National Health Act 1953 Determination under Schedule 1, paragraph (bj) (HIB 12/2005) (Cth)
Australian Government
NATIONAL HEALTH ACT 1953
Determination under Schedule 1, paragraph (bj)
(HIB 12/2005)
I, LINDA ADDISON, Assistant Secretary, Private Health Insurance Branch, delegate of the Minister for Health and Ageing, pursuant to Schedule 1, paragraph (bj) of the National Health Act 1953 (the Act):
AMEND, with effect from 14 September 2005, the Determination made under Schedule 1, paragraph (bj) of the Act dated 24 June 2005 (HIB 11/2005) by OMITTING Schedule 5 of that Determination and SUBSTITUTING the attached Schedule 5.
Dated this 18 day of August 2005.
L Addison
Linda Addison
Assistant Secretary
Private Health Insurance Branch
Acute Care Division
Australian Government Department of Health and Ageing
Position No: 01202874
Delegate of the Minister for Health and Ageing
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
5.3Subject 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.
5.4Where 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.
5.5Where 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.
5.6If 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.
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Human tissues
5.7The level of benefit payable in respect of a human tissue supplied by a particular facility is the amount specified in the “Benefit” 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.
PART A - Prostheses August 2005
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Annuloplasty Rings
Edwards Lifesciences Pty Ltd
EL028 Baxter Sterile Grafts, Implants & Prostheses, Non- Carpentier-Edwards Classic Annuloplasty Ring. 24mm-40mm
Animal Origin Annuloplasty: Ring-Mitral Ring with Composition: Titanium Alloy; Silicone Rubber;
Holder; Mitral Cosgrove-Edwards Annuloplasty Polyester Fabric Carpentier-Edwards Physio
System Model 4600; Classic Annuloplasty Ring- Annuloplasty 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; Polyester Fabric
EL049 Edwards Etlogix Annuloplasty Ring Titanium/silicon/dacron polyester cloth/plastic 24mm/26mm/28mm/30mm/32mm/34mmd
template Mitral valve annular repair device designed
specifically for patients with Ischemic Mitral
EL050 Edwards MC3 Tricuspid Annuloplasty System Annuloplasty Ring, titanium/silicone/polyester 26mm to 36mm in 2mm increment
velour cloth/plastic template
Medtronic Australasia Pty Ltd
MC005 Medtronic Posterior Annuloplasty Band; Medtronic Annuloplasty Devices - Models 610B, 610R & Models 610B & 610R 25-35mm, Models
Duran Annuloplasty Ring; Colvin - Galloway 620B, 620R Silicone / Barium Sulphate, Dacron. 620B & 620R 23-35mm, Model 638B - 26-
Future Band Model 638B; Duran Ancore Band Models 638B semi-rigid metal alloy core, silicone 38mm, Model 620RG & G20BG 23 -35mm.
620B; Duran Ancore Ring 620R; Duran Ancore coating, polyester knit fabric, kit includes - band,
Chordal Model 620RG & 620BG malleable handle, template with suture markers,
sizers, molded tray; Model 620RG & G20BG
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
Prostheses List by Category, Groups and Sponsor Page 1 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size 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
Medical & Optical Instruments Australia Pty Ltd
MO212 Martin Fixation Device Internal - Screw Sterile Titanium Screw 2.00mm diameter; 4 to 11mm length Only to be funded
where used in a service
for which a Medicare
Benefit is payable
Drug Eluting Stents
Boston Scientific Pty Ltd
BS074 Taxus on Express2 Coronary Stent System Models balloon expandable stent with conformal Length 8 - 32mm; Diameter 2.25 - 5.0mm
38001-0822 to 0840; 38001-1222 to 1250; 38001- polymer/drug matrix coating, pre-mounted on high
1622 to 1650; pressure monorail delivery catheter
38001-2022 to 2050; 38001-2422 to 2450; 38001-
2827 to 2850; 38001-3227 to
3250
Johnson & Johnson Medical Pty Ltd
JJ302 CYPHER Sirolimus-Eluting Stent & Delivery Stainless steel coronary stent with Rapamycin (an Diameter 2.25 - 5.0mm, length 8-33mm
System Model CRS - 23300, 08225, 08250, immunosuppressive and antiproliferative drug)
08275, 08300, 28225, 28250, 28275, 28300, bound to the stent struts
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,
Prostheses List by Category, Groups and Sponsor Page 2 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
General Purpose Bare Metal Stents
Abbott Australasia Pty Ltd
AY006 Bio-Divysio Stent SV/OC/AS Balloon expandable Phosophoryl-Choline coated Divysio Stent SV - Diameters: 2.0, 2.25, 2.5
stainless-steel endovascular coronary stent Lengths: 7mm, 10mm, 15mm, 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
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 cut 2.5 x 8mm; 3.0 x 8mm; 3.5 x 8mm; 4.0 x
slotted tube. Product includes: Coronary stent 8mm; 2.5 x 13mm; 3.0 x 13mm; 3.5 x
mounted on delivery balloon catheter. 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; Laser cut Dia 2.5-4.0mm, length 8-25mm
slotted tube, coated with Polyzene-F; includes
Coronary Stent mounted on delivery balloon
BB173 Coroflex Delta Coronary Stent System Electropolished Stainless Steel 316L; Laser cut Dia 2.5-4.0mm, length 8-25mm
slotted tube, includes Coronary Stent mounted on
delivery balloon catheter.
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 - 30mm
BT065 Lekton Motion Mega Amorphous silicon carbide coated Diameter 4.5 and 5 mm; Length 13 - 40 mm
BT069 Lekton Motion Petite Amorphous silicon carbide coated Diameter 2, 2.25, 2.5mm; Length 8-20mm
Boston Scientific Pty Ltd
BS069 Express 2/Liberte Coronary Stent System, Consists of a balloon expandable stent, pre- Stent lengths: 8,12,16,20,24,28 & 32 mm
mounted on a Maverick 2 Monorail delivery Stent diameters: 2.25, 2.5, 2.75, 3.0, 3.5, 4.0,
4.5 & 5.0 mm
Prostheses List by Category, Groups and Sponsor Page 3 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size 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; SRX1-4030L 4.0 x 28.2mm
Guidant Australia Pty Ltd
GU102 Stents ACS Multilink Coronary Stent; ACS Megalink 1.5mm - 8.0mm
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 mm
JJ239 BX Sonic Stainless steel coronary stent mounted on a balloon Dia 2.25 - 4.0mm, lengths 8 - 33mm
delivery system
Medical Vision Australia Pty Ltd
MF004 Vivant Z Stent Coronary stent made of alloyed medical grade Dia 2.5 - 4.0mm, length 9 - 28mm
stainless steel
Medtel Australia Pty Ltd
ME050 Antares Coronary Stent System Stent Length: 8mm - 32mm Diameter: 2.5mm -
Prostheses List by Category, Groups and Sponsor Page 4 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size 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
Balloon 2.5mm, 3.0mm, 3.5mm, 4.0mm
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, S670 Stainless Steel S660 Coronary Stent - Diameter (2.5mm-
Coronary Stents, S7 Coronary Stents, BeStent2, 2.75mm), Length (9mm-24mm); S670 & S7
Coronary Stent - Diameter (3mm-4mm),
Length (9mm-30mm); BeStent2 - Diameter
(2.5mm-4mm), Length (9mm-30mm);
MC329 Medtronic Driver, Micro Driver Coronary Stent Cobalt Alloy Driver Stent: diameter (2.25 - 4.5mm), length
(8-30mm); Micro-Driver Stent: diameter
(2.25 - 2.75mm), length (8 - 24mm)
Neich Medical Pty Ltd
NM002 Constant Rx Coronary Stent System Stainless Steel Balloon Expandable Tubular Stent Lengths - 9-32mm; Diameters - 2.5 - 4.0mm
NM003 R Stent Evolution Z Coronary Delivery System 316LVM Stainless Steel Balloon Expandable Stent Lengths - 9-33mm; Diameters - 2.5-4.0mm
(Tubular)
Pacing Importers Pty Ltd
PI003 Med-X-Flexy Stent Tubular Stent, Stainless steel 316L, Gold markers Dia 5 - 9mm length: 20 - 100mm
Terumo Corporation Australia
TU001 Intra Coronary Stent Stainless Steel mounted on balloon catheter 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 Diameter
Premounted on Rail Design Catheter 2.5, 2.75, 3.0, 3.5, 4.0mm
Zynergy Medical Pty Limited
ZY001 Carbostent Coronary stent - includes Carbostent Syncro & Dia 2.5mm x Length 9, 12, 15, 19, 25mm;
Carbostent Sirius 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,
Prostheses List by Category, Groups and Sponsor Page 5 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Special Purpose Stents
Abbott Australasia Pty Ltd
AY012 JoStent Coronary Stent Graft Stainless Steel/PTFE 9 - 26 mm x 2.5 - 5 mm
Boston Scientific Pty Ltd
BS067 Symbiot Covered Stent System A self-expending nitinol stent encased within an Stent lengths: 20, 31 & 45 mm Stent
ePTFE covering, premounted on a Monorail diameters: 4.0 & 5.0 mm
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 H120, Model Implantable cardiac pacemaker 45x54x8.5mm, 14cc, 26gm
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
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 H140, Model Implantable Cardiac pacemaker 45x54x8.5mm, 14cc, 26gm
H145
Medtronic Australasia Pty Ltd
MC226 Medtronic Insync III Triple Chamber Pacemaker Titanium One size only
Model 8042
St. Jude Medical Australia Pty Ltd
SJ072 Frontier II - Model 5596 Biventricular Cardiac Resynchronisation Device 49mm(h) x 52(1) x 6(t), 25g
with AF suppression algorithm - Titanum
Prostheses List by Category, Groups and Sponsor Page 6 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Dual Chamber ICDs
Generation 2
Medtronic Australasia Pty Ltd
MC202 Medtronic Gem III DR Model 7275 Implantable Titanium One size only, 39.5cc
Cardioverter Defibrillator
Progressive Medical
PG004 Alto II DR Dual Chamber Implantable Cardioverter One size only
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 pacing. One size only.
Guidant Australia Pty Ltd
GU111 Ventak Prizm II DR Model 1861, titanium, dual chamber, adaptive rate One size only
GU132 Vitality DR Model 1871 This device acts to defibrillate the heart chambers Model 1871 Vitality DR Dual Chamber Rate
when the patient enters into an arrhythmia or uses Responsive Pacemaker/Defibrillator
shocks or anti tachy pacing to revert Ventricular
Tachycardia (VT) or Ventricular Fibrillation (VF).
While also acting as a dual chamber pacemaker.
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 Cardioverter Titanium 36cc
Defibrillator
MC318 Maximo DR Model 7278 Titanium One size only 38.9cc
MC358 Intrinsic Model 7287, Implantable Cardioverter Defibrillator 36cc, 75g
MC363 EnTrust Model D153DRG, Dual chamber, VT Therapies, 30J 33cc, 63g
33cc, 63g
Prostheses List by Category, Groups and Sponsor Page 7 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
St. Jude Medical Australia Pty Ltd
SJ049 Epic Plus DR Model V-236 Implantable Dual Chamber sensing, bradycardia pacing with 33cc
Cardioverter Defibrillator atrial fibrillation suppression
SJ070 Epic + DR Model V-233 ICD Dual Chamber Implantable Cardio-verter 33cc 70g
SJ071 Epic + DR Model V-239 ICD Dual chamber implantable cardio-verter defibrillator 33cc 70g
Dual Chamber ICDs with CRT
Generation 1
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 chambers One Size Only
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 chamber
GU147 Contak Renewal 4 CRT-D Model H190, Model H195 Implantable dual-chamber defibrillator One size only
Medtronic Australasia Pty Ltd
MC306 InSync III Marquis Model 7279 Titanium One size only - Volume 38cc
MC325 InSync Sentry Model 7298 Defibrillator, Titanium 40cc
St. Jude Medical Australia Pty Ltd
SJ062 Epic HF Model V-339 Implantable Cardiac Cardioverter/defibrillator with dual chamber (atrial One size only
and RV) sensing and bradycardia pacing with
ventricular resynchronisation
SJ067 Epic + HF Model V-350 ICD Epic + HF V-350 ICD is a cardioverter defibrillator 36cc / 73g
with dual chamber (atrial and RV) sensing and
bradycardia pacing with ventricular
Prostheses List by Category, Groups and Sponsor Page 8 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Dual Chamber Pacemakers
Generation 1
Biotronik Australia Pty Ltd
BT026 Philos D Model 122447 Implantable Pacemaker Multiprogrammable, ventricula, rate responsive One size only
modes, DDDC
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
MC243 Medtronic Kappa KVDD 900 Model KVDD 901 Cardiac Pacemaker, Titanium 11.1cc
MC319 EnPulse VDD; Model E2VDD01 EnPulse VDD pacemaker with IS1 connector. One size only
Titanium silicone
MC320 EnPulse D Series: Model E2D01, Model E2D03 EnPulse DDD-Pacemakers - with IS1 connector; One size only
with 3.2mm low profile connector. Titanium and
St. Jude Medical Australia Pty Ltd
SJ050 Verity ADx Model XL DC 5256 Dual - Chamber Dual Chamber multi-programmable rate-adaptive 11cc, 23.5g
pacemaker pacing devices with extended longevity
SJ061 Identity Adx Model XL DC 5286 Dual Chamber Identity ADx Model XL DC Model 5286 is an 11cc, 23.5g
Pacemaker implantable, multi-programmable rate-adaptive
pacing device with AF suppression
Generation 2
Biotronik Australia Pty Ltd
BT027 Philos SLR Model 122456 Implantable Pacemaker Single pass, multiprogrammable, rate responsive, One size only
St. Jude Medical Australia Pty Ltd
SJ054 Identity ADx Model VDR 5480 implantable Single Chamber multi-programmable rate-adaptive 8cc, 18g
pacing device with extended longevity
SJ057 Verity ADx Model XL VDR 5456 implantable Single Chamber multi-programmable rate-adaptive 11cc, 23.5g
pacemaker pacing device with extended longevity
Prostheses List by Category, Groups and Sponsor Page 9 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Generation 3
Biotronik Australia Pty Ltd
BT024 Philos DR Model 122450 Implantable Pacemaker Multiprogrammable, rate responsive, DDDR One size only
BT029 Philos DR-A Model 122600 Implantable Pacemaker Multiprogrammable, rate responsive, DDDR 5mm ports, One size only
BT047 Protos DR/CLS Dual chamber, rate responsive, closed loop system. One size only.
