MBS item changes to impact GPs

Matt Woodley

31/10/2019 3:33:52 PM

GPs now have to update billing practices related to heart health assessments, telehealth consultations, eating disorders and colonoscopy.

MBS logo.
MBS item changes are effective from November 1.

Changes to the Medicare Benefits Scheme (MBS) include new item numbers, different rebate percentages, and updated schedule fees.
However, while some updates have the potential to immediately impact clinical practice, others, such as those associated with heart health, are unlikely to have much effect.
Heart health assessment items
The new changes will see the rebate percentage for MBS item 699 – heart health assessment by a general practitioner lasting at least 20 minutes – increase from 85% to 100% of the fee.
However, the patient rebate value will remain at $73.95 despite the percentage increase, effectively reducing the scheduled fee for this service.
The rebate percentage for item 177 – heart health assessment by a medical practitioner (other than a specialist or consultant physician) lasting at least 20 minutes – will also change to 100% of the fee, ensuring the rebate value remains equivalent to a Level C consultation.
The Department of Health (DoH) has advised the changes are designed to align the two interim items for heart health assessments with other health assessment items in the MBS where patients receive 100% of the patient rebate.
However, RACGP concerns around the low rebate value and the limitations in Aboriginal and Torres Strait Islander Health have still not been addressed.
Telehealth consultations in rural and remote areas
Four new MBS items for attendance between a GP and their patient via video conference will be introduced for patients in rural and remote areas (items 2461, 2463, 2464 and 2465).
These items are claimable only if:

  • the patient is not an admitted patient
  • the patient is located within a Modified Monash 6 area or a Modified Monash 7 area
  • at the time of the attendance, the patient and the medical practitioner are at least 15 km by road from each other
  • the patient has received three face-to-face professional attendances from that practitioner in the preceding 12 months.
The GP providing the service does not need to be located in a Modified Monash 6 area or a Modified Monash 7 area.
Eating disorders
A new suite of 64 MBS items, including 11 items for GPs, will support patients with anorexia nervosa and other eligible patients with eating disorders.
The new listings stem from 2018 recommendations by the clinician-led MBS Review Taskforce and will allow patients with an eating disorder treatment and management plan will be able to access up to 40 psychological treatment services in a 12 month period.
The new item structure includes:
  • four new items (90250–90253) for the preparation of eating disorder treatment and management plans by GPs
  • one new item (90264) for the review of eating disorder treatment and management plans by GPs
  • four new items (90271–90274) for the provision of psychological treatment services by GPs
  • two new items (90279–90280) for the provision of psychological treatment services by GPs, if the attendance is by video conference.
The RACGP is currently clarifying the training requirements for the new items with the DoH.
More information is available via the RACGP website and a DoH factsheet.
Colonoscopy items
A number of changes will be made to the MBS items for colonoscopy services to ensure patients don’t undergo unnecessary procedures and that those most at risk receive timely access to when required. Items for colonoscopy procedures will also be better defined.
The changes were recommended by expert clinicians after nearly three years of consultation with stakeholders and patients, and will also see updated item definitions for colonoscopy procedures.
The revised item structure includes:
  • eight new items – seven for endoscopic examination of the colon to the caecum by colonoscopy (32222–32228), and one new item (32229) for the removal of one or more polyps during colonoscopy, in association with a service to which an item 32222 to 32228 applies
  • four deleted items
  • one new explanatory note to detail the appropriate use of items 32222 to 32229.
GPs seeking more information are able to consult MBS Online, which houses a factsheet summarising the changes, a Quick Reference Guide that includes detail to support the use of the new items, and information on the new item numbers and descriptors.
The RACGP Medicare Benefits Schedule fee summary will also be released shortly, while GPs may also access the college’s position statement on Billing for general practice services.

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Dr Janice Faye Sheringham   1/11/2019 9:49:35 AM

Re the rural and remote access to new Telehealth items, the restrictions of at least 3 prior FTF consults PER YEAR effectively castrates the usefulness of these items! I thought the idea was to make access for remote patients easier NOT HARDER! I can think of lots of situations where, without this limitation, patients living in 6/7 RR areas would truly benefit from Telehealth access for several follow-up visits, but it seems thus is not rebated adequately! Pity, opportunity lost.

Dr Diana May House   3/11/2019 5:05:12 PM

If patients ate registered regular patients of the practice and choose to travel around Australia can they and the GP access telehealth as an option for care if they need review and are remote at the time

Dr Maureen Anne Howard   16/11/2019 11:14:33 AM

On checking the DOH site for explanation of the new eating disorder items, I found that there are 64 new items relating to this. A sosurce of confusion from the start! I have had my receptionist on the phone to Medicare this week trying to find out if a patient who already has a Better Access MH Plan can also get access to the new items, or do they have to wait till their plans expire, and I could get no clear answer. Nor could I find this on websites given in this article. This is also the first time I've heard 'training requirements' mentioned, presumably for referring GPs. This should have been be clarified before the new items were rolled out.