You’re not alone.
Until 31 October 2019, things were simple. Both the AMA and MBS schedules allowed the use of an anaesthetic modifier item (M1 for AMA, 25015 for MBS) if the patient was under 1 year of age or over 70 years of age.
But then things got interesting.
On 1 November 2019, the AMA and MBS schedules parted way over the age modifier. The AMA extended the younger age limit to include patients under 4 while keeping the older age limit at ‘greater than 70’. The MBS extended the younger age limit similarly but changed the upper age limit to ‘greater than 75’, while still keeping the same item numbers (25015).
However, although the original intention in the MBS change was to include patients under the age of 4, the wording was incorrect when it was gazetted in legislation as ‘not greater than 3 years’ – meaning all patients between 3 years/1 day and 3 years/364 days would be ineligible. So an additional modifier 25012 was introduced on 18 December 2019 although it was effective from 7 weeks earlier (1 November 2019).
On 1 May 2020, the original age modifier (25015) and the hurriedly added modifier (25012) were deleted from the schedule. 2 new items were introduced: 25013 (for patients under 4 years of age) and 25014 (for patients over 75 years). Meanwhile, the AMA modifier continues in its November 2019 form.
If you’re confused about which item to use, you’re not alone.
Thankfully, all these rule changes are incorporated into VaperTrail’s billing platform – which automatically chooses the correct modifier item (AMA or MBS) depending on the age of the patient at surgery, and depending on which particular rules/items were applicable then.
So if you’re using VaperTrail, you don’t need to know any of the above.