Summary of Changes

From March 2021 there have been a number of changes to the MBS. These changes include minor policy changes which were recommended by the clinician-led MBS Review Taskforce or the Medicare Benefits Schedule Committee and also incorporates eight legislative instruments which are made under subsection 3C(1) of the Health Insurance Act 1973. Details of the changes are as follows:

Cardio-thoracic

From 1 March 2021, eight diagnostic and therapeutic procedures of the lung, tranche and bronchus items are being relocated from subgroups 1 and 8 of group T8 to subgroup 6 to better reflect the type and nature of these services. The following items will be ceased and replaced with new item numbers:

Pathology

Items 73296 and 73297 have been amended to update the clinical terminology and align these items with the related changes, which occurred on 1 August 2020. As part of the changes, the term ‘pathogenic or likely pathogenic gene variant’ is included and the descriptor for item 73296 will now include ‘ovarian, fallopian tube or primary peritoneal cancer’.

The updated item descriptor for item 73297 also specifies that patients cannot receive this service if they have previously received a service under items 73295 or 73297 (as well item 73296 which is currently specified in the descriptor). This is to prevent unnecessary repeat testing, as the presence of a hereditary gene will not change over the life of a patient or their family member.

There was also a minor descriptor change for item 73357 to extend the genetic testing to ‘biological’ relative.

Other Changes

Amendment to MBS items 15900 and 31516 for targeted intraoperative radiation therapy to enable this service to be provided by using the Xoft® Axxent® device. Targeted intraoperative radiation therapy is usually delivered as part of a breast conserving surgical procedure and is an alternative treatment option for breast cancer patients. In items 15900 and 31516 the word ‘radiotherapy’ to be replaced with ‘radiation therapy’ and both items will include ‘Applicable only once per breast per lifetime’.

As of 1 March 2021, minor amendments to the current colonoscopy items 32223, 32224 and 32226 will be made to reflect the patient’s clinical indications better and to ensure that for patients with serrated polyps can access these services at appropriate service intervals.

A new item 45658 is being introduced for the correction of a congenital deformity of the ear in patients of any age. Currently only patients who are under 18 years of age are able to access a Medicare service (item 45659) for the correction of congenital deformity of the ear.

The schedule fee for medical perfusion item 22060 will be increase from $408.00 to $612.00. This change was announced by Government in the 2020-21 Budget under the Guaranteeing Medicare – Medicare Benefits Schedule review measure. Item 22060 is for patients requiring cardiopulmonary bypass and cardioplegia when undergoing cardiac surgery.

In addition, there has been a minor changes to the descriptor for item 42739, to clarify that the service requires the administration of anaesthetic by an anaesthetist, to ensure appropriate use.

As at 1 March 2021, 24 items (55126, 55127, 55128, 55129, 55132, 55133, 55134, 55137, 55141, 55143, 55145, 55146, 61321, 61324, 61325, 61329, 61345, 61349, 61357, 61394, 61398, 61406, 61410 and 61414) from the Health Insurance (Section 3C Diagnostic Imaging Services – Cardiac Services) Determination will be incorporated into the Diagnostic Imaging Services Table (DIST). In addition, 11 items (11704, 11705, 11707, 11714, 11716, 11717, 11723, 11729, 11730, 11731 and 11735) from the Health Insurance (Section 3C General Medical Services – Cardiac Services) Determination 2020 will be incorporated into the General Medical Services Table (GMST).

There are minor changes to items 11704, 11707, 11714, 11716, 11717, 11723, 11729, 11730 and 11735 to include the restriction that the items are not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies. In addition these items cannot be provided as part of an episode of hospital treatment or as part of hospital-substitute treatment where a benefit is paid from a private health insurer.

Sleep study items 12203, 12204, 12205, 12207 and 12208 have also been amended so that these services cannot be provided in association with cardiac items 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723 and 11735. This change will align these items with other sleep study and cardiac items.

Thirty items (90250, 90251, 90252, 90253, 90254, 90255, 90256, 90257, 90260, 90261, 90262, 90263, 90264, 90265, 90266, 90267, 90268, 90269, 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 90279, 90280, 90281 and 90282) from the Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019 will be incorporated into the GMST. These items are for treatment and management services for patients with an eating disorder.

Seven items 33570, 35571, 35573, 35577, 35581, 35582 and 35585 from the Health Insurance (Section 3C General Medical Services—Transvaginal repair of pelvic organ prolapse and procedures for the excision of graft material) Determination 2018 will be incorporated into the GMST.

One item 11219 from the Health Insurance (Section 3C General Medical Services – Optical Coherence Tomography) Determination 2018 will be incorporated into the GMST. Item 11219 provides an imaging test, known as optical coherence tomography to determine if patients with ocular conditions can access treatment with certain medicines listed on the Pharmaceutical Benefits Scheme.

Two items (2729 and 2731) from the Health Insurance (Section 3C General Medical Services – General Practitioner Telehealth Services) Determination 2018 will be incorporated into the GMST. These services are for the provision of focussed psychological strategies for assessed mental disorders by a general practitioner by teleconference for patients who are located in a Modified Monash 4 to 7 area.

One item (72860) from the Health Insurance (Section 3C Pathology Services – Archival Tissue Retrieval) Determination 2019 will be incorporated into the Pathology Services Table (PST). This service is for the retrieval of stored pathology tissue samples.

One item (57357) from the Health Insurance (Section 3C Diagnostic Imaging Services – Computed Tomography Angiography) Determination 2020 will be incorporated into the DIST. This service is for computed tomography angiography of the pulmonary artery for an initial investigation for pulmonary embolism.