National Health Act 1953 - Determination made under subsections 73aag (6) and (7) (Hib 13/2005) (Cth)
Australian Government
NATIONAL HEALTH ACT 1953
Determination made under subsections 73AAG (6) and (7)
(HIB13/2005)
I, TONY ABBOTT, Minister for Health and Ageing acting under subsections 73AAG(6) and (7) of the National Health Act 1953 (the Act):
DETERMINE, under subsection 73AAG(6) of the Act, that each prosthesis listed against a Billing Code in the attached Schedule, without an amount under the heading ‘maximum benefit amount’, is a no gap prosthesis for the purposes of the Act, and the benefit amount for that no gap prosthesis is the amount appearing in the ‘benefit amount/minimum benefit amount’ column corresponding to that Billing Code.
DETERMINE, under subsection 73AAG(7) of the Act, that each prosthesis listed against a Billing Code in the attached Schedule, with an amount under the heading ‘maximum benefit amount’, is a gap permitted prosthesis for the purposes of the Act, and the minimum benefit amount for that gap permitted prosthesis is the amount appearing in the ‘benefit amount/minimum benefit amount’ column corresponding to that Billing Code, and the maximum benefit amount is the amount appearing in the ‘maximum benefit amount’ column corresponding to that Billing Code.
This determination commences on 31 October 2005.
Dated this 31 day of August 2005.
Tony Abbott
TONY ABBOTT
MINISTER FOR HEALTH AND AGEING
PART A - Prostheses 31 October 2005
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Annuloplasty Rings
Edwards Lifesciences Pty Ltd
EL028 Baxter Sterile Grafts, Implants & Carpentier-Edwards Classic Annuloplasty 24mm-40mm $2,151.80
Prostheses, Non-Animal Origin Ring. Composition: Titanium Alloy;
Annuloplasty: Ring-Mitral Ring with Silicone Rubber; Polyester Fabric
Holder; Mitral Cosgrove-Edwards Carpentier-Edwards Physio Annuloplasty
Annuloplasty System Model 4600; Classic Ring. Composition: Elgiloy Bands;
Polyester Film Strips; Silicone Rubber;
Polyester Cloth, Cosgrove-Edwards
Annuloplasty Band. Composition: Silicone
Rubber; Polyester Cloth. Carpentier-
Edwards Tricuspid Ring. Composition:
Titanium Alloy; Silicone Rubber;
EL049 Edwards Etlogix Annuloplasty Ring Titanium/silicon/dacron polyester 24mm/26mm/28mm/30mm/32m $2,400.00
cloth/plastic template Mitral valve annular m/34mmd
repair device designed specifically for
patients with Ischemic Mitral regurgitation
Medtronic Australasia Pty Ltd
MC005 Medtronic Posterior Annuloplasty Band; Annuloplasty Devices - Models 610B, Models 610B & 610R 25- $1,848.18
Medtronic Duran Annuloplasty Ring; 610R & 620B, 620R Silicone / Barium 35mm, Models 620B & 620R
Colvin - Galloway Future Band Model Sulphate, Dacron. Models 638B semi- 23-35mm, Model 638B - 26-
638B; Duran Ancore Band 620B; Duran rigid metal alloy core, silicone coating, 38mm, Model 620RG & G20BG
Ancore Ring 620R; Duran Ancore polyester knit fabric, kit includes - band,
Chordal Model 620RG & 620BG malleable handle, template with suture
markers, sizers, molded tray; Model
St. Jude Medical Australia Pty Ltd
SJ034 SJM Seguin Annuloplasty Ring Semi Rigid 24mm - 40mm $2,078.14
SJ035 SJM Tailor Annuloplasty Ring Fully Flexible 25mm - 35mm $2,630.00
|
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Tag Medical
TM001 AnnuloFlo Annuloplasty System Annuloflex Ring or AnnuloFlo Ring 26-36mm $1,600.00
Catheters, Angioplasty, Laser
Pacing Importers Pty Ltd
PI002 Excimer Laser Stent Polyester Fibre optic fibre catheter 0.457mm, 0.9mm, 1.4mm, $6,801.27
1.7mm and 2.0mm
Coronary Stents
Medical & Optical Instruments Australia Pty Ltd
MO212 Martin Fixation Device Internal - Screw Sterile Titanium Screw 2.00mm diameter; 4 to 11mm $280.00 Only to be funded where used in
length a service for which a Medicare
Benefit is payable
Drug Eluting Stents
Boston Scientific Pty Ltd
BS074 Taxus on Express2 Coronary Stent balloon expandable stent with conformal Length 8 - 32mm; Diameter $3,350.00
System Models 38001-0822 to 0840; polymer/drug matrix coating, pre- 2.25 - 5.0mm
38001-1222 to 1250; 38001-1622 to mounted on high pressure monorail
1650;
38001-2022 to 2050; 38001-2422 to
2450; 38001-2827 to 2850; 38001-3227
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CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Johnson & Johnson Medical Pty Ltd
JJ302 CYPHER Sirolimus-Eluting Stent & Stainless steel coronary stent with Diameter 2.25 - 5.0mm, length $3,350.00
Delivery System Model CRS - 23300, Rapamycin (an immunosuppressive and 8-33mm
08225, 08250, 08275, 08300, 28225, antiproliferative drug) bound to the stent
28250, 28275, 28300, 33225, 33250,
33275, 33300, 13225, 13250, 13275,
18225, 18250, 18275, 18300, 23225,
23250, 23275, 23350, 23400, 08350,
08400, 28350, 28400, 33350, 33400,
13300, 13350, 13400, 18350, 18400,
23450, 23500, 28450, 28500, 33450,
33500, 08450, 13450, 18450, 18500
General Purpose Bare Metal Stents
Abbott Australasia Pty Ltd
AY006 Bio-Divysio Stent SV/OC/AS Balloon expandable Phosophoryl-Choline Divysio Stent SV - Diameters: $750.00
coated stainless-steel endovascular 2.0, 2.25, 2.5 Lengths: 7mm,
coronary stent 10mm, 15mm, 18mm, 21mm;
Divysio Stent OC & AS -
Diameters: 2.75, 3.0, 3.5, 4.0
Lengths: 8mm, 11mm, 15mm,
AY013 JoStent Coronary Stent Stainless Steel 9 - 26 mm x 2.5 - 4 mm $750.00
Atrium Australia-Pacific Rim Pty Ltd
AC022 Flyer RX Coronary Stent System Stainless Steel Coronary Stent Dia 2-5mm, Length 6-40mm $750.00 $1,450.00
B Braun Australia Pty Ltd
BB244 Coroflex Blue Cobalt Chromium Alloy L605 2-4mm diameter, 8-25mm $1,000.00
Biotronik Australia Pty Ltd
BT040 Lekton Intracoronary stent - balloon mounted Dia 2.5-4mm, length 10-30mm $750.00 $2,100.00
BT058 Lekton Motion Coated flexible stent, Balloon mounted Diameter 2.5mm to 4mm, $750.00 $2,100.00
Length 8 - 30mm
Boston Scientific Pty Ltd
BS069 Express 2/Liberte Coronary Stent Consists of a balloon expandable stent, Stent lengths: 8,12,16,20,24,28 $1,200.00
pre-mounted on a Maverick 2 Monorail & 32 mm Stent diameters: 2.25,
delivery catheter. 2.5, 2.75, 3.0, 3.5, 4.0, 4.5 &
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CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Guidant Australia Pty Ltd
GU102 Stents ACS Multilink Coronary Stent; ACS 1.5mm - 8.0mm $1,200.00
Megalink Peripheral Stent; ACS RX
Herculink Peripheral Stent. Stainless steel
GU105 Multilink Coronary Stent System Stainless Steel Length 1.5mm - 8.0mm $1,200.00
GU127 Multilink Coronary Stent System - Frontier 316L Stainless steel stent Length 1.5 - 8.0mm $2,400.00
GU128 Multilink Coronary Stent System - Vision Cobalt chrome stent Length 1.5 - 8.0mm $1,200.00
Johnson & Johnson Medical Pty Ltd
JJ026 BX Velocity with Hepacoat System Balloon expandable, stainless steel, $1,173.00
heparin coated
JJ200 BX Velocity Stent and Delivery System Stainless steel stent Diameter: 2.25-5.0 mm; Length $1,173.00
8 - 33 mm
JJ239 BX Sonic Stainless steel coronary stent mounted on Dia 2.25 - 4.0mm, lengths 8 - $1,173.00
a balloon delivery system 33mm
Medtronic Australasia Pty Ltd
MC197 Medtronic AVE S660 Coronary Stents, Stainless Steel S660 Coronary Stent - Diameter $1,100.00
S670 Coronary Stents, S7 Coronary (2.5mm-2.75mm), Length
Stents, BeStent2, (9mm-24mm); S670 & S7
Coronary Stent - Diameter
(3mm-4mm), Length (9mm-
30mm); BeStent2 - Diameter
(2.5mm-4mm), Length (9mm-
MC329 Medtronic Driver, Micro Driver Coronary Cobalt Alloy Driver Stent: diameter (2.25 - $1,200.00
Stent System 4.5mm), length (8-30mm);
Micro-Driver Stent: diameter
(2.25 - 2.75mm), length (8 -
Pacing Importers Pty Ltd
PI003 Med-X-Flexy Stent Tubular Stent, Stainless steel 316L, Gold Dia 5 - 9mm length: 20 - $750.00
markers
Terumo Corporation Australia
TU001 Intra Coronary Stent Stainless Steel mounted on balloon Diameter 2.0mm - 4.0mm, $1,200.00
Length 10mm - 30mm length
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CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Woodstock Biomedical Pty Ltd
WO031 Duraflex Coronary Stent System 316L Medical Grade Stainless Steel Stent Length 8, 11, 14, 18, 21, 25mm $1,200.00
Premounted on Rail Design Catheter x Diameter 2.5, 2.75, 3.0, 3.5,
Zynergy Medical Pty Limited
ZY001 Carbostent Coronary stent - includes Carbostent Dia 2.5mm x Length 9, 12, 15, $750.00 $1,425.00
Syncro & Carbostent Sirius 19, 25mm; Dia 3.0mm x Length
9, 12, 15, 19, 25, 32mm; Dia
3.5mm x Length 9, 12, 15, 19,
25, 32mm; Diameter 4.0mm x
Length 9, 12, 15, 19, 25, 32mm
Special Purpose Stents
Abbott Australasia Pty Ltd
AY012 JoStent Coronary Stent Graft Stainless Steel/PTFE 9 - 26 mm x 2.5 - 5 mm $3,098.00
Boston Scientific Pty Ltd
BS067 Symbiot Covered Stent System A self-expending nitinol stent encased Stent lengths: 20, 31 & 45 mm $1,200.00
within an ePTFE covering, premounted Stent diameters: 4.0 & 5.0 mm
on a Monorail delivery catheter
CRT Pacemakers
Generation 1
Guidant Australia Pty Ltd
GU087 Contak TR Model 1241 Pacemaker Titanium 3.2mm/IS-1 $9,000.00
GU143 Contak Renewal TR CRT -P Model Implantable cardiac pacemaker 45x54x8.5mm, 14cc, 26gm $9,000.00
H120, Model H125
Medtronic Australasia Pty Ltd
MC006 InSync model 8040 Stimulator Titanium 14.4cc $9,000.00
St. Jude Medical Australia Pty Ltd
SJ040 Frontier 3x2 Model 5510 Biventricular Stimulation Device with AF Height 48mm, Length 52mm, $9,000.00 $16,250.00
suppression Depth 6mm
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CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Generation 2
Biotronik Australia Pty Ltd
BT056 Stratos LV Multiprogrammable, Biventricular, DDDRV One size only $12,000.00 $18,500.00
Guidant Australia Pty Ltd
GU142 Contak Renewal TR2 CRT - P Model Implantable Cardiac pacemaker 45x54x8.5mm, 14cc, 26gm $12,000.00 $14,000.00
H140, Model H145
Medtronic Australasia Pty Ltd
MC226 Medtronic Insync III Triple Chamber Titanium One size only $12,000.00
Pacemaker Model 8042
Dual Chamber ICDs
Generation 2
Medtronic Australasia Pty Ltd
MC202 Medtronic Gem III DR Model 7275 Titanium One size only, 39.5cc $37,000.00
Implantable Cardioverter Defibrillator
Progressive Medical
PG004 Alto II DR Dual Chamber Implantable One size only $37,000.00 $44,000.00
Cardioverter Defibrillator
St. Jude Medical Australia Pty Ltd
SJ009 Photon Micro DR Model V-232 37cc $37,000.00
Defibrillators/Cardioverters
Generation 3
Biotronik Australia Pty Ltd
BT053 Lexos DR Dual chamber ICD, rate responsive One size only. $42,000.00 $48,000.00
Guidant Australia Pty Ltd
GU111 Ventak Prizm II DR Model 1861, titanium, dual chamber, One size only $42,000.00
adaptive rate
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CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
GU132 Vitality DR Model 1871 This device acts to defibrillate the heart Model 1871 Vitality DR Dual $42,000.00
chambers when the patient enters into an Chamber Rate Responsive
arrhythmia or uses shocks or anti tachy Pacemaker/Defibrillator
pacing to revert Ventricular Tachycardia
(VT) or Ventricular Fibrillation (VF).
While also acting as a dual chamber
GU149 Vitality 2 DR - Model T165 Implantable Cardiac Defibrillator 30cc ; 82g $42,000.00
GU150 Vitality 2 EL Dr - Model T167 Implantable cardiac Defibrillator 35cc ; 90g $42,000.00 $47,000.00
Medtronic Australasia Pty Ltd
MC245 Marquis DR Model 7274 Implantable Titanium 36cc $42,000.00
Cardioverter Defibrillator
MC318 Maximo DR Model 7278 Titanium One size only 38.9cc $44,000.00
St. Jude Medical Australia Pty Ltd
SJ049 Epic Plus DR Model V-236 Implantable Dual Chamber sensing, bradycardia 33cc $42,000.00
Cardioverter Defibrillator pacing with atrial fibrillation suppression
SJ070 Epic + DR Model V-233 ICD Dual Chamber Implantable Cardio-verter 33cc 70g $42,000.00
Defibrillator
SJ071 Epic + DR Model V-239 ICD Dual chamber implantable cardio-verter 33cc 70g $42,000.00
defibrillator
Dual Chamber ICDs with CRT
Generation 1
Medtronic Australasia Pty Ltd
MC252 Medtronic InSync Marquis Implantable Titanium Volume 38cc $39,000.00
Cardioverter Defibrillator Model 7277
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CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Generation 2
Guidant Australia Pty Ltd
GU134 Contak Renewal 2 This device acts to defibrillate the heart One Size Only $44,000.00
chambers when the patient enters into an
arrhythmia or uses shocks or anti tachy
pacing to revert Ventricular Tachycardia
(VT) or Ventricular Fibrillation (VF).