BT060 Philos II DR Multiprogrammable, rate responsive, DDDR One size only
Guidant Australia Pty Ltd
GU045 Pulsar Max II Pacemaker DDDR Model 1280
GU120 Insignia Plus DR Model 1297, Insignia Plus DR Dual Chamber Rate Responsive Permanent One size only
Model 1298
GU121 Insignia Entra DR Models 1294,1295,1296 Dual Chamber Rate Responsive Permanent One size only
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
MC230 Vitatron Selection Model 9000 Pacemaker Titanium, polyurethane One size only
MC289 Vitatron C60 DR Pacemaker Titanium, polyurethane one size only
MC333 Medtronic Kappa Pacemaker Model KDR 901, Cardiac Pacemaker, Titanium 12.1cc, 11.1cc, 13.1cc
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 Pacemaker, Dual chamber, rate responsive pacemaker Volume 11cc, weight 23.5gm
Cardiac, Implantable
SJ028 Integrity Micro DR 5336 Pacemaker Dual Chamber Rate Responsive Pacemaker Volume 8cc, Weight 18gm
SJ031 Identity XL DR 5376 Dual Chamber Rate Responsive Pacemaker Volume 11cc, Weight 23.5gm
SJ032 Identity DR 5370 Dual Chamber Rate Responsive Pacemaker Volume 8cc, Weight 18gm
SJ051 Verity Adx Implantable Pacemaker, Models XL DR Dual - Chamber, multi-programmable, rate- 45x52x6mm,11cc, 23g, 5mm or 6mm M/S
5356 and XL DR 5357M/S responsive pacemaker withAF suppression
Prostheses List by Category, Groups and Sponsor Page 10 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
SJ056 Integrity ADx Model DR 5360 and XL DR 5366 Dual-Chamber, multi-programmable, rate- Model DR 5360 - 8cc, 18g, Model XL DR
responsive pacemaker with AF suppression 5366 - 11cc, 23.5g
SJ059 Identity ADx Models DR 5380 and XL DR 5386 Dual-Chamber, multi-programmable, rate-adaptive ADx DR 5380: 43x44x6mm, 18g and 8cc
pacing devices with AF suppression ADx XL DR 5386: 44x52x6mm, 23.5g and
Generation 4
Medtronic Australasia Pty Ltd
MC322 EnPulse DR Series: Model E2DR01, Model EnPulse DDDR Pacemakers - with IS1 connector one size only
E2DR03, Model E2DR06, Model E2DR21, Model and normal battery size; with 3.2mm low profile
E2DR31, Model E2DR33 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
Embolization Prostheses, Intravascular
William A Cook Aust Pty Ltd
WC076 Flipper-Patient Ducts Arteriosus-Occluding System Detachable Coil for PDA Closure Coil Diameter 3,5,6.5 & 8 mm Number of
Loops (3,4,5)
Filters, Vena Cava
B Braun Australia Pty Ltd
BB105 Celsa Vena Cava Filter System Phynox/ combination of various metals inc. One size, expands to Max length 38mm/Max
Nickel,Copper, Molubden,Steel diameter 30mm
BB106 Celsa Temporary Vena Cava System Phynox/ combination of various metals inc. One size, expands to Max length 38mm/Max
Nickel,Copper, Molubden,Steel diameter 30mm
Grafts
Woodstock Biomedical Pty Ltd
WO033 Endofit Endoluminal Stent Graft Tapered Thoracic Endoluminal Stent Graft with Max Dia. 42mm, Min Dia. 14mm, Length 12-
external fixation 26cm
Prostheses List by Category, Groups and Sponsor Page 11 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
WO034 Endofit Endoluminal Stent Graft Occluder Endoluminal Stent Graft Max Dia. 42mm, Min Dia. 14mm, Length 2
or 3.5cm
WO035 Endofit Endoluminal Stent Graft Extender Endoluminal Stent Graft, abdominal and Max Dia. 42mm, Min Dia. 14mm, Length 4-
thoracic, Preloaded
WO036 Endofit Endoluminal Stent Graft Extender Endoluminal Stent Graft, abdominal and Max Dia. 42mm, Min Dia. 14mm, Length 4-
thoracic, Cartridge
WO037 Endofit Endoluminal Stent Graft Endoluiminal Cuff Stent Graft with external Max Dia. 42mm, Min Dia. 24mm, Length 5
fixation, abdominal and thoracic, Cartridge or 7cm
WO038 Endofit Endoluminal Stent Graft Endoluminal Cuff Stent Graft with external fixation, Max Dia. 42mm, Min Dia. 24mm, Length 5
abdominal and thoracic, Preloaded or 7cm
WO039 Endofit Endoluminal Stent Graft Aortomonoiliac Endoluminal Stent Graft with Max Proximal Dia. 38mm, Min Distal Dia.
external fixation 14mm, Length 14 - 26cm
WO040 Jotec Flowline Bipore Vascular Graft Thin Wall with Spiral Reinforcement 40 & 50cm
WO041 Jotec Flowline Bipore Vascular Graft Thin Wall 40 & 50cm
WO042 Jotec Flowline Bipore Vascular Graft Standard Wall with Spiral Reinforcement 70 & 80cm
WO043 Jotec Flowline Bipore Vascular Graft Standard Wall 80cm
WO044 Jotec Flow Weave Vascular Graft Flow Weave 30cm
WO045 Jotec Flow Weave Vascular Graft Flow Weave 60cm
WO046 Jotec Flow Weave Vascular Graft Flow Weave BioSeal 15cm
WO047 Jotec Flow Weave Vascular Graft Flow Weave BioSeal 30cm
WO048 Jotec Flow Weave Vascular Graft Flow Weave BioSeal 60cm
Grafts, Dura, Biological
Edwards Lifesciences Pty Ltd
EL033 Baxter Augmentation / Substitution Material, Human Edwards Pericardial Patch. Bovine Pericardium. 10cm x 16cm
or Animal Origin, Sterile Pericardial Patch.
Grafts, Vascular, Synthetic
Bard Australia Pty Ltd
BA089 Impra PTFE Vascular Grafts ePTFE Cardiovascular Patch 0.4mm Oval 20 x 90mm
Prostheses List by Category, Groups and Sponsor Page 12 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
BA090 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, Circular 100 x 150mm
BA091 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, Rectangular 50 x 75mm
BA092 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, Rectangular 50 x 150mm
BA093 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, Rectangular, 30 x 30mm, 10 x 90mm, 30 x 60mm
Patch 0.4 Oval, Rectangular
BA095 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, Rectangular 25 x 150mm
Woodstock Biomedical Pty Ltd
WO049 Jotec Flowline Bipore Heparin ePTFE Vascular ePTFE Vascular Graft with microporous structure. All sizes up to 50cm in length
Graft Straight, Standard Wall Standard Wall with Heparin
WO050 Jotec Flowline Bipore Heparin ePTFE Vascular ePTFE Vascular Graft with microporous structure. All sizes at over 50cm in length
Graft Straight, Standard Wall Standard Wall with Heparin
WO051 Jotec Flowline Bipore Heparin ePTFE Vascular ePTFE Vascular Graft with microporous structure. All sizes up to 50cm Length
Graft Straight, Standard Wall with Reinforcement Standard Wall with Heparin and Reinforcement
WO052 Jotec Flowline Bipore Heparin ePTFE Vascular ePTFE Vascular Graft with microporous structure. All sizes at over 50cm in Length
Graft Straight, Standard Wall with Reinforcement Standard Wall with Heparin and Reinforcement
WO053 Jotec Flowline Bipore ePTFE Vascular Graft, ePTFE Vascular Graft with microporous structure. All sizes up to 50cm in Length
Straight, Thin Wall Thin Wall
WO054 Jotec Flowline Bipore ePTFE Vascular Graft, ePTFE Vascular Graft with microporous structure. All sizes at over 50cm in length
Straight, Thin Wall Thin Wall
WO055 Jotec Flow Nit Bioseal Polyester Vascular Grafts, Flow Nit Bioseal Straight grafts are texturised For all diameters in 30cm lengths
Straight Grafts exterior yarns for superior tissue incorporation and
healing characteristics, with the new Bioseal
impregnation to make the grafts blood tight.
WO056 Jotec Flow Nit Bioseal Polyester Vascular Grafts, Flow Nit Bioseal Straight grafts are texturised For all diameters in 15cm lengths
Straight Grafts exterior yarns for superior tissue incorporation and
healing characteristics, with the new Bioseal
impregnation to make the grafts blood tight.
WO057 Jotec Flow Nit Bioseal Polyester Vascular Grafts, Flow Nit Bioseal Straight grafts are texturised For all diameters in 60 and 100cm lengths
Straight Grafts exterior yarns for superior tissue incorporation and
healing characteristics, with the new Bioseal
impregnation to make the grafts blood tight.
WO058 Jotec Flowline Bipore ePTFE Vascular Graft, ePTFE Vascular Graft with microporous structure, All sizes up to 50cm in Length
Straight, Standard Wall With Reinforcement Straight, Standard Wall with Reinforcement
WO059 Jotec Flowline Bipore ePTFE Vascular Graft, ePTFE Vascular Graft with microporous structure, All sizes at over 50cm in Length
Straight, Standard Wall With Reinforcement Straight, Standard Wall with Reinforcement
Prostheses List by Category, Groups and Sponsor Page 13 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
WO060 Jotec Flowline Bipore ePTFE Vascular Graft, ePTFE Vascular Graft with microporous structure. All sizes up to 50cm in Length
Straight, Thin Wall with Reinforcement Thin Wall with spiral reinforcement
WO061 Jotec Flowline Bipore ePTFE Vascular Graft, ePTFE Vascular Graft with microporous structure. All sizes at over 50cm in Length
Straight, Thin Wall with Reinforcement Thin Wall with spiral reinforcement
WO062 Jotec Flow Nit Bioseal Polyester Vascular Grafts, Flow Nit Bioseal Bifurcated grafts are texturised 45 cm length, 12x6mm, 14x7mm, 16x8mm,
Bifurcated Grafts exterior yarns for superior tissue incorporation and 18x9mm, 20x10mm, 22x11mm, 24x12mm
healing characteristics, with the new Bioseal
impregnation to make the grafts blood tight
ICD Leads
Group 1 - Coronary Sinus Leads
Guidant Australia Pty Ltd
GU135 Perimeter CS Defibrillation Lead - Model 0202, The Perimeter CS Lead is a flexible coil lead Model 0202 - 59cm; Model 0203 - 64cm;
Model 0203 & Model 0204 designed to be placed in the coronary sinus and Model 0204 - 80cm
connected to an implantable defibrillator and
delivers energy to the atrium.
Medtronic Australasia Pty Ltd
MC373 Medtronic Transvene SVC Lead Model 6937; Model 6937-35, Model 6937-52, Model 6937-58, 35 - 110cm x 660mm
Model 6937-110; Silicone;
Group 2 - Subcutaneous Leads
Medtronic Australasia Pty Ltd
MC026 Medtronic Transvene SVC Lead Model 6937; Model 6937-35, Model 6937-52, Model 6937-58, 35 - 110cm x 660mm
Model 6937-110; Silicone;
Group 3 - Transvenous/Non steroid/Active Leads
Biotronik Australia Pty Ltd
BT048 Kentrox RV-S ICD lead, right ventricle, screw-in. One size only.
BT049 Kentrox SL-S ICD Lead, Singel lead, Screw-in. Tip to second shock coil 16 cms or 18 cms.
Group 4 - Transvenous/Non steroid/Passive Leads
Biotronik Australia Pty Ltd
BT014 Kainox RV 75 Implantable Defibrillator endocardial shock lead 75 cms 100,18 cms 100,16 cms 100,13 cms
with sensing and pacing. SL 100/18, SL 100/16, SL 75,18 cms
Prostheses List by Category, Groups and Sponsor Page 14 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
BT050 KAINOX A+ ICD Lead, Single Pass. Atrial ring spacing 15, 17cms.
BT051 KENTROX RV ICD Lead, right ventricle. 65 or 75 cms
BT057 Kentrox SL ICD Lead, Single Lead 65, 75 or 100cm length. Tip to second shock
coil 16cm or 18cm.
