National Health Act 1953 Determination made under subsections 73AAG(6) and (7) (HIB 30/2006) (Cth)

Case

Australian Government

NATIONAL HEALTH ACT 1953

Determination made under subsections 73AAG (6) and (7)

(HIB 30/2006)

I, VERONICA HANCOCK, 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 12 September 2006 (Determination Number HIB 22/2006) (the Determination) as set out below.

  1. Delete from Part A – Prostheses, at page 12 of 778, the Billing Code EL033 and the contents of all fields associated with it.

  1. Delete from Part A – Prostheses, at page 13 of 778, the text under the heading "Product Name" for Billing Code AB002 and replace it with "ATS medical open pivot heart valve model 500FA standard flexi-cuff aortic valve series, ATS medical open pivot heart valve model 500DM standard flexi-cuff mitral valve series".

  1. Delete from Part A – Prostheses, at page 14 of 778, the text under the heading "Product Name" for Billing Code AB064 and replace it with "ATS medical open pivot heart valve model 501DA advanced performance (AP) aortic valve series, ATS medical open pivot heart valve model 501DM advanced performance (AP) mitral valve series".

  1. Delete from Part A – Prostheses, at page 15 of 778, the Billing Code AC002 and the contents of all fields associated with it.

  1. Delete from Part A – Prostheses, at page 15 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code EL031 and replace it with $4900.00; then insert under the heading Maximum Benefit Amount $5144.00.

  1. Delete from Part A – Prostheses, at page 16 of 778, for Billing Code MC005, the contents of all fields associated with it and insert the wording under the appropriate fields as per the table below:

Billing Code Product Name Description Size MinBenefit MaxBenefit
MC005 Medtronic Duran Annuloplasty Ring; Duran Ancore Ring 620R; Duran Ancore Chordal Model 620R Annuloplasty Devices - Models 610R & 620R Silicone / Barium Sulphate, Dacron Model 610R 25-35mm & Model 620R 23-35mm $1900.00

  1. Insert at page 17 of 778, after Billing Code SJ088, the item heading “Group 5 – Cardiothoracic Membranes and Patches, Group 5a – Tissue, Edwards Lifesciences Pty Ltd” and insert the Billing Code EL033 with the wording under the appropriate fields as per the table below:

Group 5 - Cardiothoracic Membranes and Patches

Group 5a - Tissue

Edwards Lifesciences Pty Ltd

Billing Code Product Name Description Size MinBenefit MaxBenefit
EL033 Baxter Augmentation/Substitution Material, Human or Animal Origin, Sterile Pericardial Patch Edwards Pericardial Patch, Bovine Pericardium  10cm x 16cm $740.00

  1. Delete from Part A – Prostheses, at page 17 of 778, for Billing Code MC709, the contents of all fields associated with it and insert the wording under the appropriate fields as per the table below:

Billing Code Product Name Description Size MinBenefit MaxBenefit
MC709 Posterior Annuloplasty Band;  Colvin - Galloway Future Band Model 638B; Duran Ancore Band 620B; Duran Ancore Chordal Model 620BG Annuloplasty - Model 610B & 620B Silicone / Barium Sulphate, Dacron. Models 638B semi-regid metal alloy core, silicone coating, polyester knit fabric, kit includes-band, malleable handle, template with suture markers, sizers Model 610B: 25-35mm; Models 620B & 620BG: 23-35mm, Model 638B - 26-38mm” $1900.00

  1. Delete from Part A – Prostheses, at page 29 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC013 and replace it with $5000.00.

  1. Delete from Part A – Prostheses, at page 29 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC198 and replace it with $6800.00.

  1. Delete from Part A – Prostheses, at page 29 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC292 and replace it with $5909.00.

  1. Delete from Part A – Prostheses, at page 29 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC324 and replace it with $5909.00.

  1. Delete from Part A – Prostheses, at page 29 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC681 and replace it with $5909.00.

  1. Delete from Part A – Prostheses, at page 29 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SJ036 and replace it with $6800.00; then insert under the heading Maximum Benefit Amount $7800.00.

  1. Delete from Part A – Prostheses, at page 29 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SJ037 and replace it with $5909.00; then insert under the heading Maximum Benefit Amount $6050.00.

  1. Delete from Part A – Prostheses, at page 29 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SJ039 and replace it with $5909.00; then insert under the heading Maximum Benefit Amount $6990.00.

  1. Delete from Part A – Prostheses, at page 30 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code EL039 and replace it with $4900.00; then insert under the heading Maximum Benefit Amount $5690.00.

  1. Delete from Part A – Prostheses, at page 30 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC701 and replace it with $4350.00.

  1. Delete from Part A – Prostheses, at page 30 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SJ069 and replace it with $4350.00; then insert under the heading Maximum Benefit Amount $5000.00.

  1. Delete from Part A – Prostheses, at page 30 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code TM039 and replace it with $4445.00.

  1. Delete from Part A – Prostheses, at page 41 of 778, the amount for Billing Code ET031 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 43 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code PM074 and replace it with $17.83.

  1. Delete from Part A – Prostheses, at page 51 of 778, the text under the heading "Size" for Billing Code CO027 and replace it with "4mm and 3mm".

  1. Delete from Part A – Prostheses, at page 51 of 778, the text under the heading "Size" for Billing Code CO030 and replace it with "Self Tapping 4mm and 3mm".

  1. Delete from Part A – Prostheses, at page 51 of 778, the text under the heading "Size" for Billing Code CO032 and replace it with "Self Tapping 4mm and 3mm with BAHA Abutment".

  1. Delete from Part A – Prostheses, at page 58 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC275 and replace it with $14.00.

  1. Delete from Part A – Prostheses, at page 77 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code FE003 and replace it with $155.00.

  1. Delete from Part A – Prostheses, at page 78 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SS004 and replace it with $300.00.

  1. Delete from Part A – Prostheses, at page 82 of 778, the amount for Billing Code ET042 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 83 of 778, the amount for Billing Code GY083 under the heading Maximum Benefit Amount.

  1. Insert in Part A – Prostheses, at page 85 of 778, the amount $22.90 under the heading Maximum Benefit Amount for Billing Code RO004; and insert under the heading “Notation” the following text “The price indicated is per unit and there are 10 units per box”.

  1. Delete from Part A – Prostheses, at page 85 of 778, the amount under the heading Maximum Benefit Amount, for the Billing Code RO010 and replace it with $29.90; and insert under the heading “Notation” the following text “The price indicated is per unit and there are 10 units per box”.

  1. Delete from Part A – Prostheses, at page 85 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code RO011 and replace it with $7.70; then delete the amount under the heading Maximum Benefit Amount and replace it with $29.90; and insert under the heading “Notation” the following text “The price indicated is per unit and there are 10 units per box”.

