National Health Act 1953 Determination made under subsections 73AAG(6) and (7) (HIB 19/2006) (Cth)
Australian Government
NATIONAL HEALTH ACT 1953
Determination made under subsections 73AAG (6) and (7)
(HIB 19/2006)
I, LOUISE CLARKE, Acting Assistant Secretary, Private Health Insurance Branch, delegate of the Minister for Health and Ageing, pursuant to subsections 73AAG (6) and (7) of the National Health Act 1953 (the Act):
REVOKE the determination dated 21 March 2006 (HIB 13/2006);
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; and
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 14 September 2006.
Dated this 28 day of August 2006.
L M Clarke
Louise Clarke
Acting Assistant Secretary
Private Health Insurance Branch
Acute Care Division
Australian Government Department of Health and Ageing
Position No: 01202874
Delegate of the Minister for Health and Ageing
PART A - Prostheses August 2006
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Applier, Surgical, Clip, Haemostatic, Single Use
Medtronic Australasia Pty Ltd
MC680 Spyder Proximal Anastomotic Device 6-clip assembly $590.00
Catheters, Angioplasty, Laser
Pacing Importers Pty Ltd
PI002 Excimer Laser Stent Polyester Fibre optic fibre catheter 0.457mm, 0.9mm, 1.4mm, $6,800.00
1.7mm and 2.0mm
Coronary Stents
Drug Eluting Stents
Boston Scientific Pty Ltd
BS074 Taxus on Express2 Coronary Stent balloon expandable stent with conformal Length 8 - 32mm; Diameter $3,484.00
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
|
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 $3,484.00
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
JJ481 CYPHER SELECT Sirolimus-Eluting Stainless steel coronary stent with Diameter 2.25 - 5.0mm, length $3,350.00
Stent & Delivery System Sirolimus (an immunosuppressive and 8 - 33mm
anti-proliferative drug) bound to the stent
by a polymer. Model CRA-23300, 08225,
08250, 08275, 08300, 28225, 28250,
28275, 28300, 33225, 33250, 33275,
33300, 13225, 13250, 13275, 18225,
18250, 18275, 18300, 23225, 23250,
23275, 23350, 23400, 08350, 08400,
28350, 238400, 33350, 33400, 13300,
13350, 13400, 18350, 18400, 23450,
23500, 28450, 28500, 33450, 33500,
General Purpose Bare Metal Stents
Abbott Australasia Pty Ltd
AY013 JoStent F1 Coronary Stent Stainless Steel 9 - 26 mm x 2.5 - 4 mm $780.00
Atrium Australia-Pacific Rim Pty Ltd
AC022 Flyer RX Coronary Stent System Stainless Steel Coronary Stent Dia 2-5mm, Length 6-40mm $780.00 $1,508.00
Biotronik Australia Pty Ltd
BT058 Lekton Motion Coated flexible stent, Balloon mounted Diameter 2.5mm to 4mm, $1,248.00
Length 8 - 30mm
BT065 Lekton Motion Mega Amorphous silicon carbide coated Diameter 4.5 and 5 mm; Length $1,248.00
13 - 40 mm
Page 2 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
BT069 Lekton Motion Petite Amorphous silicon carbide coated Diameter 2, 2.25, 2.5mm; $1,248.00
Length 8-20mm
Boston Scientific Pty Ltd
BS069 Express 2/Liberte Coronary Stent Consists of a balloon expandable stent, Stent lengths: 8,12,16,20,24,28 $1,248.00
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 &
Guidant Australia Pty Ltd
GU102 Stents ACS Multilink Coronary Stent; ACS 1.5mm - 8.0mm $1,248.00
Megalink Peripheral Stent; ACS RX
Herculink Peripheral Stent. Stainless steel
GU105 Multilink Coronary Stent System Stainless Steel Length 1.5mm - 8.0mm $1,248.00
GU127 Multilink Coronary Stent System - Frontier 316L Stainless steel stent Length 1.5 - 8.0mm $2,496.00
GU128 Multilink Coronary Stent System - Vision Cobalt chrome stent Length 1.5 - 8.0mm $1,248.00
Johnson & Johnson Medical Pty Ltd
JJ026 BX Velocity with Hepacoat System Balloon expandable, stainless steel, $1,220.00
heparin coated
JJ200 BX Velocity Stent and Delivery System Stainless steel stent Diameter: 2.25-5.0 mm; Length $1,220.00
8 - 33 mm
JJ239 BX Sonic Stainless steel coronary stent mounted on Dia 2.25 - 4.0mm, lengths 8 - $1,220.00
a balloon delivery system 33mm
Medtronic Australasia Pty Ltd
MC197 Medtronic AVE S660 Coronary Stents, Stainless Steel S660 Coronary Stent - Diameter $1,144.00
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 - $1,248.00
Stent System 4.5mm), length (8-30mm);
Micro-Driver Stent: diameter
(2.25 - 2.75mm), length (8 -
Page 3 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Neich Medical Pty Ltd
NM002 Constant Rx Coronary Stent System Stainless Steel Balloon Expandable Lengths - 9-32mm; Diameters - $1,040.00
Tubular Stent 2.5 - 4.0mm
NM003 R Stent Evolution 2 Coronary Delivery 316LVM Stainless Steel Balloon Lengths - 9-33mm; Diameters - $1,144.00
System Expandable Stent (Tubular) 2.5-4.0mm
Pacing Importers Pty Ltd
PI003 Med-X-Flexy Stent Tubular Stent, Stainless steel 316L, Gold Dia 5 - 9mm length: 20 - $780.00
markers
Terumo Corporation Australia
TU001 Tsunami Gold Coronary Stent Stainless Steel mounted on balloon Diameter 2.0mm - 4.0mm, $1,248.00
Length 10mm - 30mm length
Zynergy Medical Pty Limited
ZY001 Carbostent Coronary stent - includes Carbostent Dia 2.5mm x Length 9, 12, 15, $780.00 $1,482.00
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 $3,222.00
Boston Scientific Pty Ltd
BS067 Symbiot Covered Stent System A self-expending nitinol stent encased Stent lengths: 20, 31 & 45 mm $1,248.00
within an ePTFE covering, premounted Stent diameters: 4.0 & 5.0 mm
on a Monorail delivery catheter
Page 4 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
CRT Pacemakers
Generation 1
Guidant Australia Pty Ltd
GU143 Contak Renewal TR CRT -P Model Implantable cardiac pacemaker 45x54x8.5mm, 14cc, 26gm $9,360.00
H120, Model H125
Medtronic Australasia Pty Ltd
MC006 InSync model 8040 Stimulator Titanium 14.4cc $9,360.00
St. Jude Medical Australia Pty Ltd
SJ040 Frontier 3x2 Model 5510 Biventricular Stimulation Device with AF Height 48mm, Length 52mm, $9,360.00
suppression Depth 6mm
Generation 2
Biotronik Australia Pty Ltd
BT056 Stratos LV Multiprogrammable, Biventricular, DDDRV One size only $12,480.00
Guidant Australia Pty Ltd
GU142 Contak Renewal TR2 CRT - P Model Implantable Cardiac pacemaker 45x54x8.5mm, 14cc, 26gm $12,480.00
H140, Model H145
Medtronic Australasia Pty Ltd
MC226 Medtronic Insync III Triple Chamber Titanium One size only $12,480.00
Pacemaker Model 8042
St. Jude Medical Australia Pty Ltd
SJ072 Frontier II - Model 5596 Biventricular Cardiac Resynchronisation 49mm(h) x 52(1) x 6(t), 25g $12,480.00
Device with AF suppression algorithm -
Titanum
Page 5 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Dual Chamber ICDs
Generation 2
Medtronic Australasia Pty Ltd
MC202 Medtronic Gem III DR Model 7275 Titanium One size only, 39.5cc $38,480.00
Implantable Cardioverter Defibrillator
Progressive Medical
PG004 Alto II DR Dual Chamber Implantable One size only $38,480.00
Cardioverter Defibrillator
St. Jude Medical Australia Pty Ltd
SJ009 Photon Micro DR Model V-232 37cc $38,480.00
Defibrillators/Cardioverters
Generation 3
Biotronik Australia Pty Ltd
BT053 Lexos DR Dual chamber ICD, rate responsive One size only. $43,680.00
Guidant Australia Pty Ltd
GU111 Ventak Prizm II DR Model 1861, titanium, dual chamber, One size only $43,680.00
adaptive rate
GU132 Vitality DR Model 1871 This device acts to defibrillate the heart Model 1871 Vitality DR Dual $43,680.00
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 $43,680.00
GU150 Vitality 2 EL DR - Model T167 Implantable cardiac Defibrillator 35cc ; 90g $43,680.00
Medtronic Australasia Pty Ltd
MC245 Marquis DR Model 7274 Implantable Titanium 36cc $43,680.00
Cardioverter Defibrillator
Page 6 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
MC358 Intrinsic Model 7287, Implantable Cardioverter 36cc, 75g $43,680.00
Defibrillator
MC363 EnTrust Model D153DRG, Dual chamber, VT 33cc, 63g $43,680.00
Therapies, 30J 33cc, 63g
St. Jude Medical Australia Pty Ltd
SJ049 Epic Plus DR Model V-236 Implantable Dual Chamber sensing, bradycardia 33cc $43,680.00
Cardioverter Defibrillator pacing with atrial fibrillation suppression
SJ070 Epic + DR Model V-233 ICD Dual Chamber Implantable Cardio-verter 33cc 70g $43,680.00
Defibrillator
SJ071 Epic + DR Model V-239 ICD Dual chamber implantable cardio-verter 33cc 70g $43,680.00
defibrillator
Dual Chamber ICDs with CRT
Generation 1
Medtronic Australasia Pty Ltd
MC252 Medtronic InSync Marquis Implantable Titanium Volume 38cc $40,560.00
Cardioverter Defibrillator Model 7277
Generation 2
Guidant Australia Pty Ltd
GU134 Contak Renewal 2 This device acts to defibrillate the heart One Size Only $45,760.00
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 biventricular
GU147 Contak Renewal 4 CRT-D Model H190, Implantable dual-chamber defibrillator One size only $45,760.00
Model H195
Medtronic Australasia Pty Ltd
MC306 InSync III Marquis Model 7279 Titanium One size only - Volume 38cc $45,760.00
Page 7 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
St. Jude Medical Australia Pty Ltd
SJ062 Epic HF Model V-339 Implantable Cardioverter/defibrillator with dual One size only $45,630.00
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 $45,760.00
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 $5,200.00
Pacemaker responsive modes, DDDC
Guidant Australia Pty Ltd
GU079 Pulsar Model VDD 870 Titanium 3.2mm/IS-1 $5,200.00
St. Jude Medical Australia Pty Ltd
SJ050 Verity ADx Model XL DC 5256 Dual - Dual Chamber multi-programmable rate- 11cc, 23.5g $5,200.00
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 $5,200.00
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 $6,760.00
Pacemaker responsive, VDDR
Medtronic Australasia Pty Ltd
MC243 Medtronic Kappa KVDD 900 Model Cardiac Pacemaker, Titanium 11.1cc $6,552.00
KVDD 901
Page 8 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
MC319 EnPulse VDD; Model E2VDD01 EnPulse VDD pacemaker with IS1 One size only $6,760.00
connector. Titanium silicone
St. Jude Medical Australia Pty Ltd
SJ054 Identity ADx Model VDR 5480 Single Chamber multi-programmable rate- 8cc, 18g $6,760.00
implantable pacemaker adaptive pacing device with extended
longevity
SJ057 Verity ADx Model XL VDR 5456 Single Chamber multi-programmable rate- 11cc, 23.5g $6,760.00
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 $9,360.00
Pacemaker
BT029 Philos DR-A Model 122600 Implantable Multiprogrammable, rate responsive, 5mm ports, One size only $9,360.00
Pacemaker
BT047 Protos DR/CLS Dual chamber, rate responsive, closed One size only. $9,360.00
loop system.
