FibroScan and Medicare: Why MSAC Rejected Application 1797

If you are considering purchasing a FibroScan for your practice, there is one regulatory fact that should inform your decision above all others: as of early 2025, the Medical Services Advisory Committee (MSAC) declined to fund vibration-controlled transient elastography (VCTE) — the technology used by FibroScan — on the Medicare Benefits Schedule for MASLD fibrosis assessment.

What Is MSAC Application 1797?

Application 1797 was a submission to include VCTE for the identification of advanced liver fibrosis in patients with MASLD (Metabolic dysfunction-Associated Steatotic Liver Disease) on the MBS. The application was supported by organisations including GESA (Gastroenterological Society of Australia) and the RACGP, who argued that non-invasive fibrosis testing would reduce unnecessary liver biopsies and improve care for Australia's growing MASLD population.

What Did MSAC Decide?

In early 2025, MSAC did not support the application. The committee's rationale centred on two key findings:

• The FIB-4 index — a simple calculation from routine blood tests (age, AST, ALT, platelet count) — already performs well as a rule-out test for significant fibrosis, with a negative predictive value of 95–97%. As FIB-4 costs the health system near-zero, adding an expensive technology that largely duplicates this rule-out function was not considered cost-effective.
• The clinical evidence did not sufficiently demonstrate that adding VCTE to the MBS pathway improved patient treatment outcomes compared to existing assessments. Without a clear, incremental benefit to the patient, MSAC could not justify the additional cost to the taxpayer.

What This Means for FibroScan Buyers

The practical commercial implications of MSAC 1797 for practice owners are significant:

• Any practice purchasing a FibroScan today is investing $65,000–$120,000+ AUD in a device whose primary clinical use attracts no Medicare rebate — and no rebate is likely in the immediate future.
• Every patient scan must be charged entirely out-of-pocket: typically $250–$330 per scan. This cost is a meaningful barrier to patient access and referral volume, particularly in bulk-billing and mixed-billing GP practices.
• Annual service contracts for FibroScan run approximately $11,400 per year — a fixed cost regardless of scan volume.
• MSAC did not reject elastography as a clinical modality. It rejected the specific application for VCTE (FibroScan's core technology) in MASLD. The door remains open for future applications, but there is no current timeline.

Is There a Medicare Rebate for Any Liver Elastography?

Yes — via a different pathway. Two-dimensional shear wave elastography (2D-SWE) is frequently performed as an adjunct to a standard abdominal ultrasound in radiology-led settings. Abdominal ultrasound attracts a Medicare rebate of approximately $100–$120 under existing item numbers, meaning the out-of-pocket gap for a patient receiving both anatomical imaging and a liver stiffness measurement in one appointment is often substantially lower than a standalone FibroScan consultation.

This billing pathway does not apply to VCTE-only devices. It requires a system capable of full diagnostic ultrasound imaging combined with SWE — the type of integrated guided system supplied by Elastography Australia.

The MBS Item 55292 Context

MBS item 55292 covers transient elastography in eligible clinical settings — primarily specialist-led assessment of chronic liver disease. It does not provide a blanket rebate for all FibroScan services, and it does not apply in the primary care or GP setting without specific provider and clinical criteria being met. Practices should verify whether their workflow meets the current item descriptor with their billing advisor.

What MSAC Did Not Reject

It is important to note what MSAC explicitly did not reject. The committee affirmed:

• Elastography is safe and non-invasive.
• FIB-4 is a validated first-line tool — which is why content targeting clinicians at the FIB-4 decision point (indeterminate FIB-4 → next step) remains clinically aligned with the MSAC pathway.
• Liver biopsy should be avoided where possible — meaning the demand for non-invasive fibrosis assessment tools is not going away.

The MSAC decision essentially tells clinicians: use FIB-4 first, then use a more resource-efficient technology for those who need further staging. Guided 2D-SWE, which can be delivered as part of a standard ultrasound appointment with a Medicare contribution, fits this model better than a standalone proprietary VCTE device.