PHI 64/22 Private Health Insurance Legislation Amendment Rules (No. 11) 2022

Private health insurance clinical category and procedure type updates following Medicare Benefits Schedule (MBS) item changes from 1 October 2022

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

The Private Health Insurance Legislation Amendment Rules (No. 11) 2022 (the Amendment Rules) make consequential changes to the Private Health Insurance Rules to reflect changes to Medical Benefit Schedule (MBS) commencing 1 October 2022.

Further information on the new temporary item, including fact sheets and quick reference guides will be made available at MBS Online.

The Amendment Rules were registered on the Federal Register of Legislation to commence 1 October 2022.

The amendments add temporary MBS items 69506, 69507, 69508, 69509, 69510, 69511, 69512, 69513, 69514, and 69515 to, and remove items 69479 and 69480 from, Schedule 3 of the Private Health Insurance (Benefit Requirements) Rules 2011 (the Benefit Requirements Rules) for the purpose of specifying minimum hospital accommodation benefit requirements, to classify the new temporary MBS items as Type C procedure.

The new temporary pathology items are automatically categorised as Support treatment as they are in the Pathology services Table (PST). The new temporary items enable pathology laboratory testing for SARS-CoV-2 (the virus that causes COVID-19) and other respiratory pathogens and will cease 31 December 2022. The new temporary MBS items supersede MBS items 69479 and 69480 which cease 30 September 2022.

Further details on the Amendment Rules are included in the Explanatory Statement accompanying the Amendment Rules available on the Federal Register of Legislation at or by searching ‘Private Health Insurance Legislation Amendment Rules (No. 11) 2022’.