New Colonoscopy Medicare Rebate Rules

New Medicare item numbers for colonoscopy will apply from 1 November 2019. This is to pave the way for the complete roll out of the National Bowel Cancer Screening Program (NBCSP) in 2020. This is the most dramatic change to the access of colonoscopy since the item number was created in the MBS a few decades ago. Referring doctors are advised to refer to the new MBS guidelines to avoid patient’s claims being rejected by Medicare.

  1. This essentially means that 3 main groups of patients will be affected:
  2. Most patients with between 1 and 4 sub-centimetre colonic tubular adenomas with low grade dysplasia will only be allowed one colonoscopy every 5 years. More frequent colonoscopies will be rejected by Medicare.
  3. Family history is defined as a First Degree Relative (FDR) aged below 55, or 2 (FDR) of any age, or one (FDR) and 2 Second Degree Relatives of any age. These patients are allowed one colonoscopy every 5 years only. Medicare will reject colonoscopies outside these criteria.
  4. Patients are allowed one asymptomatic colonoscopy per lifetime after 1/11/2019.

There are NO restrictions on patients accessing colonoscopies if they have new symptoms.

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