Home /About the MBS /News / The 1 November 2014 MBS files (DOC, PDF, ZIP, ASCII and XML) can now be downloaded from the 1 November 2014 downloads page. The following changes will take effect from 1 November 2014 (updated 30 October 2014): 18379 35534 57362 57363 63740 63741 63743 63744 63746 63747 66833 66834 66835 66836 66837 66838 66839 66840 66841 73339 73340 18356 18358 56025 56026 66599 66602 66608 66609 73328 73330 Chronic Disease and General Consultation Items A restriction will be introduced to prevent co-claiming of GP consultation items 3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60, 65, 597, 599, 598, 600, 5000, 5003, 5020, 5023, 5040, 5043, 5060, 5063, 5200, 5203, 5207, 5208, 5220, 5223, 5227 and 5228 with chronic disease management items 721, 723, or 732 for the same patient, on the same day. Home-based Sleep Studies Item Item 12250 will be amended to clarify that the item cannot be provided on the same occasion as another service mentioned in items 11000 to 11005, 11503, 11700 to 11709, 11713 and 12203.
An improved structure of fourteen items (18350 – 18373) for injecting botulinum toxin will be introduced. The updated structure will result in the removal of items 18356 and 18358 as the clinical indications for these items will be incorporated into existing botulinum toxin item 18354. Sixteen items (18350 – 18377) for injecting botulinum toxin will be updated to specify the full name of the applicable medicine - ‘Clostridium Botulinum Type A Toxin-Haemagglutin Complex (Dysport)’ and/or ‘Botulinum Toxin Type A Purified Neurotoxin Complex’ (Botox). A new item (18379) will be listed for the intravesical injection of Botox for the treatment of certain patients with urinary incontinence due to idiopathic overactive bladder. As a consequence, items 36851 and 37339 will be amended to ensure that a service to which the new item applies cannot be claimed with items 36851 and 37339. Assisted Reproductive Technology Items Amendments will be made to make clear that a treatment cycle for assisted reproductive services ends either;
if a service mentioned in item 13212, 13215 or 13221 is provided in connection with the series of treatments—on the day after the day on which the last of those services is provided or in all other cases not more than 30 days from when the treatment cycle begins. This is to ensure that patients with an irregular menstrual cycle are not disadvantaged. The restriction on claiming the introduction of an intra-uterine contraceptive device (35503) with a service which removes etonogestrel subcutaneous implant (30062) on the same day will be removed, as it maybe clinically appropriate for these two services to occur in the same consultation. Five rhinoplasty items (45632, 45635, 45641, 45644, and 45650) will be amended to include reference to clinical indications. Vulvoplasty item 35533 will be clarified by splitting it into two separate items (35533 and 35534) to include reference to clinical indications to which the service applies. Claiming of item 35534 will require pre-approval from the Medicare Claims Review Panel (MCRP).
Items 18350 to 18373 for Injections of Botulinum Toxin: Following an MBS Review of items 18350 to 18373 for injection of botulinum toxin, an improved structure of these items has been MBS-listed from 1 November 2014. Changes to Vitamin B12 and Folate testing items Items 66599 and 66602 have been deleted and new items 66838, 66839 and 66840 have been added to the Schedule for vitamin B12 and folate testing. Note that vitamin B12 and folate testing has been separated and folate testing is restricted to patients with risk of folate deficiency. A new item for the test of vitamin B12 markers has been listed. Changes to Vitamin D testing items Items 66608 and 66609 have been deleted and new items 66833, 66834, 66835, 66836 and 66837 have been added to the Schedule for Vitamin D testing. Note the patient criteria listed in the new item descriptors. Item for HbA1c test for diagnosis of Diabetes Mellitus Item 66841 has been added to the Schedule for HbA1c test for diagnosis of Diabetes Mellitus.
