National Health Act 1953 Determination made under subsections 73AAG (6) and (7) (HIB 23/2005) (Cth)
Australian Government
NATIONAL HEALTH ACT 1953
Determination made under subsections 73AAG (6) and (7)
(HIB 23/2005)
I, LINDA ADDISON, delegate of the Minister for Health and Ageing, acting pursuant to subsections 73AAG (6) and (7) of the National Health Act 1953 (the Act), AMEND the determination under subsections 73AAG (6) and (7) of the Act dated 19 October 2005 (Determination Number HIB 18/2005) (the Determination) as set out below.
1.Insert the text after the headings in Attachment 1 of this determination into Part A - Prostheses, at page 4 of 740, after Neich Medical Pty Ltd and before Billing Code NM003.
2.Delete from Part A – Prostheses, at page 49 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code OS016, Tympanostomy Tube, and replace it with $25.00.
3.Delete the text after the headings in Attachment 2 of this determination from Part A – Prostheses, at page 90 of 740.
4.Insert the text after the headings in Attachment 3 of this determination into Part A – Prostheses, at page 90 of 740, after Billing Code SI025 and before Billing Code SI028.
5.Delete from Part A – Prostheses, at page 90 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SI042, Extension Set, and replace it with $6.20.
6.Insert into Part A – Prostheses, at page 90 of 740, under the heading Notations for Billing Code SI042, Extension Set, the following text: “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of six”, and substitute all the text under the heading Size with “152cm”.
7.Delete from Part A – Prostheses, at page 90 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SI043, Administration Set, and replace it with $18.00.
8.Insert into Part A – Prostheses, at page 90 of 740, under the heading Notations for Billing Code SI043, Administration Set, the following text: “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of eight”, and delete all the text under the heading Size.
9.Delete from Part A – Prostheses, at page 90 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SI044, Administration Set, and replace it with $21.60.
10.Insert into Part A – Prostheses, at page 90 of 740, under the heading Notations for Billing Code SI044, Administration Set, the following text: “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of ten”, and substitute all the text under the heading Size with “305cm”.
11.Delete the text after the headings in Attachment 4 of this determination from Part A – Prostheses, at page 93 of 740.
12.Substitute all the words in Part A – Prostheses, at page 123 of 740, under the heading Product Name for Billing Code AB005, Bioglue Surgical Adhesive – 5ml Solutions Cartridge Shelf Box: 5 pack” with “Bioglue Surgical Adhesive – 5ml Solutions Cartridge 5 per pack”.
13.Substitute all the words in Part A – Prostheses, at page 123 of 740, under the heading Notation for Billing Code AB005, Bioglue Surgical Adhesive – 5ml Solutions Cartridge: 5 per pack” with “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of five, Temporary Approval.”.
14.Delete from Part A – Prostheses, at page 123 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code AB006, Bioglue Surgical Adhesive – Applicator Tip Extender, and replace it with $30.50.
15.Substitute all the words in Part A – Prostheses, at page 123 of 740, under the heading Product Name for Billing Code AB007, Bioglue Surgical Adhesive – 10ml Solutions Cartridge Shelf Box: 5 pack” with “Bioglue Surgical Adhesive – 10ml Solutions Cartridge 5 per pack”.
16.Substitute all the words in Part A – Prostheses, at page 123 of 740, under the heading Notation for Billing Code AB007, Bioglue Surgical Adhesive – 10ml Solutions Cartridge: 5 per pack” with “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of five, Temporary Approval.”.
17.Delete from Part A – Prostheses, at page 123 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code AB008, Bioglue Surgical Adhesive – Standard Applicator Tip, and replace it with $25.50.
18.Delete from Part A – Prostheses, at page 123 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code AB009, Bioglue Surgical Adhesive – Applicator Tip Extender, and replace it with $30.50.
19.Delete from Part A – Prostheses, at page 123 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code AB010, Bioglue Surgical Adhesive – Applicator Tip Extender, and replace it with $30.50.
20.Substitute all the words in Part A – Prostheses, at page 123 of 740, under the heading Product Name for Billing Code AB011, “Bioglue Surgical Adhesive – 2ml Solutions Cartridge Shelf Box: 5 pack” with “Bioglue Surgical Adhesive – 2ml Solutions Cartridge 5 per pack”.
