The July 2021 Medicare Benefits Schedule (MBS) files, including an updated XML file and the MBS Book in PDF and Word, are available from the
Summary of Change for 1 July 2021
From July 2021 there have been a number of changes to the MBS. These changes include indexation of majority of Medicare services, Government’s response to recommendations from the clinician-led MBS Review Taskforce regarding general surgery, orthopaedic and cardiac services, and include other minor policy changes which were recommended by the clinician-led MBS Review Taskforce or the Medicare Benefits Schedule Committee. Details of the changes are as follows:
General surgery
From 1 July 2021, MBS items for general surgery services are changing to reflect contemporary practice, incentivise best clinical practice, combine like procedures, and clarify the requirements of ambiguous services to simplify the arrangements for doctors and patients.
The changes will introduce 35 new items, amend 50 items and delete 73 items relating to laparoscopies and laparotomies, small bowel resections, abdominal wall hernia repairs, oncology and bariatric services, surgical excisions, and procedures relating to the oesophageal, stomach, liver, biliary, pancreas, spleen and lymph nodes.
These changes are a result of MBS Review Taskforce recommendations and consultation with stakeholders. These changes are relevant for surgeons involved in the performance and claiming of eligible general surgery services; consumers claiming these services; private health insurers; and private hospitals. Further information is available on the General Surgery Services Changes factsheet page.
Orthopaedic surgery
From 1 July 2021 MBS items for orthopaedic surgery services are changing to ensure services are clinically appropriate, reflect contemporary clinical practice and improve quality of care and safety for patients. The changes include:·168 new items.
·280 amended items for services considered as requiring change in order to improve clarity of services for patients and providers, and improve the MBS to better reflect contemporary clinical practice.
·137 superseded items where services have been consolidated into new or amended items.
·9 deleted items for services considered to be obsolete or no longer reflective of contemporary best practice.consequential amendments to explanatory notes.
These changes are a result of the MBS Review Taskforce recommendations and extensive consultation with stakeholders. These changes are relevant for all specialists involved in the provision of orthopaedic services, consumers claiming these services, private hospitals and private health insurers. Further information is available on the Changes to MBS Items for Orthopaedic Surgery Services factsheet page.
Cardiac Services
On 1 July 2021, the Australian Government is making changes to modernise cardiac surgical services to ensure they reflect current medical practice, support high-value care and ensure patients receive procedures in line with best practice. These changes follow recommendations from the MBS Review Taskforce.
The range of changes to cardiac surgical services include updates to item descriptors, combining similar surgical procedures, introducing items that represent a complete medical service, incentivising advanced techniques, removal of procedures that no longer represent best practice, and reducing low value angiography and coronary artery stenting by aligning the items with appropriate use criteria.
From 1 July 2021, there will also be some minor changes to existing cardiac imaging services to align co-claiming restrictions with other cardiac services, better reflect the policy intent of the services and better align these services with clinical guidelines.
Further information is available on the Modernising Cardiac Surgical Services factsheet page.
Indexation
Indexation was applied to most of the general medical services items, all diagnostic imaging services, except nuclear medicine imaging and magnetic resonance imaging (MRI) and two pathology items (74990 and 74991). The MBS indexation factor for 1 July 2021 is 0.9 per cent.
Further information on the indexation schedule for the MBS is available on the Medicare Indexation Schedule page.
Minor Changes
Computed Tomography
Item 57351 will be amended to provide a patient who has had a service under item 57357 (which is for a repeat CT angiography service) in the previous 12 months, is able to access item 57351.
Magnetic Resonance Imaging
Item 63454 will be amended to remove the current 12 month restriction on the claiming of this item and restrict the claiming of this service to once per pregnancy. This change recognises that there may be occasions when a woman has two pregnancies within a 12 month period.
Item 63454 will also be relocated from Subgroup 19 – Scan of body – for specified conditions into Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions under Group I5 – Magnetic resonance imaging. This is to better reflect the type and nature of this service.
Heart Health Assessment
Items 699 and 177 will be amended from 1 July 2021, to provide that these services can only be performed on a patient who is 30 years old or older. This will align the items with the current evidence-based age cohorts for the Australian Absolute Cardiovascular Disease Risk calculator, which is the basis for the assessment requirements for the heart health assessment items.
Transcatheter mitral valve repair
On 1 July 2021, the Australian Government will introduce four new items for the provision of transcatheter mitral valve repair (TMVr) using the MitraClip™ implant for managing severe mitral valve regurgitation. Mitral valve regurgitation occurs when the heart’s mitral valve doesn’t close tightly and blood flows backward in the heart.
Eligible patients, who are ineligible for open surgical management with moderate-severe mitral valve regurgitation will be able to receive a Medicare rebate for this less invasive approach through transcatheter repair using the MitraClip™ implant.
Relevant legislation
Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2021
Health Insurance (General Medical Services Table) Regulations 2021
Health Insurance Legislation Amendment (2021 Measures No. 1) Regulations 2021
Health Insurance (Section 3C General Medical Services – Transcatheter Aortic Valve Implantation) Determination 2018
information is available at https://www.legislation.gov.au/