Clarifying MBS Item 41647: Microsuction, Medicare, and Safer Ear Care for Patients
There has been significant confusion among GPs regarding the appropriate use of MBS item 41647 for ear toileting using micro-inspection and microsuction. Many GPs are now hesitant to claim this item out of concern about Medicare audits and potential repayments — leading some to revert to ear syringing, a method that ENT specialists have long advised against due to its associated risks.
Let’s revisit how we got here and where things now stand.
The Shift from Syringing to Microsuction
Historically, ear syringing was the standard method used in general practice to manage impacted wax, simply because there were no other tools available. Over time, an increasing number of GPs began using microsuction with a microscope, aligning with ENT-recommended best practices, as ear syringing carries a significant risk of major complications—approximately 1 in every 1,000 cases. This shift wasn’t financially motivated, but clinically driven — many GPs invested in expensive, hospital-grade microscopes to deliver better outcomes and safer care for their patients.
Naturally, GPs began billing MBS item 41647 for these procedures, believing in good faith that they were providing the right care — both medically and in accordance with Medicare guidelines. The item helped offset the cost of equipment while ensuring high-quality ear care.
Medicare Audits and a Wave of Fear
Unfortunately, after Medicare conducted audits of item 41647 usage, some GPs were required to repay varying sums. In most cases, these claims were rejected because they were considered to relate to uncomplicated wax removal or insufficient documentation of the procedure and its clinical justification, which Medicare deemed ineligible under item 41647.
This created widespread fear. As a result, many GPs stopped billing the item entirely — and, worse still, returned to syringing as a default option, even though microsuction is known to be safer, particularly in cases of tympanic membrane pathology, otitis externa, or anatomical risk.
A Brief Timeline of Change
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2019: Medicare released guidance suggesting that item 41647 be used by ENT specialists only. This was challenged by the RACGP and broader GP community.
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Post-review: Rather than restricting the item to specialists, Medicare chose to revise the item descriptor to reduce misuse — not eliminate GP access.
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2021: RACGP published an article clarifying that item 41647 could still be used by GPs — but only in specific circumstances.
“The Taskforce recommends adding an explanatory note to item 41647 to state that the item is not for the removal of uncomplicated wax or debris if it can be achieved using a simpler method, such as topical eardrops or syringing.”
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March 2023: The descriptor for MBS item 41647 was officially updated to its current form:
“Micro inspection of tympanic membrane and auditory canal, requiring use of operating microscope or endoscope, including any removal of wax, with or without general anaesthesia, other than a service associated with a service to which item 41509 applies. Not applicable for the removal of uncomplicated wax in the absence of other disorders of the ear.”
What Does This Mean for GPs Now?
Good news: GPs can still bill item 41647 — it is not limited to ENT specialists.
However, the procedure must meet the following conditions:
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Microscope or endoscope is used
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Ear drops or syringing have failed, are contraindicated, or inappropriate
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There is a clinically relevant ear disorder (e.g. suspected otitis externa, acute hearing loss, foreign body, perforation, or unclear view of tympanic membrane requiring micro-inspection)
In 2021, RACGP further advised that the clinical note should document that ear drops and syringing were ineffective or unsuitable, and that a disorder of the ear is present.
Clinical Rationale: Why This Matters
We often see patients with acute hearing loss, otalgia, or visible debris, and are unable to inspect the tympanic membrane clearly. Without a clear view, proper diagnosis and treatment cannot be initiated. In these situations, microsuction via microscope may be necessary, and MBS item 41647 is both clinically and ethically appropriate to claim — provided the criteria as outlined in the descriptor of MBS item 41647 are met.
Final Recommendation to GPs
If you’re performing microsuction with a microscope or endoscope due to failure or contraindication of other methods, and there is an associated ear disorder, you are entitled to claim MBS item 41647. Item 41647 applies to a single ear and can be claimed twice if performed bilaterally
But:
- Document carefully: Note the clinical indication, failed attempts with drops/syringing, and the findings or rationale for micro-inspection.
- Do not use item 41647 for simple wax removal with no underlying disorder.
Let’s return to providing safe, evidence-based ear care for our patients — without unnecessary fear. The revised item descriptor now supports GPs to do exactly that.
