Summary of Item Changes

New items

2461	2463	2464	2465	2471	2472	2475	2478	2480	2481	2482	2483	18297
22041	22042	23025	23035	23045	23055	23065	23075	23085	25012	32222	32223	32224
32225	32226	32227	32228	32229	41501	45627	57541	61524	61525	63531	63532	63533
63534	82350	82351	82352	82353	82354	82355	82356	82357	82358	82359	82360	82361
82362	82363	82364	82365	82366	82367	82368	82369	82370	82371	82372	82373	82374
82375	82376	82377	82378	82379	82380	82381	82382	82383	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	90282

Deleted items

20705	20805	20953	21927	22001	22018	22040	22045	22050	22070	23021	23022	23023
23031	23032	23033	23041	23042	23043	23051	23052	23053	23061	23062	23063	23071
23072	23073	23081	23082	23083	32088	32089	32090	32093	41846

Description amended

52	53	54	57	58	59	60	65	99	104	105	106	107
108	109	110	111	112	113	114	116	117	119	120	122	128
131	132	133	135	141	143	145	147	149	170	171	172	177
288	289	291	293	296	297	299	300	302	304	306	308	310
312	314	316	318	319	320	322	324	326	328	330	332	334
336	338	342	344	346	348	350	352	353	355	356	357	358
359	361	364	366	367	369	370	384	385	386	387	388	389
501	503	507	511	515	519	520	530	532	534	536	699	820
822	823	825	826	828	830	832	834	835	837	838	855	857
858	861	864	866	880	2799	2801	2806	2814	2820	2824	2832	2840
2946	2949	2954	2958	2972	2974	2978	2984	2988	2992	2996	3000	3003
3005	3010	3014	3015	3018	3023	3028	3032	3040	3044	3051	3055	3062
3069	3074	3078	3083	3088	3093	6007	6009	6011	6013	6015	6016	6018
6019	6023	6024	6025	6026	6028	6029	6031	6032	6034	6035	6037	6038
6042	6051	6052	6057	6058	6059	6060	6062	6063	6064	6065	6067	6068
6071	6072	6074	6075	11507	11508	11512	12205	12207	12208	18216	18219	18226
18227	20160	20162	20706	20745	20750	20790	20840	20902	21952	22002	22012	22014
22025	22031	25015	30075	30078	30275	30329	30330	32084	32087	35551	35664	35670
45626	51051	51052	51053	51061	51062	51063	51064	51065	51066	52027	73336	73832
90092	90093	90095	90096

Fee amended

177

699

20142

20144

20145

20410

20745

20750

21922

21926

21936

21952

Summary of Policy Changes

INCREASE IN MAXIMUM PATIENT GAP
The maximum patient gap between the Medicare Benefits Schedule (MBS) fee and the benefits payable for out-of-hospital services increases to $84.70 as at 1 November 2019. The 85% benefit level will apply for all fees up to $564.70, after which benefits are calculated at the Schedule fee less $84.70.

New Item 25012 for the Anaesthesia, Perfusion or Assistance in the Management of Anaesthesia for Patients Aged over 3 Years Old But Under 4 Years Old
On 1 November 2019, changes were introduced through the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019 which changed the age parameters in the descriptor for item 25015. The change to the item descriptor was introduced to better reflect the anaesthesia complexities of the patients of this age cohort.

The Health Insurance (Section 3C General Medical Services – Childhood Access to Anaesthesia) Determination 2019 (the Determination) will add a temporary item to the Medicare Benefits Schedule to provide for the anaesthesia, perfusion or assistance in the management of anaesthesia for patients aged over 3 years old but under 4 years old. The service will move into the GMST from 1 May 2020.

The purpose of the Determination is to allow benefits to be available for patients over three years of age but under four years of age as their physical status results in an increase of complexity of anaesthesia. To this effect, the amendments are taken to have commenced from 1 November 2019.

Heart Health Assessment 1 November 2019 update
From 1 November 2019 an administrative amendment will be made to items 699 and 177 to make all health assessment items have a 100% benefit. The fees will be adjusted for items 699 and 177 so there is no change to the Medicare rebate patients will receive for a heart health assessment service.

Amendment to eight A2 services
Amends the descriptor of eight A2 services (items 52, 53, 54, 57, 58, 59, 60 and 65) by omitting reference to clause 2.3.1.

