Decisions on MBS Items – December 2015

Please note that the Department is undertaking a review of the previous Government’s decisions. The MSAC reviews are continuing as per the published MSAC review process.

Look up any current MBS item number on line in the schedule at MBS Online.
Draw a report from Medicare on MBS Item number utilization and payment from Medicare Australia.

  1. Lipectomy services (December 2015)
    ASPS Representative: James Savundra (WA), Alastair Taylor (ACT)
    Status: MSAC’s final report (November 2015) was submitted for a decision to the Ministers for Finance and Health. On 21 December 2015, ASPS was notified of amendments to lipectomy services effective 1 January 2016. Download the full mendments here. Read President Hugh Bartholomeusz’ Important Message about Lipectomy services (21 December 2015) about pre-booked surgery booked prior to 18 December 2015.
    Overview: ASPS representatives have largely maintained the status quo and improved the situation through consideration of a new circumferential lipectomy item number. Historical documents are archived below for reference:
    – ASPS President’s message (14 Oct 2015)
    – Download MSAC’s letter regarding lipectomy (Jan 2012)
    – Read more about the MBS Review on MSAC’s website.
  2. Botulinum Toxin injection services (updated September 2015)
    ASPS Representative: James Savundra (WA)
    Status: Commenced April 2012. Complete April 2014. Updated August 2015
    Final decision: Read the letter from the Department of Health (May 2014)
    Supply of PBS subsidised Botulinum toxin: 
    Download: Frequently Asked Questions (24 August 2015)
    Download: Extract from PBS in relation to the FAQs (24 August 2015)
  3. MBS item  45051 for contour restoration is subject to MCRP eff. 1 November 2015 (September 2015)
    The Department of Health wrote to ASPS regarding changes to the MBS Item 45051. Effective 1 November 2015, 45051 descriptor will be better defined and subject to MCRP scrutiny. Read to DoH letter.
  4. MBS item benefit and item descriptor inconsistencies for room based and hospital-only procedures (Jan 2015)
    The Department of Health wrote to ASPS Fees Committee regarding for a number of inconsistencies between 75% and 85% benefits and related descriptors. ASPS Fees Committee supports the proposed changes. Read the DoH letter.
    Also see Removal of 85% benefit of MBS items outside of recognised hospital settings.
  5. MBS 30192 and 30195 Inconsistent explanatory note T.8.9 relating to solar keratoses (Jan 2015)
    The Department of Health wrote to ASPS Fees Committee regarding housekeeping for inconsistencies with MBS 30192 and 30195 and an inconsistent explanatory text in note T.8.9. ASPS Fees Committee supports the proposed change. Read the DoH letter.
  6. MBS 45546 Nipple or areolar or both intradermal colouration (Dec 2014)
    The Department of Health wrote to ASPS Fees Committee to provide guidance on the use of MBS Item 45546 for cosmetic tattoo to complete breast reconstruction. Read the letter.
  7. MBS 30071 Diagnostic Biopsy of Skin or Mucous Membrane – Intepretation (December 2014)
    The Department of Health wrote to ASPS Fees Committee to provide guidance on the interpretation of MBS Item 30071 for multiple sites. Read the letter.
  8. Rhinoplasty Services Review (updated October 2014)
    ASPS Representative: Gwyn Morgan (SA), nominated by Council.
    Status: Commenced Jan 2012. Complete April 2014. Amended item numbers are effective 1 November 2014.
    Findings: The Review was conducted with the assistance of the Rhinoplasty Review Working Group, which comprised representatives of ASPS, ENT Surgeons, Oral and Maxillofacial Surgeons, and the AMA. The Review found that although rhinoplasty items were appropriate for use in a relatively small patient population with definite clinical issues, there was nevertheless marked growth and gender imbalance in utilisation. Accordingly, descriptors for 45638, 45639, 45641 , 45644, and 45650 have been amended to better reflect current Australian practice, identify indications for clinically relevant rhinoplasty services, and prevent potential leakage for cosmetic use.
