Application Detail

Description of Medical Service

Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is a virus that causes COVID-19 (coronavirus disease 2019). Testing methods for SARS-CoV-2 nucleic acids test a sample collected using a nasopharyngeal swab, typically using polymerase chain reaction (PCR) methods. Testing may be conducted as point-of-care-testing (PoCT), or by sending the sample to a pathology laboratory.

Temporary Medicare Benefits Schedule (MBS) items were listed on the MBS on 1 October 2022, and provide reimbursement for a single-target SARS‑CoV‑2 testing, and testing of SARS-CoV-2 with other respiratory pathogen targets within a ladder structure depending on the number of targets requested. The existing permanent generic nucleic acid amplification test (NAAT) MBS items remain available for requests for respiratory pathogen testing that do not involve the detection of SARS-CoV-2 and non-respiratory pathogen testing. The temporary MBS items will cease on 31 December 2023, and in the absence of a decision of Government to embed new, permanent items in the MBS testing for SARS-CoV-2 will revert to the existing, permanent generic NAAT MBS item 69494 and combined testing for SARS-CoV-2 and other respiratory pathogens claimed under MBS items 69495 and 69496.

Description of Medical Condition

COVID-19 is a contagious disease that has spread worldwide resulting in the COVID-19 pandemic. It has variable symptoms that can include including fever, cough, headache, fatigue, breathing difficulties, loss of smell, and loss of taste. Some people who are infected do not develop noticeable symptoms. Of those who develop symptoms noticeable enough to be classified as patients, most develop mild to moderate symptoms (up to mild pneumonia), while some develop severe symptoms such as dyspnea or hypoxia, and a small proportion develop critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Older people are at a higher risk of developing severe symptoms. Some people continue to experience a range of effects (long COVID) for months after recovery.

Reason for Application

Because the temporary MBS items will cease on 31 December 2023, the Government has asked the Minister for Health and Aged Care to seek the Medical Services Advisory Committee (MSAC)’s advice on the appropriate use and public funding of laboratory-based testing for SARS-CoV-2 nucleic acids, including the use and utility of multiplex testing for SARS-CoV-2 and other respiratory pathogens, publicly funded under the MBS. The Department of Health and Aged Care is therefore seeking advice from MSAC on permanent MBS items for COVID-19 nucleic acid testing.

Medical Service Type

Investigative technology

Previous Application Number/s

Not Applicable

Associated Documentation

Parameters for the Assessment

Parameters for the Assessment (PDF 407 KB)
Parameters for the Assessment (Word 25 KB)

Consultation Survey

Consultation Survey (PDF 653 KB)
Consultation Survey (Word 27 KB)

PASC Consultation
Bypassing PASC

MSAC Consultation
MSAC consultation input closed Friday, 9 June 2023.

For further information please refer to PASC, ESC, MSAC Key Dates
For further information on the consultation process please refer to MSAC Consultation Process

PICO Confirmation

Not applicable

Assessment Report

-

Public Summary Document

Public Summary Document (PDF 855 KB)
Public Summary Document (Word 184 KB)

Meetings for this Application

PASC

Bypassing PASC

ESC

8-9 June 2023

MSAC

27-28 July 2023