Commonwealth Coat of Arms of Australia

 

Private Health Insurance Legislation Amendment Rules (No. 7) 2020

I, Brian Kelleher, delegate of the Minister for Health, make the following Rules.

Dated 30 October 2020

Brian Kelleher

Assistant Secretary

Private Health Insurance Branch

Medical Benefits Division
Health Resourcing Group

Department of Health

 

 

Contents

1  Name

2  Commencement

3  Authority

4  Schedules

Schedule 1—Amendments—Minimum Accommodation Benefits

Private Health Insurance (Benefit Requirements) Rules 2011

Schedule 2—Amendments—Type C procedures

Private Health Insurance (Benefit Requirements) Rules 2011

Schedule 3—Amendments—Clinical categories, Common and Support Treatments

Private Health Insurance (Complying Product) Rules 2015

Schedule 4—Amendments—COVID-19 Accreditation Arrangements

Private Health Insurance (Health Insurance Business) Rules 2018

 

1  Name

  This instrument is the Private Health Insurance Legislation Amendment Rules (No. 7) 2020.

2  Commencement

 (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  The whole of this instrument

1 November 2020.

 

1 November 2020.

 

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

 (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3  Authority

  This instrument is made under section 333-20 of the Private Health Insurance Act 2007.

4  Schedules

  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule 1—Amendments—Minimum Accommodation Benefits

Private Health Insurance (Benefit Requirements) Rules 2011

1  Repeal Clause 4(3) of Schedule 1, substitute:

(3) The MBS item numbers for this clause are those set out in the following table, but only where those items have a fee in the MBS greater than $879.60:

 

Type A procedures: Advanced surgical patient – list of MBS items

15600  30176  30177  30179  30250  30251  30255  30275  30294  30296  30297  30315  30317  30318  30320  30323  30324  30335  30336  30379  30382  30384  30388  30396  30405  30415  30417  30418  30421  30425  30427  30428  30430  30438  30448  30449  30454  30455  30457  30458  30460  30461  30463  30464  30466  30467  30469  30472  30500  30502  30503  30506  30508  30509  30517  30518  30521  30523  30524  30526  30527  30529  30532  30533  30535  30536  30538  30539  30541  30542  30545  30547  30548  30550  30551  30553  30554  30556  30557  30560  30565  30566  30577  30578  30580  30583  30584  30589  30590  30593  30594  30596  30599  30601  30602  30603  30605  30606  30608  30640  30680  30682  30684  30686  31002  31409  31412  31429  31432  31435  31438  31464  31466  31468  31472  31516  31524  31572  31581  31584  32000  32003  32004  32005  32006  32009  32012  32015  32018  32024  32025  32026  32028  32030  32033  32036  32039  32042  32047  32051  32054  32060  32063  32069  32104  32106  32108  32117  32209  32220  32221  32514  32517  32700  32703  32708  32710  32711  32712  32715  32718  32721  32724  32730  32733  32739  32742  32745  32748  32751  32754  32763  33050  33055  33075  33080  33100  33103  33109  33112  33115  33116  33118  33119  33121  33124  33127  33130  33133  33136  33139  33142  33145  33148  33151  33154  33157  33160  33163  33166  33169  33172  33175  33178  33181  33500  33506  33509  33512  33515  33518  33521  33524  33527  33530  33533  33536  33539  33542  33800  33803  33811  33812  33815  33818  33821  33824  33827  33830  33833  33836  33839  33842  34112  34115  34118  34121  34124  34127  34136  34139  34142  34148  34151  34154  34157  34160  34163  34166  34169  34172  34175  34509  34512  34518  34533  34803  34806  34809  34812  34815  34818  34821  34833  35003  35006  35009  35307  35312  35315  35320  35412  35414  35551  35552  35561  35562  35585  35595  35597  35641  35661  35664  35667  35670  35697  35753  35754  36503  36506  36516  36519  36522  36525  36528  36529  36531  36532  36533  36543  36564  36567  36570  36573  36576  36588  36591  36594  36597  36600  36603  36606  36610  36611  36645  36656  37014  37015  37016  37018  37019  37021  37029  37040  37042  37045  37047  37048  37053  37200  37203  37207  37209  37210  37211  37213  37214  37220  37230  37245  37309  37338  37340  37344  37338  37341  37343  37372  37375  37384  37390  37405  37411  37423  37426  37432  37607  37610  37824  37825  37831  37842  37848  37851  38212  38231  38237  38240  38246  38270  38272  38273  38274  38276  38287  38290  38293  38309  38312  38315  38318  38358  38368  38384  38390  38418  38421  38424  38427  38438  38440  38441  38446  38447  38449  38450  38453  38455  38456  38457  38466  38468  38469  38470  38477  38478  38480  38481  38483  38487  38488  38489  38493  38495  38497  38498  38500  38501  38503  38504  38506  38507  38508  38509  38512  38515  38518  38550  38553  38556  38559  38562  38565  38568  38571  38572  38600  38603  38615  38618  38624  38640  38643  38647  38650  38653  38654  38656  38670  38673  38677  38680  38700  38703  38706  38709  38712  38715  38718  38721  38724  38727  38730  38733  38736  38739  38742  38745  38748  38751  38754  38757  38760  38763  38766  39109  39113  39124  39139  39315  39503  39604  39612  39615  39638  39639  39641  39651  39654  39656  39700  39703  39710  39712  39715  39718  39720  39801  39803  39815  39818  39821  39900  39903  40004  40012  40104  40106  40109  40112  40119  40600  40700  40703  40706  40709  40712  40801  40803  40850  40851  40860  41518  41521  41530  41533  41536  41539  41542  41551  41554  41557  41560  41563  41564  41566  41569  41572  41575  41576  41578  41579  41581  41584  41587  41590  41593  41596  41599  41608  41614  41615  41617  41618  41623  41635  41638  41728  41734  41782  41785  41834  41837  41840  41843  41879  42521  42539  42543  42545  42557  42569  42626  42653  42656  42662  42672  42705  42710  42716  42725  42731  42746  42749  42752  42767  42773  42776  42779  42801  42842  42851  42860  43801  43804  43807  43810  43813  43816  43819  43822  43825  43828  43831  43834  43837  43838  43840  43843  43846  43852  43855  43861  43864  43870  43873  43876  43879  43882  43900  43903  43906  43909  43912  43915  43936  43945  43951  43954  43957  43963  43966  43969  43972  43975  43978  43984  43987  43990  43993  43996  44334  44373  45006  45036  45060  45061  45062  45215  45415  45418  45460  45461  45464  45465  45466  45468  45469  45471  45472  45474  45475  45477  45478  45480  45481  45483  45484  45490  45491  45492  45494  45500  45501  45502  45503  45504  45505  45520  45523  45528  45530  45533  45539  45558  45561  45562  45563  45564  45565  45566  45570  45587  45588  45596  45597  45599  45624  45641  45644  45646  45647  45660  45661  45686  45720  45723  45726  45729  45731  45732  45735  45738  45741  45744  45747  45752  45753  45754  45767  45770  45773  45776  45779  45782  45785  45788  45791  45853  45861  45863  45869  45871  45873  45897  46315  46318  46321  46393  46477  46504  46507  47486  47489  47501  47504  47507  47510  47519  47525  47531  47534  47566  47588  47591  48203  48427  48512  48918  48921  48924  48933  48939  48942  48951  48954  48957  48960  49106  49115  49116  49117  49210  49211  49306  49312  49318  49319  49321  49324  49327  49330  49333  49339  49342  49345  49512  49517  49518  49519  49521  49524  49527  49530  49533  49536  49539  49542  49548  49551  49554  49564  49715  49716  49717  49836  49838  49842  50212  50215  50218  50221  50224  50227  50230  50233  50236  50239  50300  50303  50306  50321  50324  50327  50336  50351  50354  50366  50372  50378  50384  50394  50399  50408  50411  50414  50417  50420  50423  50450  50451  50455  50456  50460  50461  50465  50466  50470  50471  50475  50476  50604  50608  50612  50620  50624  50628  50632  50636  50640  50644  51011  51012  51013  51014  51015  51021  51022  51023  51024  51025  51026  51031  51032  51033  51034  51035  51036  51041  51042  51043  51044  51045  51051  51052  51053  51054  51055  51056  51057  51058  51059  51061  51062  51063  51064  51065  51066  51071  51072  51073  51102  51103  51130  51131  51160  51165  51170  51171  52123  52126  52129  52158  52337  52342  52345  52348  52351  52354  52357  52360  52363  52366  52369  52372  52375  52379  52380  52382  52430  52446  52821  53209  53212  53221  53224  53227  53230  53233

2  Repeal Clause 6(3) of Schedule 1, substitute:

(3) The MBS item numbers for this clause are those set out in the following table, but only where those items have a fee in the MBS within the range of $261.90 to $879.60:

 

