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News

Changes to Medicare Benefits Schedule (MBS)

Posted: 19th of June, 2018

In late 2017, the Department became aware of Medicare claims being rejected when bariatric reversal item 31584 was claimed in association with bariatric items 31569 to 31590.

In order to rectify the issue as timely as possible, on 16 November 2017, a new MBS item for bariatric reversal surgery was listed (item 31591). This item was implemented as an interim item and will cease to exist on 1 July 2018.

On 1 July 2018, item 31584 will be reinstated with its original policy intent (see below) – to be claimed when a reversal of a bariatric procedure is performed, either as a stand-alone procedure, or when the reversal procedure is also followed by an additional bariatric procedure during the same episode of care.

 31584

Surgical reversal of adjustable gastric banding (removal or replacement of gastric band), gastric bypass, gastroplasty (excluding by gastric plication) or biliopancreatic diversion being services to which items 31569 to 31581 apply

 

Multiple Services Rule

 

(Anaes.) (Assist.)

 

Fee: $1, 539.10    Benefit: 75% = $1, 154.35


Explanatory note TN.8.30 – Reversal of a Bariatric Procedure (Item 31584)

If a revisional procedure requires the reversal of the existing bariatric procedure, item 31584 can be claimed with items 31569 to 31581 for the new procedure for the same patient on the same occasion. For example, item 31584 could be claimed for the reversal of a gastric band, and 31572 for conversion to gastric bypass or 31575 for conversion to sleeve gastrectomy.

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