Private Health Insurance clinical category definitions 1 July 2024

Standard clinical category definitions for private health insurance hospital policies, released on 31 May 2024 and effective 1 July 2024.


Private Health Insurance clinical category definitions 1 July 2024

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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-20240701 (XML 7959 KB’ released on 24 May 2024 through MBS Online and effective 1 July 2024. The current documents reflect consequential PHI changes to the General Medical Services Table (GMST), Pathology Services Table (PST) and the Diagnostic Imaging Services Table (DIST). 

Key MBS item changes of potential interest to stakeholders are summarised below, and outlined in the MBS Online - July 2024 News:

  • Radiation oncology services
  • Otolaryngology services
  • Colorectal services
  • Pathology services 
  • Diagnostic Imaging services
  • Other administrative and machinery changes

Further information including fact sheets and quick reference guides is at MBS Online.

The clinical category definitions reflect amendments made to the MBS items assigned to the following categories:

  • Bone, joint and muscle
  • Brain and nervous system
  • Chemotherapy, radiotherapy and immunotherapy for cancer
  • Ear, nose and throat
  • Gastrointestinal endoscopy
  • Common list

New PST items and DIST items are automatically categorised as Support treatments so do not need to be listed in the clinical categories tables in the PHI Rules. All Support items are identified in the Private Health Insurance classification of 1 July 2024.

The assignment of MBS items by clinical category reflects the Private Health Insurance Legislation Amendment Rules for 1 July 2024 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.

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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.

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