  1. Delete from Part A – Prostheses, at page 85 of 778, the amount for Billing Code RO012 under the heading Maximum Benefit Amount and replace it with $21.90; and insert under the heading “Notation” the following text “The price indicated is per unit and there are 10 units per box”.

  1. Delete from Part A – Prostheses, at page 87 of 778, the amount for Billing Code RO003 the amount under the heading Maximum Benefit Amount; and insert under the heading “Notation” the following text “The price indicated is per unit and there are 10 units per box”.

  1. Delete from Part A – Prostheses, at page 87 of 778, the amount under the heading Maximum Benefit Amount, for Billing Code RO006 and replace it with $11.96; and insert under the heading “Notation” the following text “The price indicated is per unit and there are 25 units per box”.

  1. Insert in Part A – Prostheses, at page 87 of 778, the text under the heading “Notation” for Billing Code RO007 “The price indicated is per unit and there are 5 units per box”.

  1. Delete from Part A – Prostheses, at page 114 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code TB137 and replace it with $41.00.

  1. Delete from Part A – Prostheses, at page 116 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code OC006 and replace it with $370.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 116 of 778, the amount under the heading  Amount/Minimum Benefit Amount for Billing Code OC007 and replace it with $265.00; then delete the amount under the heading Maximum Benefit Amount and replace it with $395.00.

  1. Delete from Part A – Prostheses, at page 116 of 778, the amount under the heading Maximum Benefit Amount for Billing Code OC008 and replace it with $395.00.

  1. Delete from Part A – Prostheses, at page 120 of 778, the amount for Billing Code ET001 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 121 of 778, the Billing Code NG033 and the contents of all fields associated with it, including the heading “N Stenning  & Co Pty  Ltd”, and replace it with the heading “Boston Scientific Pty Ltd” and billing Codes BS101 and BS102 with the following details:

Boston Scientific Pty Ltd

Billing Code Product Name Description Size MinBenefit MaxBenefit
BS101 Polyflex Airway Stent Poylester braided material encapsulated with silicone, self expanding stent Stent inner diameters up to 22mm, stent lengths up to 80mm $2,040.00
BS102 Polyflex Oesophageal Stent Poylester braided material encapsulated with silicone, self expanding stent Stent inner diameters up to 22mm, stent lengths up to 80mm $2,040.00

  1. Delete from Part A – Prostheses, at page 131 of 778, the amount for Billing Code AS025 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 132 of 778, the amount for Billing Code AS115 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 132 of 778, the amount for Billing Code AS117 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 139 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB108 and replace it with $215.00.

  1. Delete from Part A – Prostheses, at page 146 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC690 and replace it with $4230.00.

  1. Delete from Part A – Prostheses, at page 146 of 778, for the Billing Code MC710, the word “without” in the text under the heading "Description" and replace it with the word “with”.

  1. Delete from Part A – Prostheses, at page 146 of 778, for the Billing Code MC712, the word “without” in the text under the heading "Description" and replace it with the word “with”.

  1. Delete from Part A – Prostheses, at page 149 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB161 and replace it with $1150.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 149 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB226 and replace it with $1200.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 149 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB227 and replace it with $1200.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 150 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DP567 and replace it with $944.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Insert in Part A - Prostheses, the Billing Code DY321 and its respective wordings under the appropriate fields as per the table below, on page 150 of 778, after the Billing Code DY309.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY321 Codman Anterior Cervical Plate System Rescue screw 12 & 15mm $178.00

  1. Delete from Part A – Prostheses, at page 151 of 778, the amount for Billing Code DY333 under the heading Maximum Benefit Amount.

  1. Insert in Part A - Prostheses, the Billing Code DY401 and its respective wordings under the appropriate fields as per the table below, on page 151 of 778, after the Billing Code DY346.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY401 Monarch Monoaxial Pedicle Screw 4.75mm - 8.5mm x 25 to 80mm length $1,004.00 $1,782.00

58.Insert in Part A - Prostheses, the Billing Code DY454 and its respective wordings under the appropriate fields as per the table below, on page 151 of 778, after the Billing Code DY453.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY454 Swift Spine System Titanium Anterior Cervical Plate System - 3.8mm Bicortical Screw 10 - 28mm $850.00

59.Insert in Part A - Prostheses, the Billing Code DY455 and its respective wordings under the appropriate fields as per the table below, on page 151 of 778, after the Billing Code DY454.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY455 Swift Spine System Titanium Anterior Cervical Plate System - Graft Screw 10mm $850.00

  1. Delete from Part A – Prostheses, at page 152 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code HW385 and replace it with $1225.00.

  1. Delete from Part A – Prostheses, at page 152 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code HW393 and replace it with $577.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 152 of 778, the amount for Billing Code MC402 the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 153 of 778, the amount for Billing Code MC503 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 153 of 778, the amount for Billing Code MC598 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 153 of 778, the amount for Billing Code MC636 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 154 of 778, the amount for Billing Code SX001 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 154 of 778, the amount for Billing Code SX009 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 154 of 778, the amount for Billing Code SX012 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 155 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ST687 and replace it with $879.00.

  1. Delete from Part A – Prostheses, at page 156 of 778, the amount for Billing Code SU173 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 156 of 778, the amount for Billing Code SY175 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 157 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY291 and replace it with $275.00.

  1. Delete from Part A – Prostheses, at page 157 of 778, the amount for Billing Code ZI487 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 158 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB159 and replace it with $541.82.

  1. Delete from Part A – Prostheses, at page 158 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB160 and replace it with $1800.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 158 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB174 and replace it with $1800.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 158 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB224 and replace it with $1550.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 158 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB225 and replace it with $1550.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Insert in Part A - Prostheses, the Billing Code DP848 and its respective wordings under the appropriate fields as per the table below, on page 158 of 778, after the Billing Code DP408.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP848 Moss Miami 4mm Anterior System (SS) Screws - Polyaxial 6mm x 25 - 55mm $1,330.00 $1,619.00

  1. Delete from Part A – Prostheses, at page 159 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC579 and replace it with $1500.00; then delete the amount under the heading Maximum Benefit Amount and replace it with $1600.00.

  1. Delete from Part A – Prostheses, at page 159 of 778, the amount for Billing Code MC586 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 159 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code OH178 and replace it with $1480.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 159 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code OH190 and replace it with $1480.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 159 of 778, the amount for Billing Code SX002 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 160 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY289 and replace it with $1390.50.

  1. Delete from Part A – Prostheses, at page 161 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code OH185 and replace it with $360.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 162 of 778, the amount for Billing Code ZI334 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 163 of 778, the amount for Billing Code MC589 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 163 of 778, the amount for Billing Code SX010 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 163 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB211 and replace it with $4250.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Insert in Part A - Prostheses, the Billing Code DY198 and its respective wordings under the appropriate fields as per the table below, on page 165 of 778, after the Billing Code DP851.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY198 Carbon Fibre Cages ALIF 1 C/F Cage 5 - 10 deg Sm to Lg 10 - 18 mm $3,080.00 $3,128.00

  1. Delete from Part A – Prostheses, at page 166 of 778, the amount for Billing Code SX007 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 166 of 778, the amount for Billing Code SX014 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 168 of 778, the amount for Billing Code SU172 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 169 of 778, the amount for Billing Code ZI330 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 169 of 778, the amount for Billing Code ZI483 under the heading Maximum Benefit Amount.

