Private Health Insurance (Prostheses) Rules 2009 (No. 1) (Cth)
Private Health Insurance (Prostheses) Rules 2009 (No.1)
As amended
Made under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007.
This compilation was prepared on 6 April 2009 taking into account amendments up to the Private Health Insurance (Prostheses) Amendment Rules 2009 (No 1).
Prepared by the Department of Health and Ageing, Canberra
Contents
Part 1 Preliminary 3
1.Name of Rules 3
2.Commencement 3
3.Revocation 3
4.Definitions 3
Part 2 Benefit requirements 4
5.Listing of, and benefits, for prostheses 4
6.Benefits for prostheses provided as part of hospital treatment 4
7.Benefits for prostheses provided as part of hospital-substitute treatment 5
8.Timing of applications to have a prosthesis listed 5
9.Minister may have regard to recommendations and advice 6
Part 1 Preliminary
Name of Rules
These Rules are the Private Health Insurance (Prostheses) Rules 2009 (No.1).
Commencement
These Rules commence on 3 March 2009.
Revocation
These Rules revoke the Private Health Insurance (Prostheses) Rules 2008 (No.1) (as amended by the Private Health Insurance (Prostheses) Amendment Rules 2008 (No.1)).
Definitions
Note: Terms used in these Rules have the same meaning as in the Act―see section 13 of the Legislative Instruments Act 2003. These terms include:
complying health insurance policy
hospital-substitute treatment
hospital treatment
medicare benefit
In these rules:
accredited podiatrist has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.
Act means the Private Health Insurance Act 2007.
gap permitted prosthesis means a prosthesis listed in the Schedule where an amount is specified for that prosthesis in the column under the heading 'Minimum Benefit' and a different amount is specified in the column under the heading 'Maximum Benefit'.
no gap prosthesis means a prosthesis listed in the Schedule where an amount is specified for that prosthesis in the column under the heading 'Minimum Benefit' and no amount is specified in the column under the heading 'Maximum Benefit'.
private hospital means a hospital in respect of which there is in force a statement under subsection 121-5 (8) of the Act that the hospital is a private hospital.
Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.
professional service has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.
public hospital means a hospital in respect of which there is in force a statement under subsection 121-5(8) of the Act that the hospital is a public hospital.
Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.
Schedule means the Schedule in these Rules.
Part 2 Benefit requirements
Listing of, and benefits, for prostheses
For item 4 of the table in subsection 72-1 (2) of the Act:
(a)the Schedule lists the prostheses (listed prostheses) the Minister has listed under subsection 72-10 (5) of the Act and section 12 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007; and
Note: Section 12 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the listing of a prosthesis that was a no gap prosthesis or a gap permitted prosthesis for the purposes of the National Health Act 1953 immediately before the commencement of the Act.
(b)rule 6 sets out the method for working out the minimum benefit and maximum benefit for hospital treatment, covered under a complying private health insurance policy, that is the provision of a listed prosthesis in circumstances where:
(i)a medicare benefit is payable in respect of the professional service associated with the provision of the prosthesis; or
(ii)the provision of the prosthesis is associated with podiatric treatment by an accredited podiatrist; and
(c)rule 7 sets out the method for working out the minimum benefit and maximum benefit for hospital-substitute treatment, covered under a complying private health insurance policy, that is the provision of a listed prosthesis in circumstances where a medicare benefit is payable in respect of the professional service associated with the provision of the prosthesis.
Benefits for prostheses provided as part of hospital treatment
(1) For a no gap prosthesis provided as part of an episode of hospital treatment by a private hospital in the circumstances mentioned in paragraph 5(b), the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’.
(2) For a gap permitted prosthesis provided as part of an episode of hospital treatment by a private hospital in the circumstances mentioned in paragraph 5(b):
(a)the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and
(b)the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’.
(3) For a no gap prosthesis provided as part of an episode of hospital treatment by a public hospital in the circumstances mentioned in paragraph 5(b):
(a)the minimum benefit is the lesser of the following amounts:
(i)the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or
(ii)the amount of the insured person’s liability to the public hospital for that prosthesis; and
(b)the maximum benefit is the amount for that prosthesis listed in the column under the heading 'Minimum Benefit'.
(4) For a gap permitted prosthesis provided as part of an episode of hospital treatment by a public hospital in the circumstances mentioned in paragraph 5(b):
(a)the minimum benefit is the lesser of the following amounts:
(i)the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or
(ii)the amount of the insured person’s liability to the public hospital for that prosthesis; and
(b)the maximum benefit is the amount for that prosthesis listed in the column under the heading ‘Maximum Benefit’ in the Schedule.
Benefits for prostheses provided as part of hospital-substitute treatment
(1) For a no gap prosthesis provided as part of an episode of hospital-substitute treatment in the circumstances mentioned in paragraph 5(c) the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’.
(2) For a gap permitted prosthesis provided as part of an episode of hospital-substitute treatment in the circumstances mentioned in paragraph 5(c):
(a)the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and
(b)the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’.
Note: Private health insurers cannot cover, as part of hospital-substitute treatment, a service for which medicare benefit is payable unless the service is specified in the Private Health Insurance (Health Insurance Business) Rules 2007―see paragraph 121-10 (3) (a) of the Act.
Timing of applications to have a prosthesis listed
As a matter of normal administrative practice, applications made under subsection 72-10 (2) of the Act will be considered after they have been received and, if the Minister decides to grant the application, the prosthesis will be listed in the Schedule the next time the Minister makes or varies the Rules.
Note 1: Under subsection 72-10 (5) of the Act the Minister must list the kind of prosthesis, set out the minimum benefit and, if the Minister considers it appropriate, the maximum benefit for the prosthesis in these Rules on the next occasion that the Minister makes or varies the Rules after he or she grants an application and the applicant has paid to the Commonwealth any initial listing fee within 14 days of being informed of the Minister's decision to grant the application.
Note 2: Under subsection 72-15 (3) of the Act, the Minister may remove a prosthesis from the list in the Rules if the applicant fails to pay an ongoing listing fee..
Minister may have regard to recommendations and advice
(1) In making the decision under subsection 72-10 of the Act, the Minister may have regard to a recommendation from the Prostheses and Devices Committee.
(2) In setting the minimum and the maximum (if any) amounts for a prosthesis, the Minister may have regard to the amounts as negotiated between the Prostheses and Devices Negotiating Group and the applicant.
