National Health Act 1953 Determination under Schedule 1, paragraph (bj) (HIB 11/2005) (Cth)
Australian Government
NATIONAL HEALTH ACT 1953
Determination made under Schedule 1, paragraph (bj)
(HIB 11/2005)
I, CHARLES MASKELL-KNIGHT, Principal Advisor, Acute Care Division, delegate of the Minister for Health and Ageing, pursuant to Schedule 1, paragraph (bj) of the National Health Act 1953 (the Act):
- REVOKE, with effect on and from 1 July 2005, all previous determinations made under Schedule 1, paragraph (bj) to the Act; and
- DETERMINE, with effect on and from 1 July 2005, for the purposes of Schedule 1, paragraph (bj) to the Act, that the minimum level of benefits payable in respect of episodes of hospital treatment specified under Schedule 1, subparagraph (bh)(ii) to the Act, be those applicable in the attached Schedules.
- In this Determination the “Medicare Benefits Schedule” (MBS) means the table of medical services made in accordance with subsection 4(1) of the Health Insurance Act 1973, as in force from time to time.
- For the purposes of this Determination:
(a)the level of benefits payable for overnight accommodation in private hospitals in all States and Territories and shared ward accommodation in recognised hospitals in Victoria and Tasmania are set out in Schedule 1 to this Determination;
(b)the level of benefits payable for overnight shared ward accommodation in recognised hospitals in the Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia and Western Australia are set out in Schedule 2 to this Determination;
(c)the level of benefits payable for same day accommodation in hospitals and day hospital facilities in all States and Territories are set out in Schedule 3 to this Determination;
(d)the level of benefits payable for nursing home type patient accommodation in hospitals in all States and Territories are set out in Schedule 4 to this Determination;
(e)the level of benefits payable for prostheses and human tissues in all States and Territories are set out in Schedule 5 to this Determination;
(f)the second tier level of benefits payable for accommodation in private hospitals and day hospital facilities specified in Schedule 6 are set out in Schedule 6 to this Determination;
(g)the level of benefits payable for Care Plans and Case Conferencing in hospitals and day hospital facilities in all States and Territories are set out in Schedule 7 to this Determination;
(h)the level of benefits payable for Outreach Services provided to a patient by, or on behalf of, a hospital or day hospital facility in all States and Territories are set out in Schedule 8 to this Determination.
Dated this 24TH day of June 2005.
(Signed By)
…………………………………
CHARLES MASKELL-KNIGHT
Principal Advisor
Acute Care Division
Australian Government Department of Health and Ageing
Position No: 20003818
Delegate of the Minister for Health and Ageing
SCHEDULE 1 including Part 1 – OVERNIGHT ACCOMMODATION
PRIVATE HOSPITALS IN ALL STATES/TERRITORIES and Shared Ward Accommodation in RECOGNISED HOSPITALS IN VICTORIA AND TASMANIA
In respect of hospital treatment provided to patients (other than nursing-home type patients or patients in situations of emergency) in private hospitals in all States/Territories and in shared ward accommodation in recognised hospitals in Victoria and Tasmania for the purpose of permitting the provision to them at the hospital of hospital treatment for a period that includes part of an overnight stay for a continuous period of hospitalisation, benefits are payable as specified hereunder, for patients falling within a class of patient as specified hereunder:
PRIVATE HOSPITALS AND SHARED WARD ACCOMMODATION
(all States/Territories)
| CLASS OF PATIENT | BENEFIT PAYABLE PER NIGHT |
| Advanced Surgical | |
| - first 14 days | $316 |
| - over 14 days | $219 |
| Surgical/Obstetric | |
| - first 14 days | $292 |
| - over 14 days | $219 |
| Psychiatric | |
| - first 42 days | $292 |
| - 43 – 65 days | $254 |
| - over 65 days | $219 |
| Rehabilitation | |
| - first 49 days | $292 |
| - 50 - 65 days | $254 |
| - over 65 days | $219 |
| Other | |
| - first 14 days | $254 |
| - over 14 days | $219 |
This is page 1 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
VICTORIA – shared ward accommodation in recognised hospitals
| CLASS OF PATIENT | BENEFIT PAYABLE PER NIGHT |
| Advanced Surgical | |
| - first 14 days | $316 |
| - over 14 days | $219 |
| Surgical/Obstetric | |
| - first 14 days | $292 |
| - over 14 days | $219 |
| Psychiatric | |
| - first 42 days | $292 |
| - 43 – 65 days | $254 |
| - over 65 days | $219 |
| Rehabilitation | |
| - first 49 days | $292 |
| - 50 – 65 days | $254 |
| - over 65 days | $219 |
| Other | |
| - first 14 days | $254 |
| - over 14 days | $219 |
This is page 2 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005..
A. Mastoris
Witness
TASMANIA – shared ward accommodation in recognised hospitals
| CLASS OF PATIENT | BENEFIT PAYABLE PER NIGHT |
| Advanced Surgical | |
| - first 14 days | $316 |
| - over 14 days | $219 |
| Surgical/Obstetric | |
| - first 14 days | $292 |
| - over 14 days | $219 |
| Psychiatric | |
| - first 42 days | $292 |
| - 43 – 65 days | $254 |
| - over 65 days | $219 |
| Rehabilitation | |
| - first 49 days | $292 |
| - 50 – 65 days | $254 |
| - over 65 days | $219 |
| Other | |
| - first 14 days | $254 |
| - over 14 days | $219 |
This is page 3 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
For the purposes of Schedule 1:
- in counting days, a continuous period of hospitalisation is deemed to be any two periods, being periods during which a patient was, or is, a patient in a hospital (whether or not the same hospital), that are separated from each other by a period of not more than seven days during which a patient was not a patient in any hospital.
- an advanced surgical patient is specified in Part 1 of this Schedule and the item numbers are derived from the MBS and apply to those MBS items that have an MBS fee that is greater than $723.75.
- an obstetric patient is specified in Part one of this Schedule.
- a surgical patient is specified in Part 1 of this Schedule and the item numbers are derived from the MBS and apply to those MBS items that have an MBS fee within the range of $215.50 to $723.75.
- a psychiatric patient is deemed to be a patient in a hospital who, subject to approval by individual health benefits organisations, is admitted for the purposes of undertaking a specific psychiatric treatment program.
- a rehabilitation patient is deemed to be a patient in a hospital who, subject to approval by individual health benefits organisations, is admitted for the purposes of undertaking a specific rehabilitation treatment program.
- other patients are deemed to be any patients in a hospital other than advanced surgical, surgical, obstetric, psychiatric, or rehabilitation patients.
Overnight benefits in relation to Type B procedures:
Overnight accommodation benefits are not payable for Type B professional attention (as specified in Part 1 of Schedule 3) unless overnight certification is provided. In order for an overnight benefit to be payable to a patient in receipt of a Type B procedure requiring overnight hospitalisation, the:
(a) practitioner providing the professional attention; or
(b) a professional employed by a hospital or day hospital facility who is involved in the provision of the professional attention provided by that hospital or day hospital facility;
must certify in writing that:
(a) because of the medical condition of the patient specified in the certificate; or
This is page 4 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
(b) because of the special circumstances specified in the certificate;
it would be contrary to accepted medical practice to provide the professional attention to the patient unless the patient were given hospital treatment in the hospital for a period that included part of an overnight stay.
This is page 5 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
Overnight Benefits in relation to Type C Procedures
Overnight accommodation benefits are not payable for Type C professional attention (as defined in Part 2 of Schedule 3) unless overnight certification, in addition to day certification, is provided. In order for an overnight benefit to be payable to a patient in receipt of a Type C procedure requiring hospitalisation, the practitioner providing the professional attention must certify in writing that:
(a) because of the medical condition of the patient specified in the certificate; or
(b) because of the special circumstances specified in the certificate;
it would be contrary to accepted medical practice to provide the professional attention to the patient unless the patient were given hospital treatment in the hospital for a period that included part of an overnight stay.
This is page 6 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
PART 1 of SCHEDULE 1
Advanced Surgical Patient
A patient shall be taken to be an advanced surgical patient upon admission to a hospital from and including the day before a professional service, the MBS item number of which is specified hereunder, is rendered to the patient in that hospital, unless the particular advanced surgical procedure to be rendered is recognised as requiring a longer pre-operative period. If advanced surgery is rendered to a patient during an admission, the patient shall be taken to be an advanced surgical patient from the day the advanced surgery is performed (not the day before).
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This is page 7 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
38477 38478 38480 38481 38483 38487 38488 38489 38493 38497 38498 38500 38501 38503 38504 38506 38507 38508 38509 38512 38515 38518 38521 38550 38553 38556 38559 38562 38565 38568 38571 38572 38600 38603 38615 38618 38624 38640 38643 38647 38650 38653 38656 38670 38673 38677 38680 38700 38703 38706 38709 38712 38715 38718 38721 38724 38727 38730 38733 38736 38739 38742 38743 38745 38748 38751 38754 38757 38760 38763 38766 39106 39112 39124 39139 39315 39500 39503 39603 39609 39612 39615 39640 39642 39646 39650 39653 39654 39656 39658 39660 39662 39706 39709 39712 39715 39718 39800 39803 39806 39815 39818 39821 39903 40000 40003 40012 40103 40106 40109 40112 40118 40300 40301 40303 40306 40309 40312 40315 40316 40318 40321 40330 40331 40332 40334 40335 40339 40342 40345 40348 40351 40600 40700 40703 40706 40712 40801 40803 41518 41521 41530 41533 41536 41539 41542 41551 41554 41557 41560 41563 41564 41566 41569 41572 41575 41576 41578 41579 41581 41584 41587 41590 41593 41596 41599 41608 41614 41615 41617 41623 41635 41638 41728 41734 41782 41785 41834 41837 41840 41843 41879 42521 42539 42543 42545 42557 42569 42626 42653 42656 42659 42662 42672 42702 42710 42716 42725 42731 42746 42749 42752 42767 42773 42776 42779 42842 42851 42860 43801 43804 43807 43810 43813 43816 43819 43822 43825 43828 43831 43834 43837 43840 43843 43846 43852 43855 43861 43864 43870 43873 43876 43879 43882 43900 43903 43906 43909 43912 43915 43936 43945 43951 43954 43957 43963 43966 43969 43972 43975 43978 43984 43987 43990 43993 43996 44334 44373 45006 45036 45215 45415 45418 45460 45461 45464 45465 45466 45468 45469 45471 45472 45474 45475 45477 45478 45480 45481 45483 45484 45490 45491 45492 45494 45500 45501 45502 45503 45504 45505 45520 45528 45530 45533 45539 45558 45562 45563 45564 45565 45566 45587 45588 45596 45597 45599 45624 45638 45639 45641 45644 45646 45647 45660 45661 45686 45720 45723 45726 45729 45731 45732 45735 45738 45741 45744 45747 45752 45753 45754 45767 4577 0 45773 45776 45779 45782 45785 45788 45791 45853 45861 45863 45869 45871 45873 46315 46318 46321 46393 46477 46504 46507 47486 47489 47501 47504 47507 47510 47519 47525 47531 47534 47566 47588 47591 47687 47690 47693 47699 47702 48203 48427 48512 48606 48609 48612 48613 48618 48621 48624 48627 48630 48632 48639 48640 48645 48648 48651 48654 48657 48660 48669 48672 48681 48684 48687 48690 48918 48921 48924 48933 48939 48942 48951 48954 48957 48960 49106 49115 49306 49312 49318 49319 49321 49324 49327 49330 49333 49339 49342 49345 49512 49517 49518 49519 49521 49524 49527 49530 49533 49536 49539 49542 49548 49551 49554 49564 49715 49836 49838 49842 50212 50215 50218 50221 50224 50227 50230 50233 50236 50239 50300 50303 50306 50321 50324 50327 50336 50351 50354 50366 50372 50378 50384 50394 50399 50408 50411 50414 50417 50420 50423 52123 52126 52129 52158 52337 52342 52345 52348 52351 52354 52357 52360 52363 52366 52369 52372 52375 52379 52380 52382 52430 52446 52821 53209 53212 53221 53224 53227 53230 53233
This is page 8 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
PART 1 of SCHEDULE 1
Obstetric Patient
A patient shall be taken to be an obstetric patient during an admission to a hospital from an including:
- the day on which the patient commences labour leading to delivery in that hospital or the day on which a professional service the MBS item number of which is 16515, 16518, 16519, 16522 (excluding caesarean) or 16525 is rendered to the patient in that hospital, whichever is the earlier; or
- the day before a professional service, the MBS item number of which is 16520 and 16522 (including caesarean) is rendered to the patient in that hospital, unless the particular obstetric procedure to be rendered is recognised as requiring a longer pre-operative period.
