PHI 10/25 Private Health Insurance Legislation Amendment Rules (No. 2) 2025

Private health insurance clinical category and procedure type updates following Medicare Benefits Schedule (MBS) item changes from 31 January and 1 July 2025.

Date published:
PHI circular type:
PHI announcement
Audience:
Health sector

The Private Health Insurance Legislation Amendment Rules (No. 2) 2025 (the Amendment Rules) make consequential changes to the Private Health Insurance (Benefit Requirement) Rules 2011. These reflect changes to MBS item 42738 and correction of an administrative error.

Commencing 31 January 2025, the reclassification of MBS item 297 from a Type C procedure to an Unlisted procedure is to correct an administrative error in the legislative amendment commenced 1 January 2025 when the item was incorrectly added to the Type C table.

From 1 July 2025, MBS item 42738 will be replaced with MBS item 43030 for injection of the left eye and MBS item 43032 for injection of the right eye. The new MBS items will be classified as Type C procedures and relate to a measure announced in the 2024-25 Budget and the MBS Review Taskforce recommendations.

The Amendment Rules were registered on 20 January 2025 on the Federal Register of Legislation and commence from 1 July 2025. Further details on the Amendment Rules can be found in the accompanying Explanatory Statement.