Factsheet - Anaesthesia Age Modifier Changes - 1 May 2020 (PDF 300 KB)
Factsheet - Anaesthesia Age Modifier Changes - 1 May 2020 (Word 89 KB)
Quick Reference Guide Anaesthesia Age Modifier - 1 May 2020 (PDF 362 KB)
Quick Reference Guide Anaesthesia Age Modifier - 1 May 2020 (Word 96 KB)
What are the changes?
From 1 May 2020, two new anaesthesia age modifier items will be introduced on the Medicare Benefits Schedule (MBS) these include:
· item 25013 will be claimable for paediatric patients under four years old who have an eligible anaesthesia service.
· item 25014 will be claimable for patients 75 years or older who have an eligible anaesthesia service.
The new items will replace item 25015 and interim item 25012.
A Medicare benefit is only payable for anaesthesia which is performed in connection with an "eligible" service. An "eligible" service is defined as a clinically relevant professional service which is listed in the MBS and which has been identified as attracting an anaesthetic fee.
Why are the changes being made?
The creation of items 25013 and 25014 and the resulting deletion of items 25012 and 25015 is an administrative change to separate the paediatric and adult anaesthesia age modifier items and allow for easier processing of claims.
What does this mean for providers and consumers?
Billing practices from 1 May 2020 will need to be adjusted to reflect the new and deleted items.
How will these changes affect patients?
Patients will continue to receive MBS rebates for anaesthesia services that are clinically appropriate and reflect modern clinical practice.
Who was consulted on the changes?
The Australian Medical Association, the Australian Society of Anaesthetists and Private Healthcare Australia were consulted about these changes.
How will the changes be monitored and reviewed?
Anaesthesia items are subject to MBS compliance processes and activities, including random and targeted audits which may require a provider to submit evidence about the services claimed.
Significant variation from forecasted expenditure may warrant review and amendment of fees, and incorrect use of MBS items can result in penalties including the health professional being asked to repay monies that have been incorrectly received.
Where can I find more information?
The full item descriptors and information on other changes to the MBS will be available on the MBS Online website at www.mbsonline.gov.au. You can also subscribe to future MBS updates by visiting MBS Online and clicking ‘Subscribe’.
The Department of Health provides an email advice service for providers seeking advice on interpretation of the MBS items and rules and the Health Insurance Act and associated regulations. If you have a query relating exclusively to interpretation of the Schedule, you should email askMBS@health.gov.au.
Subscribe to ‘News for Health Professionals’ on the Services Australia website and you will receive regular news highlights.
If you are seeking advice in relation to Medicare billing, claiming, payments, or obtaining a provider number, please visit the Health Professionals page on the Services Australia website or contact Services Australia on the Provider Enquiry Line – 13 21 50.