Type A procedures: Surgical patient – list of MBS items

13212  13218  13251  13700  13834  13837  14234  14237  15303  15304  15307  15308  15311  15312  15315  15316  15319  15320  15323  15324  15327  15328  15331  15332  15335  15336  15345  16567  16570  16571  16573  30017  30020  30023  30024  30068  30111  30114  30165  30168  30171  30172  30190  30225  30229  30235  30241  30244  30246  30247  30253  30256  30272  30286  30287  30289  30293  30299  30300  30302  30303  30306  30310  30314  30326  30330  30332  30373  30375  30376  30378  30385  30387  30391  30392  30393  30394  30399  30400  30402  30403  30408  30414  30416  30419  30422  30431  30433  30434  30436  30437  30440  30443  30445  30446  30450  30451  30452  30475  30479  30481  30484  30485  30490  30491  30492  30494  30495  30496  30497  30499  30505  30515  30520  30530  30544  30559  30562  30563  30564  30568  30569  30571  30572  30575  30581  30586  30587  30597  30600  30609  30611  30614  30615  30618  30619  30621  30622  30623  30626  30629  30635  30637  30639  30641  30642  30643  30644  30645  30646  30672  30676  30688  30690  30692  30694  30696  30710  31000  31001  31003  31004  31005  31225  31245  31250  31340  31350  31355  31400  31403  31406  31423  31426  31450  31452  31454  31460  31462  31470  31500  31503  31506  31509  31512  31515  31519  31525  31554  31569  31575  31578  32021  32023  32029  32045  32046  32057  32066  32094  32096  32099  32102  32103  32105  32111  32112  32120  32123  32126  32129  32131  32138  32139  32150  32159  32162  32165  32180  32183  32186  32200  32203  32206  32210  32213  32214  32216  32504  32507  32508  32511  32736  32757  32760  32766  32769  33070  33545  33548  33551  33554  33806  33810  33845  33848  34100  34103  34106  34109  34130  34133  34145  34500  34503  34515  34521  34524  34527  34528  34529  34534  34538  34800  34824  34827  34830  35000  35012  35100  35202  35300  35303  35306  35309  35317  35319  35321  35324  35327  35330  35331  35360  35361  35362  35363  35404  35406  35408  35410  35508  35530  35533  35534  35536  35539  35542  35548  35560  35564  35565  35566  35568  35570  35571  35573  35577  35578  35581  35582  35596  35599  35602  35605  35612  35613  35622  35623  35634  35635  35636  35637  35638  35645  35648  35649  35653  35657  35658  35673  35677  35678  35680  35684  35688  35694  35700  35710  35713  35717  35720  35723  35726  35750  35756  35759  36502  36508  36509  36537  36546  36549  36552  36558  36579  36585  36604  36607  36608  36609  36612  36615  36618  36621  36624  36627  36633  36636  36639  36649  36652  36654  36663  36664  36666  36803  36806  36809  36811  36818  36821  36822  36823  36833  36840  36842  36845  36854  36863  37000  37004  37008  37020  37023  37026  37038  37039  37043  37044  37046  37050  37201  37202  37206  37208  37215  37221  37224  37227  37233  37306  37318  37327  37330  37333  37336  37342  37345  37348  37351  37354  37381  37387  37396  37402  37408  37417  37418  37429  37438  37601  37604  37605  37606  37613  37616  37619  37800  37801  37803  37804  37806  37807  37809  37810  37812  37813  37818  37819  37821  37822  37827  37828  37830  37833  37834  37836  37839  37845  37854  38200  38203  38206  38209  38213  38215  38218  38222  38225  38228  38234  38241  38243  38256  38275  38300  38303  38306  38350  38353  38356  38362  38365  38371  38387  38393  38415  38430  38448  38452  38458  38460  38462  38464  38473  38475  38485  38490  38496  38505  38577  38588  38609  38612  38613  38621  38627  38637  39015  39018  39118  39121  39125  39126  39127  39128  39130  39134  39137  39138  39140  39300  39303  39306  39309  39312  39318  39321  39323  39324  39327  39330  39331  39333  39610  39906  40701  40704  40705  40708  40852  40854  40856  40858  40905  41512  41515  41524  41527  41545  41548  41603  41611  41620  41629  41671  41672  41707  41710  41713  41716  41722  41725  41729  41731  41737  41743  41746  41749  41752  41767  41770  41773  41776  41779  41786  41787  41789  41793  41813  41825  41831  41855  41858  41861  41864  41867  41868  41870  41873  41876  41880  41881  41885  41895  41898  41901  41905  41910  42505  42506  42509  42510  42512  42515  42518  42527  42530  42533  42536  42542  42548  42551  42554  42563  42574  42584  42590  42596  42599  42602  42605  42608  42623  42629  42635  42638  42641  42665  42680  42686  42692  42695  42698  42701  42702  42703  42704  42707  42713  42719  42734  42740  42743  42758  42761  42764  42770  42782  42785  42788  42791  42802  42805  42806  42807  42808  42809  42810  42815  42818  42833  42836  42839  42848  42854  42857  42863  42866  42869  43021  43022  43506  43509  43512  43515  43518  43521  43524  43805  43832  43835  43841  43849  43858  43867  43930  43933  43939  43960  43981  43999  44101  44102  44108  44111  44114  44130  44133  44325  44328  44331  44350  44354  44359  44361  44364  44367  44370  45000  45003  45009  45012  45015  45018  45019  45024  45026  45035  45042  45045  45048  45051  45200  45201  45202  45203  45206  45207  45209  45218  45221  45227  45233  45236  45239  45240  45403  45406  45409  45412  45439  45442  45445  45448  45451  45462  45485  45486  45487  45488  45489  45493  45496  45497  45498  45512  45519  45522  45524  45527  45536  45542  45545  45548  45551  45553  45554  45556  45560  45568  45569  45572  45575  45578  45581  45584  45585  45590  45593  45602  45605  45608  45611  45614  45620  45623  45626  45627  45629  45632  45635  45652  45653  45656  45659  45662  45665  45668  45669  45671  45675  45676  45677  45680  45683  45689  45692  45695  45698  45701  45704  45707  45710  45713  45714  45716  45755  45758  45761  45794  45803  45809  45811  45813  45815  45817  45819  45821  45825  45827  45831  45833  45835  45837  45839  45841  45843  45845  45849  45855  45857  45859  45865  45867  45875  45877  45879  45885  45888  45891  45939  45984  45987  45990  45993  46300  46303  46306  46307  46309  46312  46324  46325  46330  46333  46336  46339  46342  46345  46351  46354  46357  46360  46372  46375  46378  46381  46384  46387  46390  46396  46399  46402  46405  46408  46411  46414  46417  46423  46426  46429  46432  46435  46441  46442  46444  46447  46453  46462  46468  46471  46474  46480  46483  46489  46492  46500  46501  46502  46503  46510  46522  47012  47021  47027  47033  47048  47051  47054  47063  47066  47310  47313  47316  47319  47357  47364  47370  47373  47381  47384  47385  47386  47387  47390  47393  47399  47402  47408  47417  47420  47426  47429  47432  47435  47438  47441  47447  47450  47451  47453  47456  47459  47468  47480  47483  47495  47498  47513  47516  47522  47528  47537  47546  47549  47552  47555  47558  47561  47564  47565  47567  47570  47573  47582  47585  47597  47600  47603  47609  47612  47615  47618  47621  47624  47630  47648  47654  47657  47732  47741  47753  47756  47765  47768  47771  47774  47777  47780  47783  47786  47789  47920  47930  47936  47954  47957  47966  47969  47975  47982  48200  48206  48209  48212  48215  48218  48221  48224  48227  48230  48233  48236  48239  48242  48400  48403  48406  48409  48412  48415  48418  48421  48424  48500  48503  48506  48900  48903  48906  48909  48912  48915  48927  48930  48936  48945  48948  49100  49103  49109  49112  49118  49121  49200  49203  49206  49209  49215  49218  49221  49224  49227  49300  49303  49309  49315  49336  49346  49360  49363  49366  49500  49503  49506  49509  49515  49534  49545  49557  49558  49559  49560  49561  49562  49563  49566  49569  49700  49703  49706  49709  49712  49718  49724  49727  49728  49812  49815  49818  49821  49824  49827  49830  49833  49837  49839  49845  49854  49857  49860  49863  49866  50102  50103  50104  50106  50109  50112  50118  50121  50127  50130  50201  50203  50206  50209  50309  50312  50315  50318  50333  50339  50342  50345  50353  50357  50360  50363  50369  50375  50381  50387  50393  50396  50402  50405  50426  50500  50504  50508  50512  50516  50520  50524  50528  50532  50536  50540  50544  50548  50552  50556  50560  50564  50568  50572  50576  50580  50584  50588  50600  50616  50650  50654  50950  50952  51020  51110  51111  51114  51115  51140  51141  51145  51150  51900  51904  51906  52018  52035  52039  52048  52051  52054  52059  52063  52066  52078  52090  52092  52094  52095  52105  52108  52111  52114  52117  52120  52122  52130  52131  52138  52141  52144  52147  52148  52182  52184  52186  52300  52303  52306  52312  52315  52321  52324  52330  52333  52336  52339  52378  52424  52440  52442  52444  52450  52452  52456  52458  52460  52480  52482  52484  52600  52603  52609  52612  52615  52618  52621  52624  52626  52627  52633  52800  52803  52806  52809  52812  52815  52818  52824  52828  52830  52832  53006  53009  53015  53016  53017  53019  53215  53218  53220  53225  53226  53236  53239  53242  53406  53409  53412  53413  53414  53415  53416  53418  53419  53422  53423  53424  53425  53427  53429  53453  53455  53460  55135  57351

 

