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2018/01 - Medical Treatment (MT) Item Numbers to be used for claiming non-listed services

Subject 

Medical Treatment (MT) Item Numbers to be used for claiming non-listed services

Purpose 
Describes arrangements for payment of non-MBS requests using specific MT item numbers
Service providers 
Various. Not to be used by hospitals. These items are for practitioner claims only.
Item number 
MT Numbers as listed in this HIMN.
MEPI reimbursement 
See HIMN 18/2006 MEPI – National Guidelines Reimbursement of Medical Expenses Privately Incurred
Record keeping 
Approved/declined items listed in this HIMN should be recorded by the delegate in the specified records management system. This information will assist in monitoring activity and expenditure.
Fee/cost 
See table.
Delegation 
Assistant Secretary Program Management Branch; Director and Assistant Director Health Programs for approval outside HIMN guidelines.
Contact 
Request for treatment outside of these guidelines should be referred to Primary Care Policy for consideration under the non-MBS: phcpolicy@dva.gov.au
Enquiries 
Any internal enquiries about the content of this HIMN should be referred to the following mailbox address: mailto:phcpolicy@dva.gov.au
Background 

Under the Department of Veterans’ Affairs (DVA) Health Card arrangements, entitled persons can receive, at DVA’s expense, clinically necessary treatment and services as listed in the relevant fee schedules developed by DVA.

Prior financial authorisation is required for requests for most treatment or services outside of these arrangements, for example where:
• the proposed treatment does not appear on a DVA fee schedule;
• the provider wishes to charge a higher fee than the one listed on the fee schedule; or
• where the level of treatment or service is higher than that prescribed for the item on the fee schedule.

DVA have developed a number of additional item numbers – Medical Treatment (MT) item numbers – to enable providers to claim for services outside of normal DVA arrangements. These MT item numbers in this HIMN allow providers to claim for these services either:
a. with a generic MT item (MTO2, MT04 or MT06) which is assigned according to the cost of the service, or
b. by way of an individual MT number assigned to a specific health service or treatment.

This HIMN provides a reference list of both existing HIMNs as described above in (1a) and (1b) , and several new MT items that have been developed for specific treatment or service. The new MT items have been developed to assist DVA with maintaining accurate statistical data on treatment or services received through prior financial authorisation requests.

Policy 

MT item numbers may only be claimed by providers where they meet the specific requirements of the item number, and in many cases where prior financial authorisation has been approved by DVA Including where clinical advice from a Departmental Medical Adviser (DMA) has been received. Several of these items are covered in HIMN 02/2014- Non-MBS - Frequently Requested Medical Treatment, Devices and Diagnostic Procedures. The below table indicates the correct usage of each MT item number.

Item No Treatment Type Prior approval required? Conditions of Use
MT12 Optical Coherence Tomography (OCT) No • Can be claimed by an ophthalmologist.
• DVA will fund clinically required OCT for eligible persons for the assessment and management of retinal diseases, excluding glaucoma.
• DVA will not fund OCT as a screening tool, but will allow a one-off OCT in circumstances where standard screening tests are inconclusive in the diagnosis of glaucoma.
• Only one MT12 payable per day.
MT13 Corneal Topography Yes • Can be claimed by an ophthalmologist:
o When clients are suffering from significant astigmatism and require cataract removal and replacement with intraocular lenses; and
o For clients who have had corneal transplants.
• Maximum fee of $90 per test.
• See HIMN 02/2014 - Non-MBS - Frequently Requested Medical Treatment, Devices and Diagnostic Procedures for more information.

MT14 Provision of B-type natriuretic peptide (BNP)
No • Can be claimed by eligible providers where the treatment is outside of the MBS rules for item 66830.
• MT14 can be paid for:
o diagnosis of heart failure in patients with dyspnoea;
o monitoring or prognosis of patients with an established diagnosis of heart failure, especially where the heart failure is moderate to severe
• Tests can be ordered/requested by a medical specialist.
• Entitled persons can present outside of a hospital emergency department for the test.
• Limit of six services in a 365 days rolling year.
• MT14 fee payable is the same as item 66830.

MT16 Photodynamic Therapy (PDT) No • Can be claimed by specialist dermatologists and plastic and reconstructive surgeons.
• Items MT16 and 30196 can be claimed on the same date of service if the two treatments are on different areas - for example one to REMOVE a skin cancer (30196) and the other to provide treatment (PDT) to a different skin cancer.
• Refer to HIMN 13/2008 - Non-MBS - Photodynamic Therapy (PDT) for Skin Cancer for further information.

