Private Health Insurance Legislation Amendment Rules (No. 8) 2026

Contents

1 Name #

This instrument is the Private Health Insurance Legislation Amendment Rules (No. 8) 2026.

2 Commencement #

Commencement information
Column 1	Column 2	Column 3
Provisions	Commencement	Date/Details
1. The whole of this instrument	1 October 2026	1 October 2026

Note:, This table relates only to the provisions of this instrument as originally made.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.

3 Authority #

This instrument is made under subsection 333-20(1) of the Private Health Insurance Act 2007.

Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Private Health Insurance (Complying Product) Rules 2015 #

1 Clause 4 Definitions of Part 1 Preliminary

Repeal the definition of National Law, substitute:

National Law, for a State or Territory, means the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld), as it applies (with or without modification) as a law of the State or Territory.

Note The Intergovernmental Agreement for a National Registration and Accreditation Scheme for the Health Professions that was made on 26 March 2008 provides for the enactment of the State and Territory legislation mentioned in this definition.

2 Clause 4 Definitions of Part 1 Preliminary

Repeal the definition of registered podiatric surgeon, substitute:

registered surgical podiatrist means a surgical podiatrist who holds specialist registration in the specialty of surgical podiatry under the National Law.

Note: The registration requirements for a registered surgical podiatrist for the purpose of these Rules are the same registration requirements for surgical podiatrist as set out in rule 8 of the Private Health Insurance (Accreditation) Rules as made from time to time.

3 Clause 8(1) of Part 2 General (table dealing with Coverage requirements)

Repeal the table, substitute:

Coverage requirements
Item	Kind of policy	Treatments the policy must cover
1	A policy that includes cover for hospital-substitute treatment.	Hospital treatment for the same types of treatment covered by the policy for hospital-substitute treatment.
2	A policy under which a person is covered, wholly or partly, for hospital treatment where:(a) the treatment includes the provision of a kind of medical device or human tissue product that is listed in the Private Health Insurance (Medical Devices and Human Tissue Products) Rules, made under the Act, as in force from time to time; and(b) either:(i) a medicare benefit is payable in respect of the professional service associated with the provision of the medical device or human tissue product; or(ii) the provision of the medical device or human tissue product is associated with podiatric treatment by a registered surgical podiatrist; or(iii) for a medical device or human tissue product that is an insulin infusion pump:(A) the insulin infusion pump is provided during a professional service for which a medicare benefit is payable; and(B) the professional service is a professional attendance by a consultant physician in the practice of his or her specialty; and(C) the professional service is provided as a certified Type C procedure or certified overnight Type C procedure; and(D) the insulin infusion pump is provided for the purpose of administering insulin.	The provision of the medical device or human tissue product.

4 Clause 11F(6) of Part 2B Requirements relating to product tiers for, and names of, insurance policies

Repeal the clause, substitute:

Paragraph (5) (b) does not apply in relation to the clinical category “Podiatric surgery (provided by a registered surgical podiatrist)”.

5 Clause 1 of Schedule 4—Product tiers and clinical categories

Repeal the table, substitute:

Product tiers and clinical categories

For the definition of gold policy, silver policy, bronze policy and basic policy in rule 4, and for rule 11H, the following table sets out the clinical categories that are indicated for policies of each product tier.