Surgical Patient
A patient shall be taken to be a surgical patient upon admission to a hospital from and including the day before a professional service, the MBS item number of which is specified hereunder, is rendered to the patient in that hospital, unless the particular surgical procedure to be rendered is recognised as requiring a longer pre-operative period. If surgical treatment is rendered to a patient during admission, the patient shall be taken to be a surgical patient from the day the surgery is performed (not the day before).
12210 12213 12215 12217 13212 13700 14130 14132 15303 15304 15307 15308 15311 15312 15315 15316 15319 15320 15323 15324 15327 15328 15331 15332 15335 15336 15345 15360 15363 15541 16567 16570 16571 16573 30017 30020 30023 30068 30110 30111 30114 30165 30168 30171 30174 30178 30187 30190 30197 30225 30229 30235 30241 30244 30246 30247 30253 30256 30272 30286 30289 30293 30306 30308 30310 30313 30314 30330 30332 30373 30375 30376 30378 30385 30387 30391 30392 30393 30394 30399 30400 30402 30403 30408 30414 30416 30419 30422 30431 30433 30434 30436 30437 30440 30443 30445 30446 30450 30451 30452 30475 30479 30481 30484 30485 30490 30491 30492 30493 30494 30495 30496 30497 30499 30505 30511 30515 30520 30530 30544 30559 30562 30563 30564 30568 30569 30571 30572 30575 30581 30586 30587 30597 30600 30609 30612 30614 30615 30616 30617 30620 30621 30635 30638 30641 30644 30672 30675 30676 31000 31001 31225 31245 31250 31260 31270 31275 31295 31300 31305 31310 31315 31320 31325 31330 31335 31340 31350
This is page 9 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
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This is page 10 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
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This is page 11 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
52315 52321 52324 52330 52333 52336 52339 52378 52424 52440 52442 52444 52450 52452 52456 52458 52460 52480 52482 52484 52600 52603 52609 52612 52615 52618 52621 52624 52626 52627 52633 52800 52803 52806 52809 52812 52815 52818 52824 52828 52830 52832 53006 53009 53015 53016 53017 53019 53215 53218 53220 53225 53226 53236 53239 53242 53406 53409 53412 53413 53414 53415 53416 53418 53419 53422 53423 53424 53425 53427 53429 53453 53455 53460 55135 57351 57356
This is page 12 of 12 pages of Schedule 1 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
SCHEDULE 2 – OVERNIGHT ACCOMMODATION
Shared ward accommodation in RECOGNISED HOSPITALS IN THE AUSTRALIAN CAPITAL TERRITORY, NEW SOUTH WALES, NORTHERN TERRITORY, QUEENSLAND, SOUTH AUSTRALIA AND WESTERN AUSTRALIA
In respect of hospital treatment provided to patients (other than nursing-home type patients or patients in situations of emergency) in shared ward accommodation in a hospital in a State or Territory for the purpose of permitting the provision to them at the hospital of hospital treatment for a period that includes part of an overnight stay for a continuous period of hospitalisation (as specified hereunder), benefits will be as follows:
| STATE/TERRITORY | BENEFIT PAYABLE PER NIGHT |
| Australian Capital Territory | $261 |
| New South Wales | $261 |
| Northern Territory | $255 |
| Queensland | $261 |
| South Australia | $261 |
| Western Australia | $261 |
In counting days, a continuous period of hospitalisation is deemed to be any two periods, being periods during which a patient was, or is, a patient in a hospital (whether or not the same hospital), that are separated from each other by a period of not more that seven days during which a patient was not a patient in any hospital.
Overnight benefits in relation to Type B procedures:
Overnight accommodation benefits are not payable for Type B professional attention (as specified in Part 1 of Schedule 3) unless overnight certification is provided. In order for an overnight benefit to be payable to a patient in receipt of a Type B procedure requiring overnight hospitalisation, the:
(a) practitioner providing professional attention; or
(b) a professional employed by a hospital or day hospital facility who is involved in the provision of the professional attention provided by that hospital or day hospital facility;
must certify in writing that:
(a) because of the medical condition of the patient specified in the certificate; or
(b) because of the special circumstances specified in the certificate;
it would be contrary to accepted medical practice to provide the professional attention to the patient unless the patient were given hospital treatment in the hospital for a period that included part of an overnight stay.
This is page 1 of 2 pages of Schedule 2 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
Overnight benefits in relation to Type C procedures:
Overnight accommodation benefits are not payable for Type C professional attention (as specified in Part 2 of Schedule 3) unless overnight certification, in addition to day certification, is provided. In order for an overnight benefit to be payable to a patient in receipt of a Type C procedure requiring hospitalisation, the practitioner providing the professional attention must certify in writing that:
(a) because of the medical condition of the patient specified in the certificate; or
(b) because of the special circumstances specified in the certificate;
it would be contrary to accepted medical practice to provide the professional attention to the patient unless the patient were given hospital treatment in the hospital for a period that included part of an overnight stay.
This is page 2 of 2 pages of Schedule 2 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
SCHEDULE 3 – SAME DAY ACCOMMODATION
HOSPITAL AND DAY HOSPITAL FACILITIES IN ALL STATES/TERRITORIES
In respect of hospital treatment provided to patients in all hospitals or day hospital facilities (otherwise than in situations of emergency) in a State or Territory for the purpose of permitting the provision of hospital treatment to them for a period that does not include part of an overnight stay benefits are payable per day as specified hereunder, for patients receiving Type B professional attention as specified in Part 1 of this Schedule:
| BAND 1 | BAND 2 | BAND 3 | BAND 4 | |
| NSW | $188 | $212 | $233 | $261 |
| ACT | $189 | $213 | $233 | $261 |
| NT | $181 | $207 | $227 | $255 |
| QLD | $191 | $213.50 | $235 | $261 |
| SA | $189 | $216 | $237 | $261 |
| TAS | $183 | $218 | $253 | $292 |
| VIC | $184 | $219 | $254 | $292 |
| WA | $201 | $201 | $201 | $201 |
| Private Hospitals | $164 | $206 | $250 | $292 |
| Private Day Hospitals | $164 | $206 | $250 | $292 |
The above day only accommodation benefits are not payable for Type C professional attention (as specified in Part 2 of this Schedule) unless certification is provided. In order for a day benefit to be payable to a patient in receipt of a Type C procedure requiring hospitalisation the medical practitioner providing the professional attention must certify in writing that:
(a) because of the medical condition of the patient specified in the certificate; or
(b) because of the special circumstances specified in the certificate;
it would be contrary to accepted medical practice to provide the professional attention to the patient unless the patient were given hospital treatment in the hospital for a period that does not include part of an overnight stay.
This is page 1 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
PART 1 of SCHEDULE 3
TYPE B PROFESSIONAL ATTENTION PROCEDURES
These procedures normally require hospital treatment that does
not include part of an over-night stay
The following item numbers are from the Medicare Benefits Schedule
BAND 1:
(a) CATEGORY 3 – THERAPEUTIC PROCEDURES
T1: Miscellaneous Therapeutic Procedures:
13100 13103 13703 13706 13915 13918 13927 13930
T8: Surgical Operations:
30210 30473 30475 30476 30478 30679 32075 32078 32081 32084 32087 32090 32095 35500 35539 35545 35703 37011 39000 39100 41647 41674 41680 42575 45027
CATEGORY 5 – DIAGNOSTIC IMAGING SERVICES
I1: Ultrasound:
55118 55600 55603
(b) Professional Attention that embraces all other day admission to hospital not related to Bands 2, 3 or4.
NON-BAND SPECIFIC TYPE B DAY PROCEDURES:
13110 13212 13215 13292 13750 13755 13757 14218 15338 15513 15539 16512 16603 16618 18216 18230 18242 18274 18276 18280 18284 18286 18290 18294 18296 18298 30041 30042 30045 30055 30081 30084 30087 30094 30096 30099 30102 30103 30104 30106 30107 30187 30189 30190 30223 30225 30262 30269 30281 30282 30283 30390 30391 30409 30484 30493 30653 30656 30659 30660 31225 31230 31235 31240 31255 31256 31257 31258 31260 31261 31262 31263 31265 31266 31267 31268 31270 31271 31272 31273 31275 31276 31277 31278 31280 31281 31282 31283 31285 31286 31287 31288 31290 31291 31292 31293 31295 31300 31305 31310 31315 31320 31325 31330 31335 31340 31345 31346 31350 31355 31441 31456 31458 31530 31551 31557 31560 31563 31566 32093
This is page 2 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
32094 32145 32147 32150 32153 32156 32168 32171 32177 32180 32504 34109
34130 34500 34503 34506 34524 34539 35324 35507 35508 35509 35512 35513 35516 35517 35520 35523 35526 35527 35542 35557 35569 35572 35611 35615 35616 35617 35618 35622 35623 35626 35627 35630 35633 35637 35639 35640 35643 35644 35645 35646 35647 35648 35687 35688 36812 36815 36818 36821 36824 36827 36830 36833 36836 36860 37219 37315 37318 37321 37354 37369 37435 37622 37623 37803 37806 37809 37812 37815 37854 38285 38286 39013 39118 39135 39140 39331 41503 41506 41509 41626 41629 41632 41644 41650 41653 41665 41668 41677 41695 41701 41716 41761 41764 41800 41801 41816 41819 41822 41825 41831 41849 41852 41855 41858 41861 41864 41886 41889 41892 41898 42503 42572 42573 42584 42593 42610 42611 42673 42680 42683 42686 42689 42692 42812 42818 42833 42845 42869 43942 43948 44102 44105 44136 44338 45019 45020 45030 45033 45039 45200 45224 45239 45506 45515 45626 45665 45668 45823 46327 46330 46336 46363 46366 46369 46396 46420 46423 46438 46441 46450 46486 46489 46494 46495 46501 46510 46525 47738 47906 47915 47918 47927 47972 48600 48603 48945 49218 49557 49700 49800 49803 49806 49809 50100 50115 51902 52015 52025 52042 52045 52057 52058 52061 52062 52064 52072 52073 52075 52081 52084 52087 52097 52099 52102 52144 52180 52300 52303 52321 52826 53003 53006 53009 53054 53056 53058 53060 53062 53064 53070 53206 53215 53218 53225 53410 53459 58939 59903 59912 59925 59970 59971 59972 59973 59974 60000 60003 60006 60009 60012 60015 60018 60021 60024 60027 60030 60033 60036 60039 60042 60045 60048 60051 60054 60057 60060 60063 60066 60069 60072 60075 60078
THE NON-BAND SPECIFIED ITEMS LISTED ABOVE WILL QUALIFY FOR DAY BENEFITS AT THE LEVEL OF BAND 2, 3 OR 4 DEPENDING ON ANAESTHETIC TYPE AND WHERE APPLICABLE, THEATRE TIME. IN THE ABSENCE OF ANAESTHETIC OR THEATRE TIMES, A BAND 1 BENEFIT IS PAYABLE.
