MCRP - Factsheet (PDF 565 KB)
MCRP - Factsheet (DOC 523 KB)
What are the changes?
From 1 November 2018, the Medicare Claims Review Panel (MCRP) will be dissolved and relevant items will be changed, to assist medical practitioners in understanding the appropriate use of items and to minimise misuse.
In addition, over 30 potentially cosmetic plastic surgery items will be amended to ensure consistency with the MCRP item changes, and to align them with appropriate clinical practice. Medicare does not fund cosmetic services.
Why are the changes being made?
The amendments are consistent with the MBS Review Taskforce’s objectives of ensuring a contemporary MBS, with clearly written items retaining the clinical relevance test to which all MBS items are subject. More information about the Taskforce can be found on the MBS Review Taskforce website.
What does this mean for providers?
Medical practitioners will no longer need to seek the MCRP’s judgement on the clinical relevance of services they wish to perform under Medicare. This will reduce the administrative burden on providers.
What does this mean for patients?
Patients will hereafter have items processed in the same manner as the rest of the more than 5,700 items in the MBS. This will reduce the time it takes for patients to get rebates for these services.
When will this change be reviewed?
The Department of Health regularly reviews the usage of new and amended MBS items in consultation with the profession.
All MBS items may be subject to compliance processes and activities, including random and targeted audits which may require a provider to submit information about the services claimed.
Significant variation from forecasted expenditure may warrant review and amendment of fees, and incorrect use of MBS items can result in penalties including the health professional being asked to repay monies that have been incorrectly received.
Where can I find more information?
For information on the administrative arrangements for the MCRP, including if you have a current MCRP application, contact the Department of Human Services on 132 150.
Further information on other changes to the MBS can be found at the MBS Online website.
New, amended and ceased items
(Draft wording of items to be finalised through regulatory amendments)
| CATEGORY 2
DI – Miscellaneous diagnostic procedures and investigations |
| 2 - Ophthalmology |
| Overview |
|
| 11221
Amended | Full quantitative computerised perimetry (automated absolute static threshold), other than a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, bilateral—to a maximum of 3 examinations (including examinations to which item 11224 applies) in any 12 month period
Fee: $67.75 Benefit: 75% = $50.85 85% = $57.60 |
| 11222
Ceased | Full quantitative computerised perimetry (automated absolute static threshold), other than a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, with assessment and report, bilateral, if it can be demonstrated that a further examination is indicated in the same 12 month period to which item 11221 applies due to presence of one of the following conditions:
(a) established glaucoma (when surgery may be required within a 6 month period) if there has been definite progression of damage over a 12 month period;
(b) established neurological disease which may be progressive and if a visual field is necessary for the management of the patient;
(c) monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug toxicity, if there may also be other disease such as glaucoma or neurological disease;
each additional examination
Fee: $67.75 Benefit: 75% = $50.85 85% = $57.60
|
| 11224
Amended | Full quantitative computerised perimetry (automated absolute static threshold), other than a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, if indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, unilateral—to a maximum of 3 examinations (including examinations to which item 11221 applies) in any 12 month period
Fee: $40.85 Benefit: 75% = $30.65 85% = $34.75 |
| 11225
Ceased | Full quantitative computerised perimetry (automated absolute static threshold), other than a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, with assessment and report, unilateral, if it can be demonstrated that a further examination is indicated in the same 12 month period to which item 11224 applies due to presence of one of the following conditions:
(a) established glaucoma (when surgery may be required within a 6 month period) if there has been definite progression of damage over a 12 month period;
(b) established neurological disease which may be progressive and if a visual field is necessary for the management of the patient;
(c) monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug toxicity, if there may also be other disease such as glaucoma or neurological disease;
each additional examination
Fee: $40.85 Benefit: 75% = $30.65 85% = $34.75
|
| CATEGORY 2
DI – Miscellaneous diagnostic procedures and investigations |
| 10 – Other diagnostic procedures and investigations |
| Overview |
ˇ A number of changes to diagnostic procedures for thoracic items are being made as a result of recommendations from the MBS Taskforce Review of Thoracic Medicine. Further information on the full suite of changes to Thoracic Medicine items can be accessed via the MBS online factsheet.
ˇ Item 12207 is for an additional lab based sleep study for patients over 18 years of age, where a further investigation in the same 12 month period to which items 12204 and 12205 applies.
ˇ Item 12215 is a lab-based investigation for a patient aged 0 - 12 years, where a further investigation to which item 12210 applies, is required in the same 12 month period.
ˇ Item 12217 is for additional lab-based investigation/s for a patient aged 12 - 18 years, where a further investigation under 12213 is required in the same 12 month period.
ˇ From 1 November 2018, the MCRP pre-approval requirement for 12207; 12215; and 12217 will be removed.
|
| 12207
Amended | Overnight investigation, for a patient aged 18 years or more, for a sleep-related breathing disorder, following professional attendance by a qualified sleep medicine practitioner or a consultant respiratory physician (either face-to-face or by video conference), if:
(a) the patient is referred by a medical practitioner; and
(b) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and
(c) there is continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:
(i) airflow;
(ii) continuous EMG;
(iii) anterior tibial EMG;
(iv) continuous ECG;
(v) continuous EEG;
(vi) EOG;
(vii) oxygen saturation;
(viii) respiratory movement (chest and abdomen)
(ix) position; and
(d) a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and
(e) polygraphic records are:
(i) analysed (for assessment of sleep stage, arousals, respiratory events and assessment of clinically significant alterations in heart rate and limb movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and
(ii) stored for interpretation and preparation of report; and
(f) interpretation and preparation of a permanent report is provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and
(g) the investigation is not provided to the patient on the same occasion that a service mentioned in any of items 11000 to 11005, 11503, 11700 to 11709, 11713 or 12250 is provided to the patient; and
(h) previous studies have demonstrated failure of continuous positive airway pressure or oxygen; and
(i) if the patient has severe cardio-respiratory failure—a further investigation is indicated in the same 12 month period to which items 12204 and 12205 apply to a service for the patient, for the adjustment or testing, or both, of the effectiveness of a positive pressure ventilatory support device (other than continuous positive airway pressure) in sleep
Applicable only once in the same 12 month period to which item 12204 or 12205 applies
Fee: $588.00 Benefit: 75% = $441.00 85% = $506.30 |
| 12215
Amended | Overnight paediatric investigation, for a period of at least 8 hours in duration, for a patient less than 12 years of age, if:
(a) the patient is referred by a medical practitioner; and
(b) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and
(c) there is continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:
(i) airflow;
(ii) continuous EMG;
(iii) ECG;
(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);