3 Repeal Clause 4(1)(a) of Schedule 3, substitute:

(1) Hospital treatment that involves a professional service of the type identified by the MBS item number specified in this subclause is Band 1 treatment for the purposes of the tables in clause 2 of this Schedule:

a)      category 3―therapeutic procedures, being the items below in the general medical services table:

 

Type B Band 1 - T1: Miscellaneous Therapeutic Procedures:

13100  13103  13706  13950

 

Type B Band 1 – T8: Surgical Operations

30210  30473  30475  30478  30679  32075  32084  32087  32095  32215  35500  35539  35545  35703  36665  39000  39100  41604  41647  41674  42575  42741  45027  50658; and

 

4 Repeal Clause 5(1) of Schedule 3, substitute:

(1)    Hospital treatment that involves a professional service of the type identified by the MBS item number specified in the following table in this clause is a non-band specific Type B day procedure:

 

Non-band specific Type B day procedures – list of MBS items

111      117      120       6080   6081    11919  13110  13212  13215  13292  13318  13750  13755  13757  13815  14218  14247  14249  15338  15513  15539  16512  16603  16618  18216  18230  18242  18274  18276  18280  18284  18286  18290  18294  18296  18298  18375  18379  30042  30045  30055  30081  30084  30087  30094  30096  30099  30103  30104  30105  30107  30187  30189  30190  30223  30225  30262  30269  30281  30283  30390  30391  30409  30484  30627  30630  30658  30687  31225  31340  31345  31346  31350  31355  31356  31358  31359  31360  31361  31363  31364  31367  31369  31371  31372  31373  31374  31375  31376  31456  31458  31530  31551  31557  31560  31563  31566  31590  32094  32145  32147  32150  32153  32156  32168  32171  32177  32180  32217  32222  32223  32224  32225  32226  32227  32228  32229  32504  34109  34130  34500  34503  34506  34524  34539  35324  35507  35508  35509  35513  35517  35520  35523  35527  35542  35557  35569  35572  35611  35615  35616  35618  35622  35623  35626  35627  35630  35633  35637  35640  35643  35644  35645  35646  35647  35648  35688  35730  36504  36505  36507  36561  36650  36667  36668  36812  36815  36818  36821  36822  36823  36824  36827  36830  36833  36836  36840  36860  37011  37215  37216  37217  37218  37219  37226  37318  37321  37324  37339  37354  37369  37435  37623  37803  37806  37809  37812  37815  37816  37854  38285  38286  38288  39013  39118  39133  39135  39140  39331  40702  41503  41506  41509  41626  41629  41632  41644  41650  41653  41668  41677  41701  41716  41764  41801  41816  41822  41825  41831  41855  41858  41861  41864  41886  41889  41892  41898  42503  42504  42572  42573  42576  42584  42593  42610  42611  42652  42673  42680  42683  42686  42689  42692  42738  42739  42812  42818  42833  42845  42869  43942  43948  44102  44104  44105  44136  44338  44376  45019  45030  45033  45039  45200  45224  45239  45506  45515  45626  45665  45668  45823  46327  46330  46336  46363  46366  46369  46396  46420  46423  46438  46441  46450  46486  46489  46494  46495  46501  46510  46525  47738  47906  47915  47918  47927  47972  48945  49218  49557  49700  49800  49803  49806  49809  50100  50115  51112  51113  51120  51902  52015  52025  52042  52045  52057  52058  52061  52062  52064  52072  52073  52075  52081  52084  52087  52097  52099  52102  52180  52321  52826  53003  53006  53009  53054  53056  53058  53060  53062  53064  53070  53206  53215  53218  53225  53410  53459  58939  59903  59912  59925  59970  59971  59972  59973  59974  60000  60001  60003  60004  60006  60007  60009  60010  60012  60013  60015  60016  60018  60019  60021  60022  60024  60025  60027  60028  60030  60031  60033  60034  60036  60037  60039  60040  60042  60043  60045  60046  60048  60049  60051  60052  60054  60055  60057  60058  60060  60061  60063  60064  60066  60067  60069  60070  60072  60073  60075  60076  60078  60079

 

Schedule 2—Amendments—Type C procedures

Private Health Insurance (Benefit Requirements) Rules 2011

1 Clause 8 of Schedule 3 (Category 2 – Diagnostic procedures & investigations, under the heading “D1:”)

Omit “11006”, “11009” and “11919”.

2 Clause 8 of Schedule 3 (Category 3 – Therapeutic procedures, under the heading “T1:”)

Omit “13709”, “13760”, “13939”, “13942”, and “13945”.

3 Clause 8 of Schedule 3 (Category 3 – Therapeutic procedures, under the heading “T8”)

Omit “37217” and “37218”.

After “37303”, insert “37388”.

4 Clause 8 of Schedule 3 (Category 5 – Diagnostic Imaging Services, under the heading “I2”)

Omit “57355”, insert “57357”.

Schedule 3—Amendments—Clinical categories, Common and Support Treatments

Private Health Insurance (Complying Product) Rules 2015

1 Clause 2 of Schedule 5 (table dealing with Clinical categories)

Repeal the table, substitute:

 

Clinical categories table

Clinical category

Scope of cover (see Note 1)

Treatments that must be covered (MBS Items) (see Notes 1, 2 and 3)

Rehabilitation

Hospital treatment for physical rehabilitation for a patient related to surgery or illness.

For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation.

 

Hospital psychiatric services

Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.

For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy.

Treatments involving the provision of the following MBS items:
170, 171, 172, 289, 297, 320, 322, 324, 326, 328, 342, 344, 346, 348, 350, 352, 364, 366, 367, 369, 370, 855, 857, 858, 861, 864, 866, 2700, 2701, 2712, 2713, 2715, 2717, 2721, 2723, 2725, 2727, 6018, 6019, 6023, 6024, 6025, 6026, 6028, 6029, 6031, 6032, 6034, 6035, 6037, 6038, 6042, 90250, 90251, 90252, 90253, 90254, 90255, 90256, 90257, 90264, 90265, 90272, 90274, 90276, 90278, 91285, 91287, 91723, 91727, 93300, 93303, 93306, 93309, 14224, 80005, 80015, 80020, 80101, 80105, 80115, 80120, 80130, 80140, 80145, 80155, 80165, 80170

Palliative care

Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.

Treatments involving the provision of the following MBS items:
3005, 3010, 3014, 3015, 3018, 3023, 3028, 3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, 3093

Assisted reproductive services

Hospital treatment for fertility treatments or procedures.

For example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra-fallopian Transfer (GIFT).

Treatment of the female reproductive system is listed separately under Gynaecology.

Pregnancy and birth-related services are listed separately under Pregnancy and birth.

Treatments involving the provision of the following MBS items:
13200, 13201, 13202, 13203, 13206, 13209, 13212, 13215, 13218, 13221, 13251, 13260, 13290, 13292, 14203, 14206, 37605, 37606

Back, neck and spine

Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.

For example: sciatica, prolapsed or herniated disc, and spine curvature disorders such as scoliosis, kyphosis and lordosis.

Joint replacements are listed separately under Joint replacements.

Joint fusions are listed separately under Bone, joint and muscle.

Spinal cord conditions are listed separately under Brain and nervous system.

Management of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:
30672, 44133, 50600, 50604, 50608, 50612, 50616, 50620, 50624, 50628, 50632, 50636, 50640, 50644, 51020, 51021, 51022, 51023, 51024, 51025, 51026, 51031, 51032, 51033, 51034, 51035, 51036, 51041, 51042, 51043, 51044, 51045, 51051, 51052, 51053, 51054, 51055, 51056, 51057, 51058, 51059, 51061, 51062, 51063, 51064, 51065, 51066, 51071, 51072, 51073, 51102, 51103, 51110, 51111, 51112, 51113, 51114, 51115, 51120, 51130, 51131, 51140, 51141, 51145, 51150, 51160, 51165, 51170, 51171

Blood

Hospital treatment for the investigation and treatment of blood and blood-related conditions.

For example: blood clotting disorders and bone marrow transplants.

Treatment for cancers of the blood is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS item:
13700

Bone, joint and muscle

Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.

For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.

Chest surgery is listed separately under Lung and chest.

Spinal cord conditions are listed separately under Brain and nervous system.

Spinal column conditions are listed separately under Back, neck and spine.

Joint reconstructions are listed separately under Joint reconstructions.

Joint replacements are listed separately under Joint replacements.

Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).

