The Private Health Insurance (Prostheses) Amendment Rules (No. 2) 2022 gave effect to the changes to the July 2022 Prostheses List, including the changes related to the PL reforms announced in the 2021-22 Budget such as introduction of the PL Part D for the general use items, completion of two outstanding new applications and rectifying the incorrectly listed benefit (refer further information in the PHI Circular 45/22).
After the Amendment Rules had been made, however, the Department became aware about a few errors in the PL due to some technical glitches in the Prostheses List Management System (PLMS).
The Department is planning to prepare the further Amendment Rules to rectify the errors as soon as practicable, but in order to minimise the effect on the stakeholders, this PHI Circular has been prepared to advise about the incoming changes.
The corrections that we plan to make are the following:
- The billing codes listed on the PL Part D have incorrectly stated benefits:
- LV086 has incorrectly stated benefit of $250, the correct benefit is $112
- MN229 has incorrectly stated benefit of $180, the correct benefit is $31
Stakeholders are asked to claim and pay the correct benefit amounts in anticipation of the amendments to be made to the Prostheses List.
- The billing codes unintentionally omitted in the PL Part A:
- AK012, ER650, WA011 were listed on 1 July 2022, appeared incorrectly in Part D in the PL Excel version published on the Department’s website in August but were not included in Schedule of the Prostheses Rules
- BT212 and BT213 were not included
Stakeholders are asked to consider paying benefits in respect of these devices in anticipation of the amendments to be made to the Prostheses List.
- The billing codes appearing in the incorrect Part but with no implications for the benefits or other details:
- ET064, MS056 and OB003 are listed correctly in the PL Part A in the Excel version published on the Department’s website in August but appear incorrectly in Part D in Schedule of the Prostheses Rules
- DF004 was correctly listed in the PL Part C in July 2022, but appeared incorrectly in Part A in August
Stakeholders are asked to note that this will be corrected.
- Deleted billing code: WC199
Stakeholders are asked to note that this billing code will be deleted.