Released

1. Medicare
   
2. AHSA
3. BUPA
   
4. HCF
   
5. Medibank Private

Summary of Changes

GENERAL MEDICAL SERVICES CHANGES
Nuclear medicine items 12503, 12506, 12509, 12512, 12515, 12518, 12521 and 12530
Eight nuclear medicine items (12503, 12506, 12509, 12512, 12515, 12518, 12521 and 12530) will cease as they no longer reflect clinical practice. This was recommended by MBS Review Taskforce.

Anaesthesia items
Item 25015 will be replaced by two new anaesthesia items 25013 and 25014 to clarify the ages of eligible patients.

Item 25013 is for patients under 4 years and item 25014 for patients 75 years or over.

Breast biopsy items as recommended by the MBS Taskforce

· Three bore-enbloc stereotactic biopsy breast biopsy items (31539, 31542 and 31545) will cease as they no longer reflect clinical practice.
· The schedule fee for mechanical breast biopsy item 31548 will increase from $140.10 to $203.20 to reflect the higher costs, clinical superiority and technical difficulty of mechanical breast biopsy compared to fine needle aspiration biopsy.

· items 32084 and 32087 have been amended to remove the requirement that sigmoidoscopies and colonoscopies must be ‘flexible’ or ‘fibreoptic’. These terms are redundant as all contemporary colonoscopies and sigmoidoscopy use flexible endoscopes with digital technology;
· item 32087 has been further amended by deleting “the treatment of radiation proctitis, angiodysplasia or post-polypectomy bleeding by argon plasma coagulation” in the descriptor. This change will clarify that doctors should generally be claiming item 32227 for therapeutic colonoscopy service for the treatment of radiation proctitis, angiodysplasia or post-polypectomy bleeding; and
· amendment to item 32224 to ensure patient entitlement where a certain adenoma is exactly 10 mm in diameter.

• Subgroup 6—Scan of spine—one region or 2 contiguous regions— for infection or tumour
• Subgroup 7—Scan of spine—one region or 2 contiguous regions— for other conditions
• Subgroup 8—Scan of spine—3 contiguous or 2 non contiguous regions— for infection or tumour
• Subgroup 9—Scan of spine—3 contiguous or 2 non contiguous regions— for other conditions
• Subgroup 11—Scan of musculoskeletal system— for tumour, infection or osteonecrosis
• Subgroup 12—Scan of musculoskeletal system— for joint derangement
• Subgroup 13—Scan of musculoskeletal system— for Gaucher disease
• Subgroup 17—Magnetic resonance imaging— person under the age of 16 years – for physeal fusion or Gaucher disease
• Subgroup 18—Magnetic resonance imaging— person under the age of 16 years – for other conditions
• Subgroup 20—Scan of pelvis and upper abdomen— for specified conditions
• Subgroup 21—Scan of body— for suspected hepato-biliary or pancreatic pathology
• Subgroup 33—Scan of body— person under the age of 16 years – general practice requests
• Subgroup 34—Scan of body— person over the age of 16 years – general practice requests

• From 1 May 2020, benefits will no longer be payable for diagnostic imaging services rendered on equipment that has reached its effective life age or maximum extended life age unless there is a remote area exemption or special exemption in place.
• All ‘NK’ items will be deleted from the MBS and remaining items will no longer include the annotation ‘K’.

• Two new items for ultrasound of the breast in conjunction with a surgical procedure 55066 (both breasts) and 55071 (one breast). The relevant surgical procedure item in the General Medical Services Table is able to be claimed in conjunction with these items.
• Items covering musculo-skeletal ultrasound of the extremities will be deleted and replaced with items covering unilateral and bilateral scans. The unilateral scans will retain the same schedule fee as the items being deleted. The bilateral scan fees will be approximately 11% higher than the unilateral scan fees.
• Item descriptors for general ultrasound, obstetric and gynaecological ultrasound and musculoskeletal ultrasound will be amended to remove co-claiming restrictions with cardiac or vascular ultrasound. A restriction will still apply for vascular ultrasound of the lower leg and musculo-skeletal ultrasound of the lower leg.
• The general pelvic ultrasound items 55065 and 55068 will no longer be able to claimed where an obstetric ultrasound item would apply.
• The descriptor for breast ultrasound items 55076 and 55079 will be amended so that they also apply to post mastectomy surveillance. The chest or abdominal wall items 55812 and 55814 will no longer be able to be co-claimed with the breast ultrasound items (items 55070, 55073, 55076 and 55079).
• The schedule fees for the interventional ultrasound items 55848 and 55850 will be increased.
• The list of conditions in the obstetric ultrasound items will be deleted. For the less than 12 week scan items (item 55700 and 55703), the items apply where the scan is for ‘determining the gestation, location, viability or number of foetuses’. For the 12 to 16 week scan, the items (55704 and 55705) apply for determining the structure, gestation, viability or number of foetuses’. The later obstetric scans apply where clinically appropriate.
• MSAC change: the descriptors for abdominal ultrasound items 55036 and 55037 will be amended to include the term ‘morphological assessment’ so that the items should only be used for imaging purposes, not for non-imaging techniques such as transient elastography.

