Introduction of MBS item 69485-Microbiology Test for SARS-CoV-2 (COVID-19) factsheet
Last updated: 13 March 2020
• The Government has created a dedicated Medicare bulk-billed pathology test for COVID-19.
• GPs can request a COVID-19 test at no out-of-pocket cost to the patient if the requesting medical practitioner suspects their patient is at risk of having COVID-19.
• To ensure that resources are allocated effectively during this public health emergency GPs should be satisfied that their patient is a ‘suspect case’ that satisfies epidemiological and clinical criteria.
• Detailed epidemiological and clinical criteria for determination of a COVID-19 suspect case is available in the Communicable Disease Network Australia (CDNA) National Guidelines for Public Health Units in the Series of National Guidelines (SoNGs):
What are the changes?
From 13 March 2020, Medicare Benefits Schedule (MBS) item 69485 will be listed for microbiology testing for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Why are the changes being made?
The introduction of this item will help ensure that there is adequate capacity to provide accessible and rapid laboratory testing of SARS-CoV-2, the virus which causes the disease known commonly as COVID-19.
What does this mean for providers/referrers/other stakeholders?
To ensure appropriate concurrent testing for other respiratory viruses, including influenza, the test will be required to be performed in the same patient episode as testing for other respiratory viruses under MBS items 69494, 69495 or 69496.
New MBS item 69485 will not be subject to episode coning arrangements.
Non-Public Health Laboratory Network (PHLN) laboratories planning to provide clinical diagnostic testing and reporting for SARS-CoV-2 (item 69485) are strongly recommended to meet the following criteria to ensure quality testing is maintained across Australia:
a) Participation in the Royal College of Pathologists of Australasia Quality Assurance Program (RCPAQAP) for SARS-CoV-2 testing when available;
b) Access and utilise positive control material provided by a state or territory reference laboratory; and
c) Arrange for parallel testing to be conducted by a PHLN laboratory to validate the results. In the short term, this means referring all positive samples for confirmatory testing, and referring a subset of negative samples where a strong clinical or epidemiological suspicion exists.
How will these changes affect patients?
The test will be able to be requested by all Medical Practitioners and will only be claimable where the service has been bulk-billed.
Who was consulted on the changes?
Pathology providers and the Royal College of Pathologists of Australasia.
How will the changes be monitored and reviewed?
Item 69485 is scheduled to be listed until 30 September 2020. Disease progression in the community and advice from the Australian Health Protection Principal Committee will determine whether the item is required for a longer time.
Where can I find more information?
The full item descriptor(s) and information on other changes to the MBS can be found on the MBS Online website at www.mbsonline.gov.au. You can also subscribe to future MBS updates by visiting MBS Online and clicking ‘Subscribe’.
The Department of Health provides an email advice service for providers seeking advice on interpretation of the MBS items and rules and the Health Insurance Act and associated regulations. If you have a query relating exclusively to interpretation of the Schedule, you should email askMBS@health.gov.au.
Subscribe to ‘News for Health Professionals’ on the Department of Human Services website and you will receive regular news highlights.
If you are seeking advice in relation to Medicare billing, claiming, payments, or obtaining a provider number, please go to the Health Professionals page on the Department of Human Services website or contact the Department of Human Services on the Provider Enquiry Line – 13 21 50.
The data file for software vendors is expected to become available on [date] and can be accessed via the MBS Online website under the Downloads page.
Please note that the information provided is a general guide only. It is ultimately the responsibility of treating practitioners to use their professional judgment to determine the most clinically appropriate services to provide, and then to ensure that any services billed to Medicare fully meet the eligibility requirements outlined in the legislation.
This sheet is current as of the Last updated date shown above, and does not account for MBS changes since that date.