Please note: Only the XML has been uploaded. The Excel files will be provided after 1 July 2025. If you require Excel files before then, please email us at prescribedlist.reforms@health.gov.au
The Delegate for the Minister for Health and Ageing has made the Private Health Insurance (Medical Devices and Human Tissue Products) Amendment Rules (No. 1) 2025 (MDHTP Rules).
We expect the MDHTP Rules to be registered on the Federal Register of Legislation by Monday 30 June 2025. The Amendment Rules replace the Private Health Insurance (Medical Devices and Human Tissue Products) Rules 2025.
See the Prescribed List.
Changes effected
New and variation applications
Schedule 1 has been substituted to give effect to all changes resulting from completion of Prescribed List applications (new, amendment, expansion, compression, deletion, and transfer applications).
Changes to conditions placed on billing codes
A total of 37 billing codes in subcategory 07.02 - Plastic and Reconstructive – Craniomaxillofacial Implants have had their conditions updated. The updated condition limits the benefits payable for surgical guides and/or biomodels to 6 in any combination per procedure.
See the related PHI Circular for more information.
CIED benefit changes
The benefits for cardiac electronic implantable devices (CIED) have changed, giving effect to the third and final 20% reduction of the gap. These reductions apply to the device component of the PL benefit (established at 56.3%). The reduction of these benefits was part of the PL Reforms Budget Measure 2021-22.
See the related PHI Circular for more information.
Incorrectly listed billing codes
Billing codes listed in incorrect groupings have been moved to the correct grouping. This activity will continue as part of the ongoing assurance actions to fix inconsistencies and errors in the PL. Sponsors input and the information they provided was used to inform decision making.
Cost recovery
The cost recovery fees have been updated in Part 4 for new and variation applications for the 2025/2026 financial year. The fees are consistent with the 2025-2026 Prescribed List Cost Recovery Implementation Statement (CRIS).
Other
Section 15 has minor changes to clarify that sponsors must apply for a listing consistent with the grouping structure of Part D of the Prescribed List in force at the time of application.
Section 19 has minor changes to clarify that where a sponsor has paid both a clinical and an economic assessment fee, they do not have to pay the full health technology assessment pathway fee.