The 1 January 2020 MBS XML file can be downloaded from the Download page.
SUMMARY OF CHANGES INCLUDED IN THIS EDITION
Schedule fee change for MBS item 591 (urgent after hours)
A schedule fee change for the urgent after-hours service rendered by other medical practitioners (MBS item 591) will take place on 1 January 2020, as announced by Government in the 2017-18 MYEFO under the Guaranteeing Medicare — Medicare Benefits Schedule Review — response to Taskforce recommendations measure. The fee will change from $101.60 to $91.45 on 1 January 2020.
Amend item 73348 cystic fibrosis testing
Item 73348 has been amended to omit the words "when requested by a specialist or consultant physician who manages the treatment of the patient."
Amended geographic eligibility requirements for MBS item 10991, 64991 and 74991
The geographic eligibility requirements for MBS items 10991, 64991 and 74991 will be amended so that incentives are targeted to current rural and remote areas. The amendment was announced by the Government in the 2018-19 Budget as part of the A Stronger Rural Health Strategy measure. In the 2019-20 Budget, the Government announced the change would commence on 1 January 2020 under the Guaranteeing Medicare — strengthening primary care measure.
In order to be billed using these MBS items a service must be provided at, or from, a practice location that is in a regional, rural or remote area (MMM 2 to 7 areas under the Modified Monash Model classification system).
A locator map to identify a medical practice's MMM classification is available at the Doctor Connect website at: http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator.
Indexation of fixed EMSN caps
MBS items with fixed caps in the Health Insurance (Extended Medicare Safety Net) Determination 2017 have had their caps increased. This change increases the caps of 40 capped items in the 13200 - 16600 range from 1 January 2020 and 13 capped items in the range 16603 to 82140 from 1 January 2020.
Indexation of Original Medicare Safety Net and Extended Medicare Safety Net thresholds
The Original Medicare Safety Net (OMSN) increases the Medicare rebate from 85 per cent of the schedule fee to 100 per cent of the MBS fee for out-of-hospital services, once the annual threshold amount has been met.
The Extended Medicare Safety Net (EMSN) benefits are paid in addition to the standard Medicare rebate and any benefit received through the Original Medicare Safety Net (OMSN). Under the EMSN, once the annual threshold is met, Medicare will pay up to 80 per cent of future out-of-pocket costs (for eligible out-of-hospital services) for the remainder of that calendar year. The EMSN benefit applies in addition to any OMSN benefit.
The thresholds have been indexed. The 2020 OMSN threshold will be $477.90. The 2020 EMSN concessional threshold will be $692.20. The 2020 EMSN general threshold will be $2,169.20.
Items 73336 and 73832
There were two new MBS Items introduced after the 1 November 2019 MBS XML was released (so they were not included in the November XML) but they were introduced in time for the MBS Book and MBS Online. These items have been incorporated in the January 2020 XML. These Items are:
- § MBS Item 73336 to expand testing of the BRAF gene to all patients with Stage III and Stage IV metastatic melanoma; and
§ MBS Item 73832 to ensure that the same requirements apply as for the performance of item 73805 (effective date 1 November 2019).
As part of the Department’s ongoing quality assurance processes of the output of the IT system that generates the MBS files, we have identified some minor inconsistencies between how MBS Items are reflected in the MBS XML, MBS Book and MBS Online, and the legislation under which Medicare Benefits are paid. This has necessitated some minor updates to these files to ensure the legislation and MBS files are consistent. The items affected are set out below:
MBS XML file and MBS Book
The following Items have been updated to better reflect the item associations under which the items can be claimed:
Category 5, Group I1: 55238, 55252, 55278, 55282, 55284, 55292, 55294, 55296, 55709, 55768
Category 2: 11614
For the following Items, there was some missing text in the item descriptor that has now been reinstated:
Category 5, Group I1 : 55704, 55705, 55708, 55710, 55711, 55718, 55722, 55723, 55726.
The titles of the date fields have been amended as follows:
o The Description Start Date field has been renamed to “Description Updated”; and
o The Schedule Fee Start Date field has been renamed to “Schedule Fee Updated”.
This is to more accurately reflect the dates on which the MBS items were last updated.
MBS XML file, MBS Book and MBS Online
The legislation under which Medicare Benefits is paid is being continually improved to reflect contemporary legislative drafting standards, which will be progressively reflected in MBS Items. For the January 2020 release, we have updated some Item Notes in the range AN to GN to include gender-neutral wording in the descriptors.