While also acting as a dual or single
GU147 Contak Renewal 4 CRT-D Model H190, Implantable dual-chamber defibrillator One size only $44,000.00
Model H195
Medtronic Australasia Pty Ltd
MC306 InSync III Marquis Model 7279 Titanium One size only - Volume 38cc $44,000.00
MC325 InSync Sentry Model 7298 Defibrillator, Titanium 40cc $50,000.00
St. Jude Medical Australia Pty Ltd
SJ062 Epic HF Model V-339 Implantable Cardioverter/defibrillator with dual One size only $43,875.00
Cardiac Defibrillator chamber (atrial and RV) sensing and
bradycardia pacing with ventricular
SJ067 Epic + HF Model V-350 ICD Epic + HF V-350 ICD is a cardioverter 36cc / 73g $44,000.00
defibrillator with dual chamber (atrial and
RV) sensing and bradycardia pacing with
ventricular resynchronisation therapy.
Dual Chamber Pacemakers
Generation 1
Biotronik Australia Pty Ltd
BT026 Philos D Model 122447 Implantable Multiprogrammable, ventricula, rate One size only $5,000.00 $6,950.00
Pacemaker responsive modes, DDDC
Guidant Australia Pty Ltd
GU079 Pulsar Model VDD 870 Titanium 3.2mm/IS-1 $5,000.00
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CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Medtronic Australasia Pty Ltd
MC243 Medtronic Kappa KVDD 900 Model Cardiac Pacemaker, Titanium 11.1cc $6,300.00
KVDD 901
MC319 EnPulse VDD; Model E2VDD01 EnPulse VDD pacemaker with IS1 One size only $6,500.00
connector. Titanium silicone
St. Jude Medical Australia Pty Ltd
SJ050 Verity ADx Model XL DC 5256 Dual - Dual Chamber multi-programmable rate- 11cc, 23.5g $5,000.00 $8,960.00
Chamber pacemaker adaptive pacing devices with extended
longevity
SJ061 Identity Adx Model XL DC 5286 Dual Identity ADx Model XL DC Model 5286 11cc, 23.5g $5,000.00 $9,460.00
Chamber Pacemaker is an implantable, multi-programmable
rate-adaptive pacing device with AF
Generation 2
Biotronik Australia Pty Ltd
BT027 Philos SLR Model 122456 Implantable Single pass, multiprogrammable, rate One size only $6,300.00 $7,400.00
Pacemaker responsive, VDDR
St. Jude Medical Australia Pty Ltd
SJ054 Identity ADx Model VDR 5480 Single Chamber multi-programmable rate- 8cc, 18g $6,500.00
implantable pacemaker adaptive pacing device with extended
longevity
SJ057 Verity ADx Model XL VDR 5456 Single Chamber multi-programmable rate- 11cc, 23.5g $6,500.00
implantable pacemaker adaptive pacing device with extended
longevity
Generation 3
Biotronik Australia Pty Ltd
BT024 Philos DR Model 122450 Implantable Multiprogrammable, rate responsive, One size only $9,000.00 $9,400.00
Pacemaker
BT029 Philos DR-A Model 122600 Implantable Multiprogrammable, rate responsive, 5mm ports, One size only $9,000.00 $9,400.00
Pacemaker
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CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
BT047 Protos DR/CLS Dual chamber, rate responsive, closed One size only. $9,000.00 $10,500.00
loop system.
BT060 Philos II DR Multiprogrammable, rate responsive, One size only $9,000.00 $10,500.00
Guidant Australia Pty Ltd
GU045 Pulsar Max II Pacemaker DDDR Model 1280 $9,000.00
GU120 Insignia Plus DR Model 1297, Insignia Dual Chamber Rate Responsive One size only $9,000.00
Plus DR Model 1298 Permanent Pacemaker
GU121 Insignia Entra DR Models Dual Chamber Rate Responsive One size only $9,000.00
Permanent Pacemaker
GU140 Insignia Ultra DR Model 1291 Implantable Cardiac Pacemaker One size only $9,000.00
GU141 Insignia Ultra DR Model 1290 Implantable Cardiac Pacemaker One size only $9,000.00
Medtronic Australasia Pty Ltd
MC333 Medtronic Kappa Pacemaker Model KDR Cardiac Pacemaker, Titanium 12.1cc, 11.1cc, 13.1cc $8,700.00
901, KDR921 and KDR931
Progressive Medical
PG002 Talent II DR Pacemaker Model 233 Dula Chamber Pacemaker. 99% titanium 57.5 x 37.2 x 8mm $9,000.00 $10,500.00
PG005 Symphony DR 2550 Active Implantable pacemaker 1 size only $9,000.00 $13,500.00
St. Jude Medical Australia Pty Ltd
SJ026 St Jude Medical Integrity AFX DR5346 Dual chamber, rate responsive pacemaker Volume 11cc, weight 23.5gm $9,000.00
Pacemaker, Cardiac, Implantable
SJ028 Integrity Micro DR 5336 Pacemaker Dual Chamber Rate Responsive Volume 8cc, Weight 18gm $9,000.00
SJ031 Identity XL DR 5376 Dual Chamber Rate Responsive Volume 11cc, Weight 23.5gm $9,000.00
SJ032 Identity DR 5370 Dual Chamber Rate Responsive Volume 8cc, Weight 18gm $9,000.00
SJ051 Verity Adx Implantable Pacemaker, Dual - Chamber, multi-programmable, 45x52x6mm,11cc, 23g, 5mm or $9,000.00
Models XL DR 5356 and XL DR 5357M/S rate-responsive pacemaker withAF 6mm M/S
SJ056 Integrity ADx Model DR 5360 and XL Dual-Chamber, multi-programmable, rate- Model DR 5360 - 8cc, 18g, $9,000.00
DR 5366 responsive pacemaker with AF Model XL DR 5366 - 11cc,
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CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
SJ059 Identity ADx Models DR 5380 and XL Dual-Chamber, multi-programmable, rate- ADx DR 5380: 43x44x6mm, $9,000.00
DR 5386 adaptive pacing devices with AF 18g and 8cc
ADx XL DR 5386: 44x52x6mm,
23.5g and 11cc
Generation 4
Medtronic Australasia Pty Ltd
MC322 EnPulse DR Series: Model E2DR01, EnPulse DDDR Pacemakers - with IS1 one size only $11,000.00
Model E2DR03, Model E2DR06, Model connector and normal battery size; with
E2DR21, Model E2DR31, Model E2DR33 3.2mm low profile connector and normal
battery size; with 5/6 mm connector and
normal battery size; with IS1 connector
and small battery size; with IS1
connector and large battery size; with
3.2mm low profile connector and large
battery size. Titanium and silicone.
Embolization Prostheses, Intravascular
William A Cook Aust Pty Ltd
WC076 Flipper-Patient Ducts Arteriosus- Detachable Coil for PDA Closure Coil Diameter 3,5,6.5 & 8 mm $236.47
Occluding System Number of Loops (3,4,5)
Filters, Vena Cava
B Braun Australia Pty Ltd
BB105 Celsa Vena Cava Filter System Phynox/ combination of various metals One size, expands to Max length $1,840.00
inc. Nickel,Copper, Molubden,Steel 38mm/Max diameter 30mm
BB106 Celsa Temporary Vena Cava System Phynox/ combination of various metals One size, expands to Max length $1,376.82
inc. Nickel,Copper, Molubden,Steel 38mm/Max diameter 30mm
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CARDIO-THORACIC
Benefit
Amount/
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Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Grafts
Woodstock Biomedical Pty Ltd
WO033 Endofit Endoluminal Stent Graft Tapered Thoracic Endoluminal Stent Max Dia. 42mm, Min Dia. $11,029.00
Graft with external fixation 14mm, Length 12-26cm
WO034 Endofit Endoluminal Stent Graft Occluder Endoluminal Stent Graft Max Dia. 42mm, Min Dia. $2,671.00
14mm, Length 2 or 3.5cm
WO035 Endofit Endoluminal Stent Graft Extender Endoluminal Stent Graft, Max Dia. 42mm, Min Dia. $4,029.00
abdominal and thoracic, Preloaded 14mm, Length 4-12cm
WO036 Endofit Endoluminal Stent Graft Extender Endoluminal Stent Graft, Max Dia. 42mm, Min Dia. $3,424.00
abdominal and thoracic, Cartridge 14mm, Length 4-12cm
WO037 Endofit Endoluminal Stent Graft Endoluiminal Cuff Stent Graft with Max Dia. 42mm, Min Dia. $3,424.00
external fixation, abdominal and thoracic, 24mm, Length 5 or 7cm
WO038 Endofit Endoluminal Stent Graft Endoluminal Cuff Stent Graft with Max Dia. 42mm, Min Dia. $4,282.00
external fixation, abdominal and thoracic, 24mm, Length 5 or 7cm
WO039 Endofit Endoluminal Stent Graft Aortomonoiliac Endoluminal Stent Graft Max Proximal Dia. 38mm, Min $11,176.00
with external fixation Distal Dia. 14mm, Length 14 -
26cm
WO040 Jotech Flowline Bipore Vascular Graft Thin Wall with Spiral Reinforcement 40 & 50cm $1,700.00
WO041 Jotech Flowline Bipore Vascular Graft Thin Wall 40 & 50cm $1,100.00
WO042 Jotech Flowline Bipore Vascular Graft Standard Wall with Spiral Reinforcement 70 & 80cm $1,300.00
WO043 Jotech Flowline Bipore Vascular Graft Standard Wall 80cm $850.00
WO044 Jotech Flow Weave Vascular Graft Flow Weave 30cm $550.00
WO045 Jotech Flow Weave Vascular Graft Flow Weave 60cm $700.00
WO046 Jotech Flow Weave Vascular Graft Flow Weave BioSeal 15cm $600.00
WO047 Jotech Flow Weave Vascular Graft Flow Weave BioSeal 30cm $750.00
WO048 Jotech Flow Weave Vascular Graft Flow Weave BioSeal 60cm $1,000.00
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CARDIO-THORACIC
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Amount/
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Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Grafts, Dura, Biological
Edwards Lifesciences Pty Ltd
EL033 Baxter Augmentation / Substitution Edwards Pericardial Patch. Bovine 10cm x 16cm $670.00
Material, Human or Animal Origin, Sterile Pericardium.
Pericardial Patch.
Grafts, Vascular, Synthetic
Bard Australia Pty Ltd
BA089 Impra PTFE Vascular Grafts ePTFE Cardiovascular Patch 0.4mm Oval 20 x 90mm $199.00
BA090 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, 100 x 150mm $740.40
BA091 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, 50 x 75mm $358.20
Rectangular
BA092 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, 50 x 150mm $361.20
Rectangular
BA093 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, 30 x 30mm, 10 x 90mm, 30 x $1,530.00
Rectangular, Patch 0.4 Oval, Rectangular 60mm
BA095 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, 25 x 150mm $304.10
Rectangular
Woodstock Biomedical Pty Ltd
WO049 Jotec Flowline Bipore Heparin ePTFE ePTFE Vascular Graft with microporous All sizes up to 50cm in length $950.00
Vascular Graft Straight, Standard Wall structure. Standard Wall with Heparin
WO050 Jotec Flowline Bipore Heparin ePTFE ePTFE Vascular Graft with microporous All sizes at over 50cm in length $1,350.00
Vascular Graft Straight, Standard Wall structure. Standard Wall with Heparin
WO051 Jotec Flowline Bipore Heparin ePTFE ePTFE Vascular Graft with microporous All sizes up to 50cm Length $1,100.00
Vascular Graft Straight, Standard Wall structure. Standard Wall with Heparin and
with Reinforcement Reinforcement
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CARDIO-THORACIC
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Billing Code Product Name Description Size Amount Amount Notations
WO052 Jotec Flowline Bipore Heparin ePTFE ePTFE Vascular Graft with microporous All sizes at over 50cm in Length $1,500.00
Vascular Graft Straight, Standard Wall structure. Standard Wall with Heparin and
with Reinforcement Reinforcement
WO053 Jotec Flowline Bipore ePTFE Vascular ePTFE Vascular Graft with microporous All sizes up to 50cm in Length $870.00
Graft, Straight, Thin Wall structure. Thin Wall
WO054 Jotec Flowline Bipore ePTFE Vascular ePTFE Vascular Graft with microporous All sizes at over 50cm in length $1,100.00
Graft, Straight, Thin Wall structure. Thin Wall
WO055 Jotec Flow Nit Bioseal Polyester Vascular Flow Nit Bioseal Straight grafts are For all diameters in 30cm lengths $430.00
Grafts, Straight Grafts texturised exterior yarns for superior
tissue incorporation and healing
characteristics, with the new Bioseal
impregnation to make the grafts blood
WO056 Jotec Flow Nit Bioseal Polyester Vascular Flow Nit Bioseal Straight grafts are For all diameters in 15cm lengths $540.00
Grafts, Straight Grafts texturised exterior yarns for superior
tissue incorporation and healing
characteristics, with the new Bioseal
impregnation to make the grafts blood
WO057 Jotec Flow Nit Bioseal Polyester Vascular Flow Nit Bioseal Straight grafts are For all diameters in 60 and $750.00
Grafts, Straight Grafts texturised exterior yarns for superior 100cm lengths
tissue incorporation and healing
characteristics, with the new Bioseal
impregnation to make the grafts blood
WO058 Jotec Flowline Bipore ePTFE Vascular ePTFE Vascular Graft with microporous All sizes up to 50cm in Length $920.00
Graft, Straight, Standard Wall With structure, Straight, Standard Wall with
Reinforcement
WO059 Jotec Flowline Bipore ePTFE Vascular ePTFE Vascular Graft with microporous All sizes at over 50cm in Length $1,050.00
Graft, Straight, Standard Wall With structure, Straight, Standard Wall with
Reinforcement
WO060 Jotec Flowline Bipore ePTFE Vascular ePTFE Vascular Graft with microporous All sizes up to 50cm in Length $1,100.00
Graft, Straight, Thin Wall with structure. Thin Wall with spiral
WO061 Jotec Flowline Bipore ePTFE Vascular ePTFE Vascular Graft with microporous All sizes at over 50cm in Length $1,300.00
Graft, Straight, Thin Wall with structure. Thin Wall with spiral
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CARDIO-THORACIC
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Amount/
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Billing Code Product Name Description Size Amount Amount Notations
WO062 Jotec Flow Nit Bioseal Polyester Vascular Flow Nit Bioseal Bifurcated grafts are 45 cm length, 12x6mm, $1,000.00
Grafts, Bifurcated Grafts texturised exterior yarns for superior 14x7mm, 16x8mm, 18x9mm,
tissue incorporation and healing 20x10mm, 22x11mm,
characteristics, with the new Bioseal
impregnation to make the grafts blood
ICD Leads
Group 1 - Coronary Sinus Leads
Guidant Australia Pty Ltd
GU135 Perimeter CS Defibrillation Lead - Model The Perimeter CS Lead is a flexible coil Model 0202 - 59cm; Model $2,250.00 $9,500.00
0202, Model 0203 & Model 0204 lead designed to be placed in the coronary 0203 - 64cm; Model 0204 - 80cm
sinus and connected to an implantable
defibrillator and delivers energy to the
Group 2 - Subcutaneous Leads
Medtronic Australasia Pty Ltd
MC026 Medtronic Transvene SVC Lead Model Model 6937-35, Model 6937-52, Model 35 - 110cm x 660mm $2,250.00
6937-58, Model 6937-110; Silicone;
Group 3 - Transvenous/Non steroid/Active Leads
Biotronik Australia Pty Ltd
BT048 Kentrox RV-S ICD lead, right ventricle, screw-in. One size only. $7,000.00 $9,500.00
BT049 Kentrox SL-S ICD Lead, Singel lead, Screw-in. Tip to second shock coil 16 $7,000.00 $9,500.00
cms or 18 cms.