(v) EOG;
(vi) oxygen saturation;
(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);
(viii) measurement of carbon dioxide (either end-tidal or transcutaneous); and
(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and
(e) polygraphic records are:
(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and
(ii) stored for interpretation and preparation of report; and
(f) interpretation and report are provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and
(g) a further investigation is indicated in the same 12 month period to which item 12210 applies to a service for the patient, for a patient using Continuous Positive Airway Pressure (CPAP) or non-invasive or invasive ventilation, or supplemental oxygen, in either or both of the following circumstances:
(i) there is ongoing hypoxia or hypoventilation on the third study to which item 12210 applied for the patient, and further titration of respiratory support is needed to optimise therapy;
(ii) there is clear and significant change in clinical status (for example lung function or functional status) or an intervening treatment that may affect ventilation in the period since the third study to which item 12210 applied for the patient, and repeat study is therefore required to determine the need for or the adequacy of respiratory support
Applicable only once in the same 12 month period to which item 12210 applies
Fee: $701.85 Benefit: 75% = $526.40 85% = $620.15 |
| 12217
Amended | Overnight paediatric investigation for a period of at least 8 hours in duration for a patient aged at least 12 years but less than 18 years, if:
(a) the patient is referred by a medical practitioner; and
(b) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and
(c) there is continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:
(i) airflow;
(ii) continuous EMG;
(iii) ECG;
(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);
(v) EOG;
(vi) oxygen saturation;
(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);
(viii) measurement of carbon dioxide (either end-tidal or transcutaneous); and
(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and
(e) polygraphic records are:
(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and
(ii) stored for interpretation and preparation of report; and
(f) interpretation and report are provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and
(g) a further investigation is indicated in the same 12 month period to which item 12213 applies to a service for the patient, for a patient using Continuous Positive Airway Pressure (CPAP) or non-invasive or invasive ventilation, or supplemental oxygen, in either or both of the following circumstances:
(i) there is ongoing hypoxia or hypoventilation on the third study to which item 12213 applied for the patient, and further titration is needed to optimise therapy;
(ii) there is clear and significant change in clinical status (for example lung function or functional status) or an intervening treatment that may affect ventilation in the period since the third study to which item 12213 applied for the patient, and repeat study is therefore required to determine the need for or the adequacy of respiratory support
Applicable only once in the same 12 month period to which item 12213 applies
Fee: $632.30 Benefit: 75% = $474.25 85% = $550.60 |
| CATEGORY 3
T10 – Anaesthesia performed in connection with certain services (Relative Value Guide) |
| Overview |
ˇ From 1 November, the MCRP pre-approval requirement for item 21965 and item 21997 will be removed.
|
| 17 – Anaesthesia for radiological or other diagnostic or therapeutic procedures |
| 21965
Amended | Initiation of the management of anaesthesia as a therapeutic procedure if there is a clinical need for anaesthesia, not for headache of any etiology
Fee: $99.00 Benefit: 75% = $74.25 85% = $84.15 |
| 18 – Miscellaneous |
| 21997
Amended | Initiation of the management of anaesthesia in connection with a procedure covered by an item that does not include the word “(Anaes.)”, other than a service to which item 21965 or 21992 applies, if there is a clinical need for anaesthesia
Fee: $79.20 Benefit: 75% = $59.40 85% = $67.35 |
‘
| CATEGORY 3
T8 – Surgical Operations |
| 1 – General |
| Overview |
ˇ A number of changes to general surgical operations will be made to remove the MCRP pre-approval requirements, and delete items that are no longer considered best clinical practice.
ˇ Item 30176 has been amended to clarify that patients who have previously had a massive intra-abdominal or pelvic tumour surgically removed are eligible to claim this item.
|
| 30176
Amended | Lipectomy, radical abdominoplasty (Pitanguy type or similar), with excision of skin and subcutaneous tissue, repair of musculoaponeurotic layer and transposition of umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30177, 30179, 45530, 45564 or 45565 applies, if the patient has previously had a massive intra-abdominal or pelvic tumour surgically removed (H) (Anaes.) (Assist.)
Fee: $985.70 Benefit: 75% = $739.30 |
| 30214
Ceased | Telangiectases or starburst vessels on the head or neck if lesions are visible from 4 metres, diathermy or sclerosant injection of, including associated consultation‑session of at least 20 minutes in duration—if it can be demonstrated that a seventh or subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period
Fee: $109.80 Benefit: 75% = $82.35 85% = $93.35
|
| 31346
Amended | Liposuction (suction assisted lipolysis) to one regional area for contour problems of abdominal, upper arm or thigh fat because of repeated insulin injections, if:
(a) the lesion is subcutaneous; and
(b) the lesion is 50 mm or more in diameter; and
(c) photographic and/or diagnostic imaging evidence demonstrating the need for this service must be included in patient notes
(Anaes.)
Fee: $985.70 Benefit: 75% = $739.30 |
| 32501
Ceased | Varicose veins if varicosity measures 2.5 mm or greater in diameter, multiple injections of sclerosant using continuous compression techniques, including associated consultation—one or both legs—other than a service associated with another varicose vein operation on the same leg (excluding after‑care)—if it can be demonstrated that truncal reflux in the long or short saphenous veins has been excluded by duplex examination and that a seventh or subsequent treatment (including any treatments to which item 32500 applies) is indicated in a 12 month period
Fee: $109.80 Benefit: 75% = $82.35 85% = $93.35
|
| CATEGORY 3
T8 – Surgical operations |
| 4 – Gynaecological |
| Overview |
ˇ From 1 November, the MCRP pre-approval requirement for item 35534 will be removed. Item 35534 will be amended to specify that the procedure must only be performed by specialists on patients who are 18 years of age or over. Detailed clinical notes on the structural abnormality demonstrating the need for the service must be included in the patient notes.
|
| 35533
Amended | Vulvoplasty or labioplasty, for repair of:
(a) female genital mutilation; or
(b) an anomaly associated with a major congenital anomaly of the uro-gynaecological tract
other than a service associated with a service to which item 35536, 37836, 37050, 37842, 37851 or 43882 applies (H) (Anaes.)
Fee: $349.85 Benefit: 75% = $262.40 |
| 35534
Amended | Vulvoplasty or labioplasty, in a patient aged 18 years or more, performed by a specialist in the practice of the specialist’s specialty, for a structural abnormality that is causing significant functional impairment, if the patient’s labium extends more than 8 cm below the vaginal introitus while the patient is in a standing resting position (H) (Anaes.)
Fee: $349.85 Benefit: 75% = $262.40 |
| CATEGORY 3
DI – Miscellaneous diagnostic procedures and investigations |
| 9 – Ophthalmology |
| Overview |
ˇ Former MCRP items for laser trabeculoplasty (42783), laser iridotomy (42786), laser capsulotomy (42789), and laser vitreolysis or corticolysis of lens material or fibrinolysis (42792) will be removed from the MBS, with additional treatments allowed under items 42785 and 42791 in a 2 year period.
|
| 42783
Ceased | Laser trabeculoplasty, for the treatment of glaucoma—each treatment to one eye—if it can be demonstrated that a fifth or subsequent treatment to that eye (including any treatments to which item 42782 applies) is indicated in a 2 year period (Anaes.) (Assist.)
