PHI 40/24 Private Health Insurance (Medical Devices and Human Tissue Products) Rules (No. 1) 2024

The Prescribed List of Medical Devices and Human Tissue Products (PL) will be updated on 1 July 2024.

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

The Prescribed List of Medical Devices and Human Tissue Products (PL) will be updated on 1 July 2024. The delegate of the Minister for Health and Aged Care has made the Private Health Insurance (Medical Devices and Human Tissue Products) Rules (No. 1) 2024, to replace the Private Health Insurance (Medical Devices and Human Tissue Products) Rules (No. 2) 2023.

The Private Health Insurance (Medical Devices and Human Tissue Products) Rules (No. 1) 2024 (the Rules) were registered on the Federal Register of Legislation on 22 June 2024 and will commence on 1 July 2024.

The changes effected in the MDHTP Rules

The Rules give effect to all changes resulting from completion of the Prescribed List applications (new, amendment, expansion, deletion, and sponsors’ transfers).

Other changes

Scheduled benefit reductions for Part A medical devices

The July 2024 Prescribed List reflects the final 20% benefit reduction to the billing codes for medical devices listed on Part A, and the second 20% benefit reduction to the device component of the cardiac implantable electronic devices benefit.

Incorrectly listed billing codes

Some billing codes were listed incorrectly (in the incorrect groupings) in the specialist orthopaedics, knee, and spinal categories. 

The department sought advice and contacted the sponsors of these billing codes to seek required information for their respective devices. The information available (including information received from the sponsors) was assessed and further advice was sought in relation to these issues.

Following detailed consideration of the above, decisions were made to correct the details of the billing codes in the 1 July 2024 PL.

Listing criteria for Part D

The Rules incorporate listing criteria that general use items (Part D) are required to meet in order to be eligible for listing on the PL (refer to Part 3 of the Rules). The repeal provision of Part D has also been removed from the Rules, as general use items will continue to be listed post 1 July 2024. 

For further information refer the Explanatory Statement for the MDHTP Rules.

Other

The department previously used the web-based Prostheses List Management System (PLMS) for administration of the Prescribed List. Since 2023, administration of the Prescribed List has been transitioning to the Health Products Portal (HPP).

The information published on the 1 July 2024 PL is extracted from the HPP. This is the first time the department has used the HPP for this purpose. The PLMS included functionality for providing a draft PL to sponsors prior to finalising the PL. This functionality is yet to be built into the HPP. This means that while sponsors have received advice on the recommendations for their applications and billing codes, they have not had access to the draft PL.

The PL (Part A, Part B, Part C and Part D) reports on changes are provided in Excel and Portable Document Format at Prescribed List of Medical Devices and Human Tissue Products webpage.