Group 4 - Transvenous/Non steroid/Passive Leads
Biotronik Australia Pty Ltd
BT014 Kainox RV 75 Implantable Defibrillator endocardial 75 cms 100,18 cms 100,16 cms $7,000.00 $9,000.00
shock lead with sensing and pacing. SL 100,13 cms 75,18 cms
100/18, SL 100/16, SL 100/13
BT050 KAINOX A+ ICD Lead, Single Pass. Atrial ring spacing 15, 17cms. $7,000.00 $9,500.00
Prostheses List by Category, Groups and Sponsor with Negotiated Page 15 of 681
CARDIO-THORACIC
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Amount/
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Billing Code Product Name Description Size Amount Amount Notations
BT051 KENTROX RV ICD Lead, right ventricle. 65 or 75 cms $7,000.00 $9,500.00
BT057 Kentrox SL ICD Lead, Single Lead 65, 75 or 100cm length. Tip to $7,000.00 $9,500.00
second shock coil 16cm or
Group 5 - Transvenous/Steroid/Passive Leads
Guidant Australia Pty Ltd
GU112 Endotak Reliance S Lead Model 0127 & Model 0128, defibrillation 59cm, 64cm $7,200.00 $9,500.00
lead, 9fr introducer (silicone coated),
steroid eluting, high impedence
GU115 Endotak Reliance Lead Model 0147, Model 0148 & Model 0149, 59cm, 64cm, 90cm $7,200.00 $9,500.00
defibrillation lead, 9fr introducer (silicone
coated), steroid eluting, high impedence
Medtronic Australasia Pty Ltd
MC002 Medtronic Sprint Quattro Lead Model Silicone and polyurethane 65-100cm $9,000.00
6944RV/SVC 65cm; Model 6944RV/SVC
75cm; or Model 6944RV/SVC 100cm;
Medtronic Sprint Quattro Lead Model
6944RV/SVC 58cm
MC018 Medtronic Sprint Lead Model 6942RV/SVC Model 6942-65, Model 6942-75, Model 65 - 100cm $7,200.00
6942-100; Silicone
MC025 Medtronic Sprint Lead Model 6932RV Model 6932-65, Model 6932-75, Model 65 - 100cm $7,200.00
6932-100; Silicone
St. Jude Medical Australia Pty Ltd
SJ016 Riata Transvenous Tachyarrhythmia Lead Quadripolar, dual-coil, steroid eluting, One size only $10,000.00
Model 1580, Model 1581, Model 1570, active fixation tachyarrhythmia leads
Model 1571
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Billing Code Product Name Description Size Amount Amount Notations
Group 6 - Transvenous/ Steroid/Active Leads
Guidant Australia Pty Ltd
GU118 Endotak Endurance EZ Leads Model Defibrillation lead, steroid eluting, 64, 70, 100cm $7,200.00 $8,700.00
0154, Model 0155, Model 0156 trilumen lead body contains one
conductor for pacing/sensing and two
conductors for defibrillation. The helix is
composed of platinum iridium.
GU145 Endotak Reliance G Lead Model 0164, Implantable defibrillator/pacemaker lead Lead Lengths: 59 - 90cm $11,000.00
Model 0165, Model 0166, Model 0167
GU146 Endotak Reliance SG Lead Model 0160, Implantable defibrillator/pacemaker lead Lead Lengths: 59 - 90cm $11,000.00
Model 0161, Model 0162, Model 0163
Medtronic Australasia Pty Ltd
MC208 Medtronic Sprint Quattro Secure Lead Leads, Defibrillator, Implantable, Silicone, 58-100cm $9,000.00
Model 6947 58cm; Model 6947 65cm; polyurethane, platinized tantalum coils,
Model 6947 75cm; Model 6947 100cm steroid eluting tip
MC331 Medtronic Sprint Lead Model 6943 Model 6943-58, Model 6943-65, Model 58 - 100cm $7,200.00
6943-75, Model 6943-100; Silicone
MC341 Medtronic Sprint Lead Model 6945 Model 6945-58, Model 6945-65; Silicone, 58 - 100cm $7,200.00
Model 6945-75, Model 6945-100; Silicone
Limited Functionality ICDs
Generation 2
Biotronik Australia Pty Ltd
BT052 Cardiac Airbag Single chamber ICD rate responsive One size only. $15,000.00 $35,000.00
Mesh, Polymeric
W L Gore & Associates
GT128 Helex Septal Occluder ePTFE 15-35mm $10,500.00
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CARDIO-THORACIC
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Billing Code Product Name Description Size Amount Amount Notations
Occluders
Medtel Australia Pty Ltd
ME068 Amplatzer PFO Occluder Nitinol Wire Mesh 25mm & 35mm $9,817.45
Occluders, Vascular
Medtel Australia Pty Ltd
ME065 Amplatzer Duct Occluder Nitinol Wire Mesh 5 - 24mm $9,537.00
ME066 Amplatzer Septal Occluder Nitinol Wire Mesh 4mm - 40mm $9,817.17
ME067 Amplatzer Muscular VSD Occluder Nitinol Wire Mesh 4 - 24mm $9,537.00
ME074 Amplatzer Membranous VSD Occluder Nitinol wire mesh, double disc occluder 4-24mm, Length 7-10mm $9,817.50
and delivery system
Pacemaker Lead Adapters, Implantable
Guidant Australia Pty Ltd
GU129 LV-1 Lead Adaptor to IS-1 Connects Left ventricular leads to IS-1 One size only $500.00
ports in pacemakers and defibrillators to
replace abnormal cardiac excitation
GU130 Y Adaptor Connects multiple defibrillator electrodes One size only $500.00
to a common port, enabling the use of
shocks to revert Ventricular Tachycardia
and normal cardiac function to return
Medtronic Australasia Pty Ltd
MC035 Medtronic lead Extender Kit Model: Silicone 14 - 50cm $521.27
6984M, 6981M, 6985M, 5866-24M,
5866-38M, 5866-40M, 6986M, 5866-
37M; Bipolar Lead Adaptor Kit Model 2872
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CARDIO-THORACIC
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Billing Code Product Name Description Size Amount Amount Notations
MC036 Medtronic Lead End Cap Kit Model: Silicone or Polyurethane; Plug to Seal IS- 10 - 25mm, IS-1 Pin Plug - One $77.94
5867-3M; Medtronic Adaptor Kit Line 1 connector in a pacemaker or Size only
5866-23; Connector Sleeve 5866-45; defibrillator, Silicone
Metronic lead sleeve kit model: 5866-46;
Medtronic Pinplug kit. Model 6719, IS-1
MC246 DF-I Y-Adaptor/Extender Model 6726 Silicone Lengths 25cm, 37cm $537.00
25cm & 37cm
Pacemaker leads
Group 1 - Non-transvenous, Bi-Polar, Steroid
Medtronic Australasia Pty Ltd
MC011 Capsure EPI steroid eluting bipolar Silicone 25 - 60cm $1,650.00
epicardial lead Model 4968 - ventricle
Group 11 - Transvenous, Bi-Polar, Passive, Steroid, Left Ventricular
Guidant Australia Pty Ltd
GU138 Easytrak 2, Model 4514,4515, 4516, The Easytrak 2 lead is a dual electrode $6,000.00
4517, 4518, 4519, 4520 version of the Easytrak lead. The
Easytrak 2 lead is a coronary sinus lead,
steroid eluting, dual electrode, pace/sense
lead. The lead provides chronic pacing
and sensing of the left ventricle by
placement in the coronary venous
GU153 Easytrak 2 Is-1 Lead - Models 4542, Implantable left ventricular lead 80 to 100cm $6,000.00
4543 & 4544
GU156 Easytrak 3 Lead - Models 4521, 4522, Implantable left ventricular pacemaker lead 80 to 100cm $6,000.00
4523, 4524, 4525, 4526 and 4527
Group 2 - Non-transvenous, Uni-Polar, Steroid
Medtronic Australasia Pty Ltd
MC053 Capsure EPI steroid eluting unipolar Silicone 25 - 50cm $1,485.00
epicardial lead Model 4965 ventricle
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Billing Code Product Name Description Size Amount Amount Notations
Group 3 - Non-Transvenous, Uni-Polar, Non-Steroid
Guidant Australia Pty Ltd
GU037 Myocardial Pacing Lead Model 4312 and 4316 54cm and 35cm $1,100.00
Medtronic Australasia Pty Ltd
MC009 Medtronic Epicardial Pacing Leads IS-1 Silicone 35 - 53cm $1,100.00
Model 5071
Group 4 - Transvenous, Uni-Polar, Passive, Steroid, Right Ventricular/Atrial
Medtronic Australasia Pty Ltd
MC254 CapSure Sense pacemaker lead Models Titanium Nitride CapSure Sense Lead Model $1,200.00 Also grouped in Pacemaker Lead
4073, 4074 & 4574 4073 - 30cm to 85cm; CapSure Group 8
Sense Lead Model 4074 - 30cm
to 85cm; CapSure Sense Lead
Model 4574 - 30cm to 53cm
Progressive Medical
PG003 Swift 4040 1CT pacemaker lead length 58 cm - 69 cm $1,100.00 $9,000.00
Group 5 - Transvenous, Uni-Polar, Passive, Non- Steroid, Left Ventricular
Biotronik Australia Pty Ltd
BT061 Corox OTW Coronary Sinus Lead for Left Ventricular 75 or 85cm $2,630.00 $6,000.00
Pacing
Medtronic Australasia Pty Ltd
MC037 Medtronic Attain Cardiac Vein Pacing Polyurethane; 4 FR Polyurethane, 5 FR 58 - 75cm: 85cm/75cm/110cm $2,630.00
Lead Model 2187; Medtronic Coronary Electrode Tip, Kit Includes: Stylet x 3, or 75-110cm; 75cm/85cm
Sinus Pacing Lead Model 2188; Valve lifter, Attain Lead & Anchoring
Medtronic Attain SD Model 4189; Sleeve; 4 FR Polyurethane Body, 6.1FR
Medtronic Attain Side-Wire Model 4191
St. Jude Medical Australia Pty Ltd
SJ033 Aescula LV Model 1055K Left Ventricular Pacing Lead 75cm $2,630.00 $3,200.00
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Billing Code Product Name Description Size Amount Amount Notations
Group 6 - Transvenous, Uni-Polar, Passive, Steroid, Left Ventricular
Guidant Australia Pty Ltd
GU056 Easytrak Lead Model 4510, Model 4511, Model 4512 65cm, 72cm, 80cm $3,000.00
Transvenous Coronary Sinus Lead
GU152 Easytrak IS-1 Lead, Models 4535 to 4538 Implantable left ventricular lead 80 - 90cm $3,000.00
Medtronic Australasia Pty Ltd
MC225 Attain Over the Wire Model 4193 Titanium, polyurethane 78-88cm $3,000.00
Group 7 - Transvenous, Bi-Polar, Passive, Non-Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT018 Merox Mex 53 JBP Pacemaker Lead High Performance Lead, Model 124884, 53cm Atrial $1,000.00 $1,500.00
one only
BT019 Merox Mex 60/15 BP Pacemaker Lead High Performance Lead, Model 124962, 60cm Ventricular $1,000.00 $1,500.00
one only
BT020 Merox Mex 53 JBP and Merox Mex High Performance Lead, Model 124884 53cm Atrial and 60cm $1,000.00 $1,450.00
60/15 BP Pacemaker Leads and Model 124962, (used together)
St. Jude Medical Australia Pty Ltd
SJ013 Transvenous Superior Vena Cava Lead TVL lead system models SV01, SV02, SV01- 100cm; SV02 - 45cm; $7,000.00
Model SV01, Transvenous Superior Vena SV03 transvenous leads SV03 - 55cm
Cava Lead Model SV02, Transvenous
Superior Vena Cava Lead Model SV03
Group 8 - Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atrial
Guidant Australia Pty Ltd
GU002 Guidant Aust Selute Atrial J Lead Model 4293, Model 4294 $1,200.00
GU009 Fineline II Sterox IROX Lead Model 4458, Model 4459 52cm, 58cm $1,200.00
GU011 Fineline II Sterox IROX Lead Model 4456, Model 4457 52cm, 58cm $1,200.00
GU012 Fineline II Sterox IROX Lead Model 4479, Model 4480 45cm, 52cm $1,200.00
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Billing Code Product Name Description Size Amount Amount Notations
GU023 Guidant Aust Selute Picotip Steroid Model 4033, Model 4034, Model 4035, 45cm , 52cm, 59cm $1,200.00
Eluting Bipolar Lead Model 4063, Model 4064
GU082 Selute Lead Model 4285 Silicone 45, 52, 59cm $1,200.00
Medtronic Australasia Pty Ltd
MC010 Medtronic Capsure SP Novus Model Silicone Polyurethane 45 -110cm $1,100.00
5092; Capsure SP Novus Lead Model
5592; Medtronic Capsure Model 4023
Lead; Medtronic Capsure Model 4024
Lead (med.dexamethasone) Medtronic
Capsure Model 4523(MED) Medtronic
Capsure Model 4524 Lead; Medtronic
Capsure Model 5023M Lead; Medtronic
Model 5024M Capsure Lead; Medtronic
Model 5024M Capsure Lead; Medtronic
Capsure Model 5524M SP Bipolar Lead
MC229 Medtronic Capsure SP Novus Model Silicone, platinum 30-100cm $1,100.00
5594 Lead 30cm
MC336 Medtronic Capsure Z Novus Model 5054 Silicone; Contents: 1 x lead with 45-58cm $1,200.00
Pacing Lead anchoring sleeve, stylet & guide, 1 x vein
lifter, 2 x fixation tools, extra stylets
MC337 Medtronic Capsure Z Novus Model 5554 Silicone; Contents: 1 x lead with 45-58cm $1,200.00
Pacing Lead anchoring sleeve, stylet & guide, 1 x vein
lifter, 2 x fixation tools, extra stylets
