Summary of changes for the November 2008 Medicare Benefits Schedule
The 1 November 2008 MBS is now available. Below is a summary of changes.
General Fee Increase
- A 2.3% increase in Schedule fees will apply to all items in Group A1 plus equivalent attendance items. There has been no increase in the Schedule Fee for items in Group A2 (other non-referred attendances), item 173 in Group A7 (acupuncture), Group A19 (PIP incentive payments, other non-referred); and
- A 2.3% increase will apply to all other items except Diagnostic Imaging and Pathology items.
Increase in Maximum Gap Payment
The maximum patient gap between the Schedule fee and the benefits payable for out-of-hospital services increases to $68.10 as at 1 November 2008. The 85% benefit level will apply for all fees up to $454.00, after which, benefits are calculated at the Schedule fee less $68.10.
Review of general medical services
New interim item for home-based sleep studies and prohibition on other Category 2 items being billed for home-based sleep studies
A new item (item 12250) was interimly listed in Category 2 of the MBS on 1 October 2008 to allow qualified sleep medicine practitioners to bill home-based sleep studies to Medicare. To attract benefits, the new item requires a comprehensive (three-component) investigation to be completed, with the allowance of only one investigation per annum. In conjunction with the listing of this item, the Health Regulations were amended to disallow the billing of home-based sleep studies under any other Category 2 item. Interim item 12250 will remain listed while the Medical Services Advisory Committee evaluates the evidence on the clinical effectiveness, cost effectiveness and safety of home-based sleep studies; a process which is expected to take between 12 and 18 months.
Transitional Hours items for urgent after hours attendances
Two new items for urgent out of surgery attendances have been created for use during 'transitional hours', which are 6-8pm on weekdays and 12-1pm on Saturdays. Item numbers are: 603 for general practitioners (rebate $87.50) and 696 for other medical practitioners (rebate $67.00). Where applicable, bulk billing incentive items 10990 or 10991 can be claimed with the transitional hours items.
Aboriginal Health Worker
New item 10987 has been introduced to allow for the provision of follow up services by a practice nurse or registered Aboriginal health worker on behalf of a GP. The service is provided to an Indigenous person who has received a health check. The follow up services relate to any issues identified in the health check
Blood Pressure Monitoring
Item descriptions for 11600, 13876, 22012 and 22014 have been amended to clarify how often these items can be claimed.
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New anaesthesia item 20804 has been introduced for microvascular free tissue flap surgery involving the lower abdomen.
Anaesthetic monitoring using intra-operative transoesophageal echocardiograpy
Item 22051 has been introduced into the Relative Value Guide for Anaesthesia to be used as part of the anaesthetic monitoring of a patient during cardiac surgery. This item more effectively denotes the service as a component of anaesthesia and differentiates it from intra-operative transoesophageal echocardiography used for diagnostic purposes.
Assistance at Anaesthesia
Items 25200 and 25205 have been amended to allow claiming from Subgroup 19 (items 22001-22051) when performed in association.
Services rendered to a doctor’s dependants, practice partner, or practice partner’s dependants
The definition of a dependant has been clarified in the general explanatory notes.
Definition of a therapeutic substance
A therapeutic substance has been defined in the explanatory notes for use with items in Category 3 – Therapeutic Procedures
Plastic and Reconstructive Surgery
Items 45903, 45906, 45909, 45912, 45915, 45918, 45921 and 45924 that were introduced in 1 November 2007 have been removed as these replicated existing items 45827, 45829, 45831, 45833, 45835, 45837 and 45839.
Oral and Maxillofacial Services
Explanatory note OC.5 for items 51700 and 51703 has been amended to establish consistency between the explanatory note and the descriptor of consultation items. Item 52131 for bone grafting with internal fixation has been amended to allow for the claiming of item 52300 (single stage local flap) where the site of the graft placement cannot be closed by direct suture. An explanatory note has been added to this effect.
Cleft Lip and Cleft Palate Services
Item 75621 for the provision of fitting of surgical templates may be claimed in association with the appropriate orthognathic surgical items in Category 3 of the MBS in the range of 45720 to 45754 for prescribed dental patients registered under the Cleft Lip and Cleft Palate Scheme, where performed by a qualified oral and maxillofacial surgeon.
Allied Health Items for People of Aboriginal and Torres Strait Islander Descent
Items 81300 to 81360 have been introduced for allied health professionals to provided follow-up allied health services for people of Aboriginal and Torres Strait Islander descent who have had a health assessment. These items are available on referral from a GP.
Changes to diagnostic imaging services
Registration of sites undertaking diagnostic imaging procedures
New notes inserted outlining the requirements for practice sites to be accredited or deemed accredited from 1 July 2008 to provide certain diagnostic imaging services under Medicare.
Measures introduced through the Health Insurance Amendment (Inappropriate and Prohibited Practices and Other Measures) Act 2007 make a number of amendments to the Act in relation to prohibited practices for diagnostic imaging services.
An amendment to the explanatory notes is intended to clarify that x-ray items of the spine and hip in the diagnostic imaging services table cannot be claimed when images are produced using Dual Energy X-ray Absorptiometry (DEXA) equipment.
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Changes to pathology services
Group P2 – Chemical
Two new items 66831and a referred test item 66832 have been added for the quantitation of copper and iron in liver biopsy.
There have been some wording changes to items 66500, 66566, 66650, 66695, 66697, 66719, 66752, 66764, 66767, 66770, 66819 and 66822.
Items 66767 and 66770 have had their fees slightly reduced.
Group P3 – Microbiology
There has been an amendment to the wording of item 69401 and 69471.
Group P5 – Tissue Pathology
Four new items have been added.
A new item 72827 for the examination of complexity level 4 biopsy material with 1 or more tissue blocks including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions – 12-17 separately identified specimens.
A new item 72828 for the examination of complexity level 4 biopsy material with 1 or more tissue blocks including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions – 18 or more separately identified specimens.
A new item 72849 for the immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen – 6-10 antibodies.
A new item 72850 for the immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen – 11 or more antibodies
Items 72813, 72816 and 72823 have had their fees slightly reduced.
There has been a wording change to items 72826 and 72847.
Group P7 Genetics
There have been minor wording changes to items 73287, 73289, 73300, 73305, 73314 and 73323.
A new item 73324 has been added for the referral of item 73323.
Part 5 – Complexity levels for Histopathology Items
Complexity Level 7 – Breast, orientated wide local excision for carcinoma, with margin assessment has been amended to remove the weight requirement.
Rules of Interpretation
Rules 6, 13, 22 and 25 have been amended
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Created on 8 October 2008.