Joint Reconstructions

What is covered under Joint Reconstructions?

Hospital Cover for Joint Reconstructions includes hospital treatment for surgery for joint reconstructions.

Examples include:

• torn tendons
• rotator cuff tears
• damaged ligaments.

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

Some treatments you might expect to be in the Joint Reconstructions clinical category are under other clinical categories. For example, treatments for:

• joint replacements (like knee or hip replacements) are under Joint Replacements
• bone fractures and setting bones are under Bone, Joint and Muscle
• procedures to the spinal column, such as spinal fusion, are under Back, Neck and Spine
• foot surgery performed by a registered podiatric surgeon is under Podiatric Surgery.

Which Hospital Cover tiers include Joint Reconstructions?

What does it mean if cover is ‘optional’?

‘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 Joint Reconstructions 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 Joint Reconstructions. 

Does Medicare cover Joint Reconstructions?

Yes. Medicare includes all treatments under the Joint Reconstructions clinical category.

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

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