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Make sure you read the relevant item descriptions, fact sheets and explanatory notes at MBS Online.
Assisted Reproductive Technology (ART) services include a range of treatments to achieve pregnancy including:
- in-vitro fertilisation (IVF)
- gamete intrafallopian transfer (GIFT)
- intracytoplasmic sperm injection (ICSI)
- intrauterine insemination (IUI).
We pay Medicare benefits for clinically relevant services. ART services are clinically relevant when accepted by the medical profession as necessary to appropriately treat a patient’s infertility. Services performed must also comply with relevant state and territory laws.
Reciprocal Health Care Agreement (RHCA) patients aren’t eligible for MBS ART services, with the exception of item 13260.
Treatment cycle
A treatment cycle is a series of treatments for ART services.
An ART treatment cycle starts on either:
- the day the patient starts treatment with superovulatory drugs
- the first day of the patient’s menstrual cycle.
An ART treatment cycle ends no more than 30 days after the treatment cycle starts, or the day after the last:
- oocyte retrieval
- transfer of embryos or both ova and sperm
- preparation of sperm for artificial insemination.
ART global items
Services provided as part of an ART treatment cycle are covered under ART global items and can’t be billed separately to Medicare.
The first day of the treatment cycle is the date of service for billing ART global items.
The following MBS items are global items:
- 13200 - Assisted reproductive technologies superovulated treatment cycle proceeding to oocyte retrieval - initial cycle.
- 13201 - Assisted reproductive technologies superovulated treatment cycle proceeding to oocyte retrieval - subsequent cycle.
- 13202 - Assisted reproductive technologies superovulated treatment cycle that is cancelled before oocyte retrieval.
- 13203 - Ovulation monitoring services for artificial insemination or gonadotrophin.
- 13218 - Preparation of frozen or donated embryos or donated oocytes for transfer to the uterus or fallopian tubes.
These items cover all services related to an ART treatment cycle and include consultations, pathology and diagnostic imaging services.
Services that aren’t related to the ART treatment cycle are still eligible for Medicare benefits.
We may ask you to verify in writing that these services weren’t related to ART treatment.
Pathology and diagnostic imaging services
If you request pathology or diagnostic imaging services under an ART treatment cycle, you should indicate on the request that the services aren’t eligible for a Medicare benefit.
Check with the requesting practitioner before billing the services if it’s unclear if they relate to a treatment cycle.
We pay Medicare benefits in accordance with the Health Insurance Act 1973 (the Act). Under subsection 129 AC (1), the Commonwealth may recover incorrectly paid Medicare benefits from the practitioner who provided the service, even if the benefit was not paid to them.
Embryology laboratory services
Embryology laboratory services for items 13200 and 13201 include any of the following:
- egg recovery from aspirated follicular fluid
- semen preparation
- monitoring of fertilisation and embryo development
- insemination
- preparation of gametes or embryos for transfer or freezing.
Pre-implantation genetic testing (PGT) services
PGT is used by couples or individuals who carry a serious genetic disorder. PGT is applied within the In vitro fertilisation (IVF) process to detect specific genetic or chromosomal abnormalities prior to implantation and pregnancy.
During the IVF cycle, the created embryos have a small number of cells extracted and tested for specific genetic variations.
PGT services include:
- one ART surgical item for an embryo biopsy from a couple at high risk of having a child affected by a genetic disorder item 13207
- pathology tests items 73384, 73385, 73386, 73387.
Surrogacy
You can’t bill MBS ART items 13200 to 13221 for patients with surrogacy arrangements.
You can bill item 13251 for patients with surrogacy arrangements when male factor infertility applies.
Surrogacy arrangements occur when a person either:
- agrees to become pregnant and to bear a child for another person
- transfers guardianship and custodial rights to the other person at or shortly after birth.