Group 5 - Transvenous/Steroid/Passive Leads
Guidant Australia Pty Ltd
GU112 Endotak Reliance S Lead Model 0127 & Model 0128, defibrillation lead, 9fr 59cm, 64cm
introducer (silicone coated), steroid eluting, high
impedence
GU115 Endotak Reliance Lead Model 0147, Model 0148 & Model 0149, 59cm, 64cm, 90cm
defibrillation lead, 9fr introducer (silicone coated),
steroid eluting, high impedence
GU158 Endotak Reliance SG Passive Fixation Lead Endotak Reliance SG Passive Fixation Lead: Models 54cm - 90cm
0170, 0171, 0172, and 0173 Implantable
cardioverter defibrillator lead with GORE ™ ePTFE
GU159 Endotak Reliance G Passive Fixation Lead Endotak Reliance G Passive Fixation Lead: Models 54cm -90cm
0174, 0175, 0176 and 0177. Implantable
Cardioverter defibrillator lead with GORE ™ ePTFE
Medtronic Australasia Pty Ltd
MC002 Medtronic Sprint Quattro Lead Model 6944RV/SVC Silicone and polyurethane 65-100cm
65cm; Model 6944RV/SVC 75cm; or Model
6944RV/SVC 100cm; Medtronic Sprint Quattro
Lead Model 6944RV/SVC 58cm
MC018 Medtronic Sprint Lead Model 6942RV/SVC Model 6942-65, Model 6942-75, Model 6942-100; 65 - 100cm
Silicone
MC025 Medtronic Sprint Lead Model 6932RV Model 6932-65, Model 6932-75, Model 6932-100; 65 - 100cm
Silicone
St. Jude Medical Australia Pty Ltd
SJ016 Riata Transvenous Tachyarrhythmia Lead Model Quadripolar, dual-coil, steroid eluting, active One size only
1580, Model 1581, Model 1570, Model 1571 fixation tachyarrhythmia leads
Group 6 - Transvenous/ Steroid/Active Leads
Biotronik Australia Pty Ltd
BT064 Kentrox SL-S steroid Fractal coated steroid electrode, dual shock coil 16 and 18 cms tip to second shock coil
Prostheses List by Category, Groups and Sponsor Page 15 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
BT068 Kentrox RV-S steroid Fractal coated steroid electrode, single shock coil 65cm lengths
Guidant Australia Pty Ltd
GU118 Endotak Endurance EZ Leads Model 0154, Model Defibrillation lead, steroid eluting, trilumen lead 64, 70, 100cm
0155, Model 0156 body contains one conductor for pacing/sensing
and two conductors for defibrillation. The helix is
composed of platinum iridium.
GU145 Endotak Reliance G Lead Model 0164, Model 0165, Implantable defibrillator/pacemaker lead Lead Lengths: 59 - 90cm
Model 0166, Model 0167
GU146 Endotak Reliance SG Lead Model 0160, Model Implantable defibrillator/pacemaker lead Lead Lengths: 59 - 90cm
0161, Model 0162, Model 0163
GU160 Endotak Reliance Active Fixation Lead Endotak Reliance Active Fixation Lead: Models 54cm - 90cm
0157, 0158 and 0159 Implantable cardioverter
GU161 Endotak Reliance S Active Fixation Lead Endotak Reliance S Active Fixation Lead: Models 54cm - 90cm
0137, 0138 and 0139
Medtronic Australasia Pty Ltd
MC208 Medtronic Sprint Quattro Secure Lead Model 6947 Leads, Defibrillator, Implantable, Silicone, 58-100cm
58cm; Model 6947 65cm; Model 6947 75cm; polyurethane, platinized tantalum coils, steroid
Model 6947 100cm
MC331 Medtronic Sprint Lead Model 6943 Model 6943-58, Model 6943-65, Model 6943-75, 58 - 100cm
Model 6943-100; Silicone
MC341 Medtronic Sprint Lead Model 6945 Model 6945-58, Model 6945-65; Silicone, Model 58 - 100cm
6945-75, Model 6945-100; Silicone
St. Jude Medical Australia Pty Ltd
SJ074 Riata Transvenous tachyarrhythmia Leads Model Tri-polar Active - Fixation, Steroid-Eluting, Single 60cm, 65cm, 8F introducer
shock Coil Tachyarrhythmia; Lead
SJ075 Riata Transvenous Tachyarrhythmia Lead Model Quadripolar, dual-coil, steroid eluting, active One size only
1580, Model 1581, Model 1570, Model 1571 fixation tachyarrhythmia leads
Limited Functionality ICDs
Generation 2
Biotronik Australia Pty Ltd
BT052 Cardiac Airbag Single chamber ICD rate responsive pacing. One size only.
Prostheses List by Category, Groups and Sponsor Page 16 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Mesh, Polymeric
W L Gore & Associates
GT128 Helex Septal Occluder ePTFE 15-35mm
Occluders
Medtel Australia Pty Ltd
ME068 Amplatzer PFO Occluder Nitinol Wire Mesh 25mm & 35mm
Occluders, Vascular
Medtel Australia Pty Ltd
ME065 Amplatzer Duct Occluder Nitinol Wire Mesh 5 - 24mm
ME066 Amplatzer Septal Occluder Nitinol Wire Mesh 4mm - 40mm
ME067 Amplatzer Muscular VSD Occluder Nitinol Wire Mesh 4 - 24mm
ME074 Amplatzer Membranous VSD Occluder Nitinol wire mesh, double disc occluder and 4-24mm, Length 7-10mm
delivery system
Pacemaker Lead Adapters, Implantable
Guidant Australia Pty Ltd
GU129 LV-1 Lead Adaptor to IS-1 Connects Left ventricular leads to IS-1 ports in One size only
pacemakers and defibrillators to replace abnormal
cardiac excitation
GU130 Y Adaptor Connects multiple defibrillator electrodes to a One size only
common port, enabling the use of shocks to revert
Ventricular Tachycardia and normal cardiac
Prostheses List by Category, Groups and Sponsor Page 17 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Medtronic Australasia Pty Ltd
MC035 Medtronic lead Extender Kit Model: 6984M, Silicone 14 - 50cm
6981M, 6985M, 5866-24M, 5866-38M, 5866-40M,
6986M, 5866-37M; Bipolar Lead Adaptor Kit
MC036 Medtronic Lead End Cap Kit Model: 5867-3M; Silicone or Polyurethane; Plug to Seal IS-1 10 - 25mm, IS-1 Pin Plug - One Size only
Medtronic Adaptor Kit Line 5866-23; Connector connector in a pacemaker or defibrillator, Silicone
Sleeve 5866-45; Metronic lead sleeve kit model:
5866-46; Medtronic Pinplug kit. Model 6719, IS-1
MC246 DF-I Y-Adaptor/Extender Model 6726 25cm & 37cm Silicone Lengths 25cm, 37cm
Pacemaker leads
Group 1 - Non-transvenous, Bi-Polar, Steroid
Medtronic Australasia Pty Ltd
MC011 Capsure EPI steroid eluting bipolar epicardial lead Silicone 25 - 60cm
Model 4968 - ventricle
Group 11 - Transvenous, Bi-Polar, Passive, Steroid, Left Ventricular
Guidant Australia Pty Ltd
GU138 Easytrak 2, Model 4514,4515, 4516, 4517, 4518, The Easytrak 2 lead is a dual electrode version of
4519, 4520 the Easytrak lead. The Easytrak 2 lead is a
coronary sinus lead, steroid eluting, dual electrode,
pace/sense lead. The lead provides chronic pacing
and sensing of the left ventricle by placement in the
coronary venous vasculature.
GU153 Easytrak 2 Is-1 Lead - Models 4542, 4543 & 4544 Implantable left ventricular lead 80 to 100cm
GU156 Easytrak 3 Lead - Models 4521, 4522, 4523, 4524, Implantable left ventricular pacemaker lead 80 to 100cm
4525, 4526 and 4527
GU162 Easytrak 3 IS-1 Lead Models 4548, 4549 and 4550. Silicone and Sizes 80 to 100cm
polyurethane insulation and polyurethane protective
Group 2 - Non-transvenous, Uni-Polar, Steroid
Medtronic Australasia Pty Ltd
MC053 Capsure EPI steroid eluting unipolar epicardial lead Silicone 25 - 50cm
Model 4965 ventricle
Prostheses List by Category, Groups and Sponsor Page 18 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Group 3 - Non-Transvenous, Uni-Polar, Non-Steroid
Guidant Australia Pty Ltd
GU037 Myocardial Pacing Lead Model 4312 and 4316 54cm and 35cm
Medtronic Australasia Pty Ltd
MC009 Medtronic Epicardial Pacing Leads IS-1 Model Silicone 35 - 53cm
Group 4 - Transvenous, Uni-Polar, Passive, Steroid, Right Ventricular/Atrial
Medtronic Australasia Pty Ltd
MC254 CapSure Sense pacemaker lead Models 4073, 4074 Titanium Nitride CapSure Sense Lead Model 4073 - 30cm to Also grouped in
& 4574 85cm; CapSure Sense Lead Model 4074 - Pacemaker Lead Group 8
30cm to 85cm; CapSure Sense Lead Model
Progressive Medical
PG003 Swift 4040 1CT pacemaker lead length 58 cm - 69 cm
Group 5 - Transvenous, Uni-Polar, Passive, Non- Steroid, Left Ventricular
Biotronik Australia Pty Ltd
BT061 Corox OTW Coronary Sinus Lead for Left Ventricular Pacing 75 or 85cm
Medtronic Australasia Pty Ltd
MC037 Medtronic Attain Cardiac Vein Pacing Lead Model Polyurethane; 4 FR Polyurethane, 5 FR Electrode 58 - 75cm: 85cm/75cm/110cm or 75-110cm;
2187; Medtronic Coronary Sinus Pacing Lead Tip, Kit Includes: Stylet x 3, Valve lifter, Attain 75cm/85cm
Model 2188; Medtronic Attain SD Model 4189; Lead & Anchoring Sleeve; 4 FR Polyurethane
Medtronic Attain Side-Wire Model 4191 Body, 6.1FR Electrode Tip
St. Jude Medical Australia Pty Ltd
SJ033 Aescula LV Model 1055K Left Ventricular Pacing Lead 75cm
Group 6 - Transvenous, Uni-Polar, Passive, Steroid, Left Ventricular
Guidant Australia Pty Ltd
GU056 Easytrak Lead Model 4510, Model 4511, Model 4512 Transvenous 65cm, 72cm, 80cm
Coronary Sinus Lead
GU152 Easytrak IS-1 Lead, Models 4535 to 4538 Implantable left ventricular lead 80 - 90cm
Prostheses List by Category, Groups and Sponsor Page 19 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Medtronic Australasia Pty Ltd
MC225 Attain Over the Wire Model 4193 Titanium, polyurethane 78-88cm
Group 7 - Transvenous, Bi-Polar, Passive, Non-Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT018 Merox Mex 53 JBP Pacemaker Lead High Performance Lead, Model 124884, one only 53cm Atrial
BT019 Merox Mex 60/15 BP Pacemaker Lead High Performance Lead, Model 124962, one only 60cm Ventricular
BT020 Merox Mex 53 JBP and Merox Mex 60/15 BP High Performance Lead, Model 124884 and Model 53cm Atrial and 60cm Ventricular
Pacemaker Leads 124962, (used together)
St. Jude Medical Australia Pty Ltd
SJ013 Transvenous Superior Vena Cava Lead Model TVL lead system models SV01, SV02, SV03 SV01- 100cm; SV02 - 45cm; SV03 - 55cm
SV01, Transvenous Superior Vena Cava Lead transvenous leads
Model SV02, Transvenous Superior Vena Cava
Group 8 - Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT066 Selox ST Transvenous Bipolar Passive Steroid Ventricular 53 and 60cm lengths
Pacing Lead, fractal coated
BT067 Selox JT Fractal coated steroid electrode 45 and 53cm lengths
Guidant Australia Pty Ltd
GU002 Guidant Aust Selute Atrial J Lead Model 4293, Model 4294
GU009 Fineline II Sterox IROX Lead Model 4458, Model 4459 52cm, 58cm
GU011 Fineline II Sterox IROX Lead Model 4456, Model 4457 52cm, 58cm
GU012 Fineline II Sterox IROX Lead Model 4479, Model 4480 45cm, 52cm
GU023 Guidant Aust Selute Picotip Steroid Eluting Bipolar Model 4033, Model 4034, Model 4035, Model 45cm , 52cm, 59cm
4063, Model 4064
GU082 Selute Lead Model 4285 Silicone 45, 52, 59cm
Prostheses List by Category, Groups and Sponsor Page 20 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Medtronic Australasia Pty Ltd
MC010 Medtronic Capsure SP Novus Model 5092; Capsure Silicone Polyurethane 45 -110cm
SP Novus Lead Model 5592; Medtronic Capsure
Model 4023 Lead; Medtronic Capsure Model 4024
Lead (med.dexamethasone) Medtronic Capsure
Model 4523(MED) Medtronic Capsure Model 4524
Lead; Medtronic Capsure Model 5023M Lead;
Medtronic Model 5024M Capsure Lead; Medtronic
Model 5024M Capsure Lead; Medtronic Capsure
Model 5524M SP Bipolar Lead
MC216 Vitatron Excellence PS+Model IMK 49B Pacemaker Leads, Titanium, Polyurethane 52-65cm
MC217 Vitatron Excellence SS+Model IML 49B Pacemaker Leads, Titanium, Polyurethane 52-65cm
MC218 Vitatron Excellence PS+Model IMK 49JB Pacemaker Leads, Titanium, Polyurethane 45-53cm
MC219 Vitatron Excellence SS+Model IML 49JB Pacemaker Leads, Titanium, Polyurethane 45-53cm
MC229 Medtronic Capsure SP Novus Model 5594 Lead Silicone, platinum 30-100cm
MC231 Vitatron Crystalline Lead Model ICL08JB Leads, Titanium, polyurethane 30-53cm Lengths
Pacemaker 30cm, 45cm, 53cm