BT060 Philos II DR Multiprogrammable, rate responsive, One size only $9,360.00
BT071 Philos II DR-T Dual Chamber Rate Responsive with One size only $9,000.00 $10,000.00
Home Monitoring
Guidant Australia Pty Ltd
GU120 Insignia Plus DR Model 1297, Insignia Dual Chamber Rate Responsive One size only $9,360.00
Plus DR Model 1298 Permanent Pacemaker
GU121 Insignia Entra DR Models Dual Chamber Rate Responsive One size only $9,360.00
Permanent Pacemaker
GU140 Insignia Ultra DR Model 1291 Implantable Cardiac Pacemaker One size only $9,360.00
GU141 Insignia Ultra DR Model 1290 Implantable Cardiac Pacemaker One size only $9,360.00
Medtronic Australasia Pty Ltd
MC029 Medtronic Kappa 400 pacemaker Model Titanium 13.9cc $9,048.00
KDR401
Page 9 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
MC333 Medtronic Kappa Pacemaker Model KDR Cardiac Pacemaker, Titanium 12.1cc, 11.1cc, 13.1cc $9,048.00
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 $9,360.00
PG005 Symphony DR 2550 Active Implantable pacemaker 1 size only $9,360.00
St. Jude Medical Australia Pty Ltd
SJ026 St Jude Medical Integrity AFX DR5346 Dual chamber, rate responsive pacemaker Volume 11cc, weight 23.5gm $9,360.00
Pacemaker, Cardiac, Implantable
SJ028 Integrity Micro DR 5336 Pacemaker Dual Chamber Rate Responsive Volume 8cc, Weight 18gm $9,360.00
SJ031 Identity XL DR 5376 Dual Chamber Rate Responsive Volume 11cc, Weight 23.5gm $9,360.00
SJ032 Identity DR 5370 Dual Chamber Rate Responsive Volume 8cc, Weight 18gm $9,360.00
SJ051 Verity Adx Implantable Pacemaker, Dual - Chamber, multi-programmable, 45x52x6mm,11cc, 23g, 5mm or $9,360.00
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, $9,360.00
DR 5366 responsive pacemaker with AF Model XL DR 5366 - 11cc,
SJ059 Identity ADx Models DR 5380 and XL Dual-Chamber, multi-programmable, rate- ADx DR 5380: 43x44x6mm, $9,360.00
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 $11,440.00
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.
Page 10 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Fixation Device, Internal, Plate
Biomet Australia Pty Ltd
BI930 Sternalock Plates - xyphoid, "L" & square 4 hole $195.00
BI931 Sternalock Plates - "X" & "T" 5-8 hole $300.00
Fixation Device, Internal, Screw
Biomet Australia Pty Ltd
BI929 Sternalock Screws Ti 2.4-2.7mm x 8-12mm $44.00
Grafts, Dura, Biological
Edwards Lifesciences Pty Ltd
EL033 Baxter Augmentation / Substitution Edwards Pericardial Patch. Bovine 10cm x 16cm $740.00
Material, Human or Animal Origin, Sterile Pericardium.
Pericardial Patch.
Grafts, Vascular, Synthetic
Incision Pty Ltd
IP028 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
Page 11 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
IP029 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
IP030 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
IP031 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
IP032 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
IP033 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
Group 1- Cardiothoracic Mechanical Valves
Group 1a - Ball Valve, Standard
Edwards Lifesciences Pty Ltd
EL029 SE SIL Ball Valve Aortic Models Starr Edwards - Silastic Ball Valve. 16mm-34mm $3,850.00
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)
Group 1c - Bi-Leaflet, rotatable
Advanced Biomedical Pty Ltd
AB002 ATS medical open pivot heart valve Pyrolythic Carbon, Double Velour 16-33mm $5,909.00
model 500FA standard flexi-cuff aortic Polyester, Titanium
Page 12 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
AB064 ATS medical open pivot heart valve Pyrolythic Carbon, Double Velour 16-33mm $5,909.00
model 501DM advanced performance Polyester, Titanium
mitral valve series, ATS medical open
pivot heart valve model 501DM advanced
performance aortic valve series, ATS
medical open pivot heart valve model
500DM mitral standard valve series
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;
Tag Medical
TM003 Optiform Mechanical Valve 19mm to 33mm $4,950.00
Group 1e - Tilting Disc, rotatable
Hjorth Health Pty Limited
HH001 Omnicarbon 4000 4313 Aortic UPP Pure pyrolitic carbon mono-leaflet Aortic - Sizes 19mm - 27mm; $5,000.00
prosthetic heart valve Mitral - Sizes 27mm - 33mm
HH002 Omnicarbon 4000 4523 Mitral UPP Pure pyrolitic carbon mono-leaflet Aortic - Sizes 19mm - 27mm; $5,000.00
SupraAnnular prosthetic heart valve Mitral - Sizes 27mm - 33mm
Group 2 - Cardiothoracic Tissue Valves
Group 2a - Stented, porcine
Edwards Lifesciences Pty Ltd
EL030 CE Supra Annular Aortic Valve Model Carpentier-Edwards SAV Bioprosthesis. 19mm-33mm $4,350.00
2650 Carpentier-Edwards S.A.V Composition: Porcine Valve; Elgiloy
Bioprosthesis Model 6650 Mitral Valve Alloy; Silicone Rubber,
Page 13 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Group 2b - Stented, pericardial
Edwards Lifesciences Pty Ltd
EL031 Carpentier-Edwards Perimount Pericardial Carpentier-Edwards Pericardial Models 2900/6900 19-33mm, $5,144.00
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
Group 2c - Non-Stented, porcine
Edwards Lifesciences Pty Ltd
EL032 Baxter Edwards Prima Plus Stentless Edwards Prima Plus. Porcine Valve; 19mm-29mm for pack of 7 items $4,600.00
Bioprosthesis Model 2500P Prosthetic Woven Polyester Cloth.
Heart Valve
Medtronic Australasia Pty Ltd
MC015 Freestyle bioprosthesis Models 995xx, 995MSxx 19 - 35mm $5,110.00
St. Jude Medical Australia Pty Ltd
SJ038 St Jude Medical Toronto SPV Valve Tissue Heart Valves, Bioimplant TSPV: 21 - 29mm, Bioimplant $4,800.00
Model SPA-101, St Jude Medical Aortic: 21-27mm, Bioimplant
Bioimplant Heart Valve Mitral: 27-32mm
Group 3 - Cardiothoracic Valve Conduits
Group 3a - Mechanical Valve
Advanced Biomedical Pty Ltd
AB001 ATS Medical open pivot aortic valved Pyrolythic Carbon, Double Velour 21-33mm $6,800.00
graft model 502AG Polyester, Titanium
Atrium Australia-Pacific Rim Pty Ltd
AC002 Atrium PTFE Vascular Graft Straight PTFE Standard Wall 6mm x 10cm - 10mm x 90cm $1,648.00
Page 14 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Tag Medical
TM002 CarboSeal Ascending Aortic Prosthesis, Mechanical Conduit AP 21-33mm, CP 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,
Carboseal Valsalva
Group 3b - Tissue Valve, stented porcine
Medtronic Australasia Pty Ltd
MC012 Medtronic Hancock Valved Conduit Porcine bioprosthesis, dacron 12, 14, 16, 18, 20, 22, 25, $5,750.00
Model 100/150
Group 4 - Cardiothoracic Atrio-Ventricular Rings and Bands
Group 4a - Ring, Standard
Edwards Lifesciences Pty Ltd
EL028 Baxter Sterile Grafts, Implants & Carpentier-Edwards Classic Annuloplasty 24mm-40mm $2,200.00
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;
Medtronic Australasia Pty Ltd
MC005 Medtronic Duran Annuloplasty Ring; Annuloplasty Devices - Models 610B, Models 610B & 610R 25- $1,900.00
Duran Ancore Ring 620R; Duran Ancore 610R & 620B, 620R Silicone / Barium 35mm, Models 620B & 620R
Chordal Model 620RG & 620BG Sulphate, Dacron. 23-35mm, Model 638B - 26-
38mm, Model 620RG & 620BG
St. Jude Medical Australia Pty Ltd
SJ035 SJM Tailor Annuloplasty Ring Fully Flexible 25mm - 35mm $2,150.00
Page 15 of 758
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
Group 4b - Band, multiplanar
Edwards Lifesciences Pty Ltd
EL049 Edwards Etlogix Annuloplasty Ring Titanium/silicon/dacron polyester 24mm/26mm/28mm/30mm/32m $2,350.00
cloth/plastic template Mitral valve annular m/34mmd
repair device designed specifically for
patients with Ischemic Mitral regurgitation
Group 4b - Ring, multiplanar
Edwards Lifesciences Pty Ltd
EL050 Edwards MC3 Tricuspid Annuloplasty Annuloplasty Ring, 26mm to 36mm in 2mm $2,350.00
titanium/silicone/polyester velour
cloth/plastic template
Group 4c - Band Standard
Medtronic Australasia Pty Ltd
MC709 Medtronic Posterior Annuloplasty Band; Models 638B semi-rigid metal alloy core, Models 610B & 610R 25- $1,900.00
Medtronic Duran Annuloplasty Ring; silicone coating, polyester knit fabric, kit 35mm, Models 620B & 620R
Colvin - Galloway Future Band Model includes-band, malleable handle, template 23-35mm, Model 638B - 26-
638B; Duran Ancore Band 620B; Duran with suture markers, sizers, molde 38mm, Model 620RG & 620BG
Ancore Ring 620R; Duran Ancore
Chordal Model 620BG
Group 5 - Cardiothoracic Membranes and Patches
Group 5b - Synthetic, Cardiovascular
W L Gore & Associates
GT117 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm Thickness 2 x 9cm $233.00
Page 16 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
GT118 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm - 3 x 6cm $275.00
0.6mm - 2.5cm x 15cm & 5cm
x 7.5cm
GT120 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 5 x 15cm $510.00
GT121 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 10 x 15cm $925.00
GT126 Acuseal Cardiovascular Patch Vascular ePTFE 0.5mm Thickness 1 x 9cm; 0.8 $217.00
x 7.5cm
GT127 Acuseal Cardiovascular Patch Cardiac ePTFE 0.5mm Thickness 3 x 6cm & 5 $264.00
x 7.5cm
Group 5c - Synthetic, Non-cardiovascular
W L Gore & Associates
GT122 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 6 x 12cm $353.00
