A GP's guide to the big MBS shake-up

Mr 2018 May22

GP rebates for post-bronchodilator spirometry tests are set to double after the Federal Government finally accepted calls by the Medicare Review Taskforce to improve the detection of serious respiratory conditions.

The MBS funds about 280,000 tests a year but there has been long-running concern that the $20.55 rebate is inadequate for the time involved.

The decision to accept the taskforce’s recommendations, which were first handed to the government more than a year ago, means from November, the rebate for item 11506 should rise to $40.

GPs will also be able to make referrals for Medicare-funded sleep studies for patients with a high pre-test probability of moderate to severe obstructive sleep apnoea.

The reforms are long overdue and have been welcomed by the profession.

But there was also despair last week at the other changes in the biggest shake-up to the MBS for more than a decade (see box).

The AMA and RDAA have already joined forces to demand the government reconsider its “insulting” decision to withdraw Medicare funding for GPs to use liquid nitrogen to treat skin cancer.


The key changes

  • New quality requirements and an increase in the rebate for GP-performed spirometry

  • GPs can refer patients with a high pre-test probability of sleep apnoea for sleep studies

  • GPs prevented from claiming items for cryotherapy on malignant lesions

  • A ban on GPs referring for MBS-funded MRI scans in patients over 50 with knee injuries

  • A new item to support dialysis in very remote areas

  • Funding for 3D breast tomosynthesis


From November, GPs, even those with skin cancer qualifications, will be banned from claiming item 30202, worth $48.35, for cryotherapy on malignant lesions. Instead they will have to refer patients to a dermatologist or plastic surgeon for removal of malignant neoplasms or mucous membranes. Items 30203 and 30205, which are claimed when performing multiple or complex cryotherapies, will be scrapped entirely.

Dr Philip Hayden, a skin cancer GP based in Logan, Queensland, said: “It is insulting to GPs to suggest we don’t know how to do this stuff. To say that a rural and remote GP can’t pick a skin cancer and know the right treatment for it is idiocy.”

The Medicare descriptor for 30202 stipulates that the lesions must be confirmed by histopathology or the opinion of a specialist for the item to be claimed.

The taskforce review said GPs ordered pathology in just 55% of cases. But it also acknowledged that GPs performed more than half of the 60,000 procedures annually and were more than twice as likely as dermatologists to request histopathology or biopsy.

Under the shake-up, patient rebates for GPs referring MRI scans in those aged over 50 with knee injuries will also be withdrawn.

The taskforce argued the age cut-off was needed because many MRI scans were being ordered for older patients in whom osteoarthritis might coexist with meniscal tears, and for whom MRIs had dubious clinical value.

“Including an age cut-off in the item descriptor will require GPs to follow a structured process to determine whether osteoarthritis is present for patients aged over 50,” it said.

The Australian Association of Muskuloskeletal Medicine has previously said a complete ban was not the right approach given GPs need the ability to address individual clinical scenarios.