St. Jude Medical Australia Pty Ltd
SJ024 PASSIVE PLUS DX 1342T, 1343K, Single, passive fixation, steroid eluting, 46-58cm $1,200.00
1345K, 1346T low polarisation lead; Models: Bipolar
Atrial Lead, IS-1 Unipolar Atrial Lead, IS-
1 Unipolar Ventricular Lead, IS-1 or
Bipolar Ventricular Lead, IS-1
Group 9 - Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atrial
Guidant Australia Pty Ltd
GU013 Fineline II EZ Sterox IROX Lead Model 4472, Model 4473 & Model 4474 45cm, 52cm, 58cm $1,200.00
GU016 Fineline II EZ Sterox IROX Lead Model 4469, Model 4470 & Model 4471 45cm, 52cm, 58cm $1,200.00
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Billing Code Product Name Description Size Amount Amount Notations
GU031 Sweet Picotip RX Lead Model 4050, Model 4051, Model 4052, 45cm, 52cm, 59cm, 45cm & $1,200.00
Model 4053, Model 4054 & Model 4055
GU122 Flextend Lead Models 4086, 4087 & Bipolar, steroid eluting, transvenous 45,52,59cm $1,200.00
silicon pace/sense leads with an
extendable/retractable active fixation for
implantation into the atrium or ventricle
Medtronic Australasia Pty Ltd
MC008 Medtronic Capsurefix Model 6940, Silicone Polyurethane 30 - 85cm $1,100.00
Pacing Lead; Medtronic Tined IS-1
Model 4557M; Medtronic Capsurefix
Model 4067/8/4568 Pacing Leads;
Medtronic Capsurefix Model 5067 Pacing
Leads; Medtronic Capsurefix Model
5068 Pacing Leads; Medtronic Capsurefix
Model 5568 Pacing Leads; Capsure SP
Novus Pacing Lead Model 4092; Capsure
SP Novus Pacing Lead Model 4592
MC338 Medtronic Capsurefix Novus Model 5076 Silicone; Contents: 1 x lead with 45-85cm $1,200.00
Pacing Lead anchoring sleeve, stylet & guide, 1 x vein
lifter, 2 x fixation tools, extra stylets
St. Jude Medical Australia Pty Ltd
SJ023 TENDRIL SDX 1488T, 1388T Single, Active Fixation, Steroid Eluting, 46cm-58cm $1,200.00
Low Polarisation Lead, IS-1
Patches, Myocardial
W L Gore & Associates
GT117 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm Thickness 2 x 9cm $226.00
GT118 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm - 3 x 6cm $267.00
0.6mm - 2.5cm x 15cm & 5cm
x 7.5cm
GT120 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 5 x 15cm $505.00
GT121 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 10 x 15cm $917.00
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Billing Code Product Name Description Size Amount Amount Notations
GT122 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 6 x 12cm $343.00
GT123 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 8 x 16cm $623.00
GT124 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 12 x 12cm $711.00
GT125 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 15 x 20cm $1,437.00
GT126 Acuseal Cardiovascular Patch Vascular ePTFE 0.5mm Thickness 1 x 9cm; 0.8 $211.00
x 7.5cm
GT127 Acuseal Cardiovascular Patch Cardiac ePTFE 0.5mm Thickness 3 x 6cm & 5 $256.00
x 7.5cm
Prostheses, Blood Vessel, Artificial
Atrium Australia-Pacific Rim Pty Ltd
AC002 Atrium PTFE Vascular Graft Straight PTFE Standard Wall 6mm x 10cm - 10mm x 90cm $1,241.50
Prostheses, Cardiac Valve, Artificial
Advanced Biomedical Pty Ltd
AB002 ATS medical open pivot heart valve Pyrolythic Carbon, Double Velour 16-33mm $5,940.00
model 500FA standard flexi-cuff aortic Polyester, Titanium
valve series, ATS medical open pivot
heart valve model 501DM advanced
performance mitral valve series, ATS
medical open pivot heart valve model
501DA advanced performance aortic
valve series, ATS medical open pivot
heart valve model 500DM mitral standard
valve series
Prostheses List by Category, Groups and Sponsor with Negotiated Page 24 of 681
CARDIO-THORACIC
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Amount/
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Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Edwards Lifesciences Pty Ltd
EL029 SE SIL Ball Valve Aortic Models Starr Edwards - Silastic Ball Valve. 16mm-34mm $4,031.00
1200/1260, SE SIL Ball Valve Mitral Composition: Stellite Alloy No. 21;
Polytetrafluroethelyne; polypropylene
cloth; Silicone rubber (contains 2% by
weight barium sulphate for radiopacity)
Hjorth Health Pty Limited
HH001 Omnicarbon 4000 4523 Mitral UPP Pure pyrolitic carbon mono-leaflet Aortic - Sizes 19mm - 27mm; $5,000.00
SupraAnnular and Omnicarbon 4000 prosthetic heart valve Mitral - Sizes 27mm - 33mm
4313 Aortic UPP
Medtronic Australasia Pty Ltd
MC013 Medtronic Hall Heart Valve Aortic Model A7700/M7700 Titanium. Pyrolite. A7700 - Diameter 20-31mm, $5,184.00
A7700, Medtronic Hall Heart Valve Mitral Dacron, A7700EZ/M7700EZ Titanium. M7700 - Diameter 23-33mm,
Model M7700, Hall Easy Fit Aortic Heart A7700EZ - Diameter 19-29mm,
Valve Model A7700, Hall Easy Fit Mitral M7700EZ - Diameter 23-31mm
Heart Valve Model M7700
MC198 Medtronic Hall rotatable aortic valved Titanium, pyrolite, dacron 20 - 33mm $7,040.00
collagen impregnated conduit Model R7700
MC292 Advantage Heart Valve - Aortic Model A7760 - Pyrolytic carbon, PET Diameter 19-31 mm $6,142.86
MC324 Advantage Supra Aortic Heart Valve Mechanical Heart Valve Pyrolite Carbon Diameter (mm): 19 - 25 $6,200.00
leaflets Pyrolite carbon ring
Reid Healthcare
RH001 Aortic On-X Prosthetic Heart Valve 27-29mm, 19mm, 21mm, $5,500.00
Models ONXA-19; ONXA-21; ONXA- 23mm, 25mm, 25-33mm, 27-
23; ONXA-25; ONXA-27/29; ONXM-23; 29mm, 31-33mm, 23mm,
ONXM-25; ONXM-27/29; ONXM31/33;
St. Jude Medical Australia Pty Ltd
SJ036 St Jude Medical Coated Aortic Valved Coated Aortic Valved Graft 21mm - 33mm $7,720.83
SJ037 St Jude Medical Aortic Expanded Cuff Aortic Expanded Cuff, Aortic Aortic Expanded 19 -31mm, $5,909.00
Heart Valve; St Jude Medical Aortic Hemodynamic Plus Cuff, Mitral Aortic Hemodynamic 17 -
Hemodynamic Plus Cuff Heart Valve; St Hemodynamic Cuff, Aortic & Mitral 27mm, Mitral Hemodynamic 17
Jude Medical Mitral Hemodynamic Plus -27mm, Rotatable 17 - 33mm
Cuff Heart Valve; St Jude Medical
Mechanical Heart Valve Masters Series
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Billing Code Product Name Description Size Amount Amount Notations
SJ039 St Jude Medical Regent Prosthetic Heart Standard Cuff - Model 17AGN-751 - Standard cuff - 17-29mm, Flex $6,759.70
Valves 29AGN-751, Flex Cuff - Model cuff - 17-29mm
17AGFN-756 - 29AGFN-756
Tag Medical
TM002 CarboSeal Ascending Aortic Prosthesis, Mechanical Conduit AP 21-33mm $6,800.00
sterile, CarboSeal Ascending Aortic
Prosthesis with Handle Model AP21,
Model AP23, Model AP25, Model AP27,
Model AP29, Model AP31, Model AP33
TM003 SuMit - Supra-Annular Mitral Valve: Mechanical Valve 16mm to 33mm $4,950.00
Carbomedics Aortic Model S500 Supra
Annular Prosthetic Heart Valve:
Carbomedics Model 700 Mitral Prosthetic
Heart Valve: CarboMedics Aortic Model
A500 Prosthetic Heart Valve:
CarboMedics Aortic Model R500
Reduced Tissue Annulus Diameter
Prostheses, Cardiac Valve, Biological
Edwards Lifesciences Pty Ltd
EL030 CE Supra Annular Aortic Valve Model Carpentier-Edwards SAV Bioprosthesis. 19mm-33mm $4,149.09
2650 Carpentier-Edwards S.A.V Composition: Porcine Valve; Elgiloy
Bioprosthesis Model 6650 Mitral Valve Alloy; Silicone Rubber,
EL031 Carpentier-Edwards Perimount Pericardial Carpentier-Edwards Pericardial Models 2900/6900 19-33mm, $4,444.85
Bioprosthesis - Models 2900/6900 Bioprosthesis. Composition: Bovine Model 6900P 25, 27, 29, 31,
Carpentier-Edwards Perimount Plus Pericardium; Elgiloy Alloy; Silicone
Pericardial Bioprosthesis Mitral - Model Rubber, Polytetrafluoroethylene
6900P
EL032 Baxter Edwards Prima Plus Stentless Edwards Prima Plus. Porcine Valve; 19mm-29mm $700.00
Bioprosthesis Model 2500P Prosthetic Woven Polyester Cloth.
Heart Valve
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Billing Code Product Name Description Size Amount Amount Notations
EL039 Edwards Perimount Magna Model 3000 Carpentier-Edwards Perimount Magna 19MM Aortic Pericardial Tissue $5,584.38
composition: Glutaraldehyde treated Valve; 21MM Aortic Pericardial
bovine pericardium/elgiloy wireform Tissue Valve; 23MM Aortic
stent/polyester band/silicone rubber Pericardial Tissue Valve; 25MM
suture ring/polytetrafluoroethylene Aortic Pericardial Tissue Valve;
cloth/polyester cloth. 27MM Aortic Pericardial Tissue
Valve; 29MM Aortic Pericardial
Tissue Valve
Medtronic Australasia Pty Ltd
MC012 Medtronic Hancock Valved Conduit Porcine bioprosthesis, dacron 12, 14, 16, 18, 20, 22, 25, $5,640.00
Model 100/150
MC015 Medtronic Freestyle modified Models FR995MS, FR995 - Porcine 19 - 27mm, 19 - 29mm, 19 - $4,804.51
subcoronary aortic root bioprosthesis Bioprosthesis, dacron, Models 305, 305C, 35mm, 21 - 33mm
(Model 995MS); Medtronic Freestyle 310, T505, T510 - Porcine
aortic root bioprosthesis (Model FR995); bioprosthesis, polyester
Medtronic Mosaic Aortic heart Valve
Model 305; Medtronic Mosaic Mitral
heart Valve Model 310; Medtronic
Hancock II heart valve model T510
Mitral; Medtronic Hancock II heart valve
model T505 Aortic
St. Jude Medical Australia Pty Ltd
SJ038 St Jude Medical Toronto SPV Valve Tissue Heart Valves, Bioimplant TSPV: 21 - 29mm, Bioimplant $4,824.09
Model SPA-101, St Jude Medical Aortic: 21-27mm, Bioimplant
Bioimplant Heart Valve Mitral: 27-32mm
SJ069 St Jude Medical Biocor Porcine St Jude Medical Biocor Porcine Aortic Valves - Tissue Annulus $5,000.00
Prosthetic Heart Valve Prosthetic Heart Valve is manufactured Diameter - 21-29mm, Implant
from selected procine aortic valve cusps Height - 11-15c; Mitral Valves -
that have been cross-linked with a Tissue Annulus Diameter - 25-
35mm, Implant Height - 8-
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CARDIO-THORACIC
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Amount/
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Billing Code Product Name Description Size Amount Amount Notations
Recorders, Long Term, ECG, Implantable
Medtronic Australasia Pty Ltd
MC028 Medtronic Reveal ILR Model 9525, Titanium 8cc $3,587.16
Implantable Cardiogram Recorder;
Reveal Plus Implantable Loop Recorder
Single Chamber ICDs
Advanced Biomedical Pty Ltd
AB001 ATS medical open pivot aortic valved Pyrolythic Carbon, Double Velour 21-33mm $7,755.00
graft model 502AG Polyester, Titanium
Generation 1
St. Jude Medical Australia Pty Ltd
SJ058 St Jude Medical Australia Ventritex Contour MD Models V - 175 AC, V-175C 57-65cc, 109 - 118g $32,175.00
Contour MD Models V-175AC, V-175D and V-175D Single chamber
and V- 175C Defibrillators/Cardioverters Defibrillators/Cardioverters
Generation 2
Biotronik Australia Pty Ltd
BT054 Lexos VR Single chamber ICD, Rate responsive One size only. $35,000.00 $42,000.00
Medtronic Australasia Pty Ltd
MC201 Medtronic A/Asia Gem III VR Model Titanium One size only, 39.2cc $35,000.00
7231CX
Progressive Medical
PG001 Alto II VR Single Chamber ICD Debrillator, implantable, automatic $35,000.00 $42,000.00
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CARDIO-THORACIC
Benefit
Amount/
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Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Generation 3
Biotronik Australia Pty Ltd
BT055 Lexos A+ Single chamber ICD, rate responsive One size only. $39,000.00 $40,000.00
pricing, dual chamber sensing.