GT123 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 8 x 16cm $630.00
GT124 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 12 x 12cm $732.00
GT125 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 15 x 20cm $1,425.00
ICD Leads
Group 1 - Coronary Sinus Leads
Medtronic Australasia Pty Ltd
MC026 Medtronic Transvene SVC Lead Model Model 6937-35, Model 6937-52, Model 35 - 110cm x 660mm $2,340.00
6937-58, Model 6937-110; Silicone;
Group 4 - Transvenous/Non steroid/Passive Leads
Biotronik Australia Pty Ltd
BT050 KAINOX A+ ICD Lead, Single Pass. Atrial ring spacing 15, 17cms. $7,280.00
BT057 Kentrox SL ICD Lead, Single Lead 65, 75 or 100cm length. Tip to $7,280.00
second shock coil 16cm or
Page 17 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Progressive Medical
PG003 Swift 4040 1CT lead length 58 cm - 69 cm $7,280.00
Group 5 - Transvenous/Steroid/Passive Leads
Guidant Australia Pty Ltd
GU112 Endotak Reliance S Lead Model 0127 & Model 0128, defibrillation 59cm, 64cm $7,488.00
lead, 9fr introducer (silicone coated),
steroid eluting, high impedence
GU115 Endotak Reliance Lead Model 0147, Model 0148 & Model 0149, 59cm, 64cm, 90cm $7,488.00
defibrillation lead, 9fr introducer (silicone
coated), steroid eluting, high impedence
GU158 Endotak Reliance SG Passive Fixation Lead Endotak Reliance SG Passive Fixation 54cm - 90cm $7,200.00 $10,000.00
Lead: Models 0170, 0171, 0172, and
0173 Implantable cardioverter defibrillator
lead with GORE ™ ePTFE covered
GU159 Endotak Reliance G Passive Fixation Lead Endotak Reliance G Passive Fixation 54cm -90cm $7,200.00 $10,000.00
Lead: Models 0174, 0175, 0176 and
0177. Implantable Cardioverter
defibrillator lead with GORE ™ ePTFE
Medtronic Australasia Pty Ltd
MC002 Medtronic Sprint Quattro Lead Model Silicone and polyurethane 65-100cm $9,360.00
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 $7,488.00
6942-100; Silicone
MC025 Medtronic Sprint Lead Model 6932RV Model 6932-65, Model 6932-75, Model 65 - 100cm $7,488.00
6932-100; Silicone
MC696 Sprint Fidelis Lead Model 6948, dual-coil, tined 58-100cm $10,000.00
MC698 Sprint Fidelis Lead Model 6930, single-coil, tined 58-100cm $10,000.00
Page 18 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
St. Jude Medical Australia Pty Ltd
SJ016 Riata Transvenous Tachyarrhythmia Lead Quadripolar, dual-coil, steroid eluting, One size only $10,400.00
Model 1570, Model 1571 active fixation tachyarrhythmia leads
SJ083 Riata Transvenous Tachyarrhythmia Lead Tri-polar Passive-Fixation, Steroid 60cm, 65cm, 8F introducer $10,000.00
Model 1572 Eluting, Single Shock Coil
SJ085 Riata iTransvenous Tachyarrhythmia Passive Fixation, Steroid-Eluting, Dual 60cm, 65cm, 70cm, 8F $10,000.00
Leads Models 1560 and 1561 Shock Coil Defibrillation Lead
SJ086 Riata i Transvenous Tachyarrhythmia Passive Fixation, Steroid Eluting, Single 60cm, 65cm, 70cm, 8F $10,000.00
Lead Model 1562 Shock Coil Defibrillation Lead
Group 6 - Transvenous/ Steroid/Active Leads
Biotronik Australia Pty Ltd
BT064 Kentrox SL-S steroid Fractal coated steroid electrode, dual 16 and 18 cms tip to second $7,488.00
shock coil shock coil
BT068 Kentrox RV-S steroid Fractal coated steroid electrode, single 65cm lengths $7,488.00
shock coil
Guidant Australia Pty Ltd
GU118 Endotak Endurance EZ Leads Model Defibrillation lead, steroid eluting, 64, 70, 100cm $7,488.00
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 $11,440.00
Model 0165, Model 0166, Model 0167
GU146 Endotak Reliance SG Lead Model 0160, Implantable defibrillator/pacemaker lead Lead Lengths: 59 - 90cm $11,440.00
Model 0161, Model 0162, Model 0163
GU160 Endotak Reliance Active Fixation Lead Endotak Reliance Active Fixation Lead: 54cm - 90cm $7,200.00
Models 0157, 0158 and 0159 Implantable
cardioverter defibrillator lead
GU161 Endotak Reliance S Active Fixation Lead Endotak Reliance S Active Fixation Lead: 54cm - 90cm $7,200.00
Models 0137, 0138 and 0139
Page 19 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
GU163 ENDOTAK RELIANCE G Lead 018 Series Endotak Reliance G Lead: Models 0184 to 59-90cm $7,200.00 $11,000.00
0187. Implantable cardioverter
defribrillator lead. Active fixation.
GU164 ENDOTAK RELIANCE SG Lead 018 Endotak Reliance SG Lead: Models 0180 59-90cm $7,200.00 $11,000.00
to 0183. Implantable cardioverter
defibrillator lead. Active fixation.
Medtronic Australasia Pty Ltd
MC208 Medtronic Sprint Quattro Secure Lead Leads, Defibrillator, Implantable, Silicone, 58-100cm $9,360.00
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 $7,488.00
6943-75, Model 6943-100; Silicone
MC341 Medtronic Sprint Lead Model 6945 Model 6945-58, Model 6945-65; Silicone, 58 - 100cm $7,488.00
Model 6945-75, Model 6945-100; Silicone
MC695 Sprint Fidelis Lead Model 6949, dual-coil, screw-in 58-100cm $10,000.00
MC697 Sprint Fidelis Lead Model 6931, single-coil, screw-in 58-100cm $10,000.00
St. Jude Medical Australia Pty Ltd
SJ074 Riata Transvenous tachyarrhythmia Leads Tri-polar Active - Fixation, Steroid- 60cm, 65cm, 8F introducer $10,400.00
Model 1582 Eluting, Single shock Coil
SJ075 Riata Transvenous Tachyarrhythmia Lead Quadripolar, dual-coil, steroid eluting, One size only $10,400.00
Model 1580, Model 1581 active fixation tachyarrhythmia leads
SJ081 Riata i Transvenous Tachyarrhythmia Active fixation leads, Steroid Eluting, 60cm, 65cm, 75cm, 8F $10,000.00
Leads Model 1590/1591 Dual Shock Coil Defibrillation Lead
SJ084 Riata i Transvenous Tachyarrhythmia Active Fixation, Steroid Eluting, Single 60cm, 65cm, 75cm, 8F $10,000.00
Lead Model 1592 Shock Coil Defibrillation Lead
Limited Functionality ICDs
Generation 2
Biotronik Australia Pty Ltd
BT052 Cardiac Airbag Single chamber ICD rate responsive One size only. $15,600.00
Page 20 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Mesh, Polymeric
W L Gore & Associates
GT128 Helex Septal Occluder ePTFE 15-35mm $10,200.00
Occluders
Medtel Australia Pty Ltd
ME068 Amplatzer PFO Occluder Nitinol Wire Mesh 25mm & 35mm $10,200.00
Occluders, Vascular
Medtel Australia Pty Ltd
ME065 Amplatzer Duct Occluder Nitinol Wire Mesh 5 - 24mm $10,200.00
ME066 Amplatzer Septal Occluder Nitinol Wire Mesh 4mm - 40mm $10,200.00
ME067 Amplatzer Muscular VSD Occluder Nitinol Wire Mesh 4 - 24mm $10,200.00
ME074 Amplatzer Membranous VSD Occluder Nitinol wire mesh, double disc occluder 4-24mm, Length 7-10mm $10,200.00
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
Page 21 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
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 $530.00
6984M, 6981M, 6985M, 5866-24M,
5866-38M, 5866-40M, 6986M, 5866-
37M; Bipolar Lead Adaptor Kit Model 2872
MC036 Medtronic Lead End Cap Kit Model: Silicone or Polyurethane; Plug to Seal IS- 10 - 25mm, IS-1 Pin Plug - One $80.00
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 $1,716.00
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 $6,240.00
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
Page 22 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
GU153 Easytrak 2 Is-1 Lead - Models 4542, Implantable left ventricular pacemaker lead 80 to 100cm $6,240.00
4543 & 4544
GU156 Easytrak 3 Lead - Models 4521, 4522, Implantable left ventricular pacemaker lead 80 to 100cm $6,240.00
4523, 4524, 4525, 4526 and 4527
GU162 Easytrak 3 IS-1 Lead Models 4548, 4549 and 4550. Silicone Sizes 80 to 100cm $6,240.00
and polyurethane insulation and
polyurethane protective sleeve
Medtronic Australasia Pty Ltd
MC699 Attain OTW Model 4194 Lead Model 4194 78cm, 88cm $6,000.00
Group 2 - Non-transvenous, Uni-Polar, Steroid
Medtronic Australasia Pty Ltd
MC053 Capsure EPI steroid eluting unipolar Silicone 25 - 50cm $1,544.00
epicardial lead Model 4965 ventricle
Group 3 - Non-Transvenous, Uni-Polar, Non-Steroid
Guidant Australia Pty Ltd
GU037 Myocardial Pacing Lead Model 4312 and 4316 54cm and 35cm $1,144.00
Medtronic Australasia Pty Ltd
MC009 Medtronic Epicardial Pacing Leads IS-1 Silicone 35 - 53cm $1,144.00
Model 5071
Group 4 - Transvenous, Uni-Polar, Passive, Steroid, Right Ventricular/Atrial
Medtronic Australasia Pty Ltd
MC254 CapSure Sense pacemaker lead Models Titanium Nitride 30 - 85cm $1,248.00 Also grouped in Pacemaker Lead
Group 8
St. Jude Medical Australia Pty Ltd
SJ078 IsoFlex S, Models 1645K, 1643K, 1635K Endocardial, Steroid Eluting, Silicone, 34cm, 40cm, 46cm, 52cm, $1,200.00
Passive Fixation Leads with Fast-Pass 58cm, 85cm, 7F
Page 23 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Group 5 - Transvenous, Uni-Polar, Passive, Non- Steroid, Left Ventricular
Medtronic Australasia Pty Ltd
MC037 Medtronic Attain Cardiac Vein Pacing Polyurethane; 4 FR Polyurethane, 5 FR 58 - 75cm: 85cm/75cm/110cm $2,735.00
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 $2,735.00 $3,328.00
Group 6 - Transvenous, Uni-Polar, Passive, Steroid, Left Ventricular
Biotronik Australia Pty Ltd
BT070 Corox OTW UP Steroid Coronary Sinus Lead 77, 87cm $3,000.00
Guidant Australia Pty Ltd
GU056 Easytrak Lead Model 4510, Model 4511, Model 4512 65cm, 72cm, 80cm $3,120.00
Transvenous Coronary Sinus Lead
