Public health

Spinal surgery no longer available for back pain on Medicare

The Federal government has accepted recommendations to simplify and clarify MBS items for spinal surgery from the Medicare Review Taskforce.

Changes to come into effect from 1 November 2018 mean MBS items can no longer be claimed for spinal fusion for treatment of uncomplicated axial chronic lower back pain.

Several obsolete MBS items are being removed and the current 74 spinal surgery items will be replaced by around 60 new service items based on more rational criteria.

The new rules are intended to address inappropriate claiming of multiple MBS items for single episodes of spinal surgery.

According to the Taskforce, the decision to exclude spinal fusion from Medicare for the treatment of uncomplicated axial chronic lower back pain “is in accordance with the recommendation in the February 2018 Choosing Wisely Australia report that lumbar spinal fusion is not recommended for the treatment of this condition.”

According to the Taskforce, the revised items will be cost neutral and will “provide greater clarity for surgeons using the item numbers and to ensure consistency in claiming, which will result in patients being eligible for the same level of benefit for the same surgery.”

The item numbers cover all adult spinal pathologies including degenerative disease, infection, deformity (scoliosis and kyphosis), trauma, inflammatory conditions and vertebral column neoplasia. Paediatric deformity surgery and spinal implants for pain relief are covered by the existing schedule.

A review conducted by the Spinal Surgery Clinical Committee found that MBS claims for spinal surgery had doubled in the past decade, with the spinal items accounting for almost 80,000 services at a cost of $40 million a year to the MBS in 2016.

Medicare funding for vertebroplasty for osteoporotic spinal fractures was withdrawn in 2011, but the procedure is now being reconsidered for an MBS item for patients with recent fractures (within six weeks) by the Medicare Services Advisory Committee.

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