21.Substitute all the words in Part A – Prostheses, at page 123 of 740, under the heading Notation for Billing Code AB011, “Bioglue Surgical Adhesive – 2ml Solutions Cartridge 5 pack” with “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of five, Temporary Approval.”.
22.Insert the text after the headings in Attachment 5 of this determination into Part A - Prostheses, at page 175 of 750, after Billing Code BL015 and before “Spectrum Ophthalmics”.
23.Delete from Part A – Prostheses, at page 201 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK176, Stryker Cuff Anchor, and replace it with $390.00.
24.Delete from Part A – Prostheses, at page 207 of 740, the text after the headings in Attachment 6 of this determination.
25.Delete from Part A – Prostheses, at page 212 of 740, the text after the headings in Attachment 7 of this determination.
26.Delete from Part A – Prostheses, at page 215 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DY350, RECO Spinal System, and replace it with $78.38.
27.Delete from Part A – Prostheses, at page 215 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code GM025, Maxima/Optima Anterior Cervical Plate System, and replace it with $200.00.
28.Delete from Part A – Prostheses, at page 215 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code GM026, Maxima/Optima Anterior Cervical Plate System, and replace it with $1,900.00.
29.Insert the text after the headings in Attachment 8 of this determination into Part A – Prostheses, at page 215 of 740, after Billing Code GM039.
30.Insert the text after the headings in Attachment 9 of this determination into Part A – Prostheses, at page 223 of 740, after Billing Code ZI334 and before Billing Code ZI486.
31.Delete from Part A – Prostheses, at page 224 of 740, the text after the headings in Attachment 10 of this determination.
32.Delete from Part A – Prostheses, at page 226 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code LM029, Kompressor, and replace it with $550.00.
33.Insert in Part A – Prostheses, at page 227 of 740, for Billing Code MO252, Martin Fixation Device Internal – Screw, under the heading Notations, “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of two”.
34.Insert in Part A – Prostheses, at page 227 of 740, for Billing Code MO253, Martin Fixation Device Internal – Screw, under the heading Notations, “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of two”.
35.Insert in Part A – Prostheses, at page 227 of 740, for Billing Code MO254, Martin Fixation Device Internal – Screw, under the heading Notations, “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of two”.
36.Insert in Part A – Prostheses, at page 227 of 740, for Billing Code MO255, Martin Fixation Device Internal – Screw, under the heading Notations, “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of two”.
37.Insert in Part A – Prostheses, at page 227 of 740, for Billing Code MO256, Martin Fixation Device Internal – Screw, under the heading Notations, “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of two”.
38.Delete from Part A – Prostheses, at page 232 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK221, Stryker Plating System, and replace it with $975.00.
39.Insert in Part A – Prostheses, at page 250 of 740, the amount under the heading Maximum Benefit Amount for Billing Code GS174, PLUS Hip Joint Prostheses System, of $1,500.00.
40.Delete from Part A – Prostheses, at page 254 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK010, ABGII Cup with Hydroxyapartite, and replace it with $2,460.00.
41.Delete from Part A – Prostheses, at page 254 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ST565, Alumina acetabular inserts, and replace it with $2,460.00.
42.Delete from Part A – Prostheses, at page 254 of 740, the text under the heading Size for Billing Code AD289, Transcend/Lineage Articulation System, and replace it with “Grp 1, Grp 2, Grp 3, Grp 4. 28, 32 & 36mm”.
43.Insert the text after the headings in Attachment 11 of this determination into Part A – Prostheses, at page 263 of 740, after Group 11 – Unipolar/Monoblock and before Biomet Australia Pty Ltd.
44.Delete from Part A – Prostheses, at page 272 of 740, the amount under the heading Maximum Benefit Amount for Billing Code DP119, Solution Implantable Hip System.
45.Delete from Part A – Prostheses, at page 275 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DY474, Solution Implantable Hip System, and replace it with $3,450.00.
46.Insert the text after the headings in Attachment 12 of this determination into Part A – Prostheses, at page 280 of 740, after Billing Code OH201 and before Zimmer.
