Medicare Benefits Schedule (MBS) Reviews prior to the MBS Reviews Taskforce

Page last updated: 19 January 2017

This page contains information on the reviews completed prior to the establishment of the MBS Reviews Taskforce in 2015. Many of these reviews were considered by the Medical Services Advisory Committee (MSAC). Minutes or public summary documents have been provided where MSAC considered the outcomes of a review. If a report is not available for one of the reviews below please email Surgical Services with your request and a copy will be emailed to you.

Reviews

Ambulatory electrocardiogram for arrhythmias

Arthroscopic hip procedures

Cardiac perfusion services

Colonoscopy

Ear, nose and throat services

Inguinal hernia surgery

Lipectomy services

Ophthalmology services, Stages 1 and 2

Paediatric services

Percutaneous coronary artery interventions

Pulmonary artery catheterisation

Skin services

Surgical treatment of obesity

Treatment of wrist and finger fracture services

Vulvoplasty
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Ambulatory electrocardiogram (AECG) for arrhythmias


This review was referred to the MBS Review Taskforce and the items were considered by the Cardiac Services Clinical Committee.

The purpose of the Ambulatory Electrocardiogram for Arrhythmias review was to consider the relative role of short, medium and long term heart monitoring, in the management of patients presenting arrhythmias to evaluate: clinical utility of different types of AECG monitors; the clinical roles of the different types of available AECG monitors; and clinical indications for use of the AECG monitors.

Review Report (PDF 10753 KB)
Review Report (Word 7529 KB)

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Arthroscopic hip procedures


This review was considered by MSAC in November 2015. The MBS amendments supported by MSAC came into effect on 1 November 2016.

In its review of therapeutic hip arthroscopy procedures, MSAC found a lack of evidence supporting the use of the service to treat femoroacetabular impingement (FAI, or hip impingement). As a consequence, MBS items 49366 (therapeutic hip arthroscopy), 49303 (hip arthrotomy) and 48424 (femur or pelvis, osteotomy or osteectomy) were amended to prevent their use for the management of FAI.

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Cardiac perfusion services


This review was considered by MSAC in April 2015. The MBS amendments supported by MSAC came into effect on 1 November 2015.

The review of cardiac perfusion was prompted by perceived concerns about the relative roles of medical perfusionist and clinical perfusionist services in Australia. The review determined that there was no evidence, nor any concerns for that matter, that safety and efficacy outcomes were different between the two groups. However, in order to address the economic issues revealed by the Department’s investigations, MSAC agreed that the MBS items for cardiac perfusion should be amended to prevent two providers, who were able to independently provide the service, from claiming payments for providing the same service at the same time.
MSAC supported a change to the descriptor for whole body perfusion, MBS item 22060, and the explanatory notes applying to medical perfusion, to incorporate the intent of:

• continuous attendance during the perfusion service;
• personal operation of the heart lung machine (HLM); and
• meeting the training requirements for perfusion set by the Australian and New Zealand College of Anaesthetists (ANZCA).

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Colonoscopy


This review was considered by MSAC in November 2011.

The 2011 review found strong evidence that colonoscopy was an effective diagnostic and therapeutic procedure. MSAC supported no amendments to existing MBS items.

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Ear, nose and throat services


This review was considered by MSAC in April 2015.

MSAC considered the two ENT surgery reviews stereotactic anatomical localisation, and obstructive sleep apnoea and supported no changes to the MBS items for ENT services as the evidence presented supported current service provision.

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Inguinal hernia surgery


This review was considered by MSAC in April 2015. The MBS changes supported by MSAC came into effect on 1 September 2015.

The purpose of the Inguinal Hernia Review was to examine whether the MBS items relating to the surgical repair of adult inguinal hernia (items 30609, 30612, 30614 and 30615) were being used appropriately; reflected contemporary evidence; improved health outcomes for patients; and represented value for money.

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Lipectomy services


This review was considered by MSAC April 2015. The MBS amendments supported by MSAC came into effect on 1 January 2016.

MSAC supported amendments to MBS items 30165, 30168, 30171, and 30177 so that they specified eligible patients’ indications—significant weight loss, refractory skin conditions and impeded activities of daily living.

It also supported MBS funding of two new items with the above indications specified:

• one that provides for three or more wedge excisions; and
• one for circumferential lipectomy.

MSAC also supported funding of a new MBS item for abdominoplasty following surgical removal of large intra-abdominal or pelvic tumours, but not MBS funding of abdominoplasty for post-partum women.

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Ophthalmology services, Stages 1 and 2


Stage 1 of this review was considered by MSAC in March 2012 and Stage 2 of this review was considered by MSAC in December 2012 and April 2013.

The primary focus of this review was to align Medicare-funded ophthalmology services with available evidence, and to ensure service delivery is targeted to the most appropriate patient groups. The Schedule lists approximately 160 ophthalmology items. Given the large volume of ophthalmic items the review was undertaken in two stages.

The first stage of the review considered 61 items. When MSAC considered the ophthalmology (Stage 1) review report in March 2012, it supported proposed item amendments and deletions.

