The 1 January 2025 MBS files are available on the January 2025 Downloads Page.
Summary of Changes for 1 January 2025
From 1 January 2025 there will be several changes to the MBS. These changes include:
- indexation of the Extended Medicare Safety Net (EMSN);
- changes to three co-dependent pathology MBS items;
- introduction of a new MBS item for magnetic resonance imaging (MRI) for diagnosis of myocarditis in patients; and
- cessation of MBS items for duplex scanning for erectile dysfunction.
Extended Medicare Safety Net (EMSN)
The EMSN provides an additional Medicare benefit once an annual threshold in out-of-pocket costs for out-of-pocket hospital services has been reached. Out-of-hospital services include general practitioner, specialist and allied health attendances as well as many pathology and diagnostic imaging services. The Original Medicare Safety Net (OMSN) and EMSN thresholds are indexed annually on 1 January in line with the CPI (September Quarter). In addition to applying indexation, the latest changes also include:
- Indexation of the fixed dollar EMSN benefit cap; and
- Add EMSN benefit caps to two MBS items for cleft dental services.
| 2025 Medicare Safety Nets Thresholds | Threshold amount | Who it’s for | What counts towards the threshold | What benefit you’ll get back |
| Original Medicare Safety Net (OMSN) | $576.00 | Everyone in Medicare | Your gap amount for the calendar year. | 100% of the schedule fee for out of hospital services. |
| Extended Medicare Safety Net (EMSN)- General | $2,615.50 | Everyone in Medicare | Your out of pocket amount for the calendar year. | 80% of out of pocket costs or the EMSN benefit caps for out of hospital services. |
| Extended Medicare Safety Net (EMSN) - Concessional and Family Tax Benefit Part A | $834.50 | Concession cardholders and families eligible for Family Tax Benefit Part A | Your out of pocket amount for the calendar year. | 80% of out of pocket costs or the EMSN benefits caps for out of hospital services. |
Changes to diagnostic imaging services from 1 January 2025
From 1 January 2025, MBS items 55208 and 55211 for duplex scanning services for erectile dysfunction will cease. The items were previously provided by a doctor who was not a specialist or consultant physician in the specialities referred to in the eligibility requirements for the service but had the experience to render duplex scanning services for erectile dysfunction. The items will be ceased following advice to the Department of Health and Aged Care that the relevant practitioner is no longer practicing.
From 1 January 2025, a new permanent MBS item (63390) will be introduced for MRI for the diagnosis of myocarditis. Item 63390 will replace temporary MBS item 63399 which will cease from 1 January 2025. The new permanent item will continue to support the diagnosis of vaccine-induced myocarditis, including cases associated with COVID-19, and assist adverse events reporting to the Therapeutic Goods Administration. The new item will also broaden patient access to MRI for the diagnosis of myocarditis by removing the limitation on the patient having received an mRNA COVID-19 vaccine, or the symptoms having materialised within 21 days of receiving the vaccine, as an eligibility condition.
Changes to co-dependent pathology services from 1 January 2025
From 1 January 2025, amendments will be made to co-dependent pathology services in line with recommendations made by the Medical Services Advisory Committee and Pharmaceutical Benefits Advisory Committee. MBS item 73295 for or breast cancer gene 1 and 2 (BRCA) mutations testing will be amended to support testing in patients with ovarian, fallopian tube or peritoneal cancer and patients with breast cancer. Currently, breast cancer patients seeking testing under item 73295 must meet certain clinical criteria as listed in the item descriptor. The amendments to item 73295 will remove these requirements to allow testing in all eligible breast cancer patients.
Additionally, from 1 January 2025, MBS items 73303 and 73304 for BRCA mutation testing of patients with metastatic castration-resistant prostate cancer will be amended to support determining patient eligibility for any relevant treatment under the PBS. Previously, items 73303 and 73304 were limited to determining patient eligibility for PBS treatment with olaparib. The amendment to items 73303 and 73304 will enable them to be used to identify patients suitable for the drug talazoparib, which will be listed on the PBS from 1 January 2025, or, for other relevant treatments which may be listed on the PBS in the future.
Relevant legislation
Please note links will be added as they become available on the Federal Register of Legislation
- Health Insurance (Extended Medicare Safety Net) Amendment (Indexation) Determination 2024
- Health Insurance (Section 3C Diagnostic Imaging Services – Duplex Scanning for Erectile Dysfunction) Repeal Determination 2024
- Health Insurance (Section 3C Co-Dependent Pathology Services) Amendment (No. 2) Determination 2024
- Health Insurance (Section 3C Diagnostic Imaging Services – Cardiac MRI for Myocarditis) Determination 2024
- Health Insurance (Section 3C Diagnostic Imaging Services – Cardiac MRI for Myocarditis) Repeal Determination 2024
Please note that this news page is correct at the date of publication listed under “Page last updated” and does not account for any updates to the MBS since this time