Guidant Australia Pty Ltd
GU110 Ventak Prizm II VR Model 1860, titanium, single chamber, One size only $39,000.00 $40,000.00
adaptive rate
GU133 Vitality VR Model 1870 This device acts to defibrillate the heart Model 1870 Vitality VR Single $39,000.00 $41,500.00
chambers when the patient enters into an Chamber Rate Responsive
arrhythmia or uses shocks or anti tachy Pacemaker/Defibrillator
pacing to revert Ventricular Tachycardia
(VT) or Ventricular Fibrillation (VF).
While also acting as a single chamber
GU148 Vitality 2 EL VR - Model T177 Implantable Cardiac Defibrillator 35cc 90g $39,000.00 $46,500.00
GU151 Vitality 2 VR - Model T 175 Implantable cardiac defibrillator 30cc; 82g $39,000.00 $41,500.00
Medtronic Australasia Pty Ltd
MC253 Medtronic Marquis VR 7230CX Titanium, Sterile, Single Chamber Volume 36cc $39,000.00
Implantable Cardioverter Defibrillator
MC317 Maximo VR Model 7232Cx Titanium One size only 38.5cc $41,000.00
St. Jude Medical Australia Pty Ltd
SJ010 Photon Micro VR Model V-194 36cc $39,000.00
Defibrillators/Cardioverters
SJ048 Epic Plus VR Model V-196 Implantable Single Chamber sensing and bradycardia 32cc $39,000.00
Cardioverter Defibrillator pacing
Single Chamber Pacemakers
Generation 1
Biotronik Australia Pty Ltd
BT036 PHILOS S Implantable Cardiac Pulse Multiprogrammable SSI One size only $4,100.00 $5,300.00
Generator Cat No 122 453
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CARDIO-THORACIC
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Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
St. Jude Medical Australia Pty Ltd
SJ020 REGENCY SC+ 2402L Single Chamber, VVI, Autocapture, IS-1 8.6cc, 18.5gm $4,100.00
SJ052 Verity Adx Models XL SR 5156 and XL Single Chamber multi-programmable 11cc, 23g $5,700.00
SR 5157 M/S implantable pacemaker rate-adaptive pacing devices with
extended longevity
SJ053 Verity Adx Model XL SC 5056 Single Chamber multi-programmable rate- 10.5cc, 23g $4,100.00
implantable pacemaker adaptive pacing device with extended
longevity
Generation 3
Biotronik Australia Pty Ltd
BT028 Philos SR Model 122459 Implantable Multiprogrammable, rate responsive, One size only $5,400.00 $6,250.00
Pacemaker
BT030 Philos SR-B Model 122610 Implantable Multiprogrammable, rate responsive, 5/6mm port, One size only $5,400.00 $6,200.00
Pacemaker
BT046 Protos VR/CLS Single chamber rate responsive, closed One size only $5,400.00 $7,000.00
loop system.
BT062 Philos II SR Multiprogrammable, Rate Responsive, One size only $5,400.00 $7,000.00
SSIR pacemaker
Guidant Australia Pty Ltd
GU067 Pulsar Max II Pacemaker SSIR Model 1180, Model 1181 $5,700.00
GU124 Insignia Entra SR Models 1195 & 1198 Single Chamber Rate Responsive One size only $5,700.00
Permanent Pacemaker
GU126 Insignia Plus SR Model 1194 Single Chamber Rate Responsive One size only $5,700.00
Permanent Pacemaker
GU139 Insignia Ultra SR Lodel 1190 Implantable Cardiac Pacemaker One size only $5,700.00
Medtronic Australasia Pty Ltd
MC321 EnPulse SR Series: Model E2SR01, EnPulse SR - Pacemakers - with IS1 One size only $5,950.00
Model E2SR03, Model E2SR06 connector; with 3.2mm low profile
connector; with 5mm connector.
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Billing Code Product Name Description Size Amount Amount Notations
St. Jude Medical Australia Pty Ltd
SJ022 REGENCY SR+ 2400L Single Chamber, Rate Response, 8.6cc, 18.5gm $5,700.00
Autocapture, IS-1
SJ025 St Jude Medical Integrity SR5142 Single chamber, rate responsive Volume 10.4cc, weight 23gm $5,700.00
Pacemaker, Cardiac Implantable
SJ029 Integrity Micro SR 5136 Pacemaker Single Chamber Rate Responsive Volume 8cc, weight 18gm $5,700.00
SJ030 Identity SR 5172 Single Chamber Rate Responsive Volume 8cc, Weight 17gm $5,700.00
SJ055 Integrity ADx Model SR 5160 implantable Single Chamber multi-programmable rate- 8cc, 17g $5,700.00
pacemaker adaptive pacing device
SJ060 Identity ADx Model SR 5180 implantable Single Chamber multi-programmable rate- 8cc, 18g $5,700.00
pacemaker adaptive pacing device
Special Implantable Cardioverter Defibrillator Leads
Group 2 - Subcutaneous Leads
Guidant Australia Pty Ltd
GU123 Endotak SQ Array XP Lead Model 0085 Endotak SQ Array XP Lead Model 0085 70 cm $4,500.00 $6,000.00
is used in addition to an Endotak
endocardial leads for patients with a high
DFT (Defibrillation Threshold)
Medtronic Australasia Pty Ltd
MC251 Implantable Subcutaneous Defibrillator Silicone and Platinum Alloy Lengths 41-85cm inclusive $4,500.00
Lead Model 6996SQ 41cm, 58cm, 85cm
Group 7 - Epicardial Patches
Medtronic Australasia Pty Ltd
MC027 Model 6721 Unipolar Epicardial Patch Model 6721S-50, Model 6721M-50, 370, 660, 840mm $2,250.00
Leads S/M/L Model 6721L-50; Silicone
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Billing Code Product Name Description Size Amount Amount Notations
Special Purpose Dual Chamber Pacemaker - Custom Header
Generation 3
Medtronic Australasia Pty Ltd
MC029 Medtronic Kappa 400 pacemaker Model Titanium 13.9cc $8,700.00
KDR401
MC241 Medtronic Kappa Pacemaker Model KDR Cardiac Pacemaker, Titanium 13.9cc $8,700.00
MC242 Medtronic Kappa KSR 900 Model KSR Cardiac Pacemaker, Titanium 9.7,10.5,11.0 cc $5,700.00
901,903, 906
MC332 Medtronic Kappa Pacemaker KDR 903 Cardiac Pacemaker, Titanium 13cc, 14.2cc $8,700.00
and KDR 906
MC340 Medtronic Kappa 400 pacemaker Model Titanium 13.9cc $8,700.00
KDR403
Special Purpose ICDs - High energy products
Generation 1
Medtronic Australasia Pty Ltd
MC019 Medtronic Gem DR Model 7271 Titanium 62cc $35,000.00
MC020 Medtronic Gem Model 7227Cx; Gem Titanium 49cc, 40cc $33,000.00
Model 7227 Implantable Cardioverter
Generation 2
Guidant Australia Pty Ltd
GU107 Ventak Prizm HE DR Model 1853 & Model 1858, titanium, dual One size only $39,000.00
chamber, adaptive rate
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Amount/
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Billing Code Product Name Description Size Amount Amount Notations
Generation 3
St. Jude Medical Australia Pty Ltd
SJ011 Atlas DR Model V-240 Dual chamber implantable cardioverter 37cc $43,875.00
defibrillator with rate response
SJ012 Atlas VR Model V-199 Single chamber implantable cardioverter 36cc $40,950.00
defibrillator with rate response
SJ063 Atlas DR Model V-242 ICD Implantable Dual Chamber Cardio-verter 38cc/78g $44,000.00
Defibrillator
SJ065 Atlas + VR Model V-193 ICD Single chamber implantable cardio-verter 38cc, 77g $41,000.00
defibrillator
SJ066 Atlas + VR - C Model V-193C ICD Single chamber implantable cardio-verter 38cc, 77g $41,000.00
defibrillator
SJ068 Atlas + DR Model V-243 ICD Implantable Dual Chamber Cardio-verter 38cc, 78g $44,000.00
Defibrillator
Special Purpose ICDs - With custom headers
Generation 1
Medtronic Australasia Pty Ltd
MC237 Gem Model 7227B Implantable Titanium, "B" Style Connector 56cc $32,500.00
Cardioverter Defibrillator
MC238 Gem Model 7227D Implantable Titanium, "D" style connector 53cc $32,500.00
Cardioverter Defibrillator
MC239 Gem Model 7227EImplantable Titanium, "E" style connector 55cc $32,500.00
Cardioverter Defibrillator
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Amount/
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Billing Code Product Name Description Size Amount Amount Notations
Special Purpose ICDs - With therapies for Atrial Tachyarrhythmia
Generation 2
Medtronic Australasia Pty Ltd
MC227 Medtronic Gem III AT Model 7276 Titanium 39.5cc $39,000.00
Implantable Cardioverter Defibrillator
Generation 3
Guidant Australia Pty Ltd
GU137 Vitality AVT Dual or single chamber pacemaker One size only $44,000.00
GU157 Vitality AVT - Model A155 Implantable cardiac defibrillator with both 30cc $44,000.00
Atrial and Ventricular tachyarrhythmia
therapy
Special Purpose ICDs with CRT - High energy products
Generation 2
Guidant Australia Pty Ltd
GU144 Contak Renewal 4 HE CRT-D Model Implantable dual-chamber defibrillator one size only $46,000.00
H197, Model H199
St. Jude Medical Australia Pty Ltd
SJ064 Atlas + HF Model V - 341 ICD - Atlas + HF ICD is a cardioverter 40cc/81g $46,000.00
Defibrillator, Implantable, automatic, defibrillator with dual chamber (atrial and
dual-chamber RV) sensing and bradycardia Pacing with
ventricular resynchronisation therapy.
