Definitions of private health insurance clinical categories 1 January 2022

Definitions of clinical categories for hospital treatment policies as set out in the Private Health Insurance (Compliant Product) Rules 2015.

The clinical categories include an indicative list of Medicare Benefit Schedule (MBS) items that must be covered. The list of items is derived from MBS XML data file ‘MBS-XML-220101′ published on December 17, 2021 and includes changes from January 1, 2022 which include minor administrative changes, continuation of telehealth agreements, indexing to Extended Medicare Safety Net Fixed Cap, Changes to Bulk Billing Incentives, New Items to Support COVID-19 Vaccine Adequacy Assessment, New Item for Cardiac MRI, and Expanded Temporary Items for support governments’ response to the COVID-19 pandemic. A number of changes to the MBS General Medical Services Table, Diagnostic Imaging Services Table and Pathology Services Table will also be implemented.

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

For other versions of this publication, see the Private Health Insurance Clinical Categories and Intervention Types Collection, or visit the National Library’s Web Archive.