MC232 Vitatron Crystalline Lead Model ICL08 Leads, Titanium, polyurethane 52-65cm Lengths
Pacemaker 52cm, 58cm, 65cm
MC233 Vitatron Crystalline Lead Model ICL08B Leads, Titanium, polyurethane 52-65cm Lengths
Pacemaker 35cm, 45cm, 52cm, 58cm, 65cm
MC336 Medtronic Capsure Z Novus Model 5054 Pacing Silicone; Contents: 1 x lead with anchoring sleeve, 45-58cm
stylet & guide, 1 x vein lifter, 2 x fixation tools,
MC337 Medtronic Capsure Z Novus Model 5554 Pacing Silicone; Contents: 1 x lead with anchoring sleeve, 45-58cm
stylet & guide, 1 x vein lifter, 2 x fixation tools,
MC371 Medtronic Capsurefix Medtronic Capsurefix Model 6940, Pacing Lead; 30 - 85cm
Medtronic Tined IS-1 Model 4557M; Medtronic
Capsurefix Model 4067/8/4568 Pacing Leads;
Medtronic Capsurefix Model 5067 Pacing Leads;
Medtronic Capsurefix Model 5068 Pacing Leads;
Medtronic Capsurefix Model 5568 Pacing Leads;
Capsure SP Novus Pacing Lead Model 4092;
Capsure SP Novus Pacing Lead Model 4592
MC372 CapSure Sense pacemaker lead Models 4073, 4074 Titanium Nitride CapSure Sense Lead Model 4073 - 30cm to
& 4574 85cm; CapSure Sense Lead Model 4074 -
30cm to 85cm; CapSure Sense Lead Model
Prostheses List by Category, Groups and Sponsor Page 21 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
St. Jude Medical Australia Pty Ltd
SJ024 PASSIVE PLUS DX 1342T, 1343K, 1345K, 1346T Single, passive fixation, steroid eluting, low 46-58cm
polarisation lead; Models: Bipolar Atrial Lead, IS-1
Unipolar Atrial Lead, IS-1 Unipolar Ventricular
Lead, IS-1 or Bipolar Ventricular Lead, IS-1
Group 9 - Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT063 Selox SR Lead, pacemaker, implantable, endocardial 45, 53, 60cm length
Guidant Australia Pty Ltd
GU013 Fineline II EZ Sterox IROX Lead Model 4472, Model 4473 & Model 4474 45cm, 52cm, 58cm
GU016 Fineline II EZ Sterox IROX Lead Model 4469, Model 4470 & Model 4471 45cm, 52cm, 58cm
GU031 Sweet Picotip RX Lead Model 4050, Model 4051, Model 4052, Model 45cm, 52cm, 59cm, 45cm & 59cm
4053, Model 4054 & Model 4055
GU122 Flextend Lead Models 4086, 4087 & 4088 Bipolar, steroid eluting, transvenous silicon 45,52,59cm
pace/sense leads with an extendable/retractable
active fixation for implantation into the atrium or
Medtronic Australasia Pty Ltd
MC008 Medtronic Capsurefix Model 6940, Pacing Lead; Silicone Polyurethane 30 - 85cm
Medtronic Tined IS-1 Model 4557M; Medtronic
Capsurefix Model 4067/8/4568 Pacing Leads;
Medtronic Capsurefix Model 5067 Pacing Leads;
Medtronic Capsurefix Model 5068 Pacing Leads;
Medtronic Capsurefix Model 5568 Pacing Leads;
Capsure SP Novus Pacing Lead Model 4092;
Capsure SP Novus Pacing Lead Model 4592
MC221 Vitatron Crystalline Actfix Model ICF09 Pacemaker Pacemaker Leads, Titanium, Polyurethane 52-65cm
MC338 Medtronic Capsurefix Novus Model 5076 Pacing Silicone; Contents: 1 x lead with anchoring sleeve, 45-85cm
stylet & guide, 1 x vein lifter, 2 x fixation tools,
St. Jude Medical Australia Pty Ltd
SJ023 TENDRIL SDX 1488T, 1388T Single, Active Fixation, Steroid Eluting, Low 46cm-58cm
Polarisation Lead, IS-1
SJ073 Tendril SDX Models 1688T and 1688TC Endocardial Steroid-Eluting Active Fixation Pacing 100cm, 25cm, 34cm, 40cm, 46cm, 52cm,
58cm, 85cm, 7F
Prostheses List by Category, Groups and Sponsor Page 22 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Patches, Myocardial
W L Gore & Associates
GT117 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm Thickness 2 x 9cm
GT118 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm - 3 x 6cm
0.6mm - 2.5cm x 15cm & 5cm x 7.5cm
GT120 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 5 x 15cm
GT121 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 10 x 15cm
GT122 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 6 x 12cm
GT123 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 8 x 16cm
GT124 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 12 x 12cm
GT125 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 15 x 20cm
GT126 Acuseal Cardiovascular Patch Vascular ePTFE 0.5mm Thickness 1 x 9cm; 0.8 x 7.5cm
GT127 Acuseal Cardiovascular Patch Cardiac ePTFE 0.5mm Thickness 3 x 6cm & 5 x 7.5cm
Prostheses, Blood Vessel, Artificial
Atrium Australia-Pacific Rim Pty Ltd
AC002 Atrium PTFE Vascular Graft Straight PTFE Standard Wall 6mm x 10cm - 10mm x 90cm
Prostheses, Cardiac Valve, Artificial
Advanced Biomedical Pty Ltd
AB002 ATS medical open pivot heart valve model 500FA Pyrolythic Carbon, Double Velour Polyester, 16-33mm
standard flexi-cuff aortic valve series, ATS medical
open pivot heart valve model 501DM advanced
performance mitral valve series, ATS medical open
pivot heart valve model 501DA advanced
performance aortic valve series, ATS medical open
pivot heart valve model 500DM mitral standard
Prostheses List by Category, Groups and Sponsor Page 23 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Edwards Lifesciences Pty Ltd
EL029 SE SIL Ball Valve Aortic Models 1200/1260, SE Starr Edwards - Silastic Ball Valve. Composition: 16mm-34mm
SIL Ball Valve Mitral Model 6120 Stellite Alloy No. 21; Polytetrafluroethelyne;
polypropylene cloth; Silicone rubber (contains 2%
by weight barium sulphate for radiopacity)
Hjorth Health Pty Limited
HH001 Omnicarbon 4000 4523 Mitral UPP SupraAnnular Pure pyrolitic carbon mono-leaflet prosthetic heart Aortic - Sizes 19mm - 27mm; Mitral - Sizes
and Omnicarbon 4000 4313 Aortic UPP 27mm - 33mm
Medtronic Australasia Pty Ltd
MC013 Medtronic Hall Heart Valve Aortic Model A7700, A7700/M7700 Titanium. Pyrolite. Dacron, A7700 - Diameter 20-31mm, M7700 -
Medtronic Hall Heart Valve Mitral Model M7700, A7700EZ/M7700EZ Titanium. Pyrolite. PET Diameter 23-33mm, A7700EZ - Diameter 19-
Hall Easy Fit Aortic Heart Valve Model A7700, Hall 29mm, M7700EZ - Diameter 23-31mm
Easy Fit Mitral Heart Valve Model M7700
MC198 Medtronic Hall rotatable aortic valved collagen Titanium, pyrolite, dacron 20 - 33mm
impregnated conduit Model R7700
MC292 Advantage Heart Valve - Aortic Model A7760 A7760 - Pyrolytic carbon, PET Diameter 19-31 mm
MC324 Advantage Supra Aortic Heart Valve Mechanical Heart Valve Pyrolite Carbon leaflets Diameter (mm): 19 - 25
Pyrolite carbon ring
Reid Healthcare
RH001 Aortic On-X Prosthetic Heart Valve Models ONXA- 27-29mm, 19mm, 21mm, 23mm, 25mm, 25-
19; ONXA-21; ONXA-23; ONXA-25; ONXA- 33mm, 27-29mm, 31-33mm, 23mm, 25mm
27/29; ONXM-23; ONXM-25; ONXM-27/29;
ONXM31/33; ONXMC25/33
St. Jude Medical Australia Pty Ltd
SJ036 St Jude Medical Coated Aortic Valved Graft Coated Aortic Valved Graft 21mm - 33mm
SJ037 St Jude Medical Aortic Expanded Cuff Heart Valve; Aortic Expanded Cuff, Aortic Hemodynamic Plus Aortic Expanded 19 -31mm, Aortic
St Jude Medical Aortic Hemodynamic Plus Cuff Cuff, Mitral Hemodynamic Cuff, Aortic & Mitral Hemodynamic 17 - 27mm, Mitral
Heart Valve; St Jude Medical Mitral Hemodynamic Rotatable Cuff Hemodynamic 17 -27mm, Rotatable 17 - 33mm
Plus Cuff Heart Valve; St Jude Medical Mechanical
Heart Valve Masters Series
SJ039 St Jude Medical Regent Prosthetic Heart Valves Standard Cuff - Model 17AGN-751 - 29AGN-751, Standard cuff - 17-29mm, Flex cuff - 17-
Flex Cuff - Model 17AGFN-756 - 29AGFN-756
Tag Medical
TM002 CarboSeal Ascending Aortic Prosthesis, sterile, Mechanical Conduit AP 21-33mm
CarboSeal Ascending Aortic Prosthesis with Handle
Model AP21, Model AP23, Model AP25, Model
AP27, Model AP29, Model AP31, Model AP33
Prostheses List by Category, Groups and Sponsor Page 24 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
TM003 SuMit - Supra-Annular Mitral Valve: Carbomedics Mechanical Valve 16mm to 33mm
Aortic Model S500 Supra Annular Prosthetic Heart
Valve: Carbomedics Model 700 Mitral Prosthetic
Heart Valve: CarboMedics Aortic Model A500
Prosthetic Heart Valve: CarboMedics Aortic Model
R500 Reduced Tissue Annulus Diameter Prosthetic
Prostheses, Cardiac Valve, Biological
Edwards Lifesciences Pty Ltd
EL030 CE Supra Annular Aortic Valve Model 2650 Carpentier-Edwards SAV Bioprosthesis. 19mm-33mm
Carpentier-Edwards S.A.V Bioprosthesis Model Composition: Porcine Valve; Elgiloy Alloy; Silicone
Rubber, Polytetrafluoroethylene
EL031 Carpentier-Edwards Perimount Pericardial Carpentier-Edwards Pericardial Bioprosthesis. Models 2900/6900 19-33mm, Model 6900P
Bioprosthesis - Models 2900/6900 Carpentier- Composition: Bovine Pericardium; Elgiloy Alloy; 25, 27, 29, 31, 33mm
Edwards Perimount Plus Pericardial Bioprosthesis Silicone Rubber, Polytetrafluoroethylene
Mitral - Model 6900P
EL032 Baxter Edwards Prima Plus Stentless Bioprosthesis Edwards Prima Plus. Porcine Valve; Woven 19mm-29mm
Model 2500P Prosthetic Heart Valve Polyester Cloth.
EL039 Edwards Perimount Magna Model 3000 Carpentier-Edwards Perimount Magna composition: 19MM Aortic Pericardial Tissue Valve; 21MM
Glutaraldehyde treated bovine pericardium/elgiloy Aortic Pericardial Tissue Valve; 23MM
wireform stent/polyester band/silicone rubber Aortic Pericardial Tissue Valve; 25MM Aortic
suture ring/polytetrafluoroethylene cloth/polyester Pericardial Tissue Valve; 27MM Aortic
Pericardial Tissue Valve; 29MM Aortic
Pericardial Tissue Valve
Medtronic Australasia Pty Ltd
MC012 Medtronic Hancock Valved Conduit Model 100/150 Porcine bioprosthesis, dacron 12, 14, 16, 18, 20, 22, 25, 30mm.
MC015 Medtronic Freestyle modified subcoronary aortic Models FR995MS, FR995 - Porcine Bioprosthesis, 19 - 27mm, 19 - 29mm, 19 - 35mm, 21 -
root bioprosthesis (Model 995MS); Medtronic dacron, Models 305, 305C, 310, T505, T510 -
Freestyle aortic root bioprosthesis (Model FR995); Porcine bioprosthesis, polyester
Medtronic Mosaic Aortic heart Valve Model 305;
Medtronic Mosaic Mitral heart Valve Model 310;
Medtronic Hancock II heart valve model T510
Mitral; Medtronic Hancock II heart valve model
St. Jude Medical Australia Pty Ltd
SJ038 St Jude Medical Toronto SPV Valve Model SPA- Tissue Heart Valves, Bioimplant TSPV: 21 - 29mm, Bioimplant Aortic: 21-
101, St Jude Medical Bioimplant Heart Valve 27mm, Bioimplant Mitral: 27-32mm
Prostheses List by Category, Groups and Sponsor Page 25 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
SJ069 St Jude Medical Biocor Porcine Prosthetic Heart St Jude Medical Biocor Porcine Prosthetic Heart Aortic Valves - Tissue Annulus Diameter -
Valve is manufactured from selected procine aortic 21-29mm, Implant Height - 11-15c; Mitral
valve cusps that have been cross-linked with a Valves - Tissue Annulus Diameter - 25-
glutaraldehyde solution 35mm, Implant Height - 8-10mm
Recorders, Long Term, ECG, Implantable
Medtronic Australasia Pty Ltd
MC028 Medtronic Reveal ILR Model 9525, Implantable Titanium 8cc
Cardiogram Recorder; Reveal Plus Implantable
Loop Recorder Model 9526
Single Chamber ICDs
Advanced Biomedical Pty Ltd
AB001 ATS medical open pivot aortic valved graft model Pyrolythic Carbon, Double Velour Polyester, 21-33mm
502AG
Generation 1
St. Jude Medical Australia Pty Ltd
SJ058 St Jude Medical Australia Ventritex Contour MD Contour MD Models V - 175 AC, V-175C and V- 57-65cc, 109 - 118g
Models V-175AC, V-175D and V- 175C 175D Single chamber Defibrillators/Cardioverters
Defibrillators/Cardioverters
Generation 2
Biotronik Australia Pty Ltd
BT054 Lexos VR Single chamber ICD, Rate responsive pacing One size only.