GU152 Easytrak IS-1 Lead, Models 4535 to 4538 Implantable left ventricular pacemaker lead 80 - 90cm $3,120.00
Medtronic Australasia Pty Ltd
MC225 Attain Over the Wire Model 4193 Titanium, polyurethane 78-88cm $3,120.00
St. Jude Medical Australia Pty Ltd
SJ079 QuickSite Model 1056K Unipolar, Steroid Eluting, Titanium Nitride 75cm, 6F and 86cm, 6F $3,000.00
Electrode, Guidewire/Stylet-placed Left
Heart Lead with Fast-Pass Coating
Group 7 - Transvenous, Bi-Polar, Passive, Non-Steroid, Right Ventricular/Atrial
St. Jude Medical Australia Pty Ltd
SJ013 Transvenous Superior Vena Cava Lead TVL lead system models SV01, SV02, SV01- 100cm; SV02 - 45cm; $7,280.00
Model SV01, Transvenous Superior Vena SV03 transvenous leads SV03 - 55cm
Cava Lead Model SV02, Transvenous
Superior Vena Cava Lead Model SV03
Page 24 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Group 8 - Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT066 Selox ST Transvenous Bipolar Passive Steroid 53 and 60cm lengths $1,248.00
Ventricular Pacing Lead, fractal coated
BT067 Selox JT Fractal coated steroid electrode 45 and 53cm lengths $1,248.00
Guidant Australia Pty Ltd
GU009 Fineline II Sterox IROX Lead Model 4458, Model 4459 52cm, 58cm $1,248.00
GU011 Fineline II Sterox IROX Lead Model 4456, Model 4457 52cm, 58cm $1,248.00
GU012 Fineline II Sterox IROX Lead Model 4479, Model 4480 45cm, 52cm $1,248.00
GU023 Guidant Aust Selute Picotip Steroid Model 4033, Model 4034, Model 4035, 45cm , 52cm, 59cm $1,248.00
Eluting Bipolar Lead Model 4063, Model 4064
Medtronic Australasia Pty Ltd
MC010 Medtronic Capsure SP Novus Model Silicone Polyurethane 45 -110cm $1,144.00
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 $1,144.00
5594 Lead 30cm
MC336 Medtronic Capsure Z Novus Model 5054 Silicone; Contents: 1 x lead with 45-58cm $1,248.00
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 $1,248.00
Pacing Lead anchoring sleeve, stylet & guide, 1 x vein
lifter, 2 x fixation tools, extra stylets
Page 25 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
MC371 Medtronic Capsurefix Model 6940 Pacing Silicone Polyurethane 30 - 85cm $1,144.00
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; Capsure SP Novus Pacing Lead
Model 4092; Capsure SP Novus Pacing
MC372 CapSure Sense pacemaker lead Models Titanium Nitride CapSure Sense Lead Model $1,248.00
4074 & 4574 4074 - 30cm to 85cm; CapSure
Sense Lead Model 4574 - 30cm
St. Jude Medical Australia Pty Ltd
SJ024 PASSIVE PLUS DX 1342T, 1343K, Single, passive fixation, steroid eluting, 46-58cm $1,248.00
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
SJ082 Isoflex S, Models 1646T, 1642T and endocardial, Steroid Eluting, Silicone, 34cm, 40cm, 46cm, 52cm, $1,200.00
Passive Fixation Pacing Leads with Fast- 58cm, 85cm, 7F, 120cm 8F
Pass Coating
Group 9 - Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT063 Selox SR Lead, pacemaker, implantable, 45, 53, 60cm length $1,248.00
Guidant Australia Pty Ltd
GU013 Fineline II EZ Sterox IROX Lead Model 4472, Model 4473 & Model 4474 45cm, 52cm, 58cm $1,248.00
GU016 Fineline II EZ Sterox IROX Lead Model 4469, Model 4470 & Model 4471 45cm, 52cm, 58cm $1,248.00
GU122 Flextend Lead Models 4086, 4087 & Bipolar, steroid eluting, transvenous 45,52,59cm $1,248.00
silicon pace/sense leads with an
extendable/retractable active fixation for
implantation into the atrium or ventricle
Page 26 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Medtronic Australasia Pty Ltd
MC008 Medtronic Capsurefix Model 5568 Pacing Silicone Polyurethane 30 - 85cm $1,144.00
Leads
MC338 Medtronic Capsurefix Novus Model 5076 Silicone; Contents: 1 x lead with 45-85cm $1,248.00
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 $1,248.00
Low Polarisation Lead, IS-1
SJ073 Tendril SDX Models 1688T and 1688TC Endocardial Steroid-Eluting Active 100cm, 25cm, 34cm, 40cm, $1,248.00
Fixation Pacing Lead 46cm, 52cm, 58cm, 85cm, 7F
Prostheses, Cardiac Valve, Artificial
Medtronic Australasia Pty Ltd
MC013 Medtronic Hall Heart Valve Aortic Model A7700/M7700 Titanium. Pyrolite. A7700 - Diameter 20-31mm, $5,491.00
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 $7,322.00
collagen impregnated conduit Model R7700
MC292 Advantage Heart Valve - Aortic Model A7760 - Pyrolytic carbon, PET Diameter 19-31 mm $6,389.00
MC324 Advantage Supra Aortic Heart Valve Mechanical Heart Valve Pyrolite Carbon Diameter (mm): 19 - 25 $6,448.00
leaflets Pyrolite carbon ring
MC681 Advantage Mitral Mechanical Heart Valve 23mm-33mm $6,143.00
St. Jude Medical Australia Pty Ltd
SJ036 St Jude Medical Coated Aortic Valved Coated Aortic Valved Graft 21mm - 33mm $8,030.00
Page 27 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
SJ037 St Jude Medical Aortic Expanded Cuff Aortic Expanded Cuff, Aortic Aortic Expanded 19 -31mm, $6,145.00
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
SJ039 St Jude Medical Regent Prosthetic Heart Standard Cuff - Model 17AGN-751 - Standard cuff - 17-29mm, Flex $7,030.00
Valves 29AGN-751, Flex Cuff - Model cuff - 17-29mm
17AGFN-756 - 29AGFN-756
Prostheses, Cardiac Valve, Biological
Edwards Lifesciences Pty Ltd
EL039 Edwards Perimount Magna Model 3000 Carpentier-Edwards Perimount Magna 19MM Aortic Pericardial Tissue $5,808.00
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
MC701 Mosaic Cinch, Aortic, Mitral Models 305cxx, 310cxx 19mm - 35mm $4,865.52
St. Jude Medical Australia Pty Ltd
SJ069 St Jude Medical Biocor Porcine St Jude Medical Biocor Porcine Aortic Valves - Tissue Annulus $5,200.00
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-
Tag Medical
TM039 Mitroflow Pericardial Bioprosthesis 19-27mm $4,950.00
Page 28 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
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 $3,635.00
Implantable Cardiogram Recorder;
Reveal Plus Implantable Loop Recorder
Single Chamber ICDs
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 $33,462.00
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. $36,400.00
Medtronic Australasia Pty Ltd
MC201 Medtronic A/Asia Gem III VR Model Titanium One size only, 39.2cc $36,400.00
7231CX
Progressive Medical
PG001 Alto II VR Single Chamber ICD Debrillator, implantable, automatic $36,400.00
Generation 3
Biotronik Australia Pty Ltd
BT055 Lexos A+ Single chamber ICD, rate responsive One size only. $40,560.00
pricing, dual chamber sensing.
Page 29 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Guidant Australia Pty Ltd
GU110 Ventak Prizm II VR Model 1860, titanium, single chamber, One size only $40,560.00
adaptive rate
GU133 Vitality VR Model 1870 This device acts to defibrillate the heart Model 1870 Vitality VR Single $40,560.00
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 $40,560.00
GU151 Vitality 2 VR - Model T 175 Implantable cardiac defibrillator 30cc; 82g $40,560.00
Medtronic Australasia Pty Ltd
MC253 Medtronic Marquis VR 7230CX Titanium, Sterile, Single Chamber Volume 36cc $40,560.00
Implantable Cardioverter Defibrillator
MC365 EnTrust Model D153VRC, Single chamber, 30J 33cc, 63g $40,560.00
St. Jude Medical Australia Pty Ltd
SJ010 Photon Micro VR Model V-194 36cc $40,560.00
Defibrillators/Cardioverters
SJ048 Epic Plus VR Model V-196 Implantable Single Chamber sensing and bradycardia 32cc $40,560.00
Cardioverter Defibrillator pacing
Single Chamber Pacemakers
Generation 1
Biotronik Australia Pty Ltd
BT036 PHILOS S Implantable Cardiac Pulse Multiprogrammable SSI One size only $4,264.00
Generator Cat No 122 453
St. Jude Medical Australia Pty Ltd
SJ020 REGENCY SC+ 2402L Single Chamber, VVI, Autocapture, IS-1 8.6cc, 18.5gm $4,264.00
SJ053 Verity Adx Model XL SC 5056 Single Chamber multi-programmable rate- 10.5cc, 23g $4,264.00
implantable pacemaker adaptive pacing device with extended
longevity
Page 30 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Generation 2
St. Jude Medical Australia Pty Ltd
SJ076 Verity Adx Model XL SR 5157 M/S Single Chamber multi-programmable 11cc, 23g $5,928.00
implantable pacemaker rate-adaptive pacing devices with
extended longevity
Generation 3
Biotronik Australia Pty Ltd
BT028 Philos SR Model 122459 Implantable Multiprogrammable, rate responsive, One size only $5,928.00
Pacemaker
BT030 Philos SR-B Model 122610 Implantable Multiprogrammable, rate responsive, 5/6mm port, One size only $5,928.00
Pacemaker
BT046 Protos VR/CLS Single chamber rate responsive, closed One size only $5,928.00
loop system.
BT062 Philos II SR Multiprogrammable, Rate Responsive, One size only $5,928.00
SSIR pacemaker
Guidant Australia Pty Ltd
GU124 Insignia Entra SR Models 1195 & 1198 Single Chamber Rate Responsive One size only $5,928.00
Permanent Pacemaker
GU126 Insignia Plus SR Model 1194 Single Chamber Rate Responsive One size only $5,928.00
Permanent Pacemaker
GU139 Insignia Ultra SR Lodel 1190 Implantable Cardiac Pacemaker One size only $5,928.00
Medtronic Australasia Pty Ltd
MC321 EnPulse SR Series: Model E2SR01, EnPulse SR - Pacemakers - with IS1 One size only $6,188.00
Model E2SR03, Model E2SR06 connector; with 3.2mm low profile
connector; with 5mm connector.
