November 2022 News

News containing information on changes to the MBS for 1 November 2022

Page last updated: 25 August 2022

The 1 November 2022, Medicare Benefits Schedule (MBS) files are available on the November 2022 Downloads page

Summary of Change for 1 November 2022

From 1 November 2022, there have been a number of changes to the MBS. These changes include minor administrative and policy changes, an increase in greatest permissible gap due to annual indexation, as well as the Government’s response to recommendations from the independent MBS Review Taskforce (the Taskforce) and the Medical Services Advisory Committee (MSAC). Further changes include the implementation of three legislative instruments which were made under subsection 3C(1) of the Health Insurance Act 1973.

A number of changes to the General Medical Services Table (GMST), Pathology Services Table (PST), Diagnostic Imaging Services Table (DIST) and the Health Insurance Regulations 2018 (HIR) will be implemented through the Health Insurance Legislation Amendment (2022 Measures No. 3) Regulations 2022commencing from 1 November 2022.

Details of the changes are as follows:

Medical Services

Cardiothoracic changes for the amendment of eight cardiothoracic surgery items (38510, 38513, 38516, 38517, 38555, 38556, 38557 and 38572) to ensure that these items align with best practice.

Deep brain stimulation changes for the introduction of new item 40863 for Parkinson’s disease, essential tremor and dystonia.

Varicose veins changes for the amendment of six varicose veins services, items (32520, 32522, 32523, 32526, 32528 and 32529) to allow co-claiming with appropriate venography services when required during varicose vein interventions.

Cardiac implantable loop recorder devices changes for the introduction of two new items (11736 and 11737) for the monitoring of electrical activity of the heart, continuously storing information as electrocardiograms and recording abnormal activity such as arrhythmias.

Paediatric surgery services changes for the introduction of two new items, items (30661 and 30662) to allow for surgical repairs following circumcision revision procedures. Further changes include amendments one item (43882) to specify it is an in hospital only service and to increase the schedule fee for items 44108, 44111 and 44114.

Chronic neuropathic pain changes for the introduction of a new item, item 39141 for remote programming of a neurostimulator for the management of chronic neuropathic pain.

Oculoplastic surgery changes for the amendment of item 45617 to ensure the item does not unintentionally exclude patients requiring appropriate treatment.

Melanoma services changes for the introduction of seven new items, items (31377 to 31383) for the excisions of clinically suspected melanoma and amend six existing items, items (31371 to 31376) to ensure clarity regarding appropriate claiming for melanoma excision services.

Orthopaedic services changes for the introduction of three new items (47790, 47791 and 47792) to address potential service gaps and amendments to five items (47967, 49212, 49236, 49215 and 49734).

Acupuncture services changes for the amendment of four items (193, 195, 197 and 199) and removal of item 173. The changes to items 193 to 199 allow all appropriately credentialled medical practitioners to provide acupuncture services (in addition to general practitioners) and clarify that item duration refers only to the time a clinician is physically present with an individual patient. The fee for item 195 has also been retrospectively indexed from 1 July 2022 in-line with annual indexation of the MBS services.

Renal Cell Carcinoma changes for the introduction of new item 36530 for cryoablation of renal cell carcinoma.

Practice Incentive Program (PIP) changes for the removal of PIP consultation items for Asthma, Cervical Screening and Diabetes in subgroup 8 of Group A7 and Groups A18 and A19. These items are no longer required due to the program ceasing on 31 July 2019.

Administrative changes for the amendment cardio-thoracic item 38417 to correct a typographical error, as well as amending items 11614, 35412 to remove redundant references to items that no longer exist. Administrative changes have also been made to gynaecology items 35657, 35673 and 35726 to provide clarity on appropriate co-claiming restrictions at the point of benefit claiming.

Pathology Services

National Cervical Screening Program (NCSP) changes for the amendment of cervical screening items 73072 and 73074 to expand access to self-collected cervical screening tests. The removal of item 73073 to avoid duplication of item 73072, as a result of amendments made to this item.

