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How the Government’s 2009-10 Federal Budget Measure will affect patient out-of-pocket costs

The AMA has prepared a list of the MBS items and the amount of the cuts to the Medicare rebates that will apply from 1 November 2009.  A template letter is available so that medical practices can inform their patients about the Government's decision to withdraw its support to patients and to obtain informed financial consent.

01 Feb 2010

Since 1 November 2009 Medicare rebates are no longer payable for aspiration and/or injection of a joint or other synovial cavity (joint injections).

From 1 November 2009 Medicare Benefits Schedule (MBS) fees for coronary angiography have been reduced by 20%.

From 1 February 2010 MBS fees for cataract surgery are 12% less than they were on 31 October 2009.

The AMA has prepared a list of the MBS items and the amount of the cuts to the Medicare rebates.  A template letter is available so that medical practices can inform their patients about the Government’s decision to withdraw its support to patients and to obtain informed financial consent.

Joint injections

Coronary angiography

Cataract surgery

Injection into Joint or Other Synovial Cavity

The following table shows the difference between the Medicare rebate payable for services provided before and after 1 November 2009, and the amount of the extra out-of-pocket cost to the patient because of the Government’s decision to withdraw Medicare funding joint injection.  As most joint injections services are provided outside the hospital setting, the table provides the rebate payable for an out of hospital service (i.e. the rebate is 85% of the MBS fee).

While the Government has removed items 50124 and 50125 from the MBS, AMA items MY095 and MY100 have been retained in the AMA List of Medical Services and Fees as clinically appropriate, stand-alone services.

MBS Item     Item Descriptor Rebate payable before 1 November 2009Rebate payable after 1 November 2009Cost shifted to patient
50124JOINT or other SYNOVIAL CAVITY, aspiration of, injection into, or both of these procedures$23.25       $0$23.25
50125JOINT OR OTHER SYNOVIAL CAVITY, aspiration of, or injection into, or both of these procedures - where it can be demonstrated that a 26th or subsequent treatment is indicated         $23.25$0 $23.25

Template letter to provide patients with informed financial consent for joint injection

Coronary Angiography

The following table shows the difference between the Medicare rebate payable for services provided before and after 1 November 2009, and the amount of the extra out-of-pocket cost to the patient because of the Government’s decision to cut the MBS fee for coronary angiography by 20%.  As most coronary angiography services are provided as part of hospital treatment, the table provides the rebate payable for an in-hospital service (i.e. the rebate is 75% of the MBS fee).

MBS Item  Item Descriptor Rebate payable before 1 November 2009 Rebate payable after 1 November 2009 Cost shifted to patient
38215SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material into the native coronary arteries$307.35      $251.55$55.80
38218SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography$461.05$377.30$83.75
38220SELECTIVE CORONARY GRAFT ANGIOGRAPHY placement of catheter(s) and injection of opaque material into free coronary graft(s) attached to the aorta (irrespective of the number of grafts)$153.70      $125.80$27.90
38222SELECTIVE CORONARY GRAFT ANGIOGRAPHY, placement of catheter(s) and injection of opaque material into direct internal mammary artery graft(s) to one or more coronary arteries (irrespective of the number of grafts)$307.35     $251.55$55.80
38225SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material into the native coronary arteries and placement of catheter(s) and injection of opaque material into free coronary graft(s) attached to the aorta (irrespective of the number of grafts)$461.10     $377.35 $83.75
38228SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material into the native coronary arteries and placement of catheter(s) and injection of opaque material into direct internal mammary artery graft(s) to one or more coronary arteries (irrespective of the number of grafts)      $614.85 $503.20$111.65
38231SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material into the native coronary arteries and placement of catheter(s) and injection of opaque material into the free coronary graft(s) attached to the aorta (irrespective of the number of grafts), and placement of catheter(s) and injection of opaque material into direct internal mammary artery graft(s) to one or more coronary arteries (irrespective of the number of grafts)          $768.45$628.95$139.50
38234SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of catheter(s) and injection of opaque material into free coronary graft(s) attached to the aorta (irrespective of the number of grafts)        $614.75$503.10$111.65
38237SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of catheter(s) and injection of opaque material into direct internal mammary artery graft(s) to one or more coronary arteries (irrespective of the number of grafts)         $768.45$628.90$139.55
38240SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of catheter(s) and injection of opaque material into free coronary graft(s) attached to the aorta (irrespective of the number of grafts) and placement of catheter(s) and injection of opaque material into direct internal mammary artery graft(s) to one or more coronary arteries (irrespective of the number of grafts)        $922.05$754.65$167.40
  38246 SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography followed by placement of catheters prior to any coronary interventional procedure         $768.45 $628.90

$139.55

Template letter to provide patients with informed financial consent for coronary angiography

Cataract Surgery

The following table shows the difference between the Medicare rebate payable for services provided before 1 November 2009 and after 1 February 2010, and the amount of the extra out-of-pocket cost to the patient because of the Government’s decision to reduce the MBS fee for cataract surgery.  As almost every cataract procedure is performed as part of hospital treatment, the table provides the rebate payable for an in-hospital service (i.e. the rebate is 75% of the MBS fee).

MBS Item Item Descriptor Rebate payable before 1 November 2009 Rebate payable after 1 February 2010Cost shifted to patient
42698LENS EXTRACTION, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye$487.70$429.15$58.55
42701ARTIFICIAL LENS, insertion of, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye$271.95$239.35$32.60
42702LENS EXTRACTION AND INSERTION OF ARTIFICIAL LENS, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye$623.70$548.85$74.85

Template letter to provide patients with informed financial consent for cataract procedures

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Published: 01 Feb 2010