Note
All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See align="left">Table of Instruments
Instrument Date of FRLI registration Date of commencement Application, saving or transitional provision Private Health Insurance (Prostheses) Rules 2009 (No. 1)
Private Health Insurance (Prostheses) Amendment Rules 2009 (No. 1)
5 February 2009
(see F2009L00265)2 March 2009
(see F2009L00768)23 February 2009
3 March 2009
Table of Amendments
ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted Provision affected How affected Schedule
Part A…………
am. 2009 No. F2009L00768
Schedule
PART A - Prostheses
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Cardiac - Other
St. Jude Medical Australia Pty Ltd
SJ127 Proxis Embolic Protection System - Proximal embolic protection device and 6F and 7F $2,100.00
Long Sheath delivery system
Coronary Stents
Boston Scientific Australia Pty Ltd
BS125 Promus Everolimus Coronary Stent Cobalt chromium alloy stent coated with 2.25mm to 4.0mm diameter, $3,450.00
a blended polymer mixed with Everolimus. 8mm to 28mm length
Terumo Corporation Australia
TU001 Tsunami Gold Stainless Steel mounted on balloon Diameter 2.0mm - 4.0mm, $1,248.00
Length 8mm - 30mm length
Drug Eluting Stents
Abbott Australasia Pty Ltd
AY023 Xience V Everolimus Eluting Coronary Everolimus Eluting Coronary Stent 2.25mm to 4.0mm widths, 8mm $3,450.00
Stent System to 28mm lengths
Boston Scientific Australia Pty Ltd
BS074 Taxus on Express2 Coronary Stent balloon expandable stent with conformal Length 8 - 32mm; Diameter $3,450.00
System Models 38001-0822 to 0840; polymer/drug matrix coating, pre- 2.25 - 5.0mm
38001-1222 to 1250; 38001-1622 to mounted on high pressure monorail
1650;
38001-2022 to 2050; 38001-2422 to
2450; 38001-2827 to 2850; 38001-3227
BS099 Taxus Liberte Paclitaxel-Eluting 316L Stainless Steel Stent with Translute 2.0mm-5.0mm & 8.0mm-38mm $3,450.00
Coronary Stent System Polymer and Paclitaxel
Prostheses List by Category, Groups and Sponsor Page 1 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
JJ302 CYPHER Sirolimus-Eluting Stent & Stainless steel coronary stent with Diameter 2.25 - 5.0mm, length $3,450.00
Delivery System Model CRS - 23300, Rapamycin (an immunosuppressive and 8-33mm
08225, 08250, 08275, 08300, 28225, antiproliferative drug) bound to the stent
28250, 28275, 28300, 33225, 33250,
33275, 33300, 13225, 13250, 13275,
18225, 18250, 18275, 18300, 23225,
23250, 23275, 23350, 23400, 08350,
08400, 28350, 28400, 33350, 33400,
13300, 13350, 13400, 18350, 18400,
23450, 23500, 28450, 28500, 33450,
33500, 08450, 13450, 18450, 18500
JJ481 CYPHER SELECT Sirolimus-Eluting Stainless steel coronary stent with Diameter 2.25 - 5.0mm, length 8 $3,450.00
Stent & Delivery System Sirolimus (an immunosuppressive and - 33mm
anti-proliferative drug) bound to the stent
by a polymer. Model CRA-23300, 08225,
08250, 08275, 08300, 28225, 28250,
28275, 28300, 33225, 33250, 33275,
33300, 13225, 13250, 13275, 18225,
18250, 18275, 18300, 23225, 23250,
23275, 23350, 23400, 08350, 08400,
28350, 238400, 33350, 33400, 13300,
13350, 13400, 18350, 18400, 23450,
23500, 28450, 28500, 33450, 33500,
JJ587 CYPHER Select Plus Sirolimus Eluting Stainless steel coronary stent with Diameter 2.25 - 5.00mm, $3,450.00
Coronary Stent Sirolimus bound to the stent by a polymer Length 8 - 33mm
Medtronic Australasia Pty Ltd
MC732 Endeavour Drug Eluting Coronary Stent Cobalt Alloy, ABT - 578 Diameter: 2.25mm-4.5mm; $3,450.00
System Length: 8.00mm-38.0mm
MC769 Endeavor Sprint Drug Eluting Stent Cobals Alloym ABT - 578 Diameter: 2.25mm-4.0mm; $3,450.00
Length: 8.0mm-30.0mm
MC816 Endeavor Resolute Drug Eluting Cobalt Alloy, ABT - 578, BioLinx Diameter:2.25mm-4.0mm; $3,450.00
Coronary Stent System Length: 8.00mm-30.0mm
General Purpose Bare Metal Stents
Abbott Australasia Pty Ltd
AY025 Stents ACS Multilink Coronary Stent; ACS 1.5mm - 8.0mm $1,248.00
Megalink Peripheral Stent; ACS RX
Herculink Peripheral Stent. Stainless steel
Prostheses List by Category, Groups and Sponsor Page 2 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AY026 Multilink Coronary Stent System Stainless Steel Length 1.5mm - 8.0mm $1,248.00
AY027 Multilink Coronary Stent System - 316L Stainless steel stent Length 1.5 - 8.0mm $2,496.00
AY028 Multilink Coronary Stent System - Cobalt chrome stent Length 1.5 - 8.0mm $1,248.00
Atrium Australia - Pacific Rim Pty Limited
AC022 Flyer RX Coronary Stent System Stainless Steel Coronary Stent Dia 2-5mm, Length 6-40mm $780.00
Biotronik Australia Pty Ltd
BT058 Lekton Motion Coated flexible stent, Balloon mounted Diameter 2.5mm to 4mm, $1,248.00
Length 8 - 30mm
BT065 Lekton Motion Mega Amorphous silicon carbide coated Diameter 4.5 and 5 mm; Length $1,248.00
13 - 40 mm
BT069 Lekton Motion Petite Amorphous silicon carbide coated Diameter 2, 2.25, 2.5mm; $1,248.00
Length 8-20mm
BT082 PRO-Kinetic Cobalth Chromium coronary stent system 8-40mm length 2-5mm diameter $1,200.00
Boston Scientific Australia Pty Ltd
BS069 Express 2/Liberte Coronary Stent Consists of a balloon expandable stent, Stent lengths: 8,12,16,20,24,28 $1,248.00
pre-mounted on a Maverick 2 Monorail & 32 mm Stent diameters: 2.25,
delivery catheter. 2.5, 2.75, 3.0, 3.5, 4.0, 4.5 &
Daralan Pty Ltd
DA001 Gazelle Coronary Stent Stainless Steel Diam 2.25-4.0mm Length 8- $600.00
Johnson & Johnson Medical Pty Ltd
JJ026 BX Velocity with Hepacoat System Balloon expandable, stainless steel, . $1,220.00
heparin coated
JJ200 BX Velocity Stent and Delivery System Stainless steel stent Diameter: 2.25-5.0 mm; Length $1,220.00
8 - 33 mm
JJ239 BX Sonic Stainless steel coronary stent mounted on Dia 2.25 - 4.0mm, lengths 8 - $1,220.00
a balloon delivery system
JJ670 Presillion CoCr Coronary Stent on RX Cobalt Chromium, bare metal coronary Stent Length (mm) x Stent $1,248.00
System Diameter (mm) 8 x 2.50, 2.75,
3.0, 3.50, 4.0; 12 x 2.50, 2.75,
3.0, 3.50, 4.0; 17 x 2.50, 2.75,
3.0, 3.50, 4.0; 24 x 2.75, 3.0,
3.50, 4.0; 33 x 2.75, 3.0, 3.50,
4.0; 33 x 2.75, 3.0, 3.50, 4.0,
20 x 2.50, 2.75, 3.0, 3.50, 4.0
Prostheses List by Category, Groups and Sponsor Page 3 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC197 Medtronic AVE S660 Coronary Stents, Stainless Steel S660 Coronary Stent - Diameter $1,144.00
