Medicare Benefits Schedule - Note IN.2.3

Patient eligibility for the National Lung Cancer Screening Program (NLCSP)

As per the Medical Services Advisory Committee’s (MSAC) recommendation, the patient:

• is aged 50 to 70 years and 364 days; and
• is asymptomatic (no signs or symptoms of lung cancer); and
• currently smoke or have quit smoking in the past 10 years; and
• have a history of cigarette tobacco smoking of at least 30 pack-years.

Patient eligibility is assessed and confirmed by the requesting healthcare provider in line with clinical judgement.

CT dose

Refer to current Royal Australian and New Zealand College of Radiologists (RANZCR) guidelines for appropriate low-dose CT dosage – www.ranzcr.com/college/document-library/nlcsp-low-dose-chest-ct-acquisition-guidelines.

Screening low-dose CT scan (MBS item 57410)

The Screening low-dose CT scan is the test individuals undertake approximately every 2 years when they participate in the NLCSP, i.e. it is the service performed at the beginning of a 2-yearly lung cancer screening round. Noting that not all screening rounds remain on a consistent 2-year cycle as this is dependent on findings and the nodule management protocol.

Screening low-dose CT scan is restricted to one scan within a 2-year screening round.

The National Cancer Screening Register will send screening reminders 3 months prior to the commencement of a new screening round. This is particularly relevant in rural and remote regions where access to GP services and radiology services might take longer. The individual may see a healthcare practitioner and present earlier following receipt of the screening reminder. This item may be claimed for services rendered within the 3-month period prior to commencement of the 2 year screening round. There is no time limit on when an individual can present for their Screening low-dose CT scan after 2 years, pending all other eligibility criteria is satisfied.

Interval low-dose CT scans (MBS item 57413)

This item allows for follow-up management of a patient who requires it following a Screening low-dose CT scan (item 57410).

Following the screening low-dose CT scan, some individuals will require clinical follow-up based on the nodule management guidelines. This item enables individuals to access subsequent low dose CT scans, noting there is no time restriction for when individuals must present for clinical follow-up within their screening round.

The Interval low-dose CT scan must either be linked to an initial Screening low-dose CT scan within the past two years OR linked to a previous Interval low-dose CT scan which occurred within the 2-year time period of a Screening low-dose CT scan.

Lung nodule identification, classification, and reporting system for low-dose CT scan

The lung nodule management protocols were developed based on the MSAC recommended nodule management guidelines, which are:

• PanCan for the first Screening low-dose CT scan
• LungRADS for subsequent Screening low-dose CT scans and Interval low-dose CT scans.

Reporting of low-dose CT scan results

Results of the Screening low-dose CT scan and Interval low-dose CT scans are required to be reported to the National Cancer Screening Register in line with the National Cancer Screening Register Rules 2017. The report on the service is submitted using a standardised reporting form and communicated back to the requesting healthcare provider per usual practice.

Exemption to supervision requirements for low-dose CT services performed as part of mobile screening services for the NLCSP

Mobile screening services will be used in remote areas, more than 30km from fixed radiology infrastructure. Mobile screening will be used to support eligible participants who do not have access to fixed radiology infrastructure. In these circumstances low-dose CT scans for the NLCSP can be performed without the supervision of a radiologist. The low-dose CT scan can be conducted by a radiographer in these circumstances.

Related Items: 57410 57413

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Bulk bill incentive

Low-dose computed tomography (low-dose CT) scan of chest for the National Lung Cancer Screening Program, without intravenous contrast medium, where:

(a) the request states that the patient’s eligibility to participate in the National Lung Cancer Screening Program has been assessed and confirmed; and

(b) the service utilises the agreed nodule management protocol for standardised lung nodule identification, classification and reporting; and

(c) the service is bulk-billed

(R)

(Anaes.)

Fee: $338.75 Benefit: 75% = $254.10 85% = $287.95

(See para IN.2.3 of explanatory notes to this Category)

Bulk bill incentive

Low-dose computed tomography (low-dose CT) scan of chest for the National Lung Cancer Screening Program, without intravenous contrast medium, where:

(a) the service is:

(i) performed as a clinical follow-up within 2 years of a screening low-dose CT scan of MBS item 57410; or

(ii) performed as a clinical follow-up to a previous interval low-dose CT scan of MBS item 57413 linked to MBS item 57410; and

(b) the service utilises the agreed nodule management protocol for standardised lung nodule identification, classification and reporting; and

(c) the service is bulk-billed

(R)

(Anaes.)

Fee: $338.75 Benefit: 75% = $254.10 85% = $287.95

(See para IN.2.3 of explanatory notes to this Category)