PHI 84/15

This circular contains information about changes to the Private health Insurance (Benefit Requirements) Rules 2011

Page last updated: 23 December 2015

Printable version of 84/15 (PDF 138 KB)

23 December 2015

Private Health Insurance (Benefit Requirements) Amendment Rules 2015 (No.6)
Changes to the Private Health Insurance (Benefit Requirements) Rules 2011



The Private Health Insurance (Benefit Requirements) Amended Rules 2015 (No.6) (the Amendment Rules) were registered with the Federal Register of Legislative Instruments and commence on 1 January 2016.

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 one item and insert three 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 Principal Rules by inserting two new MBS items numbers (30176 and 30179).

MBS items 30176 and 30179 are new surgical items for Lipectomy services.

These items will be included in the General Medical Services Table (GMST) from 1 January 2016.

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 Principal Rules by inserting one new MBS item number (30172) and deleting one item (30174). MBS item 30172 is a new surgical item for Lipectomy services.

This item will be included in the GMST from 1 January 2016.

Medical Benefits Schedule (MBS) item numbers – Schedule 3

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

Item 3 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 3 – Therapeutic procedures, T2

Item 3 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 3 – Therapeutic procedures, T2 of the Principal Rules by inserting four new MBS item numbers (15275, 15555, 15565 and 15715). MBS items 15275, 15555, 15565 and 15715 are all new MBS items for the treatment of various forms of cancer using Intensity-modulated radiation therapy (IMRT).

These items will be included in the GMST from 1 January 2016.

Item 4 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 6 – Pathology services, P7

Item 4 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 6 – Pathology services, P7 of the Principal Rules by inserting one new MBS item number (73342) in the pathology services table. Item 73342 is a new item for in-situ hybridisation test of tumour tissue from a patient to determine eligibility to access trastuzumab (for treatment of gastric cancer) under the Pharmaceutical Benefits Scheme.

This item will be included in the Pathology Services Table (PST) from 1 January, 2016.

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