Fee: $451.10 Benefit: 75% = $338.35 85% = $383.45
|
| 42785
Amended | Laser iridotomy—each treatment episode to one eye, to a maximum of 3 treatments to that eye in a 2 year period (Anaes.) (Assist.)
Fee: $353.35 Benefit: 75% = $265.05 85% = $300.35 |
| 42786
Ceased | Laser iridotomy—each treatment episode to one eye—if it can be demonstrated that a third or subsequent treatment to that eye (including any treatments to which item 42785 applies) is indicated in a 2 year period (Anaes.) (Assist.)
Fee: $353.35 Benefit: 75% = $265.05 85% = $300.35
|
| 42789
Ceased | Laser capsulotomy—each treatment episode to one eye—if it can be demonstrated that a third or subsequent treatment to that eye (including any treatments to which item 42788 applies) is indicated in a 2 year period—other than a service associated with a service to which item 42702 applies (Anaes.) (Assist.)
Fee: $353.35 Benefit: 75% = $265.05 85% = $300.35
|
| 42791
Amended | Laser vitreolysis or corticolysis of lens material or fibrinolysis, excluding vitreolysis in the posterior vitreous cavity—each treatment to one eye, to a maximum of 3 treatments to that eye in a 2 year period (Anaes.) (Assist.)
Fee: $353.35 Benefit: 75% = $265.05 85% = $300.35 |
| 42792
Ceased | Laser vitreolysis or corticolysis of lens material or fibrinolysis, excluding vitreolysis in the posterior vitreous cavity—each treatment to one eye—if it can be demonstrated that a third or subsequent treatment to that eye (including any treatments to which item 42791 applies) is indicated in a 2 year period (Anaes.) (Assist.)
Fee: $353.35 Benefit: 75% = $265.05 85% = $300.35
|
| 42872
Amended | Eyebrow, elevation of, by skin excision, to correct for a reduced field of vision caused by paretic, involutional, or traumatic eyebrow descent/ptosis to a position below the superior orbital rim (Anaes.)
Fee: $240.70 Benefit: 75% = $180.55 85% = $204.60 |
| CATEGORY 3
T8 – Surgical operations |
| 13 – Plastic and Reconstructive Surgery |
| Overview |
ˇ From 1 November, the MCRP pre-approval requirement for items 45019 will be removed.
ˇ Item 45019 will be amended to specify it must be performed by specialist dermatologists or plastic surgeons and only one treatment should be performed in any 12 month period.
ˇ Item 45020 will be removed as it is obsolete.
ˇ The MCRP pre-approval requirement for item 45051 will be removed. It is expected that patient records will include photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service.
|
| 45019
Amended | Full face chemical peel for severely sun-damaged skin, if:
(a) the damage affects at least 75% of the facial skin surface area; and
(b) the damage involves photo-damage (dermatoheliosis); and
(c) the photo-damage involves:
(i) a solar keratosis load exceeding 30 individual lesions; or
(ii) solar lentigines; or
(iii) freckling, yellowing or leathering of the skin; or
(iv) solar kertoses which have proven refractory to, or recurred following, medical therapies; and
(d) at least medium depth peeling agents are used; and
(e) the chemical peel is performed in the operating theatre of a hospital by a medical practitioner recognised as a specialist in the specialty of dermatology or plastic surgery.
Applicable once only in any 12 month period (H) (Anaes.)
Fee: $396.70 Benefit: 75% = $297.55 |
| 45020
Ceased | Full face chemical peel for severe chloasma or melasma refractory to all other treatments, if it can be demonstrated that the chloasma or melasma affects 75% of the facial skin surface area involving diffuse pigmentation visible at a distance of 4 metres, when at least medium depth peeling agents are used, performed in the operating theatre of a hospital by a specialist in the practice of his or her specialty—one session only in a 12 month period (H) (Anaes.) |
| 45051
Amended | Contour reconstruction by open repair of contour defects, due to deformity, if:
(a) contour reconstructive surgery is indicated because the deformity is secondary to congenital absence of tissue or has arisen from trauma (other than trauma from previous cosmetic surgery); and
(b) insertion of a non-biological implant is required, other than one or more of the following:
(i) insertion of a non-biological implant that is a component of another service specified in Group T8;
(ii) injection of liquid or semisolid material;
(iii) an oral and maxillofacial implant service to which item 52321 applies;
(iv) a service to insert mesh; and
(c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
(H) (Anaes.) (Assist.)
Fee: $473.75 Benefit: 75% = $355.35 |
| CATEGORY 3
T8 – Surgical operations |
| 13 – Plastic and Reconstructive Surgery - BREAST PROCEDURES |
| Overview |
ˇ Three new items (45060, 45061 and 45062) will be introduced to replace item 45559 for treatment of developmental breast abnormality. The items will more accurately reflect current clinical practice, including allowing for two stage procedures.
|
| 45060
New item | Developmental breast abnormality, single stage correction of, if:
(a) the correction involves either:
(i) bilateral mastopexy for symmetrical tubular breasts; or
(ii) surgery on both breasts with a combination of insertion of one or more implants (which must have at least a 10% volume difference), mastopexy or reduction mammaplasty, if there is a difference in breast volume, as demonstrated by an appropriate volumetric measurement technique, of at least 20% in normally shaped breasts, or 10% in tubular breasts or in breasts with abnormally high inframammary folds; and
(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.)
Fee: $1,271.30 Benefit: 75% = $953.50 |
| 45061
New item | Developmental breast abnormality, 2 stage correction of, first stage, involving surgery on both breasts with a combination of insertion of one or more tissue expanders, mastopexy or reduction mammaplasty, if:
(a) there is a difference in breast volume, as demonstrated by an appropriate volumetric measurement technique, of at least:
(i) 20% in normally shaped breasts; or
(ii) 10% in tubular breasts or in breasts with abnormally high inframammary folds; and
(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes.
Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.)
Fee: $1,271.30 Benefit: 75% = $953.50 |
| 45062
New item | Developmental breast abnormality, 2 stage correction of, second stage, involving surgery on both breasts with a combination of exchange of one or more tissue expanders for one or more implants (which must have at least a 10% volume difference), mastopexy or reduction mammaplasty, if:
Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.)
Fee: $920.00 Benefit: 75% = $690.00 |
| CATEGORY 3
T8 – Surgical operations |
| 13 – Plastic and Reconstructive Surgery - BREAST PROCEDURES CONT. |
| Overview |
ˇ Item 45523 will be introduced for bilateral breast reduction procedures for patients with macromastia. Item 45520 will be amended to specify it should be used in the context of breast cancer or developmental abnormality of the breast.
ˇ Item 45524 for unilateral augmentation mammaplasty will be amended to specify it should be used only in the context of breast cancer or in the context of developmental breast abnormality where there is a demonstrated difference in breast volume.
ˇ Item 45527 will be amended to clarify that it is for breast reconstruction.
