1 January 2021 Item Update
The 1 January 2021 item update is now available to download.
Please read through all these notes prior to running your item update.
If you are prompted, please update your Medcomms.
Summary of Changes
Extended Medicare Safety Net (EMSN)
The EMSN provides an additional Medicare benefit once an annual threshold in out-of-pocket costs for out-of-hospital services has been reached. Out-of-hospital services include GP and specialist attendances, as well as many pathology and diagnostic imaging EMSN cap to attending services. The Original Medicare Safety Net (OMSN) and EMSN thresholds are indexed annually on 1 January in line with the CPI (September Quarter). In addition to applying indexation the latest changes also include applying an EMSN cap to attendance items, coronavirus (COVID-19) telehealth items and one cardiac item.2021 Medicare Safety Nets Thresholds | Threshold amount | Who it’s for | What counts towards the threshold | What benefit you’ll get back |
| Original Medicare Safety Net (OMSN) | $481.20 | Everyone in Medicare | Your gap amount for the calendar year. | 100% of the schedule fee for out of hospital services. |
| Extended Medicare Safety Net (EMSN)- General | $2,184.30 | Everyone in Medicare | Your out of pocket amount for the calendar year. | 80% of out of pocket costs or the EMSN benefit caps for out of hospital services. |
| Extended Medicare Safety Net (EMSN) - Concessional and Family Tax Benefit Part A | $697.00 | Concession cardholders and families eligible for Family Tax Benefit Part A | Your out of pocket amount for the calendar year. | 80% of out of pocket costs or the EMSN benefits caps for out of hospital services. |
Other Changes
From 1 January 2021 there were minor changes to three neurosurgery items (39018, 39109 and 39113) to clarify that assistance is required in the provision of these services. These services involve the use of stereotaxy, which requires the use of an assistant to set up the stereotactic navigation and planning. This change will align these services with best practice and ensure patient safety.
There is also a change to item 73337 which commenced on 1 January 2014 for the testing of tumour tissue from a patient diagnosed with non-small lung cancer, in order to determine if the patient meets the requirements relating to the epidermal growth factor receptor (EGFR) gene status for access to medicines under the Pharmaceutical Benefits Scheme (PBS). From 1 January 2021 patients will be able to access medicines identified as an EGFR tyrosine kinase inhibitor, which will include the drug osimertinib.
| Amended Items from 1 January 2021 (excluding Safety Net changes) | 39018 39109 39913 73337 |
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