MT18 Ambulatory Blood Pressure Monitors (ABPM)
Yes • ABPM are generally provided by a general practitioner or a cardiologist, but may be provided by other medical specialists, if indicated.
• Applications for the provision of ABPM must demonstrate the reasons for using this treatment over conventional blood pressure monitoring.
• Approval may be granted up to a maximum of $100.
• Where pharmaceutical company representatives provide this service free of charge, no payment should be made by DVA.
• All other items associated with this treatment, such as other consultation fees, should be claimed against the normal item numbers, and submitted to Medicare Australia.
• See HIMN 02/2014 - Non-MBS - Frequently Requested Medical Treatment, Devices and Diagnostic Procedures for more information.
MT20 Magnetic Resonance Imaging (MRI) on an unlicensed machine No • Can be claimed by providers with specialty codes C01 046 (Radiology), C01 047 (Diagnostic Radiology) or C01 118 (Magnetic Resonance Imaging).
• The relevant MBS item number (63001 – 63561) must be quoted on the claim when item MT20 is submitted.

MT25 Physiotherapy – Incontinence Yes • Can be claimed where treatment is being provided for incontinence.
• Fee to be set at $134.20.
MT26 Physiotherapy – Vestibular Yes • Can be claimed when requested by a qualified Vestibular Physiotherapist.
• Fee to be set at $134.20.
MT30 Fibroscan (ERCP) – Liver Yes • Can be claimed when requested by a gastroenterologist for investigation of the liver.
• See HIMN 02/2014 - Non-MBS - Frequently Requested Medical Treatment, Devices and Diagnostic Procedures for more information.
• Approval up to $300.
MT31 MRI Liver with Contrast Yes • Can be claimed where requested by a specialist.
• See HIMN 02/2014 - Non-MBS - Frequently Requested Medical Treatment, Devices and Diagnostic Procedures for more information.

MT32 MRI prostate investigation / staging Yes • Can be claimed when requested by a specialist for investigation / staging of prostate cancer.
• Approval up to $700.
MT33 Positron Emission Tomography (PET) scan and PET Computed Tomography (PET CT) scan for the diagnosis, staging, or follow-up of prostate cancer
Yes • Can be claimed where requested by specialists for the diagnosis, staging, or follow-up of malignant disease where considered clinically appropriate by DMA.
• See HIMN 02/2014 - Non-MBS - Frequently Requested Medical Treatment, Devices and Diagnostic Procedures for more information.

MT34 Consumables for Endovenous Laser Treatment and radio ablation frequency
Yes • Can be claimed when ordered by a specialist vascular surgeon.
• Prior approval must be sought, with DMA recommendation required for consideration.
• The specialist should claim for the procedure via the usual MBS item numbers at RMFS fees.
• Approval may be granted up to $1,500 per leg and is not payable for in-hospital treatment.
MT35 Bone Densitometry (outside MBS criteria) Yes • Can be claimed when ordered by a specialist and where it does not meet the Medicare guidelines and is considered clinically indicated by a DMA.
• See MBS item numbers 12306, 12309, 12312, 12315, 12318, 12321 and 12323 for the Medicare guidelines.

MT40 Xiaflex Yes • Can be claimed when provided by a specialist.
• For the treatment of Dupuytren’s contractures, where treatment is performed by a specialist.
• The fee to cover the consultations, injections and subsequent manipulation of the contractures.
• Maximum cost of up to $2,200 per injection.
• See HIMN 02/2014 - Non-MBS - Frequently Requested Medical Treatment, Devices and Diagnostic Procedures for more information.

MT50 Unlisted Pathology Services No • Providers are encouraged to use Medicare item numbers whenever possible.

MT51 Semen Storage Yes • Can be claimed when requested by a specialist.
• Maximum cost of up to $400 per 12 month period.
• See HIMN 02/2014 - Non-MBS - Frequently Requested Medical Treatment, Devices and Diagnostic Procedures for more information.

MT52 Stem Cell Storage Yes • Can be claimed when requested by a haematologist or an oncologist where considered clinically indicated by a DMA.
• Maximum cost of up to one year’s storage, up to $800.
• See HIMN 02/2014 - Non-MBS - Frequently Requested Medical Treatment, Devices and Diagnostic Procedures for more information.

MT15 Vestibular Auditory Testing Yes • Can be claimed when provided by an audiologist on referral from an ENT specialist for investigation of balance problems.
• See HIMN 02/2014 - Non-MBS - Frequently Requested Medical Treatment, Devices and Diagnostic Procedures for more information.