The Revised 1 January 2020 MBS XML and Book files (PDF, DOC and ZIP) can be downloaded from the 1 January 2020 downloads page. The revisions to the 10 January 2020 versions of the XML and Book files are necessary to include 36 new mental health items with an effective date of 17 January 2020, as part of the Supporting the Mental Health of Australians Affected by Bushfires Package.
SUMMARY OF CHANGES INCLUDED IN THIS EDITION
Mental Health Services for Bushfire Response
On 12 January 2020, the Prime Minister, the Hon. Scott Morrison MP, announced more mental health services will be provided immediately to firefighters, emergency personnel, individuals and communities impacted by the ongoing bushfire disaster. As part of this response, extra mental health services, including telehealth services, are available under the Medicare Benefits Schedule (MBS) to people whose mental health is adversely affected by a bushfire which occurred in the 2019-20 financial year. Further information on the bushfire response is available at Department of Health - Bushfire information and support and Mental Health Services for Bushfire Response Factsheet.
From 17 January 2020, 36 new items (items 91000 to 91731) are available for any patient who is considered to have had their mental health adversely affected by bushfire in the 2019-20 financial year is eligible for services. Eligible patients may be identified by a psychologist, a GP or medical practitioner, or a social worker or occupational therapist. Alternatively, patients may identify themselves and request a mental health service from an eligible practitioner. The services are available to anyone whose mental health has been affected by the bushfire crisis, and are not restricted to people living in areas directly affected by bushfire.
Patients are not required to have a referral from a medical or allied health practitioner in order to access the services. In addition, patients wishing to access the new items via video conference are not required to have an existing relationship with the treating practitioner, and there is no distance restriction on the services. This will support patients residing in communities affected by bushfire to access mental health services, where required.
MBS Mental Health and Well-Being Telehealth Support Services for Patients Affected by Bushfire
From 10 January 2020, people affected by bushfire in the 2019-20 financial year will be able to access MBS telehealth and well-being services provided by GPs and medical practitioners using MBS items 2121, 2150, 2196 (for GPs) and 894, 896, 898 (for medical practitioners).
Eligible patients may be identified by a GP or medical practitioner as being affected by bushfire; or may self-identify as being affected by bushfire.
In addition to people who reside in areas directly affected by the bushfires, eligible patients may include people who reside in areas which have not been directly affected by the bushfires. This is intended to cover emergency personnel who assisted in the bushfire fighting and recovery effort.
Cessation of temporary nuclear medicine items
Amending item descriptors for nuclear medicine items 61311, 61332, 61333, 61336, 61337, 61341 and 61344 to clarify that they were only available for use from 14 September 2019 until 20 December 2019.
New Item 25012 for the Anaesthesia, Perfusion or Assistance in the Management of Anaesthesia for Patients Aged over 3 Years Old But Under 4 Years Old
On 1 November 2019, changes were introduced through the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019 which changed the age parameters in the descriptor for item 25015. The change to the item descriptor was introduced to better reflect the anaesthesia complexities of the patients of this age cohort.
The Health Insurance (Section 3C General Medical Services – Childhood Access to Anaesthesia) Determination 2019 (the Determination) will add a temporary item to the Medicare Benefits Schedule to provide for the anaesthesia, perfusion or assistance in the management of anaesthesia for patients aged over 3 years old but under 4 years old. The service will move into the GMST from 1 May 2020.
The purpose of the Determination is to allow benefits to be available for patients over three years of age but under four years of age as their physical status results in an increase of complexity of anaesthesia. To this effect, the amendments are taken to have commenced from 1 November 2019.
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:
- The Description Start Date field has been renamed to “Description Updated”; and
- The Schedule Fee Start Date field has been renamed to “Schedule Fee 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.