PHI 57/15

This circular issued by the Private Health Insurance Branch contains information about private health insurance

Page last updated: 31 August 2015

Printable version of 57/15 (PDF 148 KB)

31 August 2015

Private Health Insurance (Benefit Requirements) Amendment Rules 2015 (No.3) Changes to the Private Health Insurance (Benefit Requirements) Rules 2011

The Private Health Insurance (Benefit Requirements) Amended Rules 2015 (No.3) (the Amendment Rules) were registered with the Federal Register of Legislative Instruments (FRLI) and commences on 1 September 2015 (FRLI No. F2015L01356).

These Benefit Requirements Amendment Rules amend the Private Health Insurance (Benefit Requirements) Rules 2011.

Medical Benefits Schedule (MBS) item numbers – Schedule 1

The Amendment Rules remove three items and insert 33 new items into Schedule 1 of the Private Health Insurance (Benefit Requirements) 2011.

Item 1 – Schedule 1, Part 2 – Type A Procedures, Clause 4, Advanced surgical patient, Subclause (3)

Item 1 amends Schedule 1, Part 2 – Type A Procedures, Clause 4, Advanced surgical patient, Subclause (3) of the Principle Rules by inserting three new MBS item numbers (31516, 43838 and 37825).

MBS item 31516 is a new item for the treatment of early stage breast cancer using targeted intraoperative radiotherapy. MBS items 43838 and 37825 are new paediatric surgery items.

These three items will be included in the General Medical Services Table (GMST) from 1 September, 2015.

Item 2 – Schedule 1, Part 2 – Type A Procedures, Clause 6 Surgical patient, Subclause (3)

Item 2 amends Schedule 1, Part 2 – Type A Procedures, Clause 6 Surgical patient, Subclause (3) of the Principle Rules by deleting three MBS item numbers (30612, 30616 and 30617) and inserting 30 new MBS item numbers (30287, 30326, 30608, 30611, 30618, 30619, 30622, 30623, 30626, 30637, 30639, 30643, 30645, 30646, 34529, 34534, 37801, 37804, 37807, 37810, 37813, 37819, 37822, 37828, 37834, 43805, 43832, 43835, 43841, 44101).

The introduction of new items has resulted in the redundancy and subsequent deletion of items 30612, 30616 and 30617.

The 33 new items have been introduced as part of a revised listing for paediatric surgical services. These new items will be included in the GMST from 1 September, 2015.

Medical Benefits Schedule (MBS) item numbers – Schedule 3

The Amendment Rules remove two and insert 18 new items into Schedule 3 of the Private Health Insurance (Benefit Requirements) 2011.

Item 3 – Schedule 3, Part 2 – Type B Procedures, Clause 4, Band 1, Subclause (1)

Item 3 amends Schedule 3, Part 2 – Type B Procedures, Clause 4, Band 1, Subclause (1) of the Principle Rules by inserting paragraph (c) Category 2 – Diagnostic procedures and investigations, being the item below in the general medical services table and group D1: Miscellaneous diagnostic procedures and investigation, which includes one new MBS item number (11801).

This item has been added as an equivalent item for endoscopy and will be included in the GMST from 1 September 2015.

Item 4 – Schedule 3, Part 2 – Type B Procedures, Clause 5 Non-band specific Type B day procedures, Subclause (1)

Item 4 amends Schedule 3, Part 2 – Type B Procedures, Clause 5 Non-band specific Type B day procedures, Subclause (1) by inserting five new MBS item numbers (30105, 30627, 37816, 42576 and 44104).

The five new items have been introduced as part of a revised listing for paediatric surgical services. These new items will be included in the GMST from 1 September, 2015.

Item 5 – Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 1 - Attendances

Item 5 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 1 – Attendances by inserting a new group A10, which includes five new MBS items (10944, 10945, 10946, 10947 and 10948).

Item 10944 is a new item for the removal of superficial embedded corneal foreign bodies by an optometrist.

Items 1094, 10946, 10947 and 10948 are new items for optometrists to provide clinical support to a patient during telehealth consultations with ophthalmologists.

These new items will be included in the GMST from 1 September, 2015.

Item 6 – Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 2 – Diagnostic Procedures & Investigations, D1

Item 6 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 2 – Diagnostic procedures & investigations, D1 by inserting four new MBS item numbers (11719, 11720, 11725 and 11726)
These new items are being introduced to enable remote monitoring of implanted cardiac devices.

These new items will be included in the GMST from 1 September, 2015.

Item 7 – Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 5 – Diagnostic Imaging Services, I2

Item 7 amends Schedule 3, part 3 – Type C Procedures, Clause 8 Interpretation, Category 5 – Diagnostic Imaging Services, I2 by deleting two MBS item numbers (56552 and 56554) and inserting two new MBS item numbers (56553 and 56555).

These two new items are for computed tomography colonography. The introduction of new items has resulted in the redundancy and subsequent deletion of items 56552 and 56554.

These new items will be included in the Diagnostic Imaging Services Table from 1 September, 2015.

Item 8 – Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 6 – Pathology Services, P7

Item 8 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 6 – Pathology services, P7 by inserting one new MBS item number 73338.

This new item will be inserted into the Pathology Services Table for pharmacogenetic testing – RAS (KRAS and NRAS) Determination.

This new item will be included in the Pathology Services Table from 1 September 2015.

Details of the amendments are set out in the Amendment Rules, which are available on the ComLaw website.

If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to Private Health Insurance Branch.

For more information visit 2015 Private Health Insurance (PHI) Circulars.

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