Update on Medicare Benefits Schedule (MBS) items for cataract surgery
Overview of amendments to Cataract items over November 2009 (PDF 24 KB)
Recently, there have been several changes to the Medicare-funding arrangements of cataract surgery. This has arisen from a number of actions taken by the Senate to disallow the Medicare items for cataract surgery. These changes have been confusing for both patients and providers, and this message will provide clarity around the rebates applicable to services performed during November 2009.
Following the disallowance of the Medicare items by the Senate on 25 November 2009, the Government has issued revised regulations to ensure patients can still access Medicare-funded cataract surgery. This means that different rebates will apply for services performed between 1 and 25 November 2009, and for services performed on 26 November 2009 onwards.
The revised regulation, effective from 26 November 2009, will see an amended fee of $491.85 for the most common cataract procedure (item 42702). It is important to note that Item 42718, which provided for complex cataract procedures, was not remade in the revised regulation. This means that Medicare benefits will not be payable for this service from 26 November 2009 onwards.
For patients who have undergone a cataract service on or since 26 November 2009 the following fees and rebates will apply:
Current MBS Rebates - effective from 26 November 2009
Item | Health service | Schedule Fee | 75% rebate | 85% rebate |
| 42698 | Lens extraction, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye (Anaes.) | $375.95 | $282.00 | $319.60 |
| 42701 | Artificial lens, insertion of, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye (Anaes.) | $231.75 | $173.85 | $197.00 |
| 42702 | Lens extraction and insertion of artificial lens, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye (Anaes.) | $491.85 | $368.90 | $422.75 |
For patients who have undergone a cataract service between 1 November and 25 November 2009 the following fees and rebates will apply:
MBS Rebates - effective between 1 November 2009 and 25 November 2009
Item | Health service | Schedule Fee | 75% rebate | 85% rebate |
| 42698 | Lens extraction, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye (Anaes.) | $350.95 | $263.25 | $298.35 |
| 42701 | Artificial lens, insertion of, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye (Anaes.) | $206.75 | $155.10 | $175.75 |
| 42702 | Lens extraction and insertion of artificial lens, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye (Anaes.) | $454.35 | $340.80 | $386.20 |
| 42718 | Complex lens extraction and insertion of artificial lens, with a surgical procedure time of 40 minutes or more, excluding surgery performed for the correction of refractive error (other than anisometropia greater than 3 dioptres following the removal of cataract in the first eye) (Anaes.) | $900.75 | $675.60 | $831.65 |
Medicare Australia is responsible for administering the Medicare program. Patients and providers seeking further information are encouraged to contact Medicare Australia on 132 011 for patients, and 132 150 for providers.