47.Delete from Part A – Prostheses, at page 282 of 740, the text after the headings in Attachment 13 of this determination.
48.Insert the text after the headings in Attachment 14 of this determination into Part A – Prostheses, at page 280 of 740, after Billing Code AD291 and before De Puy Australia.
49.Insert the text after the headings in Attachment 15 of this determination into Part A – Prostheses, at page 282 of 740, after Advanced Surgical Technologies and before De Puy Australia.
50.Insert the text after the headings in Attachment 16 of this determination into Part A – Prostheses, at page 301 of 740, after Billing Code GM044 and before Billing Code GM057.
51.Insert the text after the headings in Attachment 17 of this determination into Part A – Prostheses, at page 307 of 740, after Billing Code BI070 and before Billing Code BI896.
52.Delete from Part A – Prostheses, at page 307 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BI896, M2A Magnum Prosthesis, and replace it with $2,300.00.
53.Insert the text after the headings in Attachment 18 of this determination into Part A – Prostheses, at page 333 of 740, after Billing Code ZI454 and before Group 9d – Uncemented, polyethylene metal backed, mobile.
54.Substitute all the words in Part A – Prostheses, at page 336 of 740, under the heading Size for Billing Code AD144, Advance Revision Knee System, with “11-22mm in 1mm increments, 100 and 140mm lengths”.
55.Substitute all the words in Part A – Prostheses, at page 336 of 740, under the heading Size for Billing Code AD148, Advance Revision Knee System with “10, 12, 14, 16, 18 x 65mm, 15 x 30mm”.
56.Delete from Part A – Prostheses, at page 351 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code HW091, Duracon Total Knee System, and replace it with $1,200.00.
57.Delete from Part A – Prostheses, at page 352 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ST608, Scorpio Tibial Insert, and replace it with $1,200.00.
58.Delete from Part A – Prostheses, at page 356 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SR008, Scorpio Tibial Insert, and replace it with $1,200.00.
59.Insert the text after the headings in Attachment 19 of this determination into Part A – Prostheses, at page 409 of 740, after Billing Code ZI322 and before Orthopaedic Internal Fixation Systems, Other.
60.Insert into Part A – Prostheses, at page 417 of 740, for Billing Code BB215, Adonys Posterior Lumbar Cage System, under the heading Notations, “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of two”.
61.Insert into Part A – Prostheses, at page 417 of 740, for Billing Code BB216, Adonys Posterior Lumbar Cage System, under the heading Notations, “The benefit amount/minimum benefit amount is for an individual product which comes as a pack of two”.
62.Delete from Part A – Prostheses, at page 419 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DP311, Moss Miami (Stainless Steel), and replace it with $569.33.
63.Delete from Part A – Prostheses, at page 422 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DP848, Moss Miami 4mm Anterior System (SS), and replace it with $1,540.42.
64.Delete from Part A – Prostheses, at page 453 of 740, the text after the headings in Attachment 20 of this determination.
65.Insert the text after the headings in Attachment 21 of this determination, at page 455 of 740, after Synthes Australia Pty Ltd and before Billing Code SY090.
66.Delete from Part A – Prostheses, at page 457 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DP074, Isola System (Titanium), and replace it with $54.75.
67.Delete from Part A – Prostheses, at page 461 of 740, the text after the headings in Attachment 22 of this determination.
68.Delete from Part A – Prostheses, at page 475 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ST771, Leibinger Titanium Implant System, and replace it with $275.00.
69.Delete from Part A – Prostheses, at page 475 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ST772, Leibinger Titanium Implant System, and replace it with $290.00.
70.Insert the text after the headings in Attachment 23 of this determination, at page 480 of 740, after SY172 and before SY190.
71.Insert the text after the headings in Attachment 24 of this determination into Part A – Prostheses, at page 482 of 740, after Billing Code LO106 and before Prep Kits.
72.Insert the text after the headings in Attachment 25 of this determination into Part A – Prostheses, at page 491 of 740, after Billing Code ZI005.
73.Insert the text after the headings in Attachment 26 of this determination into Part A – Prostheses, at page 498 of 740, after Billing Code ZI329 and before Billing Code ZI473.
