News

The 1 May MBS DI changes affect items in the following MBS groups and modalities:

1. General Ultrasound
2. Cardiac, vascular and urology ultrasound
3. Obstetric & Gynaecology ultrasound
4. Musculoskeletal ultrasound
5. Computed tomography (CT)
6. Diagnostic radiology
7. Nuclear medicine
8. Magnetic Resonance Imaging (MRI) – (note the AMA will not be making changes to the AMA MRI items at this time.)

Detailed information on the MBS DI changes can be found in the Department of Health fact sheets and quick reference guides available on MBS online here.

The AMA Fees List team has been working as quickly as possible to review the large volume of diagnostic imaging items and associated changes. The types of MBS changes across all DI groups include:

• Capital sensitivity measure
  • ‘NK’ MBS items will be deleted and therefore Medicare benefits will no longer be payable for services provided on older diagnostic imaging equipment (except for those practices with a current approved exemption).
  • Whilst the AMA List does not differentiate between the age of equipment and the AMA List already has a single fee and item for the two MBS (NK) and (K) items, the deleted MBS (NK) items will be unlinked from the relevant AMA item.
• Administrative Changes to Imaging Requesting Provisions to ensure consistency with the overarching requesting provisions in section 16B of the Health Insurance Act 1973 and to provide clarity to specialists as to which item can be claimed.
• Removal of co-claiming restrictions for some items and additional claiming restrictions for others.
• Combining two or more items into one new item or splitting existing individual items into multiple items to enable better tracking of services provided.
• Commencement of new items and deletion of obsolete services.
• Amendments to item descriptors to better describe the service.

The AMA Fees List is expected to be updated to reflect the MBS changes to diagnostic imaging services by 15 May – two weeks after the MBS changes effect date of 1 May. The remaining 1 May MBS changes (ie non-DI services) will be published as soon as possible after 15 May.

The volume of MBS DI changes, the constrained timeframe (the AMA only having received detailed and accurate information from the Department of Health in March and April), and internal clinical consultation processes means that the AMA List update cannot be practically completed any sooner. The AMA has worked hard to ensure members and subscribers receive a timely and accurate update on the AMA List, within the existing constraints.

In addition, the AMA has only been recently made aware that for the 1 May DI changes, the Department has moved to align the MBS online item descriptors with the item descriptors in the Regulations. This approach differs from the usual approach, as the MBS online item descriptors are often presented and formatted for operational use and therefore often include important claiming information, whilst the Regulations is a legislative instrument and it is formatted for legal purposes as opposed to operational use.

The AMA has identified some potential unintended consequences for the approach of aligning the MBS online and Regulations item descriptors, without due consideration of the possible impacts. For example, the six MBS CT scan of spine items (56220, 56221, 56223, 56224, 56225 and 56226) and their corresponding AMA items (OD165 to OD171) currently have the following claiming restriction included in their item descriptor: “only 1 benefit payable whether 1 or more attendances are required to complete the service”. From 1 May 2020, this rule is moved from the descriptor to the explanatory note to align with the Regulations, thereby potentially burying this important claiming restriction and enabling the risk of increased patient out of pocket costs.

The AMA has raised this concern with the Department of Health who have advised that the 1 May changes are going ahead, as per the new information available on MBS online, which now aligns with the regulations. However, the Department will look into the issue and provide the AMA with further advice in due course.

With the extensive changes to MBS items, resulting from the MBS Review, the AMA reminds members to ensure they review all MBS item descriptors and claiming rules in the explanatory notes to ensure they meet the MBS claiming requirements and avoid compliance issues.

As the Fees List team are working remotely, all enquiries should be emailed to feeslist@ama.com.au for a prompt response.