PHI 30/16

Page last updated: 29 April 2016

PDF version: PHI 30/16 - Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No.2) (PDF 262 KB)

PHI 30/16 - Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No.2)
Changes to the Private Health Insurance (Benefit Requirements) Rules 2011

The Private Health Insurance (Benefit Requirements) Amended Rules 2016 (No.2) (the Amendment Rules) were registered with the Federal Register of Legislative Instruments (FRLI) and commences on 1 May 2016 (FRL No. 2016L00589).

These Benefit Requirements Amendment Rules amend the Private Health Insurance (Benefit Requirements) Rules 2011.

Medical Benefits Schedule (MBS) item numbers – Schedule 1

The Amendment Rules insert 12 new items and remove five items from Schedule 1 of the Private Health Insurance (Benefit Requirements) 2011.

Schedule – Amendments

Item 1 - Schedule 1, Part 2 – Type A Procedures, Clause 4 Advanced surgical patient, Subclause (3)

Item 1 amends Schedule 1, Part 2 – Type A Procedures, Clause 4 Advanced surgical Patient, Subclause (3) of the Principal Rules by inserting three new MBS items numbers (30640, 37040 and 37338). MBS item 30640 is a new item for the repair of large and irreducible scrotal hernias. MBS items 37040 and 37338 are new items for the insertion and removal of synthetic male sling system for the treatment of stress urinary incontinence.

Item 2 - Schedule 1, Part 2 – Type A Procedures, Clause 6 Surgical patient, Subclause (3)

Item 2 amends Schedule 1, Part 2 – Type A Procedures, Clause 6 Surgical patient, Subclause (3) of the Principal Rules by inserting nine new MBS item numbers (32088, 32089, 47310, 47313, 47316, 47319, 47364, 47370 and 47373) and deleting five items (47333, 47345, 47366, 47372 and 47375).

MBS items 32088 and 32089 are new colonoscopy items intended for participants of the National Bowel Cancer Screening Program, for follow up of a positive faecal occult blood test result.

MBS items 47310, 47313, 47316 and 47319 are new items for the treatment of finger fractures. The introduction of these new items has resulted in the redundancy and subsequent deletion of items 47333 and 47345. Changes to this suite of items will better reflect specific pathologies (as opposed to having an MBS item for every bone in the hand) and contemporary clinical practice.

MBS items 47364, 47370 and 47373 are new items for the treatment of wrist fractures. The introduction of these new items has resulted in the redundancy and subsequent deletion of items 47366, 47372 and 47375. Changes to this suite of items will better reflect specific pathologies (as opposed to having an MBS item for every bone in the hand) and contemporary clinical practice.

The 12 new items have been introduced as part of a revised listing for paediatric surgical services. These new items will be included in the GMST from 1 May 2016.

Details of the amendments are set out in the Amendment Rules, which are available on the Federal Register of Legislation website via the following link: (https://www.legislation.gov.au/Details/F2016L00589)

All 2016 circulars can be accessed here: 2016 Private Health Insurance (PHI) Circulars

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