From 1 November 2018, a new set of items for multiple sleep latency testing (MSLT) and maintenance of wakefulness testing (MWT) in adult and paediatric patients will be listed on the Medicare Benefits Schedule (MBS). The listing of these items coincides with the introduction of the new and revised items for sleep studies.
Qualified sleep medicine practitioners will need to cease billing the sleep study and electroencephalography (EEG) items for MSLT and MWT and commence billing the new set of items.
These changes are relevant to sleep medicine physicians, neurologists and sleep technicians.
What are the changes?
The following items are being introduced:
· Two new items for MSLT (12254) and MWT (12258) in patients aged 18 years
· Two new items for MSLT (12261) and MWT (12265) in patients aged at least
12 years but less than 18 years; and
· Two new items for MSLT (12268) and MWT (12272) in patients less than 12 years
Click here to view the full item descriptors.
What does this mean for practitioners?
From 1 November 2018, items 12203, 12210, 12213 for sleep studies and item 11003 for EEG will no longer apply to a service provided for an MSLT or MWT.
The new items will enable practitioners to bill a single item for MSLT or MWT as opposed to a combination of items (e.g. 12203 and 11003). It is important that qualified sleep medicine practitioners transition to the new set of items from 1 November 2018 as services provided for MSLT and MWT will no longer attract a rebate under the sleep study and EEG items from
1 November 2018.
What else do I need to know?
As with the sleep study items, use of the new MSLT and MWT items will be restricted to qualified sleep medicine practitioners (adult and/or paediatric as relevant).
The new items include various requirements that must be met including the need for a qualified adult sleep medicine practitioner (or a neurologist in some cases) to assess the patient to determine if testing is necessary.
Why are the changes being made?
From 1 November 2018, a new structure of items for sleep studies will be introduced with new requirements that will limit their use for MSLT or MWT.
The listing of the six new items will ensure eligible patients continue to have access to MBS rebates for MSLT and MWT and provide more transparency around the provision of these services. The new items were assessed recommended for listing by the Medical Services Advisory Committee (MSAC).
What do I tell patients?
From 1 November 2018, eligible patients will continue to have access to MBS rebates for MSLT and MWT through a new set of MBS items. Patients who require an MSLT for the purpose of determining eligibility for Pharmaceutical Benefits Scheme (PBS) listed medicines for narcolepsy may be eligible for a rebate for the service under items 12254, 12261 or 12268.
When will this change be reviewed?
The Department of Health will continue to review this change in consultation with the profession.
Where can I find more information?
Detailed information on the changes can be found on the MBS Online website and by calling the Department of Human Services on 132 150.