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Reviewed and updated 31 March 2024
basic
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bronze
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Covered

What is covered under Back, Neck and Spine?

Hospital Cover for Back, Neck and Spine is for hospital treatment to investigate and treat the:

  • back
  • neck
  • spinal column, including spinal fusion that involves spinal surgery.

Examples include:

  • sciatica
  • prolapsed or herniated disc 
  • spinal disc replacement 
  • spinal surgery
  • spine curvature disorders such as scoliosis, kyphosis, and lordosis.

This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).

Some treatments you might expect to be in the Back, Neck and Spine clinical category are under other clinical categories. For example, treatments for:


Which Hospital Cover tiers include Back, Neck and Spine? 

TierClinical category covered?Can insurers offer restricted cover?
BasicOptionalYes
BronzeOptionalNo
SilverYesNo
GoldYesNo

What does it mean if cover is ‘optional’?

‘Optional’ means that the Australian Governments allows insurers to choose whether or not to cover a clinical category under that Hospital Cover tier.

What does ‘restricted cover’ mean? 

Restricted cover means the insurer pays only limited benefits. 

If insurers offer cover for Back, Neck and Spine under Basic Hospital Cover, they can do so on a ‘restricted’ basis. If you are admitted as a private patient in a private hospital for treatments under this clinical category, you will face considerable out-of-pocket costs.

Always check with your insurer before agreeing to be treated as a private patient in a private hospital if you have restricted cover for Back, Neck and Spine. 


Does Medicare cover Back, Neck and Spine?

Yes. [Medicare] covers all treatments in the Back, Neck and Spine clinical category. 

If there is an MBS item number for the treatment, Medicare covers it. 


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