Clinical category	Basic	Bronze	Silver	Gold
Rehabilitation	R	R	R	
Hospital psychiatric services	R	R	R	
Palliative care	R	R	R	
Brain and nervous system	RCP			
Eye (not cataracts)	RCP			
Ear, nose and throat	RCP			
Tonsils, adenoids and grommets	RCP			
Bone, joint and muscle	RCP			
Joint reconstructions	RCP			
Kidney and bladder	RCP			
Male reproductive system	RCP			
Digestive system	RCP			
Hernia and appendix	RCP			
Gastrointestinal endoscopy	RCP			
Gynaecology	RCP			
Miscarriage and termination of pregnancy	RCP			
Chemotherapy, radiotherapy and immunotherapy for cancer	RCP			
Pain management	RCP			
Skin	RCP			
Breast surgery (medically necessary)	RCP			
Diabetes management (excluding insulin pumps)	RCP			
Heart and vascular system	RCP			
Lung and chest	RCP			
Blood	RCP			
Back, neck and spine	RCP			
Plastic and reconstructive surgery (medically necessary)	RCP			
Dental surgery	RCP			
Podiatric surgery (provided by a registered surgical podiatrist)	RCP			
Implantation of hearing devices	RCP			
Cataracts	RCP			
Joint replacements	RCP			
Dialysis for chronic kidney failure	RCP			
Pregnancy and birth	RCP			
Assisted reproductive services	RCP			
Weight loss surgery	RCP			
Insulin pumps	RCP			
Pain management with device	RCP			
Sleep studies	RCP			
	Indicates the clinical category is a minimum requirement of the product tier. The clinical category must be covered on an unrestricted basis.
R	Indicates the clinical category is a minimum requirement of the product tier. The clinical category may be offered on a restricted cover basis in Basic, Bronze and Silver product tiers only.
RCP	Restricted cover permitted: indicates the clinical category is not a minimum requirement of the product tier. Insurers may choose to offer these as additional clinical categories on a restricted or unrestricted basis.
	A blank cell indicates that the clinical category is not a minimum requirement of the product tier. Insurers may choose to offer these as additional clinical categories; however it must be on an unrestricted basis.

6 Note 2 of Schedule 5—Clinical categories

Repeal Note 2; substitute:

Note 2: The treatments that must be covered are any hospital treatments that are in the scope of cover of a clinical category in relation to which the policy provides cover. The scope of cover includes, without limitation:

