Reporting Standard HRS 604.0

Medical Specialty Block Grouping Information

Objective of this Reporting Standard

This Reporting Standard sets out the requirements for the provision of information to APRA allowing for the publication of aggregate statistics on medical services by State and Territory.

It includes Form HRF 604.0 Medical Specialty Block Grouping Information and associated specific instructions.

Authority

This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.

Purpose

Information collected under this Reporting Standard, as set out in Form HRF 604.0 Medical Specialty Block Grouping Information (HRF 604.0), is used by APRA for prudential supervision and publication to assist the Department of Health in performing its functions.

Application and commencement

This Reporting Standard applies to all private health insurers.
This Reporting Standard applies for reporting periods ending on or after 1 October 2025.

Information required

A private health insurer must provide APRA with the information required by HRF 604.0 in respect of each reporting period.
The information required by this Reporting Standard, as set out in HRF 604.0, must be provided for each health benefits fund of the private health insurer.

Forms and method of submission

The information required by this Reporting Standard must be given to APRA:
1. in electronic format using an electronic method available on APRA’s website; or

(b) by a method notified by APRA prior to submission.

Reporting periods and due dates

A private health insurer to which this Reporting Standard applies must provide the information required by this Reporting Standard in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June).
The information required by this Reporting Standard must be provided to APRA within 28 calendar days after the end of the reporting period to which the information relates.[1]
APRA may, in writing, grant a private health insurer an extension of a due date, in which case the new due date for the provision of the information will be the date on the notice of extension.

Quality control

All information provided by a private health insurer under this Reporting Standard must be subject to systems, processes and controls developed by the private health insurer for the internal review and authorisation of that information. It is the responsibility of the Board and senior management of the private health insurer to ensure that an appropriate set of policies and procedures for the authorisation of information submitted to APRA is in place.

Authorisation

A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.

Variations

APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.

Transitional

A private health insurer to which this Reporting Standard applies must report under the old reporting standard in respect of a transitional reporting period. For these purposes:

old reporting standard means the reporting standard revoked in the determination making this Reporting Standard; and

transitional reporting period means a reporting period under the old reporting standard:

that ended before the date of revocation; and
in relation to which the private health insurer was required, under the old reporting standard, to report by a date on or after the date of revocation of the old reporting standard.

Note: For the avoidance of doubt, if a private health insurer was required to report under an old reporting standard, and the reporting documents were due before the date of revocation of the old reporting standard, the private health insurer is still required to provide any overdue reporting documents in accordance with the old reporting standard.

Interpretation

In this Reporting Standard:

unless the contrary intention appears, words and expressions have the meanings given to them in Prudential Standard CPS 001 Defined terms (CPS 001); and
APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;

officer has the meaning in the Private Health Insurance (Prudential Supervision) Act 2015;

private health insurer has the meaning in the Private Health Insurance (Prudential Supervision) Act 2015; and

reporting period means a period mentioned in paragraph 8.

HRF_604_0: Medical Speciality Block Grouping Information

Australian Business Number	Institution Name

Reporting Period	Scale Factor
Quarterly	Whole dollars to two decimal places
Reporting Consolidation
Health Benefits Fund

	Total number of services			Total amount charged for hospital and general medical services
MBS Speciality Block Groupings	No gap agreement	Known gap agreement	No agreement	No gap agreement	Known gap agreement	No agreement
	(1)	(2)	(3)	(4)	(5)	(6)
1) Specialist, consultant physician, and consultant psychiatric attendances: Groups A3, A4 and A8; items 104-108, 110-131, 300-352.
2) Procedures associated with intensive care and cardiopulmonary support and management: Subgroups T1.9 and T1.10; items 13815 - 13888.
3) Obstetrics and gynaecology obstetrics: Subgroup T4; items 16500 - 16636; and Surgical operations gynaecological: Subgroup T8.4; items 35500 - 35759.
4) Anaesthesia: Groups T6, T7, and T10; items 17603 - 18298, 20100-25205.
5) General surgical operations: Subgroup T8.1; items 30001 - 31472.
6) Colorectal surgical operations: Subgroup T8.2; items 32000 - 32212.
7) Vascular surgical operations: Subgroup T8.3; items 32500 - 35330.
8) Urology: Subgroup T8.5, items 36500 - 37854
9) Cardio-thoracic surgical operations: Subgroup T8.6; items 38200 - 38766; and Diagnostic procedures and investigations cardiovascular: Subgroup D1.6; items 11700-11724
10) Neurosurgical surgical operations: Subgroup T8.7; items 39000 - 40903.
11) Ear, nose and throat surgical operations: Subgroup T8.8; items 41500 - 41910.
12) Ophthalmology surgical operations: Subgroup T8.9; items 42503 - 42872.
13) Plastic and reconstructive surgical operations: Subgroup T8.13; items 45000-45797.
14) Orthopaedic surgical operations: Subgroup T8.15; items 47000 - 50426.
15) Assistance at operations: Group T9; items 51300 - 51318.
16) Diagnostic imaging services; Category 5; all Groups I1-I5; items 55028-63946.
17) Pathology services: Category 6; all Groups P1-P10; items 65060 and over.
18) All other items.
Total all services