Management of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS item:

18350, 18351, 18353, 18354, 18360, 18361, 18365, 30103, 30107, 30111, 30114, 30226, 30229, 30232, 30235, 30238, 30241, 30244, 32036, 39331, 43500, 43503, 43506, 43509, 43512, 43515, 43518, 43521, 43524, 43876, 43879, 44325, 44328, 44331, 44334, 44338, 44342, 44346, 44350, 44354, 44358, 44359, 44361, 44364, 44367, 44370, 44373, 44376, 45605, 45788, 45851, 45855, 45857, 45859, 45861, 45863, 45867, 45869, 45871, 45873, 45875, 45945, 45978, 45981, 45987, 45993, 45996, 46300, 46303, 46306, 46307, 46327, 46330, 46333, 46336, 46339, 46342, 46348, 46351, 46354, 46357, 46360, 46363, 46366, 46369, 46372, 46375, 46378, 46381, 46384, 46387, 46390, 46393, 46396, 46399, 46402, 46405, 46459, 46462, 46464, 46465, 46468, 46471, 46474, 46477, 46480, 46483, 47000, 47003, 47006, 47009, 47012, 47015, 47018, 47021, 47024, 47027, 47030, 47033, 47036, 47039, 47042, 47045, 47048, 47051, 47054, 47057, 47060, 47063, 47066, 47069, 47072, 47301, 47304, 47307, 47310, 47313, 47316, 47319, 47348, 47351, 47354, 47357, 47361, 47362, 47364, 47367, 47370, 47373, 47378, 47381, 47384, 47385, 47386, 47387, 47390, 47393, 47396, 47399, 47402, 47405, 47408, 47411, 47414, 47417, 47420, 47423, 47426, 47429, 47432, 47435, 47438, 47441, 47444, 47447, 47450, 47451, 47453, 47456, 47459, 47462, 47465, 47466, 47467, 47468, 47471, 47474, 47477, 47480, 47483, 47486, 47489, 47492, 47495, 47498, 47501, 47504, 47507, 47510, 47513, 47516, 47519, 47522, 47525, 47528, 47531, 47534, 47537, 47540, 47543, 47546, 47549, 47552, 47555, 47558, 47561, 47564, 47565, 47566, 47567, 47570, 47573, 47576, 47579, 47582, 47585, 47588, 47591, 47594, 47597, 47600, 47603, 47606, 47609, 47612, 47615, 47618, 47621, 47624, 47627, 47630, 47633, 47636, 47639, 47642, 47645, 47648, 47651, 47654, 47657, 47663, 47666, 47672, 47678, 47726, 47729, 47732, 47753, 47756, 47762, 47765, 47768, 47771, 47774, 47777, 47780, 47783, 47786, 47789, 47900, 47903, 47920, 47921, 47924, 47927, 47930, 47933, 47936, 47948, 47951, 47954, 47957, 47960, 47963, 47966, 47969, 47972, 47975, 47978, 47981, 47982, 48200, 48203, 48206, 48209, 48212, 48215, 48218, 48221, 48224, 48227, 48230, 48233, 48236, 48239, 48242, 48400, 48403, 48406, 48409, 48412, 48415, 48418, 48421, 48424, 48427, 48500, 48503, 48506, 48509, 48512, 48912, 48936, 48939, 48942, 48945, 48954, 49100, 49106, 49109, 49118, 49200, 49203, 49206, 49212, 49218, 49300, 49303, 49306, 49360, 49363, 49366, 49500, 49509, 49512, 49545, 49566, 49569, 49700, 49712, 49718, 49721, 49724, 49727, 49728, 49800, 49803, 49806, 49809, 49812, 49815, 49818, 49821, 49824, 49827, 49830, 49833, 49836, 49837, 49838, 49845, 49848, 49851, 49854, 49860, 49863, 49866, 49878, 50100, 50102, 50103, 50104, 50109, 50112, 50115, 50118, 50121, 50130, 50200, 50201, 50203, 50206, 50209, 50212, 50215, 50218, 50221, 50224, 50227, 50230, 50233, 50236, 50239, 50300, 50303, 50306, 50309, 50312, 50315, 50318, 50321, 50324, 50327, 50330, 50336, 50339, 50342, 50345, 50348, 50349, 50351, 50352, 50353, 50354, 50357, 50360, 50363, 50366, 50369, 50372, 50375, 50378, 50381, 50384, 50387, 50390, 50393, 50394, 50396, 50399, 50402, 50405, 50408, 50426, 50450, 50451, 50455, 50456, 50460, 50461, 50465, 50466, 50470, 50471, 50475, 50476, 50500, 50504, 50508, 50512, 50516, 50520, 50524, 50528, 50532, 50536, 50540, 50544, 50548, 50552, 50556, 50560, 50564, 50568, 50572, 50576, 50580, 50584, 50588, 50650, 50654, 50658, 52056, 52057, 52058, 52059, 52060, 52061, 52062, 52063, 52064, 52066, 52069, 52072, 52073, 52075, 52078, 52081, 52084, 52087, 52090, 52092, 52094, 52095, 52096, 52097, 52098, 52099, 52102, 52105, 52114, 52126, 52129, 52130, 52131, 52180, 52182, 52184, 52186, 53200, 53203, 53206, 53209, 53212, 53215, 53218, 53220, 53221, 53224, 53225, 53226, 53227, 53230, 53233, 53236, 53239, 53400, 53403, 53406, 53409, 53410, 53411, 53412, 53413, 53414, 53415, 53416, 53418, 53419, 53422, 53423, 53424, 53425, 53427, 53429, 53439

Brain and nervous system

Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.

For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease.

Treatment of spinal column (back bone) conditions is listed separately under Back, neck and spine.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:
6007, 6009, 6011, 6013, 6015, 14227, 14234, 14237, 18377, 35000, 35003, 35006, 35009, 35012, 35412, 35414, 39007, 39013, 39015, 39018, 39113, 39300, 39303, 39306, 39309, 39312, 39315, 39318, 39321, 39324, 39327, 39330, 39333, 39503, 39604, 39610, 39612, 39615, 39638, 39639, 39641, 39651, 39654, 39656, 39700, 39703, 39710, 39712, 39715, 39718, 39720, 39801, 39803, 39815, 39818, 39821, 39900, 39903, 39906, 40004, 40012, 40018, 40104, 40106, 40109, 40112, 40119, 40600, 40700, 40701, 40702, 40703, 40704, 40705, 40706, 40707, 40708, 40709, 40712, 40801, 40803, 40850, 40851, 40852, 40854, 40856, 40858, 40860, 40862, 40905, 43987, 51011, 51012, 51013, 51014, 51015, 52800, 52803, 52806, 52809, 52812, 52815, 52818, 52821, 52824, 52826, 52828, 52830, 52832

Breast surgery (medically necessary)

Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.

For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia.

This clinical category does not require benefits to be paid for cosmetic breast surgery that is not medically necessary.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:
30299, 30300, 30302, 30303, 31500, 31503, 31506, 31509, 31512, 31515, 31516, 31519, 31524, 31525, 31530, 31533, 31536, 31548, 31551, 31554, 31557, 31560, 31563, 31566, 45060, 45061, 45062, 45520, 45522, 45523, 45524, 45527, 45528, 45530, 45533, 45536, 45539, 45542, 45545, 45546, 45548, 45551, 45553, 45554, 45556, 45558

Cataracts

Hospital treatment for surgery to remove a cataract and replace with an artificial lens.

Treatments involving the provision of the following MBS items:
42698, 42701, 42702, 42703, 42704, 42705, 42707, 42710, 42713, 42716

Chemotherapy, radiotherapy and immunotherapy for cancer

Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.

Surgical treatment of cancer is listed separately under each body system.

Treatments involving the provision of the following MBS items:
13760, 13950, 14221, 14245, 14247, 14249, 15000, 15003, 15006, 15009, 15012, 15100, 15103, 15106, 15109, 15112, 15115, 15211, 15214, 15215, 15218, 15221, 15224, 15227, 15230, 15233, 15236, 15239, 15242, 15245, 15248, 15251, 15254, 15257, 15260, 15263, 15266, 15269, 15272, 15275, 15303, 15304, 15307, 15308, 15311, 15312, 15315, 15316, 15319, 15320, 15323, 15324, 15327, 15328, 15331, 15332, 15335, 15336, 15338, 15339, 15342, 15345, 15348, 15351, 15354, 15357, 15500, 15503, 15506, 15509, 15512, 15513, 15515, 15518, 15521, 15524, 15527, 15530, 15533, 15536, 15539, 15550, 15553, 15555, 15556, 15559, 15562, 15565, 15600, 15700, 15705, 15710, 15715, 15800, 15850, 15900, 16003, 16006, 16009, 16012, 16015, 16018, 30400, 34521, 34524, 34527, 34528, 34529, 34530, 34533, 34534, 34539, 34540, 35404, 35406, 35408, 50950, 50952

Dental surgery

Hospital treatment for surgery to the teeth and gums.

For example: surgery to remove wisdom teeth, and dental implant surgery.

Treatments involving the provision of the following MBS items:
75006, 75030, 75033, 75034, 75036, 75037, 75039, 75042, 75045, 75048, 75049, 75050, 75051, 75156, 75200, 75203, 75206, 75400, 75403, 75406, 75409, 75412, 75415, 75600, 75603, 75606, 75609, 75612, 75615, 75618, 75621, 75800, 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833, 75836, 75839, 75842, 75845, 75848, 75851, 75854

Diabetes management

(excluding insulin pumps)

Hospital treatment for the investigation and management of diabetes.

For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections.

Treatment for diabetes-related conditions is listed separately under each body system affected. For example, treatment for diabetes-related eye conditions is listed separately under Eye.

Treatment for ulcers is listed separately under Skin.

Provision and replacement of insulin pumps is listed separately under Insulin pumps.

Treatments involving the provision of the following MBS items:
31346

Dialysis for chronic kidney failure

Hospital treatment for dialysis treatment for chronic kidney failure.

For example: peritoneal dialysis and haemodialysis.

Treatments involving the provision of the following MBS items:
13100, 13103, 13104, 13106, 13109, 13110

Digestive system

Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.

For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.

Endoscopy is listed separately under Gastrointestinal endoscopy.