BAND 2: means procedures (other than Band 1) carried out under local anaesthetic, no sedation.
BAND 3: means procedures (other than Band 1) carried out under general or regional anaesthesia or intravenous sedation. Theatre time (actual time in theatre) less than one hour.
BAND 4: means procedures (other than Band 1) carried out under general or regional anaesthesia or intravenous sedation. Theatre time (actual time in theatre) one hour or more.
This is page 3 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
PART 2 of SCHEDULE 3
TYPE C PROFESSIONAL ATTENTION
These procedures do not normally require hospital treatment
The following item numbers are from the Medicare Benefits Schedule
GENERAL MEDICAL SERVICES
CATEGORY 1 – ATTENDANCES
A1:
1 2 3 4 13 19 20 23 24 25 33 35 36 37 38 40 43 44 47 48 50 51 601 602
A2:
52 53 54 57 58 59 60 65 81 83 84 86 87 89 90 91 92 93 95 96 97 98 697 698
A3:
104 105 106 107 108
A4:
110 116 119 122 128 131
A5:
160 161 162 163 164
A6:
170 171 172
A7:
173 193 195 197 199
This is page 4 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
A8:
291 293 300 302 304 306 308 310 312 314 316 318 319 320 322 324 326 328 330 332 334 336 338 342 344 346 348 350 352 353 355 356 357 358 364 366 367 369 370
A9:
10801 10802 10803 10804 10805 10806 10807 10808 10809 10816
A12:
385 386 387 388
A13:
410 411 412 413 414 415 416 417
A14:
700 702 704 706 710 712
A15:
720 721 723 724 725 726 727 728 729 730 731 734 736 738 740 742 744 759 762 765 768 771 773 775 778 779 820 822 823 825 826 828 855 857 858
A16:
444 445 446 447 448 449
A17:
900 903
A18:
2497 2501 2503 2504 2506 2507 2509 2517 2518 2521 2522 2525 2526 2546 2547 2552 2553 2558 2559 2574 2575 2577 2578
This is page 5 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
A19:
2598 2600 2603 2606 2610 2613 2616 2620 2622 2624 2630 2631 2633 2635 2664 2666 2668 2673 2675 2677 2704 2705 2707 2708
A20:
2721 2723 2725 2727
A21:
501 503 507 511 515 519 520 530 532 534 536
A22:
5000 5003 5007 5010 5020 5023 5026 5028 5040 5043 5046 5049 5060 5063 5064 5067
A23:
5200 5203 5207 5208 5220 5223 5227 5228 5240 5243 5247 5248 5260 5263 5265 5267
M2:
10993 10996 10998 10999
This is page 6 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
CATEGORY 2 – DIAGNOSTIC PROCEDURES & INVESTIGATIONS
D1:
11000 11003 11006 11009 11012 11015 11018 11024 11027 11200 11203 11204 11205 11210 11211 11212 11215 11218 11221 11222 11224 11225 11235 11237 11240 11241 11242 11243 11300 11306 11309 11312 11315 11318 11321 11324 11327 11332 11333 11336 11339 11500 11503 11506 11509 11512 11602 11604 11605 11610 11611 11612 11614 11615 11700 11701 11702 11708 11709 11710 11711 11712 11713 11715 11718 11721 11722 11800 11810 11820 11830 11833 11900 11903 11906 11909 11912 11915 11917 11919 11921 12000 12003 12012 12015 12018 12021 12200 12201 12306 12309 12312 12315 12318 12321
D2:
12500 12503 12506 12509 12512 12515 12518 12521 12524 12527 12530 12533
CATEGORY 3 – THERAPEUTIC PROCEDURES
T1:
13200 13203 13206 13209 13221 13290 13312 13709 13312 13709 13760 13839 13842 13939 13942 13945 13948 14050 14053 14100 14106 14109 14112 14115 14118 14124 14200 14203 14206 14209 14215 14221
T2:
15000 15003 15006 15009 15012 15100 15103 15106 15109 15112 15115 15211 15214 15215 15218 15221 15224 15227 15230 15233 15236 15239 15242 15245 15248 15251 15254 15257 15260 15263 15266 15269 15272 15500 15503 15506 15509 15512 15515 15518 15521 15524 15527 15530 15533
T3:
16003 16006 16009 16012 16015 16018
T4:
16500 16514 16600
This is page 7 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
T6:
17603
T7:
18213 18350 18352 18354 18356 18358 18370
T8:
30003 30006 30026 30032 30038 30061 30064 30071 30185 30186 30192 30195 30196 30202 30203 30205 30207 30213 30214 30216 30219 30628 31200 31205 31210 31215 31220 32072 32115 32132 32135 32142 32500 32501 35502 35503 35554 35608 35614 35620 36800 37041 37218 37300 37303 37415 38400 39115 41500 41659 41662 41698 41704 41755 41828 41846 42587 42614 42615 42617 42620 42644 42650 42667 42668 42676 42677 42782 42783 42785 42786 42788 42789 42791 42792 42794 42797 42806 42807 42808 42809 45021 45025 45026 45546 45799 45801 45805 45807 45829 45847 45851 47471 47735 47904 47912 47916 47924 50124 50125
CATEGORY 4 – ORAL AND MAXILLOFACIAL
O1:
51700 51703
O3:
52034 52036 52039 52055 52056 52133
O7:
53000 53004 53052
O9:
53458
O10:
53600
This is page 8 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
DIAGNOSTIC IMAGING SERVICES
CATEGORY 5 – DIAGNOSTIC IMAGING SERVICES TABLE
I1:
55028 55029 55030 55031 55032 55033 55036 55037 55038 55039 55044 55045 55048 55049 55054 55070 55073 55076 55079, 55113 55114 55115 55116 55117 55238 55244 55246 55248 55252 55274 55276 55278 55280 55282 55284 55292 55294 55296 55700 55703 55704 55705 55706 55709 55712 55715 55718 55721 55723 55725 55728 55729 55731 55733 55736 55739 55812 55814 55816 55818 55820 55822 55824 55826 55828 55830 55832 55834 55836 55838 55840 55842 55844 55846 55852 55854
I2:
56001 56007 56010 56013 56016 56022 56028 56030 56036 56041 56047 56050 56053 56056 56062 56068 56070 56076 56101 56107 56141 56147 56220 56221 56223 56224 56225 56226 56227 56228 56229 56230 56231 56232 56233 56234 56235 56236 56237 56238 56239 56240 56259 56301 56307 56341 56347 56401 56407 56409 56412 56441 56447 56449 56501 56507 56541 56547 56549 56551 56619 56625 56659 56665 56801 56807 56841 56847 57001 57007 57041 57047 57201 57247 57341 57345 57350 57355
I3:
57506 57509 57512 57515 57518 57521 57524 57527 57700 57703 57706 57709 57712 57715 57721 57901 57902 57903 57906 57909 57912 57915 57918 57921 57924 57927 57930 57933 57939 57942 57945 57960, 57963 57966 57969 58100 58103 58106 58108 58109 58112 58115 58300 58306 58500 58503 58506 58509 58521 58524 58527 58700 58706 58715 58718 58721 58900 58903 58909 58912 58915 58916 58921 58924 58927 58933 58936 59103 59300 59303 59306 59309 59312 59314 59318 59503 59700 59703 59712 59715 59718 59724 59733 59736 59739 59751 59754 59760 59763 60100 60500 60503 60918 60927
This is page 9 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
I4:
61302 61303 61306 61307 61310 61313 61314 61316 61317 61320 61328 61340 61348 61352 61353 61356 61360 61361 61364 61368 61372 61373 61376 61381 61383 61384 61386 61387 61389 61390 61393 61397 61401 61402 61405 61409 61413 61417 61421 61425 61426 61429 61430 61433 61434 61437 61438 61441 61442 61445 61446 61449 61450 61453 61454 61457 61458 61462 61464 61465 61469 61473 61480 61484 61485 61495 61499
MAGNETIC RESONANCE IMAGING
I5:
63000 63003 63006 63009 63012 63015 63018 63021 63024 63050 63053 63056 63059 63062 63100 63103 63106 63109 63112 63115 63118 63121 63124 63127 63130 63133 63150 63153 63156 63159 63162 63200 63203 63206 63209 63212 63215 63218 63221 63250 63253 63256 63270 63273 63276 63279 63290 63293 63300 63303 63306 63309 63312 63315 63350 63353 63356 63359 63362 63365 63400 63403 63406 63409 63412 63415 63418 63421 63424 63427 63430 63450 63453 63456 63459 63462 63465 63468 63471 63474 63477 63480 63500 63503 63506 63509 63512 63515 63518 63521 63524 63550 63553 63556 63559 63562 63565 63568 63571 63574 63580 63583 63590 63593 63600 63603 63606 63609 63612 63615 63618 63621 63624 63627 63650 63653 63656 63659 63662 63665 63668 63671 63674 63677 63680 63700 63703 63706 63709 63712 63715 63718 63721 63736 63739 63742 63745 63750 63753 63756 63800 63803 63806 83650 63853 63856 63859 63862 63865 63868 63870 63880 63883 63900 63903 63906 63909 63920 63930 69340 63943 63946
PATHOLOGY SERVICES
P1:
65060 65066 65070 65072 65075 65078 65081 65084 65087 65090 65093 65096 65099 65102 65105 65108 65111 65114 65117 65120 65123 65126 65129 65132 65133 65134 65135 65136 65137 65139 65140 65142 65144 65147 65150 65153 65156 65159 65162 65165 65168 65171 65174
P2:
66500 66503 66506 66509 66512 66515 66518 66519 66536 66539 66542 66545 66548 66551 66554 66557 66560 66563 66566 66569 66572 66575 66578 66581
This is page 10 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
66584 66587 66590 66593 66596 66599 66602 66605 66608 66623 66626 66629 66632 66635 66638 66641 66644 66647 66650 66653 66655 66656 66659 66662 66665 66667 66669 66670 66671 66672 66673 66674 66677 66680 66683 66686 66689 66692 66695 66698 66701 66704 66707 66710 66713 66716 66719 66722 66725 66728 66731 66734 66737 66743 66749 66750 66751 66752 66755 66758 66761 66764 66767 66770 66773 66776 66779 66782 66785 66788 66791 66794 66800 66803 66806 66809 66812 66815 66818
P3:
69300 69303 69306 69309 69312 69315 69318 69321 69324 69327 69330 69333 69336 69339 69345 69354 69357 69360 69363 69369 69370 69372 69373 69374 69375 69376 69384 69387 69390 69393 69396 69399 69402 69405 69408 69411 69413 69442 69443 69445 69471 69472 69474 69475 69478 69481 69484
P4:
71057 71058 71059 71060 71062 71064 71066 71068 71069 71071 71072 71073 71074 71075 71077 71079 71081 71083 71085 71087 71089 71091 71093 71095 71097 71099 71101 71103 71106 71109 71113 71115 71117 71119 71121 71123 71125 71127 71129 71131 71133 71134 71135 71137 71139 71141 71143 71145 71146 71147 71149 71151 71153 71155 71157 71159 71163 71164
P5:
72813 72816 72817 72818 72823, 72824, 72825, 72826, 72830, 72836, 72844, 72846, 72847 72848 72851 72852 72855 72856 72857,
P6:
73043 73045 73047 73049 73051 73053 73055 73057 73059 73060 73061
P7:
73287 73289 73300 73305
P8:
73521 73523 73525 73527 73529
This is page 11 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
P9:
73801 73802 73803 73804 73805 73806 73807 73808 73809 73810 73811
P10:
73901 73903 73905 73907 73909 73910 73912 73913 73915
P11:
73921
This is page 12 of 12 pages of Schedule 3 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
SCHEDULE 4 - NURSING HOME TYPE PATIENT ACCOMMODATION
HOSPITALS IN ALL STATES/TERRITORIES
The default benefits that are payable per night for patients, that are classified as nursing-home type patients, in recognized (public) hospitals in particular States/Territories and private hospitals in all States/Territories are specified below:
| Default Benefits | |
| NSW | $90.15 |
| NT | $49.35 |
| QLD | $81.50 |
| SA | $89.00 |
| TAS | $83.50 |
| VIC | $83.15 |
| ACT | $82.85 |
| WA | $86.20 |
| Private Hospitals | $76.30 |
This is page 1 of 1 of Schedule 4 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
SCHEDULE 5 – PROSTHESES AND HUMAN TISSUES
5.1Subject to any indications on the Australian Register of Therapeutic Goods (ARTG) in relation to a prosthesis specified in Part A, this Schedule sets out the prostheses and human tissues provided to a private patient of a hospital or day hospital facility for which benefits must be paid. Clinical choice remains a matter between the doctor and the patient and is not to be influenced by the manufacturer, supplier or the registered health benefits organisation (RHBO).
