The Private Health Insurance Legislation Amendment Rules (No. 13) 2022 (the Amendment Rules) make consequential changes to the Private Health Insurance Rules to reflect changes to Medical Benefit Schedule (MBS) items to the General Medical Services Table (GMST), Pathology Services Table (PST) and Diagnostic Imaging Services Table (DIST) commencing 1 November 2022.
Further information on changes to the MBS for 1 November 2022, including fact sheets and quick reference guides is available at MBS Online.
The Amendment Rules were registered on the Federal Register of Legislation on 31 October 2022 and commence on 1 November 2022.
The amendments include re-classification of new and amended MBS items and removal of deleted items where appropriate, in the:
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Private Health Insurance (Complying Product) Rules 2015 (the Complying Product Rules)
- Schedule 5 for the Clinical categories
- Schedule 6 for the Common treatments list
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Private Health Insurance (Benefit Requirements) Rules 2011 (the Benefit Requirements Rules)
- Schedule 1 for Type A Surgical procedures
- Schedule 3 for Type B Non-band specific and Type C procedures
An error was identified in the Private Health Insurance Legislation Amendment Rules (No. 12) 2022 for 21 MBS items which had amendments to the clinical category and procedure type when these should not have been amended. The Amendment Rules repeals Private Health Insurance Legislation Amendment Rules (No.12) 2022 and will also restore existing MBS items 36531, 36532, 36533, 36537, 36543, 36546, 36549, 36552, 36558, 36561, 36564 to the ‘Kidney and bladder’ Clinical category and items 39300, 39303, 39306, 39307, 39309, 39312, 39315, 39318, 39319 and 39321 to ‘Brain and nervous system’.
Amendments will also be made to the Benefit Requirement Rules to restore MBS items 36531, 36532, 36533, 36543, 36564, 39315 to the Type A Advanced Surgical procedures list, items 36537, 36546, 36549, 36552, 36558, 39300, 39303, 39306, 39307, 39309, 39312, 39318, 39319 and 39321 to the Type A Surgical, and MBS item 36561 to the Type B Non-band specific.
Further details on the Amendment Rules 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. 13) 2022’.
Information and spreadsheets for MBS items assigned to a clinical category or procedure type are available at Private health insurance clinical category and procedure type.
Information on MBS item changes can be found at www.mbsonline.gov.au.