Bone, Joint and Muscle

What is covered under Bone, Joint and Muscle?

Hospital Cover for Bone, Joint and Muscle is for hospital treatment to investigate and treat  diseases, disorders and injuries of the musculoskeletal system.

Examples include:

• carpal tunnel
• different types of fractures
• hand surgery
• joint fusion
• bone spurs
• osteomyelitis
• bone cancer.

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:

• spinal cord conditions are under Brain and Nervous System
• spinal column conditions are under Back, Neck and Spine
• joint reconstructions are under Joint Reconstructions
• joint replacements are under Joint Replacements
• podiatric surgery performed by a registered Podiatric Surgeon is under Podiatric Surgery
• management of back pain is under Pain Management
• pain management that requires a device is listed separately under Pain Management with Device
• chemotherapy and radiotherapy are under Chemotherapy, Radiotherapy and Immunotherapy for cancer.

Which Hospital Cover tiers include Bone, Joint and Muscle? 

What does ‘optional’ mean?

‘Optional’ means that the Australian Government allows insurers to choose whether or not to cover the 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 Bone, Joint and Muscle 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.

You should check with your insurer before agreeing to be treated as a private patient in a private hospital if you have restricted cover for Bone, Joint and Muscle. 

Does Medicare cover Bone, Joint and Muscle?

Yes. Medicare covers all treatments under the Bone, Joint and Muscle clinical category. 

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

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