5.2In this Schedule:
“hospital” includes a day hospital facility;
“human tissues” means the items included in Part B;
“prostheses” means the items included in Part A; and
references to a manufacturer, supplier, hospital or a RHBO include any agent acting
on their behalf.
Prostheses
Subject to any indications on the ARTG in relation to a prosthesis specified in Part A, the level of benefit payable in respect of a prosthesis specified in Part A is the fee or charge agreed between the RHBO and one only of the manufacturer, supplier or hospital.
Note: Other than the fees or charges permitted under clause 5.3, no additional charges can be imposed on a patient by a manufacturer, supplier, hospital or a RHBO.
Where the fee or charge is agreed between the RHBO and either the manufacturer or supplier under paragraph 5.3, then the RHBO and the manufacturer or supplier must advise all hospitals of the fee or charge agreed within two weeks of the date of the agreement.
This is page 1 of 682 of Schedule 5 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
Where the fee or charge for an item cannot be agreed between the RHBO and one of the manufacturer, supplier or hospital the relevant parties may agree to request the Department of Health and Ageing to appoint a conciliator to assist them to reach agreement on the fee or charge for the item for the purpose of paragraph 5.3. If the parties so request they shall, in equal measure, meet all of the costs incurred by the Department of Health and Ageing in arranging and facilitating this conciliation process.
If an agreement on the fee or charge for an item cannot be reached, the Minister will exercise his/her powers under paragraph (bj) of Schedule 1 to the National Health Act 1953 to determine the minimum level of benefit payable for the item in dispute.
Human tissues
The level of benefit payable in respect of a human tissue supplied by a particular facility is the amount specified in the “Amount” field of Part B.
Notes:
The organisations specified in the “Facility” field of Part B must comply with any applicable State and Territory laws governing harvesting and processing of human tissue items to be eligible for the payment of private health insurance benefits.
Other than the fees or charges permitted under clause 5.7, no additional charges can be imposed on a patient by a manufacturer, supplier, hospital or a RHBO.
This is page 2 of 682 of Schedule 5 attached to the Determination under Schedule 1 paragraph (bj) National Health Act 1953 (Determination HIB 11/2005) made by the Delegate of the Minister for Health and Ageing on 24 June 2005.
A. Mastoris
Witness
PART A - Prostheses List by Category, Groups and Sponsor February 2005
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Annuloplasty Rings
Edwards Lifesciences Pty Ltd
EL028 Baxter Sterile Grafts, Implants & Carpentier-Edwards Classic Annuloplasty 24mm-40mm
Prostheses, Non-Animal Origin Ring. Composition: Titanium Alloy;
Annuloplasty: Ring-Mitral Ring with Silicone Rubber; Polyester Fabric
Holder; Mitral Cosgrove-Edwards Carpentier-Edwards Physio Annuloplasty
Annuloplasty System Model 4600; Classic Ring. Composition: Elgiloy Bands;
Polyester Film Strips; Silicone Rubber;
Polyester Cloth, Cosgrove-Edwards
Annuloplasty Band. Composition: Silicone
Rubber; Polyester Cloth. Carpentier-
Edwards Tricuspid Ring. Composition:
Titanium Alloy; Silicone Rubber;
EL049 Edwards Etlogix Annuloplasty Ring Titanium/silicon/dacron polyester 24mm/26mm/28mm/30mm/32mm/34mmd
cloth/plastic template Mitral valve annular
repair device designed specifically for
patients with Ischemic Mitral regurgitation
Medtronic Australasia Pty Ltd
MC005 Medtronic Posterior Annuloplasty Band; Annuloplasty Devices - Models 610B, Models 610B & 610R 25-35mm, Models
Medtronic Duran Annuloplasty Ring; 610R & 620B, 620R Silicone / Barium 620B & 620R 23-35mm, Model 638B -
Colvin - Galloway Future Band Model Sulphate, Dacron. Models 638B semi- 26-38mm
638B; Duran Ancore Band 620B; Duran rigid metal alloy core, silicone coating,
Ancore Ring 620R polyester knit fabric, kit includes - band,
malleable handle, template with suture
markers, sizers, molded tray.
St. Jude Medical Australia Pty Ltd
SJ034 SJM Seguin Annuloplasty Ring Semi Rigid 24mm - 40mm
SJ035 SJM Tailor Annuloplasty Ring Fully Flexible 25mm - 35mm
Tag Medical
TM001 AnnuloFlo Annuloplasty System Annuloflex Ring or AnnuloFlo Ring 26-36mm
PART A - Prostheses List by Category, Groups and Sponsor Page 1 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Catheters, Angioplasty, Laser
Pacing Importers Pty Ltd
PI002 Excimer Laser Stent Polyester Fibre optic fibre catheter 0.457mm, 0.9mm, 1.4mm, 1.7mm and
Coronary Stents
Drug Eluting Stents
Boston Scientific Pty Ltd
BS074 Taxus on Express2 Coronary Stent balloon expandable stent with conformal Length 8 - 32mm; Diameter 2.25 -
System Models 38001-0822 to 0840; polymer/drug matrix coating, pre-
38001-1222 to 1250; 38001-1622 to mounted on high pressure monorail
1650;
38001-2022 to 2050; 38001-2422 to
2450; 38001-2827 to 2850; 38001-3227
Johnson & Johnson Medical Pty Ltd
JJ302 CYPHER Sirolimus-Eluting Stent & Stainless steel coronary stent with Diameter 2.25 - 5.0mm, length 8-33mm
Delivery System Model CRS - 23300, Rapamycin (an immunosuppressive and
08225, 08250, 08275, 08300, 28225, antiproliferative drug) bound to the stent
28250, 28275, 28300, 33225, 33250,
33275, 33300, 13225, 13250, 13275,
18225, 18250, 18275, 18300, 23225,
23250, 23275, 23350, 23400, 08350,
08400, 28350, 28400, 33350, 33400,
13300, 13350, 13400, 18350, 18400,
23450, 23500, 28450, 28500, 33450,
33500, 08450, 13450, 18450, 18500
General Purpose Bare Metal Stents
Abbott Australasia Pty Ltd
AY006 Bio-Divysio Stent SV/OC/AS Balloon expandable Phosophoryl-Choline Divysio Stent SV - Diameters: 2.0, 2.25,
coated stainless-steel endovascular 2.5 Lengths: 7mm, 10mm, 15mm,
coronary stent 18mm, 21mm; Divysio Stent OC & AS -
Diameters: 2.75, 3.0, 3.5, 4.0 Lengths:
8mm, 11mm, 15mm, 18mm, 22mm, 28mm
AY013 JoStent Coronary Stent Stainless Steel 9 - 26 mm x 2.5 - 4 mm
PART A - Prostheses List by Category, Groups and Sponsor Page 2 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Atrium Australia-Pacific Rim Pty Ltd
AC022 Flyer RX Coronary Stent System Stainless Steel Coronary Stent Dia 2-5mm, Length 6-40mm
B Braun Australia Pty Ltd
BB171 Coroflex Coronary Stent System Electropolished stainless steel 316L; Laser 2.5 x 8mm; 3.0 x 8mm; 3.5 x 8mm; 4.0
cut slotted tube. Product includes: x 8mm; 2.5 x 13mm; 3.0 x 13mm; 3.5 x
Coronary stent mounted on delivery 13mm; 4.0 x 13mm; 2.5 x 16mm; 3.0 x
16mm; 3.5 x 16mm; 4.0 x 16mm; 2.5 x
19mm; 3.0 x 19mm; 3.5 x 19mm; 4.0 x
19mm; 2.5 x 25mm; 3.0 x 25mm; 3.5 x
BB172 Coroflex Theca Coronary Stent System Electropolished Stainless Steel 316L; Dia 2.5-4.0mm, length 8-25mm
Laser cut slotted tube, coated with
Polyzene-F; includes Coronary Stent
mounted on delivery balloon catheter.