Progressive Medical
PG006 Symphony SR Titanium one size only $5,928.00
Page 31 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
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 $5,928.00
Autocapture, IS-1
SJ025 St Jude Medical Integrity SR5142 Single chamber, rate responsive Volume 10.4cc, weight 23gm $5,928.00
Pacemaker, Cardiac Implantable
SJ029 Integrity Micro SR 5136 Pacemaker Single Chamber Rate Responsive Volume 8cc, weight 18gm $5,928.00
SJ030 Identity SR 5172 Single Chamber Rate Responsive Volume 8cc, Weight 17gm $5,928.00
SJ055 Integrity ADx Model SR 5160 implantable Single Chamber multi-programmable rate- 8cc, 17g $5,928.00
pacemaker adaptive pacing device
SJ060 Identity ADx Model SR 5180 implantable Single Chamber multi-programmable rate- 8cc, 18g $5,928.00
pacemaker adaptive pacing device
SJ077 Verity Adx Models XL SR 5156 Single Chamber multi-programmable 11cc, 23g $5,928.00
implantable pacemaker rate-adaptive pacing devices with
extended longevity
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 $4,680.00
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 $4,680.00
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 $2,340.00
Leads S/M/L Model 6721L-50; Silicone
Page 32 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Special Purpose Dual Chamber Pacemaker - Custom Header
Generation 3
Medtronic Australasia Pty Ltd
MC241 Medtronic Kappa Pacemaker Model KDR Cardiac Pacemaker, Titanium 13.9cc $9,048.00
MC332 Medtronic Kappa Pacemaker KDR 903 Cardiac Pacemaker, Titanium 13cc, 14.2cc $9,048.00
and KDR 906
MC340 Medtronic Kappa 400 pacemaker Model Titanium 13.9cc $9,048.00
KDR403
Special Purpose ICDs - High energy products
Generation 1
Medtronic Australasia Pty Ltd
MC019 Medtronic Gem DR Model 7271 Titanium 62cc $36,400.00
MC020 Medtronic Gem Model 7227Cx; Gem Titanium 49cc, 40cc $34,320.00
Model 7227 Implantable Cardioverter
Generation 2
Guidant Australia Pty Ltd
GU107 Ventak Prizm HE DR Model 1853 & Model 1858, titanium, dual One size only $40,560.00
chamber, adaptive rate
Generation 3
Medtronic Australasia Pty Ltd
MC317 Maximo VR Model 7232Cx Titanium One size only 38.5cc $42,640.00
MC318 Maximo DR Model 7278 Titanium One size only 38.9cc $45,760.00
MC362 EnTrust Model D154DRG, dual chamber, VT 35cc, 68g $45,760.00
Therapies, 35J
Page 33 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
MC366 EnTrust Model D154VRC, Single chamber, 35J 35cc, 68g $42,640.00
St. Jude Medical Australia Pty Ltd
SJ011 Atlas DR Model V-240 Dual chamber implantable cardioverter 37cc $45,630.00
defibrillator with rate response
SJ012 Atlas VR Model V-199 Single chamber implantable cardioverter 36cc $42,588.00
defibrillator with rate response
SJ063 Atlas DR Model V-242 ICD Implantable Dual Chamber Cardio-verter 38cc/78g $45,760.00
Defibrillator
SJ065 Atlas + VR Model V-193 ICD Single chamber implantable cardio-verter 38cc, 77g $42,640.00
defibrillator
SJ066 Atlas + VR - C Model V-193C ICD Single chamber implantable cardio-verter 38cc, 77g $42,640.00
defibrillator
SJ068 Atlas + DR Model V-243 ICD Implantable Dual Chamber Cardio-verter 38cc, 78g $45,760.00
Defibrillator
Special Purpose ICDs - With custom headers
Generation 1
Medtronic Australasia Pty Ltd
MC237 Gem Model 7227B Implantable Titanium, "B" Style Connector 56cc $33,800.00
Cardioverter Defibrillator
MC238 Gem Model 7227D Implantable Titanium, "D" style connector 53cc $33,800.00
Cardioverter Defibrillator
MC239 Gem Model 7227EImplantable Titanium, "E" style connector 55cc $33,800.00
Cardioverter Defibrillator
Special Purpose ICDs - With therapies for Atrial Tachyarrhythmia
Generation 2
Medtronic Australasia Pty Ltd
MC227 Medtronic Gem III AT Model 7276 Titanium 39.5cc $40,560.00
Implantable Cardioverter Defibrillator
Page 34 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Generation 3
Guidant Australia Pty Ltd
GU137 Vitality AVT Dual chamber defibrillator, with atrial and One size only $45,760.00
ventricular therapy
GU157 Vitality AVT - Model A155 Implantable cardiac defibrillator with both 30cc $45,760.00
Atrial and Ventricular tachyarrhythmia
therapy
Medtronic Australasia Pty Ltd
MC349 Entrust Model D 153ATG, Dual chamber, AT 33cc, 63g $45,760.00
Therapies, 30J
MC364 EnTrust Model D154ATG, Dual chamber, AT 35cc, 68g $45,760.00
Therapies, 35J
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 $47,840.00
H197, Model H199
Medtronic Australasia Pty Ltd
MC325 InSync Sentry Model 7298 Defibrillator, Titanium 40cc $52,000.00
MC700 InSync Maximo Model 7304 40cc, 35J $46,000.00
St. Jude Medical Australia Pty Ltd
SJ064 Atlas + HF Model V - 341 ICD - Atlas + HF ICD is a cardioverter 40cc/81g $47,840.00
Defibrillator, Implantable, automatic, defibrillator with dual chamber (atrial and
dual-chamber RV) sensing and bradycardia Pacing with
ventricular resynchronisation therapy.
Page 35 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Generation 3
Medtronic Australasia Pty Ltd
MC359 Intrinsic Model 7288, Implantable Cardioverter 38cc, 76g $45,760.00
Defibrillator
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 $50,960.00
M170 and M175 with Cardiac Resynchronisation Therapy
GU155 Contak Renewal 4 AVT HE CRT - D - Implantable Cardioverter Defibrillator 40cc; 89g $52,000.00
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 $5,928.00
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 $11,440.00
System Model AT501
MC360 EnRhythm Model P150 1DR, Rate Responsive dual 21g, 13cc $11,440.00
chamber pacemaker with Anti-
Tachycardia functions: DDDRP
Page 36 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
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 $2,600.00
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 $1,040.00
BP,SL60/150-BP, SL60/110-BP
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 & $1,544.00
Model 4343
Medtronic Australasia Pty Ltd
MC052 Medtronic Capsure VDD2 Model 5038 Silicone; Contents: 1 x lead with 11.5cm, 13.5cm, 15.5cm $1,544.00
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 $4,264.00
2407M/S
Page 37 of 758
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Generation 3
Medtronic Australasia Pty Ltd
MC030 Medtronic Kappa 400 Pacemaker Model Titanium 11.6cc, 11.7cc $5,616.00
KSR401
MC242 Medtronic Kappa KSR 900 Model KSR Cardiac Pacemaker, Titanium 9.7,10.5,11.0 cc $5,928.00
901,903, 906
MC330 Medtronic Kappa 400 Pacemaker Model Titanium 11.6cc, 11.7cc $5,616.00
KSR 403
Page 38 of 758
EAR, NOSE & THROAT
Benefit
Amount/
Minimum Maximum
Benefit Benefit
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 $165.00
x 33cm
Caps, Bone
Cochlear Limited
CO028 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 $1,560.00 $1,600.00
formed by the neutralisation gelletation of
a basic inorganic ionomer
ET032 Serenocem Granules Reaction bonded polymer composite 0.5 - 1mm granules, 1gm or $1,070.00
formed by the neutralisation gelletation of 5gm; 2 - 3mm granules, 1gm or
a basic inorganic ionomer 5gm - 3 pouches
Page 39 of 758
EAR, NOSE & THROAT
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Cochlear Implants
Cochlear Limited
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
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),
CO024 Nucleus Freedom Implant with Straight Cochlear implant with straight electrode One size only $12,570.00
Electrode in a titanium casing, with a removable
magnet, banded platinum electrodes
moulded in a silicone seal.
Pacing Importers Pty Ltd
PI005 Combi C40+ Implantable Auditory One Size Only $11,450.00
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 $20.00 $20.77
term, star tube, silicone
Page 40 of 758
EAR, NOSE & THROAT
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
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 $19.00
with tab
PM075 Tympo Vent Otological ventilation tubes, collar button, Length 1.5mm $29.92
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 $26.78
collar button - tubingen type, titanium
PM086 Tympo Vent Otological ventilation tubes, short medium Length 1.6 $50.10
term, reuter bobbin without holes, titanium
PM088 Tympo Vent Otological ventilation tubes, donaldson, Length 1.5mm - 9.8mm $9.00
reuter bobbin, shepard
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
Page 41 of 758
EAR, NOSE & THROAT
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Hearing Aids
Cochlear Limited
CO033 BAHA - Bone Anchored Hearing Aid - The BAHA Hearing Aids (Compact & $6,000.00 To be claimed only for patients
Various Models Cordelle II in various colours) are the with deafness who have
external hearing processors which are problems using air conduction or
attached to the implanted titanium fixture conventional hearing aids which
by a snap coupling. This allows the is made worse when a hearing
sound transmission using bone
conduction for patients where
conventional hearing devices are not
Larynxes, Artificial
Pacific Medical
PM057 Provox Voice Prosthesis Long term indwelling; Silicone 4.5,6,8,10,12.5mm $335.00 $356.00 Only able to be claimed once for
the initial implant
Middle Ear Analyzers
Medtronic Australasia Pty Ltd
MC256 Pressure Pulse Generator Meniett 20 Composition - Polycarbonate One size only $5,060.00 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
Page 42 of 758
EAR, NOSE & THROAT
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Nasal Septum Buttons
Gyrus Australasia Pty Ltd
GY018 Septal Button Plastipore One size only $149.00
Medtronic Australasia Pty Ltd
MC264 Septal Button Silicone 3cm $149.00
Plugs
Cochlear Limited
CO025 BAHA - Bone Anchored Hearing Aids Abutment Snap Coupling 5.5mm $895.00
Prostheses, Ear
Gyrus Australasia Pty Ltd
GY001 Canal Wall Prosthesis Grote, HA Small - Large $543.00
Pacific Medical
PM028 Stapes Bell/Aerial/Angular Prosthesis/Piston - 1.75 - 7.00mm $330.00 $444.00
Gold/Titanium
PM032 K-Piston Gold/Titanium ID 0.4,0.6mm $221.75 $249.00
Page 43 of 758
EAR, NOSE & THROAT
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Prostheses, Larynx
Endotherapeutics Pty Ltd
ET040 Vox Implants Vox Implants are solid, irregularly One size only $8,200.00
textured, medical grade
Polydimethylsiloxane Elastomer implants
suspended in a hydrogel carrier
Gyrus Australasia Pty Ltd
GY072 Vocal Cord Medialisation Implant Vocom Larynx Medial Implant - 3 - 7mm Head $675.00
Hydroxylapatite
GY073 Vocal Cord Medialisation Implant Vocom Shim for Medial Implant - 1mm - 3mm Offset $345.00
Hydroxylapatite
Pacific Medical
PM033 Montgomery Thyroplasty Implant System Silicone 6,7,8,9,10,11,12 $1,172.00 $1,928.00
Prostheses, Ossicular
BR & CT Enterprises Pty Ltd
BC001 Titanium Head To suit blue or grey implants $179.00
BC004 Titanium PORP with Fixed Bell and Maximum lengths of 5.0mm $360.00
Removable Head (grey) and 5.5mm (blue) -
adjustable in 1mm increments;
O R Paradigm Pty Ltd