Hernia and appendicectomy procedures are listed separately under Hernia and appendix.

Bariatric surgery is listed separately under Weight loss surgery.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:
11800, 11801, 11810, 13506, 14212, 30373, 30375, 30376, 30378, 30379, 30382, 30384, 30385, 30387, 30392, 30393, 30396, 30397, 30399, 30402, 30406, 30408, 30409, 30411, 30412, 30414, 30415, 30416, 30417, 30418, 30419, 30421, 30422, 30425, 30427, 30428, 30430, 30431, 30433, 30434, 30436, 30437, 30438, 30439, 30440, 30441, 30442, 30443, 30445, 30446, 30448, 30449, 30450, 30451, 30452, 30454, 30455, 30457, 30458, 30460, 30461, 30463, 30464, 30466, 30467, 30469, 30472, 30481, 30482, 30483, 30492, 30495, 30496, 30497, 30499, 30500, 30502, 30503, 30505, 30506, 30508, 30509, 30515, 30517, 30518, 30520, 30521, 30523, 30524, 30526, 30527, 30529, 30530, 30532, 30533, 30535, 30536, 30538, 30539, 30541, 30542, 30544, 30545, 30547, 30548, 30550, 30551, 30553, 30554, 30556, 30557, 30559, 30560, 30562, 30563, 30564, 30565, 30566, 30575, 30577, 30578, 30580, 30581, 30583, 30584, 30586, 30587, 30589, 30590, 30593, 30594, 30596, 30597, 30599, 30600, 30601, 30602, 30603, 30605, 30606, 30608, 30619, 30621, 30622, 30623, 30626, 30627, 30636, 30637, 30639, 31450, 31452, 31454, 31456, 31458, 31460, 31462, 31464, 31466, 31468, 31470, 31472, 32000, 32003, 32004, 32005, 32006, 32009, 32012, 32015, 32018, 32021, 32024, 32025, 32026, 32028, 32029, 32030, 32033, 32039, 32042, 32045, 32046, 32047, 32051, 32054, 32057, 32060, 32063, 32066, 32069, 32096, 32099, 32102, 32103, 32104, 32105, 32106, 32108, 32111, 32112, 32114, 32115, 32117, 32120, 32123, 32126, 32129, 32131, 32132, 32135, 32138, 32139, 32142, 32145, 32147, 32150, 32153, 32156, 32159, 32162, 32165, 32166, 32168, 32171, 32174, 32175, 32177, 32180, 32183, 32186, 32200, 32203, 32206, 32209, 32210, 32212, 32213, 32214, 32215, 32216, 32217, 32218, 32220, 32221, 41816, 41822, 41825, 41828, 41831, 41832, 43801, 43804, 43807, 43810, 43813, 43816, 43819, 43822, 43825, 43828, 43831, 43834, 43840, 43843, 43846, 43849, 43852, 43855, 43858, 43864, 43867, 43870, 43873, 43900, 43903, 43906, 43930, 43933, 43936, 43942, 43945, 43948, 43951, 43954, 43957, 43960, 43963, 43966, 43969, 43972, 43975, 43978, 43990, 43993, 43996, 43999, 44101, 44102, 44104, 44105

Ear, nose and throat

Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.

For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.

Tonsils, adenoids and grommets are listed separately under Tonsils, adenoids and grommets.

The implantation of a hearing device is listed separately under Implantation of hearing devices.

Orthopaedic neck conditions are listed separately under Back, neck and spine.

Sleep studies are listed separately under Sleep studies.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

 

Treatments involving the provision of the following MBS items:
11300, 18368, 30104, 30105, 30246, 30247, 30250, 30251, 30253, 30255, 30256, 30259, 30262, 30266, 30269, 30272, 30275, 30278, 30281, 30283, 30286, 30287, 30289, 30293, 30294, 30296, 30297, 30306, 30310, 30314, 30315, 30317, 30318, 30320, 30326, 30618, 31400, 31403, 31406, 31409, 31412, 31420, 31423, 31426, 31429, 31432, 31435, 31438, 41500, 41501, 41503, 41506, 41509, 41512, 41515, 41518, 41521, 41524, 41527, 41530, 41533, 41536, 41539, 41542, 41545, 41548, 41551, 41554, 41557, 41560, 41563, 41564, 41566, 41569, 41572, 41575, 41576, 41578, 41579, 41581, 41584, 41587, 41590, 41593, 41596, 41599, 41608, 41611, 41614, 41615, 41620, 41623, 41626, 41629, 41635, 41638, 41641, 41644, 41647, 41650, 41653, 41656, 41659, 41662, 41668, 41671, 41672, 41674, 41677, 41683, 41686, 41689, 41692, 41698, 41701, 41704, 41707, 41710, 41713, 41716, 41719, 41722, 41725, 41728, 41729, 41731, 41734, 41737, 41740, 41743, 41746, 41749, 41752, 41755, 41764, 41767, 41770, 41773, 41776, 41779, 41782, 41785, 41786, 41787, 41804, 41807, 41810, 41813, 41834, 41837, 41840, 41843, 41855, 41858, 41861, 41864, 41867, 41868, 41870, 41873, 41876, 41879, 41880, 41881, 41884, 41885, 41886, 41889, 41892, 41895, 41898, 41901, 41904, 41905, 41907, 41910, 43832, 45645, 45646, 47735, 47738, 47741, 51900, 51902, 52021, 52024, 52025, 52027, 52030, 52033, 52034, 52035, 52055, 52132, 52133, 52135, 52138, 52141, 52147, 52148, 52158, 53000, 53003, 53004, 53006, 53009, 53012, 53015, 53016, 53017, 53019, 53052, 53054, 53056, 53058, 53060, 53062, 53064, 53068, 53070, 53458, 53459, 53460

Eye (not cataracts)

Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket.

For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.

Cataract procedures are listed separately under Cataracts.

Eyelid procedures are listed separately under Plastic and reconstructive surgery.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:
18366, 18369, 18370, 18372, 18374, 42503, 42504, 42505, 42506, 42509, 42510, 42512, 42515, 42518, 42521, 42524, 42527, 42530, 42533, 42536, 42539, 42542, 42543, 42545, 42548, 42551, 42554, 42557, 42563, 42569, 42572, 42573, 42574, 42575, 42576, 42581, 42584, 42587, 42588, 42590, 42593, 42596, 42599, 42602, 42605, 42608, 42610, 42611, 42614, 42615, 42617, 42620, 42622, 42623, 42626, 42629, 42632, 42635, 42638, 42641, 42644, 42647, 42650, 42651, 42652, 42653, 42656, 42662, 42665, 42667, 42668, 42672, 42673, 42676, 42677, 42680, 42683, 42686, 42689, 42692, 42695, 42719, 42725, 42731, 42734, 42738, 42739, 42740, 42741, 42743, 42744, 42746, 42749, 42752, 42755, 42758, 42761, 42764, 42767, 42770, 42773, 42776, 42779, 42782, 42785, 42788, 42791, 42794, 42801, 42802, 42805, 42806, 42807, 42808, 42809, 42810, 42811, 42812, 42815, 42818, 42821, 42824, 42833, 42836, 42839, 42842, 42845, 42848, 42851, 42854, 42857, 42869, 43021, 43022, 43023

Gastrointestinal endoscopy

Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.

For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP).

Non-endoscopic procedures for the digestive system are listed separately under Digestive system.

Treatments involving the provision of the following MBS items:
11820, 11823, 30473, 30475, 30478, 30479, 30484, 30485, 30488, 30490, 30491, 30494, 30568, 30569, 30680, 30682, 30684, 30686, 30687, 30688, 30690, 30692, 30694, 32023, 32072, 32075, 32084, 32087, 32094, 32095, 32222, 32223, 32224, 32225, 32226, 32227, 32228, 32229

Gynaecology

Hospital treatment for the investigation and treatment of the female reproductive system.

For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer.

Fertility treatments are listed separately under Assisted reproductive services.

Pregnancy and birth-related conditions are listed separately under Pregnancy and birth.

Miscarriage or termination of pregnancy is listed separately under Miscarriage and termination of pregnancy.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:
30062, 35410, 35500, 35502, 35503, 35506, 35507, 35508, 35509, 35513, 35517, 35518, 35520, 35523, 35527, 35530, 35533, 35534, 35536, 35539, 35542, 35545, 35548, 35554, 35557, 35560, 35561, 35562, 35564, 35565, 35566, 35568, 35569, 35570, 35571, 35572, 35573, 35577, 35578, 35581, 35582, 35585, 35595, 35596, 35597, 35599, 35602, 35605, 35608, 35611, 35612, 35613, 35614, 35615, 35616, 35618, 35620, 35622, 35623, 35626, 35627, 35630, 35633, 35634, 35635, 35636, 35637, 35638, 35641, 35644, 35645, 35646, 35647, 35648, 35649, 35653, 35657, 35658, 35661, 35664, 35667, 35670, 35673, 35680, 35684, 35688, 35691, 35694, 35697, 35700, 35703, 35706, 35709, 35710, 35713, 35717, 35720, 35723, 35726, 35729, 35730, 35750, 35753, 35754, 35756, 35759

Heart and vascular system

Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system.

