PHI 67/12

This circular issued by the Private Health Insurance Branch contains information about the Private Health Insurance (Benefit Reqirements) Amendment Rules 2012 (NO. 7)

Page last updated: 12 June 2013

Printable version of 67/12.pdf (PDF 20 KB)

2 November 2012

Private Health Insurance (Benefit Reqirements) Amendment Rules 2012 (NO. 7)

The Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No.7)
(the Amendment Rules) were registered on the Federal Register of Legislative Instruments (FRLI) on 31 October 2012 (F2012L02114 ) and take effect on 1 November 2012, or the day after registration. The Amendment Rules can be found on ComLaw website.

On 1 November 2012, changes to the Medicare Benefits Schedule (MBS) items took effect. The Amendment Rules amend MBS items in Schedules 1 and 3 of the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules). The changes are necessary to maintain consistency between the MBS item codes listed in the Principal Rules and the MBS from 1 November 2012. The amendments also reflect an indexation of 1.9% to the MBS Schedule fees in Schedule 1 of the Principal Rules.

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 deleting $837.05 and substituting $852.95 to reflect a 1.9% increase in MBS Schedule fees, and deletes MBS item 42731 as a result of the item being removed from the MBS. It is noted that all item numbers in the Advance surgical patient category were subject to the 1.9% increase in the MBS. Item 1 also inserts MBS item 48694. This item is new and relates to cervical artificial intervertebral total disc replacement. It is expected that this item will be usually performed as an advanced surgical procedure due to its complex nature.

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 replacing the current fee range of $249.26 to $837.05 with $254.00 to $852.95 to reflect a 1.9% increase in MBS Schedule fees. It is noted that all item numbers in the Surgical patient category were subject to the 1.9% increase in the MBS except for 55135, 57351 and 57356. However these three items are not impacted because they still fall within the new price range and remain Type A surgical.

Item 2 also consequently deletes four MBS items (42560, 42566, 42722 and 42771) as a result of the items being removed from the MBS.

Item 3– Schedule 3, Part 2 Type B procedures, Clause 5 Non-band specific Type B day procedures, subclause (1)

Item 3 amends Schedule 3, Part 2 Type B procedures, Clause 5 Non-band specific Type B day procedures, subclause (1) of the Principal Rules by inserting MBS item 30687. This item relates to endoscopic surgical operations with radiofrequency ablation. It is expected that this item will be usually performed in a day surgery and will not usually require overnight hospital accommodation, unless the treating medical practitioner determines otherwise.

Item 4– Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 2 Diagnostic Procedures & Investigations, D1

Item 4 amends Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 2 Diagnostic Procedures & Investigations, D1 of the Principal Rules by deleting two MBS items (11203 and 11212) relating to diagnostic
procedures, as a result of the items being removed from the MBS.

Item 5– Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 5 Diagnostic Imaging Services, I5

Item 5 amends Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 5 Diagnostic Imaging Services, I5 of the Principal Rules by inserting 13 MBS items (63507, 63510, 63513, 63516, 63519, 63522, 63525, 63526, 63527, 63528, 63529 and 63530). These MBS items relate to Magnetic Resonance Imaging (MRI) diagnostic imaging services which are not usually performed in hospital. However, it is recognised that these items may be performed, in rare cases, in isolation in hospital if determined by the treating medical practitioner.

Item 6– Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 6 Pathology Services, P7

Item 6 amends Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 6 Pathology Services, P7 of the Principal Rules by inserting three MBS items (73333, 73334 and 73335). These MBS items relate to pathology services relating to genetic detection of mutations of the von Hippel-Lindau which are not usually performed in hospital. However, it is recognised that these items may be performed, in rare cases, in isolation in hospital if determined by the treating medical practitioner.

If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to Private Health Insurance Branch

For more information visit 2012 Private Health Insurance (PHI) Circulars.

Changing your e-mail address? No longer want circulars? Please email Private Health Insurance Branch