ˇ The MCRP pre-approval requirement for item 45528 will be removed. It is expected that patient records will include photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service.
|
| 45520
Amended | Reduction mammaplasty (unilateral) with surgical repositioning of nipple, in the context of breast cancer or developmental abnormality of the breast (H) (Anaes.) (Assist.)
Fee: $900.45 Benefit: 75% = $675.35 |
| 45522
Amended | Reduction mammaplasty (unilateral) without surgical repositioning of the nipple:
(a) excluding the treatment of gynaecomastia; and
(b) not with insertion of any prosthesis
(H) (Anaes.) (Assist.)
Fee: $631.75 Benefit: 75% = $473.85 |
| 45523
New item | Reduction mammaplasty (bilateral) with surgical repositioning of the nipple:
(H) (Anaes.) (Assist.)
Fee: $1,350.70 Benefit: 75% = $1013.05 |
| 45524
Amended | Mammaplasty, augmentation (unilateral) in the context of:
(a) breast cancer; or
(b) developmental abnormality of the breast, if there is a difference in breast volume, as demonstrated by an appropriate volumetric measurement technique, of at least:
(i) 20% in normally shaped breasts; or
(ii) 10% in tubular breasts or in breasts with abnormally high inframammary folds.
Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.) |
| 45527
Amended | Breast reconstruction (unilateral), following mastectomy, using a permanent prosthesis (H) (Anaes.) (Assist.) |
| 45528
Amended | Mammaplasty, augmentation, bilateral (other than a service to which item 45527 applies), if:
(H) (Anaes.) (Assist.) |
| CATEGORY 3
T8 – Surgical operations |
| 13 – Plastic and Reconstructive Surgery - BREAST PROCEDURES CONT. |
| Overview |
ˇ Item 45552 will be removed and Item 45551 will be amended to clarify benefits will be payable where at least half the fibrous capsule is removed and confirmed by histopathology.
ˇ Where patients are experiencing medical complications, such as the rupture, migration of prosthetic material or symptomatic capsular contracture, MBS items for the removal and replacement of the prosthesis are available under items 45553 and 45554 if:
- it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or
- the original implant was inserted in the context of breast cancer or developmental abnormality.
ˇ It is expected that patient records will include photographic and / or diagnostic evidence demonstrating the clinical need for these services.
ˇ The schedule fee for Item 45553 will be revised to $571.60.
|
| 45551
Amended | Breast prosthesis, removal of, with excision of at least half of the fibrous capsule, not with insertion of any prosthesis. The excised specimen must be sent for histopathology and the volume removed must be documented in the histopathology report (H) (Anaes.) (Assist.)
Fee: $443.70 Benefit: 75% = $332.80 |
| 45552
Ceased | Breast prosthesis, removal of, with excision of fibrous capsule and replacement of prosthesis (Anaes.) (Assist.) |
| 45553
Amended | Breast prosthesis, removal of and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), if:
(a) either:
(i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or
(ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and
(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
(H) (Anaes.) (Assist.)
Fee: $571.60 Benefit: 75% = $428.70 |
| 45554
Amended | Breast prosthesis, removal and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), including excision of at least half of the fibrous capsule or formation of a new pocket, or both, if:
(a) either:
(i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or
(ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and
(b) the excised specimen is sent for histopathology and the volume removed is documented in the histopathology report; and
(c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
(H) (Anaes.) (Assist.)
Fee: $699.45 Benefit: 75% = $524.60 |
| 45555
Ceased | Silicone breast prosthesis, removal of and replacement with prosthesis other than silicone gel prosthesis (H) (Anaes.) (Assist.)
Fee: $638.65 Benefit: 75% = $479.00 |
| CATEGORY 3
T8 – Surgical operations |
| 13 – Plastic and Reconstructive Surgery - BREAST PROCEDURES CONT. |
| Overview |
ˇ From 1 November, the MCRP pre-approval requirement for items 45556 and 45558 will be removed. It is expected that patient records will include photographic and/or diagnostic evidence demonstrating the clinical need for these services.
ˇ Item 45557 will be removed.
ˇ Item 45559 will be removed and replaced with three new items (45060, 45061 and 45062).
|
| 45556
Amended | Breast ptosis, correction of (unilateral), in the context of breast cancer or developmental abnormality, if photographic evidence (including anterior, left lateral and right lateral views) and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
Applicable only once per occasion on which the service is provided (H) (Anaes.) (Assist.)
Fee: $766.05 Benefit: 75% = $574.55 |
| 45557
Ceased | Breast ptosis, correction by mastopexy of (unilateral), following pregnancy and lactation, when performed not less than one year, and not more than 7 years, after the end of the most recent pregnancy of the patient, and if it can be demonstrated that the nipple is inferior to the infra‑mammary groove, other than a service associated with a service to which item 45522 applies (H) (Anaes.) (Assist.)
Fee: $766.05 Benefit: 75% = $574.55
|
| 45558
Amended | Breast ptosis, correction by mastopexy of (bilateral), if:
(a) at least two-thirds of the breast tissue, including the nipple, lies inferior to the infra-mammary fold where the nipple is located at the most dependent, inferior part of the breast contour; and
(b) if the patient has been pregnant—the correction is performed not less than 1 year, or more than 7 years, after completion of the most recent pregnancy of the patient; and
(c) photographic evidence (including anterior, left lateral and right lateral views), with a marker at the level of the inframammary fold, demonstrating the clinical need for this service, is documented in the patient notes
Applicable only once per lifetime (H) (Anaes.) (Assist.)
Fee: $1,148.95 Benefit: 75% = $861.75 |
| 45559
Ceased | Tuberous, tubular or constricted breast, if it can be demonstrated, correction of by simultaneous mastopexy and augmentation of (unilateral) (Anaes.) (Assist.)
Fee: $1,136.80 Benefit: 75% = $852.60 85% = $1053.40 |
| CATEGORY 3
T8 – Surgical operations |
| 13 – Plastic and Reconstructive Surgery – LIPOSUCTION |
| Overview |
ˇ Liposuction item 45586 will be deleted and combined with item 45585 for the treatment of Barraquer-Simons Syndrome, lymphoedema, macrodystrophia lipomatosa or the reduction of buffalo hump where it is secondary to an endocrine disorder or pharmacological treatment of a medical condition. Benefits are payable for liposuction of one regional area which is defined as one limb or trunk. If liposuction is required on more than one limb, item 45585 can be claimed once per limb.
|
| 45584
Amended | Liposuction (suction assisted lipolysis) to one regional area (one limb or trunk), for treatment of post-traumatic pseudolipoma, if photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes (H) (Anaes.)
Fee: $631.75 Benefit: 75% = $473.85 |
| 45585
Amended | Liposuction (suction assisted lipolysis) to one regional area (one limb or trunk), other than a service associated with a service to which item 31525 applies, if:
(a) the liposuction is for:
(i) the treatment of Barraquer-Simons syndrome, lymphoedema or macrodystrophia lipomatosa; or
(ii) the reduction of a buffalo hump that is secondary to an endocrine disorder or pharmacological treatment of a medical condition; and
(b) photographic and/or diagnostic imagining evidence demonstrating the clinical need for this service is documented in the patient notes
(H) (Anaes.)