7 Clause 2 of Schedule 5 (table dealing with Clinical categories)Repeal the table, substitute:

Clinical categories table
Column 1	Column 2	Column 3
Clinical category	Scope of cover(see Note 1)	Treatments to 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.	170, 171, 172, 289, 297, 320, 322, 324, 326, 328, 341, 342, 343, 344, 345, 346, 347, 349, 855, 857, 858, 861, 864, 866, 2700, 2701, 2715, 2717, 2721, 2723, 2725, 2727, 6018, 6019, 6023, 6024, 6028, 6029, 6031, 6032, 6034, 6035, 6037, 6038, 6042, 14216, 14217, 14219, 14220, 14224, 80005, 80015, 80105, 80115, 80130, 80140, 80155, 80165, 90250, 90251, 90252, 90253, 90254, 90255, 90256, 90257, 90264, 90265, 90272, 90274, 90276, 90278, 92478, 92479, 92480, 92481, 92482, 92483
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.	3005, 3010, 3014, 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.	13200, 13201, 13202, 13203, 13209, 13212, 13215, 13218, 13221, 13241, 13251, 13260, 13290, 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, spinal disc replacement 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.	30672, 35401, 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.	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 surgical podiatrist is listed separately under Podiatric surgery (provided by a registered surgical podiatrist).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.	18350, 18351, 18353, 18354, 18360, 18361, 18365, 30103, 30107, 30226, 30229, 30232, 30235, 30238, 30241, 30244, 32036, 39331, 39332, 39336, 39339, 39342, 39345, 43521, 43527, 43530, 43533, 43876, 43879, 44325, 44328, 44331, 44334, 44338, 44342, 44346, 44350, 44354, 44358, 44359, 44361, 44364, 44367, 44370, 44373, 44376, 45605, 45788, 45851, 45855, 45857, 45871, 45873, 46300, 46303, 46308, 46330, 46333, 46335, 46336, 46339, 46340, 46341, 46342, 46348, 46351, 46354, 46357, 46360, 46363, 46365, 46367, 46370, 46372, 46375, 46378, 46379, 46380, 46381, 46384, 46387, 46390, 46393, 46394, 46395, 46399, 46401, 46408, 46414, 46423, 46426, 46432, 46434, 46450, 46453, 46464, 46465, 46468, 46471, 46474, 46477, 46480, 46483, 46493, 46498, 46522, 47000, 47003, 47007, 47009, 47012, 47015, 47018, 47021, 47024, 47027, 47030, 47033, 47042, 47045, 47047, 47049, 47052, 47053, 47054, 47057, 47060, 47063, 47066, 47069, 47301, 47304, 47307, 47310, 47313, 47316, 47319, 47348, 47351, 47354, 47357, 47361, 47362, 47364, 47367, 47370, 47373, 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, 47491, 47495, 47498, 47501, 47511, 47514, 47516, 47519, 47528, 47531, 47534, 47537, 47540, 47543, 47546, 47549, 47552, 47555, 47558, 47559, 47561, 47565, 47566, 47568, 47570, 47573, 47577, 47579, 47582, 47585, 47588, 47591, 47595, 47597, 47600, 47603, 47612, 47615, 47618, 47621, 47624, 47630, 47637, 47639, 47648, 47657, 47663, 47666, 47672, 47678, 47753, 47762, 47765, 47786, 47789, 47790, 47791, 47900, 47903, 47921, 47924, 47927, 47929, 47953, 47954, 47955, 47956, 47960, 47964, 47967, 47968, 47970, 47973, 47975, 47978, 47981, 47982, 47983, 47984, 48245, 48248, 48251, 48254, 48257, 48400, 48403, 48406, 48409, 48412, 48415, 48419, 48420, 48421, 48422, 48423, 48424, 48426, 48427, 48430, 48433, 48435, 48436, 48438, 48440, 48442, 48444, 48446, 48448, 48450, 48452, 48454, 48456, 48507, 48509, 48512, 48942, 48943, 48944, 48945, 48954, 48972, 48980, 48983, 48986, 49100, 49106, 49109, 49118, 49124, 49200, 49203, 49206, 49212, 49213, 49218, 49219, 49220, 49239, 49300, 49303, 49306, 49309, 49360, 49363, 49366, 49500, 49509, 49512, 49569, 49590, 49592, 49594, 49596, 49712, 49718, 49724, 49727, 49728, 49730, 49732, 49734, 49736, 49738, 49740, 49742, 49744, 49760, 49761, 49762, 49763, 49764, 49765, 49766, 49767, 49768, 49769, 