The MBS item for carotid duplex ultrasound is to be restricted to curb overservicing by commercial operators who employ GPs to conduct ‘stroke check’ screening of asymptomatic people.

The vascular clinical committee of the MBS Review Taskforce has recommended that only specialists be allowed to refer asymptomatic patients for duplex examination of the carotid arteries (MBS item 55274).

In its report, the committee said stricter criteria were needed for carotid duplex examinations because a crackdown on commercial operators of ‘stroke check’ services had failed to prevent “low value overservicing”.

It noted that usage of the item continued to increase, from 126,000 to 160,000 services a year between 2007 and 2017, and unnecessary use of the $169.50 item accounted for much of its $23 million annual Medicare cost.

“The [ambiguous] item descriptor currently allows use for a wide range of indications with low efficacy, which may include asymptomatic patients without a significant stenosis. Despite compliance action on corporate entities conducting population screening, the Committee remains concerned that the item is experiencing overuse,” it stated.

The committee noted that international guidelines specify that carotid duplex ultrasound should not be performed in cases of syncope where neurological examinations are normal, or where patients are otherwise asymptomatic neurologically. It should only be done in high risk asymptomatic patients and patients with neurological symptoms or undergoing certain cardiac procedures.

“Patients with no neurological symptoms should be excluded, unless the patient has been evaluated by a specialist who considers the examination necessary for rare asymptomatic indications,” it said in its rationale for the change.

The committee therefore recommended the item descriptor be amended to include the restriction: “not for screening or examination of asymptomatic patients except when referred by a specialist, with a maximum of two services per 12 months”.

The recommendation will now be considered, along with other Taskforce recommendations,  by the Federal Minister for Health.

Last year the limbic reported that ‘Stroke Check’ scans were still being offered in community setting such as aged care homes and pharmacies by commercial operators.