74.Insert the text after the headings in Attachment 27 of this determination into Part A – Prostheses, at page 499 of 740, after Billing Code ZI313 and before Prostheses, Joint, Knee, Femoral Component.
75.Delete from Part A – Prostheses, at page 501 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK091, Duracon Total Knee System, and replace it with $1,350.00.
76.Insert the text after the headings in Attachment 28 of this determination into Part A – Prostheses, at page 505 of 740, after Billing Code DE174 and before Mathys Australia.
77.Insert the text after the headings in Attachment 29 of this determination into Part A – Prostheses, at page 507 of 740, after Billing Code ZI319 and before Billing Code ZI442.
78.Delete from Part A – Prostheses, at page 507 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ZI442, Select Shoulder, and replace it with $906.00
79.Insert the text after the headings in Attachment 30 of this determination into Part A – Prostheses, at page 507 of 740, after Billing Code ZI442.
80.Delete from Part A – Prostheses, at page 509 of 740, the text after the headings in Attachment 31 of this determination.
81.Delete from Part A – Prostheses, at page 510 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code LM010, Universal Total Wrist Implant System, and replace it with $9,500.00.
82.Delete from Part A – Prostheses, at page 523 of 740, the text after the headings in Attachment 32 of this determination.
83.Insert the text after the headings in Attachment 33 of this determination into Part A – Prostheses, at page 516 of 740, after Billing Code AD105 and before Billing Code AD303.
84.Delete from Part A – Prostheses, at page 526 of 740, the text after headings in Attachment 34 of this determination.
85.Insert the text after the headings in Attachment 35 of this determination into Part A – Prostheses, at page 530 of 740, after Billing Code LV084 and before Screws.
86.Insert the text after the headings in Attachment 36 of this determination into Part A – Prostheses, at page 533 of 740, after Billing Code SY322 and before Screws, Bone.
87.Delete from Part A – Prostheses, at page 538 of 740, the text after the headings in Attachment 37 of this determination.
88.Insert the text after the headings in Attachment 38 of this determination, at page 546 of 740, after Billing Code SY141 and before Billing Code SY266.
89.Insert the text after the headings in Attachment 39 of this determination into Part A – Prostheses, at page 548 of 740, after Billing Code ZI263 and before Screws, Cranioplasty Plate.
90.Insert the text after the headings in Attachment 40 of this determination into Part A – Prostheses, at page 552 of 740, after Billing Code HD003 and before Washers, Bone Screw.
91.Delete from Part A – Prostheses, at page 553 of 740, the text after the headings in Attachment 41 of this determination.
92.Insert the text after the headings in Attachment 42 of this determination, at page 554 of 740, after SY089 and before SY256.
93.Delete from Part A – Prostheses, at page 555 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ZI323, Zimmer Wires, and replace it with $200.00.
Delete from Part A – Prostheses, at page 559 of 740, the text after the headings in Attachment 43 of this determination.
95.Delete from Part A – Prostheses, at page 572 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SP039, Bioresorbable Fixation System, and replace it with $420.00.
96.Insert the text after the headings in Attachment 44 of this determination into Part A – Prostheses, at page 694 of 740, after “William A Cook Aust Pty Ltd” and before Billing Code WC003.
97.Delete from Part A – Prostheses, at page 731 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code AY014, Jostent Wavemax, and replace it with $1,000.00.
98.Delete from Part A – Prostheses, at page 739 of 740, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code AY016, Perclose Arterial Support and Closure, and replace it with $400.00.
This determination commences on 21 November 2005.
Dated this 17 day of November 2005.
