Private Health Insurance clinical category definitions 1 January 2025

Standard clinical category definitions for private health insurance hospital policies, released on 12 December 2024 and effective 1 January 2025.

Downloads

Private Health Insurance clinical category definitions 1 January 2025

We aim to provide documents in an accessible format. If you're having problems using a document with your accessibility tools, please contact us for help.

Publication date:
Publication type:
Dataset
Audience:
General public
Language:
English
Description:

Definitions of the clinical categories for hospital treatment policies as found in the Private Health Insurance (Complying Product) Rules 2015.

The clinical categories include an indicative list of Medicare Benefits Schedule (MBS) items that should be covered. This list of items is derived from the MBS XML Data file ‘MBS-XML-20250101 [XML 7973 KB]’ released on 6 December 2024 through MBS Online and effective 1 January 2025. 

1 January 2025 updates are limited to amendments to the Diagnostic Imaging Services Table (DIST) and Pathology Services Table (PST). 

New DIST and PST items are automatically categorised as Support treatments so do not need to be listed in the clinical categories tables in the PHI Rules. This attachment is therefore unchanged from the definitions effective 1 November 2024.

Further information, including fact sheets for the 1 January 2025 amendments, and quick reference guides is at MBS Online.

The assignment of MBS items by clinical category reflects the Private Health Insurance Legislation Amendment Rules for 1 January 2025 which will be published on the Federal Register of Legislation following the finalisation of regulatory approval processes. Details of the changes will be available in the Explanatory Statement that will accompany the Amendment Rules.

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

For previous versions of PHI Spreadsheet publications, review the Private health insurance clinical category and procedure type collection, or visit the National Library's web archive.

Help us improve health.gov.au

If you would like a response please use the enquiries form instead.