Private Health Insurance classification of MBS items 1 July 2023

The ‘Private Health Insurance classification of MBS items 1 July 2023’ (the ‘PHI Spreadsheet’) is derived from MBS XML Data file ‘MBS-XML-20230701 (XML 7832 KB)’ released on 4 April 2023, and includes indexation and changes to the General Medical Services Table, Pathology Services Table, Diagnostic Imaging Services Table and the Health Insurance Regulations 2018. This file also includes changes to various instruments made under subsection 3C(1) of the Health Insurance Act 1973.

PHI classifications and categorisations in the PHI Spreadsheet include key MBS item changes also summarised in the MBS Online July 2023 News:

• plastic and reconstructive surgery services item charges   
• new mental health case conferencing items (930, 933, 935, 937, 943, 945, 946, 948, 959, 961, 962, 964, 969, 971, 972, 973, 975, 986, 80176, 80177 and 80178)
• cardio-thoracic item 38680 will be amended so that tumour excision services under this item may only be performed in-hospital
• amendment to orthopaedic item descriptor 49706 to allow patients to access this service where no infection is indicated
• repeal of item 32221 for the removal or revision of an artificial bowel sphincter
• amendment to items 13761 and 13762 for extracorporeal photopheresis treatments of graft versus host disease to apply once per each treatment in a 25-session treatment cycle, rather than once per cycle
• amendment to therapeutic nuclear medicine item 16015 to apply to patients with all cancer types
• increased scheduled fee for therapeutic nuclear medicine items 16003, 16006, 16009, 16012 and 16018 to reflect the cost of the radiopharmaceuticals
• introduction of new nuclear medicine item 61466 for cerebro-spinal fluid transport studies using indium-111, mirroring existing MBS item 61409 but using a different radioisotope
• amendment to the descriptor for nuclear medicine item 61409 to specify use of technetium‑99m and a fee increase to better reflect isotope costs
• amendment of MRI item 63545 to clarify the item descriptor, aligning with the original policy intent of changes implemented on 1 November 2022
• new MBS pathology item (69505) for antimicrobial drug susceptibility testing for patients who have an infection caused by a pathogen in the mycobacterium tuberculosis complex
• one new MBS item (73429) for initial diagnosis somatic gene panel testing classification of gliomas, including glioneuronal tumours or glioblastoma
• two new MBS items (73434 and 73435) and one amended MBS item (73427) for single gene testing for the diagnosis of early-onset heritable neuromuscular disorders
• other administrative and machinery changes.

Further information on changes to the MBS 1 July 2023, including fact sheets and quick reference guides is at MBS Online.

PHI Spreadsheets reflect the assignment of MBS items by clinical category and procedure type set out in PHI rules. The PHI Rules for 1 July 2023 will be published on the Federal Register of Legislation and formal notification from the Department of Health and Aged Care will be via Private Health Insurance Circular following the finalisation of regulatory approval processes. Subscribe for notification of new Circulars using Health’s Latest News RSS (Really Simple Syndication) feed.

Receive notification of updates to PHI Spreadsheets, and other PHI information, by emailing PHI@health.gov.au requesting subscription to the email newsletter.

For older versions of this publication, review the Private health insurance clinical category and procedure type collection, or visit the National Library's web archive.