PurposeTo determine whether vitamin B12 testing is appropriate for MBS reimbursement, considering the safety, efficacy, effectiveness of the tests and the effect that the results of the test have on treatment.
FindingsItems 66599 and 66602 linked testing of folate and vitamin B12 levels. The review found that there had been a substantial increase in the number of claims for folate/vitamin B12 testing over the past ten years and it appeared that the majority of these tests were requested for the purposes of screening or testing, rather than follow-up monitoring.
There are no Australian clinical practice guidelines that either advocate or recommend against routine testing for vitamin B12. The international clinical practice guidelines vary widely in their recommendations. While some recommend vitamin B12 test as screening tools in commonly encountered illnesses such as dementia, others suggest restricting testing to patients who have already undergone pre-test investigations such as a full blood count or blood film examination. There are no recommendations on the frequency of vitamin B12 testing and there is no direct evidence regarding the clinical utility of vitamin B12 testing in any population.
RecommendationsSplitting current MBS items which include both folate and vitamin B12 testing, and the creation of two separate MBS items for:
- testing serum vitamin B12 – benefits payable once in a 12-month period; and
- quantification of vitamin B12 markers such as holoTranscobalamin or methylmalonic acid when the initial serum vitamin B12 test is low or equivocal.
Vitamin B12 testing Protocol (PDF 1526 KB)
Vitamin B12 testing Protocol (Word 725 KB)
Vitamin B12 testing Review Report (PDF 1722 KB)
Vitamin B12 testing Review Report (Word 824 KB)