A reduction in public funding for fertility treatment - an econometric analysis of access to treatment and savings to government

Table 1 Medicare Benefits Schedule (MBS) Assisted Reproductive Technology (ART) billing items

Cycle type	Before January 2010	After January 2010
Cycle type	(pre EMSNCap policy)	(post EMSNCap policy)
Fresh Cycle (uniquely identified by items 13200 and 13201)	13209, 13200, 13212, 13215, 13221, 13251	13209, 13200, 13212, 13201, 13215, 13251
Frozen Cycle (uniquely identified by item 13218)	13209, 13218	13209,13215,13218
IUI Cycle (identified by item 13203)	13209, 13203, 13221	13209, 13203, 13221

Notes:
13209: This item is assigned to all ART treatment types. Before 2010 it was typical for providers to assign a much higher fee to Fresh Cycles than either Frozen Cycles of IUI. Based on a survey of ART provider charging practices in 2007, the average fees, MBS benefits and OOPs were assigned to Frozen Cycles and IUI Cycles were 34% of the weighted average fee of 13209 assigned to a Fresh cycle, by quarter and age group.
13251: This item is used to bill intracytoplasmic sperm injection which is a laboratory technique to aid fertilisation. The average fees, Medicare benefits, OOPs, and number of ICSI services and patients were assigned to each quarter and age group based on the proportion of 13200 and 13201 cycles attracting a 13251 item.
13203: Prior to 2010, the MBS item 13203 was assigned to both cancelled Fresh Cycles and IUI cycles. After 2010, a specific MBS item was created for cancelled Fresh Cycles (13202) and item 13203 was retained for IUI. Therefore to estimate utilisation for IUI cycles before the 2010, the age-specific proportion of 13202 to 13203 items performed in 2010 was used to adjust service and patient counts for MBS item 13203.

ISSN: 1472-6963