  1. Insert in Part A - Prostheses, the Billing Code DP252 and its respective wordings under the appropriate fields as per the table below, on page 170 of 778, before the Billing Code DY359.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP252 Acroflex Lumbar Artificial Disc Lumbar Disc Replacement Device One size only $951.00

  1. Delete from Part A – Prostheses, at page 170 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code OH130 and replace it with $5000.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 170 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DY356 and replace it with $4200.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 171 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code OH054 and replace it with $500.00.

  1. Insert in Part A - Prostheses, the heading “Stryker Australia Pty Ltd (2)” and the Billing Code SK425 and its respective wordings under the appropriate fields as per the table below, on page 171 of 778, after the Billing Code OH054.

Stryker Australia Pty Ltd (2)

Billing Code Product Name Description Size MinBenefit MaxBenefit
SK425 VBOSS/VLIFT Titanium Available from 10 to 25mm in Diameter and from 8 to 120mm in Length $3,605.00 $4,600.00

  1. Delete from Part A – Prostheses, at page 172 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code TB293 and replace it with $2700.00.

  1. Insert in Part A - Prostheses, the Billing Code DY107 and its respective wordings under the appropriate fields as per the table below, on page 173 of 778, before the Billing Code DY109.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY107 Carbon Fibre Cages Stackable Cage Titanium Interface Screw Nuts One size only $815.00 $857.00

  1. Insert in Part A - Prostheses, the Billing Code DY322 and its respective wordings under the appropriate fields as per the table below, on page 173 of 778, after the Billing Code DY110.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY322 Carbon Fibre Interbody Fusion Device Stackable C/F Cage System Wedges 11 Degree Small-Large $3,305.00 $3,407.00

  1. Delete from Part A – Prostheses, at page 173 of 778, the amount for Billing Code MC449 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 173 of 778, the amount for Billing Code MC450 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 173 of 778, the amount for Billing Code MC451 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 174 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY295 and replace it with $1133.00; then insert under the heading Maximum Benefit Amount $1200.00.

  1. Insert in Part A - Prostheses, the Billing Code DY350 and its respective wordings under the appropriate fields as per the table below, on page 176 of 778, after the Billing Code DY345.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY350 RECO Spinal System Set Screw One size only $79.00

  1. Insert in Part A - Prostheses, the Billing Code DP849 and its respective wordings under the appropriate fields as per the table below, on page 176 of 778, after the Billing Code DP834.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP849 Moss Miami 4mm Anterior System (SS) Washer or Staple or 12 sided outie One size only $255.00 $337.00

  1. Delete from Part A – Prostheses, at page 177 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC490 and replace it with $126.36.

  1. Delete from Part A – Prostheses, at page 177 of 778, the amount for Billing Code MC504 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 177 of 778, the amount for Billing Code MC546 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 177 of 778, the amount for Billing Code MC667 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 177 of 778, the amount for Billing Code SX004 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 177 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB230 and replace it with $225.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 179 of 778, the amount for Billing Code ZI479 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 180 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SY276.

  1. Delete from Part A – Prostheses, at page 180 of 778, the amount for Billing Code SU095 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 181 of 778, the amount under the heading Maximum Benefit Amount for Billing Code DY317.

  1. Delete from Part A – Prostheses, at page 181 of 778, the amount under the heading Maximum Benefit Amount for Billing Code TB273.

  1. Delete from Part A – Prostheses, at page 182 of 778, the amount under the heading Maximum Benefit Amount for Billing Code MC635.

  1. Delete from Part A – Prostheses, at page 182 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK224 and replace it with $722.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 183 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB007 and replace it with $480.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Insert in Part A - Prostheses, the Billing Code DP060 and its respective wordings under the appropriate fields as per the table below, on page 183 of 778, before the Billing Code DP311.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP060 VSP System (Stainless Steel) Sacral Connector - Left & Right Offset One size only $521.00

  1. Insert in Part A - Prostheses, the Billing Code DP842 and its respective wordings under the appropriate fields as per the table below, on page 183 of 778, after the Billing Code DP474.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP842 Moss Miami (Stainless Steel) Sacral Extender 5mm x 5 - 20mm length $600.00

  1. Delete from Part A – Prostheses, at page 183 of 778, the amount under the heading Maximum Benefit Amount for Billing Code DP843.

  1. Delete from Part A – Prostheses, at page 184 of 778, the amount under the heading Maximum Benefit Amount for Billing Code MC542.

  1. Delete from Part A – Prostheses, at page 184 of 778, the amount under the heading Maximum Benefit Amount for Billing Code MC608.

  1. Delete from Part A – Prostheses, at page 185 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code OH186 and replace it with $780.00.

  1. Delete from Part A – Prostheses, at page 185 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU072.

  1. Delete from Part A – Prostheses, at page 185 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU198.

  1. Delete from Part A – Prostheses, at page 185 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU199.

  1. Delete from Part A – Prostheses, at page 185 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY250 and replace it with $1100.00; then delete the amount under the heading Maximum Benefit Amount and replace it with $2565.00.

  1. Delete from Part A – Prostheses, at page 186 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB228 and replace it with $1250.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 186 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB229 and replace it with $1500.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Insert in Part A - Prostheses, the Billing Code DY351 and its respective wordings under the appropriate fields as per the table below, on page 187 of 778, after the Billing Code DY344.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY351 RECO Spinal System Tranverse Connector 4 or 6mm $900.00

  1. Delete from Part A – Prostheses, at page 188 of 778, the amount under the heading Maximum Benefit Amount for Billing Code MC590.

  1. Delete from Part A – Prostheses, at page 189 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SX016.

  1. Delete from Part A – Prostheses, at page 190 of 778, the amount under the heading Maximum Benefit Amount for Billing Code DP299.

  1. Delete from Part A – Prostheses, at page 190 of 778, the amount under the heading Maximum Benefit Amount for Billing Code DP300.

  1. Delete from Part A – Prostheses, at page 191 of 778, the amount under the heading Maximum Benefit Amount for Billing Code DP410.

  1. Delete from Part A – Prostheses, at page 191 of 778, the amount under the heading Maximum Benefit Amount for Billing Code DP411.

  1. Delete from Part A – Prostheses, at page 191 of 778, the amount under the heading Maximum Benefit Amount for Billing Code DP472.

  1. Delete from Part A – Prostheses, at page 191 of 778, the amount under the heading Maximum Benefit Amount for Billing Code DP845.

