Private health insurance clinical category definitions 1 March 2022

Standard clinical category definitions for private health insurance hospital policies, effective 1 March 2022.


Private health insurance clinical category definitions 1 March 2022

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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 Benefit Schedule (MBS) items that should be covered. The list of items is derived from the MBS XML Data file ‘MBS‑XML‑220301’ released on 22 December 2021, and includes 1 March 2022 changes which implement the Government’s response to recommendations from the MBS Review Taskforce (The Taskforce) regarding pain management, anaesthesia, gynaecological and midwifery services. There will also be a further update prior to 1 March 2022 to reflect XML changes to include temporarily reinstated telehealth and telephone services, updated rapid antigen testing, Transcatheter Aortic Valve Implantation services and a fee alignment for GP and OMP telehealth and telephone services.

The assignment of MBS items by clinical category reflects the PHI rules, accessible on the Federal Register of Legislation.

For older versions of this publication, review the Private health insurance clinical category and procedure type collection, or visit the National Library's web archive.

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