Consistent billing for tonsillectomy and adenoidectomy

The Australian Government is making changes to Medicare Benefits Schedule (MBS) funded tonsillectomy and adenoidectomy items, following recommendations from the MBS Review Taskforce.

Page last updated: 22 August 2017

Consistent billing for tonsillectomy and adenoidectomy (PDF 70 KB)

What are the changes?

Currently, there is variation in billing of MBS items for tonsillectomy and adenoidectomy services that is not based on clinical factors. Gaps in regulation have led to an increase in co-claiming of procedural items by some doctors, creating inconsistent billing practices.

For example, some doctors are separately claiming the MBS item for the examination of the nasopharynx or larynx during an adenoidectomy or tonsillectomy operation, even though the Taskforce confirmed examination is integral to these procedures.

As a result of this billing practice, patients are receiving different benefit amounts for the same service.

Restrictions will be placed on the claiming of an item for the examination of the nasopharynx or larynx, when it is co-claimed with a tonsillectomy or adenoidectomy procedure. In addition, it will be made clear that the MBS rebate for the surgery includes administration of local anaesthetic.

The changes will commence on 1 November 2017.

Why are these changes being made?

The changes were recommended by the MBS Review Taskforce following an extensive period of consultation.

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

What does this mean for patients?

These changes mean all patients who have an adenoidectomy or tonsillectomy operation will receive the same MBS benefits.

What does this mean for providers?

This change will only affect the MBS benefits paid for services that have been incorrectly billed by providers. This currently accounts for about 30 per cent of all adenoid operations and 16 per cent of all tonsillectomy operations.

Further details on all the changes can be found on MBS Online website.