  1. Insert in Part A - Prostheses, the Billing Code DY304 and its respective wordings under the appropriate fields as per the table below, on page 191 of 778, after the Billing Code DP845.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY304 Monarch Spinal System Hooks - Open (Pedicle/Narrow Tapered/Wide Blade) 5-11mm $725.00

  1. Delete from Part A – Prostheses, at page 192 of 778, the amount under the heading Maximum Benefit Amount for Billing Code MC591.

  1. Delete from Part A – Prostheses, at page 192 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code OH045 and replace it with $772.00.

  1. Delete from Part A – Prostheses, at page 192 of 778, the text under the heading "Description" for Billing Code MC375 and replace it with "Colorado 2 Hook, Pedicular hook - small and large, Laminar hook - small, medium and large, Staple for pedicular hooks, Open laminar thoracic hook, Supra laminar median hook, Narrow laminar - 1 size, Open laminar - 1 size".

  1. Delete from Part A – Prostheses, at page 192 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SX006.

  1. Delete from Part A – Prostheses, at page 193 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY325 and replace it with $970.26, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 193 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DP464 and replace it with $820.00.

  1. Insert at page 195 of 778, after Billing Code DY066, the Billing Code DY069 with wording under the appropriate fields as per the table below:

Billing Code Product Name Description Size MinBenefit MaxBenefit
DY069 Codman Anterior Cervical Plate System Anterior Cervical Plate 50 – 70 mm $1271.00 $1315.00

  1. Insert in Part A - Prostheses, the Billing Code DY450 and its respective wordings under the appropriate fields as per the table below, on page 196 of 778, after the Billing Code DY449.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY450 Swift Spine System Titanium Anterior Cervical Plate System – various size Plates Level 4 size 60 - 100mm $2,700.00 $2,822.00

  1. Delete from Part A – Prostheses, at page 197 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC421 and replace it with $1550.00.

  1. Delete from Part A – Prostheses, at page 197 of 778, the amount under the heading Maximum Benefit Amount for Billing Code MC616.

  1. Delete from Part A – Prostheses, at page 197 of 778, the amount under the heading Maximum Benefit Amount for Billing Code MC637.

  1. Delete from Part A – Prostheses, at page 198 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SX008.

  1. Delete from Part A – Prostheses, at page 198 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SX011.

  1. Delete from Part A – Prostheses, at page 199 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code TB192 and replace it with $2050.00.

  1. Delete from Part A – Prostheses, at page 201 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY364 and replace it with $298.00.

  1. Delete from Part A – Prostheses, at page 201 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB219 and replace it with $600.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 201 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB220 and replace it with $600.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Insert in Part A - Prostheses, the Billing Code DY313 and its respective wordings under the appropriate fields as per the table below, on page 202 of 778, after the Billing Code DY310.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY313 Monarch Spinal System Rods - Pre Cut/Lordosed 6.35 & 5.5mm x 45 - 95mm $329.00

  1. Delete from Part A – Prostheses, at page 203 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC382 and replace it with $444.00.

  1. Delete from Part A – Prostheses, at page 203 of 778, the amount for Billing Code MC544 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 204 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SX003.

  1. Delete from Part A – Prostheses, at page 204 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SX015.

  1. Delete from Part A – Prostheses, at page 204 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU002.

  1. Delete from Part A – Prostheses, at page 204 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU003.

  1. Delete from Part A – Prostheses, at page 204 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU004.

  1. Delete from Part A – Prostheses, at page 204 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU083.

  1. Delete from Part A – Prostheses, at page 204 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU084.

  1. Delete from Part A – Prostheses, at page 204 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU085.

  1. Delete from Part A – Prostheses, at page 204 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU089.

  1. Delete from Part A – Prostheses, at page 205 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code OH058 and replace it with $1345.00.

  1. Delete from Part A – Prostheses, at page 205 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU074.

  1. Insert in Part A - Prostheses, the Billing Code DP505 and its respective wordings under the appropriate fields as per the table below, on page 206 of 778, after the Billing Code DP494.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP505 Anterior Isola System (SS) Rod with Hex End 1/4" x 18" $325.00

  1. Delete from Part A – Prostheses, at page 206 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU096.

  1. Delete from Part A – Prostheses, at page 206 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU098.

  1. Delete from Part A – Prostheses, at page 206 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU099.

  1. Delete from Part A – Prostheses, at page 206 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU100.

  1. Delete from Part A – Prostheses, at page 206 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU101.

  1. Delete from Part A – Prostheses, at page 206 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU102.

  1. Delete from Part A – Prostheses, at page 206 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU103.

  1. Delete from Part A – Prostheses, at page 206 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU104.

  1. Delete from Part A – Prostheses, at page 206 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU105.

  1. Delete from Part A – Prostheses, at page 206 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SU106.

  1. Delete from Part A – Prostheses, at page 208 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY150 and replace it with $431.00.

  1. Delete from Part A – Prostheses, at page 208 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code OH046 and replace it with $1040.00.

  1. Delete from Part A – Prostheses, at page 220 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code JJ252 and replace it with $44.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 220 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code JJ253 and replace it with $66.00.

  1. Delete from Part A – Prostheses, at page 246 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DE263 and replace it with $310.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 246 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DE264 and replace it with $350.00; then delete the amount under the heading Maximum Benefit Amount and replace it with $390.00.

  1. Delete from Part A – Prostheses, at page 249 of 778, the Billing Code IQ003 and the contents of all fields associated with it.

  1. Insert at page 252 of 778, after Billing Code DE260, the heading “IQ Medical” and insert billing code IQ003 with wording under the appropriate fields as per the table below:

IQ Medical

Billing Code Product Name Description Size MinBenefit MaxBenefit
IQ003 Tertraflex Acrylic single piece, foldable accommodating intraocular lens with square edge design, custom control precision and closed loop haptic design Available in dioptric powers from +5.0 to +36.0, ID steps: +31.0 to +36.0; 0.5D steps: +5.0 to +18.0 and +25.0 to +30.0; 0.2D steps; +18.0 to +25.0 $490.00 $1200.00

  1. Delete from Part A – Prostheses, at page 265 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code AD227 and replace it with $1795.00.

  1. Delete from Part A – Prostheses, at page 266 of 778, the amount for Billing Code BI937 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 268 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY189 and replace it with $980.20.

  1. Delete from Part A – Prostheses, at page 276 of 778, the amount under the heading Maximum Benefit Amount for Billing Code OH203.

  1. Delete from Part A – Prostheses, at page 276 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SN838.

  1. Delete from Part A – Prostheses, at page 281 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MO272 and replace it with $1550.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 281 of 778, the text under the heading "Product Name" for Billing Code SN831 and replace it with "Peri-Loc UE".

  1. Delete from Part A – Prostheses, at page 282 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SQ001 and replace it with $750.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 286 of 778, the text under the heading "Product Name" for Billing Code SN832 and replace it with "Peri-Loc UE".