Medtronic Australasia Pty Ltd
MC201 Medtronic A/Asia Gem III VR Model 7231CX Titanium One size only, 39.2cc
Progressive Medical
PG001 Alto II VR Single Chamber ICD Debrillator, implantable, automatic
Prostheses List by Category, Groups and Sponsor Page 26 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Generation 3
Biotronik Australia Pty Ltd
BT055 Lexos A+ Single chamber ICD, rate responsive pricing, dual One size only.
chamber sensing.
Guidant Australia Pty Ltd
GU110 Ventak Prizm II VR Model 1860, titanium, single chamber, adaptive rate One size only
GU133 Vitality VR Model 1870 This device acts to defibrillate the heart chambers Model 1870 Vitality VR Single Chamber Rate
when the patient enters into an arrhythmia or uses Responsive Pacemaker/Defibrillator
shocks or anti tachy pacing to revert Ventricular
Tachycardia (VT) or Ventricular Fibrillation (VF).
While also acting as a single chamber pacemaker.
GU148 Vitality 2 EL VR - Model T177 Implantable Cardiac Defibrillator 35cc 90g
GU151 Vitality 2 VR - Model T 175 Implantable cardiac defibrillator 30cc; 82g
Medtronic Australasia Pty Ltd
MC253 Medtronic Marquis VR 7230CX Implantable Titanium, Sterile, Single Chamber Volume 36cc
Cardioverter Defibrillator
MC317 Maximo VR Model 7232Cx Titanium One size only 38.5cc
MC365 EnTrust Model D153VRC, Single chamber, 30J 33cc, 63g
St. Jude Medical Australia Pty Ltd
SJ010 Photon Micro VR Model V-194 36cc
Defibrillators/Cardioverters
SJ048 Epic Plus VR Model V-196 Implantable Single Chamber sensing and bradycardia pacing 32cc
Cardioverter Defibrillator
Single Chamber Pacemakers
Generation 1
Biotronik Australia Pty Ltd
BT036 PHILOS S Implantable Cardiac Pulse Generator Cat Multiprogrammable SSI One size only
No 122 453
St. Jude Medical Australia Pty Ltd
SJ020 REGENCY SC+ 2402L Single Chamber, VVI, Autocapture, IS-1 8.6cc, 18.5gm
Prostheses List by Category, Groups and Sponsor Page 27 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
SJ052 Verity Adx Models XL SR 5156 and XL SR 5157 Single Chamber multi-programmable rate-adaptive 11cc, 23g
M/S implantable pacemaker pacing devices with extended longevity
SJ053 Verity Adx Model XL SC 5056 implantable Single Chamber multi-programmable rate-adaptive 10.5cc, 23g
pacing device with extended longevity
Generation 2
St. Jude Medical Australia Pty Ltd
SJ076 Verity Adx Models XL SR 5156 and XL SR 5157 Single Chamber multi-programmable rate-adaptive 11cc, 23g
M/S implantable pacemaker pacing devices with extended longevity
Generation 3
Biotronik Australia Pty Ltd
BT028 Philos SR Model 122459 Implantable Pacemaker Multiprogrammable, rate responsive, SSIR One size only
BT030 Philos SR-B Model 122610 Implantable Pacemaker Multiprogrammable, rate responsive, SSIR 5/6mm port, One size only
BT046 Protos VR/CLS Single chamber rate responsive, closed loop One size only
BT062 Philos II SR Multiprogrammable, Rate Responsive, SSIR One size only
Guidant Australia Pty Ltd
GU067 Pulsar Max II Pacemaker SSIR Model 1180, Model 1181
GU124 Insignia Entra SR Models 1195 & 1198 Single Chamber Rate Responsive Permanent One size only
GU126 Insignia Plus SR Model 1194 Single Chamber Rate Responsive Permanent One size only
GU139 Insignia Ultra SR Lodel 1190 Implantable Cardiac Pacemaker One size only
Medtronic Australasia Pty Ltd
MC288 Vitatron C20SR Pacemaker Titanium, polyurethane one size only
MC321 EnPulse SR Series: Model E2SR01, Model E2SR03, EnPulse SR - Pacemakers - with IS1 connector; One size only
Model E2SR06 with 3.2mm low profile connector; with 5mm
connector. Titanium and silicone.
Progressive Medical
PG006 Symphony SR Titanium one size only
St. Jude Medical Australia Pty Ltd
SJ022 REGENCY SR+ 2400L Single Chamber, Rate Response, Autocapture, IS-1 8.6cc, 18.5gm
SJ025 St Jude Medical Integrity SR5142 Pacemaker, Single chamber, rate responsive pacemaker Volume 10.4cc, weight 23gm
Cardiac Implantable
Prostheses List by Category, Groups and Sponsor Page 28 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
SJ029 Integrity Micro SR 5136 Pacemaker Single Chamber Rate Responsive Pacemaker Volume 8cc, weight 18gm
SJ030 Identity SR 5172 Single Chamber Rate Responsive Pacemaker Volume 8cc, Weight 17gm
SJ055 Integrity ADx Model SR 5160 implantable Single Chamber multi-programmable rate-adaptive 8cc, 17g
pacing device
SJ060 Identity ADx Model SR 5180 implantable Single Chamber multi-programmable rate-adaptive 8cc, 18g
pacing device
SJ077 Verity Adx Models XL SR 5156 and XL SR 5157 Single Chamber multi-programmable rate-adaptive 11cc, 23g
M/S implantable pacemaker pacing devices with extended longevity
Special Implantable Cardioverter Defibrillator Leads
Group 2 - Subcutaneous Leads
Guidant Australia Pty Ltd
GU123 Endotak SQ Array XP Lead Model 0085 Endotak SQ Array XP Lead Model 0085 is used in 70 cm
addition to an Endotak endocardial leads for patients
with a high DFT (Defibrillation Threshold)
Medtronic Australasia Pty Ltd
MC251 Implantable Subcutaneous Defibrillator Lead Model Silicone and Platinum Alloy Lengths 41-85cm inclusive
6996SQ 41cm, 58cm, 85cm
Group 7 - Epicardial Patches
Medtronic Australasia Pty Ltd
MC027 Model 6721 Unipolar Epicardial Patch Leads S/M/L Model 6721S-50, Model 6721M-50, Model 6721L- 370, 660, 840mm
50; Silicone
Special Purpose Dual Chamber Pacemaker - Custom Header
Generation 1
Medtronic Australasia Pty Ltd
MC032 Medtronic Kappa 700 Pacemaker Model KD700, Titanium 11.9cc, 14.2cc
MC250 Medtronic Kappa Pacemaker Model KD901and Cardiac Pacemaker, Titanium One size only
Model KD903
MC334 Medtronic Kappa Pacemaker Model KD906 Cardiac Pacemaker, Titanium One size only
MC335 Medtronic Kappa 700 Pacemaker Models KD703 Titanium 10.9 - 14.2cc
and KD706
Prostheses List by Category, Groups and Sponsor Page 29 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Generation 3
Medtronic Australasia Pty Ltd
MC029 Medtronic Kappa 400 pacemaker Model KDR401 Titanium 13.9cc
MC031 Medtronic Kappa 700 Pacemakers Model: KDR700, Titanium 10.9cc - 14.2cc
KDR701, KDR720, KDR721, KDR721C, KDR730,
KDR731, KDR733
MC034 Medtronic Kappa 700 Pacemaker Model Titanium 9.7cc, 11.0cc
KSR700/701/701C/703/706;
MC241 Medtronic Kappa Pacemaker Model KDR 933 Cardiac Pacemaker, Titanium 13.9cc
MC242 Medtronic Kappa KSR 900 Model KSR 901,903, 906 Cardiac Pacemaker, Titanium 9.7,10.5,11.0 cc
MC332 Medtronic Kappa Pacemaker KDR 903 and KDR 906 Cardiac Pacemaker, Titanium 13cc, 14.2cc
MC339 Medtronic Kappa 700 Pacemakers Model: KDR703 Titanium 10.9cc - 14.2cc
and KDR706
MC340 Medtronic Kappa 400 pacemaker Model KDR403 Titanium 13.9cc
Special Purpose ICDs - High energy products
Generation 1
Medtronic Australasia Pty Ltd
MC019 Medtronic Gem DR Model 7271 Titanium 62cc
MC020 Medtronic Gem Model 7227Cx; Gem Model 7227 Titanium 49cc, 40cc
Implantable Cardioverter Defibrillator
Generation 2
Guidant Australia Pty Ltd
GU107 Ventak Prizm HE DR Model 1853 & Model 1858, titanium, dual chamber, One size only
adaptive rate
Generation 3
Medtronic Australasia Pty Ltd
MC362 EnTrust Model D154DRG, dual chamber, VT Therapies, 35cc, 68g
MC364 EnTrust Model D154ATG, Dual chamber, AT Therapies, 35J 35cc, 68g
Prostheses List by Category, Groups and Sponsor Page 30 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
MC366 EnTrust Model D154VRC, Single chamber, 35J 35cc, 68g
St. Jude Medical Australia Pty Ltd
SJ011 Atlas DR Model V-240 Dual chamber implantable cardioverter defibrillator 37cc
with rate response
SJ012 Atlas VR Model V-199 Single chamber implantable cardioverter defibrillator 36cc
with rate response
SJ063 Atlas DR Model V-242 ICD Implantable Dual Chamber Cardio-verter 38cc/78g
SJ065 Atlas + VR Model V-193 ICD Single chamber implantable cardio-verter defibrillator 38cc, 77g
SJ066 Atlas + VR - C Model V-193C ICD Single chamber implantable cardio-verter defibrillator 38cc, 77g
SJ068 Atlas + DR Model V-243 ICD Implantable Dual Chamber Cardio-verter 38cc, 78g
Special Purpose ICDs - With custom headers
Generation 1
Medtronic Australasia Pty Ltd
MC237 Gem Model 7227B Implantable Cardioverter Titanium, "B" Style Connector 56cc
Defibrillator
MC238 Gem Model 7227D Implantable Cardioverter Titanium, "D" style connector 53cc
Defibrillator
MC239 Gem Model 7227EImplantable Cardioverter Titanium, "E" style connector 55cc
Special Purpose ICDs - With therapies for Atrial Tachyarrhythmia
Generation 2
Medtronic Australasia Pty Ltd
MC227 Medtronic Gem III AT Model 7276 Implantable Titanium 39.5cc
Cardioverter Defibrillator
Generation 3
Guidant Australia Pty Ltd
GU137 Vitality AVT Dual or single chamber pacemaker One size only
GU157 Vitality AVT - Model A155 Implantable cardiac defibrillator with both Atrial and 30cc
Ventricular tachyarrhythmia therapy
Prostheses List by Category, Groups and Sponsor Page 31 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Medtronic Australasia Pty Ltd
MC349 Entrust Model D 153ATG, Dual chamber, AT Therapies, 33cc, 63g
Special Purpose ICDs with CRT - High energy products
Generation 2
Guidant Australia Pty Ltd
GU144 Contak Renewal 4 HE CRT-D Model H197, Model Implantable dual-chamber defibrillator one size only
St. Jude Medical Australia Pty Ltd
SJ064 Atlas + HF Model V - 341 ICD - Defibrillator, Atlas + HF ICD is a cardioverter defibrillator with 40cc/81g
Implantable, automatic, dual-chamber dual chamber (atrial and RV) sensing and
bradycardia Pacing with ventricular
Generation 3
Medtronic Australasia Pty Ltd
MC359 Intrinsic Model 7288, Implantable Cardioverter Defibrillator 38cc, 76g
Special Purpose ICDs with CRT - With therapies for Atrial
Generation 2
Guidant Australia Pty Ltd
GU154 Contak Renewal 4 AVT CRT -D - Model M170 and Implantable Cardioverter Defibrillator with Cardiac 37cc; 89g
M175 Resynchronisation Therapy
GU155 Contak Renewal 4 AVT HE CRT - D - Model Implantable Cardioverter Defibrillator with cardiac 40cc; 89g
M177, M179 resynchronisation Therapy
Special Purpose Pacemaker - Small size (<7cc) for pacing in infants
Generation 3
St. Jude Medical Australia Pty Ltd
SJ027 St Jude Medical Microny II SR+ Model 2525T Single Chamber Rate Responsive Pacemaker Volume 5.9cc, Weight 12.8gm
Pacemaker
Prostheses List by Category, Groups and Sponsor Page 32 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Special Purpose Pacemaker - with Therapies for Atrial
Generation 3
Medtronic Australasia Pty Ltd
MC200 Medtronic A/Asia AT500 DDDRP Pacing System Titanium, silicone One size only, 14.9cc
Model AT501
MC360 EnRhythm Model P150 1DR, Rate Responsive dual chamber 21g, 13cc
pacemaker with Anti-Tachycardia functions:
Special Purpose Pacemaker Leads - Catheter Delivered
Group 9 - Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atrial
Medtronic Australasia Pty Ltd
MC301 Model 3830 PACING LEADS Active fixation pacemaker lead 59 - 75 cm
Composition: Insulation is polyurethane, Electrodes
are Titanium Nitride coated Platinum, the screw is
steriod-coated
Special Purpose Pacemaker Leads - VDD Leads
Group 7 - Transvenous, Bi-Polar, Passive, Non-Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT009 SL Tripolar Lead - SL60/130, BP,SL60/150-BP, Single pass lead 130mm, 150mm, 110mm
SL60/110-BP
Group 8 - Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atrial
Guidant Australia Pty Ltd
GU028 Guidant Aust Selute Picotip VDD Lead Model 4340, Model 4341, Model 4342 & Model
Medtronic Australasia Pty Ltd
MC052 Medtronic Capsure VDD2 Model 5038 AV Pacing Silicone; Contents: 1 x lead with anchoring sleeve, 11.5cm, 13.5cm, 15.5cm