L Addison
Linda Addison
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
Attachment 1 (Item 1)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
NM002 Constant Rx Coronary Stent System Stainless Steel Balloon Expandable Tubular Stent Lengths 9 – 32mm; Diameters 2.5 – 4.00mm $1,000.00 Attachment 2 (Item 3)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
SI026 Flexible Medication Reservoir, 250ml, Model 21-6167-24 Pump 250ml $7.08 Attachment 3 (Item 4)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
SI026 CADD Administration Set 175cm TOTM tubing For use with SI036 $7.08 The benefit amount/minimum benefit amount is for an individual product which comes as a pack of 48. Attachment 4 (Item 11)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Smiths Medical Australasia Pty Ltd
SI032 CADD-Micro Model 5900 Ambulatory Infusion Pump Pump One size only $3,694.00 Attachment 5 (Item 22)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
IQ Medical
IQ002 Ocuvis and Ocumax 2% Hydroxypropylmethylcellulose 20mg/mL hydroxypropylmethylcellulose for intraocular use. Pre-loaded in a sterile syringe with one cannula for injection, in a sterile Tyvek pouch 2mL sterile $90.00 Attachment 6 (Item 24)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
SK236 BoneSource Classic Bone Cement Calcium Phosphate Bone Matrix Replacement. Sodium Phosphate Solution and Mixing bowl included
2.5gm $280.00 SK237 BoneSource Classic Bone Cement Calcium Phosphate Bone Matrix Replacement. Sodium Phosphate Solution and Mixing bowl included
5gm pack $380.00 SK238 BoneSource Classic Bone Cement Calcium Phosphate Bone Matrix Replacement. Sodium Phosphate Solution and Mixing bowl included
10gm pack $13,000.00 Attachment 7 (Item 25)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
ST800 2.5gm Bone Source Hydroxyapatite Cement with Sodium Phosphate Self setting cement used to fill cranial defects, sodium phosphate included in packaging to allow acceleration of the 2.5gm $500.00 Attachment 8 (Item 29)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
GM060 Maxima/Optima Anterior Cervical Plate System Pedicle Screw – Mono Axial Type 4.5mm – 8.5mm Length. 25mm – 60mm
$900.00 GM061 Maxima/Optima Anterior Cervical Plate System
Rod 30mm – 100mm $450.00 GM062 Maxima/Optima Anterior Cervical Plate System
Set Screw One Size $300.00 GM063 Maxima/Optima Anterior Cervical Plate System
Transverse Link Assembly 44mm - 75mm $900.00 GM064 Maxima/Optima Anterior Cervical Plate System
Hooks Open & Closed – Pedicle & Laminar 6.5mm – 11mm $811.00 GM065 Maxima/Optima Anterior Cervical Plate System
Axial/Lateral Connections 7.5mm – 30mm $840.00 Attachment 9 (Item 30)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Zimmer
ZI459 Collagen Meniscus Implant Porous collagen-glycosaminoglycan matrix 7.5mm, 9mm $4,986.00 Attachment 10 (Item 31)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
LM034 Trimed Bullet Stainless Steel 3 - 9 holes $138.00 Attachment 11 (Item 43)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
B Braun Australia Pty Ltd
BB047 Downs Austin-Moore Hip Stem 39-54mm $460.00 BB048 Downs Thompson Stem Stem 38-55mm $380.00 Attachment 12 (Item 46)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Stryker Australia Pty Ltd
ST001 Restoration T3 Revision Hip System – Proximal Sleeve Titanium Alloy S, M, L $2,365.00 Attachment 13 (Item 47)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
AD292 WMT Perfecta Hip System Porous Titanium 10.5, 12, 12.7, 13.5, 14.2, 15, 16.5 18mm width, 140-175 $2,670.00 Attachment 14 (Item 48)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
AD292 Infinity Modular Hip System Trochanteric module titanium A, B, C, D, E, F $2,670.00 Attachment 15 (Item 49)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
AD293 WMT Perfecta Hip System Porous titanium Non HA 10.5, 12, 12.7, 13.5, 14.2, 15, 16.5, 18mm width, 140 – 175 long $3,900.00 Attachment 16 (Item 50)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