OS002 Ossicular Prostheses - PORP ALTO (adjustable Length Titanium Head Size 2.5mm x 3.5mm; $675.00
Ossicular) Partial Length 2.0mm - 5.6mm; Distal
Diameter 1.2mm (Cup)
OS004 Ossicular Prostheses - TORP/PORP OtoSil Universal Head Size 3.5mm; Length $450.00
8.0mm; Shaft Diameter 1.0mm
Page 44 of 758
EAR, NOSE & THROAT
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
OS005 Ossicular Prostheses - PORP OtoSil Partial Head Size 3.0mm - 4.0mm; $450.00
Length 6.0mm; Cannulation
Diameter 1.12mm
OS007 Ossicular Prostheses - PORP Dense HA Partial Head Size 3.0mm - 4.0mm; $360.00
Length 5.0mm; Cannulation
Diameter 1.17mm
OS008 Ossicular Prosthese - PORP Dense HA Footplate Shoe Width 2.0mm; Height 1.32mm $150.00
OS010 Ossicular Prostheses - PORP Dense HA Partial Incus Strut Length 5.0mm; Cannulation $360.00
Diameter 1.17mm
OS011 Ossicular Prostheses - PORP Gator Stapes Shaft Diameter 0.6mm; Length $450.00
3.5mm - 5.5mm
OS012 Ossicular Prostheses - PORP Titanium Bucket Shaft Diameter 0.4mm - $490.00
0.8mm; Length 4.0mm - 5.0mm
OS013 Ossicular Prostheses - PORP Causse Type Fluoroplastic Stapes Shaft Diameter 0.4mm - $90.00
0.8mm; Length 3.5mm -
6.0mm; Loop Diameter 0.6mm
Prostheses, Ossicular, Incus and Stapes
Gyrus Australasia Pty Ltd
GY002 Ossicular Prosthesis Malleus, Incus and Goldenberg Footplate - HA One size only $126.00 $915.00
Stapes
GY003 Ossicular Prosthesis Attic Defect Plate, HA 7-14mm $335.00
GY004 Ossicular Prosthesis Incus a) Applebaum HA, b) Goldenberg HA, a) small - large, b) one size only, $580.00
c) Kartusch HA , d) Grote HA, e) Wehrs c) short, medium, long, d) 7-
(single & double notched) HA 10mm, e) short, average,
GY005 Ossicular Prosthesis - PORP Sheehy plastipore, Drum to stapes, Grote One size only $190.00 $360.00
Malleus to stapes, modified, centered or
System 10mm x 30cm
ME134 Micrus ACT Platinum Microcoil Delivery Cerecyte Helical Soft Stretch Resistant $1,850.00
System Cerecyte - 2mm x 1cm - 4mm x
8cm
ME135 Micrus ACT Platinum Microcoil Delivery Cerecyte Spherical Cerecyte - 2mm x $1,850.00
System 2.5cm - 19mm x 30cm
ME136 Micrus ACT Platinum Microcoil Delivery Cerecyte Straight Cerecyte - 4mm x $1,850.00
System 10cm - 6mm x 30cm
Group 8d - Polymer
Device Technologies Australia Pty Ltd
DE006 Onyx System DSMO/Liquid Embolic Material 18, 20, 34 (formulations) $2,300.00 $2,456.00
DE175 Onyx System DSMO Liquid Embolic Material 500 Formulation $4,950.00
Group 9 - Vascular Access
Group 9a - Precut Catheters
Bard Australia Pty Ltd
BA040 VitaCuff, Hickman Catheter Dialysis/Apheresis catheter, dual lumen, 36-45cm overall length $342.00
silicone
BA048 VitaCuff, Broviac Catheters Silicone, with VitaCuff 2.4 - 6.6 French Catheter $342.00
BA049 Broviac Catheters Without VitaCuff, silicone 2.4 - 6.6 French Catheter $175.00 $275.00
Page 747 of 758
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
BA050 Hickman Catheters Single Without VitaCuff, silicone 7 - 14.4F French Catheter $247.00
BA051 Hickman Catheters Dual Without VitaCuff, silicone 7 - 9 French Catheter $343.00
BA052 Hickman Catheters Triple Without VitaCuff, silicone 13.5 French Catheter $406.00
BA053 Vitacuff, Hickman Single Lumen Catheters Silicone, with VitaCuff 7 - 14.4F French Catheter $342.00
BA054 Vitacuff, Hickman Dual Lumen Catheters Silicone, with VitaCuff 7 - 9 French Catheter $406.00
BA055 Vitacuff, Hickman Triple Catheters Silicone, with VitaCuff 13.5 French Catheter $496.00
BA125 Groshong Catheter Groshong Valved - Closed ended Single Lumen, sizes 3fr-8fr $316.00
catheter, may also include Introducer,
guidewire, tunneller, drape, gloves,
needles, scissors, syringes, gauze pads
BA126 Groshong Catheter Groshong Valved - Closed ended Dual Lumen, sizes 5fr-9.5fr $368.00
catheter, may also include Introducer,
guidewire, tunneller, drape, gloves,
needles, scissors, syringes, gauze pads
BA129 Vascular Catheter PICC - may include a Groshong Valved - Single Lumen 3Fr - 6Fr $170.00
Closed ended PICC, may also include,
Introducer, guidewire, tunneller, drape,
gloves, needles, scissors, syringes, gauze
BA130 Vascular Catheter PICC- may include a Groshong Valved - Dual Lumen 4Fr - 7Fr $205.00
Closed ended PICC, may include,
Introducer, guidewire, tunneller, drape,
gloves, needles, scissors, syringes, gauze
BA167 Poly RadPICC Catheters Single lumen open-ended Polyurethane, 3, 4, 5Fr with 70cm guide wire $126.00 Temporary approval pending
Modified Seldinger PICC kit, includes review of catheters
platinum tip guide wire, PTFE Peel Apart
Introducer & dilator, hydroglide insertion
stylet. Trimmable.
BA168 Poly RadPICC Catheters Single Lumen open-ended Polyrethane, 4, 5Fr with 135cm guide wire $126.00 Temporary approval pending
Seldinger PICC kit, includes platinum tip review of catheters
guide wire, PTFE Peel Apart Introducer
& dilator, hydroglide insertion stylet.
Trimmable.
Page 748 of 758
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
BA169 Poly RadPICC Catheters Double Lumen open-ended Polyrethane 4, 5, 6Fr with 70cm guide wire $145.00 Temporary approval pending
Modified Seldinger PICC kit, inlcudes review of catheters
platinum tip guide wire, PTFE Peel Apart
Introducer & dilator, hydroglide insertion
stylet. Trimmable.
BA170 Poly RadPICC Catheters Double Lumen open-ended, Polyurethane, 5, 6Fr with 135cm guide wire $145.00 Temporary approval pending
Seldinger PICC Kit, includes platinum tip review of catheters
guide wire, PTFE Peel Apart Introducer
& dilator, hydroglide insertion stylet.
Trimmable.
Baxter Healthcare Pty Ltd
BX255 Mahurkar 12Fr Triple Lumen Catheter Mahurkar 12Fr Triple Lumen Catheter 12Fr - 13cm, 16cm, 19cm & $230.00 Temporary approval pending
Curved Extension Kit 24cm lengths available review of catheters
BX256 Mahurkar 13.5Fr Q-Plus Dual Lumen Mahurkar 13.5Fr Q-Plus Curved 13.5Fr - 13.5cm, 16cm, 19cm $123.00 Temporary approval pending
Catheter Extension Double Lumen Catheter Kit & 24cm lengths available review of catheters
BX257 Mahurkar 13.5Fr Q-Plus Dual Lumen Mahurkar 13.5Fr Q-Plus Straight 13.5Fr - 13.5cm, 16cm, 19cm $123.00 Temporary approval pending
Catheter Extension Double Lumen Catheter Kit & 24cm lengths available review of catheters
Boston Scientific Pty Ltd
BS065 Vaxcel Implantable Vascular Access Polyurethane Catheter Material with dual 16 French catheter tapering to a $330.00
lumens and a staggered distal tip; 14 French, lengths 19, 23,
polyester cuff which provides catheter
security and tissue growth; clear
extension tubes with clamps
BS087 Vaxcel PASV PICC Single lumen catheters 3, 4, 5 & 6 Fr $175.00 Temporary approval pending
review of catheters
BS088 Vaxcel PASV PICC Dual lumen catheters 3, 4, 5 & 6Fr $210.00 Temporary approval pending
review of catheters
Medical Specialties Australia Pty Ltd
MS009 Catheterisation kits(Horizon Medical) Central Venous Catheter - right atrial 2.7 -14F $408.00
catheter, silicone
MS010 Catheterisation kits(HDC corp) Central Venous Catheter - right atrial 2 - 12F $397.00
catheter, silicone
Page 749 of 758
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
William A Cook Aust Pty Ltd
WC111 Cook Central Venous Catheterisation Kit Single lumen peripherally inserted catheter Fr 3, 4, 5 and Length 50 and $132.55
set, includes catheter, needle, J-wire and
introducer
WC112 Cook Central Venous Catheterisation Kit Double lumen peripherally inserted Fr 6, 7 and Length 50cm $199.50
catheter set, includes catheter, needle,
wire or J-wire and introducer
WC113 Cook Central Venous Catheterisation Kit Single lumen peripherally inserted catheter Fr 3, 4, 5 and Length 50 and $114.00
set, includes catheter, needle, J-wire,
MPIS wire and introducer
WC114 Cook Central Venous Catheterisation Kit Double lumen peripherally inserted Fr 6, 7 and Length 58 and 60cm $145.00
catheter set, includes catheter, needle, J-
wire, MPIS wire and introducer
WC201 Cook Central Venous Catherisation Kits Turbo-Flo Peripherally Inserted Central 4Fr - 60cm and 5Fr - 60cm $132.55
Venous Catheter Set, Single Lumen
Polyurethane with Micropuncture Peel-
Away Sheath Introducer and Wire Guide
WC202 Cook Central Venous Catheterisation Kits Turbo-Flo Peripherally Inserted Central 5Fr - 60cm $121.00
Venous Catheter Set, Single Lumen
Polyurethane with Peel Away Sheath
Introducer and Wire Guide
WC203 Cook Central Venous Catherisation Kits Turbo-Flo Peripherally Inserted Central 5Fr - 60cm $145.00
Venous Catheter Set, Dual Lumen
Polyurethane with Peel-Away Sheath
Introducer and Wire Guide
WC204 Cook Central Venous Catheterisation Kits Turbo-Flo Over-The-Wire Peripherally 4Fr - 60cm and 5Fr -60cm $132.55
Inserted Central Venous Catheter Set,
Single Lumen Polyurethane with
Micropuncture Peel-Away Sheath
WC205 Cook Central Venous Catheterisation Kits Turbo-Flo Over-The Wire Peripherally 5Fr - 60cm $145.00
Inserted Central Venous Catheter Set,
Dual Lumen Polyurethane with
Micropuncture Peel-Away Sheath
Page 750 of 758
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
WC206 Cook Central Venous Catheterisation Kits PICC Peripherally Inserted Central 3Fr - 50cm and 4Fr and 5Fr - $238.99
Venous Catheter Set, Single Lumen
Silicone with Micropuncture Peel-Away
Sheath Introducer and Nitinol Wire Guide
WC207 Cook Central Venous Catheterisation Kits PICC Peripherally Inserted Central 3Fr - 50cm and 4Fr and 5Fr - $132.55
Venous Catheter Set, Catheter without
Clamp, Single Lumen Silicone with
Micropuncture Peel-Away Sheath
WC208 Cook Central Venous Catheterisation Kits PICC Peripherally Inserted Central 4Fr - 60cm and 5Fr - 60cm $241.25
Venous Catheter Set, Catheter without
Clamp, Single Lumen Silicone with
Micropuncture Peel-Away Sheath
Introducer and Nitinol Wire Guide
WC221 Cook Spectrum Silicone Long Term Single lumen catheter CVC impregnated 4Fr, 5Fr $190.00 Temporary approval pending
Catheter Set with antibiotic with or without clamp review of catheters
WC222 Cook Spectrum Silicone Long Term Dual lumen catheter CVC impregnated 7Fr $208.00 Temporary approval pending
Catheter Set with antibiotic with or without clamp review of catheters
WC223 Cook Spectrum Silicone Long Term Triple lumen catheter CVC impregnated 8Fr $253.00 Temporary approval pending
Catheter Set with antibiotic with or without clamp review of catheters
WC224 Cook Spectrum PICC Set / Line Single lumen PICC catheter with 4fg, and 5fg 60cm $165.00 Temporary approval pending
antibiotic impregnation review of catheters
WC225 Cook Spectrum PICC Set / Line Dual lumen PICC catheter with antibiotic 6fr and 60cm $220.00 Temporary approval pending
impregnation review of catheters
WC227 Peripherally Inserted C/V catheter with Micropuncture Single Lumen PICC with 4/5Fr single lumen ABRM $238.99 Temporary Listing pending
Antibiotic Impregnation ABRM impregnated silicone central review of catheters
venous catheter set with
micropuncture introducer kit.
