Private Health Insurance (Prostheses) Amendment Rules 2013 (No. 4) (Cth)

Private Health Insurance (Prostheses) Amendment Rules 2013 (No. 4)

I, Lyndall Moore, delegate of the Minister for Health, make these Rules under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007. 

Dated    25 October    2013

Lyndall Moore

Lyndall Moore

Acting Assistant Secretary

Private Health Insurance Branch

Medical Benefits Division

Department of Health

Contents

PART 1                  PRELIMINARY

1.           Name of Rules

2.           Commencement

3.   Authority   3

4.           Schedules

SCHEDULE – AMENDMENTS        4

Part 1        Preliminary

1. Name of Rules

These Rules are the Private Health Insurance (Prostheses) Amendment Rules 2013

(No. 4).

1. Commencement

These Rules commence on 8 November 2013.

1. Authority

These Rules are made under the Private Health Insurance Act 2007.

1. Schedules

Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.  

Schedule – Amendments

Private Health Insurance (Prostheses) Rules 2013 (No. 1)

1       Schedule, Part A, Subgroup 10.2.5.2 - Multiple Branch, entry for billing code WC312

delete contents of columns headed “Description” and “Size”.

insert the contents of item 1 of the table in the columns indicated:

Item	Description	Size
1	The Zenith Universal Distal Body Endovascular Graft  (Unibody) consists of a bifurcated graft loaded into the H&L-B One-Shot delivery system	Diameters: 22 – 24mm Lengths: 81 – 32mm

2       Schedule, Part A, Subgroup 13.11.1.2 - Lumbar, after entry for billing code MC585

insert the subheading “Orthotech Pty Ltd”.

under that subheading insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum benefit
1	OH467	LP-ESP Intervertebral Disc Prosthesis	Lumbar disc prosthesis	10-12mm thickness, 7/9/11 degrees	$9,550.00

3       Schedule, Part A, Subgroup 6.3.11.12 - Frame Component – Coupling Device, after entry for billing code SY091

delete the subheading:

3D

Stryker Australia Pty Ltd

delete the contents of item 1 of the table from the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum benefit
1	HW517	HOFFMANN3 EXTERNAL FIXATION SYSTEM	MULTIPLANAR CLAMP PIN/ROD-ROD	STANDARD	$770.00

4       Schedule, Part A, Subgroup 6.3.11.14 - Frame Component – Pins, after entry for billing code ST884

delete the subheading “Standard”.

5       Schedule, Part A, Subgroup 6.3.11.3 - Frame Component - Monoplanar, Clamp, after entry for billing code SN966

insert the subheading:

3D

Stryker Australia Pty Ltd

under that subheading insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum benefit
1	HW517	HOFFMANN3 EXTERNAL FIXATION SYSTEM	MULTIPLANAR CLAMP PIN/ROD-ROD	STANDARD	$1,662.00

6       Schedule, Part A, Subgroup 6.3.3.39 – Periarticular anatomic – Tibia ≥7 to ≤15 holes, after entry for billing code BH309

insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum benefit
1	BH287	ALPS Anatomic Locked plating system	Distal and Proximal Tibial Plates, Titanium	7 to 15 holes	$1,574.00

7       Schedule, Part A, Subgroup 6.3.4.6 – Screw Washers, after entry for billing code BH280

insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum benefit
1	BH286	ALPS LFS	Flat and cupped Titanium washers	4.5-6.5mm	$103.00

8       Schedule, Part A, Group 14: Intramedullary Nails, after entry for billing code BH357

insert the subheading:

Group 14d: Other

Biomet Australia Pty Ltd

under that subheading insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum benefit	Maximum Benefit
1	BH264	Small Bone Fixation System – Small Bone Flexible Nail	Intramedullary Nail	1.6mm and 1.1mm	$700.00	$950.00

9       Schedule, Part B, Orthopaedic, after entry for billing code TBV54

insert the subheading “Bone - Demineralised Bone Matrix, DBX Putty, 5cc”

under that subheading insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Facility	Minimum benefit
1	SYN01	Synthes Australia Pty Ltd	$2,650.00

10     Schedule, Part B, Orthopaedic, above subheading “Bone – Milled <30g Freeze Dried”

insert the subheading “Bone - Demineralised Bone Matrix, DBX Putty, 10cc”

under that subheading insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Product	Minimum benefit
1	SYN02	Synthes Australia Pty Ltd	$3,400.00

11     Schedule, Part B, Dermatologic, after entry for QBB71,

insert the subheading “Skin < 25cm² - acellular dermal matrix allograft from human origin”

under that subheading insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Product	Minimum benefit
1	SYN03	Synthes Australia Pty Ltd	$2,200.00

12     Schedule, Part B, Dermatologic, after entry for SYN03

insert the subheading “Skin 26 to 60cm² - acellular dermal matrix allograft from human origin”

under that subheading insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Product	Minimum benefit
1	SYN04	Synthes Australia Pty Ltd	$3,500.00

13     Schedule, Part B, Dermatologic, after entry for SYN04

insert the subheading “Skin 61 to 120cm² - acellular dermal matrix allograft from human origin”

under that subheading insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Product	Minimum benefit
1	SYN05	Synthes Australia Pty Ltd	$5,700.00

14     Schedule, Part B, Dermatologic, after entry for SYN05

insert the subheading “Skin 121 to 300cm² - acellular dermal matrix allograft from human origin”

under that subheading insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Product	Minimum benefit
1	SYN06	Synthes Australia Pty Ltd	$14,000.00

15     Schedule, Part B, Dermatologic, after entry for SYN06

insert the subheading “Skin > 300cm² - acellular dermal matrix allograft from human origin”

under that subheading insert the contents of item 1 of the table in the columns indicated:

Item	Billing Code	Product	Minimum benefit
1	SYN07	Synthes Australia Pty Ltd	$27,000.00

16     Further amendments – Schedule, Part A, billing codes BI286, BI287 and BI264

delete the contents of items 1 to 3 of the table from the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum benefit
1	BI286	Uniflex Tibial Nail	Tibial Nail, Titanium	8-14mm x 240-420mm	$1,335.00
2	BI287	Uniflex Tibial Nail	Tibial Nail Transverse Screw,	4.0, 5.0mm x (20-70mm)	$209.00
3	BI264	EBI XFIX Dynafix System	Distal Radius Fixator, Dimension, Stainless Steel, Aluminium	One size Only	$2,150.00

17     Further amendments – Schedule, Part A, minimum benefits

The entries in the column headed “Minimum benefit” for the billing codes listed in items 1 to 10 of the table are amended as set out in the table:

Item	Billing Code	Delete	Insert
1	BS082	$412.00	$145.00
2	MH014	$412.00	$145.00
3	MH015	$412.00	$145.00
4	BS171	$412.00	$145.00
5	OL009	$412.00	$145.00
6	WC213	$412.00	$145.00
7	OL010	$412.00	$145.00
8	ST884	$135.00	$149.00
9	BR005	$36,900.00	$19,250.00
10	BR006	$19,250.00	$5,775.00

18     Further amendments – Schedule, Part B, minimum benefits

The entries in the column headed “Minimum benefit” for the billing codes listed in items 1 to 3 of the table are amended as set out in the table:

Item	Billing Code	Delete	Insert
1	SHV01	$5,350.00	$6,842.00
2	SHV02	$5,350.00	$6,842.00
3	SHV03	$987.00	$1,263.00