Fee: $631.75 Benefit: 75% = $473.85 |
| 45586
Ceased | Liposuction (suction assisted lipolysis) for reduction of a buffalo hump, if it can be demonstrated that the buffalo hump is secondary to an endocrine disorder or pharmacological treatment of a medical condition (H) (Anaes.)
Fee: $631.75 Benefit: 75% = $473.85 |
| CATEGORY 3
T8 – Surgical operations |
| 13 – Plastic and Reconstructive Surgery - MELOPLASTY |
| Overview |
ˇ Item 45587 for unilateral meloplasty will be amended to clarify that facial asymmetry be secondary to trauma, a congenital condition or other medical conditions such as facial nerve palsy. Benefits are limited to procedures performed in hospital.
ˇ Benefits for bilateral meloplasty under item 45588 will be payable where the surgery corrects a functional impairment caused by a congenital condition, disease, or trauma. The amendments restrict the payment of benefits for the correction of acne scarring to help prevent cosmetic misuse.
|
| 45587
Amended | Meloplasty for correction of facial asymmetry if:
(a) the asymmetry is secondary to trauma (including previous surgery), a congenital condition or a medical condition (such as facial nerve palsy); and
(b) the meloplasty is limited to one side of the face
(H) (Anaes.) (Assist.)
Fee: $890.85 Benefit: 75% = $668.15 |
| 45588
Amended | Meloplasty (excluding browlifts and chinlift platysmaplasties), bilateral, if:
(a) surgery is indicated to correct a functional impairment due to a congenital condition, disease (excluding post-acne scarring) or trauma (other than trauma resulting from previous elective cosmetic surgery); and
(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
(H) (Anaes.) (Assist.)
Fee: $1,336.40 Benefit: 75% = $1,002.30 |
| CATEGORY 3
T8 – Surgical operations |
| 13 – Plastic and Reconstructive Surgery |
| Overview |
ˇ Item 45617 will be amended to specify that where the indication for surgery is skin redundancy causing a visual field defect, this is to be confirmed by an optometrist or ophthalmologist. It is expected that patient records will include photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service.
|
| 45617
Amended | Upper eyelid, reduction of, if:
(a) the reduction is for any of the following:
(i) skin redundancy that causes a visual field defect (confirmed by an optometrist or ophthalmologist) or intertriginous inflammation of the eyelid;
(ii) herniation of orbital fat in exophthalmos;
(iii) facial nerve palsy;
(iv) post-traumatic scarring;
(v) the restoration of symmetry of the contralateral upper eyelid in respect of one of these conditions; and
(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
(Anaes.)
Fee: $235.05 Benefit: 75% = $176.30 85% = $199.80
Extended Medicare Safety Net Cap: $188.05 |
| 45620
Amended | Lower eyelid, reduction of, if:
(a) the reduction is for:
(i) herniation of orbital fat in exophthalmos, facial nerve palsy or post-traumatic scarring; or
(ii) the restoration of symmetry of the contralateral lower eyelid in respect of one of these conditions; and
(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
(Anaes.)
Fee: $326.05 Benefit: 75% = $244.55 85% = $277.15
Extended Medicare Safety Net Cap: $260.85 |
| 45623
Amended | Ptosis of upper eyelid (unilateral), correction of, by:
(a) sutured elevation of the tarsal plate on the eyelid retractors (Muller’s or levator muscle or levator aponeurosis); or
(b) sutured suspension to the brow/frontalis muscle;
Not applicable to a service for repair of mechanical ptosis to which item 45617 applies
(Anaes.) (Assist.)
Fee: $723.05 Benefit: 75% = $542.30 85% = $639.65
Extended Medicare Safety Net Cap: $578.45 |
| 45624
Amended | Ptosis of upper eyelid, correction of, by:
(a) sutured elevation of the tarsal plate on the eyelid retractors (Muller’s or levator muscle or levator aponeurosis); or
(b) sutured suspension to the brow/frontalis muscle;
if a previous ptosis surgery has been performed on that side
(Anaes.) (Assist.)
Fee: $937.40 Benefit: 75% = $703.05 85% = $854.00
Extended Medicare Safety Net Cap: $749.95 |
| CATEGORY 3
T8 – Surgical operations |
| 13 – Plastic and Reconstructive Surgery - RHINOPLASTY |
| Overview |
ˇ Rhinoplasty items 45632 to 45644 and 45650 have been consolidated and amended to ensure consistency and clarify that rebates are available where the indication for surgery is:
(i) Airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or
(ii) Significant acquired, congenital or developmental deformity.
ˇ The NOSE Scale refers to the Nasal Obstruction Symptom Evaluation Scale, developed by Stewart et al, as published in the Otolaryngology-Head and Neck Surgery, 130: 2.
ˇ The NOSE Scale can be accessed on the American Academy of Otolaryngology Health and Neck Surgery website.
ˇ It is expected that the clinical details are retained in patient notes, including pre-operative photographic and / or NOSE Scale evidence demonstrating the clinical need for the service.
ˇ The schedule fee for item 45641 has been revised to $1,066.00 and limited to in-hospital.
|
| 45632
Amended | Rhinoplasty, partial, involving correction of lateral or alar cartilages, if:
(a) the indication for surgery is:
(i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or
(ii) significant acquired, congenital or developmental deformity; and
(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes
(Anaes.)
Fee: $511.95 Benefit: 75% = $384.00 85% = $435.20
Extended Medicare Safety Net Cap: $409.60 |
| 45635
Amended | Rhinoplasty, partial, involving correction of bony vault only, if:
(a) the indication for surgery is:
(i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or
(ii) significant acquired, congenital or developmental deformity; and
(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes
(Anaes.)
Fee: $587.60 Benefit: 75% = $440.70 85% = $504.20
Extended Medicare Safety Net Cap: $470.10 |
| 45638
Ceased | Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose, for correction of nasal obstruction or post‑traumatic deformity (other than deformity resulting from previous elective cosmetic surgery), or both (H) (Anaes.)
Fee: $1,014.05 Benefit: 75% = $760.55 |
| 45639
Ceased | Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose, if it can be demonstrated that there is a need for correction of significant developmental deformity (H) (Anaes.)
Fee: $1,014.05 Benefit: 75% = $760.55 |
| 45641
Amended | Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose, with or without autogenous cartilage or bone graft from a local site (nasal), if:
(a) the indication for surgery is:
(i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or
(ii) significant acquired, congenital or developmental deformity; and
(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes
(Anaes.)
Fee: $1,066.00 Benefit: 75% = $799.50 |
| 45644
Amended | Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from distant donor site, including obtaining of graft, if:
(a) the indication for surgery is:
(i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or
(ii) significant acquired, congenital or developmental deformity; and
(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes
(H) (Anaes.) (Assist.)