BB173 Coroflex Delta Coronary Stent System Electropolished Stainless Steel 316L; Dia 2.5-4.0mm, length 8-25mm
Laser cut slotted tube, includes Coronary
Stent mounted on delivery balloon
BB244 Coroflex Blue Cobalt Chromium Alloy L605 2-4mm diameter, 8-25mm length
Biotronik Australia Pty Ltd
BT040 Lekton Intracoronary stent - balloon mounted Dia 2.5-4mm, length 10-30mm
BT058 Lekton Motion Coated flexible stent, Balloon mounted Diameter 2.5mm to 4mm, Length 8 -
BT059 Astron Flexible coated stent, Nitinol, self- Diameter 7-12mm, Length 30-80mm
Boston Scientific Pty Ltd
BS069 Express 2/Liberte Coronary Stent Consists of a balloon expandable stent, Stent lengths: 8,12,16,20,24,28 & 32 mm
pre-mounted on a Maverick 2 Monorail Stent diameters: 2.25, 2.5, 2.75, 3.0, 3.5,
delivery catheter. 4.0, 4.5 & 5.0 mm
PART A - Prostheses List by Category, Groups and Sponsor Page 3 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Daralan Pty Ltd
DA001 S-Stent SRX1 316L Stainless Steel SRX1-2510 2.5 x 8.5mm; SRX1-3010
3.0 x 8.5mm; SRX1-3510L 3.5 x
8.5mm; SRX1-4010L 4.0 x 8.5mm;
SRX1-2512 2.5 x 11mm; SRX1-3012
3.0 x 11mm; SRX1-3512L 3.5 x 11mm;
SRX1-4012L 4.0 x 11mm; SRX1-2515
2.5 x 14.4mm; SRX1-3015 3.0 x
14.4mm; SRX1-3515L 3.5 x 14.6mm;
SRX1-4015L 4.0 x 14.6mm; SRX1-2520
2.5 x 18.7mm; SRX1-3020 3.0 x
18.7mm; SRX1-3520L 3.5 x 18.4mm;
SRX1-4020L 4.0 x 18.4mm; SRX1-2525
2.5 x 24.5mm; SRX1-3025 3.0 x
24.5mm; SRX1-3525L 3.5 x 23.2mm;
SRX1-4025L 4.0 x 23.2mm; SRX1-
2530 2.5 x 28.9mm; SRX1-3030 3.0 x
28.9mm; SRX1-3530L 3.5 x 28.2mm;
Guidant Australia Pty Ltd
GU102 Stents ACS Multilink Coronary Stent; ACS 1.5mm - 8.0mm
Megalink Peripheral Stent; ACS RX
Herculink Peripheral Stent. Stainless steel
GU105 Multilink Coronary Stent System Stainless Steel Length 1.5mm - 8.0mm
GU127 Multilink Coronary Stent System - Frontier 316L Stainless steel stent Length 1.5 - 8.0mm
GU128 Multilink Coronary Stent System - Vision Cobalt chrome stent Length 1.5 - 8.0mm
Johnson & Johnson Medical Pty Ltd
JJ026 BX Velocity with Hepacoat System Balloon expandable, stainless steel,
heparin coated
JJ200 BX Velocity Stent and Delivery System Stainless steel stent Diameter: 2.25-5.0 mm; Length 8 - 33
JJ239 BX Sonic Stainless steel coronary stent mounted on Dia 2.25 - 4.0mm, lengths 8 - 33mm
a balloon delivery system
Medical Vision Australia Pty Ltd
MF004 Vivant Z Stent Coronary stent made of alloyed medical Dia 2.5 - 4.0mm, length 9 - 28mm
grade stainless steel
Medtel Australia Pty Ltd
ME050 Antares Coronary Stent System Stent Length: 8mm - 32mm Diameter: 2.5mm -
4.0mm
PART A - Prostheses List by Category, Groups and Sponsor Page 4 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
ME071 Antares Starflex Coronary System Stainless steel Bare stent lengths 8, 12, 16, 20, 24,
32mm; Expansion range 2.5 - 4.0mm
Stent Delivery System, stent lengths
8mm, 12mm, 16mm, 20mm, 24mm,
32mm
ME073 Lunar Starflex Coronary Stent System Niobium alloy stent coated with layer of Balloon 2.25-4.0mm, stent 8-20mm
homogenous iridiumoxide (IrOx)
Medtronic Australasia Pty Ltd
MC197 Medtronic AVE S660 Coronary Stents, Stainless Steel S660 Coronary Stent - Diameter (2.5mm-
S670 Coronary Stents, S7 Coronary 2.75mm), Length (9mm-24mm); S670 &
Stents, BeStent2, S7 Coronary Stent - Diameter (3mm-
4mm), Length (9mm-30mm); BeStent2 -
Diameter (2.5mm-4mm), Length (9mm-
MC329 Medtronic Driver, Micro Driver Coronary Cobalt Alloy Driver Stent: diameter (2.25 - 4.5mm),
Stent System length (8-30mm); Micro-Driver Stent:
diameter (2.25 - 2.75mm), length (8 -
Pacing Importers Pty Ltd
PI003 Med-X-Flexy Stent Tubular Stent, Stainless steel 316L, Gold Dia 5 - 9mm length: 20 - 100mm
markers
Terumo Corporation Australia
TU001 Intra Coronary Stent Stainless Steel mounted on balloon Diameter 2.0mm - 4.0mm, Length 10mm
- 30mm length
Woodstock Biomedical Pty Ltd
WO031 Duraflex Coronary Stent System 316L Medical Grade Stainless Steel Stent Length 8, 11, 14, 18, 21, 25mm x
Premounted on Rail Design Catheter Diameter 2.5, 2.75, 3.0, 3.5, 4.0mm
Zynergy Medical Pty Limited
ZY001 Carbostent Coronary stent - includes Carbostent Dia 2.5mm x Length 9, 12, 15, 19,
Syncro & Carbostent Sirius 25mm; Dia 3.0mm x Length 9, 12, 15,
19, 25, 32mm; Dia 3.5mm x Length 9,
12, 15, 19, 25, 32mm; Diameter 4.0mm x
Length 9, 12, 15, 19, 25, 32mm
Special Purpose Stents
Abbott Australasia Pty Ltd
AY012 JoStent Coronary Stent Graft Stainless Steel/PTFE 9 - 26 mm x 2.5 - 5 mm
PART A - Prostheses List by Category, Groups and Sponsor Page 5 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Boston Scientific Pty Ltd
BS067 Symbiot Covered Stent System A self-expending nitinol stent encased Stent lengths: 20, 31 & 45 mm Stent
within an ePTFE covering, premounted diameters: 4.0 & 5.0 mm
on a Monorail delivery catheter
CRT Pacemakers
Generation 1
Guidant Australia Pty Ltd
GU087 Contak TR Model 1241 Pacemaker Titanium 3.2mm/IS-1
GU143 Contak Renewal TR CRT -P Model Implantable cardiac pacemaker 45x54x8.5mm, 14cc, 26gm
H120, Model H125
Medtronic Australasia Pty Ltd
MC006 InSync model 8040 Stimulator Titanium 14.4cc
St. Jude Medical Australia Pty Ltd
SJ040 Frontier 3x2 Model 5510 Biventricular Stimulation Device with AF Height 48mm, Length 52mm, Depth 6mm
suppression
Generation 2
Biotronik Australia Pty Ltd
BT056 Stratos LV Multiprogrammable, Biventricular, DDDRV One size only
Guidant Australia Pty Ltd
GU142 Contak Renewal TR2 CRT - P Model Implantable Cardiac pacemaker 45x54x8.5mm, 14cc, 26gm
H140, Model H145
Medtronic Australasia Pty Ltd
MC226 Medtronic Insync III Triple Chamber Titanium One size only
Pacemaker Model 8042
Dual Chamber ICDs
Generation 1
Biotronik Australia Pty Ltd
BT042 Tachos Atx Implantable Cardioverter Defibrillator - One Size Only
Atrial Therapy
PART A - Prostheses List by Category, Groups and Sponsor Page 6 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Generation 2
Biotronik Australia Pty Ltd
BT045 Belos DR, Implantable Cardioverter Dual Chamber ICD, Rate Responsive One Size Only
Defibrillator
Medtronic Australasia Pty Ltd
MC202 Medtronic Gem III DR Model 7275 Titanium One size only, 39.5cc
Implantable Cardioverter Defibrillator
Progressive Medical
PG004 Alto II DR Dual Chamber Implantable One size only
Cardioverter Defibrillator
St. Jude Medical Australia Pty Ltd
SJ009 Photon Micro DR Model V-232 37cc
Defibrillators/Cardioverters
Generation 3
Biotronik Australia Pty Ltd
BT053 Lexos DR Dual chamber ICD, rate responsive One size only.
Guidant Australia Pty Ltd
GU111 Ventak Prizm II DR Model 1861, titanium, dual chamber, One size only
adaptive rate
GU132 Vitality DR Model 1871 This device acts to defibrillate the heart Model 1871 Vitality DR Dual Chamber
chambers when the patient enters into an Rate Responsive Pacemaker/Defibrillator
arrhythmia or uses shocks or anti tachy
pacing to revert Ventricular Tachycardia
(VT) or Ventricular Fibrillation (VF).
While also acting as a dual chamber
GU149 Vitality 2 DR - Model T165 Implantable Cardiac Defibrillator 30cc ; 82g
GU150 Vitality 2 EL Dr - Model T167 Implantable cardiac Defibrillator 35cc ; 90g
Medtronic Australasia Pty Ltd
MC245 Marquis DR Model 7274 Implantable Titanium 36cc
Cardioverter Defibrillator
MC318 Maximo DR Model 7278 Titanium One size only 38.9cc
PART A - Prostheses List by Category, Groups and Sponsor Page 7 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
St. Jude Medical Australia Pty Ltd
SJ049 Epic Plus DR Model V-236 Implantable Dual Chamber sensing, bradycardia 33cc
Cardioverter Defibrillator pacing with atrial fibrillation suppression
SJ070 Epic + DR Model V-233 ICD Dual Chamber Implantable Cardio-verter 33cc 70g
Defibrillator
SJ071 Epic + DR Model V-239 ICD Dual chamber implantable cardio-verter 33cc 70g $0.00
defibrillator
Dual Chamber ICDs with CRT
Generation 1
Guidant Australia Pty Ltd
GU119 Contak Renewal Model H135 Composition - titanium, indicated for One size only
patients with symptomatic hear failure.
Provides cardiac resynchronisation
therapy by providing electrical stimulation
to synchronize left and right ventricular
contractions. These devices also provide
defibrillation back up.
Medtronic Australasia Pty Ltd
MC252 Medtronic InSync Marquis Implantable Titanium Volume 38cc
Cardioverter Defibrillator Model 7277
Generation 2
Guidant Australia Pty Ltd
GU134 Contak Renewal 2 This device acts to defibrillate the heart One Size Only
chambers when the patient enters into an
arrhythmia or uses shocks or anti tachy
pacing to revert Ventricular Tachycardia
(VT) or Ventricular Fibrillation (VF).
While also acting as a dual or single
GU147 Contak Renewal 4 CRT-D Model H190, Implantable dual-chamber defibrillator One size only
Model H195
Medtronic Australasia Pty Ltd
MC306 InSync III Marquis Model 7279 Titanium One size only - Volume 38cc
MC325 InSync Sentry Model 7298 Defibrillator, Titanium 40cc
PART A - Prostheses List by Category, Groups and Sponsor Page 8 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
St. Jude Medical Australia Pty Ltd
SJ062 Epic HF Model V-339 Implantable Cardioverter/defibrillator with dual One size only
Cardiac Defibrillator chamber (atrial and RV) sensing and
bradycardia pacing with ventricular
SJ067 Epic + HF Model V-350 ICD Epic + HF V-350 ICD is a cardioverter 36cc / 73g
defibrillator with dual chamber (atrial and
RV) sensing and bradycardia pacing with
ventricular resynchronisation therapy.
