PHI 90/21 Private Health Insurance Legislation Amendment Rules (No. 7) 2021

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

Date published:
PHI circular type:
PHI announcement
Health sector

The Private Health Insurance Legislation Amendment Rules (No. 7) 2021 (the Amendment Rules) make consequential changes to the Private Health Insurance Rules to reflect changes to Medical Benefit Schedule (MBS) commencing 1 January 2022.

Further information on changes to the MBS for 1 January 2022, including a summary of changes, fact sheets and quick reference guides can be found at MBS Online.

The Amendment Rules were registered on the Federal Register of Legislation on 22 December 2021 and commence on 1 January 2022.

The Amendment Rules update the lists of MBS items as of 1 January 2022, in the:

  • Private Health Insurance (Complying Product) Rules 2015 (the Complying Product Rules)
    • Schedule 5 for the Clinical categories
      • removing temporary telehealth items deleted from the MBS from ‘Hospital psychiatric services’ and ‘Palliative care’ categories
    • Schedule 6 for the Common treatments list
      • removing items deleted from the MBS
    • Schedule 7 for the Support treatments list
      • updating the list of items consistent with the MBS at 1 January 2022.
  • Private Health Insurance (Benefit Requirements) Rules 2011 (the Benefit Requirements Rules)
    • Schedule 3 for Non-band specific Type B procedures
      • restoring existing MBS items 38272 and 45535 to the list, inadvertently omitted from the Private Health Insurance Legislative Amendment Rules (No. 6) 2021 (although correct in the PHI Spreadsheet).
    • Schedule 3 for Type C procedures
      • adding amended PST items 69479 and 69480 for polymerase chain reaction (PCR) testing for COVID-19;
      • adding new DIST item 63399 for cardiac magnetic resonance imaging (MRI) for myocarditis associated with mRNA COVID-19 vaccination; and,
      • adding new DIST items 55208 and 55211 for ultrasound imaging and integrated Doppler flow measurement by spectral analysis of cavernosal tissue of the penis.

Private Health Insurance (Health Insurance Business) Rules 2018 (the Business Rules)

Following the cessation of temporary MBS items for COVID-19 specialist in-hospital telehealth from 1 January 2022, the Business Rules will also be amended to repeal additions made to Part 3 Rule 8 that had ensured the temporary MBS items would not be considered hospital treatment.

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. 7) 2021’.

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