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Upcoming changes to Ophthalmology MBS items 1/5

From 1 May 2017, a number of changes to Ophthalmology procedural Medicare Benefits Schedule (MBS) items will take effect. These have been a product of ongoing discussions between the College and the Department of Health.

Please note that these changes are not part of the formal MBS Review process. The MBS Review Ophthalmology Committee is expected to be announced later this year. The College will continue to update Fellows on the MBS Review and other changes to Ophthalmology MBS items.

One significant change that Fellows should note is the limitation placed on MBS item 42758 (goniotomy). In practice, this change means that glaucoma stents cannot be billed for MBS rebate using this item. This change came about despite repeated advocacy efforts by the RANZCO Medicare Advisory Committee and the Australia and New Zealand Glaucoma Society to explain the impact of this change to the Department of Health. RANZCO will continue to advocate for the proper inclusion of stents into the MBS schedule.

The full list upcoming changes, effective 1 May, are detailed below. Changes to existing item wording are presented in underline.

  • MBS item 42725: VITRECTOMY via pars plana sclerotomies including the removal of vitreous, division of bands or removal of epiretinal membranes, and including capsulotomy if performed.
  • MBS item 42734: CAPSULOTOMY, other than by laser, not being an item associated with items 42725 or 42731.
  • MBS item 42758: GONIOTOMY for the treatment of primary congenital glaucoma, excluding the minimally invasive implantation of glaucoma drainage devices (H).
  • MBS item 42788: LASER CAPSULOTOMY – each treatment episode to 1 eye, to a maximum of 2 treatments to that eye in a 3 year period, not being an item associated with item 42702.
  • MBS item 42789: LASER CAPSULOTOMY – each treatment episode to one eye – if it can be demonstrated that a third or subsequent treatment to that eye (including any treatments to which item 42788 applies) is indicated in a 2 year period, not being an item associated with item 42702.
  • MBS item 42791: LASER VITREOLYSIS OR CONTRICOLYSIS OF LENS MATERIAL OR FIBRINOLYSIS, excluding vitreolysis in the posterior vitreous cavity – each treatment to 1 eye, to a maximum of 2 treatments to that eye in a 2 year period.
  • MBS item 42792: LASER VITREOLYSIS OR CORTICOLYSIS OF LENS MATERIAL OR FIBRINOLYSIS, excluding vitreolysis in the posterior vitreous cavity – each treatment to one eye – if it can be demonstrated that a third or subsequent treatment to that eye (including any treatments to which item 42791 applies) is indicated in a 2 year period.
Last updated: November 9, 2018

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