Dual Chamber Pacemakers
Generation 1
Biotronik Australia Pty Ltd
BT026 Philos D Model 122447 Implantable Multiprogrammable, ventricula, rate One size only
Pacemaker responsive modes, DDDC
BT031 AXIOS D Implantable Cardiac Pulse Multiprogrammable, DDD One size only
Generator Cat No. 338 843
Guidant Australia Pty Ltd
GU079 Pulsar Model VDD 870 Titanium 3.2mm/IS-1
Medtronic Australasia Pty Ltd
MC033 Medtronic Kappa 700 Pacemaker Model Titanium 10.9cc, 11.1cc
KVDD700/701
MC235 Vitatron Vita 2 VDD Model 630, Titanium, polyurethane One size only
Implantable Cardiac Pacemaker
MC243 Medtronic Kappa KVDD 900 Model Cardiac Pacemaker, Titanium 11.1cc
KVDD 901
MC290 Vitatron C50 D Pacemaker Titanium, polyurethane one size only
MC319 EnPulse VDD; Model E2VDD01 EnPulse VDD pacemaker with IS1 One size only
connector. Titanium silicone
MC320 EnPulse D Series: Model E2D01, Model EnPulse DDD-Pacemakers - with IS1 One size only
E2D03 connector; with 3.2mm low profile
connector. Titanium and silicone
St. Jude Medical Australia Pty Ltd
SJ050 Verity ADx Model XL DC 5256 Dual - Dual Chamber multi-programmable rate- 11cc, 23.5g
Chamber pacemaker adaptive pacing devices with extended
longevity
PART A - Prostheses List by Category, Groups and Sponsor Page 9 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
SJ061 Identity Adx Model XL DC 5286 Dual Identity ADx Model XL DC Model 5286 11cc, 23.5g
Chamber Pacemaker is an implantable, multi-programmable
rate-adaptive pacing device with AF
Generation 2
Biotronik Australia Pty Ltd
BT027 Philos SLR Model 122456 Implantable Single pass, multiprogrammable, rate One size only
Pacemaker responsive, VDDR
BT039 AXIOS SLR Implantable Cardiac Pulse Multiprogrammable, rate responsive, One size only
Generator Cat No 338 849
Medtronic Australasia Pty Ltd
MC212 Medtronic Vitatron Clarity VDDR Model Titanium, polyurethane One size only
St. Jude Medical Australia Pty Ltd
SJ054 Identity ADx Model VDR 5480 Single Chamber multi-programmable rate- 8cc, 18g
implantable pacemaker adaptive pacing device with extended
longevity
SJ057 Verity ADx Model XL VDR 5456 Single Chamber multi-programmable rate- 11cc, 23.5g
implantable pacemaker adaptive pacing device with extended
longevity
Generation 3
Biotronik Australia Pty Ltd
BT024 Philos DR Model 122450 Implantable Multiprogrammable, rate responsive, One size only
Pacemaker
BT029 Philos DR-A Model 122600 Implantable Multiprogrammable, rate responsive, 5mm ports, One size only
Pacemaker
BT032 AXIOS DR Implantable Cardiac Pulse Multiprogrammable, rate responsive, One size only
Generator Cat No. 338 845
BT047 Protos DR/CLS Dual chamber, rate responsive, closed One size only.
loop system.
BT060 Philos II DR Multiprogrammable, rate responsive, One size only
Guidant Australia Pty Ltd
GU045 Pulsar Max II Pacemaker DDDR Model 1280
GU120 Insignia Plus DR Model 1297, Insignia Dual Chamber Rate Responsive One size only
Plus DR Model 1298 Permanent Pacemaker
PART A - Prostheses List by Category, Groups and Sponsor Page 10 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
GU121 Insignia Entra DR Models Dual Chamber Rate Responsive One size only
Permanent Pacemaker
GU140 Insignia Ultra DR Model 1291 Implantable Cardiac Pacemaker One size only
GU141 Insignia Ultra DR Model 1290 Implantable Cardiac Pacemaker One size only
Medtronic Australasia Pty Ltd
MC210 Medtronic Vitatron Clarity DDDR Model Titanium, polyurethane One size only
MC222 Medtronic Vitatron Diamond 3 DDDR Titanium, polyurethane One size only
Model 840 Pacemaker
MC230 Vitatron Selection Model 9000 Pacemaker Titanium, polyurethane One size only
MC240 Vitatron Vita 2 DDDR Model 830, Titanium, Polyurethane One size only
Implantable Cardiac Pacemaker
MC289 Vitatron C60 DR Pacemaker Titanium, polyurethane one size only
MC333 Medtronic Kappa Pacemaker Model KDR Cardiac Pacemaker, Titanium 12.1cc, 11.1cc, 13.1cc
901, KDR921 and KDR931
Progressive Medical
PG002 Talent II DR Pacemaker Model 233 Dula Chamber Pacemaker. 99% titanium 57.5 x 37.2 x 8mm
PG005 Symphony DR 2550 Active Implantable pacemaker 1 size only
St. Jude Medical Australia Pty Ltd
SJ026 St Jude Medical Integrity AFX DR5346 Dual chamber, rate responsive pacemaker Volume 11cc, weight 23.5gm
Pacemaker, Cardiac, Implantable
SJ028 Integrity Micro DR 5336 Pacemaker Dual Chamber Rate Responsive Volume 8cc, Weight 18gm
SJ031 Identity XL DR 5376 Dual Chamber Rate Responsive Volume 11cc, Weight 23.5gm
SJ032 Identity DR 5370 Dual Chamber Rate Responsive Volume 8cc, Weight 18gm
SJ051 Verity Adx Implantable Pacemaker, Dual - Chamber, multi-programmable, 45x52x6mm,11cc, 23g, 5mm or 6mm M/S
Models XL DR 5356 and XL DR 5357M/S rate-responsive pacemaker withAF
SJ056 Integrity ADx Model DR 5360 and XL Dual-Chamber, multi-programmable, rate- Model DR 5360 - 8cc, 18g, Model XL
DR 5366 responsive pacemaker with AF DR 5366 - 11cc, 23.5g
SJ059 Identity ADx Models DR 5380 and XL Dual-Chamber, multi-programmable, rate- ADx DR 5380: 43x44x6mm, 18g and 8cc
DR 5386 adaptive pacing devices with AF
ADx XL DR 5386: 44x52x6mm, 23.5g
PART A - Prostheses List by Category, Groups and Sponsor Page 11 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Generation 4
Medtronic Australasia Pty Ltd
MC322 EnPulse DR Series: Model E2DR01, EnPulse DDDR Pacemakers - with IS1 one size only
Model E2DR03, Model E2DR06, Model connector and normal battery size; with
E2DR21, Model E2DR31, Model E2DR33 3.2mm low profile connector and normal
battery size; with 5/6 mm connector and
normal battery size; with IS1 connector
and small battery size; with IS1
connector and large battery size; with
3.2mm low profile connector and large
battery size. Titanium and silicone.
Embolization Prostheses, Intravascular
William A Cook Aust Pty Ltd
WC076 Flipper-Patient Ducts Arteriosus- Detachable Coil for PDA Closure Coil Diameter 3,5,6.5 & 8 mm Number
Occluding System of Loops (3,4,5)
Filters, Vena Cava
B Braun Australia Pty Ltd
BB105 Celsa Vena Cava Filter System Phynox/ combination of various metals One size, expands to Max length
inc. Nickel,Copper, Molubden,Steel 38mm/Max diameter 30mm
BB106 Celsa Temporary Vena Cava System Phynox/ combination of various metals One size, expands to Max length
inc. Nickel,Copper, Molubden,Steel 38mm/Max diameter 30mm
Grafts
Woodstock Biomedical Pty Ltd
WO033 Endofit Endoluminal Stent Graft Tapered Thoracic Endoluminal Stent Max Dia. 42mm, Min Dia. 14mm, Length
Graft with external fixation 12-26cm
WO034 Endofit Endoluminal Stent Graft Occluder Endoluminal Stent Graft Max Dia. 42mm, Min Dia. 14mm, Length
2 or 3.5cm
PART A - Prostheses List by Category, Groups and Sponsor Page 12 of 666
CARDIO-THORACIC Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
WO035 Endofit Endoluminal Stent Graft Extender Endoluminal Stent Graft, Max Dia. 42mm, Min Dia. 14mm, Length
abdominal and thoracic, Preloaded 4-12cm
WO036 Endofit Endoluminal Stent Graft Extender Endoluminal Stent Graft, Max Dia. 42mm, Min Dia. 14mm, Length
MC300 Medtronic MiniMed Insulin Infusion Model MMT - 508 One Size Only
Pump System
PART A - Prostheses List by Category, Groups and Sponsor Page 82 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
MC302 Medtronic Minimed Insulin Infusion Paradigm Model MMT - 512. One Size Only
pump System
MC303 Medtronic Minimed Insulin Infusion Paradigm Model MMT - 712 One Size Only
Pump System
Orthocare Pty Limited
OC003 Pain Care 2000L Pain Care 2000L System One Size Only
OC004 Pain Care 2000L "Y" Accessory Kit One Size Only
OC005 Pain Care 2000L Multiport Catheter 54" One Size Only
Infusion Pumps, Ambulatory, Insulin
Australasian Medical & Scientific Ltd
AN001 Animas IR 1000 Insulin Infusion Pump One size only
AN005 Animas IR 1200 Insulin Infusion Pump Ambulatory Insulin Infusion Pump One size only
(Insulin Infusion Pump IR 1200 series)
AN006 Animas IR 1200 Insulin Infusion Sterile, indicated as reservoir for insulin Cartridge Capacity - 2.0mL or 200 units Temporary Approval,
Cartridge (Insulin Infusion Pump IR 1200 by the Animas Infusion Pump, not pending review of
intended for use with any other infusion product group
Medical Specialties Australia Pty Ltd
MS020 Infusa MPD Powered Drug Infusion System, Micro Small, Medium, Large
dose battery operated, Syringe type
Medtronic Australasia Pty Ltd
MC283 Medtronic MiniMed Paradigm Insulin Model MMT-511- One Insulin Pump One Size Only
Infusion Pump System
Roche Diagnostics Australia Pty Ltd
RO001 "Disetronic Insulin Infusion Pump D-Tron plus Large Kit Blue or Anthracite
RO002 "Disetronic Insulin Infusion Pump H-Tron plus Large Kit Blue or Grey
RO008 "Disetronic Insulin Infusion Pump H-Tron plus Small Kit Blue or Grey
RO009 "Disetronic Insulin Infusion Pump D-Tron plus Small Kit Blue or Grey
PART A - Prostheses List by Category, Groups and Sponsor Page 83 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Infusion Pumps, Ambulatory, Other
Smiths Medical Australasia Pty Ltd
SI027 CADD Administration Sets, 198cm, with Pump 198 cm
Bag Spike & Add-on Anti-siphon Valve,
TOTM Plasticized Tubing, Model No. 21-
SI037 CADD Legacy 1 Model 6400 Ambulatory Pump One size only
Infusion Pump
SI038 CADD Legacy Plus Model 6500 Pump One size only
Ambulatory Infusion Pump
Infusion Pumps, Ambulatory, Syringe
Medical Specialties Australia Pty Ltd
MS019 Infusa T, Infusa TS or Infusa DSLT Powered Drug Infusion System, Battery Small, Medium, Large
