of the pelvis, will be amended to allow for the service to be rendered in association with gynaecological items 55736 and 55739.

Computed tomography colonography item 56553 will be amended to remove the current claiming restriction of one scan in 36 months. This change will allow high risk category patients to be able to access diagnostic scans as frequently as recommended. This change aligns with the National Health and Medical Research Council (NHMRC) clinical guidelines.

Computed tomography item 57360 will be amended to remove the requirement that the patient is known to have coronary artery disease. This change reflects the policy intent of the item 57360 as recommended by the MBS Review Taskforce.

New item 61560 will be introduced for positron emission tomography for the diagnosis of Alzheimer’s disease. The new item will allow patients with suspected Alzheimer Disease to access more effective diagnostic imaging where diagnosis through clinical evaluation is equivocal.

Magnetic resonance imaging item 63541 will be restricted to a claiming frequency of once every 12 months.

Item 63489 currently includes a component for a breast biopsy procedure and ultrasound scan, and currently the biospy procedure and the ultrasound scan cannot also be claimed with 63489. This item will be amended such that the service only applies to the MRI scan component, and the biopsy and ultrasound scan can now be co-claimed with the scan. The fee for a service under item 63489 has been reduced to reflect the MRI scan element only.

Pathology Services

New items 66522 and 66523 will be introduced for feceal calprotectin testing to diagnose inflammatory bowel disease. A service under these items will be available to patients who are less than 50 years of age presenting with gastrointestinal symptoms suggestive of inflammatory or functional bowel disease with more than six weeks duration.

New item 71175 will be introduced for the diagnosis of neuromyelitis optica spectrum disorder (NMOSD) or myelin oligodendrocyte glycoprotein antibody-related demyelination (MARD).

Item 73297, which is for the characterisation of specific germline variations, will be amended to align with the original policy intent of the service.

Items 73361, 73362 and 73363, which are for the genetic testing of childhood syndromes, will be amended to clarify the requirements for targeted cascade testing of relatives under the items. This change will assist in confirming the presence of a spontaneous gene variant that is the cause of the affected child’s condition.

New items 13207, 73384, 73385, 73386 and 73387 will be introduced for preimplantation genetic testing (PGT) for specific genetic or chromosomal abnormalities. The new suite of PGT items includes a test to identify pathogenic variants in reproductive couples (item 73384), and to further identify the genetic variants in the biopsied embryo or embryos (items 73385, 73386 and 73387).

Item 73388 will be introduced for genome-wide microarray testing for pregnancies with major fetal structural abnormalities. This service will provide for the investigation of a pregnancy where there are major fetal structural abnormalities, which can often result from pathological gene variants, detected by ultrasound.

A new item 73389 is being introduced for the analysis of products of conception from a patient with suspected hydatidiform moles for the characterisation of ploidy status. This item will assist doctors in providing patients with targeted treatment and advice regarding when patients can safely become pregnant again.

New item 73391 will be introduced for genome-wide microarray testing for people with multiple myeloma. Item 73391 will allow for the diagnosis and monitoring of multiple myeloma, as a complementary service to fluorescence in-situ hybridisation (FISH) testing currently provided under item 73290.

Other changes
Item 41904 will be moved from Subgroup 8 – Ear, nose and throat into Subgroup 6 – Cardio-thoracic of Group T8. Under this change item 41904 will be repealed, and item 38428 will be introduced to provide for the service instead. This change does not change the nature of the service nor patent access.

Items 63541 and 63545 from the Health Insurance (Section 3C Diagnostic Imaging Services—Multiparametric MRI of the prostate) Determination 2018 will be incorporated into the DIST. The timing and purpose for item 63545 will also be amended.

Item 47491 from the Health Insurance (Section 3C General Medical Services – Anterior and Posterior Pelvic Ring Disruption) Determination 2021 and items 63541 and 63543 from the Health Insurance (Section 3C Diagnostic Imaging Services – Multiparametric MRI of the prostate) Determination 2018 will be incorporated into the GMST and DIST from 1 November 2021.

Items 35638, 38212, 38727, 38730, 45720 to 45752, 46486, 46498, 46500, 46501, 46503, 46534, 47450, 48958, 49776, 49833 to 49838 and 50224 will be amended to make minor administrative changes which align with the policy intent of the services. This includes removing references to repealed items and correction of typographical errors and specifying services must be assisted (where applicable).

Item 57351 will be repealed.