stylet & guide, 1 x vein lifter, 2 x fixation tools,
Prostheses List by Category, Groups and Sponsor Page 33 of 653
CARDIO-THORACIC
Billing Code Product Name Description Size Notation
Special Purpose Single Chamber Pacemaker - Custom Header
Generation 1
St. Jude Medical Australia Pty Ltd
SJ019 REGENCY SC 2406L, SCX 2408L, SC 2407M/S Single Chamber, Standard VVIC, IS-1/5-6mm 8.6cc, 18.5-19gm
Generation 3
Medtronic Australasia Pty Ltd
MC030 Medtronic Kappa 400 Pacemaker Model KSR401 Titanium 11.6cc, 11.7cc
MC330 Medtronic Kappa 400 Pacemaker Model KSR 403 Titanium 11.6cc, 11.7cc
Tissue Reconstructive Materials
Advanced Biomedical Pty Ltd
AB003 Bioglue Surgical Adhesive - 5ml Starter Kit Model No BG 3005 S (Bioglue Surgical Adhesive) One size only Temporary Approval
Prostheses List by Category, Groups and Sponsor Page 34 of 653
EAR, NOSE & THROAT
Billing Code Product Name Description Size Notation
Cannulae, Eye, Lacrimal
Device Technologies Australia Pty Ltd
DE191 Canaliculus Intubation Sets Silicone, SS & Nylon 17.7 x .064 x 29cm, 15.5 x .051 x 33cm
Caps, Bone
Medtel Australia Pty Ltd
ME078 BAHA - Bone Anchored Hearing Aids Cover screw unigrip One size only
Cement
Endotherapeutics Pty Ltd
ET031 Serenocem Cement Reaction bonded polymer composite formed by the One size only - box of 2
neutralisation gelletation of a basic inorganic ionomer
ET032 Serenocem Granules Reaction bonded polymer composite formed by the 0.5 - 1mm granules, 1gm or 5gm; 2 - 3mm
neutralisation gelletation of a basic inorganic ionomer granules, 1gm or 5gm - 3 pouches
Cochlear Implants
Cochlear Limited
CO012 SPrint Speech Processor (INITIAL) Consists of: SPrint Speech Processor - body worn Processor: One Size Only, Transmit Cable, 8-
speech processor to suit Nucleus 24 cochlear 28cm, Headset Cable 45-100cm, Headset:
implant system; transmit cable; headset cable; 0.5-4.0 magnet strength, Hook small and large
headset; battery case - double; batteries - AA;
microphone cover; belt clip; and hook
CO015 Spectra Speech Processor (REPLACEMENT) Conists of: Spectra - body worn speech processor Processor: One Size Only, Transmit Cable: 8-
for Nucleus 22 system; transmit cable; headset 28cm Headset Cable: 45 -100cm Headset:
cable; and headset 0.5-4.0 magnet strength
Prostheses List by Category, Groups and Sponsor Page 35 of 653
EAR, NOSE & THROAT
Billing Code Product Name Description Size Notation
CO017 SPrint Speech Processor (REPLACEMENT) Consists of: SPrint Speech Processor - body worn Processor: One Size Only, Transmit Cable, 8-
speech processor to suit Nucleus 24 cochlear 28cm, Headset Cable 45-100cm, Headset:
implant system; transmit cable; headset cable; 0.5-4.0 magnet strength, Hook small and large
headset; battery case - double; batteries - AA;
microphone cover; belt clip; and hook
CO018 ESPrit 3G Speech Processor - Initial Includes speech processor with titanium ear hook, Cable lengths: 6, 8, 10, 20, 28cm
6 high powered zinc air batteries, cleaning brush,
microphone puffer, earmould compatible earhook,
soft earhook cover, magnet, drying capsules,
accessory adaptor and socket covers, signal check,
coil/cable (x2), document pack
CO019 ESPrit 3G Speech Processor - Replacement Includes speech processor with titanium ear hook, Cable lengths: 6, 8, 10, 20, 28cm
6 high powered zinc air batteries, cleaning brush,
microphone puffer, earmould compatible earhook,
soft earhook cover, magnet, drying capsules,
accessory adaptor and socket covers, signal check,
coil/cable (x2), document pack
CO024 Nucleus Freedom Implant with Straight Electrode Cochlear implant with straight electrode in a One size only
titanium casing, with a removable magnet, banded
platinum electrodes moulded in a silicone seal.
Pacing Importers Pty Ltd
PI005 Combi C40+ Implantable Auditory Stimulator One Size Only
Drains, T
Endocorp Pty Ltd
EC013 Campbell Endolymphatic T-Shunt Silicone rubber 0.125 mm dia
Ear/Nose/Throat Treatment Units
Pacific Medical
PM065 Tympo Vent Otological ventilation tubes, short medium term, Length 2.2
Donaldson fluoroplastic/blue
PM066 Tympo Vent Otological ventilation tubes, straight tube Length 7.0 - 7.2mm
PM068 Tympo Vent Otological ventilation tubes, short medium term, Length 2.8
star tube, silicone
Prostheses List by Category, Groups and Sponsor Page 36 of 653
EAR, NOSE & THROAT
Billing Code Product Name Description Size Notation
PM072 Tympo Vent Otological ventilation tubes, short medium term, Length 12.4
shepard with tail, silicone/blue
PM074 Tympo Vent Otological ventilation tubes, paparella with tab Length 2.2mm
PM075 Tympo Vent Otological ventilation tubes, collar button, tubingen Length 1.5mm
type gold, gilded silver
PM079 Tympo Vent Otological ventilation tubes, t-tube Length 6 - 12mm
PM083 Tympo Vent Otological ventilation tubes, long term, collar button Length 1.5
- tubingen type, titanium
PM086 Tympo Vent Otological ventilation tubes, short medium term, Length 1.6
reuter bobbin without holes, titanium
PM088 Tympo Vent Otological ventilation tubes, donaldson, reuter Length 1.5mm - 9.8mm
bobbin, shepard
PM089 Tympo Vent Otological ventilation tubes, short medium term, Length 1.8
bevel bobbin, fluoroplastic/blue
PM090 Tympo Vent Otological ventilation tubes, armstrong Length 3.8 - 10.0mm
PM091 Tympo Vent Otological ventilation tubes, short medium term, Length 2.0
collar button, fluoroplastic/blue
Grafts
Pacific Medical
The balloon shaft is polyurethane with coextrusion
balloon on a distal end where stent is crimped to.
BS060 Transhepatic Biliary Permalume Covered Wallstent Elgiloy (cobalt chromium), permalume (silicone 8 x 60mm, 8 x 80mm, 10 x 40mm, 10 x
coating), self expanding, flexible, Model numbers: 60mm, 10 x 80mm
4356, 4357, 4358, 4359
BS063 Wallstent RP; 7Fr Placehit Wallstent Wallstent TIPS endoprosthesis, wallstent biliary Diameter 6mm - 24mm, Length 18mm - 90mm
endoprosthesis, wallstent iliac endoprosthesis,
wallstent endoprosthesis tracheobronchial with
unistep plus delivery sytem, 7Fr Placehit Wallstent.
Stent composition - biomedical superalloy wire,
braided in mesh, unistep delivery system
composition - blue polyimid material, stainless steel
Device Technologies Australia Pty Ltd
DE212 Intracoil Stent Nickel titanium alloy 40 x 4,5,6,7,8 mm
Endotherapeutics Pty Ltd
ET024 Optimed Tips Sinus Stent Sinus-wave nitinol stent 10-12mm x 50-90 mm
ET025 Optimed Iliac Sinus Stent Sinus-wave nitinol stent 4-12mm x 30-100mm
ET026 Optimed Femoral Sinus Stent Sinus-wave nitinol stent 4-12mm x 30-100mm
ET030 Aspire Covered Stent Expandible Nitinol Stent covered with ePTFE Dia 6-14mm, Length 2.5-10cm
ET037 SX-Ella Endovascular Stent Uncovered, self-expanding nitinol stent Dia 6-16mm, length 22-77mm
Five Corners Pty Ltd
FC001 Endoluminal Stent Graft and Delivery System Multiple sizes of stent graft on pre-loaded catheter Dia 15-27mm, Length 87-189mm
shaft for delivery and deployment, comprised of
Guidant Australia Pty Ltd
GU058 Dynalink Peripheral Self Expanding Stent System - Lengths 80cm and 120cm, Sizes range from
5mm x 28mm to 10mm x 56mm
Jacobs Medical Australia Pty Ltd
JM001 Angiodynamics Angiostent Balloon Expandable Platinum wire 5mm to 10mm
Stent System (Vistaflex)
Prostheses List by Category, Groups and Sponsor Page 647 of 653
VASCULAR
Billing Code Product Name Description Size Notation
Johnson & Johnson Medical Pty Ltd
JJ057 Palmaz Balloon Expandable Stent Stainless steel stent Diameter 4-12mm, length 20-30mm
JJ058 Palmaz Balloon Expandable Stent Stainless steel stent Extra-large
JJ059 Palmaz Balloon Expandable Stent Corinthian stainless steel stent Diameter 4-10mm; Length 12 - 79 mm
JJ063 Smart Peripheral Stent System Nitinol vascular stent 6 - 14 mm
JJ064 Duo Via Main Endograft Leg and Delivery System Nitinol abdominal aortic aneurysm device leg 13F, 16-28 mm
JJ065 Duo Via Bioseal and Delivery System Nitinol abdominal aortic aneurysm device 13F, 16-28 mm
JJ068 SMART .018" Peripheral Stent System Nitinol carotid stent and delivery system 6 - 10 mm
JJ069 Palmaz Corinthian IQ Peripheral Stent Stainless steel hypotube stent 12 - 80 mm
JJ230 Palmaz Corinthian IQ Peripheral Stent and Delivery Laser cut from 316L stainless steel hypotube. Cells Corinthian IQ M3 (available in 15 and 18mm
System connected by omega shaped hinges. Stent stent diameteres) mounted on 5 - 7 mm rapid
mounted on a rapid exchange balloon, a very low exchange balloon.
JJ235 SMART Peripheral stent system Laser cut nitinol tube. Available in long stents to Dia 6 - 8mm, length 120mm
treat large vessel lesions.
JJ236 SMART Peripheral stent system Laser cut nitinol tube. Added to the stent ends are Dia 6 - 10mm, length 26, 40, 60, 80mm.
Tantalum Micromarkers for enhanced radiopacity Delivery system 80 and 120 SDS
JJ304 Palmaz Genesis Peripheral Stent and Delivery Stainless steel balloon expandable stent mounted on Diameter 4-8mm, length 12-39mm
System on Slalom a slalom balloon
JJ305 Palmaz Genesis Peripheral Stent and Delivery Stainless steel balloon expandable stent mounted on Diameter 4-8mm, length 12-39mm
System on Opta Pro an Opta Pro Balloon
JJ306 Palmaz Genesis Peripheral Stent Stainless steel peripheral stent Diameter 4-12mm, length 11-79mm
JJ419 SMART Control Peripheral Stent System SMART Control is a laser cut nitinol self expanding Dia 6-10mm; Length 20, 40, 60, 80, 100mm
stent, used to treat peripheral vessel disease.
Medtronic Australasia Pty Ltd
MC143 Medtronic Stents, Sterile Medtronic AneuRx Aortic / Illiac Stent - Nitinol / 20-28mm x 12-16mm x 13-16.5cm
Polyester:
MC145 Medtronic Aust Stents, Sterile Medtronic AneuRx Aortic or Iliac Cuff Stent - 12-16mm x 5.5/8.5/11.5mm, 20-28mm x
Nitinol / Polyester.
Prostheses List by Category, Groups and Sponsor Page 648 of 653
VASCULAR
Billing Code Product Name Description Size Notation
MC146 Medtronic Sterile Stents; Carotid Self Expanding Stainless Steel Carotid Stent - Nitinol, Stainless Bridge Assurant Stents - Diameter (6mm-
Stent Delivery System; Bridge SE-Self Expanding Steel Flexible Iliac Bridge Stents, Stainless Steel 10mm), Length (20mm-60mm); Bridge X3
Stents, Bridge Assurant Stents, Bridge X3 Stents, Extra Support Renal Plus Bridge Stent or S/Steel Stents - Diameter (5mm-7mm), Length
Bridge Stents, Aurora Stents; Exponent RX Self Bridge - Nitinol, Stainless Steel Bridge Assurant (17mm); Bridge Stents - Diameter (5mm-
Expanding Carotid Stent System Stents, Stainless Steel Bridge X3 Stents, Stainless 7mm), Length (9mm-16mm); Bridge SE
Steel Bridge Stents, Aurora Stents - Nitinol; Stents - Diameter (6mm-10mm), Length
Exponent RX Self Expanding Carotid Stent System (20mm-80mm); Aurora Stents - Diameter
(6mm-10mm), Length (20mm - 80mm);
Exponent RX Self Expanding Caraotid Stent
System - Diameter (6mm - 10mm), Length
(20mm - 40mm)
MC147 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Bifurcated System. 22-32 x 12-16 x 145mm, 20-36 x 10-20 x
Nitinol / Polyester or Talent Endoluminal stent-graft 155-170mm
system Aorto Uni Iliac
MC148 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Bifurcated System. 18-36 x 8-18 x 140-170mm
Nitinol / Polyester
MC150 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Bifurcated System. 16-50mm
Nitinol / Polyester, FreeFlow / Open Web.
Custom Sizing
MC152 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Straight Abdominal 50-180mm
Aortic Custom System. Nitinol / Polyester,
FreeFlow/Open Web. Custom Sizing
MC153 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Aorto-Unilliac 16-50mm
Tapered Custom System. Nitinol / Polyester.