operated, Syringe type
Medtronic Australasia Pty Ltd
MC282 Medtronic MiniMed Insulin Infusion Ambulatory Insulin Infusion Pump One Size Only
Pump Reservoir System Administration Sets and
Accessories; Insulin Infusion Pump
Reservoir MMT-103A (for use with
MC284 Medtronic MiniMed Paradigm Insulin Paradigm Insulin Infusion Pump One Size Only
Infusion Pump Reservoir Reservoir MMT-326A (for use with
Model MMT-511 insulin infusion pump)
Infusion Pumps, General-Purpose
Medical Specialties Australia Pty Ltd
MS021 Medical Specialties "Walkmed Infusion Ambulatory Infusion Pump System, Walkmed Infusion Pump System
Pump System" Powered Drug Infusion Administration Sets and Accessories
System and Ancillary Equipment
(McKinley, USA)
MS022 Medical Specialties "Walkmed Drug Ambulatory Infusion Pump System, Walkmed Drug Administration Reservoirs
Administration Reservoir" (McKinley, Administration Sets and Accessories
PART A - Prostheses List by Category, Groups and Sponsor Page 84 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
MS023 Medical Specialties "Walkmed Drug Ambulatory Infusion Pump System, Walkmed Drug Administration Sets
Administration Sets" (McKinley, USA) Administration Sets and Accessories
Infusion Pumps, Implantable
Getz Bros. & Co. (Aust) Pty Ltd
GB111 AccuRx Constant Flow Implantable Drug Infusion Systems, powered and One Size Only
Pump Model ancillary equipment
5304,5305,5306,5307,5308,5309,5310,53
12,5315,5320,5326,5332
Infusion Pumps, Micro
Smiths Medical Australasia Pty Ltd
SI032 CADD-Micro Model 5900 Ambulatory Pump One size only
Infusion Pump
Infusion Pumps, Patient-Controlled Analgesic
Medical Specialties Australia Pty Ltd
MS028 Medical Specialties Microject Infusion Ambulatory Infusion Pump System, Microject Pumps
Pump System Administration Sets and Accessories
Smiths Medical Australasia Pty Ltd
SI034 CADD-PRIZM VIP (Variable Infusion Pump One size only
Profile) Model 6100; CADD-PRIZM PCS
Ambulatory Infusion Pump, Model 6100
SI039 CADD Legacy PCA Model 6300 Pump One size only
Ambulatory Infusion Pump
PART A - Prostheses List by Category, Groups and Sponsor Page 85 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Injection/Infusion Ports, Implantable
Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd
AS052 Chemosite Implantable Venous Access Port - Single Lumen (ChemoSite*) 7-9 french; 10.5 french. * Trademark of United
System States Surgical
Corporation
B Braun Australia Pty Ltd
BB082 Celsite Epoxy Single Access Port Epoxy/titanium Standard/small/baby
BB083 Celsite Epoxy Dual Access Port Epoxy/titanium Standard/small/baby
BB084 Celsite MBS Single Access Port Methylbutadeine styrene Standard/small
BB086 Celsite Epoxy Peritoneal Port Epoxy/titanium 32x27x13mm
Bard Australia Pty Ltd
BA046 The Bard Button Implantable Injection, Silicone Replacement Gastrostomy 18 - 24 French
Infusion Port
BA056 Subcutaneous Ports Hickman open-ended catheter, single 8 - 9.6 French Catheter
BA057 Groshong Subcutaneous Ports Single or dual lumen catheter 8 - 9.6 French Catheter
BA058 Cathlink Implanted Port Single lumen 6 - 8 French Catheter
BA059 Dual Lumen Subcutaneous Ports Silicone, Polyurethane or ChronoFlex 7 - 10 French Catheter
Open-ended Catheter
BA060 Hickman Subcutaneous Ports Low-Profile 6 - 6.6 French Catheter
Cecil E Mayo Pty Ltd
CM009 L-Port Implantable Vascular Access Arrow Model No.'s VARRX AP01040, Ports - H10mm, L25mm, Weight 9grams,
AP01010, AP01011, AP001012, Internal Vol. 0.3ml. Catheter75cm
AP01013, AP01015, AP01017, AP06046,
AP06016, AP06020, AP06012,
AP06022, AP06025. Plastic low profile
port with self sealing silicone septum and
detached silicone catheters.
CM010 L-Port Implantable Vascular Access Arrow Model No.'s VARRX AP01031, Ports - H10mm, L25mm, Weight 9grams,
AP01031, AP01032, AP01033, AP01035, Internal Vol. 0.3ml. Catheter75cm
AP01037, AP06036, AP06040,
AP06041, AP06042, AP06045. Titanium
Low Profile Ports with self sealing
silicone septum and detached silicone
PART A - Prostheses List by Category, Groups and Sponsor Page 86 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Endotherapeutics Pty Ltd
ET021 Jet Port Catheter System Polyoxymethylene injection port 28mm
Inamed Australia Pty Ltd
IN002 Lap-Band Access Port For use with the Lap-Band Adjustable Standard, low profile
Gastric Banding System
Johnson & Johnson Medical Pty Ltd
JJ444 Swedish Adjustable Gastric Band - Titanium implantable infusion port & One size only
Injection Port & Locking Connector locking connector for the Swedish
Adjustable Gastric Band. Replacement
port & locking connector to the one
included with the Swedish Adjustable
Medical Specialties Australia Pty Ltd
MS014 Injection/Infusion Ports Sterile Plastic/titanium, single lumen 5-15F
MS015 Injection/Infusion Ports Sterile Plastic/titanium, dual lumen 10, 10.5, 12F
MS016 Injection/Infusion Ports Sterile Plastic/titanium, paediatric 5, 6, 7,8, 9.6F
Smiths Medical Australasia Pty Ltd
SI001 Injection/Infusion Ports, Sterile - PORT- Port - single lumen One size only
A-CATH II Trans Arterial Percuataneous
SI002 Injection/Infusion Ports, Sterile - PORT- Port - single lumen One size only
A-CATH Intraspinal 501CS System
SI003 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm O.D. PolyFlow Polyurethane
A-CATH P.A.S Port T2 System
SI005 Injection/Infusion Ports, Sterile - PORT- Port - single lumen One size only
A-CATH Peritoneal System
SI006 Injection/Infusion Ports, Sterile - PORT- Port - single lumen One size only
A-CATH Intraspinal 500CS System
SI007 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.3 mm silicone catheter
A-CATH Arterial Titanium System
SI008 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.8 mm silicone catheter & 9 French
A-CATH Titanium Venous Portal introducer set
SI009 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter
A-CATH Implantable Venous Access
SI010 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9mm polyurethane catheter
A-CATH Implantable Access System -
Venous Portal, with introducer set
PART A - Prostheses List by Category, Groups and Sponsor Page 87 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
SI011 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter
A-CATH Low Profile Titanium Venous
SI012 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter
A-CATH Low Profile Implantable Venous
System, with introducer set
SI013 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.8 mm silicone catheter
A-CATH II Titanium Venous System
SI014 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.8 mm silicone catheter
A-CATH II Titanium Venous System,
with introducer set
SI015 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter
A-CATH II Titanium Venous System
SI016 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter
A-CATH II Titanium Venous System
with introducer set
SI017 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.6 mm polyurethane catheter
A-CATH Titanium Venous System with
introducer set
SI018 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter
A-CATH II Low Profile Titanium Venous
System
SI019 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter
A-CATH II Low Profile Titanium Venous
System with introducer set
SI022 Injection/Infusion Ports, Sterile - PORT- Port - dual lumen 3.4 mm silicone catheter
A-CATH II Dual Lumen Titanium Venous
system
SI023 Injection/Infusion Ports, Sterile - PORT- Port - dual lumen 3.4 mm silicone catheter
A-CATH II Dual Lumen Titanium Venous
system and introducer set
Mesh
Endocorp Pty Ltd
EC045 Parietex Multifibre Polyester Surgical Mesh 12cm x 8cm to 30cm x 32cm (3D)
PART A - Prostheses List by Category, Groups and Sponsor Page 88 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Endotherapeutics Pty Ltd
ET046 Parietene Monofilament Polypropylene Surgical 6cm x 11cm to 30cm x 30cm Single
ET047 Parietex Multifibre Polyester Surgical Mesh 7cm x 1.5cm to 20cm x 20cm Single
ET048 Parietene Monofilament Polypropylene Surgical 6cm x 11cm to 30cm x 32cm (3D)
Mesh - three dimensional & X-shape
Johnson & Johnson Medical Pty Ltd
JJ179 VYPRO Mesh Vicryl (polyglactin 910) / Prolene 30cm x 30cm
(polypropylene) composite mesh
JJ240 VYPRO II Mesh Composition - equal part Vicryl Small 6 x 11cm
polyglactin yarn - non-absorbable Prolene
polypropylene yarn. Partly absorbable
lightweight mesh for tension free-inguinal
JJ241 VYPRO II Mesh Composition - equal part Vicryl Medium 12 x 10cm
polyglactin yarn - non-absorbable Prolene
polypropylene yarn. Partly absorbable
lightweight mesh for tension free-inguinal
JJ242 VYPRO II Mesh Composition - equal part Vicryl Large 15 x 10cm
polyglactin yarn - non-absorbable Prolene
polypropylene yarn. Partly absorbable
lightweight mesh for tension free-inguinal
JJ243 VYPRO II Mesh Composition - equal part Vicryl Extra large 15 x 15cm
polyglactin yarn - non-absorbable Prolene
polypropylene yarn. Partly absorbable
lightweight mesh for tension free-inguinal
JJ434 GYNECARE GYNEMESH* PS Gynecare Gynemesh* PS is a non- 10cm x 15cm (4" x 6")
absorbable Prolene soft mesh indicated
for tissue reinforcement and long lasting
stabilisation of fascial structures of the
pelvic floor in vaginal wall prolapse.
Gynemesh PS* is constructed of knitted
filaments of extruded polypropylene
identical in composition to Prolene*
polypropylene suture. It is packaged
sterile, one 10 x 15cm piece per box.
