As of 1st November 2018, MBS items for Thoracic medicine (sleep studies and Respiratory function testing) are changing. For Referrals containing these questionnaires, follow this link: http://thoracicandsleep.com.au/referrals-online-referral/
For MBS changes to diagnostic services for sleep disorders:
http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-SleepDisorders
General practitioners (GP’s) who want to refer patients for a diagnostic sleep study must use approved assessment tools to determine eligibility. For those who wish to refer directly to a sleep physician, the process remains unchanged.
For MBS changes to diagnostic services for respiratory function tests:
There will also be a number of new and amended lung function tests including the introduction of improved quality requirements, a contemporary list of MBS funded complex lung function tests, and a new higher-rebated item to encourage the use of well performed spirometry in general practice. For GPs referring for respiratory tests, we have summarised the new items below.
Please note: TSGQ routinely perform all of the tests listed below.
Direct referral pathway (i.e. the sleep studies GP’s can refer) include:
12203 – In lab diagnostic sleep study changes:
- GP referrals need a positive Epworth Sleepiness Score (ESS) > 8 AND one of either STOP BANG > 4 or OSA50 > 5 or Berlin Questionnaire
- One only per 12 months
12250 – Home diagnostic sleep study changes:
- GP referrals need a positive Epworth Sleepiness Score (ESS) > 8 AND one of either STOP BANG > 4 or OSA50 > 5 or Berlin Questionnaire
- Confirmation of booking no longer required to be sent to GP
- Must be applied by qualified sleep technician
- One only per 12 months
- Explanatory note: “Unattended sleep studies are suitable for many patients with suspected OSA but patients with other sleep disorders should undergo an attended study.”
Alternate referral pathway (i.e. studies a sleep/respiratory physician can refer) include:
12203 – In lab diagnostic sleep study
- One only per 12 months
12250 – Home diagnostic sleep study
- One only per 12 months
12208 – In lab repeat diagnostic sleep study
- A qualified sleep/respiratory physician has determined the study is required
- A sleep efficiency of < 25% noted in original diagnostic sleep study
- One only per 12 months
12204 – In lab CPAP sleep study – new item
- Must be preceded by qualified sleep/respiratory physician consultation
- One only per 12 months
12205 – In lab CPAP review sleep study – new item
- Must be preceded by qualified sleep/respiratory physician consultation
- Must have had physiological changes or recurrence of symptoms
- One only per 12 months
12207 – In lab non-invasive ventilation study
- Must be preceded by qualified sleep/respiratory physician consultation
- One only per 12 months
11503 – Updated – Laboratory complex respiratory function tests
- Includes a contemporary list of complex lung function tests commonly performed by TSGQ eg: lung volumes, gas transfer, high altitude simulation, 6 minute walk test
11505 – New – for GP Clinics – Spirometry (office based – higher rebate)
- Before and after bronchodilator
- 3 permanent recordings are made
- One only per 12 months
11506 – Updated – for GP Clinics – Spirometry (office based – lower rebate) (has been updated)
- Permanently recorded trace
- No limit on numbers of tests that can be performed
11507 – New – Spirometry + Fraction of exhaled nitric oxide (FeNO)
- Performed by respiratory scientist & includes relationship between flow and volume
- FeNO measured
- Specified standards to be met
11508 – New – Cardiopulmonary exercise testing (CPET)
- Only specialists can refer
- Performed by respiratory scientist
- Performed in a respiratory laboratory
- Specified standards to be met
11512 – Spirometry (respiratory lab based)
- Performed by respiratory scientist & includes relationship between flow and volume
- Before and after bronchodilator
- One only per 12 months
For more information on the changes to Medicare item numbers for Thoracic and Sleep Medicine refer to the links below:
http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-SleepDisorders
https://www1.racgp.org.au/newsGP/Professional/Changes-to-the-Medicare-Benefits-Schedule-What-GPs