New items 10995, 10957, 10959, 82001, 82002 and 82003 will be introduced through the Health Insurance Legislation Amendment (Section 3C General Medical Services – Allied Health Case Conference) Determination 2021. These items will enable a Medicare benefit to be paid where allied health practitioners participate in case conferences to manage the care of certain patients.

Items 72814, 73337, 73341, 73343 and 73344 will be amended through the Health Insurance (Section 3C Co-Dependent Pathology Services) Amendment Determination 2021 to align items 72814, 73337, 73341 and 73344 with changes to the Pharmaceutical Benefits Scheme (PBS) which exclude the need for positive programmed cell death ligand 1 (PD-L1) status for access the drug pembrolizumab and amend item 73343 to include genome wide micro-array in addition to fluorescence in situ hybridisation (FISH) testing.

Item 73844 will be amended through the Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Amendment Determination 2021 to align the service with clinical best-practice. Item 73844 currently provides for the quantitation of urinary microalbumin as determined by urine albumin excretion on a timed overnight urine sample or urine albumin/creatinine ratio (ACR), as determined on a first morning urine sample for patients with diagnosed diabetes.

Under the changes to item 73844, the requirement for the test to be performed on a first morning urine sample and instead require the test be performed on random spot collection will be removed. Item 73844 will also be amended to expand the service to patients at risk of microalbuminuria, in addition to patients with established diabetes.

New HbA1c Point of Care testing items 73812 and 73826 will be introduced through the Health Insurance (Section 3C Pathology Services – HbA1c Point of Care Testing) Determination 2021 and the Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Amendment Determination 2021.

Relevant Legislation

Health Insurance Legislation Amendment (2021 Measures No. 2) Regulations 2021

The purpose of the Health Insurance Legislation Amendment (2021 Measures No. 2) Regulations 2021 is to amend the GMST, DIST and PST from 1 November 2021. The Regulations will make changes to general medical services, pathology services and diagnostic imaging services to reflect Government policy.

Health Insurance Legislation Amendment (Section 3C General Medical Services – Allied Health Case Conference) Determination 2021

The purpose of the Health Insurance Legislation Amendment (Section 3C General Medical Services – Allied Health Case Conference) Determination 2021 is to list six new items to enable a Medicare benefit to be paid where allied health practitioners participate in case conferences to manage the care of certain patients.

Health Insurance (Section 3C Co-Dependent Pathology Services) Amendment Determination 2021

The purpose of the Health Insurance (Section 3C Co-Dependent Pathology Services) Amendment Determination 2021 (the Determination) is to amend the Health Insurance (Section 3C Co-Dependent Pathology Services) Determination 2018 from 1 November 2021. This amendment will align items 72814, 73337, 73341 and 73344 with changes to the Pharmaceutical Benefits Scheme (PBS) which exclude the need for positive programmed cell death ligand 1 (PD-L1) status for access the drug pembrolizumab. The Determination will also amend item 73343 to include genome wide micro-array in addition to fluorescence in situ hybridisation (FISH) testing.

Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Amendment Determination 2021

The purpose of the Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Amendment Determination 2021 (the Determination) is to amend the Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination 2015 (the Principal Determination) by repealing and replacing the table in the Schedule to update the table formatting and amend item 73844.

Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Amendment Determination 2021

The purpose of the Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Amendment Determination 2021 (the Determination) is to amend the Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Determination 2020 to introduce new glycated haemoglobin (HbA1c) point of care testing item 73826 and to clarify that a service under items 73826 to 73837 is considered a prescribed pathology service.

Health Insurance (Section 3C Pathology Services – HbA1c Point of Care Testing) Determination 2021

The purpose of the Health Insurance (Section 3C Pathology Services – HbA1c Point of Care Testing) Determination 2021 is to introduce new item 73812, which is for glycated haemoglobin (HbA1c) point of care testing, onto the Medicare Benefits Schedule (MBS) as of 1 November 2021.

Health Insurance Legislation Amendment (No. 2) Determination 2021

The purpose of the Health Insurance Legislation Amendment (No. 2) Determination 2021 (the Determination) is to revoke the Health Insurance (Section 3C General Medical Services – Anterior and Posterior Pelvic Ring Disruption) Determination 2021 and the Health Insurance (Section 3C Diagnostic Imaging Services – Multiparametric MRI of the prostate) Determination 2018 because items included in those instruments will be included in the GMST and DIST from 1 November 2021.