Private Health Insurance (Prostheses) Amendment Rules 2016 (No. 1) (Cth)
Private Health Insurance (Prostheses) Amendment Rules 2016 (No. 1)
I, Tracey Duffy, 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 12 May 2016
Tracey Duffy
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
Name of Rules
These Rules are the Private Health Insurance (Prostheses) Amendment Rules 2016 (No. 1).
Commencement
These Rules commence on 2 June 2016.
Authority
These Rules are made under the Private Health Insurance Act 2007.
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Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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 2016 (No. 2)
Schedule, Part A, SubGroup 03.08.07.03 – 401-600cm2, entry for Billing Code KC005
delete the contents of Item 1 of the table from the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 KC005 Strattice Reconstructive Tissue Strattice reconstructive Tissue Matrix is a biologic, surgical implant made from porcine dermis. It is intended for use as a soft tissue patch to reinforce soft tissue where weakness exists and for the surgical repair of of damaged or ruptured soft tissue membranes. Indications for use include breast reconstruction and repair of hernias. 401 – 550cm2 $3,450.00
insert the contents of Item 1 of the table in the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 KC005 Strattice Reconstructive Tissue Matrix Strattice reconstructive Tissue Matrix is a biologic, surgical implant made from porcine dermis. It is intended for use as a soft tissue patch to reinforce soft tissue where weakness exists and for the surgical repair of damaged or ruptured soft tissue membranes. Indications for use include breast reconstruction and repair of hernias. 401 – 600cm2 $3,450.00
Schedule, Part A, SubGroup 03.08.07.04 – 601-800cm², entry for Billing Code KC006
delete the contents of Item 1 of the table from the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 KC006 Strattice Reconstructive Tissue Strattice reconstructive Tissue Matrix is a biologic, surgical implant made from porcine dermis. It is intended for use as a soft tissue patch to reinforce soft tissue where weakness exists and for the surgical repair of of damaged or ruptured soft tissue membranes. Indications for use include breast reconstruction and repair of hernias. 551 – 800 cm2 $4,500.00
insert the contents of Item 1 of the table in the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 KC006 Strattice Reconstructive Tissue Matrix Strattice reconstructive Tissue Matrix is a biologic, surgical implant made from porcine dermis. It is intended for use as a soft tissue patch to reinforce soft tissue where weakness exists and for the surgical repair of damaged or ruptured soft tissue membranes. Indications for use include breast reconstruction and repair of hernias. 601 – 800cm² $4,500.00
Schedule, Part A, SubGroup 06.03.01.02 - Femoral, Proximal long (≥220mm), before subheading “Austofix”
insert the subheading “Allegra Orthopaedics 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 AE260 Fixion Classic Femoral or Interlocking Nails An expandable self-locking intra medullary nailing system. Classic Nail: Reduced Diameter 10-12mm, Expanded Diameter 16-19mm, Length 300-440mm
Interlocking Nail: Reduced Diameter 10mm, Expanded Diameter 16mm, Length 220-340mm$1,442.00
Schedule, Part A, SubGroup 06.03.04.01 - Standard ( ≥4.5mm), before subheading “Biomet Australia Pty Ltd”
insert the subheading “Allegra Orthopaedics 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 AE261 Fixion Femoral Interlocking Screws 6.0mm Proximal Interlocking screw Diameter 6mm, Length 50-90mm $72.00
Schedule, Part A, SubGroup 06.03.02.04 - End caps and extension caps, before subheading “Austofix”
insert the subheading “Allegra Orthopaedics 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 AE262 Fixion Femoral Nail - End Cap Fixion Femoral Nail End Cap, Classic or Interlocking Size not applicable, one size cap fits all size nails. $101.00
Schedule, Part A, SubGroup 06.03.04.01 - Standard ( ≥4.5mm), entry for Billing Code SF087
delete the contents of Item 1 of the table from the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 SF087 DTS - DOUBLE THREADED
CANNULATED SCREWDTS - DOUBLE THREADED - SELF
TAPPING OR SELF DRILLING
CANNULATED SCREWDiameter 4.5 and 6.5mm x Length 30 to
100mm$402.00
insert the contents of Item 1 of the table in the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 SF087 Speyside Double Threaded Cannulated Screw Speyside - Double threaded – Self tapping or self drilling cannulated screw Diameter 4.5 and 6.5mm x Length 30 to
100mm$402.00
Schedule, Part A, SubGroup 06.03.04.03 - Mini (2.01 – 2.7 mm), entry for Billing Code SF088
delete the contents of Item 1 of the table from the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 SF088 HVS BONE SCREW Self drilling, self threading double threaded
cannulated screwLength 10-34mm $423.00
insert the contents of Item 1 of the table in the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 SF088 Speyside HVS Bone Screw Self drilling, self threading double threaded cannulated screw Length 10-34mm $423.00
Schedule, Part A, SubGroup, 06.03.04.04 – Micro (≤2.0mm), above subheading “Australian Pacific Medical Pty Ltd”
delete the subheading “Amplitude Australia”
under that subheading delete the contents of Item 1 of the table from the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 LI090 Nexis osteosynthesis screws Bone screw titanium alloy snap off Diameter 2mm, Length 11-16mm $67.00
Schedule, Part A, SubGroup, 06.03.04.04 - Micro (≤ 2.0mm), after entry for Billing Code BH193
insert the subheading “CAB MEDICAL 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 C1001 Nexis osteosynthesis screws Bone screw titanium alloy snap off 11-16mm $312.00
Schedule, Part A, SubGroup 06.03.04.04 - Micro (≤ 2.0mm), entry for Billing Code SF091
delete the contents of Item 1 of the table from the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 SF091 Self Breaking Screw - Micro Self Breaking Screw - Micro Dia 2.0 mm x Length 7-24 mm $312.00
insert the contents of Item 1 of the table in the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 SF091 Speyside Self Breaking Screw - Micro Speyside Self Breaking Screw - Micro Dia 2.0 mm x Length 7-24 mm $312.00
Schedule, Part A, SubGroup, 06.03.06.01 – Staples, entry for Billing Code LI079
delete the contents of Item 1 of the table from the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 LI079 Arcad osteosynthesis memory staples Memory metal implants 25mm $134.00
Schedule, Part A, SubGroup 06.03.06.01 - Staples, entry for Billing Code SF089
delete the contents of Item 1 of the table from the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 SF089 Hot Memory Staple 4 leg - Medium Hot Memory Staple 4 leg - Medium Width 11-20 mm $534.00
insert the contents of Item 1 of the table in the columns indicated:
Item Billing Code Product Description Size Minimum Benefit 1 SF089 Speyside Memory Staple Speyside Memory Staple - Medium Width 11-20 mm $534.00
Schedule, Part A, SubGroup, 06.03.06.01 – Staples, after entry for Billing Code BH192
insert the subheading “CAB MEDICAL 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 C1002 Arcad osteosynthesis memory staples Memory metal implants 25mm $534.00
Schedule, Part A, SubGroup 07.03.03.03 – Implants and Fixtures, after entry for Billing Code IC001
insert the subheading “Straumann 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 SB008 Straumann Dental Implant Straumann Dental Implant 4 – 16mm $360.00
Schedule, Part A, SubGroup 13.11.01.01 - Cervical, after entry for Billing Code NV090
insert the subheading “Orthotech”
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 OH521 CP ESP Cervical disc Cervical disc prosthesis 13-15 x 15-20 H5/6/7 $6,500.00
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