Medical Specialties Australia Pty Ltd
MS030 TiMESH light Prosthetic warp-knitted fabric made of 10 x15 cm TiMESH light
monofil polypropylene threads with an
encapsulating titanic coating
PART A - Prostheses List by Category, Groups and Sponsor Page 89 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
MS032 TiMESH extralight Prosthetic warp-knitted fabric made of 10 x 15cm TiMESH extralight
monfil polypropylene threads with an
encapsulating titanic coating
MS033 TiMESH light Prosthetic warp-knitted fabric made of 15 x 15cm TiMESH light
monofil polypropylene threads with an
encapsulating titanic coating
MS034 TiMESH extralight Prosthetic warp-knitted fabric made of 15 x15cm TiMESH extralight
monofil polypropylene threads with an
encapsulating titanic coating
MS035 TiMESH light Prosthetic warp-knitted fabric made of 20 x 15cm TiMESH light
monofil polypropylene threads with an
encapsulating titanic coating
MS036 TiMESH extralight Prosthetic warp-knitted fabric made of 20 x 15cm TiMESH extralight
monofil polypropylene threads with an
encapsulating titanic coating
MS037 TiMESH Extra Large Prosthetic warp-knitted fabric made of 30 x 30cm TiMESH
monofil polypropylene threads with an
encapsulating titanic coating
MS038 TiMESH Extra Large Prosthetic warp-knitted fabric made of Extra Large TiMESH
monofil polypropylene threads with an
encapsulating titanic coating
MS041 TiCOVER Titanized polypropylene composite. TiCOVER light
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
MS042 TiCOVER Titanized polypropylene composite. TiCOVER strong
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
MS043 TiPLUG/TiPATCH System Titanized polypropylene composite. TiPLUG
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
MS044 TiPLUG/TiPATCH System Titanized polypropylene composite. TiPATCH
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
PART A - Prostheses List by Category, Groups and Sponsor Page 90 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
MS045 TiPLUG/TiPATCH System Titanized polypropylene composite. TiPLUG + TiPATCH
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
MS046 TiLIFT Titanized polypropylene composite. One size
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
MS047 TiGUARD Titanized polypropylene composite. TiGUARD light 20 x 15cm
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
MS048 TiGUARD Titanized polypropylene composite. TiGUARD light 30 x 30cm
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
MS049 TiGUARD Titanized polypropylene composite. TiGUARD strong 20 x 15cm
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
MS050 TiGUARD Titanized polypropylene composite. TiGUARD strong 30 x 30cm
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
Mesh, Polyglycolic Acid
Johnson & Johnson Medical Pty Ltd
JJ019 Vypro Mesh Vicryl/Prolene Composite Mesh Medium - 15cm x 15cm
JJ020 Vicryl Mesh 1 sheet/box Large - 30cm x 30cm
JJ173 VICRYL Mesh Polyglactin 910 - synthetic absorbable 15cm x 15cm
Sherwood Davis & Geck T/A Tyco Healthcare Pty Ltd
SG002 Dexon Mesh Danbury 7979-00 Beige polyglycolic acid absorbable 18 x 23cm
surgical mesh fabric
PART A - Prostheses List by Category, Groups and Sponsor Page 91 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
Mesh, Polymeric
Atrium Australia-Pacific Rim Pty Ltd
AC005 Atrium polypropolene mesh - surgical Polypropolene 7.5 x 15cm
AC006 Atrium polypropolene mesh - surgical Polypropolene 30 x 30cm
AC007 Atrium polypropolene mesh - surgical Polypropolene 15 x 15cm
AC008 Atrium polypropolene mesh - surgical Polypropolene 26 x 36cm
AC009 Atrium polypropolene mesh - surgical Polypropolene - Pre-shaped with hole 6.5 x 12.5cm
AC010 Atrium polypropolene mesh - surgical Polypropolene 5 x 10cm
AC011 Atrium polypropolene mesh - surgical Polypropolene mesh plug Small, Medium, Large and Extra Large
Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd
AS055 Mesh Polyproplene; Monofilament Multifilament Polypropylene; 7.6cm x 12.7cm Surgipro* mesh (3 x 5 * Trademark of United
Polyproplylene. Monofilament Polypropylene. States Surgical
Corporation
AS056 Mesh Polyproplene; Monofilament Multifilament Polypropylene; 35.6cm x 22.9cm Surgipro* mesh (14 x * Trademark of United
Polyproplylene. Monofilament Polypropylene. 9 inch). States Surgical
Corporation
AS057 Mesh Polyproplene; Monofilament Multifilament Polypropylene; 2.5cm x 10.2cm Surgipro* mesh (1 x 4 * Trademark of United
Polyproplylene. Monofilament Polypropylene. States Surgical
Corporation
AS058 Mesh Polyproplene; Monofilament Multifilament Polypropylene; 15.3cm x 15.3cm Surgipro* mesh (6 x 6 * Trademark of United
Polyproplylene; SURGIPRO* Non Monofilament Polypropylene; inch); SPMM46: 10.2cm x 15.3cm (4 x 6 States Surgical
Absorbable Monofilament Polypropylene SURGIPRO, Non-Asborbable inch). Corporation
Mesh.
AS068 Surgipro Non Absorbable Polypropylene Polypropylene Medium and Large
Hernia Mate Plug System
B Braun Australia Pty Ltd
BB177 Premilene Mesh Premilene Nonabsorbable Polypropylene 2.5x10cm, 5 pieces
Surgical Suture Material Low Profile.
BB178 Premilene Mesh Premilene Nonabsorbable Polypropylene 5x10cm, 5 pieces
Surgical Suture Material Low Profile.
BB179 Premilene Mesh Premilene Nonabsorbable Polypropylene 7.5x15cm, 5 pieces
Surgical Suture Material Low Profile.
PART A - Prostheses List by Category, Groups and Sponsor Page 92 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
BB180 Premilene Mesh Premilene Nonabsorbable Polypropylene 10x15cm, 5 pieces
Surgical Suture Material Low Profile.
BB181 Premilene Mesh Premilene Nonabsorbable Polypropylene 5x30cm, 5 pieces
Surgical Suture Material Low Profile.
BB182 Premilene Mesh Premilene Nonabsorbable Polypropylene 26x36cm, 5 pieces
Surgical Suture Material Low Profile.
BB183 Premilene Mesh Premilene Nonabsorbable Polypropylene 7.5x7.5cm, 5 pieces
Surgical Suture Material Low Profile.
BB184 Premilene Mesh Premilene Nonabsorbable Polypropylene 15x15cm, 5 pieces
Surgical Suture Material Low Profile.
BB185 Premilene Mesh Premilene Nonabsorbable Polypropylene 30x30cm, 5 pieces
Surgical Suture Material Low Profile.
BB186 Premilene Mesh Premilene Nonabsorbable Polypropylene 4.5x9.5cm, 5 pieces
Surgical Suture Material Low Profile.
BB187 Premilene Mesh Premilene Nonabsorbable Polypropylene 6x12.5cm, 5 pieces
Surgical Suture Material Low Profile.
BB188 Premilene Mesh Premilene Nonabsorbable Polypropylene 4.5x10cm, 5 pieces
Surgical Suture Material Low Profile.
BB189 Premilene Mesh Premilene Nonabsorbable Polypropylene 6x13.5cm, 5 pieces
Surgical Suture Material Low Profile.
BB190 Premilene Mesh Premilene Nonabsorbable Polypropylene 4.5x10cm, 5 pieces
Surgical Suture Material Low Profile.
BB191 Premilene Mesh Premilene Nonabsorbable Polypropylene 6x13.5cm, 5 pieces
Surgical Suture Material Low Profile.
BB192 Premilene Mesh Premilene Nonabsorbable Polypropylene Self-Forming Plug-Small, 5 pieces
Surgical Suture Material Low Profile.
BB193 Premilene Mesh Premilene Nonabsorbable Polypropylene Self-Forming Plug-Medium, 5 pieces
Surgical Suture Material Low Profile.
BB194 Premilene Mesh Premilene Nonabsorbable Polypropylene Self-Forming Plug-Large, 5 pieces
Surgical Suture Material Low Profile.
BB195 Premilene Mesh Premilene Nonabsorbable Polypropylene Self-Forming Plug-X-Large, 5 pieces
Surgical Suture Material Low Profile.
Bard Australia Pty Ltd
BA061 Bard Mesh PerFix Plug Small, Medium, Large
BA062 Bard Mesh Visilex Laparoscopic mesh 3 x 6" & 4.5 x 6"
PART A - Prostheses List by Category, Groups and Sponsor Page 93 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
BA063 Bard Mesh Composix Ventral mesh 10"x14"
BA064 Bard Mesh Composix Ventral mesh 12"x12"
BA065 Bard Mesh Composix Ventral mesh 2" x 4"
BA066 Bard Mesh Composix Ventral mesh 3" x 6"
BA067 Bard Mesh Composix Ventral mesh 4" x 8"
BA068 Bard Mesh Composix Ventral mesh 6" x 8"
BA069 Bard Mesh Composix Ventral mesh 8" x 10"
BA070 Bard Mesh Flat mesh Small - 1" x 4" / 2" x 4" / 2" x 12" / 3 " x
6" / Pre-shaped 1.8" x 4" / Pre-shaped
BA071 Bard Mesh 3D Mesh Large Left
BA072 Bard Mesh 3D Mesh Medium Left
BA073 Bard Mesh 3D Mesh Large Right
BA074 Bard Mesh 3D Mesh Medium Right
BA083 Bard Mesh Kugel Patch Small Oval 8 x 12cm
BA084 Bard Mesh Kugel Patch Large Oval 14 x 18cm
BA085 Bard Mesh Kugel Patch Small Circle 8 x 8cm
BA086 Bard Mesh Kugel Patch Large Circle 12 x 12cm
BA087 Bard Mesh Kugel Patch Medium Oval 11 x 14cm
BA096 Bard Composix Kugel Hernia Patch Small Oval w/e PTFE 8 x 12 cms
BA097 Bard Composix Kugel Hernia Patch Medium Oval w/e PTFE 11 x 14 cms
BA098 Bard Composix Kugel Hernia Patch Large Oval w/e PTFE 14 x 18 cms
BA099 Bard Composix Kugel Hernia Patch Small Circle w/e PTFE 8 x 8cms
BA100 Bard Composix Kugel Hernia Patch Large Circle w/e PTFE 12 x 12cms
BA101 Bard Composix E/X Mesh Elliptical 4" x 6" (10 x 15cm)
BA102 Bard Composix E/X Mesh Elliptical 6" x 8" (15 x 20cm)
BA103 Bard Composix E/X Mesh Elliptical 7" x 9" (18 x 23cm)
BA104 Bard Composix E/X Mesh Elliptical 8" x 10" (20 x 25 cm)
BA105 Bard Composix E/X Mesh Elliptical 10" x 13" (25 x 33 cm)
PART A - Prostheses List by Category, Groups and Sponsor Page 94 of 666
GENERAL/MISCELLANEOUS Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Level Level Notation
BA106 Bard Composix E/X Mesh Rectangle 10" x 14" (25 x 36 cm)
BA107 Bard Dulex Mesh Oval Shaped 7.5 x 10 cm, 1mm thickness
BA108 Bard Dulex Mesh Oval Shaped 8 x 12cm, 1mm thickness
BA109 Bard Dulex Mesh Oval Shaped 10 x 15 cm, 1mm thickness
BA110 Bard Dulex Mesh Oval Shaped 15 x 19 cm, 1mm thickness
BA111 Bard Dulex Mesh Oval Shaped 18 x 24 cm, 1mm thickness
BA112 Bard Dulex Mesh Oval Shaped 20 x 30cm, 1mm thickness
BA113 Bard Dulex Mesh Oval Shaped 26 x 34 cm, 1mm thickness
BA114 Bard Dulex Mesh Oval Shaped 10 x 15 cm, 2 mm thickness
BA115 Bard Dulex Mesh Oval Shaped 15 x 19 cm, 2 mm thickness
BA116 Bard Dulex Mesh Oval Shaped 18 x 24 cm, 2 mm thickness
BA117 Bard Dulex Mesh Oval Shaped 20 x 30 cm, 2 mm thickness
BA118 Bard Dulex Mesh Oval Shaped 26 x 34 cm, 2 mm thickness
BA127 Composix Kugel Hernia Patch Extra large oval - w/e PTFE 20cm X 25cm
BA128 Composix Kugel Hernia Patch Extra large oval - w/ePTFE 25cm X 33cm
BA131 Bard Composix Kugel Hernia Patch The Bard Composix Kugel Hernia Patch is Extra Large Oval w/e PTFE 18cm x
a self-expanding, non-absorbable, sterile
prosthesis. Two layers of monofilament,
polypropylene mesh are stitched to an
ePTFE sheet; an extruded monofilament
PET polymer "ring" provides memory,
adds stability to the device.
BA132 Bard Modified Kugel Hernia Patch The Bard Modified Kugel Hernia Patch is 7.5 cm (3") diameter
a self-expanding, non-absorbable, sterile
prosthesis. It consists of two layers of
monofilament, polypropylene mesh; an
extruded monofilament PET polymer
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0
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