Medicare Rebates for Capsule Endoscopy for Peutz-Jeghers Syndrome and Artificial Bowel Sphincter

Three new MBS items (11823, 32220, and 32221) which provide for capsule endoscopy for Peutz-Jeghers Syndrome and the insertion, removal or revision of an artificial bowel sphincter will be available from 1 March 2009.

The introduction of the items follows a recommendation by the Medical Services Advisory Committee that capsule endoscopy is a safe and effective way to conduct small bowel surveillance for eligible people with Peutz-Jeghers Syndrome, and that an artificial bowel sphincter is safe and effective in treating severe faecal incontinence.

MBS item 11823 provides for capsule endoscopy to conduct small bowel surveillance of a patient diagnosed with Peutz-Jeghers Syndrome. There are a number of requirements which must be met for this service to attract a Medicare benefit, which is detailed in the item descriptor and accompanying explanatory notes.

To attract a Medicare benefit the capsule endoscopy device used for this procedure must be approved by the Therapeutic Goods Administration, and the specialist or consultant physician that undertakes this service must be recognised in undertaking endoscopic procedures by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy. In addition, item 11823 is only available once in any two-year period.

MBS item 32220 provides for the insertion of an artificial bowel sphincter for the treatment of severe faecal incontinence. This item can be claimed for a patient for whom conservative and other less invasive forms of treatment are contraindicated or have failed. Accompanying this service is item 32221, which provides for the removal or revision of an artificial bowel sphincter. It is important to note that the safety and effectiveness of artificial bowel sphincters has not been established in children prior to puberty.

For further information on these items please refer to the item descriptor and accompanying explanatory notes, or contact Medicare Australia on 132 150.