S670 Coronary Stents, S7 Coronary (2.5mm-2.75mm), Length
Stents, BeStent2, (9mm-24mm); S670 & S7
Coronary Stent - Diameter
(3mm-4mm), Length (9mm-
30mm); BeStent2 - Diameter
(2.5mm-4mm), Length (9mm-
MC329 Medtronic Driver, Micro Driver Cobalt Alloy Driver Stent: diameter (2.25 - $1,248.00
Coronary Stent System 4.5mm), length (8-30mm);
Micro-Driver Stent: diameter
(2.25 - 2.75mm), length (8 -
OrbusNeich Medical Pty Ltd
NM003 R Stent Evolution 2 Coronary Delivery 316LVM Stainless Steel Balloon Lengths - 9-33mm; Diameters - $1,144.00
System Expandable Stent (Tubular) 2.5-4.0mm
NM004 Blazer Coronary Stent Delivery System L605 Cobalt Chromium alloy balloon Expanded Stent Diameter 2.5 to $1,248.00
expandable vascular prosthesis 4.0mm, Stent Length 9 to 33mm
Pacing Importers Pty Ltd - Life Systems
PI003 Med-X-Flexy Stent Tubular Stent, Stainless steel 316L, Gold Dia 5 - 9mm length: 20 - $780.00
markers
Special Purpose Stents
Abbott Australasia Pty Ltd
AY012 JoStent Coronary Stent Graft Stainless Steel/PTFE 9 - 26 mm x 2.5 - 5 mm $3,222.00
Pacing Importers Pty Ltd - Life Systems
PI001 Excimer Laser Stent Polyester Fibre optic catheter 2.5 and 2.2mm $6,800.00
PI002 Excimer Laser Stent Polyester Fibre optic fibre catheter 0.457mm, 0.9mm, 1.4mm, $6,800.00
1.7mm and 2.0mm
CRT Pacemakers
Generation 1
Guidant Australia Pty Ltd
GU143 Contak Renewal TR CRT -P Model Implantable cardiac pacemaker 45x54x8.5mm, 14cc, 26gm $9,360.00
H120, Model H125
Prostheses List by Category, Groups and Sponsor Page 4 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Generation 2
Biotronik Australia Pty Ltd
BT056 Stratos LV Multiprogrammable, Biventricular, DDDRV One size only $12,480.00
BT085 Stratos LV-T Multiprogrammable Biventricular DDDRV One size only $12,480.00
with Home Monitoring
Guidant Australia Pty Ltd
GU142 Contak Renewal TR2 CRT - P Model Implantable Cardiac pacemaker 45x54x8.5mm, 14cc, 26gm $12,480.00
H140, Model H145
Medtronic Australasia Pty Ltd
MC226 Medtronic Insync III Triple Chamber Titanium One size only $12,480.00
Pacemaker Model 8042
St. Jude Medical Australia Pty Ltd
SJ072 Frontier II - Model 5596 Biventricular Cardiac Resynchronisation 49mm(h) x 52(1) x 6(t), 25g $12,480.00
Device with AF suppression algorithm -
Titanum
Dual Chamber ICDs
Generation 3
Biotronik Australia Pty Ltd
BT053 Lexos DR Dual chamber ICD, rate responsive One size only. $43,680.00
BT076 Lumos DR-T Dual Chamber ICD with home monitoring one size only $43,680.00
BT091 Lumax 300 DR-T ICD-DR with bidirectional Home One size only $43,680.00
Boston Scientific Australia Pty Ltd
BS128 Confient RF HE Dual chamber, high energy implantable 44cc, 87.5g $45,760.00
cardioverter defibrillator with wireless
radio frequency capability
Guidant Australia Pty Ltd
GU111 Ventak Prizm II DR Model 1861, titanium, dual chamber, One size only $43,680.00
adaptive rate
Prostheses List by Category, Groups and Sponsor Page 5 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
GU132 Vitality DR Model 1871 This device acts to defibrillate the heart Model 1871 Vitality DR Dual $43,680.00
chambers when the patient enters into an Chamber Rate Responsive
arrhythmia or uses shocks or anti tachy Pacemaker/Defibrillator
pacing to revert Ventricular Tachycardia
(VT) or Ventricular Fibrillation (VF).
While also acting as a dual chamber
GU149 Vitality 2 DR - Model T165 Implantable Cardiac Defibrillator 30cc ; 82g $43,680.00
GU150 Vitality 2 EL DR - Model T167 Implantable cardiac Defibrillator 35cc ; 90g $43,680.00
Medtronic Australasia Pty Ltd
MC363 EnTrust Model D153DRG, Dual chamber, VT 33cc, 63g $43,680.00
Therapies, 30J 33cc, 63g
Sorin Group
SA140 OVATIO DR 6550 Titanium dual chamber ICD, 29 cc 29cc $43,680.00
St. Jude Medical Australia Pty Ltd
SJ049 Epic Plus DR Model V-236 Implantable Dual Chamber sensing, bradycardia 33cc $43,680.00
Cardioverter Defibrillator pacing with atrial fibrillation suppression
SJ070 Epic + DR Model V-233 ICD Dual Chamber Implantable Cardio-verter 33cc 70g $43,680.00
Defibrillator
SJ071 Epic + DR Model V-239 ICD Dual chamber implantable cardio-verter 33cc 70g $43,680.00
defibrillator
SJ092 Epic II + DR V-258 Epic II + DR V-258 Implantable 35cc, 72g $43,680.00
Cardioverter Defibrillator
SJ101 Epic II DR V-255 Epic II DR V-255 Implantable 34cc, 72g $43,680.00
Cardioverter Defibrillator
a
Biotronik Australia Pty Ltd
BT101 Lumax 540 DR-T High Energy, Dual-Chamber ICD Diamensions: 66*55*13mm, $45,760.00
(Implantable Cardiac Defibrillator) with Volume/Weight: 37.2cc/92g
Advanced Patient Management Via unique
Home Monitoring Technology
incorporating Automatic Ventricular
Boston Scientific Australia Pty Ltd
BS134 TELIGEN 100 HE DR 4-SITE High energy dual chamber ICD with 4 31.55cc, 9.9mm $46,510.00 $47,760.00
SITE (GDT-LLH) inline RV connector
BS135 Teligen 100 DR DF-1/IS-1 High energy dual chamber ICD 31.5cc, 9.9mm $45,760.00
Prostheses List by Category, Groups and Sponsor Page 6 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BS138 COGNIS 100 HE 4-SITE High Energy CRT-D with 4SITE (GDT- 32cc, 9.9mm $50,750.00 $52,000.00
LLHH) inline RV connector
BS139 COGNIS 100 HE (DF-1/IS-1 & DF- High Energy CRT-D (DF-1/IS-1 & DF- 32.5cc, 9.9mm $50,000.00
1/LV-1connectors)
Dual Chamber ICDs with CRT
Generation 1
Biotronik Australia Pty Ltd
BT081 Kronos LV-T CRT ICD with home monitoring one size $40,560.00
Generation 2
Biotronik Australia Pty Ltd
BT088 Lumax 300 HF-T CRT-D with bidirectional Home One size only $45,760.00
Boston Scientific Australia Pty Ltd
BS112 Contak Renewal 4 RF CRT-D CRT-D with RF telemetry, IS-1 39cc, 82g $47,840.00
connector H230
BS113 Contak Renewal 4 RF CRT-D CRT-D with RF telemetry, IS-1 39cc, 82g $47,840.00
connector H235
BS129 LIVIAN CRT-D CRT-D (IS-1 and LV-1 connectors) 40cc, 79.5g, 14.5mm $47,840.00
Guidant Australia Pty Ltd
GU134 Contak Renewal 2 This device acts to defibrillate the heart One Size Only $45,760.00
chambers when the patient enters into an
arrhythmia or uses shocks or anti tachy
pacing to revert Ventricular Tachycardia
(VT) or Ventricular Fibrillation (VF).
