The Relative Value Guide (RVG) has an age modifier for anaesthesia on children and the elderly.
Prior to 1 November 2019 there was a single MBS item 25015 which was applicable for patients under 1 year of age and 70+ years. It had a value of 1 basic unit.
Changes were introduced from 1 November 2019. While it seems the original intention was to adjust the age range to patients under 4 years of age and 75+ years, there have been two issues.
- Children - the published description in the CMBS is "Anaesthesia, perfusion or assistance in the management of anaesthesia, if the patient is aged not more than 3 years or at least 75 years". This resulted in claims for children between 3 and 4 years being rejected. To address this, the Department of Health has created a new MBS item 25012 specifically for over 3 years and under 4 years. There are some indications that this is a temporary measure that may be addressed in May 2020.
For further information on this item please see http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-ChildhoodAccess
- Elderly - the MBS, funds and WAGMSS in Western Australia have adopted the 75+ years threshold for 25015/M1. The ASA still recommends 70+ years as the threshold; the decision when to apply the age modifier rest with the servicing practitioner however you should note that this may result in an increased out of pocket for insured patients.