The Stage 2 ophthalmology review was undertaken in 2012 and evaluated services which relate to: blockage or malfunction of lacrimal apparatus; corneal transplantation, corneal epithelial debridement, laser coagulation of the cornea, cataract needling of the posterior capsule and capsulotomy, glaucoma and various eye diseases. When MSAC considered the second stage of the Ophthalmology review at its December 2012 and April 2013 meetings, it supported the proposed amendments that arose from this review. No report was produced for Stage 2 of the Ophthalmology Review.

Both reviews had the full support of the ophthalmology profession.

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Paediatric services


This review was considered by MSAC in November 2014. The MBS changes supported by MSAC came into effect on 1 September 2015.

The Paediatric Services Review consisted of three stages:

Stage One


This stage recommended amendments to 27 MBS items to either redefine, mirror (existing items cover services in a person aged 10 years or over, and the new items in subgroup 11 for services in a person aged under 10 years) or delete items to reflect current clinical practices. It also proposed the introduction of a 30 per cent fee loading for 39 items in Group T8 where it has been demonstrated that those services are more complex and time consuming than the same service performed on an adult.

Stage Two


This stage focused on the provision of circumcision in an Australian context, in particular variation in the way the service is provided, use of anaesthesia and issues with different techniques. The review considered that a patient’s age should not be the determining factor for choosing an appropriate service and recommended that services might be more appropriately separated by the type of anaesthesia used.

The MSAC Executive supported the proposed changes in February 2016. These changes will come into effect from 1 November 2016. The four existing circumcision items on the MBS will be replaced by two new items: one for circumcision services performed under general or regional anaesthesia and one for all other circumcision services.

Stage Three


This stage evaluated additional listings of new paediatric services on the MBS as proposed by ANZAPS.

In August 2015, the Department closed off Stage Three of The Review by writing to the PSRWG stating the Department’s view was that no further action was required.

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Percutaneous coronary artery interventions


The purpose of the Percutaneous Coronary Interventions (PCI) review was to examine whether MBS-funded PCI is a clinically necessary, safe and effective service.

The review considered the relative role of coronary interventional procedures, such as angioplasty and coronary stent insertion, in the management of patients presenting with coronary artery disease to evaluate:

• clinical utility of different types of coronary artery stents;
• the clinical roles of the different types of available PCIs; and
• clinical indications for PCI.

This review was referred to the MBS Review Taskforce and the items were considered by the Cardiac Services Clinical Committee.

PCI Review Report (PDF 3903 KB)
PCI Review Report (Word 2002 KB)
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Pulmonary artery catheterisation


This review was considered by MSAC in November 2011.

The 2011 review found that even after 40 years of using PAC around the world, the published evidence was inconclusive as to whether or not there was a benefit in using the procedure for haemodynamic monitoring in the theatre and ICU settings. MSAC supported no amendments to existing MBS items.

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Skin services


This review was considered by MSAC in November 2015. The MBS changes supported by MSAC came into effect on the MBS on 1 November 2016.

The review considered current skin excision items 31200-31335 (excluding items 31245 and 31250), the biopsy item 30071 and the flap items 45000, 45003 and 45200-45207. These items have been restructured to reflect best clinical practice and to simplify the schedule by reducing the number of items.

The changes included:

• a restructure of 48 current skin excision items to 21 new skin excision items,
• the creation of two more restricted items for flap repair and the amendment of items 45000, 45003 and 45200-45207 to prevent their use
for closure of skin cancer excisions,
• the creation of five new items for the biopsy or excision of lesions from mucous membranes,
• two item amendments to separate the biopsy or excision of lesions of mucous membranes from two existing items and
• an amendment to item 31340 to reflect the new arrangements.

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Surgical treatment of obesity


This review was considered by MSAC in November 2011. The MBS amendments supported by MSAC came into effect on 1 July 2013.

The 2011 MBS review of bariatric surgery review found that the clinical outcomes from bariatric surgery were better and more cost effective in the long-term than non-surgical interventions for managing obesity.

MSAC supported amendments including five new MBS items for bariatric surgery to replace three existing and changes to other existing items.

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Treatment of wrist and finger fracture services


This review was considered by MSAC in April 2015. The MBS amendments supported by MSAC came into effect on 1 May 2016.

The aim of reviewing the wrist and finger fracture items was to amend existing MBS items so they better reflect fracture pathologies and current treatments. The 16 previous items for finger fractures and the six previous items for wrist fractures were repealed, being replaced by seven new items for finger fractures and six new items for wrist fractures.

Amendments were drafted in consultation with relevant professional medical groups.

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Vulvoplasty


This review was considered by MSAC in April 2014. The MBS amendments supported by MSAC came into effect on 1 November 2014.

MSAC supported the removal of rebates for out-of-hospital services and the replacement of former MBS item number 35533 (vulvoplasty) by two items: 35533 (surgical repair of female genital mutilation and major congenital anomalies) and 35534 (surgical repair for localised gigantism causing significant functional impairment), payable only on demonstrated clinical need.