While also acting as a biventricular
Prostheses List by Category, Groups and Sponsor Page 7 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
GU147 Contak Renewal 4 CRT-D Model H190, Implantable dual-chamber defibrillator One size only $45,760.00
Model H195
Sorin Group
SA138 OVATIO CRT-D 6750 Titanium, dual chamber ICD with CRT 30cc $45,760.00
St. Jude Medical Australia Pty Ltd
SJ062 Epic HF Model V-339 Implantable Cardioverter/defibrillator with dual One size only $45,760.00
Cardiac Defibrillator chamber (atrial and RV) sensing and
bradycardia pacing with ventricular
SJ067 Epic + HF Model V-350 ICD Epic + HF V-350 ICD is a cardioverter 36cc / 73g $45,760.00
defibrillator with dual chamber (atrial and
RV) sensing and bradycardia pacing with
ventricular resynchronisation therapy.
SJ098 Epic II+ HF V-357 Epic II + HF V-357 Cardiac 36cc, 74g $45,760.00
Resynchronisation Therapy Defibrillator
with V-V Timing programmability
SJ100 Epic II HF V-355 Epic II HF V-355 Cardiac 36cc,73g $45,760.00
resynchronisation Therapy Defibrillator
with V-V Timing programmability
a
Biotronik Australia Pty Ltd
BT102 Lumax 540 HF-T High Energy, Three Chamber ICD Diamensions: 66*59*13 mm, $47,840.00
(Implantable Cardiac Defibrillator) with Volume/Weight: 39.8cc/94g
Advanced Patient Management Via unique
Home Monitoring Technology
incorporating Automatic RV/LV
Threshold Monitoring and Extended
Boston Scientific Australia Pty Ltd
BS130 LIVIAN CRT-D HE CRT_D RF High Energy (IS-1 and LV-1 44cc, 87.5g, 14.5mm $50,000.00
connectors)
c
Medtronic Australasia Pty Ltd
MC812 Consulta CRT-D Fully Automatic, Wireless Implantable 38cc $52,000.00
cardioverter defibrillator with cardiac
resynchronization therapy (CRT), and
therapies for ventricular and atrial
tachyarrhythmia
Prostheses List by Category, Groups and Sponsor Page 8 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Dual Chamber Pacemakers
Generation 1
Boston Scientific Australia Pty Ltd
BS123 Insignia AVT 882 VDD Pacemaker 10.0cc, 23.5g $5,200.00
Guidant Australia Pty Ltd
GU079 Pulsar Model VDD 870 Titanium 3.2mm/IS-1 $5,200.00
Medtronic Australasia Pty Ltd
MC727 Adapta Pacemaker DDD Pacemaker 12.1cc $5,200.00 $6,500.00
Models ADD01 27.1g
St. Jude Medical Australia Pty Ltd
SJ050 Verity ADx Model XL DC 5256 Dual - Dual Chamber multi-programmable rate- 11cc, 23.5g $5,200.00
Chamber pacemaker adaptive pacing devices with extended
longevity
SJ061 Identity Adx Model XL DC 5286 Dual Identity ADx Model XL DC Model 5286 11cc, 23.5g $5,200.00
Chamber Pacemaker is an implantable, multi-programmable
rate-adaptive pacing device with AF
Generation 2
Medtronic Australasia Pty Ltd
MC713 Adapta Pacemaker VDDR Pacemaker 11.1cc $6,760.00
Models ADVDD01 23.6g
St. Jude Medical Australia Pty Ltd
SJ054 Identity ADx Model VDR 5480 Single Chamber multi-programmable rate- 8cc, 18g $6,760.00
implantable pacemaker adaptive pacing device with extended
longevity
SJ057 Verity ADx Model XL VDR 5456 Single Chamber multi-programmable rate- 11cc, 23.5g $6,760.00
implantable pacemaker adaptive pacing device with extended
longevity
Generation 3
Biotronik Australia Pty Ltd
BT029 Philos DR-A Model 122600 Implantable Multiprogrammable, rate responsive, 5mm ports, One size only $9,360.00
Pacemaker
Prostheses List by Category, Groups and Sponsor Page 9 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BT047 Protos DR/CLS Dual chamber, rate responsive, closed One size only. $9,360.00
loop system.