Fee: $1,279.45 Benefit: 75% = $959.60 |
| 45650
Amended | Rhinoplasty, revision of, if:
(a) the indication for surgery is:
(i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or
(ii) significant acquired, congenital or developmental deformity; and
(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes
(Anaes.)
Fee: $147.80 Benefit: 75% = $110.85 85% = $125.65 |
| CATEGORY 3
T8 – Surgical operations |
| 13 – Plastic and Reconstructive Surgery - CONGENTIAL DEFORMITIES OF THE EAR |
| Overview |
ˇ The correction of congenital deformities of the ear, such as ‘bat ear’, will be amended to clarify the clinical indications for the procedure, limited to in-hospital only procedures and restricted to patients less than 18 years of age to help prevent cosmetic misuse.
|
| 45659
Amended | Correction of a congenital deformity of the ear if:
(a) the patient is less than 18 years of age; and
(b) the deformity is characterised by an absence of the antihelical fold and/or large scapha and/or large concha; and
(c) photographic evidence demonstrating the clinical need for this service is documented in the patient notes
(H) (Anaes.) (Assist.)
Fee: $521.25 Benefit: 75% = $390.95 |
In this section
- Current Factsheets
- All Fact Sheets
- Changes to MBS items for orthopaedic surgery services
- 1 January 2025 pathology MBS changes
- 1 July 2023 pathology MBS changes
- 1 July 2024 pathology MBS changes
- 1 March 2021 fee increase for item 30630
- 1 March 2025 Pathology Changes - Amendment of MBS items 73296 and 73297 for BRCA-related breast, ovarian, fallopian tube or primary peritoneal cancer due to family history
- 1 November 2023 pathology MBS changes
- 1 November 2024 pathology MBS changes
- 17p chromosomal deletion testing for chronic lymphocytic leukaemia or small lymphocytic lymphoma – MBS item 73343
- Abdominal magnetic resonance imaging for rare genetic conditions associated with risk of renal tumours – new items for 1 July 2024
- Accreditation for SARS-CoV-2 Testing
- Acupuncture Services MBS item changes
- Allied Health Case Conferencing
- Alternative positron emission tomography (PET) item for use during gallium-67 supply disruptions
- Ambulatory blood pressure monitoring for diagnosis of hypertension
- Amended MBS mental health and wellbeing telehealth items
- Amendment to existing skin excision and skin flap items
- Amendment to MBS item 51071 for spinal surgery
- Anaesthesia Age Modifier Items
- Appropriate Billing of MBS Item 13950
- Assessment for a COVID-19 oral anti-viral medication
- Autologous Fat Grafting
- Benign prostatic hyperplasia (BPH): introduction of two new Medicare Benefits Schedule (MBS) items and removal of four outdated MBS items
- Blood Product Services
- Bulk Billing in General Practice from 1 November 2023
- Capital Sensitivity exemption changes to diagnostic imaging services
- Capital sensitivity exemption changes to diagnostic imaging services
- Cardiac implantable loop recorder (ILR) devices - new MBS items for remote monitoring
- Cardiac magnetic resonance imaging (MRI) for myocarditis associated with mRNA COVID-19 vaccination - item continuation
- Cardiac magnetic resonance imaging (MRI) for myocarditis associated with mRNA COVID-19 vaccination - item continuation
- Cardiac magnetic resonance imaging (MRI) for myocarditis associated with mRNA COVID-19 vaccination
- Cardiac magnetic resonance imaging for myocarditis from 1 January 2025
- Cardiac Services T8 Item amendments
- Cardiac Stress Echocardiography and Stress Myocardial Perfusion Studies (MPS) - Claiming Information Guide
- Cardiothoracic surgery MBS item changes
- Cardiothoracic surgery – Amended item for complex replacement or repair of aortic arch
- Cessation of Approved Collection Centre pathology measures
- Cessation of the temporary Medicare Benefits Schedule (MBS) items for nuclear medicine factsheet
- Change to Botulinum Toxin Injection Item 18365 Factsheet
- Change to MBS medical perfusion (item 22060) factsheet
- Changes for diagnostic imaging services factsheet
- Changes to Anaesthesia MBS items
- Changes to Category 7 – Cleft and Craniofacial Services
- Changes to Colonoscopy services
- Changes to emergency medicine services
- Changes to in and out of hospital benefit for plastic and reconstructive surgery services
- Changes to MBS - 26 February 2021
- Changes to MBS anaesthesia items
- Changes to MBS benefit for eyelid reconstruction item 45614 from 1 November 2024
- Changes to MBS colonoscopy items factsheet
- Changes to MBS heart health assessment items 699 and 177
- Changes to MBS heart health assessment items factsheet
- Changes to MBS item 72814 for Programmed Cell Death Ligand (PD-L1) testing from 1 September 2023
- Changes to MBS items 15900 and 31516 factsheet
- Changes to MBS items 30196 and 30202
- Changes to MBS items 37207 and 37208 factsheet
- Changes to MBS items for breast biopsy services factsheet
- Changes to MBS Items for colonoscopy services factsheet
- Changes to MBS items for intensive care services
- Changes to MBS varicose vein items
- Changes to Obstetric MRI items factsheet
- Changes to psychiatry services from 1 March 2024
- Changes to supervision requirements for nuclear medicine imaging services from 1 July 2024
- Changes to the MBS - 26 February 2021
- Changes to the Medicare Benefits Schedule for radiation therapy items
- Changes to thoracic surgery Medicare Benefits Schedule (MBS) items
- Chemotherapeutic Procedures Factsheet
- Childhood Access to Anaesthesia Services Factsheet
- Chronic disease management by consultant physicians
- Claiming Microbiology Tests for SARS-CoV-2 (COVID-19) factsheet
- Clarifying clinical intent of spinal decompression items (MBS items 51011 to 51015)
- Clarifying MBS Items that are Hospital Only Services
- Clarifying the clinical intent of partial rhinoplasty (MBS item 45632)
- Clinically suspected melanoma item fee changes to include 2022 indexation
- Co-claiming limitations of subsequent attendance items with certain Group T8 surgical operations
- Co-claiming of subsequent attendance items with group T8 surgical operations.