6/7Fr double lumen ABRM
impregnated silicone central
venous catheter set with
micropuncture introducer kit,
Page 751 of 758
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Group 9b - Infuser Ports
Bard Australia Pty Ltd
BA056 Subcutaneous Ports Hickman open-ended catheter, single 8 - 9.6 French Catheter $490.00 $715.64
BA057 Groshong Subcutaneous Ports Single or dual lumen catheter 8 - 9.6 French Catheter $510.00 $727.82
BA059 Dual Lumen Subcutaneous Ports Silicone, Polyurethane or ChronoFlex 7 - 10 French Catheter $788.00
Open-ended Catheter
BA060 Hickman Subcutaneous Ports Low-Profile 6 - 6.6 French Catheter $640.00
Medical Specialties Australia Pty Ltd
MS014 Injection/Infusion Ports Sterile Plastic/titanium, single lumen 5-15F $755.00
MS015 Injection/Infusion Ports Sterile Plastic/titanium, dual lumen 10, 10.5, 12F $770.00
MS016 Injection/Infusion Ports Sterile Plastic/titanium, paediatric 5, 6, 7,8, 9.6F $755.00
William A Cook Aust Pty Ltd
WC093 Cook Implantable Injection/Infusion Ports Standard Single Chamber Polysulfone 5fr, 6.5fr, 7.5fr, 9.5fr Pre- $490.00
with Standard Introducer Set, Petite attached or Detached Catheter
Single Chamber Polysulfone with
Standard Introducer Set, Petite Single
Chamber Polysulfone with Micropuncture
Introducer Set
WC094 Cook Implantable Injection/Infusion Ports Mini Single Chamber Titanium with 5.0fr, 6.5fr, 7.5fr, 8.5fr Pre- $523.00
Standard Introducer Set; Petite Single attached or Detached Catheter
Chamber Titanium with Standard
Introducer Set; Petite Single Chamber
Titanium with Micropuncture Introducer
Set; Standard Single Chamber Titanium
with Standard Introducer Set
WC115 Cook Implantable Injection/Infusion Port Mini Single Chamber Titanium with 5.2fr Detached Catheter $639.00
Micropuncture Introducer Set
WC164 Cook Implantable Injection/Infusion Ports Dual Chamber Titanium Port 7.5 fr, 11.5 fr Pre-Attached or $746.00
Detached Catheter with
Standard or Micropuncture
Page 752 of 758
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Injection/Infusion Ports, Implantable
B Braun Australia Pty Ltd
BB170 Celsite Access Port for pain relief Composition - polysulphone. Kit includes Diameter of septum:11.7mm. $495.00
tunnelling rod, filter, connectors, Height: 11.5mm. Dimension:
needles, syringe, tuohy needle 25.8 x 37.8mm
Occluders, Vascular
Johnson & Johnson Medical Pty Ltd
JJ223 TruFill DCS Detachable coil Platinum detachable coil of complex and Size .012" outer diameter. $1,400.00
helical shapes. Embolic coil and delivery Complex shape - 2 -12mm (dia),
tube. 2 - 30cm lengths; helical shape
- 2 - 30mm (dia), lengths 2 -
JJ224 TruFill Pushable coil Platinum pushable coil of 1. Straight, 2. Size .014" outer diameter. Size $33.25
C, 3. Flat spiral and 4. Complex shapes. 2 - 10mm and length 2 - 100mm
Embolic coil and delivery tube.
Procedure Trays, Surgical
Kendall Australasia Pty Ltd T/A Tyco Healthcare Pty Ltd
KA014 Mahurkar Maxid Catheters Catheters constructed of radiopaque Size, 38, 43, 48, 53cm $298.70
polyurethans, high kink resistant. The
arterial lumen is shorter than the venous
lumen at the catheter's distal end in order
to reduce recirculation during
Page 753 of 758
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Prostheses, Blood Vessel, Artificial
Edwards Lifesciences Pty Ltd
EL005 PTFE Vascular Graft Expanded, reinforced 5-10mm x 10cm $190.00 $325.00
Polytetrafluoroethylene. Straight, Regular
Wall, Spiral Externally Supported
EL006 PTFE Vascular Graft Expanded, reinforced 5-10mm x 20cm $190.00 $325.00
Polytetrafluoroethylene. Straight, Regular
Wall, Spiral Externally Supported
EL013 PTFE Vascular Graft Expanded, reinforced 5-10mm x 10cm $190.00 $325.00
Polytetrafluoroethylene. Straight, Thin
Wall, Spiral Externally Supported
EL014 PTFE Vascular Graft Expanded, reinforced 5-10mm x 20cm $190.00 $325.00
Polytetrafluoroethylene. Straight, Thin
Wall, Spiral Externally Supported
EL024 PTFE Vascular Graft Expanded, reinforced 4-7mm x 70cm $1,285.00
Polytetrafluoroethylene. Regular Wall,
EL027 PTFE Vascular Graft Expanded, reinforced 4-7mm x 70cm $1,285.00
Polytetrafluoroethylene. Thin Wall,
Terumo Corporation Australia
TU038 Gelweave Graft Straight Thoracic Graft, with antiflo side 22-34 mm x 20-40 cm $1,677.00 $1,744.00
branch, Polyester, woven, gelatin sealed
Prostheses, Blood Vessel, Biological
Bio Nova International Pty Ltd
BN001 Bio Nova Vascular Graft Flonova One size only $4,032.00
BN002 Omniflow II Vascular Prosthesis - - 5 - 10 mm x 65 cm $3,891.00
BN003 Omniflow II Vascular Prosthesis - - 5 - 10 mm x 55 cm $3,357.00
Page 754 of 758
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
BN004 Omniflow II Vascular Prosthesis - - 3 - 4 mm x 20 cm $2,283.00
BN005 Omniflow II Vascular Prosthesis - Vascular Patch One size only $672.00
Prosthesis, Internal, Embolisation, Vascular
Medtel Australia Pty Ltd
ME182 Amplatzer Vascular Plug Self expandable nitinol wire mesh Diameter 4mm - 16mm, Length $1,900.00
7 & 8mm
Prosthesis, Internal, Stent
Johnson & Johnson Medical Pty Ltd
JJ463 PRECISE RX Nitinol Stent System Nitinol self expandable stent and repid Stent Lengths 20, 30, 40mm; $2,420.00
exchange delivery system Stent Diameter: 5, 6, 7, 8, 9,
Spring Infusor, Ambulatory
Tuta Healthcare Pty Ltd
TT001 Paragon Ambulatory Drug Infusion System The top of the Paragon infuser is made of Infuser - 100mL Administration $988.00
acetyl with stainless steel parts; the Sets - 0.50mL, 1mL, 2mL,
bottom is made of clear polycarbonate. 4mL, 10mL, 50mL, 100mL, or
Diam: 10cm Height: 5.8cm.
