Appendix B Summary for consumers

This table describes the medical service, the recommendation(s) of the clinical experts and why the recommendation(s) has been made.

Recommendation 1: TSH (thyroid-stimulating hormone)
Item What it does Committee recommendation What would be different Why

66716

Measures blood levels of the hormone that stimulates the thyroid gland, to assess thyroid disease.

Include guidance on when the test is appropriate for doctors to request.

The test would be avoided in patients who do not show thyroid disease symptoms, unless they are pregnant or at high risk of thyroid disease.

To align testing with current medical guidelines, such as the RACGP Choosing Wisely recommendations.

Recommendation 2: TFTs (thyroid function tests)
Item What it does Committee recommendation What would be different Why

66719

Measures blood levels of thyroid hormones to assess thyroid disease.

Include guidance on when the test is appropriate for doctors and pathologists to request.

The test would be avoided in patients when the results can be unreliable and misleading.

To align testing with current medical guidelines.

Recommendation 3: New item for TFTs
Item What it does Committee recommendation What would be different Why

New item

Measures all thyroid hormone levels.

Create a new item that includes the measurement of all thyroid hormone levels in patients with totally suppressed thyroid-stimulating hormone (TSH).

An additional test would be available that measures the levels of all thyroid hormones in patients with totally suppressed TSH.

For most patients TFT tests don't include testing all thyroid hormones, but for some with suppressed TSH the additional tests will offer more information about the severity and prognosis of their overactive thyroid and identify patients with toxic levels of thyroid hormones.

Recommendation 4: Oral glucose tolerance and challenge tests
Item What it does Committee recommendation What would be different Why

66545

Measures blood sugar levels to test for diabetes mellitus in pregnancy.

Remove this item from the MBS.

This item would no longer be available.

This item is out of date.

66542, 66548

Measures blood sugar levels to test for diabetes mellitus.

Include use in pregnant women and certain specific patient groups, plus guidance on who those specific patient groups are.

The test would be able to be done in pregnant and specific patient groups.

To align testing with current medical guidelines as recommended by the Australian Diabetes in Pregnancy Society.

Recommendation 5: Quantitation of glycated haemoglobin (how much oxygen-carrying protein in red blood cells is bound to sugar)
Item What it does Committee recommendation What would be different Why

66551

Measures blood sugar levels to test for diabetes mellitus.

Restrict to a maximum of four tests per year.

Test would be limited to four times per year per patient.

To align testing with the current Health Insurance Regulation 2015.

66554

Measures blood sugar levels to test for diabetes mellitus.

Restrict to a maximum of six tests per year.

The test would be limited to six times per year per patient.

To align testing with the current Health Insurance Regulation 2015.

Recommendation 6: Quantitation of glycated haemoglobin (how much oxygen-carrying protein in red blood cells is bound to sugar)
Item What it does Committee recommendation What would be different Why

66841

Measures blood sugar levels to test for diabetes mellitus.

Specify medical situations in which the test should be used. Increase the number of tests to a maximum of two per year.

The test would be prevented from being used to see if diabetes is present, except in pregnant women or people at high risk of thyroid disease.

To align the number of tests with current medical guidelines, such as the Australian Diabetes Society Position Statement 2015 as well as the RACGP, World Health Organisation and American Diabetes Association’s advice.

Recommendation 7: Quantitation of fructosamine (blood fructose level)
Item What it does Committee recommendation What would be different Why

66557

Measures blood fructose (sugar) levels to test for diabetes mellitus.

Specify when the test should be used and provide guidance on appropriate use of this test.

Doctors will have clear guidance on when they can use this test. The test would only be used in appropriate medical situations.

The test may not have been used optimally.

Recommendation 8: Microalbumin (albumin is a protein that, when found in urine, indicates kidney damage due to diabetes)
Item What it does Committee recommendation What would be different Why

66560

Measures levels of albumin and creatinine in urine to test for diabetes mellitus.

Change the title of the test to albumin:creatinine ratio and specify medical situations in which the test is appropriate.

The Medical Benefits Schedule (MBS) would be updated to use more current medical terms. The test would only be used in appropriate medical situations.

To update the MBS and make it current.

Recommendation 9: Quantitation of hormones and hormone-binding proteins

Item What it does Committee recommendation What would be different Why

66695–66698, 66701, 66704, 66707

Measures the levels of various hormones (which regulate body functions) and the proteins that regulate their action.

To review these items at a later stage. No recommendations at this time.

No difference at this stage.

No recommendations made at this time.

Recommendation 10: Thyroid antibodies to tissue antigens
Item What it does Committee recommendation What would be different Why

71165–71170

Identifies thyroid cancer or immune response against the thyroid gland.

Awaiting input from the Immunology Working Group. No recommendations at this time.

No difference at this stage.

No recommendations made at this time.

Recommendation 11: Quantitation of products of collagen breakdown or formation
Item What it does Committee recommendation What would be different Why

66773, 66776

Measures bone density in patients with bone diseases.

Leave these items unchanged.

No difference.

These items are recommended to be left unchanged.

Recommendation 12: Adrenaline and other tests
Item What it does Committee recommendation What would be different Why

66779, 66780

Measures level of adrenal gland hormones.

Requires review by the Committee. No recommendations at this time.

No difference at this stage.

No recommendations made at this time.

Recommendation 13: 1, 25-dihydroxivitamin D quantification
Item What it does Committee recommendation What would be different Why

66835, 66836, 66837

Measures the amount of vitamin D in the blood.

Leave these items unchanged.

No difference.

These items were recently reviewed and changed within the MBS Schedule; they do not require further revision at this stage.

Recommendation 14: Hormones and other tests
Item What it does Committee recommendation What would be different Why

66686

Testing for irregular production of growth hormone, cortisol or chloride in sweat, indicating underlying diseases.

Leave these items unchanged.

No difference.

This item is recommended to be left unchanged.

Recommendation 15: Quantification in saliva of cortisol
Item What it does Committee recommendation What would be different Why

66711–66712, 66714–66715

Tests saliva for abnormally high or low cortisol levels that indicate underlying diseases

Leave these items unchanged.

No difference.

These items are recommended to be left unchanged.

Recommendation 16: Electrophoresis of serum for lipoprotein subclasses
Item What it does Committee recommendation What would be different Why

66539

Tests for hereditary high cholesterol by measuring levels of cholesterol components.

Remove this item from the MBS.

This item would no longer be available.

This item is out of date and has been superseded by genetic testing.

New item

Tests for hereditary high cholesterol by checking for mutations in certain genes that produce components of the cholesterol system.

New genetic test for hereditary high cholesterol.

New test would replace existing outdated test.

To update the MBS and make it current.

New item

Tests for markedly high cholesterol level by checking for mutations in the gene that produces a key cholesterol component.

New genetic test for markedly high cholesterol.

New test would replace existing outdated test and has added benefit of predicting increased risk of Alzheimer’s disease.

To update the MBS and make it current.