Two new items for RET Two new items have been listed for the detection of germline mutations in the RET gene in patients and with a suspected clinical diagnosis of multiple endocrine neoplasia type 2 (MEN2) and in an asymptomatic relative of a patient with a documented pathogenic germline RET mutation. Items 73336, 73337 and 73328 Inserting two current MBS items (73336 and 73337) into the Principle Regulation from the Health Insurance (Pharmacogenetic Testing) Determination 2013 (No.1) and the Health Insurance (Pharmacogenetic Testing Epidermal Growth Factor Receptor) Determination 2013. This will be an administrative change that ensures the Principle Regulation is reflective of current MBS pathology services. As a consequence, item 73328 will be removed as that item was made redundant when items 73336 and 73337 were listed on the MBS. Item 73330 has been superseded by item 73338 which has been added to the schedule by the Health Insurance (Pharmacogenetic Testing - Kirsten ras (KRAS)) Determination 2014.
As a consequence, item 73330 has been made redundant and has been removed. Replacement of CBCT dental items from 1 November 2014, with added restrictions on the new items From 1 November 2014, interim CBCT dental items 56025 and 56026 will be replaced with items 57362 and 57363, which have the following restrictions: The new items can be requested by medical practitioners and specialist dentists; To be Medicare eligible, services must be delivered in practices accredited under the Diagnostic Imaging Accreditation Scheme, and performed on dedicated (rather than hybrid) CBCT units; Claims for more than one CBCT per patient per day are excluded; Claiming with two-dimensional imaging in the same episode (items 57959-57969) and with CT in the same episode (items 56001-57361) is also excluded. In this sectionMBS Online - Archive NewsMBS Online RSSBefore November 2014, vitamin B12 and folate tests were linked in the same MBS item numbers (66599 and 66602) and could be used singularly or together to find vitamin deficiency.
Linking these tests resulted in difficulty identifying which test or tests were being ordered at an individual patient level and may have led to over-ordering. To encourage the quality use of testing under Medicare, vitamin B12 and serum folate are now listed as separate items.2 The following item numbers need to be used when investigating B12 levels.4 Serum vitamin B12 test (item is subject to rule 25*) Quantification of vitamin B12 markers such as holotranscobalamin or methylmalonic acid, where initial serum vitamin B12 result is low or equivocal† * Rule 25: For any particular patient, this item is applicable not more than once in a 12-month period † Check with laboratory pathologist to determine if this test is clinically warranted. Laboratories will perform serum B12 when indicated and when the result is ‘low’ or ‘equivocal’ (ie, not clearly replete and not clearly deficient) the laboratory pathologist can determine if holotranscobalamin or methylmalonic acid is required as a reflex test
Who requires vitamin B12 testing? The MBS review did not identify any prospective studies that evaluated the clinical indications for vitamin B12 testing.2 However, several guidelines recommend testing vitamin B12 levels to investigate the following clinical indications: initial evaluation of anaemia in chronic kidney disease5 initial evaluation of mild cognitive impairment or dementia in elderly patients.6, 7 The incidence of low vitamin B12 levels in Australia appears to increase with age (>65 years)8, 9 patients with Crohn's disease with macrocytic anaemia or who do not respond to iron treatment11 patients with symptoms or signs of macrocytic anaemia11 patients with chronic fatigue syndrome or myalgic encephalopathy, if they have already undergone pre-test investigations (such as full blood examinations).12, 13 Guidance on whether other special populations should be tested for B12 deficiency (eg, patients with suspect neuropsychiatric abnormalities) remains unclear.2, 11, 14, 15
MBS item number for folate testing The following item number needs to be used when investigating folate levels.4 Serum folate test and, if required, red cell folate test for a patient at risk of folate deficiency, including patients with malabsorption conditions, macrocytic anaemia or coeliac disease Who requires folate testing? The MBS review did not identify any prospective trials that evaluate the clinical indications for folate testing.1 With the introduction of mandatory folate fortification of wheat flour for bread-making in Australia, folate deficiency is now very rare.16, 17 However, folate deficiency may still occur in some people because of inadequate nutritional intake caused by poor diet, alcoholism, increased requirements such as in pregnancy and lactation, and impaired absorption and intake, for example, coeliac disease. Folate testing is not required to inform folate supplementation before and during pregnancy. All women should be given folic acid supplements prophylactically (0.5 mg/day, or 5 mg/day if at high risk of having babies with neural tube defects) for 1 month before conception and for the