  1. Delete from Part A – Prostheses, at page 286 of 778, the text under the heading "Product Name" for Billing Code SN833 and replace it with "Peri-Loc UE".

  1. Delete from Part A – Prostheses, at page 303 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code PL140 and replace it with $2350.00.

  1. Insert in Part A - Prostheses, the Billing Code DP222 and its respective wordings under the appropriate fields as per the table below, on page 306 of 778, after the Billing Code DP112.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP222 Thackray Hip System Poly Liner Custom Made to order $1,248.00

  1. Insert in Part A - Prostheses, the Billing Code DY280 and its respective wordings under the appropriate fields as per the table below, on page 306 of 778, after the Billing Code DY032.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY280 Pinnacle Acetabular Cup System Pinnacle GVF +4 or Neutral or 10 Degree or Lipped Liners 38-80mm x 22.225 or 26 or 28 or 32 or 36mm $936.00

  1. Delete from Part A – Prostheses, at page 309 of 778, the text under the heading "Size" for Billing Code CR073 and replace it with "22-32mm".

  1. Delete from Part A – Prostheses, at page 312 of 778, the text under the heading "Size" for Billing Code CR063 and replace it with "28-36mm".

  1. Insert in Part A - Prostheses, the Billing Code DP969 and its respective wordings under the appropriate fields as per the table below, on page 316 of 778, after the Billing Code DP014.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP969 SROM Total Hip System UHMWPE Constrained 0Deg, 10 Deg, 28mm, 32mm, $2,435.00

  1. Insert in Part A - Prostheses, the Billing Code DP170 and its respective wordings under the appropriate fields as per the table below, on page 324 of 778, after the Billing Code DP168.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP170 Austin Moore Hip Prosthesis Ortron Custom sizes $615.00

  1. Insert in Part A - Prostheses, the heading “De Puy Australia” and the Billing Code DY167 and its respective wordings under the appropriate fields as per the table below, on page 330 of 778, after the Billing Code HW399.



De Puy Australia

Billing Code Product Name Description Size MinBenefit MaxBenefit
DY167 G2 Hip System G2 Stem Cemented 1 - 11L $2,080.00

  1. Insert in Part A - Prostheses, the Billing Code DP205 and its respective wordings under the appropriate fields as per the table below, on page 331 of 778, after the Billing Code DP175.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP205 Elite Modular Hip System Stem Ortron Custom size $3,848.00

  1. Delete from Part A – Prostheses, at page 333 of 778, the amount for Billing Code SN842 under the heading Maximum Benefit Amount.

  1. Insert in Part A - Prostheses, the Billing Code DY501 and its respective wordings under the appropriate fields as per the table below, on page 341 of 778, after the Billing Code DY493.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY501 SROM Total Hip System (Titanium) ZT/HA Small / Large /XX Large  size 14B-24F $2,860.00

  1. Delete from Part A – Prostheses, at page 338 of 778, the text under the heading "Size" for Billing Code CR086 and replace it with "5-20mm".

  1. Delete from Part A – Prostheses, at page 344 of 778, the amount under the heading Maximum Benefit Amount for Billing Code PD021.

  1. Delete from Part A – Prostheses, at page 344 of 778, the amount under the heading Maximum Benefit Amount for Billing Code PD022.

  1. Insert in Part A - Prostheses, the Billing Code DP980 and its respective wordings under the appropriate fields as per the table below, on page 349 of 778, after the Billing Code DP979.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP980 SROM Total Hip System (Titanium) Stem STD 14 x 09 x 130 NK36mm to 24 x 19 x 175 NK42mm $4,605.00

  1. Insert in Part A - Prostheses, the Billing Code DP549 and its respective wordings under the appropriate fields as per the table below, on page 358 of 778, after the Billing Code DP124.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP549 C- Stem C-Stem Heads Ortron Size -3 to +8 $700.00

  1. Insert in Part A - Prostheses, the Billing Code DP988 and its respective wordings under the appropriate fields as per the table below, on page 358 of 778, after the Billing Code DP549.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP988 SROM Total Hip System (Titanium) Unipolar 38-66mm $897.00

  1. Delete from Part A – Prostheses, at page 358 of 778, the Billing Code HW018 and the contents of all fields associated with it.

  1. Delete from Part A – Prostheses, at page 359 of 778, the Billing Code HW027 and the contents of all fields associated with it.

  1. Delete from Part A – Prostheses, at page 359 of 778, the text under all of the headings for Billing Code HW032 and replace it with the wordings under the appropriate fields as per the table below.

Billing Code Product Name Description Size MinBenefit MaxBenefit
HW032 Stryker CoCr Femoral Head 22, 26, 28, 30, 32  mm $811.00

  1. Delete from Part A – Prostheses, at page 359 of 778, the Billing Code HW058 and the contents of all fields associated with it.

  1. Delete from Part A – Prostheses, at page 359 of 778, the Billing Code HW059 and the contents of all fields associated with it.



  2. Delete from Part A – Prostheses, at page 359 of 778, the Billing Code ST567 and the contents of all fields associated with it.



  3. Delete from Part A – Prostheses, at page 359 of 778, the Billing Code ST598 and the contents of all fields associated with it.

  1. Delete from Part A – Prostheses, at page 360 of 778, the text under the heading "Size" for Billing Code CR065 and replace it with ">32mm".

  1. Delete from Part A – Prostheses, at page 361 of 778, the text under all of the headings for Billing Code HW017 and replace it with the wordings under the appropriate fields as per the table below.

Billing Code Product Name Description Size MinBenefit MaxBenefit
HW017 Stryker Biolox Forte Alumina Femoral Head 28, 32 mm $2080.00

  1. Delete from Part A – Prostheses, at page 362 of 778, the Billing Code ST928 and the contents of all fields associated with it.

  1. Delete from Part A – Prostheses, at page 362 of 778, the Billing Code SK011 and the contents of all fields associated with it.



  2. Delete from Part A – Prostheses, at page 362 of 778, the Billing Code SK012 and the contents of all fields associated with it.



  3. Delete from Part A – Prostheses, at page 363 of 778, the Billing Code SR010 and the contents of all fields associated with it.

  1. Delete from Part A – Prostheses, at page 363 of 778, the text under all of the headings for Billing Code SR023 and replace it with the wordings under the appropriate fields as per the table below.

Billing Code Product Name Description Size MinBenefit MaxBenefit
SR023 Stryker Revision Femoral Head, Biolox Forte With pre-assembled titanium sleeve 28, 32 mm $2080.00

  1. Delete from Part A – Prostheses, at page 365 of 778, the Billing Code SR015 and the contents of all fields associated with it.



  2. Delete from Part A – Prostheses, at page 365 of 778, the text under all of the headings for Billing Code SR025 and replace it with the wordings under the appropriate fields as per the table below.