Special Purpose ICDs with CRT - With therapies for Atrial
Generation 2
Guidant Australia Pty Ltd
GU154 Contak Renewal 4 AVT CRT -D - Model Implantable Cardioverter Defibrillator 37cc; 89g $49,000.00
M170 and M175 with Cardiac Resynchronisation Therapy
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Amount/
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Billing Code Product Name Description Size Amount Amount Notations
GU155 Contak Renewal 4 AVT HE CRT - D - Implantable Cardioverter Defibrillator 40cc; 89g $50,000.00
Model M177, M179 with cardiac resynchronisation Therapy
Special Purpose Pacemaker - Small size (<7cc) for pacing in infants
Generation 3
St. Jude Medical Australia Pty Ltd
SJ027 St Jude Medical Microny II SR+ Model Single Chamber Rate Responsive Volume 5.9cc, Weight 12.8gm $5,700.00
2525T Pacemaker
Special Purpose Pacemaker - with Therapies for Atrial
Generation 3
Medtronic Australasia Pty Ltd
MC200 Medtronic A/Asia AT500 DDDRP Pacing Titanium, silicone One size only, 14.9cc $11,000.00
System Model AT501
Special Purpose Pacemaker Leads - Catheter Delivered
Group 9 - Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atrial
Medtronic Australasia Pty Ltd
MC301 Model 3830 PACING LEADS Active fixation pacemaker lead 59 - 75 cm $2,500.00
Composition: Insulation is polyurethane,
Electrodes are Titanium Nitride coated
Platinum, the screw is steriod-coated
Special Purpose Pacemaker Leads - VDD Leads
Group 7 - Transvenous, Bi-Polar, Passive, Non-Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT009 SL Tripolar Lead - SL60/130, Single pass lead 130mm, 150mm, 110mm $1,000.00 $1,500.00
BP,SL60/150-BP, SL60/110-BP
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Amount/
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Billing Code Product Name Description Size Amount Amount Notations
Group 8 - Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atrial
Guidant Australia Pty Ltd
GU028 Guidant Aust Selute Picotip VDD Lead Model 4340, Model 4341, Model 4342 & $1,100.00 $2,200.00
Model 4343
Medtronic Australasia Pty Ltd
MC052 Medtronic Capsure VDD2 Model 5038 Silicone; Contents: 1 x lead with 11.5cm, 13.5cm, 15.5cm $1,485.00
AV Pacing Lead anchoring sleeve, stylet & guide, 1 x vein
lifter, 2 x fixation tools, extra stylets
Special Purpose Single Chamber Pacemaker - Custom Header
Generation 1
St. Jude Medical Australia Pty Ltd
SJ019 REGENCY SC 2406L, SCX 2408L, SC Single Chamber, Standard VVIC, IS-1/5- 8.6cc, 18.5-19gm $4,100.00
2407M/S
Generation 3
Medtronic Australasia Pty Ltd
MC030 Medtronic Kappa 400 Pacemaker Model Titanium 11.6cc, 11.7cc $5,400.00
KSR401
MC330 Medtronic Kappa 400 Pacemaker Model Titanium 11.6cc, 11.7cc $5,400.00
KSR 403
Tissue Reconstructive Materials
Advanced Biomedical Pty Ltd
AB003 Bioglue Surgical Adhesive - 5ml Starter Kit Model No BG 3005 S (Bioglue Surgical One size only $665.00 Temporary Approval
Adhesive)
Prostheses List by Category, Groups and Sponsor with Negotiated Page 36 of 681
EAR, NOSE & THROAT
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Amount/
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Billing Code Product Name Description Size Amount Amount Notations
Cannulae, Eye, Lacrimal
Device Technologies Australia Pty Ltd
DE191 Canaliculus Intubation Sets Silicone, SS & Nylon 17.7 x .064 x 29cm, 15.5 x .051 $159.00
x 33cm
Caps, Bone
Medtel Australia Pty Ltd
ME078 BAHA - Bone Anchored Hearing Aids Cover screw unigrip One size only $364.00
Cement
Endotherapeutics Pty Ltd
ET031 Serenocem Cement Reaction bonded polymer composite One size only - box of 2 $1,500.00
formed by the neutralisation gelletation of
a basic inorganic ionomer
ET032 Serenocem Granules Reaction bonded polymer composite 0.5 - 1mm granules, 1gm or $1,000.00
formed by the neutralisation gelletation of 5gm; 2 - 3mm granules, 1gm or
a basic inorganic ionomer 5gm - 3 pouches
Prostheses List by Category, Groups and Sponsor with Negotiated Page 37 of 681
EAR, NOSE & THROAT
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Amount/
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Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Cochlear Implants
Cochlear Limited
CO012 SPrint Speech Processor (INITIAL) Consists of: SPrint Speech Processor - Processor: One Size Only, $8,515.00
body worn speech processor to suit Transmit Cable, 8-28cm,
Nucleus 24 cochlear implant system; Headset Cable 45-100cm,
transmit cable; headset cable; headset; Headset: 0.5-4.0 magnet
battery case - double; batteries - AA; strength, Hook small and large
microphone cover; belt clip; and hook
CO015 Spectra Speech Processor Conists of: Spectra - body worn speech Processor: One Size Only, $3,842.55
processor for Nucleus 22 system; Transmit Cable: 8- 28cm
transmit cable; headset cable; and headset Headset Cable: 45 -100cm
Headset: 0.5-4.0 magnet
CO017 SPrint Speech Processor Consists of: SPrint Speech Processor - Processor: One Size Only, $4,282.25
body worn speech processor to suit Transmit Cable, 8-28cm,
Nucleus 24 cochlear implant system; Headset Cable 45-100cm,
transmit cable; headset cable; headset; Headset: 0.5-4.0 magnet
battery case - double; batteries - AA; strength, Hook small and large
microphone cover; belt clip; and hook
CO018 ESPrit 3G Speech Processor - Initial Includes speech processor with titanium Cable lengths: 6, 8, 10, 20, 28cm $9,700.00
ear hook, 6 high powered zinc air
batteries, cleaning brush, microphone
puffer, earmould compatible earhook,
soft earhook cover, magnet, drying
capsules, accessory adaptor and socket
covers, signal check, coil/cable (x2),
CO019 ESPrit 3G Speech Processor - Includes speech processor with titanium Cable lengths: 6, 8, 10, 20, 28cm $6,790.00
ear hook, 6 high powered zinc air
batteries, cleaning brush, microphone
puffer, earmould compatible earhook,
soft earhook cover, magnet, drying
capsules, accessory adaptor and socket
covers, signal check, coil/cable (x2),
Prostheses List by Category, Groups and Sponsor with Negotiated Page 38 of 681
EAR, NOSE & THROAT
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Billing Code Product Name Description Size Amount Amount Notations
Pacing Importers Pty Ltd
PI005 Combi C40+ Implantable Auditory One Size Only $11,457.14
Drains, T
Endocorp Pty Ltd
EC013 Campbell Endolymphatic T-Shunt Silicone rubber 0.125 mm dia $97.80
Ear/Nose/Throat Treatment Units
Pacific Medical
PM065 Tympo Vent Otological ventilation tubes, short medium Length 2.2 $12.59
term, Donaldson fluoroplastic/blue
PM066 Tympo Vent Otological ventilation tubes, straight tube Length 7.0 - 7.2mm $7.50
PM068 Tympo Vent Otological ventilation tubes, short medium Length 2.8 $20.73
term, star tube, silicone
PM072 Tympo Vent Otological ventilation tubes, short medium Length 12.4 $13.32
term, shepard with tail, silicone/blue
PM074 Tympo Vent Otological ventilation tubes, paparella Length 2.2mm $17.78
with tab
PM075 Tympo Vent Otological ventilation tubes, collar button, Length 1.5mm $29.84
tubingen type gold, gilded silver
PM079 Tympo Vent Otological ventilation tubes, t-tube Length 6 - 12mm $19.08
PM083 Tympo Vent Otological ventilation tubes, long term, Length 1.5 $26.73
collar button - tubingen type, titanium
PM086 Tympo Vent Otological ventilation tubes, short medium Length 1.6 $50.04
term, reuter bobbin without holes, titanium
PM088 Tympo Vent Otological ventilation tubes, donaldson, Length 1.5mm - 9.8mm $9.00
reuter bobbin, shepard
Prostheses List by Category, Groups and Sponsor with Negotiated Page 39 of 681
EAR, NOSE & THROAT
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Amount/
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Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
PM089 Tympo Vent Otological ventilation tubes, short medium Length 1.8 $10.55
term, bevel bobbin, fluoroplastic/blue
PM090 Tympo Vent Otological ventilation tubes, armstrong Length 3.8 - 10.0mm $13.10
PM091 Tympo Vent Otological ventilation tubes, short medium Length 2.0 $8.62
term, collar button, fluoroplastic/blue
Grafts
Pacific Medical
PM107 Laryngeal Keel 12-16mm Keel $251.00
Hearing Aids
Medtel Australia Pty Ltd
ME176 BAHA - Bone Anchored Hearing Aid - The BAHA Hearing Aids (Compact, $6,800.00 To be claimed only for patients
Various Models Classic 300 & Cordelle II in various with deafness who have
colours) are the external hearing problems using air conduction or
processors which are attached to the conventional hearing aids which
implanted titanium fixture by a snap is made worse when a hearing
coupling. This allows the sound
transmission using bone conduction for
patients where conventional hearing
Larynxes, Artificial
Pacific Medical
PM057 Provox Voice Prosthesis Long term indwelling; Silicone 4.5,6,8,10,12.5mm $281.00 Only able to be claimed once for
the initial implant
Prostheses List by Category, Groups and Sponsor with Negotiated Page 40 of 681
EAR, NOSE & THROAT
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Billing Code Product Name Description Size Amount Amount Notations
Middle Ear Analyzers
Medtronic Australasia Pty Ltd
MC256 Pressure Pulse Generator Meniett 20 Composition - Polycarbonate One size only $5,000.00 To be claimed only where
medical therapy such as lifestyle
(general health assessment and
stress reduction) and oral
medications (diuretics, anti-
emetics, anti-vertigo and
Nasal Septum Buttons
Gyrus Australasia Pty Ltd
GY018 Septal Button Plastipore One size only $343.02
Medtronic Australasia Pty Ltd
MC264 Septal Button Silicone 3cm $123.00
Plugs
Medtel Australia Pty Ltd
ME075 BAHA - Bone Anchored Hearing Aids Abutment Snap Coupling 5.5mm $895.00
Prostheses List by Category, Groups and Sponsor with Negotiated Page 41 of 681
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Billing Code Product Name Description Size Amount Amount Notations
Prostheses, Ear
Endocorp Pty Ltd
EC008 Exmoor Middle Ear Prostheses - Causse Consists of three components: a dense Mushroom = 3.0 mm flange dia; $716.00
Universal HA Prosthesis hydroxylapatite white mushroom; a clear 1.5mm length. Clear tube =
teflon tube & a white teflon plug. 20.0mm length x 1.32 dia o.d.
a distal end where stent is crimped to.
BS060 Transhepatic Biliary Permalume Covered Elgiloy (cobalt chromium), permalume 8 x 60mm, 8 x 80mm, 10 x $2,200.00
Wallstent (silicone coating), self expanding, flexible, 40mm, 10 x 60mm, 10 x 80mm
Model numbers: 4356, 4357, 4358, 4359
BS063 Wallstent RP; 7Fr Placehit Wallstent Wallstent TIPS endoprosthesis, wallstent Diameter 6mm - 24mm, Length $1,800.00
biliary endoprosthesis, wallstent iliac 18mm - 90mm
endoprosthesis, wallstent endoprosthesis
tracheobronchial with unistep plus
delivery sytem, 7Fr Placehit Wallstent.
Stent composition - biomedical superalloy
wire, braided in mesh, unistep delivery
system composition - blue polyimid
material, stainless steel
Device Technologies Australia Pty Ltd
DE212 Intracoil Stent Nickel titanium alloy 40 x 4,5,6,7,8 mm $2,018.18
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VASCULAR
Benefit
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Billing Code Product Name Description Size Amount Amount Notations
Endotherapeutics Pty Ltd
ET024 Optimed Tips Sinus Stent Sinus-wave nitinol stent 10-12mm x 50-90 mm $6,000.00
ET025 Optimed Iliac Sinus Stent Sinus-wave nitinol stent 4-12mm x 30-100mm $2,800.00
ET026 Optimed Femoral Sinus Stent Sinus-wave nitinol stent 4-12mm x 30-100mm $2,800.00
ET030 Aspire Covered Stent Expandible Nitinol Stent covered with Dia 6-14mm, Length 2.5-10cm $4,911.11
ET037 SX-Ella Endovascular Stent Uncovered, self-expanding nitinol stent Dia 6-16mm, length 22-77mm $3,500.00
Five Corners Pty Ltd
FC001 Endoluminal Stent Graft and Delivery Multiple sizes of stent graft on pre-loaded Dia 15-27mm, Length 87- $9,950.00
catheter shaft for delivery and
deployment, comprised of Pet & Nitinol
Guidant Australia Pty Ltd
GU058 Dynalink Peripheral Self Expanding Stent - Lengths 80cm and 120cm, Sizes $1,600.00
System range from 5mm x 28mm to
10mm x 56mm
Johnson & Johnson Medical Pty Ltd
JJ057 Palmaz Balloon Expandable Stent Stainless steel stent Diameter 4-12mm, length 20- $1,488.20
JJ058 Palmaz Balloon Expandable Stent Stainless steel stent Extra-large $1,751.00
JJ059 Palmaz Balloon Expandable Stent Corinthian stainless steel stent Diameter 4-10mm; Length 12 - $1,491.33
79 mm
JJ063 Smart Peripheral Stent System Nitinol vascular stent 6 - 14 mm $1,854.00
JJ064 Duo Via Main Endograft Leg and Delivery Nitinol abdominal aortic aneurysm device 13F, 16-28 mm $2,163.00
System leg extension
JJ065 Duo Via Bioseal and Delivery System Nitinol abdominal aortic aneurysm device 13F, 16-28 mm $1,648.00
JJ068 SMART .018" Peripheral Stent System Nitinol carotid stent and delivery system 6 - 10 mm $2,163.00
JJ069 Palmaz Corinthian IQ Peripheral Stent Stainless steel hypotube stent 12 - 80 mm $1,648.00
JJ230 Palmaz Corinthian IQ Peripheral Stent and Laser cut from 316L stainless steel Corinthian IQ M3 (available in $2,317.50
Delivery System hypotube. Cells connected by omega 15 and 18mm stent diameteres)
shaped hinges. Stent mounted on a rapid mounted on 5 - 7 mm rapid
exchange balloon, a very low profile .014 exchange balloon.
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Billing Code Product Name Description Size Amount Amount Notations
JJ235 SMART Peripheral stent system Laser cut nitinol tube. Available in long Dia 6 - 8mm, length 120mm $1,905.50
stents to treat large vessel lesions.
JJ236 SMART Peripheral stent system Laser cut nitinol tube. Added to the stent Dia 6 - 10mm, length 26, 40, $2,317.50
ends are Tantalum Micromarkers for 60, 80mm. Delivery system 80
enhanced radiopacity and 120 SDS
JJ304 Palmaz Genesis Peripheral Stent and Stainless steel balloon expandable stent Diameter 4-8mm, length 12- $1,957.00
Delivery System on Slalom mounted on a slalom balloon
JJ305 Palmaz Genesis Peripheral Stent and Stainless steel balloon expandable stent Diameter 4-8mm, length 12- $1,956.19
Delivery System on Opta Pro mounted on an Opta Pro Balloon
JJ306 Palmaz Genesis Peripheral Stent Stainless steel peripheral stent Diameter 4-12mm, length 11- $1,674.88
JJ419 SMART Control Peripheral Stent System SMART Control is a laser cut nitinol self Dia 6-10mm; Length 20, 40, 60, $2,400.00
expanding stent, used to treat peripheral 80, 100mm
vessel disease.
Medtronic Australasia Pty Ltd
MC143 Medtronic Stents, Sterile Medtronic AneuRx Aortic / Illiac Stent - 20-28mm x 12-16mm x 13- $12,839.75
Nitinol / Polyester:
MC145 Medtronic Aust Stents, Sterile Medtronic AneuRx Aortic or Iliac Cuff 12-16mm x 5.5/8.5/11.5mm, $3,000.00
Stent - Nitinol / Polyester. 20-28mm x 3.75mm
MC146 Medtronic Sterile Stents; Carotid Self Stainless Steel Carotid Stent - Nitinol, Bridge Assurant Stents - $2,176.82
Expanding Stent Delivery System; Bridge Stainless Steel Flexible Iliac Bridge Stents, Diameter (6mm-10mm), Length
SE-Self Expanding Stents, Bridge Stainless Steel Extra Support Renal Plus (20mm-60mm); Bridge X3
Assurant Stents, Bridge X3 Stents, Bridge Bridge Stent or S/Steel Bridge - Nitinol, Stents - Diameter (5mm-7mm),
Stents, Aurora Stents; Exponent RX Self Stainless Steel Bridge Assurant Stents, Length (17mm); Bridge Stents -
Expanding Carotid Stent System Stainless Steel Bridge X3 Stents, Stainless Diameter (5mm-7mm), Length
Steel Bridge Stents, Aurora Stents - (9mm-16mm); Bridge SE Stents
Nitinol; Exponent RX Self Expanding - Diameter (6mm-10mm),
Carotid Stent System - Nitinol Length (20mm-80mm); Aurora
Stents - Diameter (6mm-
10mm), Length (20mm -
80mm); Exponent RX Self
Expanding Caraotid Stent
System - Diameter (6mm -
10mm), Length (20mm -
Prostheses List by Category, Groups and Sponsor with Negotiated Page 676 of 681
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
MC147 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Bifurcated 22-32 x 12-16 x 145mm, 20-36 $11,128.25
System. Nitinol / Polyester or Talent x 10-20 x 155-170mm
Endoluminal stent-graft system Aorto Uni
Iliac
MC148 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Bifurcated 18-36 x 8-18 x 140-170mm $12,094.67
System. Nitinol / Polyester
MC150 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Bifurcated 16-50mm $12,706.80
System. Nitinol / Polyester, FreeFlow /
Open Web. Custom Sizing
MC152 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Straight 50-180mm $8,549.83
Abdominal Aortic Custom System.