For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:
13400, 32500, 32504, 32507, 32508, 32511, 32514, 32517, 32520, 32522, 32523, 32526, 32528, 32529, 32700, 32703, 32708, 32710, 32711, 32712, 32715, 32718, 32721, 32724, 32730, 32733, 32736, 32739, 32742, 32745, 32748, 32751, 32754, 32757, 32760, 32763, 32766, 32769, 33050, 33055, 33070, 33075, 33080, 33100, 33103, 33109, 33112, 33115, 33116, 33118, 33119, 33121, 33124, 33127, 33130, 33133, 33136, 33139, 33142, 33145, 33148, 33151, 33154, 33157, 33160, 33163, 33166, 33169, 33172, 33175, 33178, 33181, 33500, 33506, 33509, 33512, 33515, 33518, 33521, 33524, 33527, 33530, 33533, 33536, 33539, 33542, 33545, 33548, 33551, 33554, 33800, 33803, 33806, 33810, 33811, 33812, 33815, 33818, 33821, 33824, 33827, 33830, 33833, 33836, 33839, 33842, 33845, 33848, 34100, 34103, 34106, 34109, 34112, 34115, 34118, 34121, 34124, 34127, 34130, 34142, 34145, 34148, 34151, 34154, 34157, 34160, 34163, 34166, 34169, 34172, 34175, 34500, 34503, 34506, 34509, 34512, 34515, 34518, 34800, 34803, 34806, 34809, 34812, 34815, 34818, 34821, 34824, 34827, 34830, 34833, 35100, 35103, 35200, 35202, 35300, 35303, 35306, 35307, 35309, 35312, 35315, 35317, 35319, 35320, 35321, 35324, 35327, 35330, 35331, 35360, 35361, 35362, 35363, 38200, 38203, 38206, 38209, 38212, 38213, 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38237, 38240, 38241, 38243, 38246, 38256, 38270, 38272, 38273, 38274, 38275, 38276, 38285, 38286, 38287, 38288, 38290, 38293, 38300, 38303, 38306, 38309, 38312, 38315, 38318, 38350, 38353, 38356, 38358, 38359, 38362, 38365, 38368, 38371, 38384, 38387, 38390, 38393, 38447, 38449, 38450, 38452, 38470, 38473, 38475, 38477, 38478, 38480, 38481, 38483, 38485, 38487, 38488, 38489, 38490, 38493, 38495, 38496, 38497, 38498, 38500, 38501, 38503, 38504, 38505, 38506, 38507, 38508, 38509, 38512, 38515, 38518, 38550, 38553, 38556, 38559, 38562, 38565, 38568, 38571, 38572, 38577, 38588, 38600, 38603, 38609, 38612, 38613, 38615, 38618, 38621, 38624, 38627, 38637, 38650, 38653, 38654, 38670, 38673, 38677, 38680, 38700, 38703, 38706, 38709, 38712, 38715, 38718, 38721, 38724, 38727, 38730, 38733, 38736, 38739, 38742, 38745, 38748, 38751, 38754, 38757, 38760, 38763, 38766, 59903, 59912, 59925

Hernia and appendix

Hospital treatment for the investigation and treatment of a hernia or appendicitis.

Digestive conditions are listed separately under Digestive system.

Treatments involving the provision of the following MBS items:
30571, 30572, 30574, 30609, 30614, 30615, 30640, 30645, 30646, 43805, 43835, 43837, 43838, 43841, 43939, 44108, 44111, 44114

Implantation of hearing devices

Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.

Stapedectomy is listed separately under Ear, nose and throat.

Treatments involving the provision of the following MBS items:
ss41603, 41604, 41617, 41618

Insulin pumps

Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.

 

Joint reconstructions

Hospital treatment for surgery for joint reconstructions.

For example: torn tendons, rotator cuff tears and damaged ligaments.

Joint replacements are listed separately under Joint replacements.

Bone fractures are listed separately under Bone, joint and muscle.

Procedures to the spinal column are listed separately under Back, neck and spine.

Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).

Treatments involving the provision of the following MBS items:
46345, 46408, 46411, 46414, 46417, 46420, 46423, 46426, 46429, 46432, 46435, 46438, 46441, 46442, 46444, 46447, 46450, 46453, 46456, 46492, 46494, 46495, 46498, 46500, 46501, 46502, 46503, 46504, 46507, 46510, 46522, 48900, 48903, 48906, 48909, 48930, 48933, 48948, 48951, 48957, 48960, 49103, 49121, 49215, 49221, 49224, 49227, 49503, 49506, 49536, 49539, 49542, 49548, 49551, 49557, 49558, 49559, 49560, 49561, 49562, 49563, 49564, 49703, 49706, 49709, 50106, 50333

Joint replacements

Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.

For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.

Joint fusions are listed separately under Bone, joint and muscle.

Spinal fusions are listed separately under Back, neck and spine.

Joint reconstructions are listed separately under Joint reconstructions.

Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).

Treatments involving the provision of the following MBS items:
46309, 46312, 46315, 46318, 46321, 48915, 48918, 48921, 48924, 48927, 49112, 49115, 49116, 49117, 49209, 49210, 49211, 49309, 49312, 49315, 49318, 49319, 49321, 49324, 49327, 49330, 49333, 49336, 49339, 49342, 49345, 49346, 49515, 49517, 49518, 49519, 49521, 49524, 49527, 49530, 49533, 49534, 49554, 49715, 49716, 49717, 49839, 49842, 49857

Kidney and bladder

Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.

For example: kidney stones, adrenal gland tumour and incontinence.

Dialysis is listed separately under Dialysis for chronic kidney failure.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:
11900, 11903, 11906, 11909, 11912, 11915, 11917, 11919, 11921, 12524, 12527, 18375, 18379, 30324, 36503, 36504, 36505, 36506, 36507, 36508, 36509, 36516, 36519, 36522, 36525, 36528, 36529, 36531, 36532, 36533, 36537, 36543, 36546, 36549, 36552, 36558, 36561, 36564, 36567, 36570, 36573, 36576, 36579, 36585, 36588, 36591, 36594, 36597, 36600, 36603, 36604, 36606, 36607, 36608, 36609, 36610, 36611, 36612, 36615, 36618, 36621, 36624, 36627, 36633, 36636, 36639, 36645, 36649, 36650, 36652, 36654, 36656, 36663, 36664, 36665, 36666, 36667, 36668, 36671, 36672, 36673, 36800, 36803, 36806, 36809, 36811, 36812, 36815, 36818, 36821, 36822, 36823, 36824, 36827, 36830, 36833, 36836, 36840, 36842, 36845, 36848, 36851, 36854, 36860, 36863, 37000, 37004, 37008, 37011, 37014, 37015, 37016, 37018, 37019, 37020, 37021, 37023, 37026, 37029, 37038, 37039, 37040, 37041, 37042, 37043, 37044, 37045, 37046, 37047, 37048, 37050, 37053, 37300, 37303, 37306, 37309, 37318, 37321, 37324, 37327, 37330, 37333, 37336, 37338, 37339, 37340, 37341, 37342, 37343, 37344, 37345, 37348, 37351, 37354, 37369, 37372, 37375, 37381, 37384, 37387, 37388, 37390, 37800, 37801, 37842, 37845, 37848, 37851, 37854, 43981, 43984

Lung and chest

Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.

For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:

30090, 30696, 30710, 34133, 34136, 34139, 38415, 38418, 38421, 38424, 38427, 38430, 38436, 38438, 38440, 38441, 38446, 38448, 38453, 38455, 38460, 38462, 38464, 38466, 38468, 38469, 38640, 38643, 38647, 38656, 38800, 38803, 38806, 38809, 38812, 43861, 43909, 43912

Male reproductive system

Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.

For example: male sterilisation, circumcision and prostate cancer.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:
30628, 30629, 30630, 30631, 30635, 30641, 30642, 30643, 30644, 30649, 30654, 30658, 30663, 30666, 37200, 37201, 37202, 37203, 37206, 37207, 37208, 37209, 37210, 37211, 37213, 37214, 37215, 37216, 37217, 37218, 37219, 37220, 37221, 37223, 37224, 37226, 37227, 37230, 37233, 37245, 37393, 37396, 37402, 37405, 37408, 37411, 37415, 37417, 37418, 37423, 37426, 37429, 37432, 37435, 37438, 37601, 37604, 37607, 37610, 37613, 37616, 37619, 37623, 37803, 37804, 37806, 37807, 37809, 37810, 37812, 37813, 37815, 37816, 37818, 37819, 37821, 37822, 37824, 37825, 37827, 37828, 37830, 37831, 37833, 37834, 37836, 37839

Miscarriage and termination of pregnancy

Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.

Treatments involving the provision of the following MBS items:
16530, 16531, 35640, 35643, 35674, 35677, 35678

Pain management

Hospital treatment for pain management that does not require the insertion or surgical management of a device.

For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.

Pain management using a device (for example an infusion pump or neurostimulator) is listed separately under Pain management with device.

Treatments involving the provision of the following MBS items:
39100, 39109, 39115, 39118, 39121, 39124, 39140, 39323, 45939

Pain management with device

Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.

For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).

Treatment of pain that does not require a device is listed separately under Pain management.

Treatments involving the provision of the following MBS items:
14218, 39125, 39126, 39127, 39128, 39130, 39131, 39133, 39134, 39135, 39136, 39137, 39138, 39139

Plastic and reconstructive surgery

(medically necessary)

Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital.

For example: burns requiring a graft, cleft palate, club foot and angioma.

