What are the changes?
From 1 November 2018, there will be a new MBS funded item (13260), for the cryopreservation of semen to preserve fertility in post-pubertal males undergoing gonadotoxic treatment.
Why are the changes being made?
The listing of this item was recommended by the Medical Services Advisory Committee (MSAC) in November 2017. Further details about the MSAC Application can be found at the MSAC website.
What does this mean for providers?
Specialists and consultant physicians managing post pubertal males undergoing gonadotoxic treatment will be able to refer patients to appropriate medical practitioners, to undertake MBS funded cryopreservation of semen prior to the initiation of treatment, or prior to further treatment in the case of relapse.
What does this mean for patients?
Specialists and consultant physicians will now be able to inform their patients that there is an MBS service for cryopreservation of semen, should they wish to explore fertility preservation.
Medical practitioners providing the cryopreservation service can inform their patients that the new MBS service covers the initial cryopreservation of semen, not ongoing storage. The service involves patients undergoing a 'collection cycle' which may include obtaining up to 3 semen samples across alternate days.
The item is claimable twice per person per lifetime, to account for patients who may experience relapse and require additional treatment.
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?
The full item descriptor and information on other changes to the MBS can be found at the MBS Online website or by calling the Department of Human Services on 132 150.
(Draft wording of items to be finalised through regulatory amendments)
|New item||Item descriptor|
|Processing and cryopreservation of semen for fertility preservation treatment before or after completion of gonadotoxic treatment for malignant or non-malignant conditions, in a post-pubertal male in Tanner stages II-V, up to 60 years old, if the patient is referred by a specialist or consultant physician, initial cryopreservation of semen (not including storage) - one of a maximum of two semen collection cycles per patient in a lifetime.|
|Fee: $415.00 Benefit: 75% = $311.25 85% = $352.75|
New note accompanying item 13260
|A semen cycle collection process involves obtaining up to 3 semen samples on alternate days producing up to 50 cryopreserved straws of frozen sperm.
Maximum of two semen collection cycles, one cycle collected prior to a patient undergoing the first cytotoxic/radiation treatment and the second cycle to be collected if the patient has relapsed and requires treatment.
From 1 January 2019, benefits paid under the Extended Medicare Safety Net (EMSN) for this MBS item will be capped at 65 per cent of the Schedule fee. This means that the maximum EMSN benefit for the service will be at the capped amount, regardless of the fee charged by the doctor.