BT060 Philos II DR Multiprogrammable, rate responsive, One size only $9,360.00
BT071 Philos II DR-T Dual Chamber Rate Responsive with One size only $9,360.00
Home Monitoring
BT079 Cylos DR-T Dual chamber dual sensor rate responsive one size $9,360.00
with home monitoring system option
Boston Scientific Australia Pty Ltd
BS126 Insignia AVT 1292 Dual chamber pacemaker 10.8cc, 25.4g $9,360.00
Guidant Australia Pty Ltd
GU120 Insignia Plus DR Model 1297, Insignia Dual Chamber Rate Responsive One size only $9,360.00
Plus DR Model 1298 Permanent Pacemaker
GU121 Insignia Entra DR Models Dual Chamber Rate Responsive One size only $9,360.00
Permanent Pacemaker
GU140 Insignia Ultra DR Model 1291 Implantable Cardiac Pacemaker One size only $9,360.00
GU141 Insignia Ultra DR Model 1290 Implantable Cardiac Pacemaker One size only $9,360.00
Sorin Group
SA136 Symphony DR 2550 Active Implantable pacemaker 1 size only $9,360.00
SA141 REPLY TM DR Dual Chamber permanent Pacemaker 8cc, Weight: 20grams, $9,360.00
with Rate Response Modulation Dimensions:41.2 x 41.5 x
St. Jude Medical Australia Pty Ltd
SJ051 Verity Adx Implantable Pacemaker, Dual - Chamber, multi-programmable, 45x52x6mm,11cc, 23g, 5mm or $9,360.00
Models XL DR 5356 and XL DR rate-responsive pacemaker withAF 6mm M/S
SJ056 Integrity ADx Model DR 5360 and XL Dual-Chamber, multi-programmable, rate- Model DR 5360 - 8cc, 18g, $9,360.00
DR 5366 responsive pacemaker with AF Model XL DR 5366 - 11cc, 23.5g
SJ059 Identity ADx Models DR 5380 and XL Dual-Chamber, multi-programmable, rate- ADx DR 5380: 43x44x6mm, $9,360.00
DR 5386 adaptive pacing devices with AF 18g and 8cc
ADx XL DR 5386: 44x52x6mm,
23.5g and 11cc
SJ089 Victory XL DR 5816 and DR 5810 Dual Chamber Rate Responsive 44x52x6mm; 23.5g; 11cc $9,360.00
Prostheses List by Category, Groups and Sponsor Page 10 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Generation 4
Medtronic Australasia Pty Ltd
MC726 Adapta Pacemaker DR Pacemaker 11.1-14.2cc $11,440.00
Models ADDR01, ADDRS1, ADDRL1, 23.6g-31.3g
ADDR06, ADDR03
St. Jude Medical Australia Pty Ltd
SJ103 Zephyr XL DR 5826 and DR 5820 Dual Chamber Rate-Responsive 5826 - 23.5g, 11cc and 5820 - $11,440.00
18g, 8.5cc
Group 1- Cardiothoracic Mechanical Valves
Group 1c - Bi-Leaflet, rotatable
Advanced Biomedical Pty Ltd
AB002 ATS medical open pivot heart valve Pyrolythic Carbon, Double Velour 16-33mm $6,000.00
model 500FA standard flexi-cuff aortic Polyester, Titanium
valve series, ATS medical open pivot
heart valve model 500DM standard
flexi-cuff mitral valve series
AB064 ATS medical open pivot heart valve Pyrolythic Carbon, Double Velour 16-33mm $6,000.00
model 501DA advanced performance Polyester, Titanium
(AP) aortic valve series, ATS medical
open pivot heart valve model 501DM
advanced performance (AP) mitral valve
Medtronic Australasia Pty Ltd
MC292 Advantage Heart Valve - Aortic Model A7760 - Pyrolytic carbon, PET Diameter 19-31 mm $6,000.00
A7760
MC324 Advantage Supra Aortic Heart Valve Mechanical Heart Valve Pyrolite Carbon Diameter (mm): 19 - 25 $6,000.00
leaflets Pyrolite carbon ring
MC681 Advantage Mitral Mechanical Heart Valve 23mm-33mm $6,000.00
Reid Healthcare
RH001 Aortic On-X Prosthetic Heart Valve 27-29mm, 19mm, 21mm, $5,500.00
Models ONXA-19; ONXA-21; ONXA- 23mm, 25mm, 25-33mm, 27-
23; ONXA-25; ONXA-27/29; ONXM- 29mm, 31-33mm, 23mm,
23; ONXM-25; ONXM-27/29;
ONXM31/33; ONXMC25/33
Prostheses List by Category, Groups and Sponsor Page 11 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Sorin Group
SA129 Optiform Mechanical Valve 19mm to 33mm $6,000.00
St. Jude Medical Australia Pty Ltd
SJ037 St Jude Medical Aortic Expanded Cuff Aortic Expanded Cuff, Aortic Aortic Expanded 19 -31mm, $6,000.00
Heart Valve; St Jude Medical Aortic Hemodynamic Plus Cuff, Mitral Aortic Hemodynamic 17 -
Hemodynamic Plus Cuff Heart Valve; St Hemodynamic Cuff, Aortic & Mitral 27mm, Mitral Hemodynamic 17
Jude Medical Mitral Hemodynamic Plus -27mm, Rotatable 17 - 33mm
Cuff Heart Valve; St Jude Medical
Mechanical Heart Valve Masters Series
SJ039 Regent Prosthestic Heart Valves Standard Cuff - Model 17AGFN-751 - Standard cuff - 17-23mm, Flex $6,500.00
23AGFN-751, Flex Cuff - Mode cuff - 17-23mm
17AGFN-756 - 23AGFN-756
SJ116 Regent Prosthestic Heart Valves Standard Cuff - Model 25AGFN-751 - Standard cuff - 25-29mm, Flex $6,000.00
29AGFN-751, Flex Cuff - Mode cuff - 25-29mm
25AGFN-756 - 29AGFN-756
Group 1e - Tilting Disc, rotatable
Medtronic Australasia Pty Ltd
MC013 Medtronic Hall Heart Valve Aortic Model A7700/M7700 Titanium. Pyrolite. A7700 - Diameter 20-31mm, $5,100.00 $5,625.00
A7700, Medtronic Hall Heart Valve Dacron, A7700EZ/M7700EZ Titanium. M7700 - Diameter 23-33mm,
Mitral Model M7700, Hall Easy Fit A7700EZ - Diameter 19-29mm,
Aortic Heart Valve Model A7700, Hall M7700EZ - Diameter 23-31mm
Easy Fit Mitral Heart Valve Model M7700
Group 2 - Cardiothoracic Tissue Valves
Edwards Lifesciences Pty Ltd
EL032 Baxter Edwards Prima Plus Stentless Edwards Prima Plus. Porcine Valve; 19mm-29mm $4,841.00
Bioprosthesis Model 2500P Prosthetic Woven Polyester Cloth.