Remove gender specific text from professional attendance items
Gender specific text has been removed from Professional Attendance items in Groups: A3, A4, A8, A21, A24, A6, A12, A26, A29, A31, A15, A28, and A32.

GP Telehealth items (MMM 6-7)
Twelve new video conferencing items for patients in rural and remote areas (as defined by Modified Monash areas 6 to 7) to assist with access to general practice services.

Amendment to items 90092, 90093, 90095 and 90096
This amends the descriptor of four attendance items provided by omitting the rendering cohort of doctors in paragraphs (a) and (b) and substituting with “by a medical practitioner who is not a general practitioner”.

Sleep study items 12205 and 12207
From 1 November 2019, minor amendments will be made to items 12205 and 12207 to provide more clarity on the clinical circumstances to which these items apply.

Sleep study item 12208
On 1 November 2019, a minor update will be made to improve the readability of the item descriptor.

Anaesthesia MBS Changes from 1 November 2019
MBS items for anaesthesia services are changing to reflect contemporary anaesthesia practice. These changes are a result of the MBS Review Taskforce recommendations and consultation with stakeholders. The revised structure contains twenty eight amended items, proposes ten new items and deletes thirty one items.

New Items for Colonoscopy
Amending existing colonoscopy services to distinguish eligible patient cohorts by appropriate interval screenings, as recommended by the Taskforce.

Minor amendments to items 30075, 30078, 30275, 30329, 30330, 35551, 35664, 35670 and 52027
Terminology for these items has been improved by replacing references to "lymph gland/s” with the term “lymph node/s”.

Split of item 45626 to delineate between trachomatous and non-trachomatous cause
Splitting MBS item 45626 into two items to be able to identify utilisation of this procedure to treat delineating ectropion / entropion repair for trachoma and non-trachomatous causes

Minor amendments to spinal surgery items from 1 November 2019
Items 51051, 51052 and 51053
The term ‘motion segment’ will be replaced with the appropriate clinical term ‘vertebra’ or ‘vertebrae’.

Items 51061 to 51066
The term 'spine fusion' will be replaced with the appropriate clinical term “spinal fusion”.

Items 51113 and 51114
The co-claiming restrictions for items 51113 and 51114 will be revised to enable appropriate co-claiming of these items with the paediatric scoliosis or kyphosis items (50600 to 50644).

Item 51145
The item will enable a second medical practitioner to be remunerated for providing assistance at the operation through the inclusion of the term (Assist.) in the item descriptor.

New item for mobile x-ray at residential aged care facilities
One new item providing a flagafall fee for the provision of skeletal x-ray (following a fall), chest x-ray (for suspected pneumonia or heart failure) and abdominal X-ray (for suspected acute abdomen or bowel obstruction) to patients within a residential aged care facility.

New items for Whole body 18F-FDG PET study for breast cancer
New items for: whole body 18F-FDG positron emission tomography (PET) study for: staging of locally advanced breast cancer; or evaluation of suspected metastatic or suspected locally or regionally recurrent breast carcinoma.

New MBS items for Breast MRI for specified populations
This change will introduce four new interim items for magnetic resonance imaging for breast cancer. These new items are for the diagnosis of breast cancer where other imaging is inconclusive, and for treatment planning for breast cancer.

Amendment to Item 73336
This amendment will enable the MBS to provide benefits for the testing of tumour issue from a patient with completely resected or unresectable stage III metastatic cutaneous melanoma.
Patients will also be able to access Pharmaceutical Benefits Schedule (PBS) funded treatment with defrafenib, in combination with trametinib, following the recommendation from Pharmaceutical Benefits Advisory Committee.
Note: This amendment will be reflected in the MBS XML file and MBS Book in the release for 1 January 2020.

Amendment to Pathology Services Table Item 73832
Item 73832 has been amended to ensure that the same requirements that apply for performance of item 73805 also apply to item 73832.

Amendment to Pathology Services Table Item 72860
This item has been amended to clarify that the retrieval and review of archived formalin fixed paraffin embedded block(s) to determine the appropriate sample(s) for the purposes of further genetic testing does not apply if the subsequent genetic test(s) is performed in the same laboratory. The item will apply if the subsequent genetic test(s) is performed in a different laboratory, including laboratories within the same laboratory network provided the laboratories are at separate locations.

New MBS items for Eating Disorders
This change will introduce, a suite of 64 Eating Disorder items to support a model of best practice evidence based care for patients with anorexia nervosa and other eligible patients with eating disorders.