Notification of MBS changes to Cardiac Imaging Services effective 1st August 2020
The changes may affect patient eligibility for Medicare rebates
On 1 August 2020, the Australian Government made changes to some MBS items for cardiac imaging services. The changes may affect patient eligibility for Medicare rebates, in relation to the type of referral and when tests should be performed.
What this means for our patients
- The changes are intended to reduce patients’ exposure to unnecessary testing.
- Patients will only have cardiac services when clinically necessary.
- Services are performed safely in a way that aligns with clinical best practice and are billed in a consistent manner.
What this means for our referring GPs
- Cardiology services that may be affected include electrocardiogram (ECG), echocardiogram (echo), ambulatory ECG, ECG stress testing, myocardial perfusion studies and stress echocardiogram (stress echo – treadmill stress echo, dobutamine stress echo).
- Some item numbers have changed, been replaced, and added, and some cardiac imaging services have repeat referral restrictions. Further details are outlined below.
- For patients who do not meet the new criteria for imaging services (outlined below) please consider a referral to a cardiologist for consultation and review to access additional imaging item numbers.
We will work with you and your patients by discussing any rebate eligibility changes with your patients at the time of booking. Continuity of cardiac care is important, and we will be in contact with you should your patient decline imaging services due to these changes.
Our cardiologists continue to be available to provide medical advice. If you are aware of an urgent patient whose treatment cannot be delayed, or if you have any questions or concerns, please contact your local centre.
ECG changes, new items
11704 Twelve-lead ECG, tracing and report replaces 11700
11705 Twelve-lead ECG, report only where the tracing has been forwarded to a specialist not in association with a consultation on the same day replaces 11701
11707 Twelve-lead ECG, tracing only replaces 11702
11714 Twelve-lead ECG, performing a trace and interpretation is a new item for specialist/consultant physician use for performing an ECG trace and reporting, which can be claimed in conjunction with a consultation if clinically required.
Ambulatory ECG changes, new items
11716 Continuous ECG recording of a patient for 12 hour or more (Holter monitor) replaces 11709. Restricted to four weeks.
Echocardiography changes, GP requested new items
55126 Initial real time echocardiographic examination (Echo): provides access to a baseline initial echocardiographic examination that is an entry point for patients who may require ongoing echocardiographic examinations. A service under item 55126 is restricted to two years. 55126 is expected to replace 55113, 55114, 55115 in certain circumstances.
55128 (MMM3-7 area GPs only) Serial real time echocardiographic examination of the heart (Echo) for valvular dysfunction requested by medical practitioners in a Modified Monash Model (MMM) 3 to 7 area (Echo) for specific clinical indications is a new item. 55128 is expected to replace 55114 in certain circumstances.
55133 Frequent repetition serial real time echocardiographic examination (Echo) of the heart for isolated pericardial effusion or pericarditis or who has commenced medication for non-cardiac purposes that have cardiotoxic side effects is a new item.
For patients who do not meet the above criteria, please refer patient to a cardiologist for consultation and review for testing as per MBS guidelines to access Item numbers 55127, 55129 and 55132.
Stress echocardiography changes, GP requested new items
Items 55141, 55145, 55146 include the exercise ECG component (11729 or 11730), and replacing 55116 and 55117.
Exercise stress echocardiography (Treadmill stress echo) – restricted to two years
55141 Exercise stress echocardiography focussed stress study (Treadmill stress echo)
55145 Pharmacological stress echocardiography (Dobutamine stress echo)
55146 Pharmacological stress echocardiography (Dobutamine stress echo) following a failed exercise stress echo.
Exercise stress ECG – restricted to two years
11729 Multi-channel ECG monitoring and recording during exercise replaces 11712
11730 Multi-channel electrocardiography monitoring and recording during exercise for persons under 17 years replaces 11712 for this age group.
Further details are available on www.mbsonline.gov.au