Heart Valve
Prostheses List by Category, Groups and Sponsor Page 12 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 2a - Stented, porcine
Edwards Lifesciences Pty Ltd
EL030 CE Supra Annular Aortic Valve Model Carpentier-Edwards SAV Bioprosthesis. 19mm-33mm $4,445.00
2650 Carpentier-Edwards S.A.V Composition: Porcine Valve; Elgiloy
Bioprosthesis Model 6650 Mitral Valve Alloy; Silicone Rubber,
Medtronic Australasia Pty Ltd
MC701 Mosaic Cinch, Aortic, Mitral Models 305cxx, 310cxx 19mm - 35mm $4,445.00 $5,345.00
MC771 Mosaic Ultra Small Aortic Root Bioprosthesis 19mm-29mm $4,445.00 $5,650.00
St. Jude Medical Australia Pty Ltd
SJ069 St Jude Medical Biocor Porcine St Jude Medical Biocor Porcine Aortic Valves - Tissue Annulus $4,445.00
Prosthetic Heart Valve Prosthetic Heart Valve is manufactured Diameter - 21-29mm, Implant
from selected procine aortic valve cusps Height - 11-15c; Mitral Valves -
that have been cross-linked with a Tissue Annulus Diameter - 25-
35mm, Implant Height - 8-
SJ136 SJM Biocor Heart Valve Stented Porcine tissue valve Aortic Valves - Tissue Annulus $4,445.00
Diameter - 21 - 29mm
Mitral Valves -
Tissue Annulus Diameter - 25-
35mm
Group 2b - Stented, pericardial
Edwards Lifesciences Pty Ltd
EL031 Carpentier-Edwards Perimount Carpentier-Edwards Pericardial Models 2900/6900 19-33mm, $5,000.00
Pericardial Bioprosthesis - Models Bioprosthesis. Composition: Bovine Model 6900P 25, 27, 29, 31,
2900/6900 Carpentier-Edwards Pericardium; Elgiloy Alloy; Silicone
Perimount Plus Pericardial Bioprosthesis Rubber, Polytetrafluoroethylene
Mitral - Model 6900P
EL039 Edwards Perimount Magna Model 3000 Carpentier-Edwards Perimount Magna 19MM Aortic Pericardial Tissue $5,000.00 $5,690.00
composition: Glutaraldehyde treated Valve; 21MM Aortic Pericardial
bovine pericardium/elgiloy wireform Tissue Valve; 23MM Aortic
stent/polyester band/silicone rubber Pericardial Tissue Valve; 25MM
suture ring/polytetrafluoroethylene Aortic Pericardial Tissue Valve;
cloth/polyester cloth. 27MM Aortic Pericardial Tissue
Valve; 29MM Aortic Pericardial
Tissue Valve
Prostheses List by Category, Groups and Sponsor Page 13 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
EL056 Magna Mitral Carpentier-Edwards PERIMOUNT 25, 27, 29, 31 and 33mm $5,000.00 $5,690.00
Magna Mitral Bioprosthesis, Model
Sorin Group
SA130 Mitroflow Pericardial Bioprosthesis 19-27mm $5,000.00
Group 2c - Non-Stented, porcine
Medtronic Australasia Pty Ltd
MC015 Freestyle bioprosthesis Models 995xx, 995MSxx 19 - 35mm $5,110.00 $5,350.00
St. Jude Medical Australia Pty Ltd
SJ038 St Jude Medical Toronto SPV Valve Tissue Heart Valves, Bioimplant TSPV: 21 - 29mm, Bioimplant $4,900.00
Model SPA-101, St Jude Medical Aortic: 21-27mm, Bioimplant
Bioimplant Heart Valve Mitral: 27-32mm
Group 3 - Cardiothoracic Valve Conduits
Group 3a - Mechanical Valve
Advanced Biomedical Pty Ltd
AB001 ATS Medical open pivot aortic valved Pyrolythic Carbon, Double Velour 21- 33mm $6,950.00
graft model 502AG Polyester, Titanium
Medtronic Australasia Pty Ltd
MC198 Medtronic Hall rotatable aortic valved Titanium, pyrolite, dacron 20 - 33mm $6,950.00
collagen impregnated conduit Model
Sorin Group
SA128 CarboSeal Ascending Aortic Prosthesis, Mechanical Conduit AP 21-33mm, CP 21 - 33mm $6,950.00
sterile, CarboSeal Ascending Aortic
Prosthesis with Handle Model AP21,
Model AP23, Model AP25, Model AP27,
Model AP29, Model AP31, Model
AP33, Carboseal Valsalva
St. Jude Medical Australia Pty Ltd
SJ036 St Jude Medical Coated Aortic Valved Coated Aortic Valved Graft 21mm - 33mm $6,950.00
SJ104 SJM Masters Series Aortic Valved St Jude Medical Mechanical Heart Valve Annulus Diameter 19-29mm $6,950.00
Prosthesis - VAVGJ sewn into the base of a woven polyester
fibre graft which has been impregnated
with bovine-derived gelatin
Prostheses List by Category, Groups and Sponsor Page 14 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 3b - Tissue Valve, stented porcine
Medtronic Australasia Pty Ltd
MC012 Medtronic Hancock Valved Conduit Porcine bioprosthesis, dacron 12, 14, 16, 18, 20, 22, 25, $5,900.00 $6,800.00
Model 100/150
Group 4 - Cardiothoracic Atrio-Ventricular Rings and Bands
Group 4a - Ring, Standard
Edwards Lifesciences Pty Ltd
EL028 Baxter Sterile Grafts, Implants & Carpentier-Edwards Classic Annuloplasty 24mm-40mm $2,200.00
Prostheses, Non-Animal Origin Ring. Composition: Titanium Alloy;
Annuloplasty: Ring-Mitral Ring with Silicone Rubber; Polyester Fabric
Holder; Mitral Cosgrove-Edwards Carpentier-Edwards Physio Annuloplasty
Annuloplasty System Model 4600; Ring. Composition: Elgiloy Bands;
Classic Annuloplasty Ring-Tricuspid 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;
Medtronic Australasia Pty Ltd
MC005 Medtronic Duran Annuloplasty Ring; Annuloplasty Devices - Models 610R & Model 610R 25-35mm & Model $2,200.00
Duran Ancore Ring 620R; Duran 620R Silicone / Barium Sulphate, Dacron. 620R 23-35mm
Ancore Chordal Model 620RG
Sorin Group
SA127 AnnuloFlo Annuloplasty System Annuloflex Ring or AnnuloFlo Ring 26-36mm $2,200.00
St. Jude Medical Australia Pty Ltd
SJ035 SJM Tailor Annuloplasty Ring Fully Flexible 25mm - 35mm $2,200.00
Group 4b - Ring, with modification
Edwards Lifesciences Pty Ltd
EL049 Edwards Etlogix Annuloplasty Ring Titanium/silicon/dacron polyester 24mm/26mm/28mm/30mm/32m $2,400.00
cloth/plastic template Mitral valve annular m/34mmd
repair device designed specifically for
patients with Ischemic Mitral regurgitation
Prostheses List by Category, Groups and Sponsor Page 15 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
EL057 Geoform Geoform annuloplasty ring Model 4200 26, 28, 30 and 32mm $2,400.00
with Holder
Medtronic Australasia Pty Ltd
MC745 CG Future Composite Ring Semi-rigid mitral annuloplasty ring, with 24, 26, 28, 30, 32, 34, 36 & $2,400.00
anterior flexibility
St. Jude Medical Australia Pty Ltd
SJ087 St Jude Medical Rigid Saddle Ring Rigid Annuloplasty Ring 24 - 34mm $2,400.00
Group 4c - Band, Standard
Edwards Lifesciences Pty Ltd
EL050 Edwards MC3 Tricuspid Annuloplasty Annuloplasty Ring, 26mm to 36mm in 2mm $2,400.00
System titanium/silicone/polyester velour
cloth/plastic template
Group 4d - Band, with modification
Medtronic Australasia Pty Ltd
MC709 Posterior Annuloplasty Band; Colvin - Annuloplasty - Model 610B & 620B Model 610B: 25-35mm; Models $2,200.00
Galloway Future Band Model 638B; Silicone / Barium Sulphate, Dacron. 620B & 620BG: 23-35mm,
Duran Ancore Band 620B; Duran Models 638B semi-regid metal alloy core, Model 638B - 26-38mm
Ancore Chordal Model 620BG silicone coating, polyester knit fabric, kit
includes-band, malleable handle, template
with suture markers, sizers
St. Jude Medical Australia Pty Ltd
SJ088 SJM Tailor Annuloplasty Band Flexible double-velour, polyester fabric 25 - 35mm $2,200.00
Group 5 - Cardiothoracic Membranes and Patches
Group 5a - Tissue
Advanced Biomedical Pty Ltd
AB066 Supple Peri-Guard (10 x 16cm) Model No PC1016SN - 10 x 16 Bovine 10 x 16cm $760.00
pericardium patch
AB067 Supple Peri-Guard (8 x 14cm) Nodel No PC0814SN - 8 x 14 Bovine 8 x 14cm $700.00
pericardium patch
AB068 Supple Peri-Guard (6 x 8cm) Model No PC0608SN -6 x 8cm Bovine 6 x 8cm $610.00
pericardium patch
Prostheses List by Category, Groups and Sponsor Page 16 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AB069 Supple Peri-Guard (4 x 4cm) Model No PC0404SN - 4 x 4cm Bovine 4 x 4cm $350.00
pericardium patch
Edwards Lifesciences Pty Ltd
EL033 Baxter Augmentation / Substitution Edwards Pericardial Patch. Bovine 10cm x 16cm $760.00
Material, Human or Animal Origin, Pericardium.