MC155 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Descending 50-180mm
Thoracic Aortic Custom System. Nitinol /
Polyester, FreeFlow / Open Web. Custom Sizing
MC157 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Trombone Aortic 16-50mm
Custom System. Nitinol / Polyester. Free Flo/Open
Web. Custom Sizing
MC158 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 18 - 36mm x 28 - 32mm long (60mm)
Polyester
MC159 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 26 - 46mm x 80 - 90mm
Polyester; Talent Endoluminal Stent Graft System
FreeFlow, Open Web. Nitinol / Polyester
MC160 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 8-26mm x 75-200mm
Polyester. Open Web
MC164 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 11-12cm
Polyester. Open-web.
Prostheses List by Category, Groups and Sponsor Page 649 of 653
VASCULAR
Billing Code Product Name Description Size Notation
MC165 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 13-14cm
Polyester. Open-web.
MC166 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 5-6cm
Polyester. One bare spring.
MC167 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 7-8cm
Polyester. One bare spring.
MC168 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 9-10cm
Polyester. One bare spring.
MC169 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 11-12cm
Polyester. One bare spring.
MC170 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 5-6cm
Polyester. Two bare spring.
MC171 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 7-8cm
Polyester. Two bare spring.
MC172 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 9-10cm
Polyester. Two bare spring.
MC173 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System Nitinol / 11-12cm
Polyester. Two bare spring.
MC199 Talent Occluder System Nitinol stents attached to polyester graft sealed both Custom Sizes ranging from 5 - 20mm x 25 -
MC203 Talent Occluder System Nitinol stents attached to polyester graft sealed both Standard Sizes, 8 - 24mm x 31 - 35mm
MC205 Cerebrence Over-the-Wire Neurovascular Stent Stainless Steel 2.5-4mm x 6-25mm
MC206 Medtronic Aust Stents Sterile Talent thoracic stent graft system, FreeFlow / 22-46mm x 22-46mm x 130mm
Open Web, bare spring, nitinol/polyester
Pacing Importers Pty Ltd
PI004 Stentself Stent Phynox construction, adapted sizes & diameters Dia 5 - 9mm Length: 20 - 100mm
Terumo Corporation Australia
TU002 Anaconda Endovascular Graft System Bifurcated Aortic System, Polyester/Nitinol 18 - 32mm
TU003 Anaconda Endovascular Graft System Aortic Extension Cuff, Polyester/Nitinol 18 - 32mm
TU004 Anaconda Endovascular Graft System Iliac Extension Cuff, Polyester/Nitinol 8 - 16mm
TU005 Anaconda Endovascular Graft System Iliac Leg, Polyester/Nitinol 8 - 16mm
W L Gore & Associates
GT024 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Trunk - 23-28.5mm Diameter, 14-18cm Length
Ipsilateral Leg
Prostheses List by Category, Groups and Sponsor Page 650 of 653
VASCULAR
Billing Code Product Name Description Size Notation
GT029 Gore Tips Endoprosthesis ePTFE 8-12mm Diameter 4-8cm Graft-Lined Length
2cm Unlined Length
GT188 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Diameter 12 - 14.5mm x 10 x 14cm Length
Contralateral Leg
GT189 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Aortic Diameter 23 - 28.5mm, Length 3.3cm
Extender
GT190 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Iliac Diameter 10 - 14.5mm, Length 7cm
GT191 Excluder Endovascular Prostheses Thoracic Stent Graft Nitinol & ePTFE Diameter 26-40mm x 10cm Length
William A Cook Aust Pty Ltd
WC041 Zenith AAA Endovascular Graft - Custom Craft AAA Bifurcate Graft Neck 20-32mm Length 74-276mm
WC042 Zenith AAA Endovascular Graft - Custom Craft AAA Aorto Uni Iliac (AUI) Graft Neck 20-32mm Length 74-276mm
WC045 Cook H & L-B - Endostent Converter Diameter 20 thru 36 Length 80-85
WC047 Cook H & L-B - Endostent Leg Extensions Diameter 18 thru 24 Length 55
WC048 Cook H & L-B - Endostent Body Extensions Diameter 22 thru 36
WC049 Cook H & L-B - Endostent - Tri-Fab Body Extension Diameter 22-32 mm Length 112-239mm
WC051 Cook H & L-B - Endostent - Tri-Fab Leg Extension Diameter 10-12 Length 36-71
WC052 Zenith AAA Endovascular Graft - Tri-fab AAA Tri-fab Graft Neck 22-32mm Length 112-239mm
WC055 Peripheral Vascular Stent (ZA Stent); Zilver Stent Vascular Stent Introducer Catheter Length 60 - 80 cm,
Diameter 6 - 10 mm, Length 1 - 8cm
WC168 Zilver Stent Vascular Design Zilver 5 & 6 5fr and 6fr - 80cm and 120cm , 5mm to
12mm diameter, 2cm to 8cm length
WC175 Cook Z Stent Gianturco Vena Caval and Venous Design Double Stent - 20, 30, 40mm Diameters,
50mm Length
WC176 Cook Z Stent Gianturco Vena Caval and Venous Design Triple Stent - 20, 30, 40mm Diameters,
75mm Length
WC189 Cook Z Stent Gianturco Vena Caval and Venous Design Single Stent - 15, 20, 30mm diameters; 25mm
length
Prostheses List by Category, Groups and Sponsor Page 651 of 653
VASCULAR
Billing Code Product Name Description Size Notation
Stents, Vascular, Peripheral
Johnson & Johnson Medical Pty Ltd
JJ479 PALMAZ GENESIS on CORDIS AMIIA RX .014 Peripheral balloon expandable stent and rapid Lengths: 12, 15, 18, 24mm. Diameter: 4, 4.5,
Delivery System exchange delivery system 5, 5.5, 6, 6.5, 7mm
Suture Units, Automatic
Abbott Australasia Pty Ltd
AY016 Perclose Arterial Support and Closure System Suture to close femoral artery puncture sites Closer S - 6-8Fr, Perclose AT - 6-8Fr,
following diagnostic and interventional procedures Prostar 8Fr, Prostar 10Fr
AY017 Starclose 6 Fr Exchange Sheath, Dilator, Guidewire, 6 Fr
implantable nitinol clip pre-mounted on a Clip Applier
Tissue Reconstructive Materials, Solid
W L Gore & Associates
GT012 Soft Tissue Patch ePTFE 1mm Thickness 5 x 10cm
GT013 Soft Tissue Patch ePTFE 1mm Thickness 10 x 15cm
GT014 Soft Tissue Patch ePTFE 1mm Thickness 15 x 20cm
GT015 Soft Tissue Patch ePTFE 1mm Thickness 20 x 30cm
GT016 Soft Tissue Patch ePTFE 2mm Thickness 5 x 10cm
GT017 Soft Tissue Patch ePTFE 2mm Thickness 10 x 15cm
GT018 Soft Tissue Patch ePTFE 2mm Thickness 15 x 20cm
GT019 Soft Tissue Patch ePTFE 2mm Thickness 20 x 30cm
Prostheses List by Category, Groups and Sponsor Page 652 of 653
VASCULAR
Billing Code Product Name Description Size Notation
Vascular Prostheses, Human or Animal Origin
Bio Nova International Pty Ltd
BN006 Omniflow II Vascular Prosthesis - Curved AV Access One size only
BN007 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 5cm x 10cm
BN008 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 10cm x 15cm
BN009 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 15cm x 20cm
BN010 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 20cm x 30cm
Grand Total: 9279 Records
Prostheses List by Category, Groups and Sponsor Page 653 of 653
PART B - Human Tissues August 2005
CARDIO-THORACIC
Billing Code Facility Benefit
Aortic Valved Conduit Patch
QHV09 Queensland Heart Valve Bank $4,706.00
Heart Valve - Aortic
QHV01 Queensland Heart Valve Bank $4,706.00
RPH01 Royal Perth Hospital $3,833.00
SHV01 Sydney Heart Valve Bank, Darlinghurst NSW $5,350.00
TBV01 Donor Tissue Bank of Victoria $5,663.00
Heart Valve - Pulmonary
QHV02 Queensland Heart Valve Bank $4,706.00
RPH02 Royal Perth Hospital $3,833.00
SHV02 Sydney Heart Valve Bank, Darlinghurst NSW $5,350.00
TBV02 Donor Tissue Bank of Victoria $5,663.00
Mitral Valve Patch
QHV03 Queensland Heart Valve Bank $985.00
Pericardium
TBV50 Donor Tissue Bank of Victoria $421.00
Pericardium Patch
QHV05 Queensland Heart Valve Bank $985.00
Pulmonary Conduit
TBV03 Donor Tissue Bank of Victoria $869.00
Pulmonary Conduit - Large
QHV07 Queensland Heart Valve Bank $985.00
Pulmonary Conduit - Small
QHV06 Queensland Heart Valve Bank $985.00
Pulmonary Valved Conduit For Patch use
QHV08 Queensland Heart Valve Bank $4,706.00
Tricuspid Valve Patch
QHV04 Queensland Heart Valve Bank $985.00
Page 1 of 14
OPHTHALMIC
Billing Code Facility Benefit
Cornea
LEM01 Lions Eye Bank - Melbourne $1,300.00
LEN01 Lions NSW Eye Bank $1,000.00
LEW01 The Lions Eye Bank of WA $1,000.00
QEB01 Queensland Eye Bank $850.00
SAE01 The Eye Bank of SA $840.00
TBV04 Donor Tissue Bank of Victoria $800.00
Cornea For Lamellar
LEN03 Lions NSW Eye Bank $600.00
Cornea for Sclera
LEM02 Lions Eye Bank - Melbourne $150.00
LEN02 Lions NSW Eye Bank $150.00
SAE02 The Eye Bank of SA $60.00
Sclera
QEB02 Queensland Eye Bank $150.00
Sclera (white outer coating of the eyeball)
LEW02 The Lions Eye Bank of WA $100.00
Page 2 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
Achilles Tendon
NBB01 New South Wales Bone Bank $450.00
QBB01 Queensland Bone Bank $1,560.00
TBV05 Donor Tissue Bank of Victoria $864.00
Achilles Tendon with Bone Plug
NBB02 New South Wales Bone Bank $1,015.00
PBT01 Perth Bone & Tissue Bank $1,900.00
TBV06 Donor Tissue Bank of Victoria $1,760.00
Anterior Cruciate Ligament Unit
PBT02 Perth Bone & Tissue Bank $1,600.00
Anterior Tibialis Tendon
PBT46 Perth Bone & Tissue Bank $1,300.00
Autologous Chondrocyte Transplantation
VAP01 Verigen Australia Pty Ltd $9,556.00
Autologous Chondrocytes
MVS22 Institute of Medical & Veterinary Science, SA $9,538.00
VAP03 Verigen Australia Pty Ltd $2,593.00
Autologous Chrondocytes
MUA01 Monash University, Dept of Surgery, Alfred Hospital, Tissue Culture Laboratory $8,694.43
Bone - Chips/cubes 40cc
TBV09 Donor Tissue Bank of Victoria $836.00
Bone - Chips/cubes 80cc
TBV10 Donor Tissue Bank of Victoria $1,590.00
Bone Plug/Dowel - Cancellous
PBT03 Perth Bone & Tissue Bank $275.00
TBV07 Donor Tissue Bank of Victoria $583.00
Bone Plug/Dowel - Tricortical
PBT04 Perth Bone & Tissue Bank $280.00
TBV08 Donor Tissue Bank of Victoria $643.00
Cartilage (costal) segments
Page 3 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
PBT11 Perth Bone & Tissue Bank $300.00
QBB12 Queensland Bone Bank $200.00
TBV17 Donor Tissue Bank of Victoria $335.00
Cartogen, Autologous - Cultured Cartilage
MTE01 Mercy Tissue Engineering Pty Ltd $9,996.00
Cortical Struts (Freeze Dried) 1 strut
QBB02 Queensland Bone Bank $600.00
Cortical Struts (1 strut)
TBV14 Donor Tissue Bank of Victoria $655.00
Cortical Struts (2 struts)
TBV13 Donor Tissue Bank of Victoria $1,310.00
Cortical Struts >15cm
PBT07 Perth Bone & Tissue Bank $1,700.00
Cortical Struts 10-15cm
PBT06 Perth Bone & Tissue Bank $1,350.00
Cortico - Cancellous Freeze Dried 20g
QBB03 Queensland Bone Bank $1,740.00
Cortico-Cancellous Strips
PBT05 Perth Bone & Tissue Bank $700.00
Disc - Freeze Dried
QBB04 Queensland Bone Bank $650.00
Dowel Plug
NBB05 New South Wales Bone Bank $797.00
PBT12 Perth Bone & Tissue Bank $450.00
QBB13 Queensland Bone Bank $1,080.00
Elbow - joint
QBB14 Queensland Bone Bank $2,100.00
TBV18 Donor Tissue Bank of Victoria $4,710.00
Fascia Lata
TBV21 Donor Tissue Bank of Victoria $578.00
Page 4 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
Fascia Lata - Large (15cm x 10cm)
PBT15 Perth Bone & Tissue Bank $1,300.00
Fascia Lata - Small (>10cm x >5cm)
NBB09 New South Wales Bone Bank $464.00
