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.
NEW CHANGES - EFFECTIVE 1 MAY 2020
As of 1 May 2020 - two new age modifiers have been updated in the MBS 25013 - for children up to years and 25014 for over 75 years. See the link below from the MBS