Ensuring appropriate use of gastroenterology MBS services

The Australian Government is introducing changes to Medicare Benefit Schedule (MBS) items for a number of gastroenterology services, to ensure that these services are being accessed appropriately and according to Australian clinical practice guidelines. These changes follow recommendations from the MBS Review Taskforce.

Page last updated: 22 August 2017

Ensuring appropriate use of gastroenterology MBS services (PDF 72 KB)

What are the changes?

Colonoscopy

Colonoscopy is an important test to diagnose bowel cancer. More than 600,000 MBS funded colonoscopies are done annually.

Changes to colonoscopy items will reduce unnecessary testing and better target the test to patients who will benefit. A reduction in unnecessary colonoscopies will mean that patients who are waiting for necessary colonoscopies should have their tests sooner.

New MBS items for colonoscopy will be introduced from 1 March 2018 to align MBS funded colonoscopy services with Australian clinical best practice guidelines.

The new items will better align the initial and follow-up colonoscopy for patients who are at an increased risk of developing colorectal cancer with current clinical guidelines.

Patients who are at risk of colorectal cancer will still be able to access MBS funded colonoscopies in line with clinical guidelines.

Other changes

Capsule endoscopy is a procedure that uses a tiny wireless camera to help identify the source of any bleeding in the upper bowel. The item descriptor for capsule endoscopy will be amended to better describe the clinical indications for the test and hence better target the test to patients who will benefit.

Co-claiming restrictions for endoscopic ultrasound services will be removed so MBS rebates will be payable for related therapeutic services done on the same day as this diagnostic test.

A variety of changes are being made to other gastroenterology services to clarify patient and procedure requirements. Clearer quality performance requirements will be introduced for colonoscopy and lower bowel examinations.

Most changes will commence on 1 November 2017. Colonoscopy changes will commence on 1 March 2018.

Why are these changes being made?

The changes were recommended by the MBS Review Taskforce following an extensive period of consultation.

The Taskforce is conducting a clinician-led review, which makes recommendations to the Government on how the MBS can be modernised to improve patient safety, support equity of access and reduce waste.

Changes to colonoscopy services are significant and have been introduced to address the wide variation in per capita use of these services across Australia and the acknowledged concern that many patients undergo colonoscopy that does not conform to current guidelines.

What does this mean for patients?

Patients will benefit from receiving recognised best practice gastroenterology services.

Patients will not undergo unnecessary colonoscopy or too frequent testing. Freed-up services will mean that patients who are waiting for necessary colonoscopy should have their colonoscopy sooner.

The addition of performance requirements for colonoscopy means patients will be assured that a complete large bowel examination has been performed during the procedure.

Patients will benefit from the removal of co claiming restrictions on endoscopic ultrasound and will no longer be required to undergo a second anaesthesia for certain therapeutic procedures. Hospital stays and private health costs will also be reduced.

What does this mean for providers?

A new suite of item numbers will be introduced from 1 March 2018 accompanied by education material for colonoscopists and those who refer patients for colonoscopy.

The Department is working with the Cancer Council to produce education materials on appropriate colonoscopic surveillance intervals.

Other changes to gastroenterology items better define indications for use (capsule endoscopy), clarify intended use, remove some co-claiming restrictions (endoscopic ultrasound) and add some quality performance requirements (colonoscopy and sigmoidoscopy).

Further details on all the changes can be found on MBS Online website.