• The scan of extremities items 56619 and 56625 will be deleted and replaced by items covering the lower and upper limbs. The new items will be 56622 (scan of lower limb or limbs without contrast), 56623 (scan of lower limb or limbs with contrast), 56627 (scan of upper limb or limbs without contrast) and 56628 (scan of upper limb or limbs with contrast). The schedule fees for these items will be the same as the replaced contrast and non contrast items.
• The descriptor for item 57341 (CT in conjunction with a surgical procedure) will be amended to allow it to be co-claimed with any other diagnostic imaging item.
• The CT spiral angiography item 57350 will be deleted and replaced by three new items overing CT angiography of different arterial regions. The schedule fees for these items will remain the same as the items they replaced.
• MSAC change: item 57362 (cone beam computed tomography – CBCT) will be able to be claimed when the service is rendered on equipment that can also provide other services (such as x-ray and OPG). Currently, CBCT services can only be rendered on dedicated CBCT equipment in order to attract Medicare benefits. ‘Approved dental practitioners’ will be able to request this service.

• Items 57903 (radiographic examination of the sinuses) and 57912 (radiographic examination of the facial bones) will be deleted and replaced with one item covering either the sinuses or facial bones. The new item will be item 57907 and have a schedule fee of $47.30.
• Items 57906 (radiographic examination of the mastoids) and 57909 (radiographic examination of the petrous temporal bones) will be deleted and replaced with one item covering either the mastoids or petrous temporal bones. The new item will be item 57905 and have a schedule fee of $64.50.
• The descriptors for the mammography items 59300 (both breasts), 59303 (one breast), 59302 (three dimensional breast tomosynthesis - both breasts) and 59305 (three dimensional breast tomosynthesis - one breast) will be amended to ensure that the items are used in the investigation of a clinical abnormality of the breast/s and not for individual, group or opportunistic screening of asymptomatic patients.
• Items 59306 (mammary ductogram – one breast) and 59309 (mammary ductogram – both breasts) will be deleted.
• Fluoroscopy items 60506, 60509 and 61109 will now be able to be co-claimed with any other diagnostic imaging service, except a diagnostic radiology service in Group I03 of the Diagnostic Imaging Services Table (DIST). Currently, the items cannot be co-claimed with any other item in the DIST.

• Items 61302, 61306, 61352, 61401, 61405, 61417, 61437, 61458 and 61484 will be deleted. The items cover various procedures considered to be obsolete.
• Items 61316, 61317 and 61320 (cardiac blood studies) will be deleted and the indications for these items will be included in item 61314.
• The item descriptors for most items that contain a reference to planar imaging or single photon emission tomography (SPECT) will be amended to remove those references.
• The descriptor for item 61473 will be amended to remove the phrase ‘including uptake measurement when undertaken’.
• Item 61505 (CT for attenuation correction and anatomical localisation of single photon emission tomography) will now be able to be co-claimed with positron emission tomography (PET). Consequently, the descriptor for item 61647 (Whole body 68Ga-DOTA-peptide PET study) will be amended to exclude references to CT for attenuation correction and anatomical localisation and the schedule fee item 61647 will be reduced by $100.
• MSAC change: the descriptors for items 61446 and 61449 (regional bone studies) will be amended so that they can be claimed for scans on other body parts.

• Items 63501 and 63502 (MRI of the breasts for Poly Implant Prosthése implant integrity) will now be only able to claimed once in 24 months. Currently, these items can be claimed every 12 months.

