Please see the 1 January 2022 Downloads page for the latest files.
From 1 January 2022, there will be a number of changes to the MBS. These changes include minor administrative changes, continued telehealth arrangements, indexation to the fixed Extended Medicare Safety Net cap, Bulk-billing incentive changes, new items to support the suitability assessment for COVID-19 vaccine, a new item for cardiac MRI and the extension of temporary items to support the Governments response to the COVID-19 pandemic.
A number of changes to the General Medical Services Table (GMST), Diagnostic Imaging Services Table (DIST) and the Pathology Services Table (PST) will be implemented through the Health Insurance Legislation Amendment (2021 Measures No. 3) Regulations 2021 (the Regulations).
Summary of changes
Continued Telehealth arrangements
From 1 January 2022, patient access to telehealth services will be supported by ongoing MBS arrangements.
The ongoing arrangements build on the temporary telehealth items introduced as part of the Government's response to the COVID-19 pandemic, and will continue to enable all Medicare eligible Australian's to access telehealth (video and phone) services for a range of (out of hospital) consultations that can also be provided in person.
MBS telehealth items will continue to be available to GPs, medical practitioners, specialists, consultant physicians, nurse practitioners, participating midwives, allied health providers and dental practitioners in the practice of oral and maxillofacial surgery.
Patients will continue to be able to access a range of specialist (out of hospital) attendances provided either in person (face to face) or by video. Patients can continue to access specialist services by telephone for less complex or shorter subsequent attendances, with a practitioner they have seen before.
The telehealth items introduced in 2011 to encourage uptake of video telehealth in rural and remote areas and specific settings (50% loading items) will be replaced by the video telehealth items introduced during the pandemic (now available Australia wide). The patient-end support items associated with the 2011 telehealth arrangements will continue to be available where support is provided by an Aboriginal Health Worker, practice nurse or optometrist (available Australia wide), but not by a GP, medical specialist or other medical practitioner, midwife or nurse practitioner.
The telepsychiatry items introduced from 2002 will be replaced by the video telehealth items introduced during the pandemic (available Australia wide). The inpatient telehealth items introduced in September 2021 as a temporary measure during the COVID-19 lockdowns will no longer be available.
A new prescribed pattern of service will apply to telephone services provided by consultant physicians and GPs (a new ‘30/20 rule’).
GP’s and Other Medical Practitioner
From 1 January 2022 the COVID-19 GP and OMP telehealth arrangements introduced 1 July 2021, including short and longer telephone items, will continue to be available with the following changes.
Two new extended telephone consultation item for attendances 20 minutes or longer for patients in rural and remote communities (Modified Monash 6 and 7 regions) will be introduced.
The COVID-19 GP ‘hotspot’ telephone items for consultations longer than 20 minutes will cease and patients who are subject to COVID-19 public health orders requiring isolation or quarantine will continue to have unrestricted access to MBS telehealth services, without needing to demonstrate an established clinical relationship with their telehealth provider.
Specific GP nicotine and smoking cessation services including telehealth will be extended to 31 December 2023. GP sexual and reproductive health services and non-directive pregnancy support counselling will be extended to 30 June 2023. These services do not require an established clinical relationship when provided by telehealth.
Medicare compliance rules will be updated to include telephone and video services in the prescribed pattern of practice (the 80/20 rule), with a new ‘30/20’ rule for GP telephone services.
Superseded pre-COVID telehealth and associated items will be removed from the MBS to avoid multiple different MBS items for the same service. This includes GP and OMP mental health consultations and general attendances by video.
GP and OMP patient-end support items linked to pre-COVID medical specialist and consultant physician telehealth services will also be removed from 1 January 2021.
Nurse practitioner, midwifery, nursing and other allied health telehealth consultations will continue without change, with the exception of patient-end support services by nurse practitioners and midwives linked to pre-COVID medical specialist and consultant physician.
Extended Medicare Safety Net (EMSN)
The EMSN provides an additional Medicare benefit once an annual threshold in out-of-pocket costs for out-of-hospital services has been reached. Out-of-hospital services include GP and specialist attendances, as well as many pathology and diagnostic imaging EMSN cap to attending services. The Original Medicare Safety Net (OMSN) and EMSN thresholds are indexed annually on 1 January in line with the CPI (September Quarter). In addition to applying indexation the latest changes also include applying an EMSN cap to attendance items, coronavirus (COVID-19) telehealth items and one cardiac item.
2022 Medicare Safety Nets Thresholds
Who it’s for
What counts towards the threshold
What benefit you’ll get back
|Original Medicare Safety Net (OMSN)||$495.60||Everyone in Medicare||Your gap amount for the calendar year.||100% of the schedule fee for out of hospital services.|
|Extended Medicare Safety Net (EMSN)- General||$2,249.80||Everyone in Medicare||Your out of pocket amount for the calendar year.||80% of out of pocket costs or the EMSN benefit caps for out of hospital services.|
|Extended Medicare Safety Net (EMSN) - Concessional and Family Tax Benefit Part A||$717.90||Concession cardholders and families eligible for Family Tax Benefit Part A||Your out of pocket amount for the calendar year.||80% of out of pocket costs or the EMSN benefits caps for out of hospital services.|
The Health Insurance Legislation Amendment (Rural Bulk-billing Incentive) Regulations 2021 (Bulk-billing Regulations) will amend the GMST, DIST and PST to increase the bulk-billing incentive doctors working in rural and remote areas will receive. There will not be any changes to the bulk-billing incentive items 10990, 64990, 74990 for doctors in metropolitan areas.
