Update for members requiring colonoscopy services

Following a recent review, Medicare has amended the criteria for claiming colonoscopies. These changes impact all Medicare claims, and not just those that relate to Private Health. These changes are designed to improve access to MBS-funded colonoscopy services for those who need it.

This change may impact items that are co-funded by Medicare and therefore claimable on your health insurance hospital policy as we only pay claims on services that attract a Medicare benefit.

So, what’s changing?

From 1 November 2019, some Medicare Benefit Schedule (MBS) items relating to colonoscopy services will no longer be valid. They will be replaced with 8 new items. There are specific conditions as to when each of these items can be used and how frequently they can be claimed.

These changes will not impact payment of claims for services performed prior to 1 November 2019.

I have a procedure soon – what do I do?

Medical practitioners who perform colonoscopy services have been advised of the changes and, if you require a colonoscopy service in the future, it’s important to ask your doctor to confirm that the service meets the MBS criteria and is eligible for Medicare Benefits.

More information

You can speak to your doctor or the hospital if you don’t believe they provided you with sufficient information to make an informed decision about your treatment.

If you need information about when you received your last colonoscopy service, the Department of Human Services (DHS) will be able to confirm the date of any previous services claimed and advise restrictions on how frequently the service can be claimed. You can call them on 132 011.

You can also access your claiming history with a My Health Record or by establishing a Medicare online account through myGov or the Express Plus Medicare mobile app.