Billing Code Product Name Description Size MinBenefit MaxBenefit
SR025 C-Taper CoCr Head Stryker CoCr Femoral Heads, LFIT treatment 36 mm $988.00

  1. Delete from Part A – Prostheses, at page 365 of 778, the Billing Code ST929 and the


    contents of all fields associated with it.

  1. Delete from Part A – Prostheses, at page 367 of 778, the text under all of the headings for Billing Code HW394 and replace it with the wordings under the appropriate fields as per the table below.

Billing Code Product Name Description Size MinBenefit MaxBenefit
HW394 Stryker Biolox Forte Alumina Femoral Head 36 mm $2080.00

  1. Delete from Part A – Prostheses, at page 367 of 778, the Billing Code SR001 and the contents of all fields associated with it.

  1. Delete from Part A – Prostheses, at page 368 of 778, the text under the heading "Size" for Billing Code CR016 and replace it with ">32mm".

  1. Delete from Part A – Prostheses, at page 397 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SN834.

  1. Delete from Part A – Prostheses, at page 423 of 778, the amount under the heading Maximum Benefit Amount for Billing Code JJ532.

  1. Insert in Part A - Prostheses, the Billing Code DP889 and its respective wordings under the appropriate fields as per the table below, on page 427 of 778, after the Billing Code DP444.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP889 AMK Chrome CobaltTray Cobalt Chrome Tibial TEX  or TX FX Tray Size 1-5 $4,667.00

  1. Delete from Part A – Prostheses, at page 439 of 778, the amount under the heading Maximum Benefit Amount for Billing Code CR061.

  1. Delete from Part A – Prostheses, at page 440 of 778, the amount under the heading Maximum Benefit Amount for Billing Code CR057.

  1. Delete from Part A – Prostheses, at page 442 of 778, the amount under the heading Maximum Benefit Amount for Billing Code MG022.

  1. Delete from Part A – Prostheses, at page 445 of 778, the amount under the heading Maximum Benefit Amount for Billing Code BI942.

  1. Delete from Part A – Prostheses, at page 455 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ST971 and replace it with $250.00.

  1. Delete from Part A – Prostheses, at page 458 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY224 and replace it with $1167.30.

  1. Delete from Part A – Prostheses, at page 467 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DP766 and replace it with $54.27, and then delete the amount under the heading Maximum Benefit Amount.

  1. Insert in Part A - Prostheses, the Billing Code DP837 and its respective wordings under the appropriate fields as per the table below, on page 468 of 778, after the Billing Code DP836.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP837 Peak Channelled Plate System Cortical Bone Screw 3.5mm $70.00  $118.00

  1. Delete from Part A – Prostheses, at page 468 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DY164 and replace it with $182.85, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 469 of 778, the amount under the heading Maximum Benefit Amount for Billing Code DY165.

  1. Insert in Part A - Prostheses, the Billing Code DP099 and its respective wordings under the appropriate fields as per the table below, on page 475 of 778, after the Billing Code DP039.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP099 Coventry Screw System S/S Cannulated Screws 7.00 mm dia $175.00  $521

  1. Insert in Part A - Prostheses, the Billing Code DP102 and its respective wordings under the appropriate fields as per the table below, on page 475 of 778, after the Billing Code DP099.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP102 Coventry Screw system Cannulated Screws 4mm and 4.50 mm $90.00  $270.00

  1. Delete from Part A – Prostheses, at page 475 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code DP859 and replace it with $2005.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Insert in Part A - Prostheses, the heading “Synthes Australia Pty Ltd” and the Billing Code SY180 and its respective wordings under the appropriate fields as per the table below, on page 479 of 778, after the Billing Code SU081.



Synthes Australia Pty Ltd

Billing Code Product Name Description Size MinBenefit MaxBenefit
SY180 Cervical Spine Locking Plate (CSLP) Small Stature Plate Length 20-77mm $1,250.00

  1. Delete from Part A – Prostheses, at page 502 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK055 and replace it with $368.00.

  1. Delete from Part A – Prostheses, at page 502 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK057 and replace it with $160.00.

  1. Delete from Part A – Prostheses, at page 502 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK067 and replace it with $53.00.

  1. Delete from Part A – Prostheses, at page 502 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK069 and replace it with $32.00.

  1. Delete from Part A – Prostheses, at page 502 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK071 and replace it with $61.00.

  1. Delete from Part A – Prostheses, at page 507 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY105 and replace it with $974.00.

  1. Delete from Part A – Prostheses, at page 516 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MM001 and replace it with $1500.00.

  1. Insert in Part A - Prostheses, the Billing Codes EA036 and EA037 and their respective wordings under the appropriate fields as per the table below, on page 517 of 778, after the Billing Code EA002.

Billing Code Product Name Description Size MinBenefit MaxBenefit
EA036 BPU Revision Total Ankle Prostheses Tibial component ceramic coated titanium 1-6 $3,850.00
EA037 Buechel-Pappas Total Ankle Prosthesis - Primary Talar Polyethylene mobile bearing 3mm - 11mm $925.00

  1. Insert in Part A - Prostheses, the Billing Code DY147 and its respective wordings under the appropriate fields as per the table below, on page 522 of 778, after the Billing Code DP884.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY147 C-Stem End Cap One size only $137.00

  1. Insert in Part A - Prostheses, the Billing Code DY168 and its respective wordings under the appropriate fields as per the table below, on page 522 of 778, after the Billing Code DY147.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DY168 G2 Hip System Distal Centraliser 1 - 11 $409.00 $420.00

  1. Delete from Part A – Prostheses, at page 522 of 778, the amount under the heading Maximum Benefit Amount for Billing Code DY403.

  1. Insert in Part A - Prostheses, the Billing Code DP296 and its respective wordings under the appropriate fields as per the table below, on page 524 of 778, after the Billing Code DP250.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP296 Cementraliser Cementraliser Size 10 -13 $206.00 $213.00

  1. Insert in Part A - Prostheses, the Billing Code DP298 and its respective wordings under the appropriate fields as per the table below, on page 524 of 778, after the Billing Code DP297.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP298 Centralisers Centraliser Size 11 - 18 $206.00 $213.00

  1. Insert in Part A - Prostheses, the Billing Code DP999 and its respective wordings under the appropriate fields as per the table below, on page 524 of 778, after the Billing Code DP998.



Billing Code Product Name Description Size MinBenefit MaxBenefit
DP999 SROM Total Hip System (Titanium) Unipolar Adaptor Sleeve +10 $165.00 $624.00

  1. Delete from Part A – Prostheses, at page 527 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SN376 and replace it with $1254.00.

  1. Delete from Part A – Prostheses, at page 532 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code EK028 and replace it with $2295.00.

  1. Delete from Part A – Prostheses, at page 533 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MA422 and replace it with $5650.00.