    Final decision: Read the letter from the Department of Health (October 2014)Historical documentation:
    – Download MSAC’s letter regarding rhinoplasty (Jan 2012)
    – Read more about the MBS Review on MSAC’s website.
  9. Labioplasty/vulvoplasty Review (updated Oct 2014)
    ASPS Representative: Paul Belt (QLD)
    Status: Commenced Jan 2012. Complete April 2014. Amended item numbers are effective 1 November 2014.
    Findings: MSAC supported splitting MBS item 35533 into two new MBS items for:
    – congenital uro-gynaecological anomalies or the repair of female genital mutilation; and
    – localised gigantism.
    MSAC considered it appropriate for the localised gigantism item to be referred to the Medical Claims Review Panel to prevent potential use for cosmetic purposes. MSAC also supported restricting both items services to in-hospital use only which includes admissions for day surgery.
    Final decision: Read the letter from the Department of Health (Oct 2014)
  10. Wrist Ganglia surgery (updated October 2013)
    ASPS Representative: Shireen Senewiratne (QLD)
    Status: Completed in November 2013.
    – Download ASPS comments on the MSAC review of wrist ganglion (Feb 2013)
    – Read more about the MBS Review on MSAC’s website.
  11. MBS Items for mastectomy aligned for gender equality
    Two amended (31524, 45585) and two new (31519, 31525) mastectomy items have been approved effective 1 July 2014. Additionally, new and amended ultrasound item numbers are confirmed. The 85% out of hospital benefit is removed for 31519, 31525 and 31524. Download the Department’s letter re removal of gender specific language (June 2014).
    Read ASPS advocacy with Medicare regarding mastectomy items (Jul 2013).
  12. Removal of 85% benefit of MBS items outside of recognised hospital settings
    DoHA is reviewing a number of MBS items for the removal of the 85% benefit when the procedure is performed outside of recognised hospital settings, as defined by the Private Health Insurance Act 2007.
    – Various items are under review from Medicare. ASPS supports the removal of the 85% benefit for items 45020, 45823, 46486, 46489, 47385, 50115 and 50516 while retaining the benefits for items 31551,45027, 46516 and 47906. (October 2013)
    – Download the letter from DoHA (Dec 2012). Includes 45000-45996 & 46300-46534.
    – Download the ASPS letter of support (Oct 2012).
  13. MBS Item 30023 – debridement of wounds
    – The Department gave verbal assurance that descriptor and explanatory notes relating to 30023 use the word “OR” and are aligned (March 2014).
    – Download MSAC’s letter regarding MBS Item review 30023 (Dec 2011)
    – Download ASPS’ response (Jan 2012)
  14. MBS Review 30023 and 30049 – Soft tissue wounds
    Download Medicare’s letter regarding Amendments to MBS Explanatory Notes (Jul 2012)
  15. MBS Items 45553, 45554 – breast prostheses removal and replacement
    Download Medicare’s correspondence regarding amendments to the schedule for breast prostheses removal and replacement (Dec 2013).
  16. MBS Review 45585 including 31527 – Gynaecomastia
    Download Medicare and ASPS latest correspondence regarding Amendments to Liposuction for Gynaecomastia (Dec 2012) and Medicare’s previous letter (Jul 2012)
  17. MBS Review 45564, 45565 – Anastomoses and conjoint surgery
    Download Medicare’s letter regarding Amendments to anastomoses and conjoint surgery descriptors (December 2012)
  18. Extended Medicare Safety Net Benefit Caps
    Download the Letter to Profession regarding EMSN changes and the EMSN summary (October 2012)
  19. MBS Review 30001 – Explanatory note T.8.6 for abandonded surgery
    Download Medicare’s letter regarding Amendments to MBS Explanatory Notes (Jul 2012)
  20. MBS Review 45524 and 45558 – Augmentation mammoplasty with mastopexy
    Download Medicare’s letter regarding Amendments to MBS Explanatory Notes (Jul 2012)
  21. MBS Review 30210 and 30207 – Keloid scars
    Download Medicare’s letter regarding Amendments to Keloid Scars (Feb 2012)
  22. Poly-L-Lactic Acid
    Download draft item descriptors for items 14201 and 14202 (Sep 2011)

  23. Direct referral of patients from Optometrists to Ophthalmologists
    Download Medicare’s letter regarding direct referral of patients (Sep 2012)