GM045 BioBall – Femoral Modular Head System Femoral Modular Head System $1,100.00 Attachment 17 (Item 51)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
BI895 M2A Magnum Prosthesis Taper Insert, Cobalt chrome 42 - 50mm, -6, -3, STD, +3, +6, +9; 52 - 60mm, -6, -3, STD,
3, +6, +9$500.00 Attachment 18 (Item 53)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
ZI460 Natural Knee Patella Durasul UHMWPE, highly cross linked 0 to 3 $500.00 $1067.00 Attachment 19 (Item 59)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
ZI331 Zimmer Periarticular Locking Plates Periarticular Locking Plate System Various lengths and numbers of holes $1,400.00 Attachment 20 (Item 64)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Mathys Australia
SY051 AO/ASIF K-Wires, Pin, Washers Seldrill 4.0/3.0mm & 4.0 – 6mm / 80 – 250mm L $107.00 Attachment 21 (Item 65)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
SY051 AO/ASIF K-Wires, Pin, Washers Seldrill 4.0/3.0mm & 4.0 – 6mm / 80 – 250mm L $107.00 Attachment 22 (Item 67)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Mathys Australia
SY188 AO/ASIF Plates Calcaneal, Locking 3.5mm, 30 – 100mm $1,174.00 Attachment 23 (Item 70)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
SY188 AO/ASIF Plates Calcaneal, Locking 3.5mm, 30 – 100mm $1,174.00 Attachment 24 (Item 71)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Zimmer
ZI356 Medullary Plug, MS 30 Centring Plug, cement restrictor, hip – PE 1 to 7 $145.00 ZI451 Allofit screw hole plugs Sterile, 7 per set One size only $50.00 Attachment 25 (Item 72)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
ZI342 GSB Cemented Elbow GSB Humerus – CoCr alloy/PE 76, 86, 86L $4,518.09 ZI343 GSB Cemented Elbow GSB Humeral Medullary Plug – PE One size only $168.00 ZI344 GSB Cemented Elbow GSB Ulna Component – CoCr alloy 12/71, 12/61, 16/71, 16/61 $1274.81 ZI345 GSB Cemented Elbow GSB Washer – PE 2/12, 4/12, 6/12, 2/16, 4/16, 6/16 $134.25 ZI464 GSB Elbow Ulna Extension One size only $1,300.00 ZI465 GSB Elbow Special Bushing for Humerus Length 76 – 86mm $1,650.00 Attachment 26 (Item 73)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
ZI366 Natural Hip System Distal Centraliser – PE 10 to 19 $245.81 ZI374 MS-30 Hip Prosthesis Centraliser for cemented stems. (Protek) – metal alloys 8 to 18 $145.00 Attachment 27 (Item 74)
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
ZI398 High Tibia Osteotomy High Tibia Osteotomy – Ti alloy L shaped steel alloy plate; Standard & Long
$917.00 ZI406 Natural Knee Tibial Spacer Screw – Ti alloy One size only $279.31 ZI407 Natural Knee Tibial Spacer Peg – Ti alloy One size only $279.31 Attachment 28 (Item 76)
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ESKA Australia
EK028 ESKA Modular Shoulder System Modular System with Humeral Plate Extensions 2 humeral components, 3 humeral heads, 3 extensions $7,750.00 Attachment 29 (Item 77)
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ZI440 Anatomical Glenoid – PE S, M, L $1,397.72 ZI441 Select Shoulder Humeral Head Eccentric – CoCr alloy 44/19 to 56/32 $1,678.00 Attachment 30 (Item 79)
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ZI443 Select Shoulder Stem – ti alloy 7mm Short to 14.5mm $3,914.00 ZI444 BiPolar Head Humeral Head used with Select Should Humeral Stem – CoCr alloy/PE
26/42 to 26/60 $1,341.94 ZI445 Intermedics Select Shoulder UniPolar Head – metal alloy 40 x 16mm to 56 x 32mm $1,096.00 ZI446 Intermedics Select Shoulder Long Stem – Ti alloy 7 to 14.5mm $4,249.22 Attachment 31 (Item 80)
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AD160 WMT Orthopaedic Implants Radial/Ulna Head
Radial head implant HP silastic 1, 1.5, 2, 2.5, 3 $695.00 AD161 WMT Orthopaedic Implants Radial/Ulna Head
Radial head titanium 1, 1.5, 2, 2.5, 3 $1,680.00 Attachment 32 (Item 82)