Administration Sets - made from PVC
TT003 Sidekick Ambulatory Disposable Delivery Spring infusor made from high impact Infuser - 50mL or 100mL, $467.00
System plastics. Administration Sets - made Administration Sets - 50mL,
from PVC and acrylic components. 100mL or 200mL/hr
Page 755 of 758
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Stents, Vascular
Bard Australia Pty Ltd
BA006 Endologix Endoluminal Prostheses Power link endoliminal stent graft 25mm - 32mm Proximal $12,500.00
diameter, 16 - 20mm Limb
diameter, 130mm - 220mm
BA007 Endologix Endoluminal Prostheses Power link limb extension 16mm x 55mm, 16mm x $2,500.00
88mm, 20mm x 55mm
BA008 Endologix Endoluminal Prostheses Power link proximal cuff 25mm x 55mm, 28mm x $2,500.00
55mm, 28mm x 75mm (55mm
Biotronik Australia Pty Ltd
BT035 PEIRON Flexible coated stent with delivery system Dia 5-8mm, length 18-38mm $2,600.00
Boston Scientific Pty Ltd
BS035 Expandable Endovascular Wallstent Wallstent - Easy Wallstent, Iliac Wallstent Stent Diameter x Stent Length: $1,872.00
(A self-expanding stent that has a 6-16mm x 18-70mm
cylindrical braided structure composed of
24 wires with core of either tantalum or
Endotherapeutics Pty Ltd
ET030 Aspire Covered Stent Expandible Nitinol Stent covered with Dia 6-14mm, Length 2.5-10cm $5,000.00
ET037 SX-Ella Endovascular Stent Uncovered, self-expanding nitinol stent Dia 6-16mm, length 22-77mm $2,500.00
Johnson & Johnson Medical Pty Ltd
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
Medtronic Australasia Pty Ltd
MC205 Cerebrence Over-the-Wire Neurovascular Stainless Steel 2.5-4mm x 6-25mm $1,700.00
Stent System
Page 756 of 758
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Stents, Vascular, Peripheral
Johnson & Johnson Medical Pty Ltd
JJ479 PALMAZ GENESIS on CORDIS AMIIA Peripheral balloon expandable stent and Lengths: 12, 15, 18, 24mm. $2,300.00
RX .014 Delivery System rapid exchange delivery system Diameter: 4, 4.5, 5, 5.5, 6, 6.5,
7mm
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 $647.00
GT014 Soft Tissue Patch ePTFE 1mm Thickness 15 x 20cm $1,167.00
GT015 Soft Tissue Patch ePTFE 1mm Thickness 20 x 30cm $2,040.00
GT016 Soft Tissue Patch ePTFE 2mm Thickness 5 x 10cm $361.00
GT017 Soft Tissue Patch ePTFE 2mm Thickness 10 x 15cm $876.00
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
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 $311.00
BN008 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 10cm x 15cm $776.00
BN009 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 15cm x 20cm $1,403.00
Page 757 of 758
VASCULAR
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
BN010 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 20cm x 30cm $2,466.00
Grand Total: 9107 Records
Page 758 of 758
PART B - Human Tissue List August 2006
CARDIO-THORACIC
Billing Code Facility Benefit Amount
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 15
OPHTHALMIC
Billing Code Facility Benefit Amount
Cornea
LEM01 Lions Eye Bank - Melbourne $1,300.00
LEN01 Lions NSW Eye Bank $1,000.00
LEW01 The Lions Eye Bank of WA $2,000.00
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
Human Amniotic Membrane for Transplantation
LEM03 Lions Eye Bank - Melbourne $321.00
SCLERA
LEW02 The Lions Eye Bank of WA $200.00
QEB02 Queensland Eye Bank $150.00
Page 2 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
Achilles Tendon
NBB01 New South Wales Bone Bank $1,560.00
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 $1,900.00
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 $1,700.00
Anterior Tibialis Tendon
PBT46 Perth Bone & Tissue Bank $1,300.00
Autologous Chondrocyte Transplantation
MTE01 Mercy Tissue Engineering Pty Ltd $9,996.00
MTE03 Mercy Tissue Engineering Pty Ltd $11,349.00
MVS22 Institute of Medical & Veterinary Science, SA $9,538.00
VAP01 Verigen Australia Pty Ltd $9,556.00
Autologous Chondrocytes
MTE02 Mercy Tissue Engineering Pty Ltd $2,509.00
VAP03 Verigen Australia Pty Ltd $2,593.00
Autologous Chrondocyte Transplantation
MUA01 Monash University, Dept of Surgery, Alfred Hospital, Tissue Culture Laboratory $8,694.43
Autologous Skull Flap
MVS23 Institute of Medical & Veterinary Science, SA $1,396.00
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 $500.00
Page 3 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
TBV07 Donor Tissue Bank of Victoria $583.00
Bone Plug/Dowel - Tricortical
TBV08 Donor Tissue Bank of Victoria $643.00
Cartilage (costal) segments
PBT11 Perth Bone & Tissue Bank $300.00
QBB12 Queensland Bone Bank $200.00
TBV17 Donor Tissue Bank of Victoria $335.00
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 10-15cm
PBT06 Perth Bone & Tissue Bank $1,450.00
Cortical Struts>15 - 20cm
PBT07 Perth Bone & Tissue Bank $1,850.00
Cortical struts>20cm
PBT48 Perth Bone & Tissue Bank $2,100.00
Cortico - Cancellous Freeze Dried 20g
QBB03 Queensland Bone Bank $1,740.00
Disc - Freeze Dried
QBB04 Queensland Bone Bank $650.00
Dowel Plug
NBB05 New South Wales Bone Bank $1,080.00
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
Page 4 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
TBV21 Donor Tissue Bank of Victoria $692.00
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 $800.00
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 $4.00
Femoral Condyle
PBT21 Perth Bone & Tissue Bank $1,800.00
Femoral Head
ACT01 ACT Bone Bank $1,638.00
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 $1,750.00
PBT22 Perth Bone & Tissue Bank $1,800.00
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 $2,020.00
Femoral Head - Half (Freeze Dried)
QBB29 Queensland Bone Bank $500.00
Page 5 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
Femoral Head - Whole (Freeze Dried)
QBB28 Queensland Bone Bank $800.00
Femoral Rings
NBB17 New South Wales Bone Bank $1,400.00
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
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 $2,850.00
TBV22 Donor Tissue Bank of Victoria $3,308.00
Femur - Distal Half
NBB10 New South Wales Bone Bank $2,370.00
Femur - Distal half > 15cm
QBB20 Queensland Bone Bank $2,370.00
Femur - Distal third
NBB11 New South Wales Bone Bank $1,144.00
Femur - Distal third < 15cm
QBB21 Queensland Bone Bank $2,270.00
Femur - Entire
MVS03 Institute of Medical & Veterinary Science, SA $2,290.00
NBB12 New South Wales Bone Bank $5,539.00
PBT18 Perth Bone & Tissue Bank $4,900.00
Page 6 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
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 $2,250.00
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 $2,850.00
TBV25 Donor Tissue Bank of Victoria $3,283.00
Femur - Proximal (shaft & trachanter, neck)
MVS04 Institute of Medical & Veterinary Science, SA $2,290.00
Femur - Proximal half
NBB15 New South Wales Bone Bank $2,570.00
Femur - Proximal half > 15cm
QBB25 Queensland Bone Bank $2,570.00
Femur - Proximal third
NBB14 New South Wales Bone Bank $1,040.00
Femur - Proximal third < 15cm
QBB24 Queensland Bone Bank $2,120.00
Femur - Segment
NBB56 New South Wales Bone Bank $1,500.00
Femur - Shaft Half
NBB57 New South Wales Bone Bank $2,200.00
Femur - Shaft Third
NBB55 New South Wales Bone Bank $1,500.00
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)
Page 7 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
TBV51 Donor Tissue Bank of Victoria $3,185.00
Fibula - Entire
MVS07 Institute of Medical & Veterinary Science, SA $2,290.00
NBB18 New South Wales Bone Bank $3,200.00
PBT25 Perth Bone & Tissue Bank $2,000.00
QBB32 Queensland Bone Bank $2,220.00
TBV27 Donor Tissue Bank of Victoria $5,775.00
Fibula - Segment
NBB54 New South Wales Bone Bank $1,925.00
Fibula - Segment (12cm)
MVS14 Institute of Medical & Veterinary Science, SA $2,290.00
NBB20 New South Wales Bone Bank $1,881.00
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 $1,300.00
TBV28 Donor Tissue Bank of Victoria $583.00
Fibula - Shaft
TBV30 Donor Tissue Bank of Victoria $1,881.00
Fibula segment (prox / distal)
PBT28 Perth Bone & Tissue Bank $1,100.00
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)
Page 8 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
QBB09 Queensland Bone Bank $1,335.00
Freeze-Dried Cancellous Strips (2)
QBB10 Queensland Bone Bank $650.00
Hemipelvis - Acetabulum
NBB21 New South Wales Bone Bank $2,568.00
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 $5,825.00
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 $2,321.00
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 $1,005.00
PBT32 Perth Bone & Tissue Bank $600.00
TBV34 Donor Tissue Bank of Victoria $880.00
Humeral Head
QBB44 Queensland Bone Bank $1,350.00
TBV37 Donor Tissue Bank of Victoria $1,419.00
Page 9 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
Humeral Head Addition
NBB26 New South Wales Bone Bank $1,419.00
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 $2,828.00
QBB43 Queensland Bone Bank $2,570.00
Humerus - Proximal half
NBB27 New South Wales Bone Bank $1,658.00
QBB40 Queensland Bone Bank $1,260.00
Humerus - Proximal half with rotator cuff
NBB28 New South Wales Bone Bank $2,500.00
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 $2,376.00
Humerus - Ring
Page 10 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
NBB53 New South Wales Bone Bank $1,300.00
Humerus - Segment
NBB52 New South Wales Bone Bank $1,400.00
Humerus - Shaft Half
NBB51 New South Wales Bone Bank $1,500.00
Humerus - Shaft Whole
NBB50 New South Wales Bone Bank $2,750.00
Humerus - Whole
PBT33 Perth Bone & Tissue Bank $3,000.00
Humerus - Whole with rotator cuff
NBB30 New South Wales Bone Bank $2,941.00
Matrix and Autologous Chondrocytes Implant
ORT01 Orthogen Australia Pty Ltd $11,400.00
Medial Ligament
NBB31 New South Wales Bone Bank $1,529.00
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 - 15cc
NBB58 New South Wales Bone Bank $720.00
Milled Bone - 30gm
NBB03 New South Wales Bone Bank $1,050.00
Milled Bone - 40cc
Page 11 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
TBV11 Donor Tissue Bank of Victoria $1,000.00
Milled Bone - 60gm
NBB04 New South Wales Bone Bank $1,675.00
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 $1,500.00
Milled Bone >50gr
PBT10 Perth Bone & Tissue Bank $2,250.00
Milled Bone 30 - 50gr
PBT09 Perth Bone & Tissue Bank $1,950.00
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 $875.00
QBB47 Queensland Bone Bank $750.00
TBV41 Donor Tissue Bank of Victoria $875.00
Patella tendon
QBB48 Queensland Bone Bank $1,715.00
Patella Tendon and Patella
TBV42 Donor Tissue Bank of Victoria $1,842.00
Patella tendon with Bone Plugs
NBB33 New South Wales Bone Bank $1,357.00
Page 12 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
Patellar unit whole with tibial block
PBT40 Perth Bone & Tissue Bank $2,000.00
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 $2,673.00
PBT13 Perth Bone & Tissue Bank $1,800.00
QBB15 Queensland Bone Bank $1,865.00
TBV19 Donor Tissue Bank of Victoria $2,673.00
Radius - Ring
NBB49 New South Wales Bone Bank $1,680.00
Radius - Segment
NBB48 New South Wales Bone Bank $1,925.00
Radius - Shaft
NBB47 New South Wales Bone Bank $2,750.00
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
Shaft - Femur / Tibia Middle third
PBT19 Perth Bone & Tissue Bank $2,400.00
Tibia - Condyles only
TBV47 Donor Tissue Bank of Victoria $1,425.00
Tibia - Cortical < 15cm
QBB50 Queensland Bone Bank $1,275.00
Page 13 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
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 $1,400.00
QBB53 Queensland Bone Bank $900.00
Tibia - Plateau (prox 1/3)
NBB35 New South Wales Bone Bank $2,065.00
Tibia - Proximal third < 15cm
QBB54 Queensland Bone Bank $2,065.00
Tibia - Proximal with Patella Tendon
NBB46 New South Wales Bone Bank $3,647.00
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 $2,198.00
Tibia - Proximal: half
MVS11 Institute of Medical & Veterinary Science, SA $2,290.00
NBB36 New South Wales Bone Bank $2,290.00
Tibia - Proximal: with Patella & Tendon
PBT44 Perth Bone & Tissue Bank $1,900.00
Tibia - Ring
NBB45 New South Wales Bone Bank $1,300.00
Tibia - Shaft Half
NBB43 New South Wales Bone Bank $2,200.00
Page 14 of 15
ORTHOPAEDIC
Billing Code Facility Benefit Amount
Tibia - Shaft Third
NBB42 New South Wales Bone Bank $2,065.00
Tibia - Shaft Whole
NBB41 New South Wales Bone Bank $2,750.00
Tibia - Strut
QBB52 Queensland Bone Bank $400.00
Tibia - Whole
MVS16 Institute of Medical & Veterinary Science, SA $2,290.00
NBB37 New South Wales Bone Bank $3,685.00
QBB55 Queensland Bone Bank $3,685.00
Tibia - Whole with Patella Tendon
NBB44 New South Wales Bone Bank $5,042.00
Ulna
MVS15 Institute of Medical & Veterinary Science, SA $2,290.00
NBB07 New South Wales Bone Bank $2,464.00
PBT14 Perth Bone & Tissue Bank $1,500.00
QBB16 Queensland Bone Bank $1,865.00
TBV20 Donor Tissue Bank of Victoria $2,464.00
Ulna - Ring
NBB40 New South Wales Bone Bank $1,680.00
Ulna - Segment
NBB39 New South Wales Bone Bank $1,925.00
Ulna - Shaft
NBB38 New South Wales Bone Bank $2,200.00
Page 15 of 15
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