Nitinol / Polyester, FreeFlow/Open Web.
Custom Sizing
MC153 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Aorto- 16-50mm $12,859.75
Unilliac Tapered Custom System. Nitinol
/ Polyester. Custom Sizing
MC155 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft 50-180mm $10,706.42
Descending Thoracic Aortic Custom
System. Nitinol / Polyester, FreeFlow /
Open Web. Custom Sizing
MC157 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Trombone 16-50mm $14,926.42
Aortic Custom System. Nitinol /
Polyester. Free Flo/Open Web. Custom
MC158 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 18 - 36mm x 28 - 32mm long $3,642.50
Nitinol / Polyester (60mm)
MC159 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 26 - 46mm x 80 - 90mm $4,822.67
Nitinol / Polyester; Talent Endoluminal
Stent Graft System FreeFlow, Open
Web. Nitinol / Polyester
MC160 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 8-26mm x 75-200mm $3,856.00
Nitinol / Polyester. Open Web
MC164 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 11-12cm $3,937.67
Nitinol / Polyester. Open-web.
Prostheses List by Category, Groups and Sponsor with Negotiated Page 677 of 681
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
MC165 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 13-14cm $4,365.00
Nitinol / Polyester. Open-web.
MC166 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 5-6cm $4,130.50
Nitinol / Polyester. One bare spring.
MC167 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 7-8cm $4,719.17
Nitinol / Polyester. One bare spring.
MC168 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 9-10cm $5,312.00
Nitinol / Polyester. One bare spring.
MC169 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 11-12cm $5,906.42
Nitinol / Polyester. One bare spring.
MC170 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 5-6cm $4,269.92
Nitinol / Polyester. Two bare spring.
MC171 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 7-8cm $4,857.83
Nitinol / Polyester. Two bare spring.
MC172 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 9-10cm $5,452.17
Nitinol / Polyester. Two bare spring.
MC173 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System 11-12cm $6,040.08
Nitinol / Polyester. Two bare spring.
MC199 Talent Occluder System Nitinol stents attached to polyester graft Custom Sizes ranging from 5 - $2,096.58
sealed both ends 20mm x 25 - 50mm
MC203 Talent Occluder System Nitinol stents attached to polyester graft Standard Sizes, 8 - 24mm x 31 - $2,106.50
sealed both ends 35mm
MC205 Cerebrence Over-the-Wire Neurovascular Stainless Steel 2.5-4mm x 6-25mm $1,642.91
Stent System
MC206 Medtronic Aust Stents Sterile Talent thoracic stent graft system, 22-46mm x 22-46mm x 130mm $11,055.50
FreeFlow / Open Web, bare spring,
Pacing Importers Pty Ltd
PI004 Stentself Stent Phynox construction, adapted sizes & Dia 5 - 9mm Length: 20 - 100mm $2,900.00
diameters
Terumo Corporation Australia
TU005 Anaconda Endovascular Graft System Iliac Leg, Polyester/Nitinol 8 - 16mm $15.00
Prostheses List by Category, Groups and Sponsor with Negotiated Page 678 of 681
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
W L Gore & Associates
GT024 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - 23-28.5mm Diameter, 14-18cm $7,440.00
Trunk - Ipsilateral Leg Length
GT029 Gore Tips Endoprosthesis ePTFE 8-12mm Diameter 4-8cm Graft- $4,120.00
Lined Length 2cm Unlined Length
GT188 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Diameter 12 - 14.5mm x 10 x $5,300.00
Contralateral Leg 14cm Length
GT189 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Diameter 23 - 28.5mm, Length $3,100.00
Aortic Extender 3.3cm
GT190 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Diameter 10 - 14.5mm, Length $3,700.00
Iliac Extender
GT191 Excluder Endovascular Prostheses Thoracic Stent Graft Nitinol & ePTFE Diameter 26-40mm x 10cm $13,400.00
William A Cook Aust Pty Ltd
WC041 Zenith AAA Endovascular Graft - Custom AAA Bifurcate Graft Neck 20-32mm Length 74- $3,500.00
Craft
WC042 Zenith AAA Endovascular Graft - Custom AAA Aorto Uni Iliac (AUI) Graft Neck 20-32mm Length 74- $9,809.00
Craft
WC045 Cook H & L-B - Endostent Converter Diameter 20 thru 36 Length 80- $772.50
WC047 Cook H & L-B - Endostent Leg Extensions Diameter 18 thru 24 Length 55 $2,610.14
WC048 Cook H & L-B - Endostent Body Extensions Diameter 22 thru 36 $2,597.19
WC049 Cook H & L-B - Endostent - Tri-Fab Body Extension Diameter 22-32 mm Length $4,635.00
112-239mm
WC051 Cook H & L-B - Endostent - Tri-Fab Leg Extension Diameter 10-12 Length 36-71 $2,663.30
WC052 Zenith AAA Endovascular Graft - Tri-fab AAA Tri-fab Graft Neck 22-32mm Length 112- $9,767.00
WC055 Peripheral Vascular Stent (ZA Stent); Vascular Stent Introducer Catheter Length 60 - $1,458.69
Zilver Stent 80 cm, Diameter 6 - 10 mm,
Length 1 - 8cm
WC168 Zilver Stent Vascular Design Zilver 5 & 6 5fr and 6fr - 80cm and 120cm , $1,164.38
5mm to 12mm diameter, 2cm
to 8cm length
Prostheses List by Category, Groups and Sponsor with Negotiated Page 679 of 681
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
WC175 Cook Z Stent Gianturco Vena Caval and Venous Design Double Stent - 20, 30, 40mm $1,195.00
Diameters, 50mm Length
WC176 Cook Z Stent Gianturco Vena Caval and Venous Design Triple Stent - 20, 30, 40mm $1,474.34
Diameters, 75mm Length
WC189 Cook Z Stent Gianturco Vena Caval and Venous Design Single Stent - 15, 20, 30mm $962.61
diameters; 25mm length
Suture Units, Automatic
Abbott Australasia Pty Ltd
AY016 Perclose Arterial Support and Closure Suture to close femoral artery puncture Closer S - 6-8Fr, Perclose AT - $395.69
sites following diagnostic and 6-8Fr, Prostar 8Fr, Prostar 10Fr
interventional procedures
AY017 Starclose 6 Fr Exchange Sheath, Dilator, 6 Fr $390.00
Guidewire, implantable nitinol clip pre-
mounted on a Clip Applier
Tissue Reconstructive Materials, Solid
W L Gore & Associates
GT012 Soft Tissue Patch ePTFE 1mm Thickness 5 x 10cm $220.00
GT013 Soft Tissue Patch ePTFE 1mm Thickness 10 x 15cm $629.00
GT014 Soft Tissue Patch ePTFE 1mm Thickness 15 x 20cm $1,133.00
GT015 Soft Tissue Patch ePTFE 1mm Thickness 20 x 30cm $2,040.00
GT016 Soft Tissue Patch ePTFE 2mm Thickness 5 x 10cm $350.00
GT017 Soft Tissue Patch ePTFE 2mm Thickness 10 x 15cm $875.00
GT018 Soft Tissue Patch ePTFE 2mm Thickness 15 x 20cm $1,596.00
GT019 Soft Tissue Patch ePTFE 2mm Thickness 20 x 30cm $2,750.00
Prostheses List by Category, Groups and Sponsor with Negotiated Page 680 of 681
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Vascular Prostheses, Human or Animal Origin
Bio Nova International Pty Ltd
BN006 Omniflow II Vascular Prosthesis - AV Access One size only $2,403.00
BN007 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 5cm x 10cm $310.83
BN008 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 10cm x 15cm $775.75
BN009 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 15cm x 20cm $1,403.33
BN010 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 20cm x 30cm $2,466.25
Grand Total: 8134 Records
Prostheses List by Category, Groups and Sponsor with Negotiated Page 681 of 681
PART B - Human Tissues 31 October 2005
CARDIO-THORACIC
Billing Code Facility Benefit
Aortic Valved Conduit Patch
QHV09 Queensland Heart Valve Bank $4,706.00
Heart Valve - Aortic
QHV01 Queensland Heart Valve Bank $4,706.00
RPH01 Royal Perth Hospital $3,833.00
SHV01 Sydney Heart Valve Bank, Darlinghurst NSW $5,350.00
TBV01 Donor Tissue Bank of Victoria $5,663.00
Heart Valve - Pulmonary
QHV02 Queensland Heart Valve Bank $4,706.00
RPH02 Royal Perth Hospital $3,833.00
SHV02 Sydney Heart Valve Bank, Darlinghurst NSW $5,350.00
TBV02 Donor Tissue Bank of Victoria $5,663.00
Mitral Valve Patch
QHV03 Queensland Heart Valve Bank $985.00
Pericardium
TBV50 Donor Tissue Bank of Victoria $421.00
Pericardium Patch
QHV05 Queensland Heart Valve Bank $985.00
Pulmonary Conduit
TBV03 Donor Tissue Bank of Victoria $869.00
Pulmonary Conduit - Large
QHV07 Queensland Heart Valve Bank $985.00
Pulmonary Conduit - Small
QHV06 Queensland Heart Valve Bank $985.00
Pulmonary Valved Conduit For Patch use
QHV08 Queensland Heart Valve Bank $4,706.00
Tricuspid Valve Patch
QHV04 Queensland Heart Valve Bank $985.00
Page 1 of 14
OPHTHALMIC
Billing Code Facility Benefit
Cornea
LEM01 Lions Eye Bank - Melbourne $1,300.00
LEN01 Lions NSW Eye Bank $1,000.00
LEW01 The Lions Eye Bank of WA $1,000.00
QEB01 Queensland Eye Bank $850.00
SAE01 The Eye Bank of SA $840.00
TBV04 Donor Tissue Bank of Victoria $800.00
Cornea For Lamellar
LEN03 Lions NSW Eye Bank $600.00
Cornea for Sclera
LEM02 Lions Eye Bank - Melbourne $150.00
LEN02 Lions NSW Eye Bank $150.00
SAE02 The Eye Bank of SA $60.00
Sclera
QEB02 Queensland Eye Bank $150.00
Sclera (white outer coating of the eyeball)
LEW02 The Lions Eye Bank of WA $100.00
Page 2 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
Achilles Tendon
NBB01 New South Wales Bone Bank $450.00
QBB01 Queensland Bone Bank $1,560.00
TBV05 Donor Tissue Bank of Victoria $864.00
Achilles Tendon with Bone Plug
NBB02 New South Wales Bone Bank $1,015.00
PBT01 Perth Bone & Tissue Bank $1,900.00
TBV06 Donor Tissue Bank of Victoria $1,760.00
Anterior Cruciate Ligament Unit
PBT02 Perth Bone & Tissue Bank $1,600.00
Anterior Tibialis Tendon
PBT46 Perth Bone & Tissue Bank $1,300.00
Autologous Chondrocyte Transplantation
VAP01 Verigen Australia Pty Ltd $9,556.00
Autologous Chondrocytes
MVS22 Institute of Medical & Veterinary Science, SA $9,538.00
VAP03 Verigen Australia Pty Ltd $2,593.00
Autologous Chrondocytes
MUA01 Monash University, Dept of Surgery, Alfred Hospital, Tissue Culture Laboratory $8,694.43
Bone - Chips/cubes 40cc
TBV09 Donor Tissue Bank of Victoria $836.00
Bone - Chips/cubes 80cc
TBV10 Donor Tissue Bank of Victoria $1,590.00
Bone Plug/Dowel - Cancellous
PBT03 Perth Bone & Tissue Bank $275.00
TBV07 Donor Tissue Bank of Victoria $583.00
Bone Plug/Dowel - Tricortical
PBT04 Perth Bone & Tissue Bank $280.00
TBV08 Donor Tissue Bank of Victoria $643.00
Cartilage (costal) segments
Page 3 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
PBT11 Perth Bone & Tissue Bank $300.00
QBB12 Queensland Bone Bank $200.00
TBV17 Donor Tissue Bank of Victoria $335.00
Cartogen, Autologous - Cultured Cartilage
MTE01 Mercy Tissue Engineering Pty Ltd $9,996.00
Cortical Struts (Freeze Dried) 1 strut
QBB02 Queensland Bone Bank $600.00
Cortical Struts (1 strut)
TBV14 Donor Tissue Bank of Victoria $655.00
Cortical Struts (2 struts)
TBV13 Donor Tissue Bank of Victoria $1,310.00
Cortical Struts >15cm
PBT07 Perth Bone & Tissue Bank $1,700.00
Cortical Struts 10-15cm
PBT06 Perth Bone & Tissue Bank $1,350.00
Cortico - Cancellous Freeze Dried 20g
QBB03 Queensland Bone Bank $1,740.00
Cortico-Cancellous Strips
PBT05 Perth Bone & Tissue Bank $700.00
Disc - Freeze Dried
QBB04 Queensland Bone Bank $650.00
Dowel Plug
NBB05 New South Wales Bone Bank $797.00
PBT12 Perth Bone & Tissue Bank $450.00
QBB13 Queensland Bone Bank $1,080.00
Elbow - joint
QBB14 Queensland Bone Bank $2,100.00
TBV18 Donor Tissue Bank of Victoria $4,710.00
Fascia Lata
TBV21 Donor Tissue Bank of Victoria $578.00
Page 4 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
