Changes to Repetitive Transcranial Magnetic Stimulation services for DVA Clients
Important changes to DVA claiming arrangements for repetitive transcranial magnetic stimulation (rTMS) services took effect on 1 November 2021. From this date, psychiatrists can claim new Medicare Benefits Schedule (MBS) items for any Veteran Card holder accessing rTMS services for the first time.
MBS items 14216, 14217, 14219 and 14220 will provide funding for the delivery of rTMS treatment to DVA clients with diagnosed medication-resistant major depressive disorder.
Importantly, DVA clients who have accessed, or are currently undertaking rTMS services under existing prior approval arrangements will continue to do so from 1 November.
These new arrangements will provide eligible clients with more timely access to initial rTMS treatment options and reduce some administrative requirements for psychiatrists.
DVA will pay 140% of the MBS fee amount when a psychiatrist claims for rTMS treatment delivered to a Veteran Card holder. Providers are not entitled to charge out-of-pocket expenses for services provided under DVA arrangements and it is the responsibility of providers to determine whether the new MBS items are appropriate to claim for their patient.
The MBS fee amount for new rTMS services and the amount paid by DVA are outlined below:
| MBS Fee | Fee Paid by DVA | |
|---|---|---|
| 14216 | $186.40 | $261.00 |
| 14217 | $160.00 | $224.00 |
| 14219 | $186.40 | $261.00 |
| 14220 | $160.00 | $224.00 |
Providers can claim for rTMS services delivered to a DVA client using the same channel as they currently use for other items on the MBS Fee Schedule (for example, via Webclaim or their practice software system).
DVA encourages providers to familiarise themselves with the descriptors and explanatory notes for these new items, which will be available on MBS Online by 1 November 2021. Any questions about MBS requirements should be directed to the AskMBS Email Advice Service, which can be accessed at MBS online - AskMBS Email Advice Service
Prior financial approval requests may be considered for DVA clients with a clinical need for rTMS treatment above the MBS service limit where there is a clinical justification to support this course of treatment. Further information about making a Treatment Prior Financial Approval Request is available at When we must approve care on the DVA website.