Information for health professionals about the Medicare benefits available for assisted reproductive technology services.
Assisted reproductive technology (ART) services include a range of treatments to achieve pregnancy, involving laboratory or clinical techniques, such as:
- in-vitro fertilisation (IVF)
- gamete intrafallopian transfer (GIFT)
- intracytoplasmic sperm injection (ICSI)
- intrauterine insemination (IUI)
Information for medical practitioners
There are a number of Medicare Benefits Schedule (MBS) items for ART treatment. Six of these items are known as ‘global items’ because they cover all related services during an ART treatment cycle including:
- pathology, and
- diagnostic imaging services
Other ART services such as oocyte retrieval or transfer of embryos are covered under separate MBS items.
Only 1 global item can be billed for each treatment cycle.
ART treatment cycle
The treatment cycle for ART services begins on either:
- the day the patient starts treatment with superovulatory drugs, or
- the first day of the patient's menstrual cycle
The treatment cycle for ART services ends:
- not more than 30 days after the treatment cycle begins, or
- the day after the last of the following services are provided:
- oocyte retrieval
- transfer of embryos or both ova and sperm, or
- preparation of sperm for the purpose of artificial insemination
Under Medicare, there isn’t a limit on the number of treatment cycles a patient can have. However, Medicare rebates are only available for ‘clinically relevant’ services, being services that meet peer-approved standards for good practice.
Billing ART services under Medicare
ART global items cover all services performed during the ART treatment cycle. This means that any consultation, pathology and diagnostic imaging services provided as part of ART treatment cannot be billed separately to Medicare, as these services are already covered under ART global items.
We can only pay Medicare benefits according to the Health Insurance Act (1973) and have a legal obligation to recover any Medicare benefits paid incorrectly. This could affect ART, pathology and diagnostic imaging practitioners who separately bill Medicare for services provided during an ART treatment cycle.
More information on the requirements for billing ART items is available on MBS Online.
Pathology and diagnostic imaging services
Practitioners who request pathology or diagnostic imaging services related to a patient’s ART treatment should note on the request that the services relate to ART. If pathology or diagnostic imaging practitioners are unsure whether a requested service relates to ART treatment, they should contact the requesting practitioner before billing the service to Medicare.
Medicare benefits for surrogacy arrangements
Legislation prevents Medicare benefits from being paid for surrogacy arrangements.
Surrogacy is defined as an arrangement whereby a woman agrees to become pregnant and to bear a child for another person or persons to whom she will transfer guardianship and custodial rights at, or shortly after, birth.
For more information about ART services under Medicare:
- go to MBS Online for more about ART services under Medicare