Notification of MBS changes to Cardiac Imaging Services effective 1st August 2020
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.
Given the extent of these changes, it is important that all testing referrals are sent to CVS prior to booking to ensure your patient meets Medicare eligibility requirements.
What this means for our patients
This means patients will only receive testing when there is a clinical need, and eliminate unnecessary testing. Services are performed safely in a way that aligns with clinical best practice and are billed in a consistent manner. This approach is aligned with the CVS ethos of outstanding patient care and appropriateness in testing.
What this means for our referring practitioners
The changes may affect patient eligibility for Medicare rebates, in relation to the type of referral and frequency in which General Practitioners can request specific investigations. Cardiology services that may be affected include electrocardiogram (ECG), echocardiogram (echo), ambulatory ECG, ECG stress testing and stress echocardiogram (stress echo – treadmill stress echo, dobutamine stress echo). Item numbers have changed, been replaced, and added, and some cardiac imaging services now have repeat referral restrictions. Further details are outlined below.
Due to referral restrictions for imaging services, there will be patients who do not meet the new criteria (as outlined below), please consider a referral to a cardiologist for consultation and review to access additional imaging item numbers.
Given the extent of these changes, it is important that all testing referrals are sent to CVS prior to booking to ensure your patient meets Medicare eligibility requirements. We will discuss any rebate eligibility changes with your patients at the time of booking. To assist us in facilitating your patient’s needs, please ensure you clearly document the patient’s specific clinical indications on the request.
Summary of Cardiac Imaging Service changes:
12 Lead 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 Monitoring changes, new items
- 11716 Continuous ECG recording of a patient for 12 hour or more (Holter monitor) replaces 11709.
Restricted to one test every four weeks.
Initial 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 replaces 55113, 55114 and 55115 in certain circumstances.
- 55128 (MMM 3-7 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 to monitor pericardial effusion/pericarditis or assessing the effects of PBS medications. This test can be referred by any practitioner.
- For patients who do not meet the above criteria, please refer the 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 stress ECG component (11729 or 11730), and replace 55116 and 55117.
Exercise stress echocardiography (Treadmill stress echo) – restricted to one study every 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 (must be performed within 4 weeks of failed stress echo).
Exercise stress ECG – restricted to one study every 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.
Note: Clinical indications of "screening" or "asymptomatic" do not meet Medicare eligibility requirements and do not attract a rebate for Exercise stress ECGs or Stress Echos. CVS can still perform these requests, however the patient will incur a private fee.
A failed Exercise Stress ECG test can be repeated as a Dobutamine Stress Echo (Item 55146) within 4 weeks (requested by GP).
Our updated referral pads include information regarding all the changes and guidelines for referring doctors. Please see referral link for a list of our updated referral templates and writable PDF referrals.
If you have any questions or require clarification please contact us on 1300 887 997 or alternatively further details are available on www.mbsonline.gov.au
Our cardiologists continue to be available to provide specialist medical advice, if you have any questions or require clarification please contact us on 1300 887 997.