Plastic surgery that is medically necessary relating to the treatment of a skin-related condition is listed separately under Skin.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:
30003, 30006, 30010, 30014, 30017, 30020, 30176, 38457, 38458, 42860, 42863, 42866, 42872, 43882, 45000, 45003, 45006, 45009, 45012, 45015, 45018, 45019, 45021, 45024, 45025, 45026, 45027, 45030, 45033, 45035, 45036, 45039, 45042, 45045, 45048, 45051, 45054, 45200, 45201, 45202, 45203, 45206, 45207, 45209, 45212, 45215, 45218, 45221, 45224, 45227, 45230, 45233, 45236, 45239, 45240, 45400, 45403, 45406, 45409, 45412, 45415, 45418, 45439, 45442, 45445, 45448, 45451, 45460, 45461, 45462, 45464, 45465, 45466, 45468, 45469, 45471, 45472, 45474, 45475, 45477, 45478, 45480, 45481, 45483, 45484, 45485, 45486, 45487, 45488, 45489, 45490, 45491, 45492, 45493, 45494, 45496, 45497, 45498, 45499, 45500, 45501, 45502, 45503, 45504, 45505, 45506, 45512, 45515, 45518, 45519, 45560, 45561, 45562, 45563, 45564, 45565, 45566, 45568, 45569, 45570, 45572, 45575, 45578, 45581, 45584, 45585, 45587, 45588, 45590, 45593, 45596, 45597, 45599, 45602, 45608, 45611, 45614, 45617, 45620, 45623, 45624, 45625, 45626, 45627, 45629, 45632, 45635, 45641, 45644, 45647, 45650, 45652, 45653, 45656, 45659, 45660, 45661, 45662, 45665, 45668, 45669, 45671, 45674, 45675, 45676, 45677, 45680, 45683, 45686, 45689, 45692, 45695, 45698, 45701, 45704, 45707, 45710, 45713, 45714, 45716, 45720, 45723, 45726, 45729, 45731, 45732, 45735, 45738, 45741, 45744, 45747, 45752, 45753, 45754, 45755, 45758, 45761, 45767, 45770, 45773, 45776, 45779, 45782, 45785, 45791, 45794, 45797, 45799, 45801, 45803, 45805, 45807, 45809, 45811, 45813, 45815, 45817, 45819, 45821, 45823, 45825, 45827, 45829, 45831, 45833, 45835, 45837, 45839, 45841, 45843, 45845, 45847, 45849, 45853, 45865, 45877, 45879, 45882, 45885, 45888, 45891, 45894, 45897, 45900, 45975, 45984, 45990, 50411, 50414, 50417, 50420, 50423, 51904, 51906, 52010, 52036, 52045, 52048, 52106, 52108, 52111, 52117, 52120, 52122, 52123, 52300, 52303, 52306, 52309, 52312, 52315, 52318, 52319, 52321, 52324, 52327, 52330, 52333, 52336, 52337, 52339, 52342, 52345, 52348, 52351, 52354, 52357, 52360, 52363, 52366, 52369, 52372, 52375, 52378, 52379, 52380, 52382, 52420, 52424, 52430, 52440, 52442, 52444, 52446, 52450, 52452, 52456, 52458, 52460, 52480, 52482, 52484, 52600, 52603, 52606, 52609, 52612, 52615, 52618, 52621, 52624, 52626, 52627, 52630, 52633, 52636, 53242, 53453, 53455, 75024, 75027

Podiatric surgery

(provided by a registered podiatric surgeon)

Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon, but limited to cover for:

   accommodation; and

   the cost of a prosthesis as listed in the prostheses list set out in the Private Health Insurance (Prostheses) Rules, as in force from time to time.

Note: Insurers are not required to pay for any other benefits for hospital treatment for this clinical category but may choose to do so.

 

Pregnancy and birth

Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.

Treatment for the baby is covered under the clinical category relevant to their condition. For example, respiratory conditions are covered under Lung and chest.

Female reproductive conditions are listed separately under Gynaecology.

Fertility treatments are listed separately under Assisted reproductive services.

Miscarriage and termination of pregnancy is listed separately under Miscarriage and termination of pregnancy.

Treatments involving the provision of the following MBS items:
16400, 16401, 16404, 16406, 16407, 16408, 16500, 16501, 16502, 16505, 16508, 16509, 16511, 16512, 16514, 16515, 16518, 16519, 16520, 16522, 16527, 16528, 16533, 16534, 16564, 16567, 16570, 16571, 16573, 16590, 16591, 16600, 16603, 16606, 16609, 16612, 16615, 16618, 16621, 16624, 16627, 82100, 82105, 82110, 82115, 82120, 82125

Skin

Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included.

For example: melanoma, minor wound repair and abscesses.

Removal of excess skin due to weight loss is listed separately under Weight loss surgery.

Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Treatments involving the provision of the following MBS items:
12012, 12017, 12021, 12022, 12024, 14050, 14100, 14106, 14115, 14118, 14124, 18362, 30023, 30024, 30026, 30029, 30032, 30035, 30038, 30042, 30045, 30049, 30052, 30055, 30064, 30071, 30099, 30180, 30183, 30187, 30189, 30190, 30191, 30192, 30196, 30202, 30207, 30210, 30216, 30219, 30223, 30676, 30679, 31000, 31001, 31002, 31003, 31004, 31005, 31206, 31211, 31216, 31220, 31221, 31225, 31245, 31250, 31340, 31345, 31356, 31357, 31358, 31359, 31360, 31361, 31362, 31363, 31364, 31365, 31366, 31367, 31368, 31369, 31370, 31371, 31372, 31373, 31374, 31375, 31376, 44136, 46486, 46489, 46513, 46516, 46528, 46531, 46534, 47904, 47906, 47912, 47915, 47916, 47918, 52000, 52003, 52006, 52009, 52039, 52042, 52051, 52054

Sleep studies

Hospital treatment for the investigation of sleep patterns and anomalies.

For example: sleep apnoea and snoring.

Treatments involving the provision of the following MBS items:
12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217, 12250, 12254, 12258, 12261, 12265, 12268, 12272

Tonsils, adenoids and grommets

Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.

Treatments involving the provision of the following MBS items:
41632, 41789, 41793, 41797, 41801

Weight loss surgery

Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.

For example: gastric banding, gastric bypass, sleeve gastrectomy.

Treatments involving the provision of the following MBS items:
30165, 30168, 30171, 30172, 30177, 30179, 31569, 31572, 31575, 31578, 31581, 31584, 31587, 31590

 

2  Clause 1 of Schedule 6 (table titled “Common treatments list”)

Repeal the table, substitute:

 

Common treatments – table of MBS items

3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60, 65, 104, 105, 106, 107, 108, 109, 110, 111, 115, 116, 117, 119, 120, 122, 128, 131, 132, 133, 135, 137, 141, 143, 145, 147, 160, 161, 162, 163, 164, 173, 193, 195, 197, 199, 214, 215, 218, 219, 220, 221, 222, 223, 224, 225, 226, 227, 228, 229, 230, 231, 232, 233, 235, 236, 237, 238, 239, 240, 243, 244, 253, 255, 257, 260, 262, 264, 266, 269, 271, 272, 276, 277, 279, 281, 282, 285, 287, 291, 293, 296, 299, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 330, 332, 334, 336, 338, 353, 355, 356, 357, 358, 359, 361, 385, 386, 387, 388, 410, 411, 412, 413, 414, 415, 416, 417, 585, 588, 591, 594, 599, 600, 701, 703, 705, 707, 715, 721, 723, 729, 731, 732, 733, 735, 737, 739, 743, 747, 750, 758, 820, 822, 823, 825, 826, 828, 830, 832, 834, 835, 837, 838, 871, 872, 880, 900, 903, 2100, 2497, 2501, 2503, 2504, 2506, 2507, 2509, 2517, 2518, 2521, 2522, 2525, 2526, 2546, 2547, 2552, 2553, 2558, 2559, 2598, 2600, 2603, 2606, 2610, 2613, 2616, 2620, 2622, 2624, 2631, 2633, 2635, 2664, 2666, 2668, 2673, 2675, 2677, 2801, 2806, 2814, 2824, 2832, 2840, 2946, 2949, 2954, 2958, 2972, 2974, 2978, 2984, 2988, 2992, 2996, 3000, 4001, 5000, 5001, 5003, 5004, 5010, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5020, 5021, 5022, 5023, 5027, 5028, 5030, 5031, 5032, 5033, 5035, 5036, 5039, 5040, 5041, 5042, 5043, 5044, 5049, 5060, 5063, 5067, 5200, 5203, 5207, 5208, 5220, 5223, 5227, 5228, 5260, 5263, 5265, 5267, 6051, 6052, 6057, 6058, 6059, 6060, 6062, 6063, 6064, 6065, 6067, 6068, 6071, 6072, 6074, 6075, 10905, 10907, 10910, 10911, 10912, 10913, 10914, 10915, 10916, 10918, 10921, 10922, 10923, 10924, 10925, 10926, 10927, 10928, 10929, 10930, 10945, 10946, 10947, 10948, 11830, 11833, 12000, 12001, 12002, 12003, 12004, 12005, 13015, 13020, 13025, 13030, 13757, 13870, 13873, 14201, 14202, 14209, 17615, 17620, 17625, 17640, 17645, 17650, 17655, 18216, 18219, 18282, 18284, 18286, 18288, 18290, 18292, 18294, 18296, 18298, 30058, 30061, 30068, 30072, 30075, 30078, 30081, 30084, 30087, 30093, 30094, 30096, 30097, 30224, 30225, 30323, 30329, 30330, 30332, 30335, 30336, 30388, 30390, 30391, 30394, 30403, 30405, 30611, 31350, 31355, 34538, 35551, 35552, 36502, 38456, 39000, 43915, 44130, 46324, 46325, 46519, 46525, 50127, 51700, 51703, 52012, 52015, 52018, 52144, 75001, 75004, 75150, 75153, 82130, 82135, 82140, 82200, 82205, 82210, 82215