  1. Delete from Part A – Prostheses, at page 566 of 778, the amount under the heading Maximum Benefit Amount for Billing Code DP040.

  1. Delete from Part A – Prostheses, at page 574 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY056 and replace it with $92.70.

  1. Delete from Part A – Prostheses, at page 574 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY065 and replace it with $67.00.

  1. Delete from Part A – Prostheses, at page 574 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY081 and replace it with $48.93.

  1. Delete from Part A – Prostheses, at page 575 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY353 and replace it with $370.80.

  1. Delete from Part A – Prostheses, at page 576 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SY352 and replace it with $268.00.

  1. Delete from Part A – Prostheses, at page 591 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MP043 and replace it with $1244.00, and insert under the heading Maximum Benefit Amount $1800.00.

  1. Delete from Part A – Prostheses, at page 597 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK422 and replace it with $110.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 597 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code SK423 and replace it with $110.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 648 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ST163 and replace it with $200.00.

  1. Delete from Part A – Prostheses, at page 653 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ST311 and replace it with $110.00.

  1. Delete from Part A – Prostheses, at page 675 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code NR001 and replace it with $96.00; then delete the amount under the heading Maximum Benefit Amount and replace it with $260.00.

  1. Delete from Part A – Prostheses, at page 676 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code NR009 and replace it with $617.00; then delete the amount under the heading Maximum Benefit Amount and replace it with $625.00.

  1. Delete from Part A – Prostheses, at page 678 of 778, the amount for Billing Code DE100 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 694 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BI397 and replace it with $360.00.

  1. Delete from Part A – Prostheses, at page 695 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BI415 and replace it with $160.00.

  1. Delete from Part A – Prostheses, at page 696 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BI602 and replace it with $444.00.

  1. Delete from Part A – Prostheses, at page 696 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BI791 and replace it with $910.00.

  1. Delete from Part A – Prostheses, at page 703 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ST346 and replace it with $65.00.

  1. Delete from Part A – Prostheses, at page 703 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ST362 and replace it with $50.00.

  1. Delete from Part A – Prostheses, at page 708 of 778, the Billing Code DY069 and the contents of all fields associated with it.

  1. Delete from Part A – Prostheses, at page 709 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code AM031 and replace it with $132.00.

  1. Delete from Part A – Prostheses, at page 711 of 778, the amount for Billing Code AM019 under the heading Maximum Benefit Amount and replace it with $990.00.

  1. Delete from Part A – Prostheses, at page 712 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code JJ070 and replace it with $850.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 712 of 778, before Billing Code DS001, the heading “Victorian Institute of Forensic Medicine” and insert the heading “Southern Surgical Distribution Pty Ltd”.

  1. Delete from Part A – Prostheses, at page 713 of 778, the amount for Billing Code ET011 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 716 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BS086 and replace it with $315.00.

  1. Delete from Part A – Prostheses, at page 716 of 778, the text under the heading "Product Name" for Billing Code BS091 and replace it with "Percuflex; Percuflex Plus; Percuflex Tail; Percuflex Tail Plus Ureteral Stents".

  1. Delete from Part A – Prostheses, at page 716 of 778, the text under the heading "Product Name" for Billing Code BS093 and replace it with "Retromax Plus Ureteral Stent".

  1. Delete from Part A – Prostheses, at page 716 of 778, the text under the heading "Product Name" for Billing Code BS092 and replace it with "Contour Ureteral Stents".

  1. Delete from Part A – Prostheses, at page 718 of 778, the text under the heading "Product Name" for Billing Code BS094 and replace it with "Contour VL; Stretch VL Flexima; Ureteral Stents".

  1. Delete from Part A – Prostheses, at page 720 of 778, the text under the heading "Product Name" for Billing Code BS095 and replace it with "Urinary Diversion Stents".

  1. Delete from Part A – Prostheses, at page 720 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code WC171 and replace it with $180.00.

  1. Delete from Part A – Prostheses, at page 722 of 778, the amount under the heading Maximum Benefit Amount for Billing Code JJ478.

  1. Delete from Part A – Prostheses, at page 723 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code AM005 and replace it with $3305.40.

  1. Delete from Part A – Prostheses, at page 727 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC180 and replace it with $3330.00; and delete the text under the heading "Further Description" and replace it with "Interstim stimulation lead Models 3080 & 3886. Platinum / Iridium, polyurethane.

  1. Delete from Part A – Prostheses, at page 729 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code WC162 and replace it with $79.00.

  1. Delete from Part A – Prostheses, at page 729 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code MC719 and replace it with $9350.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 732 of 778, the amount under the heading Maximum Benefit Amount for Billing Code ET006.

  1. Delete from Part A – Prostheses, at page 735 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code EL045 and replace it with $2533.33, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 735 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code EL048 and replace it with $2250.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 736 of 778, the amount under the heading Maximum Benefit Amount for Billing Code BS056.

  1. Delete from Part A – Prostheses, at page 738 of 778, the amount under the heading Maximum Benefit Amount for Billing Code PI004.

  1. Delete from Part A – Prostheses, at page 740 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code GT020 and replace it with $3270.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 740 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code GT021 and replace it with $3995.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 741 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code GT022 and replace it with $4530.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 741 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code GT023 and replace it with $14500.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 741 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code GT029 and replace it with $4120.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 741 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code GT190 and replace it with $3700.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 741 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code GT191 and replace it with $13400.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Insert at page 743 of 778, after Billing Code AC001, wording under the appropriate fields as per the table below:

Billing Code Product Name  Description Size MinBenefit MaxBenefit
AC002 Atrium PTFE Vascular Graft Straight PTFE Standard Wall  6mm x 10cm – 10mm x 90cm $1648.00

  1. Delete from Part A – Prostheses, at page 743 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code WC153 and replace it with $12500.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 743 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code WC210 and replace it with $4700.00.

  1. Delete from Part A – Prostheses, at page 746 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP012 and replace it with $1100.00.

  1. Delete from Part A – Prostheses, at page 746 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP014 and replace it with $850.00.

  1. Delete from Part A – Prostheses, at page 747 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP015 and replace it with $550.00.

  1. Delete from Part A – Prostheses, at page 747 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP016 and replace it with $700.00.

  1. Delete from Part A – Prostheses, at page 747 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP017 and replace it with $600.00.

  1. Delete from Part A – Prostheses, at page 747 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP018 and replace it with $750.00.

  1. Delete from Part A – Prostheses, at page 747 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP019 and replace it with $1000.00.

  1. Delete from Part A – Prostheses, at page 747 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP024 and replace it with $870.00.

  1. Delete from Part A – Prostheses, at page 747 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP025 and replace it with $1100.00.

  1. Delete from Part A – Prostheses, at page 747 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP026 and replace it with $430.00.

  1. Delete from Part A – Prostheses, at page 747 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP027 and replace it with $540.00.

