New MBS Items
for PSA Tests
By Dr David Deam
Published December 2023
Summary of Changes
- Change in Frequency for Routine Testing for Prostate Disease:
In patients who are not at increased risk of prostate cancer (based on family history), the frequency of PSA testing has been reduced from once every 12 months to once in 23 months. - Testing in High-Risk Patients (New item):
Patients with a significant family history (first-degree relative diagnosed with prostate cancer) are eligible for a PSA test once in 11 months. - Indication for Percentage Free PSA Testing in the Follow-up of an Abnormal PSA:
Free PSA eligibility, dependent on age and family history, is now based on the PSA ranges below:- Age >=50 to <70 years: >3.0 ug/L but <=5.5 ug/L
- Significant family history: >2.0 ug/L but <=5.5 ug/L
- Significant family history: >2.0 ug/L but <=5.5 ug/L
PSA Testing Medicare Benefit Schedule Item Changes
Effective from 1st November 2023, the MBS requirements for prostate-specific antigen (PSA) testing have changed.
The new items better align with the NHMRC-endorsed guidelines put forward by the Prostate Cancer Foundation of Australia and the Cancer Council of Australia in 2016.1
The general recommendation is for those men who decide to have PSA tests to assist in the early detection of prostate cancer to have a PSA blood test every two years from age 50 to 69 years.
PSA testing may also be useful in other situations, such as prostatitis and in the follow-up of patients with known prostate disease.
The importance of having a significant family history of prostate cancer is also recognised in the guidelines.
The percentage Free PSA can also be helpful in evaluating a raised PSA and in the management of known prostate disease.
The new item descriptors for PSA
| Item No | Description | Time Restriction |
|---|---|---|
| PSA | ||
| 66655 | PSA quantitation | Not more than one in 23 months |
| 66654 | PSA quantitation in the monitoring of high-risk patients | Not more than one in 11 months |
| 66656 | PSA quantitation in the monitoring of previously diagnosed prostatic disease (including prostate cancer, prostatitis or a premalignant condition such as atypical small acinar proliferation) | None |
| Free PSA Percentage | ||
| 66659 | in the follow up of a PSA result under item 66654 or 66655 that lies at: (a) more than 2.0 ug/L but less than or equal to 5.5 ug/L for patients with a family history of prostate cancer; or (b) more than 3.0 ug/L but less than or equal to 5.5 ug/L for patients who are at least 50 years of age but under 70 years of age; or (c) more than 5.5 ug/L but less than or equal to 10.0 ug/L for patients who are at least 70 years of age | Not more than one in 11 months |
| 66660 | the monitoring of previously diagnosed prostatic disease, if the current PSA level lies
at: (a) more than 2.0 ug/L but less than or equal to 5.5 ug/L for patients with a family history of prostate cancer; or (b) more than 3.0 ug/L but less than or equal to 5.5 ug/L for patients who are at least 50 years of age but under 70 years of age; or (c) more than 5.5 ug/L but less than or equal to 10.0 ug/L for patients who are at least 70 years of age | Not more than 4 times in 11 months |
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How to Order PSA Testing
Request “PSA” on our general Clinical Labs request form.
It is important that the laboratory knows if the patient is at increased risk for prostate cancer (such as with a strong family history or previous high PSA levels) or has known prostate disease so that they can be billed correctly under the new Medicare item numbers.
If the clinical information is not provided, or the patient is not eligible under these item numbers, then a private bill may be generated.
References
- See ‘PSA-Testing-Guidelines.pdf’ (pcfa.org.au): https://www.pcfa.org.au/media/612113/PSA-Testing-Guidelines.pdf
About the Author
Dr David Deam
MBBS MAACB FRCPA- endocrine function testing
- laboratory automation
- protein abnormalities
Dr Deam graduated with Honours in Medicine from Monash University in 1978 and obtained his FRCPA in 1985 following postgraduate training in Biochemistry at the Royal Melbourne Hospital. After several posts in Chemical Pathology at the Royal Melbourne Hospital and the Royal Women’s Hospital, he was appointed Head of Chemical Pathology at the Royal Melbourne in 1996. He joined Gribbles Pathology (now Australian Clinical Labs) in 1998.
Dr Deam has played an active role in teaching scientific, nursing and medical staff at both undergraduate and postgraduate levels and has been an examiner for the Australasian Association of Clinical Biochemists as well as the Royal College of Pathologists of Australasia.
Dr Deam’s research interests and publications include work on thyroid function testing, various aspects of diagnostic protein measurement and the rational use of biochemical tests. His special interests include testing of endocrine function; protein abnormalities; as well as laboratory automation and application of computing to pathology services.
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