Sterile Pericardial Patch.
Group 5b - Synthetic, Cardiovascular
W L Gore & Associates
GT117 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm Thickness 2 x 9cm $240.00
GT118 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm - 3 x 6cm $280.00
0.6mm - 2.5cm x 15cm & 5cm
x 7.5cm
GT120 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 5 x 15cm $521.00
GT121 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 10 x 15cm $945.00
GT126 Acuseal Cardiovascular Patch Vascular ePTFE 0.5mm Thickness 1 x 9cm; 0.8 $223.00
x 7.5cm
GT127 Acuseal Cardiovascular Patch Cardiac ePTFE 0.5mm Thickness 3 x 6cm & 5 $270.00
x 7.5cm
Group 5c - Synthetic, Non-cardiovascular
W L Gore & Associates
GT122 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 6 x 12cm $360.00
GT123 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 8 x 16cm $643.00
GT124 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 12 x 12cm $748.00
GT125 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 15 x 20cm $1,455.00
Group 6 - Cardiothoracic Assisted Anastomic Devices
Medtronic Australasia Pty Ltd
MC680 Spyder Proximal Anastomotic Device 6-clip assembly $590.00
Prostheses List by Category, Groups and Sponsor Page 17 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 7 - Cardiothoracic Assisted Fixation Devices
Medtronic Australasia Pty Ltd
MC714 U-Clips (Valve Repair) Double Arm, Mitral Valve Repair 2-packs $510.00
7b - Vascular
Medtronic Australasia Pty Ltd
MC765 U-Clips Nitinol Clips, 8-pack Needle Lengths: 6.5mm - $336.00
9.5mm, 8-pack
MC772 U-Clips Nitinol Clips, 2-pack Needle Lengths: 6.5mm - $84.00
9.5mm, 2-Pack
Group 8 - Cardiothoracic Grafts (Proximal Aorta)
Group 8b Modified Tube
Terumo Corporation Australia
TU036 Gelweave Valsalva Graft Woven vascular prosthesis, polyester, Diameter 24 - 34 mm, Overall $3,320.00
gelatin sealed length 18.4 - 19.6cm
Group 8c Tube with one side branch
Terumo Corporation Australia
TU038 Gelweave Graft Straight Thoracic Graft, with antiflo side 20 -34 mm x 20-40 cm $1,715.00
branch, Polyester, woven, gelatin sealed
Group 8d Tube with multiple side branches (more than 1)
Terumo Corporation Australia
TU037 Gelweave Plexus Graft Multi Branched, for Aortic Arch 20 - 34 mm x 40 cm $2,150.00
reconstruction, Polyester, Woven, gelatin
sealed
Prostheses List by Category, Groups and Sponsor Page 18 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ICD Leads
Group 1 - Coronary Sinus Leads
Medtronic Australasia Pty Ltd
MC026 Medtronic Transvene SVC Lead Model Model 6937-35, Model 6937-52, Model 35 - 110cm x 660mm $2,340.00
6937; 6937-58, Model 6937-110; Silicone;
Group 5 - Transvenous/Steroid/Passive Leads
Biotronik Australia Pty Ltd
BT077 Kentrox SL steriod Dual shock coil fractal steroid eluting 65, 75cm lengths $9,000.00
passive fixation electrode
BT078 Kentrox RV Steroid single shock coil fractal steroid eluting 65, 75 cm lenghts $9,000.00
passive fixation electrode
BT092 Linox TD Fractal and steroid coated passive fixation 65, 74 or 100cm length and 16 $9,360.00
quadripolar ICD lead or 18mm electrode spacing
BT093 Linox T Passive fix RV bipolar fractal coated 65, 75cm length $9,360.00
steroid ICD lead
Guidant Australia Pty Ltd
GU112 Endotak Reliance S Lead Model 0127 & Model 0128, defibrillation 59cm, 64cm $7,500.00
lead, 9fr introducer (silicone coated),
steroid eluting, high impedence
GU115 Endotak Reliance Lead Model 0147, Model 0148 & Model 0149, 59cm, 64cm, 90cm $7,500.00
defibrillation lead, 9fr introducer (silicone
coated), steroid eluting, high impedence
GU158 Endotak Reliance SG Passive Fixation Endotak Reliance SG Passive Fixation 54cm - 90cm $7,200.00
Lead: Models 0170, 0171, 0172, and
0173 Implantable cardioverter defibrillator
lead with GORE ™ ePTFE covered
GU159 Endotak Reliance G Passive Fixation Lead Endotak Reliance G Passive Fixation 54cm -90cm $7,200.00
Lead: Models 0174, 0175, 0176 and
0177. Implantable Cardioverter
defibrillator lead with GORE ™ ePTFE
Prostheses List by Category, Groups and Sponsor Page 19 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC002 Medtronic Sprint Quattro Lead Model Silicone and polyurethane 65-100cm $9,360.00
6944RV/SVC 65cm; Model
6944RV/SVC 75cm; or Model
6944RV/SVC 100cm; Medtronic Sprint
Quattro Lead Model 6944RV/SVC 58cm
MC696 Sprint Fidelis Lead Model 6948, dual-coil, tined 58-100cm $9,360.00 $10,000.00
MC698 Sprint Fidelis Lead Model 6930, single-coil, tined 58-100cm $9,360.00 $10,000.00
St. Jude Medical Australia Pty Ltd
SJ016 Riata Transvenous Tachyarrhythmia Quadripolar, dual-coil, steroid eluting, One size only $9,360.00
Lead Model 1570, Model 1571 active fixation tachyarrhythmia leads
SJ083 Riata Transvenous Tachyarrhythmia Tri-polar Passive-Fixation, Steroid 60cm, 65cm, 8F introducer $9,360.00
Lead Model 1572 Eluting, Single Shock Coil
SJ085 Riata iTransvenous Tachyarrhythmia Passive Fixation, Steroid-Eluting, Dual 60cm, 65cm, 70cm, 8F $9,360.00
Leads Models 1560 and 1561 Shock Coil Defibrillation Lead
SJ086 Riata i Transvenous Tachyarrhythmia Passive Fixation, Steroid Eluting, Single 60cm, 65cm, 70cm, 8F $9,360.00
Lead Model 1562 Shock Coil Defibrillation Lead
SJ110 Riata ST Transvenous Tachyarrhythmia Riata ST 7040/41 Passive-Fixation True- 60 - 75cm, 6.3 Fr, 7 Fr $9,360.00
