PHI 16/23 Private Health Insurance Legislation Amendment Rules (No. 1) 2023

Private health insurance clinical category and procedure type updates following Medicare Benefits Schedule (MBS) item changes from 1 March 2023.

Date published:
PHI circular type:
PHI announcement
Audience:
General public

The Private Health Insurance Legislation Amendment Rules (No. 1) 2023 (the Amendment Rules) make consequential changes to the Private Health Insurance Rules to reflect changes commencing 1 March 2023 to Medical Benefit Schedule (MBS) items of the General Medical Services Table (GMST), Pathology Services Table (PST) and Diagnostic Imaging Services Table (DIST), and through Ministerial Determination under subsection 3C(1) of the Health Insurance Act 1973.

Further information on changes to the MBS for 1 March 2023, including fact sheets and quick reference guides is available at MBS Online.

The Amendment Rules will be registered on the Federal Register of Legislation and commence on 1 March 2023.

The amendments include re-classification of new and amended MBS items and removal of deleted items where appropriate, in the:

  • Private Health Insurance (Complying Product) Rules 2015 (the Complying Product Rules)
    • Schedule 5 for the Clinical categories
    • Schedule 6 for the Common treatments list
    • Schedule 7 for the Support treatments list
  • Private Health Insurance (Benefit Requirements) Rules 2011 (the Benefit Requirements Rules)
    • Schedule 1 for Type A Advanced Surgical procedures
    • Schedule 1 for Type A Surgical procedures
    • Schedule 3 for Type B Band 1, Type B Non-band specific and Type C procedures

Further details on the Amendment Rules are included in the Explanatory Statement accompanying the Amendment Rules available on the Federal Register of Legislation website or by searching ‘Private Health Insurance Legislation Amendment Rules (No. 1) 2023’.

Information and spreadsheets for MBS items assigned to a clinical category or procedure type are available through the Private health insurance clinical category and procedure type resource collection.

Information on MBS item changes are available from the MBS Online.