Private health insurance clinical category definitions 11 April 2022

Standard clinical category definitions for private health insurance hospital policies, effective 11 April 2022.


Private health insurance clinical category definitions 11 April 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-220401’ released on 31 March 2022 and ‘MBS‑XML‑22011’ released on 7 April 2022.

The 31 March 2022 XML incorporates the 1 April 2022 changes, which includes one new item for Nuclear Medicine Services, two new items for BRCA1 and BRCA2 somatic or germline testing and a fee reduction for item 91792, which aligns the fee with the 1 March 2022 benefit changes to telehealth items.

The XML file released on 7 April 2022 incorporates the 11 April 2022 changes, which includes updates to six items for pain management services (39110, 39111, 39116, 39117, 39118 and 39119).

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

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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