New fee for capsule endoscopy

The Australian Government is making changes to two Medicare-funded capsule endoscopy services, following recommendations from the Medical Services Advisory Committee (MSAC) after initial review by the Medicare Benefits Schedule (MBS) Review Taskforce.

Page last updated: 29 April 2018

New fee for capsule endoscopy (PDF 208 KB)

What are the changes?

Capsule endoscopy is a procedure used to record images of the gastrointestinal tract to either diagnose or monitor certain medical conditions. It involves the patient swallowing a capsule containing a small camera, which records and sends the images to a data recorder for the treating practitioner to analyse.

Changes to capsule endoscopy (MBS items 11820 and 11823) will see a reduction in the MBS fee to $1,229.35, to better reflect the current cost of providing this service.

This change will commence on 1 November 2018.

Why are these changes being made?

These changes were made after collaboration between the independent MBS Review Taskforce (the Taskforce) and the MSAC following a comprehensive review of capsule endoscopy services.

The Taskforce is conducting a clinician-led review, and makes recommendations to the Government on how the MBS can be modernised to improve patient safety, support equity of access and address inappropriate use.

The Gastroenterology Clinical Committee of the Taskforce reviewed capsule endoscopy services and recommended a fee review by the MSAC due to significant variations in service volumes between and within states and territories that could not be explained on clinical grounds alone.

What does this mean for patients?

Patients will continue to receive this Medicare subsidised service. Patients and taxpayers can be sure the MBS continues to fund quality health care at an appropriate price.

What does this mean for providers?

Providers can continue to bill for these services. The MBS fee has been reduced to better reflect the current cost of providing capsule endoscopy services in Australia.

Providers affected by these changes will receive further information closer to the implementation date.