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Upcoming MBS changes GPs need to know
From 1 November, a number of MBS changes will be instituted that are likely to have some impact on general practice.
Changes to the MBS will come into play from 1 November.
Changes to the Medicare Benefits Schedule (MBS) will have some impact on general practice as of 1 November, including for melanoma excision services and cycle-of-care items for chronic disease management. newsGP summarises the key changes.
Removal of cycle-of-care items
Cycle-of-care items for cervical screening, diabetes and asthma – items in Subgroup 8 of Group A7 and Groups A18 and A19 – will be removed from the MBS on 1 November
These items were previously attached to Practice Incentives Program (PIP) payments which ceased on 31 July 2019.
The RACGP is aware of GPs who have co-claimed cycle-of-care items with chronic disease management services, and had these rejected earlier this year, despite co-claiming of these items being permitted under MBS billing rules.
The college understands this was due to a system issue, and providers are now able to resubmit these claims – provided the date of service is before 1 November 2022. Payments for claims that were submitted and placed on hold should now have been released.
There is no time limit for resubmitting a rejected claim, nor for patients to submit a claim for a service that was privately billed. However, section 20B(2)(b) of the Health Insurance Act 1973 states that a claim for an assigned Medicare benefit (bulk bill) must be lodged within two years from the date of service. An application to extend the two-year lodgement period is known as a ‘bulk bill late lodgement’ and must be submitted on the correct form.
Due to the upcoming removal of the cycle-of-care items, any claims with a date of service after 1 November will be rejected.
The RACGP is aware that the removal of the PIP incentives caused some confusion among members and in response has provided feedback to the Department of Health and Aged Care (DoH) about the continuation of the cycle-of-care items for more than three years. The college will continue to engage with the DoH to ensure a clearer process of item removal is followed in future to ensure minimal impact on the profession.
Changes to melanoma services
Seven new items (31377–31383) will be introduced for the excisions of clinically suspected melanoma, while six existing definitive excision items (31371–31376) will be amended to ensure clarity regarding appropriate claiming for melanoma excision services.
Providers will be able to claim one of the seven new MBS items for clinically suspected melanoma services in the first instance, pending histological confirmation of malignancy. Once malignancy is confirmed, a provider would then perform a wide excision and claim an existing definitive excision item.
The RACGP will be engaging with the DoH regarding the rebate values of the new items for clinically suspected melanoma, which represent a significant drop in value from previously claimed items.
The new items have lower rebates than those for existing MBS items for benign lesions, which have a far lower risk profile and required skill level. More information is available on the RACGP website and MBS Online.
Changes to acupuncture services
Attendance item 173 (professional attendance at which acupuncture is performed) will be removed on 1 November.
In addition, items 193, 195, 197 and 199 will be amended to allow all appropriately credentialled medical practitioners to provide acupuncture services (in addition to GPs) 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 MBS services.
Changes to group therapy items under the Better Access initiative
Currently, group therapy items under the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (Better Access) initiative require a minimum of four participants in attendance for the relevant MBS item to be claimed.
From 1 November all Better Access group therapy items will apply to a service where only three patients attend if:
- four patients were due to attend; and
- one of the patients is unable to attend.
This change is to encourage the uptake of group therapy by helping practitioners overcome barriers related to group attrition, including due to fluctuating participant motivation and wellness, or unforeseen circumstances preventing a participant attending on a given day. It also allows group therapy with fewer than four people, as long as the course of group therapy began with at least four in the group.
Extension of COVID-19 response measures
Separate to the 1 November changes, GPs are reminded of the following measures introduced in response to COVID-19 that have been extended:
- Patients with COVID-19 are to remain exempt from the existing clinical relationship requirement for telehealth until the end of the year. The rule is being backdated to 13 October, when the state isolation requirements ended. It means that any patient with a positive COVID-19 test (PCR or rapid antigen) in the past seven days will be able to access MBS-subsidised telehealth care from any GP, regardless of whether they have attended the clinic in the past year. The RACGP’s frequently asked questions on the existing relationship requirement has more information.
- MBS items for COVID-19 antiviral prescribing via phone lasting more than 20 minutes (item 93716) and for face-to-face assessment and management of a patient with COVID-19 (item 93715) has been extended until 31 December.
More information
A full list of all changes taking effect on 1 November is available on
MBS Online, along with accompanying
fact sheets.
The RACGP’s
MBS online tool allows GPs to enter fees for services provided in their practice. It will automatically calculate the patient out-of-pocket contribution based on the Medicare rebate. GPs can also click through to the full item descriptors on MBS Online.
The RACGP’s lists can be used or a customised list of items can be created. All lists can be downloaded and printed.
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chronic disease management cycle-of-care items general practice billing MBS Medicare items
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