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The current MBS item 12203 for overnight investigation of sleep apnoea (fee $588, three services per year) is superseded by three separate items for lab-based sleep studies, each with a fee of $588 and claimable only once per year: 12203 (diagnostic assessment); 12204 (CPAP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