Private health insurance clinical category definitions 1 October 2022

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


Private health insurance clinical category definitions 1 October 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 ‘XML-20221001-MBS’ released on 28 September 2022, and includes an amendment to pathology item 72814 to include testing of tumour material from a patient diagnosed with recurrent or metastatic squamous cell carcinoma of the oral cavity, pharynx or larynx. The file also includes ten new temporary pathology items (69506, 69507, 69508, 69509, 69510, 69511, 69512, 69513, 69514, and 69515) for pathology laboratory testing for SARS-CoV-2 (COVID-19) and other respiratory pathogens.

There are no changes to the clinical categories table as the new temporary pathology MBS items are automatically categorised in the Support treatments.

The assignment of MBS items by clinical category reflects the PHI rules, which will be 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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