Bulk Bill Breast MRI and PET/CT

South Coast Radiology are now bulk billing breast MRI and PET/CT for the evaluation and diagnosis of patients who have, or are suspect of having breast cancer.
 
It is expected a total of 26,000 patients each year will benefit from these new Medicare rebates, effective 1 November 2019.

New Medicare Benefits Schedule (MBS) items for FDG positron emission tomography (PET) for the evaluation of breast cancer factsheet

What are the changes?

From 1 November 2019, Medicare rebates will be available for two new items for PET for the evaluation of breast cancer. The new items are:

  • A new item (61524) for whole body 18F-FDG PET study where the patient is referred by a specialist, or consultant physician performed for the staging of locally advanced (Stage III) breast cancer in a patient considered potentially suitable for active therapy.
  • A new item (61525) for whole body 18F-FDG PET study, where the patient is referred by a specialist, or consultant physician performed for the evaluation of suspected metastatic or suspected locally or regionally recurrent breast carcinoma in a patient considered suitable for active therapy.

Why are the changes being made?

The listing of these services was recommended by the Medical Services Advisory Committee (MSAC) in November The changes are supported by MSAC as safe, clinically appropriate and cost-effective services. Further details about MSAC applications can be found under MSAC Applications on the MSAC website www.msac.gov.au.

What does this mean for providers and referrers?

These new items may be requested by specialists or consultant physicians. General practitioners may not request these items.

Like all MBS-eligible PET services, these new items must be provided by a specialist or consultant physician who is credentialed under the Joint Nuclear Medicine Specialist Credentialing Program for the Recognition of the Credentials of Nuclear Medicine Specialists for Positron Emission Tomography overseen by the Joint Nuclear Medicine

Credentialing and Accreditation Committee of the Royal Australian College of Physicians (RACP) and the Royal Australian and New Zealand College of Radiologists (RANZCR).

How will these changes affect patients?

The changes will assist patients with advanced breast cancer to manage and plan their treatment, leading to improved health outcomes. Approximately 12,000 patients will benefit from these services each year.

 

New Medicare Benefits Schedule (MBS) items for magnetic resonance imaging (MRI) for breast cancer factsheet

What are the changes?

From 1 November 2019, Medicare rebates will be available for two new services for MRI for breast cancer. The new services are:

  • New items (63531 (K) and 63532 (NK)) for MRI of both breasts where the patient has a breast lesion, the results of conventional imaging examinations are inconclusive for the presence of breast cancer, and biopsy has not been possible.
  • New items (63533 (K) and 63534 (NK)) for MRI of both breasts where the patient has been diagnosed with breast cancer, discrepancy exists between clinical assessment and conventional imaging assessment, and the results of breast MRI may alter treatment planning.

A dedicated breast coil must be used for these new services. These services can be provided on both full and partial eligible MRI machines. A complete list of full and partial Medicare-eligible units by state and territory is available at MRI unit locations.

Why are the changes being made?

The Government is listing these services as an interim measure for four years, to allow time for research to be undertaken through the Medical Research Future Fund (MRFF) on the benefits and effectiveness of these services and further consideration by the independent expert committee, the Medical Services Advisory Committee (MSAC).

Further details about MSAC applications can be found under MSAC Applications on the MSAC website www.msac.gov.au.

How will these changes affect patients?

The changes will provide greater access for diagnosis for patients with possible breast cancer and assist in treatment and surgical planning in patients with invasive breast cancer, leading to improved health outcomes. It is estimated that 14,000 patients will benefit from these services each year.

 

Reference:

http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-MRIBreastCa

http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-PETBreast