PHI 37/22 Private Health Insurance Legislation Amendment Rules (No. 7) 2022

Updates to the Private health insurance clinical category and procedure types following Medicare Benefits Schedule (MBS) item changes from 1 July 2022.

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

The Private Health Insurance Legislation Amendment Rules (No. 7) 2022 (the Amendment Rules) make consequential changes to the Private Health Insurance Rules to reflect the introduction of four new co-dependent pathology items for neurotrophic tyrosine receptor kinase (NTRK) gene fusion testing in patients with locally advanced or metastatic solid tumour to determine eligibility for access to Larotrectinib under the PBS and amendment of an existing item for removal of sacral nerve lead or leads, commencing 1 July 2022.

These Amendment Rules are in addition to the Private Health Insurance Legislation Amendment Rules (No. 5) 2022 which covered changes including to the general medical services table (GMST), pathology services table (PST) and diagnostic imaging services table (DIST) commencing 1 July 2022.

Further information on changes to the MBS for 1 July 2022, including fact sheets and quick reference guides is available at MBS Online.

The Amendment Rules No. 7 were registered on the Federal Register of Legislation and commence on 1 July 2022. The amendments include the assignment of classifications for new items and re‑classification of an amended MBS item in the:

As the four new co-dependent MBS (73430, 73431, 73432 and 73433) are in the Pathology Services Table (PST) items they are automatically categorised as Support treatments so do not need to be specifically listed under Schedule 7.

  • Private Health Insurance (Benefit Requirements) Rules 2011 (the Benefit Requirements Rules)
    • Schedule 3 for Type B Non-band procedures
      • adding existing MBS item 32218, inadvertently omitted from the Private Health Insurance Legislative Amendment Rules (No.5) 2022
    • Schedule 3 for Type C procedures
      • adding new co-dependent PST items 73430, 73431, 73432 and 73433 for neurotrophic tyrosine receptor kinase (NTRK) gene fusion testing

Further details on the changes are included in the Explanatory Statement accompanying the Amendment Rules available on the Federal Register of Legislation at www.legislation.gov.au or by searching ‘Private Health Insurance Legislation Amendment Rules (No. 7) 2022’.

Information and spreadsheets for MBS items assigned to a clinical category or procedure type will be made available at Private health insurance clinical category and procedure type. Various filters can be applied to these spreadsheets to allow sorting by clinical category, procedure type and type of MBS change.

Information on MBS item changes can be found at www.mbsonline.gov.au.