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The clinical categories include an indicative list of Medicare Benefits Schedule (MBS) items that should be covered for each category of hospital treatment. This list of items is derived from the MBS XML Data file ‘MBS-XML-20250701 Version 2.XML’ released on 10 June 2025 through MBS Online and effective 1 July 2025. The document reflects consequential Private Health Insurance (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 2025 News:
- General medical services
- Pathology services
- Diagnostic Imaging services
- Annual fee indexation will be applied to:
- most of the general medical services items
- most diagnostic imaging services (excluding: positron emission tomography (PET) items and nuclear medicine modifier items), and
- pathology items in Group P1, Group P4, Group P5, Group P6, Group P8 and Group P12.
- 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:
- Eye (not cataracts)
- Gynaecology
- Heart and vascular system
- lists of Support treatments and Common treatments.
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.
The assignment of MBS items by clinical category reflects the Private Health Insurance Legislation Amendment Rules for 1 July 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 and 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.