Private Health Insurance classification of MBS items 1 November 2022

The ‘Private Health Insurance classification of MBS items 1 November 2022 v3’ is derived from MBS XML Data file 'XML-20221101.v2-MBS (XML 7,935 KB)' released through MBS Online on 17 October 2022, effective 1 November 2022. The file includes changes to the General Medical Services Table (GMST), Pathology Services Table (PST) and Diagnostic Imaging Services Table (DIST) and indexation to the greatest permissible gap. In addition, this file also includes the October changes to the MBS, co-dependant pathology services, psychiatry telehealth and Better Access Initiative services.

Update as of 1 November 2022: 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 Private Health Insurance Legislation Amendment Rules (No. 13) 2022 repeals Private Health Insurance Legislation Amendment Rules (No.12) 2022 and will 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 were also 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 list.

The updated ‘Private Health Insurance classification of MBS items 1 November 2022 v3’ now includes all changes commencing up to and including 1 November 2022 and supersedes the PHI spreadsheet provided on 21 October 2022.

The MBS Online November 2022 News provides a summary of MBS changes for 1 November 2022. Key MBS item changes for PHI classifications and categorisations in the PHI Spreadsheet include:

• new co-dependent item (73436) for METex14sk testing in patients with locally advanced or metastatic non-small cell lung cancer
• amendment to three existing pathology MBS items (73337, 73341 and 73344) to replace reference to the specific drug ‘pembrolizumab’ with a general reference to ‘immunotherapy’
• two new items ((30661 and 30662) and four (43882, 44108, 44111 and 44114) amended items for paediatric surgery
• new item (36530) for cryoablation for biopsy-confirmed renal cell carcinoma
• new item (39141) for reprogramming of a neurostimulator for the management of chronic neuropathic pain
• seven new items (31377 to 31383) and six amended items (31371 to 31376) for melanoma excision
• amended item (45617) for Oculoplastic surgery to support patient access by removing reference to visual field testing
• new item (40863) for deep brain stimulation for the treatment of Parkinson’s disease, essential tremor, and dystonia
• two new items (11736 and 11737) for cardiac implanted loop recorders
• amendment to six varicose veins items (32520, 32522, 32523, 32526, 32528 and 32529) to allow co-claiming with appropriate venography items
• amendment to eight cardiothoracic surgery items (38510, 38513, 38516, 38517, 38555, 38556, 38557 and 38572)
• three new items (47790, 47791 and 47792) and five amended items (47967, 49212, 49236, 49215 and 49734) for orthopaedic surgery to address unintended consequences, such as service gaps, in response to MBS Taskforce Review recommendations
• removal of one item (173) and amendment to four acupuncture items (193, 195, 197 and 199) to allow appropriately credentialled medical practitioners to provide acupuncture services
• new item (63563) for pelvic MRI for the investigation of sub-fertility
• amendment to existing obstetric MRI item (63454) to expand clinical indication to include all suspected fetal abnormalities
• new obstetric MRI item (63549) for multiple pregnancies for fetal abnormalities
• six new (55740, 55741, 55742, 55743, 55757 and 55758) pregnancy ultrasound items
• new positron emission tomography (PET) item (61612) for initial staging for patients diagnosed with rare and uncommon cancers
• amendment to liver MRI item (63545) to include all cancer types that have potentially spread to the liver
• amendment to breast MRI item (63464) to increase eligible age
• permanent introduction of three nuclear medicine diagnostic imaging items (61333, 61336 and 61341) to support patient access to alternative PET imaging services during radiopharmaceutical technetium-99m (Tc-99m) supply disruptions
• seven new items (73422 to 73428) for genetic testing for the diagnosis of early-onset or familial neuromuscular disorders
• removal of one item (73073) and amendment to two National Cervical Screening Program items (73072 and 73074) to expand access to self-collected cervical screening and other administrative amendments
• other minor technical and administrative amendments .

Further information on changes to the MBS 1 November 2022, including fact sheets and quick reference guides is available at MBS Online.

PHI Spreadsheets reflect the assignment of MBS items by clinical category and procedure type set out in PHI rules, which will be accessible on the Federal Register of Legislation. Formal notification will be provided by Private Health Insurance Circular, and on the Federal Register of Legislation following the finalisation of regulatory approval processes.

We only update PHI Spreadsheets when MBS item changes result in changes to PHI clinical categorisations and procedure type classifications. Not all MBS XML Data File releases result in PHI Spreadsheet updates.

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.