Fascia Lata - Small (10cm x 5cm)
PBT16 Perth Bone & Tissue Bank $800.00
Fascia Lata (per sq cm)
QBB11 Queensland Bone Bank $5.00
Fascia Lata (per squared cm)
NBB08 New South Wales Bone Bank $3.00
Femoral Condyle
PBT21 Perth Bone & Tissue Bank $1,700.00
Femoral Head
ACT01 ACT Bone Bank $1,591.00
APH01 The Avenue Private Hospital Prahan Victoria $1,131.00
CSA01 Central Sydney Area Health t/a Rachel Forster Bone Bank $802.00
DHR01 The Douglas Hocking Research Institute - Bone Bank $1,060.00
HBB01 The Hobart Private Hospital Bone Bank $1,400.00
LPH01 Lingard Private Hospital $1,103.00
MMH01 Mater Misericordiae Hospital North Sydney $400.00
MVS05 Institute of Medical & Veterinary Science, SA $1,595.00
NBB16 New South Wales Bone Bank $1,483.00
PBT22 Perth Bone & Tissue Bank $1,700.00
QBB27 Queensland Bone Bank $1,775.00
RNB01 The Royal Newcastle Hospital Bone Bank $1,619.00
SVN01 St Vincent's Private Hospital (NSW) $731.00
TBV26 Donor Tissue Bank of Victoria $1,683.00
Femoral Head - Half (Freeze Dried)
QBB29 Queensland Bone Bank $500.00
Femoral Head - Portion
Page 5 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
PBT23 Perth Bone & Tissue Bank $450.00
Femoral Head - Whole (Freeze Dried)
QBB28 Queensland Bone Bank $800.00
Femoral Rings
NBB17 New South Wales Bone Bank $362.50
PBT24 Perth Bone & Tissue Bank $1,400.00
QBB30 Queensland Bone Bank $1,260.00
Femoral Rings - (Freeze Dried)
QBB31 Queensland Bone Bank $650.00
Femoral/Tibial Cortical Strut > 20CM
PBT48 Perth Bone & Tissue Bank $1,900.00
Femur - > 15cm
QBB19 Queensland Bone Bank $1,460.00
Femur - Cortical Portions < 15cm
QBB17 Queensland Bone Bank $1,560.00
Femur - Cortical portions> 1/3
QBB18 Queensland Bone Bank $1,100.00
Femur - Distal (Shaft & Condyles)
MVS02 Institute of Medical & Veterinary Science, SA $2,290.00
PBT17 Perth Bone & Tissue Bank $2,600.00
TBV22 Donor Tissue Bank of Victoria $2,736.00
Femur - Distal Half
NBB10 New South Wales Bone Bank $2,030.00
Femur - Distal half > 15cm
QBB20 Queensland Bone Bank $2,370.00
Femur - Distal third
NBB11 New South Wales Bone Bank $1,100.00
Femur - Distal third < 15cm
QBB21 Queensland Bone Bank $2,270.00
Femur - Entire
Page 6 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
MVS03 Institute of Medical & Veterinary Science, SA $2,290.00
NBB12 New South Wales Bone Bank $3,915.00
PBT18 Perth Bone & Tissue Bank $4,600.00
QBB22 Queensland Bone Bank $3,685.00
TBV23 Donor Tissue Bank of Victoria $5,539.00
Femur - Middle third
NBB13 New South Wales Bone Bank $1,100.00
PBT19 Perth Bone & Tissue Bank $2,200.00
QBB23 Queensland Bone Bank $1,865.00
TBV24 Donor Tissue Bank of Victoria $1,804.00
Femur - Proximal (shaft,trochanter, neck)
PBT20 Perth Bone & Tissue Bank $2,600.00
TBV25 Donor Tissue Bank of Victoria $2,736.00
Femur - Proximal (shaft & trachanter, neck)
MVS04 Institute of Medical & Veterinary Science, SA $2,290.00
Femur - Proximal half
NBB15 New South Wales Bone Bank $1,740.00
Femur - Proximal half > 15cm
QBB25 Queensland Bone Bank $2,570.00
Femur - Proximal third
NBB14 New South Wales Bone Bank $1,000.00
Femur - Proximal third < 15cm
QBB24 Queensland Bone Bank $2,120.00
Femur - Trochanter Milled
QBB26 Queensland Bone Bank $800.00
Femur- 1 Condyle only
TBV46 Donor Tissue Bank of Victoria $1,018.00
Femur-Proximal(Shaft, trochanter, neck and head)
TBV51 Donor Tissue Bank of Victoria $3,185.00
Fibula - Entire
Page 7 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
MVS07 Institute of Medical & Veterinary Science, SA $2,290.00
NBB18 New South Wales Bone Bank $2,610.00
PBT25 Perth Bone & Tissue Bank $1,950.00
QBB32 Queensland Bone Bank $2,220.00
TBV27 Donor Tissue Bank of Victoria $5,775.00
Fibula - Segment (12cm)
MVS14 Institute of Medical & Veterinary Science, SA $2,290.00
NBB20 New South Wales Bone Bank $450.00
PBT27 Perth Bone & Tissue Bank $500.00
TBV29 Donor Tissue Bank of Victoria $891.00
Fibula - Segment (6cm)
MVS13 Institute of Medical & Veterinary Science, SA $2,290.00
NBB19 New South Wales Bone Bank $300.00
PBT26 Perth Bone & Tissue Bank $275.00
TBV28 Donor Tissue Bank of Victoria $583.00
Fibula - Shaft
PBT28 Perth Bone & Tissue Bank $1,000.00
TBV30 Donor Tissue Bank of Victoria $1,881.00
Fibular Strut < 10cm:
QBB06 Queensland Bone Bank $1,210.00
Fibular Strut > 10cm:
QBB07 Queensland Bone Bank $1,335.00
Freeze Dried Milled Bone <30gm
PBT37 Perth Bone & Tissue Bank $750.00
Freeze Dried Milled Bone 30 - 50gm
PBT38 Perth Bone & Tissue Bank $900.00
Freeze-dried Cancellous Cubes (6)
QBB09 Queensland Bone Bank $1,335.00
Freeze-Dried Cancellous Strips (2)
QBB10 Queensland Bone Bank $650.00
Page 8 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
Hemipelvis - Acetabulum
NBB21 New South Wales Bone Bank $2,030.00
PBT29 Perth Bone & Tissue Bank $2,400.00
QBB33 Queensland Bone Bank $2,320.00
TBV31 Donor Tissue Bank of Victoria $2,568.00
Hemipelvis - Complete
MVS08 Institute of Medical & Veterinary Science, SA $2,290.00
NBB24 New South Wales Bone Bank $3,480.00
PBT30 Perth Bone & Tissue Bank $4,500.00
QBB37 Queensland Bone Bank $3,685.00
TBV32 Donor Tissue Bank of Victoria $5,825.00
Hemipelvis - IIliac crest
NBB22 New South Wales Bone Bank $1,450.00
PBT31 Perth Bone & Tissue Bank $1,100.00
QBB34 Queensland Bone Bank $2,060.00
TBV33 Donor Tissue Bank of Victoria $2,321.00
Hemipelvis - Tricortical wedge
QBB35 Queensland Bone Bank $1,005.00
Hemipelvis - Tricortical wedge (Freeze Dried)
QBB36 Queensland Bone Bank $700.00
Hemipelvis -Tricortical iliac wedge
NBB23 New South Wales Bone Bank $580.00
PBT32 Perth Bone & Tissue Bank $600.00
TBV34 Donor Tissue Bank of Victoria $880.00
Humeral head
PBT36 Perth Bone & Tissue Bank $500.00
QBB44 Queensland Bone Bank $1,350.00
TBV37 Donor Tissue Bank of Victoria $1,419.00
Humeral Head Addition
NBB26 New South Wales Bone Bank $1,189.00
Page 9 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
Humerus - Cortical portions/blocks < 10cm
QBB38 Queensland Bone Bank $1,110.00
Humerus - Cortical portions/blocks > 10cm
QBB39 Queensland Bone Bank $1,330.00
Humerus - Distal
MVS19 Institute of Medical & Veterinary Science, SA $2,290.00
TBV49 Donor Tissue Bank of Victoria $1,892.00
Humerus - Distal half
NBB25 New South Wales Bone Bank $1,200.00
Humerus - Entire
MVS20 Institute of Medical & Veterinary Science, SA $2,290.00
NBB29 New South Wales Bone Bank $2,610.00
QBB43 Queensland Bone Bank $2,570.00
Humerus - Proximal half
NBB27 New South Wales Bone Bank $1,595.00
QBB40 Queensland Bone Bank $1,260.00
Humerus - Proximal half with rotator cuff
NBB28 New South Wales Bone Bank $1,885.00
QBB41 Queensland Bone Bank $2,245.00
Humerus - Proximal with rotator cuff
MVS09 Institute of Medical & Veterinary Science, SA $2,290.00
PBT34 Perth Bone & Tissue Bank $2,500.00
TBV35 Donor Tissue Bank of Victoria $2,233.00
Humerus - Proximal w'out rotator cuff
PBT35 Perth Bone & Tissue Bank $1,100.00
QBB42 Queensland Bone Bank $1,260.00
TBV36 Donor Tissue Bank of Victoria $1,980.00
Humerus - Whole
PBT33 Perth Bone & Tissue Bank $3,000.00
Humerus - Whole with rotator cuff
Page 10 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
NBB30 New South Wales Bone Bank $2,827.50
Matrix and Autologous Chondrocytes Implant
ORT01 Orthogen Australia Pty Ltd $11,400.00
Medial Ligament
NBB31 New South Wales Bone Bank $797.50
TBV38 Donor Tissue Bank of Victoria $1,529.00
Meniscal Graft
PBT47 Perth Bone & Tissue Bank $1,800.00
Meniscus
QBB05 Queensland Bone Bank $1,160.00
Meniscus with Ligaments
TBV39 Donor Tissue Bank of Victoria $1,842.00
Meniscus without Ligaments
TBV40 Donor Tissue Bank of Victoria $1,000.00
Milled Bone - 30gm
NBB03 New South Wales Bone Bank $435.00
Milled Bone - 40cc
TBV11 Donor Tissue Bank of Victoria $1,000.00
Milled Bone - 60gm
NBB04 New South Wales Bone Bank $725.00
Milled Bone - 80cc
TBV12 Donor Tissue Bank of Victoria $1,788.00
Milled Bone (60cc)
QBB45 Queensland Bone Bank $1,675.00
Milled Bone (60g max)
QBB46 Queensland Bone Bank $1,200.00
Milled Bone <30gr
PBT08 Perth Bone & Tissue Bank $1,350.00
Milled Bone >50gr
Page 11 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
PBT10 Perth Bone & Tissue Bank $2,000.00
Milled Bone 30 - 50gr
PBT09 Perth Bone & Tissue Bank $1,800.00
Milled Bone 40cc
TBV15 Donor Tissue Bank of Victoria $760.00
Milled Bone 80cc
TBV16 Donor Tissue Bank of Victoria $1,445.00
Patella
NBB32 New South Wales Bone Bank $450.00
QBB47 Queensland Bone Bank $750.00
TBV41 Donor Tissue Bank of Victoria $875.00
Patella Half
PBT39 Perth Bone & Tissue Bank $275.00
Patella tendon
QBB48 Queensland Bone Bank $1,715.00
Patella Tendon and Patella
PBT40 Perth Bone & Tissue Bank $1,900.00
TBV42 Donor Tissue Bank of Victoria $1,842.00
Patella tendon with Bone Plugs
NBB33 New South Wales Bone Bank $1,305.00
Primary MACI plus 1/2
VAP02 Verigen Australia Pty Ltd $10,891.00
Proximal Third Tibia with - Patella Tendon
QBB08 Queensland Bone Bank $2,370.00
Radius
MVS18 Institute of Medical & Veterinary Science, SA $2,290.00
NBB06 New South Wales Bone Bank $2,175.00
PBT13 Perth Bone & Tissue Bank $1,800.00
QBB15 Queensland Bone Bank $1,865.00
TBV19 Donor Tissue Bank of Victoria $2,673.00
Page 12 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
Rib (5cm)
MVS21 Institute of Medical & Veterinary Science, SA $382.00
PBT41 Perth Bone & Tissue Bank $300.00
TBV43 Donor Tissue Bank of Victoria $418.00
Scaphoid
QBB49 Queensland Bone Bank $900.00
Tibia - Condyles only
TBV47 Donor Tissue Bank of Victoria $1,425.00
Tibia - Cortical < 15cm
QBB50 Queensland Bone Bank $1,275.00
Tibia - Cortical > 15 cm
QBB51 Queensland Bone Bank $1,560.00
Tibia - Distal
MVS17 Institute of Medical & Veterinary Science, SA $2,290.00
TBV48 Donor Tissue Bank of Victoria $1,837.00
Tibia - Middle third seg
NBB34 New South Wales Bone Bank $1,000.00
PBT43 Perth Bone & Tissue Bank $1,100.00
QBB53 Queensland Bone Bank $900.00
Tibia - Plateau (prox 1/3)
NBB35 New South Wales Bone Bank $1,595.00
Tibia - Proximal third < 15cm
QBB54 Queensland Bone Bank $2,065.00
Tibia - Proximal: without Patella
PBT45 Perth Bone & Tissue Bank $1,100.00
Tibia - Proximal: 16-25cm
TBV45 Donor Tissue Bank of Victoria $2,118.00
Tibia - Proximal: 7-15cm
TBV44 Donor Tissue Bank of Victoria $1,832.00
Tibia - Proximal: half
Page 13 of 14
ORTHOPAEDIC
Billing Code Facility Benefit
MVS11 Institute of Medical & Veterinary Science, SA $2,290.00
NBB36 New South Wales Bone Bank $1,885.00
Tibia - Proximal: with Patella & Tendon
PBT44 Perth Bone & Tissue Bank $1,900.00
Tibia - Strut
PBT42 Perth Bone & Tissue Bank $700.00
QBB52 Queensland Bone Bank $400.00
Tibia - Whole
MVS16 Institute of Medical & Veterinary Science, SA $2,290.00
NBB37 New South Wales Bone Bank $3,480.00
QBB55 Queensland Bone Bank $3,685.00
Ulna
MVS15 Institute of Medical & Veterinary Science, SA $2,290.00
NBB07 New South Wales Bone Bank $2,175.00
PBT14 Perth Bone & Tissue Bank $1,500.00
QBB16 Queensland Bone Bank $1,865.00
TBV20 Donor Tissue Bank of Victoria $2,464.00
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