	Total Medicare benefits paid for hospital and general medical services			Total fund benefits paid for hospital and general medical services
MBS Speciality Block Groupings	No gap agreement	Known gap agreement	No agreement	No gap agreement	Known gap agreement	No agreement
	(1)	(2)	(3)	(4)	(5)	(6)
1) Specialist, consultant physician, and consultant psychiatric attendances: Groups A3, A4 and A8; items 104-108, 110-131, 300-352.
2) Procedures associated with intensive care and cardiopulmonary support and management: Subgroups T1.9 and T1.10; items 13815 - 13888.
3) Obstetrics and gynaecology obstetrics: Subgroup T4; items 16500 - 16636; and Surgical operations gynaecological: Subgroup T8.4; items 35500 - 35759.
4) Anaesthesia: Groups T6, T7, and T10; items 17603 - 18298, 20100-25205.
5) General surgical operations: Subgroup T8.1; items 30001 - 31472.
6) Colorectal surgical operations: Subgroup T8.2; items 32000 - 32212.
7) Vascular surgical operations: Subgroup T8.3; items 32500 - 35330.
8) Urology: Subgroup T8.5, items 36500 - 37854
9) Cardio-thoracic surgical operations: Subgroup T8.6; items 38200 - 38766; and Diagnostic procedures and investigations cardiovascular: Subgroup D1.6; items 11700-11724
10) Neurosurgical surgical operations: Subgroup T8.7; items 39000 - 40903.
11) Ear, nose and throat surgical operations: Subgroup T8.8; items 41500 - 41910.
12) Ophthalmology surgical operations: Subgroup T8.9; items 42503 - 42872.
13) Plastic and reconstructive surgical operations: Subgroup T8.13; items 45000-45797.
14) Orthopaedic surgical operations: Subgroup T8.15; items 47000 - 50426.
15) Assistance at operations: Group T9; items 51300 - 51318.
16) Diagnostic imaging services; Category 5; all Groups I1-I5; items 55028-63946.
17) Pathology services: Category 6; all Groups P1-P10; items 65060 and over.
18) All other items.
Total all services

	Gap Services
	Number of gap services			Average gap per service where gap paid
MBS Speciality Block Groupings	No gap agreement	Known gap agreement	No agreement	No gap agreement	Known gap agreement	No agreement
	(1)	(2)	(3)	(4)	(5)	(6)
1) Specialist, consultant physician, and consultant psychiatric attendances: Groups A3, A4 and A8; items 104-108, 110-131, 300-352.
2) Procedures associated with intensive care and cardiopulmonary support and management: Subgroups T1.9 and T1.10; items 13815 - 13888.
3) Obstetrics and gynaecology obstetrics: Subgroup T4; items 16500 - 16636; and Surgical operations gynaecological: Subgroup T8.4; items 35500 - 35759.
4) Anaesthesia: Groups T6, T7, and T10; items 17603 - 18298, 20100-25205.
5) General surgical operations: Subgroup T8.1; items 30001 - 31472.
6) Colorectal surgical operations: Subgroup T8.2; items 32000 - 32212.
7) Vascular surgical operations: Subgroup T8.3; items 32500 - 35330.
8) Urology: Subgroup T8.5, items 36500 - 37854
9) Cardio-thoracic surgical operations: Subgroup T8.6; items 38200 - 38766; and Diagnostic procedures and investigations cardiovascular: Subgroup D1.6; items 11700-11724
10) Neurosurgical surgical operations: Subgroup T8.7; items 39000 - 40903.
11) Ear, nose and throat surgical operations: Subgroup T8.8; items 41500 - 41910.
12) Ophthalmology surgical operations: Subgroup T8.9; items 42503 - 42872.
13) Plastic and reconstructive surgical operations: Subgroup T8.13; items 45000-45797.
14) Orthopaedic surgical operations: Subgroup T8.15; items 47000 - 50426.
15) Assistance at operations: Group T9; items 51300 - 51318.
16) Diagnostic imaging services; Category 5; all Groups I1-I5; items 55028-63946.
17) Pathology services: Category 6; all Groups P1-P10; items 65060 and over.
18) All other items.
Total all services

[1] For the avoidance of doubt, if the due date for a particular reporting period falls on a day other than a usual business day, a private health insurer is nonetheless required to submit the information required no later than the due date.