49770, 49771, 49772, 49773, 49774, 49775, 49776, 49777, 49778, 49779, 49780, 49781, 49783, 49784, 49785, 49786, 49787, 49788, 49789, 49790, 49791, 49792, 49793, 49794, 49795, 49796, 49797, 49798, 49800, 49803, 49806, 49809, 49812, 49814, 49815, 49818, 49821, 49824, 49827, 49830, 49833, 49836, 49837, 49838, 49845, 49851, 49854, 49860, 49866, 49878, 49881, 49884, 49887, 49890, 50107, 50112, 50115, 50118, 50130, 50200, 50201, 50203, 50206, 50209, 50212, 50215, 50218, 50221, 50224, 50233, 50236, 50239, 50242, 50245, 50300, 50303, 50306, 50309, 50310, 50312, 50321, 50324, 50330, 50335, 50336, 50339, 50345, 50348, 50351, 50352, 50354, 50357, 50360, 50369, 50372, 50375, 50378, 50381, 50384, 50390, 50393, 50394, 50395, 50396, 50399, 50426, 50428, 50450, 50451, 50455, 50456, 50460, 50461, 50465, 50466, 50470, 50471, 50475, 50476, 50508, 50512, 50524, 50528, 50532, 50536, 50540, 50544, 50548, 50552, 50556, 50560, 50564, 50568, 50572, 50576, 50580, 50584, 50588, 50592, 50596, 50654, 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.	6007, 6009, 6011, 6013, 6015, 14227, 14234, 14237, 18377, 35000, 35003, 35006, 35009, 35012, 35412, 35414, 39007, 39015, 39018, 39113, 39300, 39303, 39306, 39307, 39309, 39312, 39315, 39318, 39319, 39321, 39324, 39327, 39328, 39329, 39330, 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, 40804, 40805, 40806, 40850, 40851, 40852, 40854, 40856, 40858, 40860, 40862, 40863, 40905, 41888, 43987, 46172, 46173, 46174, 46175, 46176, 46177, 46178, 46179, 46180, 46181, 46182, 46183, 46184, 46185, 46364, 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.	30299, 30305, 31500, 31503, 31506, 31509, 31512, 31513, 31514, 31515, 31516, 31519, 31520, 31522, 31523, 31525, 31526, 31528, 31529, 31530, 31533, 31536, 31537, 31548, 31551, 31554, 31557, 31560, 31563, 31566, 45060, 45061, 45062, 45520, 45522, 45523, 45524, 45527, 45528, 45529, 45530, 45531, 45532, 45534, 45535, 45537, 45538, 45539, 45540, 45541, 45542, 45545, 45546, 45547, 45548, 45551, 45553, 45554, 45556, 45558, 46080, 46082, 46084, 46086, 46088, 46090, 46092, 46094, 82228
Cataracts	Hospital treatment for surgery to remove a cataract and replace with an artificial lens.	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.	13760, 13950, 14221, 14245, 14247, 14249, 15900, 15902, 15904, 15906, 15908, 15910, 15912, 15914, 15916, 15918, 15920, 15922, 15924, 15926, 15928, 15930, 15932, 15934, 15936, 15938, 15940, 15942, 15944, 15946, 15948, 15950, 15952, 15954, 15956, 15958, 15960, 15962, 15964, 15966, 15968, 15970, 15972, 15974, 15976, 15978, 15980, 15982, 15984, 15990, 16003, 16006, 16009, 16012, 16015, 16018, 16050, 16055, 16060, 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.	75007, 75030, 75032, 75034, 75039, 75042, 75045, 75048, 75049, 75050, 75051, 75200, 75203, 75206, 75400, 75402, 75405, 75600, 75603, 75606, 75609, 75610, 75618, 75621, 75800, 75802, 75815, 75818, 75820, 75833, 75836, 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.	31346
Dialysis for chronic kidney failure	Hospital treatment for dialysis treatment for chronic kidney failure.For example: peritoneal dialysis and haemodialysis.	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.	