respiratory
Public Health

Revised MBS Items for sleep studies will change referral pathways for OSA


Long-awaited revised MBS items for laboratory- and home-based sleep studies for OSA patients come into effect on November 1.

The three new and two revised MBS items now require GPs to determine patient eligibility for sleep study direct referrals using approved assessment tools such as ESS and Stop-BANG scores.

An alternative referral pathway allows the need for testing to be determined during a professional attendance (either face to face or by video conference) with a qualified adult sleep medicine practitioner or a consultant respiratory physician.

The current MBS item 12203 for overnight investigation of sleep apnoea (fee $588, three services per year) is superseded by three separate items for lab-based sleep studies, each with a fee of $588 and claimable only once per year:  12203 (diagnostic assessment); 12204 (CPAP initiation) and 12205 (follow up of treatment effectiveness)

The current item 12250 for unattended home-based sleep studies is also revised to specify that it is for less complex patients. It allows for direct referral of patients whose eligibility has been determined by approved assessment tools such as ESS showing a high probability for moderate to severe OSA.

A revised descriptor for the 12250 MBS item no longer requires the sleep medicine practitioner to confirm the necessity for the investigation and communicate this to the referring practitioner.

“However, it is appropriate practice for treating practitioners to provide feedback to referring practitioners on the patient’s condition and treatment,” the health department states.

Under new arrangement, referrals for sleep studies can still be made to a non-named specialist such as a business, rather than a named physician, so long as the referral includes relevant clinical information and is signed and dated. Patients undergoing lab-based sleep studies must have equipment fitted by a trained sleep technicians, although there may be situations where it is permissiable for the patient or carer to apply thre equipment for home based studies.

The reforms broadly follow the 2016 recommendations by the Medicare Review Taskforce’s Thoracic Medicine Clinical Committee, said Dr Maree Barnes, a sleep physician at Austin Health in Melbourne and past president of the Australasian Sleep Association.

She welcomed the changes, saying it is important to give GPs a greater role in managing OSA at a time when patients face long waits for public sleep services.

“There are at least one million people Australians out there with undiagnosed and therefore untreated sleep apnoea,” Dr Barnes told the limbic.

“This is a way of giving patients more access to sleep studies and expedite them.”

The creation of specific MBS items that differentiate  between different types of sleep studies performed in laboratories is important because it will allow for better data collection, she said.

“In the past all were done under 12203 so when we are looking at the data we don’t know who is having what type of sleep study for what indication.

“That makes it very difficult to plan delivery of services.”

Dr Barnes says the ASA is happy with the outcomes of the MBS Review, although it will continue to push for reforms to make CPAP available by prescription only.

“We think this is a good outcome for patients that is hopefully going to lead to better outcomes, better and more clear management pathways and give us much better data to work with.”

She said the ASA is also optimistic another new MBS item for vigilance testing for the assessment of excessive daytime sleepiness will soon be approved.

“We did an expedited MSAC application and hopefully that will also come into effect on the first of November.”