 

3  Clause 1 of Schedule 7 (table titled “Support treatments - table of MBS items”)

Repeal the table, substitute:

 

Support treatments – table of MBS items

6080, 6081, 10801, 10802, 10803, 10804, 10805, 10806, 10807, 10808, 10809, 10816, 10931, 10932, 10933, 10940, 10941, 10942, 10943, 10944, 11000, 11003, 11004, 11005, 11009, 11012, 11015, 11018, 11021, 11024, 11027, 11200, 11204, 11205, 11210, 11211, 11215, 11218, 11219, 11220, 11221, 11224, 11235, 11237, 11240, 11241, 11242, 11243, 11244, 11303, 11304, 11306, 11309, 11312, 11315, 11318, 11324, 11327, 11330, 11332, 11333, 11336, 11339, 11503, 11505, 11506, 11507, 11508, 11512, 11600, 11602, 11604, 11605, 11610, 11611, 11612, 11614, 11615, 11627, 11705, 11713, 11715, 11718, 11719, 11720, 11721, 11724, 11725, 11726, 11727, 11728, 11729, 11730, 11731, 12200, 12201, 12306, 12312, 12315, 12320, 12321, 12322, 12325, 12326, 12500, 12533, 13300, 13303, 13306, 13309, 13312, 13318, 13319, 13703, 13706, 13750, 13755, 13815, 13818, 13830, 13832, 13834, 13835, 13837, 13838, 13839, 13840, 13842, 13848, 13851, 13854, 13857, 13876, 13881, 13882, 13885, 13888, 13899, 14255, 14256, 14257, 14258, 14259, 14260, 14263, 14264, 14265, 14266, 14270, 14272, 14277, 14278, 14280, 14283, 14285, 14288, 17610, 17680, 17690, 18213, 18222, 18225, 18226, 18227, 18228, 18230, 18232, 18233, 18234, 18236, 18238, 18240, 18242, 18244, 18248, 18250, 18252, 18254, 18256, 18258, 18260, 18262, 18264, 18266, 18268, 18270, 18272, 18274, 18276, 18278, 18280, 18297, 20100, 20102, 20104, 20120, 20124, 20140, 20142, 20143, 20144, 20145, 20146, 20147, 20148, 20160, 20162, 20164, 20170, 20172, 20174, 20176, 20190, 20192, 20210, 20212, 20214, 20216, 20220, 20222, 20225, 20230, 20300, 20305, 20320, 20321, 20330, 20350, 20352, 20355, 20400, 20401, 20402, 20403, 20404, 20405, 20406, 20410, 20420, 20440, 20450, 20452, 20470, 20472, 20474, 20475, 20500, 20520, 20522, 20524, 20526, 20528, 20540, 20542, 20546, 20548, 20560, 20600, 20604, 20620, 20622, 20630, 20632, 20634, 20670, 20680, 20690, 20700, 20702, 20703, 20704, 20706, 20730, 20740, 20745, 20750, 20752, 20754, 20756, 20770, 20790, 20791, 20792, 20793, 20794, 20798, 20799, 20800, 20802, 20803, 20804, 20806, 20810, 20815, 20820, 20830, 20832, 20840, 20841, 20842, 20844, 20845, 20846, 20847, 20848, 20850, 20855, 20860, 20862, 20863, 20864, 20866, 20867, 20868, 20880, 20882, 20884, 20886, 20900, 20902, 20904, 20905, 20906, 20910, 20911, 20912, 20914, 20916, 20920, 20924, 20926, 20928, 20930, 20932, 20934, 20936, 20938, 20940, 20942, 20943, 20944, 20946, 20948, 20950, 20952, 20954, 20956, 20958, 20960, 21100, 21110, 21112, 21114, 21116, 21120, 21130, 21140, 21150, 21155, 21160, 21170, 21195, 21199, 21200, 21202, 21210, 21212, 21214, 21216, 21220, 21230, 21232, 21234, 21260, 21270, 21272, 21274, 21275, 21280, 21300, 21321, 21340, 21360, 21380, 21382, 21390, 21392, 21400, 21402, 21403, 21404, 21420, 21430, 21432, 21440, 21445, 21460, 21461, 21462, 21464, 21472, 21474, 21480, 21482, 21484, 21486, 21490, 21500, 21502, 21520, 21522, 21530, 21532, 21535, 21600, 21610, 21620, 21622, 21630, 21632, 21634, 21636, 21638, 21650, 21652, 21654, 21656, 21670, 21680, 21682, 21685, 21700, 21710, 21712, 21714, 21716, 21730, 21732, 21740, 21756, 21760, 21770, 21772, 21780, 21785, 21790, 21800, 21810, 21820, 21830, 21832, 21834, 21840, 21842, 21850, 21860, 21865, 21870, 21872, 21878, 21879, 21880, 21881, 21882, 21883, 21884, 21885, 21886, 21887, 21900, 21906, 21908, 21910, 21912, 21914, 21915, 21916, 21918, 21922, 21925, 21926, 21930, 21935, 21936, 21939, 21941, 21942, 21943, 21945, 21949, 21952, 21955, 21959, 21962, 21965, 21969, 21970, 21973, 21976, 21980, 21990, 21992, 21997, 22002, 22007, 22008, 22012, 22014, 22015, 22020, 22025, 22031, 22036, 22041, 22042, 22051, 22055, 22060, 22065, 22075, 22900, 22905, 23010, 23025, 23035, 23045, 23055, 23065, 23075, 23085, 23091, 23101, 23111, 23112, 23113, 23114, 23115, 23116, 23117, 23118, 23119, 23121, 23170, 23180, 23190, 23200, 23210, 23220, 23230, 23240, 23250, 23260, 23270, 23280, 23290, 23300, 23310, 23320, 23330, 23340, 23350, 23360, 23370, 23380, 23390, 23400, 23410, 23420, 23430, 23440, 23450, 23460, 23470, 23480, 23490, 23500, 23510, 23520, 23530, 23540, 23550, 23560, 23570, 23580, 23590, 23600, 23610, 23620, 23630, 23640, 23650, 23660, 23670, 23680, 23690, 23700, 23710, 23720, 23730, 23740, 23750, 23760, 23770, 23780, 23790, 23800, 23810, 23820, 23830, 23840, 23850, 23860, 23870, 23880, 23890, 23900, 23910, 23920, 23930, 23940, 23950, 23960, 23970, 23980, 23990, 24100, 24101, 24102, 24103, 24104, 24105, 24106, 24107, 24108, 24109, 24110, 24111, 24112, 24113, 24114, 24115, 24116, 24117, 24118, 24119, 24120, 24121, 24122, 24123, 24124, 24125, 24126, 24127, 24128, 24129, 24130, 24131, 24132, 24133, 24134, 24135, 24136, 25000, 25005, 25010, 25013, 25014, 25020, 25025, 25030, 25050, 25200, 25205, 30001, 51300, 51303, 51306, 51309, 51312, 51315, 51318, 51800, 51803, 53700, 53702, 53704, 53706, 75009, 75012, 75015, 75018, 75021, 75023, 10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968, 10970, 10988, 10989, 81000, 81005, 81010

 

Schedule 4—Amendments—COVID-19 Accreditation Arrangements

Private Health Insurance (Health Insurance Business) Rules 2018

1 Subrule 7C(e)(Part 2A)

Omit:

"submit Hospital Casemix Protocol Data to health insurers electronically with every claim for second-tier default benefits.",

substitute:

"submit Hospital Casemix Protocol Data to health insurers electronically with every claim for private health insurance benefits."

2 Add Subrule 7F(Part 2A)

Covid-19 Accreditation Arrangements

(1) If the date on which a hospital’s accreditation will expire falls within the 12 months following the hospital’s eligibility expiry date, then the hospital is taken to be included in the second-tier eligible hospitals class until 60 calendar days after the day on which that hospital’s accreditation will expire.

(2) In this rule:

 eligibility expiry date means the second-tier expiry date listed on the Commonwealth’s list of all declared hospitals with second tier.

 Note: Further information is available in Private Health Insurance Circular ‘PHI 52/20 Second-tier Update- arrangements due to suspended accreditation assessments’ available online at https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-phicircular2020-52 and the Australian Safety and Quality Health Care Commission at www.safetyandquality.gov.au by searching for the ‘National Safety and Quality Health Service (NSQHS) Standards’ or typing in this link ‘https://www.safetyandquality.gov.au/standards/nsqhs-standards/implementation-nsqhs-standards/nsqhs-standards-updates-and-consultations#faq:-covid-19-pandemic-and-accreditation’.

3 Repeal Subrule 7E (including the heading)