11800, 11801, 11810, 13506, 14212, 30382, 30384, 30385, 30387, 30388, 30390, 30392, 30396, 30397, 30399, 30406, 30408, 30409, 30411, 30412, 30414, 30415, 30416, 30417, 30418, 30419, 30421, 30422, 30425, 30427, 30428, 30430, 30431, 30433, 30439, 30440, 30441, 30442, 30443, 30445, 30448, 30449, 30450, 30451, 30452, 30454, 30455, 30457, 30458, 30460, 30461, 30463, 30464, 30469, 30472, 30481, 30482, 30483, 30492, 30495, 30515, 30517, 30518, 30520, 30521, 30526, 30529, 30530, 30532, 30533, 30559, 30560, 30562, 30563, 30565, 30577, 30583, 30584, 30589, 30590, 30593, 30594, 30596, 30599, 30600, 30601, 30606, 30608, 30619, 30621, 30622, 30623, 30626, 30627, 30636, 30637, 30639, 30655, 30657, 30721, 30722, 30723, 30724, 30725, 30730, 30750, 30751, 30752, 30753, 30754, 30755, 30756, 30760, 30761, 30762, 30763, 30770, 30771, 30780, 30790, 30791, 30792, 30800, 30810, 31454, 31456, 31458, 31460, 31462, 31466, 31468, 31472, 32000, 32003, 32004, 32005, 32006, 32009, 32012, 32015, 32018, 32021, 32024, 32025, 32026, 32028, 32030, 32033, 32039, 32042, 32045, 32046, 32047, 32051, 32054, 32057, 32060, 32063, 32066, 32069, 32096, 32105, 32106, 32108, 32117, 32118, 32123, 32129, 32131, 32135, 32139, 32147, 32150, 32156, 32159, 32162, 32165, 32166, 32171, 32174, 32175, 32183, 32186, 32212, 32213, 32215, 32216, 32218, 32221, 32231, 32232, 32233, 32234, 32235, 32236, 32237, 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.	18368, 30104, 30105, 30246, 30247, 30250, 30251, 30253, 30255, 30256, 30257, 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, 30820, 31400, 31403, 31406, 31409, 31412, 31423, 31426, 31429, 31432, 31435, 31438, 38419, 38420, 38422, 38423, 38425, 38426, 38428, 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, 41656, 41659, 41662, 41668, 41671, 41674, 41677, 41683, 41686, 41689, 41692, 41693, 41698, 41701, 41702, 41703, 41704, 41705, 41707, 41710, 41713, 41719, 41722, 41725, 41728, 41734, 41737, 41740, 41743, 41746, 41749, 41752, 41755, 41768, 41769, 41770, 41776, 41779, 41785, 41786, 41804, 41807, 41810, 41813, 41834, 41837, 41840, 41843, 41855, 41861, 41867, 41870, 41873, 41876, 41879, 41880, 41881, 41884, 41885, 41886, 41887, 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.	18366, 18369, 18370, 18372, 18374, 41890, 42503, 42504, 42505, 42506, 42509, 42510, 42512, 42515, 42518, 42521, 42527, 42530, 42533, 42536, 42539, 42542, 42543, 42545, 42548, 42551, 42554, 42557, 42563, 42569, 42572, 42573, 42574, 42575, 42576, 42581, 42584, 42587, 42588, 42590, 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, 42743, 42744, 42746, 42749, 42750, 42752, 42755, 42758, 42761, 42764, 42767, 42770, 42773, 42776, 42779, 42782, 42785, 42788, 42791, 42794, 42801, 42802, 42805, 42808, 42809, 42810, 42811, 42812, 42815, 42818, 42821, 42824, 42833, 42836, 42839, 42842, 42845, 42848, 42851, 42854, 42857, 42869, 43021, 43022, 43030, 43032, 43034, 43036, 43038, 43040, 43050
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.	11820, 11823, 30473, 30475, 30478, 30479, 30484, 30485, 30488, 30490, 30491, 30494, 30664, 30665, 30680, 30682, 30684, 30686, 30687, 30688, 30690, 30692, 30694, 30731, 32023, 32072, 32075, 32084, 32087, 32094, 32095, 32222, 32223, 32224, 32225, 32226, 32227, 32228, 32229, 32230
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.	127, 129, 30062, 35410, 35500, 35503, 35506, 35507, 35508, 35509, 35513, 35517, 35518, 35527, 35533, 35534, 35536, 35539, 35545, 35548, 35554, 35557, 35560, 35561, 35562, 35564, 35565, 35566, 35568, 35569, 35570, 35571, 35573, 35577, 35578, 35581, 35582, 35585, 35591, 35592, 35595, 35596, 35597, 35599, 35608, 35609, 35610, 35611, 35612, 35614, 35615, 35616, 35620, 35622, 35623, 35626, 35630, 35631, 35632, 35633, 35635, 35636, 35637, 35641, 35644, 35645, 35647, 35648, 35649, 35653, 35657, 35658, 35661, 35667, 35668, 35669, 35671, 35673, 35680, 35691, 35694, 35697, 35700, 35703, 35717, 35720, 35721, 35723, 35724, 35726, 35729, 35730, 35750, 35751, 35753, 35754, 35756, 35759, 82201, 82202, 82203
