Private health insurance clinical category definitions 6 July 2022

Standard clinical category definitions for private health insurance hospital policies, effective 1 July 2022 and 6 July 2022.


Private health insurance clinical category definitions 6 July 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‑220701’ released on 8 April 2022, and includes 1 July 2022 changes which includes indexation changes to the General Medical Services Table (GMST), Pathology Services Table (PST) and Diagnostic Imaging Services Table (DIST).

Update 8 July 2022: The list has been updated to reflect the introduction of new items from the MBS XML Data files ‘XML-220701v2-MBS’ released on 30 June 2022 which includes four new co-dependent pathology services and ‘XML-220706-MBS’ released on 5 July 2022 which includes one new temporary item for ventral rectopexy 32118, the benefit percentage correctly reflecting a 75% benefit for items 35508 and 47426.

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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