Proposed changes to Medicare for eye injections
The Medicare Benefits Schedule (MBS) Review Taskforce for Ophthalmology (The Taskforce) has developed a draft report suggesting changes to Medicare rebates for intravitreal injections (eye injections). These injections are used to deliver sight-saving treatment for people with a range of macular conditions, such as wet (neovascular) age-related macular degeneration (wet AMD) and diabetic macular edema (DME).
There’s no cause for concern at this stage, because it will be quite some time before any changes would take effect, if such changes were to be accepted by Government.
Stakeholder feedback is now being sought on the draft changes. Feedback will be considered by the Taskforce before a final report is submitted to the Minister and the Australian Government for consideration.
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It is important to know that there have been no changes to the current Medicare rebate. If you are now experiencing an increase in the out-of-pocket costs for treatment as a result of the draft review, we recommend that you contact us on our National Helpline on 1800 111 709. We will provide you with an information fact sheet to take to your next appointment. |
List of current Medicare rebates
| Item | Description | Schedule fee | 85% benefit (in-rooms) | 75% benefit (private hospital) |
|---|---|---|---|---|
| 104 | Initial consultation | $88.25 | $75.05 | $66.20 |
| 105 | Subsequent consultation | $44.35 | $37.70 | $33.30 |
| 11215 | Angiogram (one eye) | $124.95 | $106.25 | $93.75 |
| 11218 | Angiogram (two eyes) | $154.40 | $131.25 | $115.80 |
| 11219 | Optical coherence tomography (OCT) (initial diagnosis only) | $40.65 | $34.60 | $30.50 |
| 42738 | Injection fee | $305.55 | $259.75 | $229.20 |
| 42739 | Injection w/ sedation/anaesthetic | $305.55 | $259.75 | $229.20 |
| 42809 | Retina photocoagulation (laser) | $458.30 | $389.60 | $343.75 |
What we are doing
We know that many in our community already struggle to afford out-of-pocket costs associated with their treatment, which in many cases is ongoing and indefinite. We also know that there are very few public services people can to turn to for an eye injection if they can’t afford private treatment. Therefore, we know that any changes to the rebate could have a negative impact on patients.
We recently commissioned research to investigate precisely what effects the Taskforce’s proposed changes in MBS rebates for eye injections would have on our community. We have presented our ‘Impact Report’ to the Minister for Health in Canberra, the Hon Greg Hunt MP. We have asked that more affordable access to treatment be made available before any changes in MBS rebates are considered so that patients are not negatively affected. We realise more affordable access models will take time to develop and implement.
Minister Hunt understands the difficulties patients currently face and has committed to work with MDFA to ensure the voices of patients are heard throughout the consultation process.
While this is an encouraging first meeting, we will continue to advocate against any cuts to eye injection rebate. MDFA will continue to engage with you, our community, and other stakeholders over the coming months. We will keep you updated every step of the way.
For more information
We have sourced a copy of the full draft Taskforce Report, if you would like more information.