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.	6080, 6081, 6082, 6084, 11607, 13400, 13851, 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, 38241, 38244, 38247, 38248, 38249, 38251, 38252, 38254, 38256, 38270, 38272, 38273, 38274, 38275, 38276, 38285, 38286, 38287, 38288, 38290, 38293, 38307, 38308, 38309, 38310, 38311, 38313, 38314, 38316, 38317, 38319, 38320, 38322, 38323, 38325, 38326, 38350, 38353, 38356, 38358, 38359, 38362, 38365, 38368, 38372, 38373, 38374, 38375, 38376, 38461, 38463, 38467, 38471, 38472, 38474, 38477, 38484, 38485, 38487, 38490, 38493, 38495, 38499, 38502, 38508, 38509, 38510, 38511, 38512, 38513, 38514, 38515, 38516, 38517, 38518, 38519, 38522, 38523, 38550, 38553, 38554, 38555, 38556, 38557, 38558, 38568, 38571, 38572, 38600, 38603, 38609, 38612, 38615, 38616, 38618, 38619, 38621, 38624, 38627, 38637, 38653, 38670, 38673, 38677, 38680, 38700, 38703, 38706, 38709, 38715, 38718, 38721, 38724, 38727, 38730, 38733, 38736, 38739, 38742, 38745, 38748, 38751, 38754, 38757, 38760, 38764, 38766, 38839, 38840, 38841, 38842, 90300
Hernia and appendix	Hospital treatment for the investigation and treatment of a hernia or appendicitis.Digestive conditions are listed separately under Digestive system.	30574, 30615, 30640, 30645, 30646, 30648, 30720, 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.	41603, 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 surgical podiatrist is listed separately under Podiatric surgery (provided by a registered surgical podiatrist).	46324, 46325, 46345, 46411, 46417, 46420, 46438, 46441, 46442, 46444, 46456, 46492, 46495, 46500, 46501, 46502, 46503, 46504, 46507, 46510, 47592, 47593, 47792, 47795, 48900, 48903, 48906, 48909, 48939, 48948, 48951, 48952, 48953, 48958, 48959, 48960, 49104, 49105, 49121, 49215, 49221, 49224, 49227, 49233, 49236, 49503, 49506, 49536, 49542, 49544, 49548, 49551, 49564, 49565, 49570, 49572, 49574, 49576, 49578, 49580, 49582, 49584, 49586, 49703, 49706, 49709, 50333
Joint replacements	Hospital treatment for surgery for joint 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 and toe joints.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 surgical podiatrist is listed separately under Podiatric surgery (provided by a registered surgical podiatrist).	46309, 46312, 46315, 46318, 46321, 46322, 48915, 48918, 48919, 48921, 48924, 48925, 48927, 48932, 49112, 49113, 49114, 49115, 49116, 49117, 49127, 49209, 49210, 49230, 49315, 49318, 49319, 49321, 49372, 49374, 49376, 49378, 49380, 49382, 49384, 49386, 49388, 49390, 49392, 49394, 49396, 49398, 49515, 49516, 49517, 49518, 49519, 49521, 49524, 49525, 49527, 49530, 49533, 49534, 49554, 49715, 49716, 49717, 49782, 49839, 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.	11900, 11912, 11917, 11919, 12524, 12527, 18375, 18379, 30324, 36503, 36504, 36505, 36506, 36507, 36508, 36509, 36516, 36519, 36522, 36525, 36528, 36529, 36530, 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, 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.	30090, 34133, 34136, 34139, 38416, 38417, 38429, 38431, 38800, 38803, 38812, 38815, 38816, 38817, 38818, 38820, 38821, 38822, 38823, 38824, 38828, 38829, 38830, 38831, 38832, 38833, 38834, 38837, 38838, 38845, 38850, 38851, 38852, 38853, 38859, 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.	30628, 30629, 30630, 30631, 30635, 30641, 30642, 30643, 30644, 30649, 30654, 30658, 30661, 30662, 30663, 30666, 37200, 37201, 37203, 37204, 37205, 37207, 37208, 37209, 37210, 37211, 37213, 37214, 37215, 37216, 37217, 37218, 37219, 37220, 37221, 37223, 37224, 37226, 37227, 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.	16530, 16531, 35640, 35643, 35674
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.	18280, 39013, 39014, 39100, 39109, 39110, 39111, 39116, 39117, 39118, 39119, 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.	14218, 39125, 39126, 39127, 39128, 39129, 39130, 39131, 39133, 39134, 39135, 39136, 39137, 39138, 39139, 39141
