Medicare Benefits Schedule - Note IN.0.11

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.11

Capital Sensitivity Measure for Diagnostic Imaging Equipment

Almost all services listed in the Diagnostic Imaging Services Table of the Medicare Benefits Schedule (MBS), excluding Positron Emission Tomography (PET) services, have two different schedule fees - schedule '(K)' items (100 per cent of the MBS fee) and schedule '(NK)' items (approximately 50 per cent of the MBS fee) for diagnostic imaging services provided on aged equipment. 

This is known as the 'capital sensitivity measure', and it is in place for almost all diagnostic imaging equipment providing services (excluding PET) under Medicare.  The measure is intended to improve the quality of diagnostic imaging services by encouraging providers to upgrade and replace aged equipment as appropriate. 

On 27 November 2013, the remote location exemptions provisions that apply to CT items 56001-57361 and angiography items 59903-59974 were amended so they are consistent with other diagnostic imaging modalities. 

A regional exemption automatically applies if services are provided in a location in Remoteness Area (RA) outer regional, remote, or very remote.  Exemptions may be granted by the Department of Health (subject to particular criteria) to practices located in RA inner regional areas, where the location was previously under the Rural, Remote and Metropolitan Area (RRMA) classification system, RRMA4 or RRMA5. 

As there may be a number of diagnostic imaging providers which met the previous exemption criteria, but not the current criteria, a grandfathering provision will be implemented.  A diagnostic imaging provider which was eligible to claim schedule '(K)' items for CT and angiography services because they met the previous exemption criteria prior to 27 November 2013, may claim schedule '(K)' items until 1 July 2016.  This transition period will allow affected providers an opportunity to upgrade or replace their equipment. 

As part of the 2014-15 Federal Budget the Government announced the 'Medicare Benefits Schedule - revised capital sensitivity provisions for diagnostic imaging equipment' measure, which will strenthen the quality and safety of MBS diagnostic imaging services through alignment and consistency of the capital sensitivity measure across all modalities (except PET). 

This measure includes:

· the extension of the capital sensitivity measure to all angiography services, including the previously excluded MBS items 60000 to 60078;

  • introduction of a 'maximum extended life age' of 15 years for CT and angiography services; and
  • increasing the 'maximum extended life age' for MRI services to 20 years. 

The changes will take effect on 1 January 2015. 

After 1 January 2015, any CT and angiography machine that has not reached maximum extended life age (15 years) but has reached its new effective life age, and is upgraded before 1 January 2015 is eligible for K items from 1 January 2015, until the machine reached its maximum extended life age. 

After 1 January 2015, any CT and angiography machine that has not reached its maximum extended life age (15 years) but has reached its new effective life age, and is upgraded between 1 January 2015 and 1 January 2016 , is eligible for K items on and from the day that it is upgraded until the machine reached its maximum extended life age. 

Further detail 

For full details about the rules for claiming the schedule '(K)' and schedule '(NK)' items, the exemptions, and the definition of upgrade, providers should access the Department of Health's website at: www.health.gov.au/capitalsensitivity


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change