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Advanced Surgical Technologies
AD283 E-Centrix Ulnar Head Replacement Ulnar Head 16 x 1.5mm Offset, 16 x 3.0mm Offset, 18 x 1.5mm Offset, 20 x 1.5mm Offset, 20 x
$1,500.00 AD284 E-Centrix Ulnar Head Replacement Ulnar Stem 5.5 STD, 6.5 STD, 7.5 STD, 8.5 STD
$1,400.00 AD285 E-Centrix Ulnar Head Replacement
Ulnar Stem Extender 20mm $800.00 Attachment 33 (Item 83)
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Billing Code Product Name Description Size Amount Amount Notations
AD160 WMT Orthopaedic Implants Radial/Ulna Head
Radial head implant HP silastic 1, 1.5, 2, 2.5, 3 $695.00
AD161 WMT Orthopaedic Implants Radial/Ulna Head
Radial head titanium 1, 1.5, 2, 2.5, 3 $1,680.00 AD283 E-Centrix Ulnar Head Replacement
Ulnar Head 16 x 1.5mm Offset, 16 x 3.0mm Offset, 18 x 1.5mm Offset, 20 x 1.5Offset, 20 x 3.0mm Offset
$1,500.00 AD284 E-Centrix Ulnar Head Replacement
Ulnar Stem 5.5 STD, 6.5 STD, 7.5 STD, 8.5 STD
$1,400.00 AD285 E-Centrix Ulnar Head Replacement
Ulnar Stem Extender 20mm $800.00 Attachment 34 (Item 84)
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LM019 Ascension Radial Head Pyrocarbon Radial Head 20, 22, 24, RH-300-20, RH-300-22, RH-300-24 $4,428.57 Attachment 35 (Item 85)
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Zimmer
ZI336 Polypin Resorbable Bone Pin Polylactide 1.5, 2.0, 2.7mm $246.00 Attachment 36 (Item 86)
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Zimmer
ZI447 Bioresorbable Screw Polylactide One size only $257.00 Attachment 37 (Item 87)
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SY173 Locking Head Screws Self drilling, Self Tapping, Sterile/Non Dia 3.5 – 5.0mm, Length 10 – 100mm $173.00 Attachment 38 (Item 88)
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SY173 Locking Head Screws Self drilling, Self Tapping, Sterile/Non Dia 3.5 – 5.0mm, Length 10 – 100mm $173.00 Attachment 39 (Item 89)
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ZI370 Cancellous Screws Orthopaedic Screws - Ti alloy 20 to 60 $145.00 ZI399 Cancellous Screws Screws – Cancell – Ti alloy 6.5/15 to 6.5/70mm $119.00 ZI400 Cortical Screws Screws – Cortical – Ti alloy 4.5/30 to 60mm $119.00 ZI448 Cannulated Screw Ti alloy One size only $144.94 Attachment 40 (Item 90)
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Zimmer
ZI471 NCB-Femur Plate System Complete Complete with all locking screws, gap insert, spacers. Special titanium alloy. Plate size 167 to 324mm long $1,927.50 Attachment 41 (Item 91)
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Mathys Australia
SY091 AO/ASIF K-Wires, Pins, Washers etc Pinless pins, clips Asymetric small and large $745.00 Attachment 42 (Item 92)
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SY091 AO/ASIF K-Wires, Pins, Washers etc Pinless pins, clips Asymetric small and large $745.00 Attachment 43 (Item 94)
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Stryker Australia Pty Ltd
ST071 Bonesource Hydroxyapatite Cement with Sodium Phosphate
Leibinger Bonesource HA Cement Hydroxyapatite With Sodium Phosphate 5g pack $989.00 Only to be funded where used in a service for which a Medicare benefit is payable.
ST073 Bonesource Hydroxyapatite Cement with Sodium Phosphate
Leibinger Bonesource HA Cement Hydroxyapatite With Sodium Phosphate 10g pack $1,730.00 Only to be funded where used in a service for which a Medicare benefit is payable.
ST075 Bonesource Hydroxyapatite Cement with Sodium Phosphate
Leibinger Bonesource HA Cement Hydroxyapatite With Sodium Phosphate 25g pack $3,708.00 Only to be funded where used in a service for which a Medicare benefit is payable.
Attachment 44 (Item 96)
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WC002 Sof-Flex Multilength Ureteric Stent Set Includes Stent, Wire, Positioner 4.7fr – 8fr. 22 – 32mm $187.65
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