12503	12506	12509	12512	12515	12518	12521	12530	25012	25015	31539	31542	31545
55005	55007	55008	55010	55011	55013	55014	55016	55017	55019	55023	55025	55026
55059	55060	55061	55062	55063	55064	55067	55069	55119	55120	55121	55122	55123
55125	55131	55136	55220	55221	55222	55223	55224	55226	55227	55228	55229	55230
55232	55233	55235	55236	55601	55604	55701	55702	55710	55711	55713	55714	55716
55717	55719	55720	55722	55724	55726	55727	55730	55735	55737	55760	55763	55765
55767	55769	55771	55773	55775	55800	55801	55802	55803	55804	55805	55806	55807
55808	55809	55810	55811	55813	55815	55816	55817	55818	55819	55820	55821	55822
55823	55824	55825	55826	55827	55828	55829	55830	55831	55832	55833	55834	55835
55836	55837	55838	55839	55840	55841	55842	55843	55845	55847	55849	55851	55853
55855	56041	56047	56050	56053	56056	56062	56068	56070	56076	56141	56147	56227
56228	56229	56230	56231	56232	56235	56236	56239	56240	56259	56341	56347	56441
56447	56449	56452	56541	56547	56555	56619	56625	56659	56660	56665	56666	56841
56847	57041	57047	57247	57345	57350	57355	57356	57361	57363	57529	57530	57532
57533	57535	57536	57537	57538	57539	57540	57702	57705	57708	57711	57714	57717
57723	57903	57906	57909	57911	57912	57914	57917	57920	57923	57926	57929	57932
57935	57938	57941	57944	57947	57950	57953	57956	57959	57962	57965	57968	58102
58105	58111	58114	58117	58123	58124	58126	58127	58302	58308	58502	58505	58508
58511	58523	58526	58529	58702	58708	58717	58720	58723	58902	58905	58911	58914
58917	58920	58923	58929	58935	58938	58941	59104	59301	59304	59306	59307	59309
59310	59313	59315	59319	59701	59704	59713	59716	59719	59725	59734	59740	59752
59755	59764	59971	59972	59973	59974	60001	60004	60007	60010	60013	60016	60019
60022	60025	60028	60031	60034	60037	60040	60043	60046	60049	60052	60055	60058
60061	60064	60067	60070	60073	60076	60079	60501	60504	60507	60510	61110	61316
61317	61320	61352	61401	61405	61417	61437	61458	61484	61651	61652	61653	61654
61655	61656	61657	61658	61659	61660	61661	61662	61663	61664	61665	61666	61667
61668	61669	61670	61671	61672	61673	61674	61675	61676	61677	61678	61679	61680
61681	61682	61683	61684	61685	61686	61687	61688	61689	61690	61691	61692	61693
61694	61695	61696	61697	61698	61699	61700	61701	61702	61703	61704	61705	61706
61707	61708	61709	61710	61712	61713	61714	61715	61716	61717	61718	61719	61729
63013	63014	63016	63017	63074	63075	63076	63077	63078	63079	63080	63081	63082
63083	63084	63085	63104	63117	63119	63134	63135	63136	63157	63158	63186	63187
63188	63189	63190	63191	63192	63193	63194	63207	63208	63257	63258	63259	63260
63261	63262	63263	63264	63265	63282	63283	63284	63285	63310	63311	63313	63341
63342	63343	63345	63346	63347	63348	63364	63392	63393	63394	63396	63398	63407
63408	63419	63432	63433	63447	63448	63449	63455	63457	63458	63479	63481	63484
63486	63488	63490	63508	63511	63514	63517	63520	63523	63532	63534	63548	63552
63555	63558	63561	63744	63746	63747

25013	25014	37226	42504	55066	55071	55856	55857	55858	55859	55860	55861	55862
55863	55864	55865	55866	55867	55868	55869	55870	55871	55872	55873	55874	55875
55876	55877	55878	55879	55880	55881	55882	55883	55884	55885	55886	55887	55888
55889	55890	55891	55892	55893	55894	55895	56622	56623	56627	56628	56629	56630
57352	57353	57354	57905	57907	73352	73353	73354	73355	73356	73357	73358	73359
73360	73361	73362	73363	73364	73365	73366	73367	73368	73369	73370	73371	73372
73373	73374	73375	73376	73377	73378	73379	73380	73381	73382	73383

31548

37207

37208

55848

55850

61647

55054