The bulk-billing incentive items, which were previously for services rendered outside of metropolitan service will be amended to services rendered by doctors in Modified Monash area 2 (10991, 64991, 74991). The fees for these items will remain at 150% of the fee for the relevant metropolitan area item.
The afterhours bulk-billing incentive item 10992 will be amended to specify that the item applies to a service rendered in a Modified Monash 2 to 7 area if the medical practitioner has travelled from a practice location outside those areas (i.e. a metropolitan area).
The Bulk-billing Incentive Regulations will create new items for doctors in:
- Modified Monash areas 3 and 4 (75855, 64992, 75861) which is 160% of the fee for the relevant metropolitan area item;
- Modified Monash area 5 (75856, 64993, 75862) which is 170% of the fee for the relevant metropolitan area item;
- Modified Monash area 6 (75857, 64994, 75863) which is 180% of the fee for the relevant metropolitan area item; and
- Modified Monash area 7 (75858, 64995, 75864) which is 190% of the fee for the metropolitan area item.
General Practice Attendance for Assessing Patient Suitability for a COVID-19 Vaccine
Two new items will be introduced which allow qualified health professionals to provide vaccine suitability assessment services outside of a medical practice without on-site supervision by a medical practitioner. These new items are intended to target the provision of COVID-19 vaccines to vulnerable people who may have difficulty travelling to a medical practice.
Cardiac MRI for Myocarditis
A new temporary item for cardiac magnetic resonance imaging (MRI) to diagnose myocarditis associated with mRNA COVID-19 vaccination will be available temporarily from 1 January 2022. This item is for use in circumstances where myocarditis cannot be definitively diagnosed using conventional imaging and other diagnostic tests.
Extension of Cessation Dates and Pathology COVID-19 Services
The cessation date of the Pathology Services COVID-19 Determination which lists temporary COVID-19 pathology services will have its cessation date extended by six months (from 31 December 2021 to 30 June 2022 at 11.59pm).
Items 69479 and 69480 will also be amended to allow pathology providers to charge a fee above the Medicare benefit amount (to a maximum amount equal to the schedule fee) for private patients admitted to hospital. Patients who have elected to be treated as a private patient will be able to use their private health insurance to cover the services fee above the Medicare benefit amount. The schedule fees for items 69479 and 69480 will also be reduced by 15 per cent to reflect adjustments in the cost of providing the service. It will continue to be a requirement that out-of-hospital COVID-19 pathology tests be bulk-billed to attract a Medicare benefit.
Item 69501 will cease from 1 January 2022 as it is a test for asymptomatic drivers of heavy vehicles and rail crew and asymptomatic aged care workers in Victoria. This item is being deleted as these persons can access workplace or border control testing free-of-charge under the National Partnership on COVID-19 Response (NPCR) between the Australian Government and state and territory governments.
The Expansion of GP and Allied Health Mental Health Services Determination 2020, which lists temporary mental health treatment items, will have its cessation date extended by 12 months (from 31 December 2021 to 31 December 2022 at 11.59pm).
From 1 January 2022, the schedule fee for a cardiac lead extraction service (item 38358) will be increased and there will be an amendment to the requirement of a cardio-thoracic attendance service (item 90300) to prevent it from being claimed by a cardiothoracic surgeon if they also performed the lead extraction service; and
Item 51071 will be amended to allow for the removal of an extradural lesion or tumour where the pathology is confirmed by histology.
The Regulations amend the GMST, DIST and PST will also make a number of administrative changes to better align the items with the original policy intent of the service. This includes:
inserting notes into the DIST and PST to clarify that items listed in the applicable groups were indexed as at 1 July 2021;
- amending diagnostic imaging item 61560 to clarify the service is an R-type diagnostic imaging service;
- Updating references to the ‘Australian Defence Force Post-discharge GP Health Assessment’ tool in the GMST to the ‘Veteran’s Health Check’ tool to reflect the renaming of the tool by the Department of Veterans’ Affairs;
- amending orthopaedic item 49200 to remove the reference to bone grafting in alignment with recommendations from the MBS Review Taskforce Orthopaedic Clinical Committee;
- amending orthopaedic surgery item 49851 to clarify the service allows for an assistant by adding the term ‘Assist.’;
- amending the fee of three autologous fat grafting items (45534, 45535 and 45589) to ensure the 1 July 2021 indexation value is appropriately applied to these items;
- amending right heart catheterisation item 38254 to clarify it can be performed in conjunction with percutaneous coronary intervention services 38307, 38308, 38310, 38311, 38313 or 38314 in certain instances;
- amending endoscopic mucosal reduction item 32230 to clarify the service is to be performed within a period of six months following a diagnostic colonoscopy service (items 32222, 32223, 32224, 32225, 32226 or 32228);
- introducing a claiming frequency restriction which prescribes that item 66551 cannot be claimed by a patient if they have received a total of four glycated haemoglobin (HbA1c) testing items performed in the management of established diabetes (66551, 73812 or 73826) in the last 12 months and amending item 66551;
- amending cardiothoracic surgery item 38519 to ensure patients receive a Medicare benefit under all circumstances when an existing prosthetic heart valve is explanted immediately prior to a new valve being implanted; and
- amending cardiothoracic surgery item 38643 to ensure a Medicare benefit is available under all circumstances when a patient requires the division of thoracic cavity adhesions.