As details emerge, leading GPs question how the new item numbers will stack up against time-based items

After much fanfare during the government’s pre-election pitch, two new MBS item numbers for menopause and perimenopause health assessments are nearly here.

But given the lengthy list of requirements, the $101.90 rebate for item 695 is underwhelming— especially when compared to time-based items, leading GPs say.

The details

From 1 July, GPs can use item 695 for consultations that last at least 20 minutes, and include all of the following (at a minimum):

• “Collecting relevant information, including taking a patient history to determine pre-, peri- or post-menopausal status, patient wellbeing and contraindications for management; and
•  undertaking a basic physical examination, including recording blood pressure, and review of height and weight; and
• initiating investigations and referrals as clinically indicated, with consideration given to the need for cervical screening, mammography and bone densitometry; and
• discussing management options including non-pharmacological and pharmacological strategies including risks and benefits;
• implementing a management plan which includes patient centred symptoms management; and
• providing the patient with preventative health care advice and information as clinically indicated, including advice on physical activity, smoking cessation, alcohol consumption, nutritional intake and weight management.”

Item 695 can be billed by GPs for a rebate of $101.90. Item 19000 has the same list of requirements, but can be billed by a prescribed medical practitioner, and attracts a rebate of $81.50.

The services can be billed once every 12 months for eligible patients.

The Department of Health, Disability and Ageing has clarified that as with other health assessment items, “a separate consultation must not be performed in conjunction with a health assessment, unless clinically necessary.”

Practice nurses can assist “in accordance with accepted medical practice and under the supervision of the medical practitioner,” they note.

“Where eligible, patients may receive both a menopause and perimenopause health assessment service and a separate time tiered or Aboriginal and Torres Strait Islander health assessment service (for example, a Type 2 diabetes risk evaluation). There is no minimum interval of time between the provision of the different health assessments,” the MBS factsheet explains.

Patients experiencing premature ovarian insufficiency, early menopause, perimenopause and menopause are eligible for the assessment.

So what does all this mean for GPs and patients?

Dr Karen Magraith, GP and past president of the Australasian Menopause Society says that while she “welcomes the recognition” of the importance of a thorough assessment and discussion about management options for symptoms during the menopause transition, the new item number may not add much to the Medicare funding already available for patient care.

“For a GP to complete a full assessment, including implementing a treatment plan, typically involves either several consultations, or a prolonged consultation,” Dr Magraith points out. “If using the menopause assessment item as the sole option, the Medicare funding is likely to be lower than it would be using time-based consultation items.”

“The requirements for the item are quite extensive, and it would often be difficult to achieve this in less than 45-60 minutes. Thus the time-based items (e.g. item 44) are likely to be more applicable, and the patient receives a higher rebate.” – Dr Karen Magraith

Dr Marita Long, also a GP with special interest in women’s health and a board member of the Australasian Menopause Society, shares similar sentiments.

“It’s great to see that the government has put some thought into this, but it has probably been a quick reactive action,” Dr Long says. “I think it is unfortunate that it’s not a time-based health assessment.”

Dr Long says many GPs would take 45 minutes to complete a comprehensive assessment, especially given the level of detail outlined in the service description. While the rebate of $102 is slightly more than a standard item 36, it is less than the rebate for item 44, she adds.

“It definitely won’t help my patients who are booked in for an initial assessment of 45 minutes and follow-up of 15 or 30 minutes,” she says, noting that she usually spends closer to an hour the first time she sees someone for menopause, though she only charges for 45 minutes.

Where the menopause item numbers might be useful

On that note, Dr Magraith says the new items may be more useful in cases where much of the relevant assessment information has already been recorded.

“I probably won’t be using this item for new patients seeking a full menopause consultation, but it might be helpful when we already have quite a lot of information in our system from previous consultations, and we are able to focus mostly on the management strategies,” Dr Magraith says.

“It might also be helpful for follow up consultations, for example if we are reviewing the patient’s progress after some time on MHT (menopausal hormone therapy).”

Dr Long expects bulk billing practices to benefit if their consultations hit the sweet spot of more than 20 minutes but less than 45 minutes.

Should reviewing height and weight be an essential part of the consultation?

Both Dr Magraith and Dr Long questioned the blanket requirement to review height and weight.

While it can be useful to assess metabolic risk factors which often increase during the menopause transition, Dr Magraith says she does not typically initiate weighing women during these consultations.

“It is very important to address cardiometabolic health as part of our comprehensive preventative care. However, many women report feeling stigmatised when their health practitioner measures or focuses on weight,” she says.

“For this reason, I no longer routinely measure weight in my menopause consultations, unless the patient brings up the topic and wishes to be weighed. I do record weight if it is likely to change the management options I offer to patients. For example, I would not usually offer oral estrogen to women with a BMI over 30.”

Dr Long also noted the importance of obtaining consent before measuring height and weight, adding that waist circumference is probably a better marker.

More information:

The item descriptor and other regulatory requirements can be seen here: Health Insurance (Section 3C General Medical Services – Menopause and Perimenopause Health Assessment Services) Determination 2025 – Federal Register of Legislation

Further explanation can be found in this fact sheet: MBS Online – Menopause and perimenopause health assessment services.

The 2023 Practitioner’s Toolkit for Managing Menopause is an RACGP Accepted Clinical Resource, gives practical guidance on assessing and managing menopause, including prescription of MHT and non-hormonal options and useful information about bone health.