26 Oct Changes to Medicare item numbers for Thoracic and Sleep Medicine
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