- Colorectal Surgery MBS Item Changes
- Complex neurodevelopmental disorder and eligible disability changes to MBS items
- Continuous nerve blockade for post-operative pain management from 1 March 2025
- COVID-19 high risk group temporary exemption from established relationship requirement
- COVID-19 Temporary MBS Telehealth Services
- Cryoablation for biopsy-confirmed renal cell carcinoma - New MBS item
- CT Angiography of Pulmonary Arteries and Minor Changes
- Deep brain stimulation (DBS) - New MBS item 40863 for remote programming of a neurostimulator
- Determining lesion size for MBS items 31356 to 31388 selection
- Device agnostic transcatheter mitral valve repair, TMVr, by transvenous or transeptal techniques in patients with degenerative-primary mitral valve regurgitation
- Diagnostic imaging capital sensitivity 1 May 2022 exemption changes factsheet
- Diagnostic Imaging Medicare Benefits Schedule (MBS) Item and Rule Changes
- Diagnostic Imaging Medicare Benefits Schedule (MBS) item changes for 1 July 2022
- Diagnostic imaging Medicare Benefits Schedule (MBS) item changes for 1 November 2021
- Diagnostic Imaging Services Table - Changes commencing from 1 July 2023
- Diagnostic Imaging Services Table - Changes to musculoskeletal ultrasound supervision requirements
- Diagnostic Imaging Services Table - New MBS item for whole body MRI scan
- Diagnostic Imaging Services Table – Changes from 1 November 2024
- Eligibility for magnetic resonance imaging (MRI) equipment changes from 1 July 2025
- Endoscopic Mucosal Resection (EMR) – minor amendment to MBS Item 32230
- Endoscopic Mucosal Resection (EMR) from 1 November 2021
- Endoscopic Mucosal Resection and related colonoscopy item changes for 1 July 2024
- Ensuring Appropriate Use of Neurosurgery and Neurology Services
- Ensuring Appropriate Use of Neurosurgery and Neurology Services
- Exercise electrocardiogram (ECG) stress testing – New item
- Expanded patient access to mastopexy (MBS item 45558)
- Expanded patient access to Transcatheter occlusion for the Left Atrial Appendage
- Expanding patient access to Cleft Dental Services
- Extended Medicare Safety Net (EMSN) caps on new ultrasound items
- EXTENDING MENTAL HEALTH SUPPORT FOR AGED CARE RESIDENTS DURING COVID-19
- Extension of COVID Pathology Items
- Extension of MBS Item 32221 for removal or revision of an artificial bowel sphincter
- Extension of SARS-CoV-2 (COVID-19) Laboratory Testing Items
- Extension of temporary pathology items for SARS-CoV-2 (COVID-19) and other respiratory pathogens
- Extension of temporary Pathology items for SARS-CoV-2 (COVID-19) and other respiratory pathogens
- Extension of the SARS-CoV-2 (COVID-19) Pathology Items
- Extracorporeal Magnetic Innervation (ExMI) factsheet
- Extracorporeal photopheresis (ECP) for chronic graft versus host disease (cGVHD)
- Factsheet Change to item 18361
- Factsheet Changes to Nuclear Medicine items
- Factsheet ECP for the Treatment of CTCL
- Factsheet for Additional 10 MBS Mental Health Sessions
- Factsheet for changes to item 73343 to enable testing for acalabrutinib
- Factsheet for MBS item 69501
- Factsheet for MBS item 73295
- Factsheet for MBS item 73344
- Factsheets for 2018
- Factsheets for 2019
- Factsheets for 2020
- Factsheets for 2021
- Factsheets for 2022
- Factsheets for 2023
- Family and Carer Participation under the Better Access Initiative
- Fee loading for bulk billed consultant psychiatrist telehealth attendance - New MBS item 294
- Full versus Partial Medicare-eligible MRI machines in the Diagnostic Imaging Services Table
- Gallium-67 - New temporary diagnostic imaging MBS item
- General Surgery Services changes factsheets
- Genetic testing changes for Pharmaceutical Benefits Scheme (PBS) immunotherapy
- Genetic testing for alpha thalassaemia - amendment to Pathology MBS item 73410
- Genetic testing for BRCA1/2 gene variants for patients with metastatic castration-resistant prostate cancer
- Genetic Testing for Childhood Syndromes
- Genetic Testing for Hydatidiform Moles
- Genetic testing for major fetal structure abnormalities
- Genetic testing for neuromuscular disorders - new pathology MBS items 73422 to 73428
- Genetic testing for neurotrophic receptor tyrosine kinase (NTRK) fusion in patients with locally advanced or metastatic solid tumours
- Genetic testing for people with multiple myeloma and chronic lymphocytic leukaemia
- Geriatrician or consultant physician assessment and management plans
- Group Therapy MBS Changes under the Better Access Initiative
- Gynaecology MBS item changes
- Gynaecology – minor changes
- Haemorrhoid treatments – changes to items 32135 and 32139
- Heart health assessment items
- Implementation of MBS Review Taskforce recommendations to optometry items - 1 March 2025
- Inclusion of communication time when claiming time-tiered MBS items
- Inpatient telehealth psychiatry services
- Insertion of marker clip(s) following a breast biopsy
- Intracranial aneurysm item – Amended item
- Intravascular ultrasound guided coronary stent insertion – New item
- Introducing a New Stroboscopy MBS Item
- Introduction of 6 minute minimum time for MBS Level B GP consultations
- Introduction of new Level E consultation items lasting 60 minutes or more
- Leadless permanent cardiac pacemaker new and amended items
- Leadless permanent cardiac pacemaker – Amended items
- Magnetic Resonance-guided Focused Ultrasound (MRgFUS)
- Magnetic Resonance Imaging (MRI) equipment MBS eligibility changes
- MBS COVID-19 Management Support Service
- MBS funded investigations for sleep disorders – current professional guidelines
- MBS Support for People in COVID-19 Hotspots
- MBS Telehealth Services - from 1 July 2024
- MBS Telehealth Services from 1 July 2022
- MBS Telehealth Services from January 2022
- Measurement of Faecal Calprotectin as a Marker of Bowel Inflammation
- Medicare Benefits Schedule (MBS) item 42739 factsheet
- Medicare Compliance and Telehealth Services
- Medicare Indexation of Diagnostic Imaging Services Factsheet
- Medicare Indexation Schedule
- Medicare Safety Net Arrangement - 1 January 2021
- Medicare Safety Net Arrangement - 1 January 2022
- Medicare Safety Net Arrangements - 1 January 2019
- Medicare Safety Net Arrangements – 1 January 2023
- Medicare Safety Net Arrangements – 1 January 2024
- Medicare Safety Net Arrangements – 1 January 2025
- Medicare Safety Net Thresholds from 1 January 2019
- Medicare Safety Net Thresholds from 1 January 2020
- Medicare Support for COVID-19 Vaccinations
- Medicare Support in Response to Omicron - GP and Other Medical Officer (OMP) Longer Telephone Consultation.
- Melanoma excision services MBS item changes
- Mental Health Case Conferencing items
- Mental Health Services for Bushfire Response
- METex14sk testing to access tepotinib on the PBS - new item 73436
- Minimally invasive ventral rectopexy – ongoing item 32118
- Minor change to colorectal surgery MBS item 32006 for left hemicolectomy
- Minor changes to MBS Items for Orthopaedic Surgery
- Minor changes to sleep study items 12205 and 12207 factsheet
- Minor changes to spinal surgery items factsheet
- Minor changes to thoracic medicine items.
