Update on MBS Item 32150 - Botulinum Toxin and PRP for the treatment of Anal Fissures

Date:13 February 2026
Category: Advocacy & Policy

The CSSANZ Council Executive has recently been in correspondence and meetings with the Department of Health (DoH) regarding proposed changes to MBS item 32150, including the planned removal of all reference to botulinum toxin for the treatment of anal fissures.

32150 – Operation for anal fissure, including excision, injection of botulinum toxin or sphincterotomy, excluding dilatation (H)

The Department has advised that botulinum toxin is not approved by the Therapeutic Goods Administration (TGA) for the treatment of anal fissures. While many clinicians recognise its clinical effectiveness, the DoH cannot support its inclusion within an MBS item without formal TGA approval.

CSSANZ has been advised that manufacturers could theoretically seek TGA approval for this indication. However, Council considers it unlikely that this will occur, given the relatively small size of the anal fissure indication compared with the broader botulinum toxin market.

As a result, it is anticipated that the proposed MBS change will proceed.

Practical implications

  • Private health insurers would no longer be obliged to fund botulinum toxin or the associated procedure when performed in isolation in hospital.
  • This may have material financial and access implications for both patients and clinicians who currently rely on this treatment option.

CSSANZ has expressed its disappointment with this outcome, particularly noting that botulinum toxin remains widely used across other specialties such as neurology and urology. However, those indications are supported by specific TGA approvals, which underpin their MBS eligibility.

Platelet-Rich Plasma (PRP)

Council has also become aware of increasing promotion of platelet-rich plasma (PRP) for the treatment of anal fissures. The Department of Health has strongly advised against this practice at present, referring to Medicare Benefits Schedule Explanatory Notes (GN.13.33), which state:

“No MBS item applies to a service mentioned in the item if the service is provided to a patient at the same time as, or in connection with, an injection of blood or a blood product that is autologous.”

In practical terms, this means that if PRP is injected, no MBS service can be claimed. Associated claims would be rejected by Medicare, private health insurers would not pay, and the patient would be liable for all medical and hospital costs.

For PRP to be considered for in-hospital use in the future, a formal application supported by appropriate clinical evidence would need to be submitted to the Department of Health. While PRP use outside hospital settings is not prohibited, it remains entirely unfunded by Medicare.

CSSANZ continues to maintain an open line of communication with the Department on these matters and will keep members informed of further developments.

Michael Johnston
Vice President, CSSANZ