Genomic Testing changes for the introduction of seven new items (73422 to 73428) for genetic testing for the diagnosis of neuromuscular disorders (NMDs) .

Further genetic testing amendments include changes to item 73410 for genetic testing for the diagnosis of alpha-thalassaemia to clarify that patients with beta-thalassaemia may also access this service.

Administrative changes for the amendment of three items (75862, 75863 and 75864) by changing the item descriptors from ‘Commonwealth concession card holder’ to ‘concessional beneficiary’ to align with updated terminology in the National Health Insurance Act 1953.

Diagnostic Imaging Services

New Pelvic MRI changes for the introduction of a new item 63563 for conditions that affect fertility.

Obstetric and gynaecology changes for the introduction of one new MRI item (63549) and six ultrasound items (55740, 55741, 55742, 55743, 55757 and 55758) as well as amend item 63454, to help improve the health outcomes of pregnant women and help ensure the successful birth if their babies at term.

PET for rare and uncommon cancer changes for the introduction of a new item 61612 for positron emission tomography computerised tomography (PET/CT) for initial staging and management in patients diagnosed with rare and uncommon cancers, who are considered suitable for active therapy.

Liver MRI changes for the amendment of item 63545. This change will expand indications from colorectal cancer to include all cancer types that have potentially spread to the liver.

Breast MRI changes for the amendment of item 63464 to raise the age limit to include patients up to 60 years of age. Evidence confirms that cancers for the high-risk cohort caused by the genetic mutation called BRCA2 becomes apparent before age 60.

PET and Technetium 99-m changes for the amendment of three items (61333, 61336 and 61341) to provide patient access to alternative positron emission tomography (PET) imaging services during supply disruptions of the radiopharmaceutical technetium-99m.

Other changes

From 1 November 2022, there will be amendments to four items (2733, 2735, 941 and 942) to enable an administrative amendment to change the benefit calculation from 85% to 100% of the fee. This is an administrative change that reduces the fees of those items, so the benefit paid for the service remains unchanged.

The Greatest Permissible Gap is indexed on 1 November annually. From 1 November 2022, the maximum patient gap between the MBS fee and the benefits payable for out-of-hospital services increases to $93.20. The 85% benefit level will apply for all fees up to $621.50, after which benefits are calculated at the Schedule fee less $93.20.

Relevant legislation

Health Insurance Legislation Amendment (2022 Measures No. 3) Regulations 2022

The purpose of the Health Insurance Legislation Amendment (2022 Measures No. 3) Regulations 2022 is to amend the GMST, the PST, the DIST and the HIR. The Regulations will make changes to general medical, pathology and diagnostic imaging services.

Health Insurance (Section 3C Diagnostic Imaging – Nuclear Medicine Services) Amendment (PET and Technetium-99m) Determination 2022

The purpose of the Health Insurance (Section 3C Diagnostic Imaging – Nuclear Medicine Services) Amendment (PET and Technetium-99m) Determination 2022 is to amend the Health Insurance (Section 3C Diagnostic Imaging – Nuclear Medicine Services) Determination 2019 by making changes to items 61333, 61336 and 61341.

Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Amendment (Fee Alignment) Determination 2022

The purpose of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Amendment (Fee Alignment) Determination 2022 is to amend the schedule fees for four items, items 2733, 2735, 941 and 942 in Schedule 4 of the Health Insurance (Section 3C General Medical - Expansion of GP and Allied Health Mental Health Services) Determination 2020.

Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Amendment (Practice Incentives Program Consultation Items) Determination 2022

The purpose of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Amendment (Practice Incentives Program Consultation Items) Determination 2022 is to make amendments to the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018, by repealing redundant consultation items used for calculating the Practice Incentive Program, for non-specialist practitioner attendances, in relation to Asthma, Cervical Screening and Diabetes.