1405 – MBS Item Number for Pulmonary Rehabilitation

New MBS item.

MSAC Application 1405 seeks five (5) new MBS items:

Phase 1

One new respiratory GPMP item number created to:

enable GPs to refer directly to a pulmonary rehabilitation program, without the need to additionally complete a TCA

Two new Allied Health MBS Item numbers:

A one-on-one (45min) consultation item number ($65) covering two (2) one-on-one assessments:

a pre-assessment – develop a complete patient medical history and plan sessions. The assessment will include but will not be limited to: testing of functional exercise capacity (6 min walk distance); assessments of health status (Quality of Life) and a psychosocial assessment questionnaires; and

a post-assessment – retesting functional exercise capacity; assessments of health status (Quality of Life) and psychosocial assessment to measure patient outcomes after completion of Group Exercise sessions below.

One Group Exercise item number ($25) to enable 16 x 1hr sessions for small group sizes - due to complexity of patients (maximum 8 participants).

Phase 2 (proposed maintenance option):

One Group exercise maintenance item number (1hr) at a reduced cost ($10) to enable those with severe disease and low-socioeconomic and/or multi-morbidity to attend one session per week for a total of 16 sessions. This is important in order to extend the benefits of the pulmonary rehabilitation program into the second year.

Phase 3

Eligibility: Patients would be eligible for Pulmonary Rehabilitation Maintenance every 2 years or following any hospitalisation for an acute exacerbation, or if a major change in clinical condition.

One Pulmonary Rehabilitation Maintenance item number (16 x 1hr sessions) – annually.

The proposed new MBS items would be in addition to the usual GPMP (Item 721) for the management of other co-morbidities that can be common in this patient group, other than emphysema, chronic bronchitis and chronic asthma that isn’t fully reversible, interstitial lung diseases, bronchiectasis and lung cancer which are covered under the proposed new GPMP item.

Type: Therapeutic

The diseases relevant to this service are the chronic lung diseases, including chronic obstructive pulmonary disease (COPD is an umbrella term for a group of diseases including emphysema, chronic bronchitis and chronic asthma that isn’t fully reversible) interstitial lung diseases, bronchiectasis and lung cancer

• PASC meeting: 
  • 13 August 2015
  • 10 December 2015
• ESC meeting: 6 - 7 October 2016
• MSAC meeting: 24 - 25 November 2016