- Modernising Cardiac Surgical Services
- MSAC Application 1523.1 - Transluminal insertion, management, and removal of an intravascular microaxial blood pump (ImpellaŽ), for patients requiring mechanical circulatory support Quick Reference Guide
- Multidisciplinary case conference items for complex neurodevelopmental disorders and eligible disabilities
- National Cervical Screening Program (NCSP) MBS item amendments
- Neuromyelitis Optica Testing
- New and amended Medicare Benefits Schedule (MBS) items for Transcatheter Aortic Valve Implantation (TAVI)
- New arrangements for GP Residential Aged Care Facility (RACF) services
- New item for homologous recombination deficiency testing of patients with ovarian, fallopian tube or peritoneal cancer
- New items using blue-light cystoscopy (BLC) with hexaminolevulinate (HAL) for improved diagnosis, treatment and management of non-muscle invasive bladder cancer (NMIBC)
- New Items – Repetitive Transcranial Magnetic Stimulation (rTMS) Therapy
- New Items – Repetitive Transcranial Magnetic Stimulation (rTMS) Therapy
- New Items – Repetitive Transcranial Magnetic Stimulation (rTMS) Therapy
- New MBS item 30175 for abdominoplasty
- New MBS Item for micro bypass glaucoma surgery (MBGS)
- New MBS Item for mobile provision of skeletal x-ray to patients within residential aged care facilities factsheet
- New MBS item for vertebroplasty
- New MBS items for Transcatheter Mitral Valve repair
- New MBS telehealth items for the remote programming of auditory implants and/or sound processors
- New Medicare Benefits Schedule (MBS) item for percutaneous transcatheter delivery of a dual filter Cerebral Embolic Protection Device (CEP) during transcatheter aortic valve implantation (TAVI)
- New Medicare Benefits Schedule (MBS) item for prostate biopsy guided by magnetic resonance imaging (MRI) factsheet
- New Medicare Benefits Schedule (MBS) item for surgical correction of congenital ear deformities
- New Medicare Benefits Schedule (MBS) Items for contrast-enhanced magnetic resonance imaging (MRI) of the liver
- New Medicare Benefits Schedule (MBS) items for FDG positron emission tomography (PET) for the evaluation of breast cancer factsheet
- New Medicare Benefits Schedule (MBS) items for magnetic resonance imaging (MRI) for breast cancer factsheet
- New Medicare Benefits Schedule (MBS) items for obstetric magnetic resonance imaging (MRI) of patients at ≥ 18 weeks gestation with suspected fetal central nervous system abnormality
- New temporary MBS item 32118 for minimally invasive ventral mesh rectopexy
- New temporary Medicare Benefits Schedule (MBS) items for nuclear medicine factsheet
- Nicotine and Smoking Cessation Counselling MBS Services
- Nuclear medicine item 61485 - One-off schedule fee increase
- Nurse practitioner MBS changes
- Nurse practitioner MBS changes from 1 July 2024
- Orthopaedic Surgery - minor changes
- Orthopaedic surgery amendments to eight MBS items
- Orthopaedic surgery – minor amendment to item 49706
- Orthopaedic Surgery – New and amended MBS items
- Other Medical Practitioner and General Practitioner Medicare Benefits Schedule (MBS) items administrative changes
- Otolaryngology and diagnostic audiology changes commencing 1 July 2024
- Otolaryngology, head and neck surgery MBS changes
- Otolaryngology, head and neck surgery MBS changes commencing 1 November 2023
- Paediatric Surgery MBS item changes
- Pain Management Services Changes
- Participating midwives MBS changes
- Participating Midwives MBS Item Changes
- Pathology Medicare Benefits Schedule (MBS) item changes for 1 July 2022
- Pathology Medicare Benefits Schedule (MBS) item changes for 1 September 2022
- Personal attendance for musculoskeletal ultrasound and personal supervision for nuclear medicine imaging services
- Plastic and reconstructive surgery MBS changes
- Plastics and reconstructive surgery MBS changes commencing 1 November 2023
- Point-of-care HbA1c testing for patients with diagnosed diabetes
- Pre-implantation Genetic Testing (PGT)
- Previous Years Factsheets
- Privacy Checklist for Telehealth Services
- Programmed Cell Death Ligand (PD-L1) testing changes to pathology MBS item 72814
- Relative Value Guide – changes to cell salvage item 22002
- Remote reprogramming of a neurostimulator for the management of chronic pain
- Removal of age restriction for glucocorticoid injections of keloid lesions (MBS Item 30210)
- Removal of legislated collaborative arrangements
- Repetitive Transcranial Magnetic Stimulation (rTMS) Therapy – updated FAQ
- Repetitive Transcranial Magnetic Stimulation therapy on the MBS
- Replication of three items into the Relative Value Guide (RVG) for Anaesthesia
- Requests for diagnostic imaging services versus referrals for other services under Medicare
- Rural Bulk Billing Incentive Changes
- Safe and Best Practice Cardiac Imaging Services
- SARS-CoV-2 (COVID-19) and other respiratory pathogens pathology items
- Sentinel Lymph Node Biopsy (SLNBx) for intermediate thickness Melanoma
- Single operator, single use peroral cholangiopancreatoscopy for the diagnosis of indeterminate biliary strictures and removal of difficult biliary stones
- Spinal surgery Medicare Benefits Schedule item changes to exclude use for Vertebral Body Tethering (VBT)
- Split of MBS item 45626 for correction of entropion or ectropion due to trachoma or non-trachomatous causes factsheet
- Streamlining First Nations Australians’ access to allied health services
- Substitute positron emission tomography (PET) item for use during thallium-201 supply shortage
- Suspension of substitute Medicare Benefits Schedule (MBS) items for nuclear medicine
- TAVI standby cardiac surgeon amendments - items 90300, 38514, 38522 for low and intermediate surgical risk patients - Quick Reference Guide
- Telehealth MBS eligibility for COVID-19 positive patients
- Telehealth Services Provided by GPs and Non-Specialist Medical Practitioners to Patients in Rural and Remote Areas
- Temporary COVID-19 MBS Telehealth Services – specialist inpatient services
- Temporary COVID-19 Allied Health Support Services and GP/OMP Services for Aged Care Residents.
- Temporary nuclear medicine items 61470 and 61477 – item continuation and one-off fee increase
- Therapeutic nuclear medicine MBS changes
- Thoracic medicine items – minor updates
- Thoracic surgery MBS changes
- Three new items relating to plastic and reconstructive surgery for nurse practitioners
- Transcatheter aortic valve implantation - Amended items
- Transcatheter aortic valve implantation (TAVI) items - complete service advice
- Transcatheter Aortic Valve Implantation (TAVI) – new and amended services
- Upcoming changes to MBS items - Eating Disorders
- Updates to the Medicare Benefits Schedule for radiation therapy items from 1 November 2024
- Upper eyelid reduction surgery - Changes to MBS item 45617
- Urology Services Factsheet
- Varicose vein MBS item changes
- Verbal assignment of benefit arrangements for telehealth services
