The Australian Government is introducing changes to breast tomosynthesis following advice from the Medicare Benefits Schedule (MBS) Review Taskforce.
What are the changes?
From 1 November 2018, the Australian Government is introducing two new time-limited MBS items for 3DBT (59302 and 59305) and removing items (60100 and 60101) for plain film tomography.
What does this mean for relevant health professionals?
Providers will be able to more appropriately bill patients for 3DBT and standard two dimensional mammograms, ahead of any recommendation by the Medical Services Advisory Committee (MSAC).
Why are the changes being made?
3DBT is a relatively new digital mammography technology that produces a 3D image of the breast by using several X-rays obtained at different angles. Despite being an established practice, it is an evolution in technology that has not yet been assessed by MSAC for safety, effectiveness and cost effectiveness. As such, there are no MBS items that provide rebates to patients that access 3DBT services. To date practitioners have been using a combination of existing MBS items which were not intended for this purpose.
These new items will provide interim funding for 3DBT while MSAC considers long term funding.
These changes follow a review of plain film tomography items by the Diagnostic Imaging Clinical Committee of the MBS Review Taskforce, which found that the tomography items would be obsolete if not for their use in 3DBT.
What do I tell patients?
Patients will continue to be able to access Medicare rebates for 3DBT and mammography services for the interim period, while an application is under consideration by MSAC.
When will this change be reviewed?
These new items are an interim measure (for two years) to enable an application for long-term funding to be lodged by the sector and considered by MSAC.
Three dimensional tomosynthesis of both breasts, not being a service associated with item 59300 or 59301, if there is reason to suspect the presence of malignancy because of: the past occurrence of breast malignancy in the patient or members of the patient’s family; or symptoms or indications of malignancy found on examination of the patient by a medical practitioner (R) (K)
Three dimensional tomosynthesis of one breast, not being a service associated with item 59303 or 59304, if there is reason to suspect the presence of malignancy because of: the past occurrence of breast malignancy in the patient or members of the patient’s family; or symptoms or indications of malignancy found on examination of the patient by a medical practitioner (R) (K)