Private Health Insurance classification of MBS items 1 July 2021

The MBS items in this spreadsheet include private health insurance information for MBS items commencing 1 July 2021.


MBS items assigned to a Private Health Insurance clinical category or procedure type

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PHI Spreadsheets are typically only updated when MBS item changes (and their associated MBS XML Data Files) result in changes to private health insurance (PHI) clinical categorisations and procedure type classifications.

The ‘MBS items assigned to a private health insurance clinical category or procedure type spreadsheet - 1 July 2021 – as at 23 June 2021’ is derived from the MBS XML file of 18 June 2021. It contains additional MBS items from the MBS XML files published on 16 and 21 June 2021. MBS item changes and associated XML files subsequently released have not required changes to PHI Rules. The 23 June PHI Spreadsheet, and notes below, remain current. PHI classifications and categorisations in the PHI Spreadsheet include:

  • general surgery, cardiac services and orthopaedic services, also previously provided in the PHI spreadsheet released on 17 June 2021
  • new MBS items for Transcatheter Mitral Valve repair
  • administrative correction of Transcatheter Aortic Valve Implantation case conference items 6080 and 6081 to include them in the Type C Procedure list, consistent with equivalent MitraClip items 6082 and 6084
  • updated procedure type classifications for orthopaedic surgery related items 47045 and 47465.

The PHI spreadsheet reflects the assignments set out in the Private Health Insurance Legislation Amendment Rules (No. 4) 2021 (the Amendment Rules No.4), with the following exceptions that will be incorporated into the next PHI Spreadsheet:

  • Item 38416 procedure type should be ‘Type A Surgical,’ not ‘N/A (Not hospital treatment)’
  • Items 30663 and 30666 procedure type should be ‘unlisted,’ not ‘Type A Advanced Surgical’
  • Item 48939 clinical category should be ‘Joint reconstructions’ not ‘Bone, joint and muscle’

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