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.	30003, 30006, 30007, 30010, 30014, 30015, 30016, 30175, 30176, 38846, 38847, 38848, 38849, 38857, 38858, 42860, 42863, 42866, 42872, 43882, 45000, 45003, 45006, 45009, 45012, 45015, 45018, 45019, 45021, 45025, 45026, 45027, 45030, 45033, 45035, 45036, 45045, 45048, 45051, 45054, 45200, 45201, 45202, 45203, 45206, 45207, 45209, 45212, 45221, 45224, 45227, 45230, 45233, 45239, 45440, 45443, 45451, 45496, 45497, 45500, 45501, 45502, 45503, 45504, 45505, 45507, 45510, 45512, 45515, 45518, 45560, 45561, 45562, 45563, 45564, 45565, 45566, 45567, 45568, 45571, 45572, 45575, 45578, 45581, 45584, 45585, 45587, 45588, 45589, 45590, 45592, 45594, 45596, 45597, 45599, 45602, 45608, 45609, 45611, 45614, 45617, 45620, 45623, 45624, 45625, 45626, 45627, 45629, 45632, 45635, 45641, 45644, 45650, 45652, 45653, 45656, 45658, 45659, 45660, 45661, 45665, 45668, 45669, 45671, 45674, 45675, 45676, 45677, 45680, 45683, 45686, 45689, 45692, 45695, 45698, 45701, 45704, 45707, 45710, 45713, 45714, 45716, 45717, 45718, 45761, 45767, 45773, 45776, 45779, 45782, 45785, 45791, 45794, 45797, 45801, 45807, 45809, 45811, 45813, 45815, 45823, 45825, 45827, 45829, 45831, 45837, 45841, 45845, 45847, 45849, 45865, 45874, 45882, 45888, 45891, 45894, 46050, 46052, 46060, 46062, 46064, 46066, 46068, 46070, 46072, 46101, 46102, 46103, 46104, 46105, 46106, 46107, 46108, 46109, 46110, 46111, 46112, 46113, 46114, 46115, 46116, 46117, 46118, 46119, 46120, 46121, 46122, 46123, 46124, 46125, 46126, 46127, 46128, 46129, 46130, 46131, 46132, 46133, 46134, 46135, 46136, 46140, 46141, 46142, 46143, 46150, 46151, 46152, 46153, 46154, 46155, 46156, 46157, 46158, 46159, 46160, 46161, 47766, 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, 82226, 82227
Podiatric surgery (provided by a registered surgical podiatrist)	Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered surgical podiatrist, but limited to cover for: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.	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, 82102, 82103, 82105, 82110, 82115, 82116, 82118, 82120, 82123, 82125, 82127
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.	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, 30311, 30676, 30679, 31000, 31001, 31002, 31003, 31004, 31005, 31206, 31211, 31216, 31220, 31221, 31225, 31227, 31245, 31250, 31340, 31344, 31345, 31356, 31357, 31358, 31359, 31360, 31361, 31362, 31363, 31364, 31365, 31366, 31367, 31368, 31369, 31370, 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382, 31383, 31386, 31387, 31388, 44136, 46486, 46489, 46513, 46528, 46531, 46534, 47904, 47906, 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.	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.	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.	30166, 30169, 30177, 30179, 31569, 31572, 31575, 31578, 31581, 31584, 31585, 31587, 31590

Schedule 2

Private Health Insurance (Accreditation) Rules 2011 #

1 Clause 4 Definitions of Part 1 Preliminary

Repeal the definition of National Law, substitute:

2 Clause 8 of Part 2

Repeal the entire clause, substitute:

Treatments provided by surgical podiatrists

If the treatment is of a kind practised by a surgical podiatrist, the standard for that kind of treatment is that it must be provided by a surgical podiatrist who holds specialist registration in the specialty of surgical podiatry under the National Law.

Sourced from the Federal Register of Legislation at legislation.gov.au, © Commonwealth of Australia, licensed under CC BY 4.0. Compilations may have been reformatted.