Private Health Insurance Branch
Medical Benefits Division
MDP 853
GPO Box 9848
CANBERRA ACT 2601
PHI 84/15
23 December 2015
Private Health Insurance (Benefit Requirements) Amendment
Rules 2015 (No.6)
Changes to the Private Health Insurance (Benefit
Requirements) Rules 2011
Private Health Insurance Circular
The Private Health Insurance (Benefit Requirements) Amended Rules
2015 (No.6) (the Amendment Rules) were registered with the Federal
Register of Legislative Instruments and commence on 1 January 2016.
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 remove one item and insert three new items into
Schedule 1 of the Private Health Insurance (Benefit Requirements) 2011.
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 two new MBS items numbers (30176 and 30179).
MBS items 30176 and 30179 are new surgical items for Lipectomy
services.
These items will be included in the General Medical Services Table
(GMST) from 1 January 2016.
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 one new
MBS item number (30172) and deleting one item (30174). MBS item
30172 is a new surgical item for Lipectomy services.
This item will be included in the GMST from 1 January 2016.
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If you require further information, please call 02 6289 9853 (24 hour answering machine) or email the enquiry to
privatehealth@health.gov.au.
Internet: http://www.health.gov.au/internet/main/publishing.nsf/Contenbt/health-phicirculars2015-index1
Changing your email address or no longer want to receive notification of circulars? Please notify the Department at the
email address above.
PHI 84/15
Medical Benefits Schedule (MBS) item numbers – Schedule 3
The Amendment Rules insert five new items into Schedule 3 of the Private Health
Insurance (Benefit Requirements) 2011.
Item 3 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 3
– Therapeutic procedures, T2
Item 3 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category
3 – Therapeutic procedures, T2 of the Principal Rules by inserting four new MBS item
numbers (15275, 15555, 15565 and 15715). MBS items 15275, 15555, 15565 and 15715
are all new MBS items for the treatment of various forms of cancer using Intensitymodulated radiation therapy (IMRT).
These items will be included in the GMST from 1 January 2016.
Item 4 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 6
– Pathology services, P7
Item 4 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category
6 – Pathology services, P7 of the Principal Rules by inserting one new MBS item number
(73342) in the pathology services table. Item 73342 is a new item for in-situ hybridisation
test of tumour tissue from a patient to determine eligibility to access trastuzumab (for
treatment of gastric cancer) under the Pharmaceutical Benefits Scheme.
This item will be included in the Pathology Services Table (PST) from 1 January, 2016.
Details of the amendments are set out in the Amendment Rules, which are available on
the ComLaw website via the following link:
https://www.comlaw.gov.au/Series/F2011L02160
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