  1. Delete from Part A – Prostheses, at page 749 of 778, the amount for Billing Code TU036 under the heading Maximum Benefit Amount and replace it with $3528.50.

  1. Delete from Part A – Prostheses, at page 749 of 778, the amount under the heading Maximum Benefit Amount for Billing Code GT134.

  1. Delete from Part A – Prostheses, at page 750 of 778, the amount under the heading Maximum Benefit Amount for Billing Code GT147.

  1. Delete from Part A – Prostheses, at page 752 of 778, the amount under the heading Maximum Benefit Amount for Billing Code GT218.

  1. Delete from Part A – Prostheses, at page 753 of 778, the amount under the heading Maximum Benefit Amount for Billing Code GT220.

  1. Delete from Part A – Prostheses, at page 753 of 778, the amount under the heading Maximum Benefit Amount for Billing Code GT222.

  1. Delete from Part A – Prostheses, at page 753 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP011 and replace it with $1700.00.

  1. Delete from Part A – Prostheses, at page 753 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP013 and replace it with $1300.00.

  1. Delete from Part A – Prostheses, at page 753 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP020 and replace it with $950.00.

  1. Delete from Part A – Prostheses, at page 753 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP021 and replace it with $1300.00.

  1. Delete from Part A – Prostheses, at page 753 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP022 and replace it with $1100.00.

  1. Delete from Part A – Prostheses, at page 753 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code IP023 and replace it with $1500.00.

  1. Delete from Part A – Prostheses, at page 754 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BB027 and replace it with $375.00.

  1. Delete from Part A – Prostheses, at page 754 of 778, the amount under the heading Maximum Benefit Amount for Billing Code GT002.

  1. Delete from Part A – Prostheses, at page 754 of 778, the amount under the heading Maximum Benefit Amount for Billing Code GT003.

  1. Delete from Part A – Prostheses, at page 754 of 778, the amount under the heading Maximum Benefit Amount for Billing Code GT006.

  1. Delete from Part A – Prostheses, at page 755 of 778, the amount under the heading Maximum Benefit Amount for Billing Code GT216.

  1. Delete from Part A – Prostheses, at page 755 of 778, the amount under the heading Maximum Benefit Amount for Billing Code SJ043.

  1. Delete from Part A – Prostheses, at page 757 of 778, the amount under the heading Maximum Benefit Amount for Billing Code GT010.

  1. Delete from Part A – Prostheses, at page 757 of 778, the amount under the heading Maximum Benefit Amount for Billing Code GT175.

  1. Delete from Part A – Prostheses, at page 758 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BA090 and replace it with $748.00, and then delete the amount under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 759 of 778, the amount under the heading Maximum Benefit Amount for Billing Code MC715; and delete the text under the heading "Product Name" and replace it with "Interceptor Plus Filter System".

  1. Delete from Part A – Prostheses, at page 763 of 778, the amount under the heading Maximum Benefit Amount for Billing Code EE007.

  1. Delete from Part A – Prostheses, at page 763 of 778, the amount under the heading Maximum Benefit Amount for Billing Code EE008.

  1. Delete from Part A – Prostheses, at page 766 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ME133 and replace it with $1850.00; then insert under the heading Maximum Benefit Amount $1950.00.

  1. Delete from Part A – Prostheses, at page 767 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ME134 and replace it with $1850.00; then insert under the heading Maximum Benefit Amount $1950.00.

  1. Delete from Part A – Prostheses, at page 767 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ME135 and replace it with $1850.00; then insert under the heading Maximum Benefit Amount $1950.00.

  1. Delete from Part A – Prostheses, at page 767 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code ME136 and replace it with $1850.00; then insert under the heading Maximum Benefit Amount $1950.00.

  1. Delete from Part A – Prostheses, at page 767 of 778, the amount for Billing Code DE006 under the heading Maximum Benefit Amount.

  1. Delete from Part A – Prostheses, at page 776 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BS035 and replace it with $1800.00.

  1. Delete from Part A – Prostheses, at page 776 of 778, the amount under the heading Benefit Amount/Minimum Benefit Amount for Billing Code BT035 and replace it with $2500.00.

  1. Insert in Part B – Human Tissue List, the item heading “Cancellous Crunch – 15cc” and the Billing Codes NBB62, with its respective wordings under the appropriate fields as per the table below, on page 4 of 15, below the Billing Code TVB08.

Cancellous Crunch - 15cc

Billing Code Facility Benefit Amount
NBB62 New South Wales Bone Bank $795.00

  1. Insert in Part B – Human Tissue List, the item heading “Cancellous Crunch – 30cc” and the Billing Codes NBB61, with its respective wordings under the appropriate fields as per the table below, on page 4 of 15, below the Billing Code NBB62.

Cancellous Crunch - 30cc

Billing Code Facility Benefit Amount
NBB61 New South Wales Bone Bank $1,450.00

  1. Insert in Part B – Human Tissue List, the item heading “Cancellous Crunch – 60cc” and the Billing Codes NBB60, with its respective wordings under the appropriate fields as per the table below, on page 4 of 15, below the Billing Code NBB61.

Cancellous Crunch - 60cc

Billing Code Facility Benefit Amount
NBB60 New South Wales Bone Bank $2,200.00

  1. Insert in Part B – Human Tissue List, the item heading “Cortico-Cancellous Crunch (40/60) – 15cc” and the Billing Codes NBB65, with its respective wordings under the appropriate fields as per the table below, on page 4 of 15, below the Billing Code QBB03.

Cortico-Cancellous Crunch (40/60) - 15cc

Billing Code Facility Benefit Amount
NBB65 New South Wales Bone Bank $795.00

  1. Insert in Part B – Human Tissue List, the item heading “Cortico-Cancellous Crunch (40/60) - 30cc” and the Billing Codes NBB64, with its respective wordings under the appropriate fields as per the table below, on page 4 of 15, below the Billing Code NBB65.

Cortico-Cancellous Crunch (40/60) - 30cc

Billing Code Facility Benefit Amount
NBB64 New South Wales Bone Bank $1,450.00

  1. Insert in Part B – Human Tissue List, the item heading “Cortico-Cancellous Crunch (40/60) - 60cc” and the Billing Codes NBB63, with its respective wordings under the appropriate fields as per the table below, on page 4 of 15, below the Billing Code NBB64.

Cortico-Cancellous Crunch (40/60) - 60cc

Billing Code Facility Benefit Amount
NBB63 New South Wales Bone Bank $2,200.00

  1. Insert in Part B – Human Tissue List, the item heading “Femur – Hemicondyle” and the Billing Code NBB59 with its respective wordings under the appropriate fields as per the table below, on page 7 of 15, below the Billing Code TVB23.

Femur - Hemicondyle

Billing Code Facility Benefit Amount
NBB59 New South Wales Bone Bank $2,000.00

This determination commences on 13 October 2006.

Dated this             5th      day of October 2006.

V.Hancock

Veronica Hancock

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

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