Fascia Lata - Large (15cm x 10cm)
PBT15 Perth Bone & Tissue Bank $1,300.00
Fascia Lata - Small (>10cm x >5cm)
NBB09 New South Wales Bone Bank $464.00
Fascia Lata - Small (10cm x 5cm)
PBT16 Perth Bone & Tissue Bank $800.00
Fascia Lata (per sq cm)
QBB11 Queensland Bone Bank $5.00
Fascia Lata (per squared cm)
NBB08 New South Wales Bone Bank $3.00
Femoral Condyle
PBT21 Perth Bone & Tissue Bank $1,700.00
Femoral Head
ACT01 ACT Bone Bank $1,591.00
APH01 The Avenue Private Hospital Prahan Victoria $1,131.00
CSA01 Central Sydney Area Health t/a Rachel Forster Bone Bank $802.00
DHR01 The Douglas Hocking Research Institute - Bone Bank $1,060.00
HBB01 The Hobart Private Hospital Bone Bank $1,400.00
LPH01 Lingard Private Hospital $1,103.00
MMH01 Mater Misericordiae Hospital North Sydney $400.00
MVS05 Institute of Medical & Veterinary Science, SA $1,595.00
NBB16 New South Wales Bone Bank $1,483.00
PBT22 Perth Bone & Tissue Bank $1,700.00
QBB27 Queensland Bone Bank $1,775.00
RNB01 The Royal Newcastle Hospital Bone Bank $1,619.00
SVN01 St Vincent's Private Hospital (NSW) $731.00
TBV26 Donor Tissue Bank of Victoria $1,683.00
Femoral Head - Half (Freeze Dried)
QBB29 Queensland Bone Bank $500.00
Femoral Head - Portion
Page 5 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
PBT23 Perth Bone & Tissue Bank $450.00
Femoral Head - Whole (Freeze Dried)
QBB28 Queensland Bone Bank $800.00
Femoral Rings
NBB17 New South Wales Bone Bank $362.50
PBT24 Perth Bone & Tissue Bank $1,400.00
QBB30 Queensland Bone Bank $1,260.00
Femoral Rings - (Freeze Dried)
QBB31 Queensland Bone Bank $650.00
Femoral/Tibial Cortical Strut > 20CM
PBT48 Perth Bone & Tissue Bank $1,900.00
Femur - > 15cm
QBB19 Queensland Bone Bank $1,460.00
Femur - Cortical Portions < 15cm
QBB17 Queensland Bone Bank $1,560.00
Femur - Cortical portions> 1/3
QBB18 Queensland Bone Bank $1,100.00
Femur - Distal (Shaft & Condyles)
MVS02 Institute of Medical & Veterinary Science, SA $2,290.00
PBT17 Perth Bone & Tissue Bank $2,600.00
TBV22 Donor Tissue Bank of Victoria $2,736.00
Femur - Distal Half
NBB10 New South Wales Bone Bank $2,030.00
Femur - Distal half > 15cm
QBB20 Queensland Bone Bank $2,370.00
Femur - Distal third
NBB11 New South Wales Bone Bank $1,100.00
Femur - Distal third < 15cm
QBB21 Queensland Bone Bank $2,270.00
Femur - Entire
Page 6 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
MVS03 Institute of Medical & Veterinary Science, SA $2,290.00
NBB12 New South Wales Bone Bank $3,915.00
PBT18 Perth Bone & Tissue Bank $4,600.00
QBB22 Queensland Bone Bank $3,685.00
TBV23 Donor Tissue Bank of Victoria $5,539.00
Femur - Middle third
NBB13 New South Wales Bone Bank $1,100.00
PBT19 Perth Bone & Tissue Bank $2,200.00
QBB23 Queensland Bone Bank $1,865.00
TBV24 Donor Tissue Bank of Victoria $1,804.00
Femur - Proximal (shaft,trochanter, neck)
PBT20 Perth Bone & Tissue Bank $2,600.00
TBV25 Donor Tissue Bank of Victoria $2,736.00
Femur - Proximal (shaft & trachanter, neck)
MVS04 Institute of Medical & Veterinary Science, SA $2,290.00
Femur - Proximal half
NBB15 New South Wales Bone Bank $1,740.00
Femur - Proximal half > 15cm
QBB25 Queensland Bone Bank $2,570.00
Femur - Proximal third
NBB14 New South Wales Bone Bank $1,000.00
Femur - Proximal third < 15cm
QBB24 Queensland Bone Bank $2,120.00
Femur - Trochanter Milled
QBB26 Queensland Bone Bank $800.00
Femur- 1 Condyle only
TBV46 Donor Tissue Bank of Victoria $1,018.00
Femur-Proximal(Shaft, trochanter, neck and head)
TBV51 Donor Tissue Bank of Victoria $3,185.00
Fibula - Entire
Page 7 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
MVS07 Institute of Medical & Veterinary Science, SA $2,290.00
NBB18 New South Wales Bone Bank $2,610.00
PBT25 Perth Bone & Tissue Bank $1,950.00
QBB32 Queensland Bone Bank $2,220.00
TBV27 Donor Tissue Bank of Victoria $5,775.00
Fibula - Segment (12cm)
MVS14 Institute of Medical & Veterinary Science, SA $2,290.00
NBB20 New South Wales Bone Bank $450.00
PBT27 Perth Bone & Tissue Bank $500.00
TBV29 Donor Tissue Bank of Victoria $891.00
Fibula - Segment (6cm)
MVS13 Institute of Medical & Veterinary Science, SA $2,290.00
NBB19 New South Wales Bone Bank $300.00
PBT26 Perth Bone & Tissue Bank $275.00
TBV28 Donor Tissue Bank of Victoria $583.00
Fibula - Shaft
PBT28 Perth Bone & Tissue Bank $1,000.00
TBV30 Donor Tissue Bank of Victoria $1,881.00
Fibular Strut < 10cm:
QBB06 Queensland Bone Bank $1,210.00
Fibular Strut > 10cm:
QBB07 Queensland Bone Bank $1,335.00
Freeze Dried Milled Bone <30gm
PBT37 Perth Bone & Tissue Bank $750.00
Freeze Dried Milled Bone 30 - 50gm
PBT38 Perth Bone & Tissue Bank $900.00
Freeze-dried Cancellous Cubes (6)
QBB09 Queensland Bone Bank $1,335.00
Freeze-Dried Cancellous Strips (2)
QBB10 Queensland Bone Bank $650.00
Page 8 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
Hemipelvis - Acetabulum
NBB21 New South Wales Bone Bank $2,030.00
PBT29 Perth Bone & Tissue Bank $2,400.00
QBB33 Queensland Bone Bank $2,320.00
TBV31 Donor Tissue Bank of Victoria $2,568.00
Hemipelvis - Complete
MVS08 Institute of Medical & Veterinary Science, SA $2,290.00
NBB24 New South Wales Bone Bank $3,480.00
PBT30 Perth Bone & Tissue Bank $4,500.00
QBB37 Queensland Bone Bank $3,685.00
TBV32 Donor Tissue Bank of Victoria $5,825.00
Hemipelvis - IIliac crest
NBB22 New South Wales Bone Bank $1,450.00
PBT31 Perth Bone & Tissue Bank $1,100.00
QBB34 Queensland Bone Bank $2,060.00
TBV33 Donor Tissue Bank of Victoria $2,321.00
Hemipelvis - Tricortical wedge
QBB35 Queensland Bone Bank $1,005.00
Hemipelvis - Tricortical wedge (Freeze Dried)
QBB36 Queensland Bone Bank $700.00
Hemipelvis -Tricortical iliac wedge
NBB23 New South Wales Bone Bank $580.00
PBT32 Perth Bone & Tissue Bank $600.00
TBV34 Donor Tissue Bank of Victoria $880.00
Humeral head
PBT36 Perth Bone & Tissue Bank $500.00
QBB44 Queensland Bone Bank $1,350.00
TBV37 Donor Tissue Bank of Victoria $1,419.00
Humeral Head Addition
NBB26 New South Wales Bone Bank $1,189.00
Page 9 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
Humerus - Cortical portions/blocks < 10cm
QBB38 Queensland Bone Bank $1,110.00
Humerus - Cortical portions/blocks > 10cm
QBB39 Queensland Bone Bank $1,330.00
Humerus - Distal
MVS19 Institute of Medical & Veterinary Science, SA $2,290.00
TBV49 Donor Tissue Bank of Victoria $1,892.00
Humerus - Distal half
NBB25 New South Wales Bone Bank $1,200.00
Humerus - Entire
MVS20 Institute of Medical & Veterinary Science, SA $2,290.00
NBB29 New South Wales Bone Bank $2,610.00
QBB43 Queensland Bone Bank $2,570.00
Humerus - Proximal half
NBB27 New South Wales Bone Bank $1,595.00
QBB40 Queensland Bone Bank $1,260.00
Humerus - Proximal half with rotator cuff
NBB28 New South Wales Bone Bank $1,885.00
QBB41 Queensland Bone Bank $2,245.00
Humerus - Proximal with rotator cuff
MVS09 Institute of Medical & Veterinary Science, SA $2,290.00
PBT34 Perth Bone & Tissue Bank $2,500.00
TBV35 Donor Tissue Bank of Victoria $2,233.00
Humerus - Proximal w'out rotator cuff
PBT35 Perth Bone & Tissue Bank $1,100.00
QBB42 Queensland Bone Bank $1,260.00
TBV36 Donor Tissue Bank of Victoria $1,980.00
Humerus - Whole
PBT33 Perth Bone & Tissue Bank $3,000.00
Humerus - Whole with rotator cuff
Page 10 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
NBB30 New South Wales Bone Bank $2,827.50
Matrix and Autologous Chondrocytes Implant
ORT01 Orthogen Australia Pty Ltd $11,400.00
Medial Ligament
NBB31 New South Wales Bone Bank $797.50
TBV38 Donor Tissue Bank of Victoria $1,529.00
Meniscal Graft
PBT47 Perth Bone & Tissue Bank $1,800.00
Meniscus
QBB05 Queensland Bone Bank $1,160.00
Meniscus with Ligaments
TBV39 Donor Tissue Bank of Victoria $1,842.00
Meniscus without Ligaments
TBV40 Donor Tissue Bank of Victoria $1,000.00
Milled Bone - 30gm
NBB03 New South Wales Bone Bank $435.00
Milled Bone - 40cc
TBV11 Donor Tissue Bank of Victoria $1,000.00
Milled Bone - 60gm
NBB04 New South Wales Bone Bank $725.00
Milled Bone - 80cc
TBV12 Donor Tissue Bank of Victoria $1,788.00
Milled Bone (60cc)
QBB45 Queensland Bone Bank $1,675.00
Milled Bone (60g max)
QBB46 Queensland Bone Bank $1,200.00
Milled Bone <30gr
PBT08 Perth Bone & Tissue Bank $1,350.00
Milled Bone >50gr
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ORTHOPAEDIC
Billing Code Facility Benefit
PBT10 Perth Bone & Tissue Bank $2,000.00
Milled Bone 30 - 50gr
PBT09 Perth Bone & Tissue Bank $1,800.00
Milled Bone 40cc
TBV15 Donor Tissue Bank of Victoria $760.00
Milled Bone 80cc
TBV16 Donor Tissue Bank of Victoria $1,445.00
Patella
NBB32 New South Wales Bone Bank $450.00
QBB47 Queensland Bone Bank $750.00
TBV41 Donor Tissue Bank of Victoria $875.00
Patella Half
PBT39 Perth Bone & Tissue Bank $275.00
Patella tendon
QBB48 Queensland Bone Bank $1,715.00
Patella Tendon and Patella
PBT40 Perth Bone & Tissue Bank $1,900.00
TBV42 Donor Tissue Bank of Victoria $1,842.00
Patella tendon with Bone Plugs
NBB33 New South Wales Bone Bank $1,305.00
Primary MACI plus 1/2
VAP02 Verigen Australia Pty Ltd $10,891.00
Proximal Third Tibia with - Patella Tendon
QBB08 Queensland Bone Bank $2,370.00
Radius
MVS18 Institute of Medical & Veterinary Science, SA $2,290.00
NBB06 New South Wales Bone Bank $2,175.00
PBT13 Perth Bone & Tissue Bank $1,800.00
QBB15 Queensland Bone Bank $1,865.00
TBV19 Donor Tissue Bank of Victoria $2,673.00
Page 12 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
Rib (5cm)
MVS21 Institute of Medical & Veterinary Science, SA $382.00
PBT41 Perth Bone & Tissue Bank $300.00
TBV43 Donor Tissue Bank of Victoria $418.00
Scaphoid
QBB49 Queensland Bone Bank $900.00
Tibia - Condyles only
TBV47 Donor Tissue Bank of Victoria $1,425.00
Tibia - Cortical < 15cm
QBB50 Queensland Bone Bank $1,275.00
Tibia - Cortical > 15 cm
QBB51 Queensland Bone Bank $1,560.00
Tibia - Distal
MVS17 Institute of Medical & Veterinary Science, SA $2,290.00
TBV48 Donor Tissue Bank of Victoria $1,837.00
Tibia - Middle third seg
NBB34 New South Wales Bone Bank $1,000.00
PBT43 Perth Bone & Tissue Bank $1,100.00
QBB53 Queensland Bone Bank $900.00
Tibia - Plateau (prox 1/3)
NBB35 New South Wales Bone Bank $1,595.00
Tibia - Proximal third < 15cm
QBB54 Queensland Bone Bank $2,065.00
Tibia - Proximal: without Patella
PBT45 Perth Bone & Tissue Bank $1,100.00
Tibia - Proximal: 16-25cm
TBV45 Donor Tissue Bank of Victoria $2,118.00
Tibia - Proximal: 7-15cm
TBV44 Donor Tissue Bank of Victoria $1,832.00
Tibia - Proximal: half
Page 13 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
MVS11 Institute of Medical & Veterinary Science, SA $2,290.00
NBB36 New South Wales Bone Bank $1,885.00
Tibia - Proximal: with Patella & Tendon
PBT44 Perth Bone & Tissue Bank $1,900.00
Tibia - Strut
PBT42 Perth Bone & Tissue Bank $700.00
QBB52 Queensland Bone Bank $400.00
Tibia - Whole
MVS16 Institute of Medical & Veterinary Science, SA $2,290.00
NBB37 New South Wales Bone Bank $3,480.00
QBB55 Queensland Bone Bank $3,685.00
Ulna
MVS15 Institute of Medical & Veterinary Science, SA $2,290.00
NBB07 New South Wales Bone Bank $2,175.00
PBT14 Perth Bone & Tissue Bank $1,500.00
QBB16 Queensland Bone Bank $1,865.00
TBV20 Donor Tissue Bank of Victoria $2,464.00
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