Leads 7040/41/42 and 7050/51/52 Bipolar, Dual-Coil, Steroid-eluting,
Endocardial Defibrillation Leads, 7042 -
Single Coil, 7050/51 - Integrated Bipolar,
Dual Coil, 7052 - Integrated Bipolar,
Single Coil
SJ113 Riata i TransvenousTachyarrhythmia Riata i 1950/51 - Passive-Fixation 60 - 75cm $9,360.00
Leads 1950/51 Integrated-Bipolar, Dual-Coil, Steroid-
Eluting, Endocardial Defibrillation Leads
SJ130 Riata ST Optim 7070/1 Passive Fixation, True bipolar, Dual Coil, 60, 65 and 70cm length, 7Fr $9,360.00
Steroid Eluting, Endocardial Defibrillation introducer
Leads with Optim insulation overlay
Group 6 - Transvenous/ Steroid/Active Leads
Biotronik Australia Pty Ltd
BT064 Kentrox SL-S steroid Fractal coated steroid electrode, dual 16 and 18 cms tip to second $7,488.00
shock coil shock coil
BT068 Kentrox RV-S steroid Fractal coated steroid electrode, single 65cm lengths $7,488.00
shock coil
Prostheses List by Category, Groups and Sponsor Page 20 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BT084 Linox SD Fractal coated and steroid electrode, 65, 75cm length, 16, 18mm elec $9,360.00
active fixation quadrapolar
BT096 Linox S Active fix RV bipolar fractal coated 65, 75cm length $9,360.00
steroid IC lead
Guidant Australia Pty Ltd
GU118 Endotak Endurance EZ Leads Model Defibrillation lead, steroid eluting, 64, 70, 100cm $7,500.00
0154, Model 0155, Model 0156 trilumen lead 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, Implantable defibrillator/pacemaker lead Lead Lengths: 59 - 90cm $9,000.00
Model 0165, Model 0166, Model 0167
GU146 Endotak Reliance SG Lead Model 0160, Implantable defibrillator/pacemaker lead Lead Lengths: 59 - 90cm $9,000.00
Model 0161, Model 0162, Model 0163
GU160 Endotak Reliance Active Fixation Lead Endotak Reliance Active Fixation Lead: 54cm - 90cm $7,200.00
Models 0157, 0158 and 0159 Implantable
cardioverter defibrillator lead
GU161 Endotak Reliance S Active Fixation Lead Endotak Reliance S Active Fixation Lead: 54cm - 90cm $7,200.00
Models 0137, 0138 and 0139
GU163 ENDOTAK RELIANCE G Lead 018 Endotak Reliance G Lead: Models 0184 to 59-90cm $7,200.00
0187. Implantable cardioverter
defribrillator lead. Active fixation.
GU164 ENDOTAK RELIANCE SG Lead 018 Endotak Reliance SG Lead: Models 0180 59-90cm $7,200.00
Series to 0183. Implantable cardioverter
defibrillator lead. Active fixation.
Medtronic Australasia Pty Ltd
MC208 Medtronic Sprint Quattro Secure Lead Leads, Defibrillator, Implantable, Silicone, 58-100cm $9,360.00
Model 6947 58cm; Model 6947 65cm; polyurethane, platinized tantalum coils,
Model 6947 75cm; Model 6947 100cm steroid eluting tip
MC695 Sprint Fidelis Lead Model 6949, dual-coil, screw-in 58-100cm $9,360.00 $10,000.00
MC697 Sprint Fidelis Lead Model 6931, single-coil, screw-in 58-100cm $9,360.00 $10,000.00
St. Jude Medical Australia Pty Ltd
SJ074 Riata Transvenous tachyarrhythmia Tri-polar Active - Fixation, Steroid- 60cm, 65cm, 8F introducer $9,360.00
Leads Model 1582 Eluting, Single shock Coil
SJ075 Riata Transvenous Tachyarrhythmia Quadripolar, dual-coil, steroid eluting, One size only $9,360.00
Lead Model 1580, Model 1581 active fixation tachyarrhythmia leads
Prostheses List by Category, Groups and Sponsor Page 21 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SJ081 Riata i Transvenous Tachyarrhythmia Active fixation leads, Steroid Eluting, 60cm, 65cm, 75cm, 8F $9,360.00
Leads Model 1590/1591 Dual Shock Coil Defibrillation Lead
SJ084 Riata i Transvenous Tachyarrhythmia Active Fixation, Steroid Eluting, Single 60cm, 65cm, 75cm, 8F $9,360.00
Lead Model 1592 Shock Coil Defibrillation Lead
SJ096 Riata ST 7000/7001/7002 Active-Fixation True-Bipolar, Dual-Coil, 60, 65cm 7F introducer $9,360.00
(7002 - Single-Coil) Steroid-Eluting
Steroid Eluting, Endocardial Defibrillation
SJ102 Riata ST Transvenous Tachyarrhythmia Riata ST 7010/7011 Active-Fixation 60 - 75cm 6.3Fr, 7 Fr Introducer $9,360.00
Leads 7010/7011/7012 Integrated-Biopolar, Dual-Coil, Steroid-
eluting, Endocardial Defibrillation Leads,
7012 - Single Coil
SJ106 Riata Transvenous Tachyarrhythmia Riata 1940/41 Active-Fixation True- 60-75cm $9,360.00
Leads 1940/41/42 bipolar, Dual-Coil, Steroid-eluting,
Endocardial Defibrillation Leads, 1942 -
SJ108 Riata i Transvenous Tachyarrhythmia Riata i 1962 - Active Fixation Integrated- 60 - 75cm $9,360.00
Leads 1962 Bipolar, Single-Coil, Steroid-Eluting,
Endocardial Defibrillation Leads
SJ122 Riata ST Optim 7020/1/2 and 7030/1 7020/1 - Active fixation, true bipolar, 60, 65 and 75cm length and 7Fr $9,360.00
7022 - Active fixation, true bipolar - introducer
single coil, 7030/1 - Active fixation,
integrated bipolar, dual coil steroid eluting
endocardial defibrillation leads with
Optim insulation overlay
Lead adaptors - Pacemaker/ ICD
Guidant Australia Pty Ltd
GU129 LV-1 Lead Adaptor to IS-1 Connects Left ventricular leads to IS-1 One size only $500.00
ports in pacemakers and defibrillators to
replace abnormal cardiac excitation
GU130 Y Adaptor Connects multiple defibrillator electrodes One size only $500.00
to a common port, enabling the use of
shocks to revert Ventricular Tachycardia
and normal cardiac function to return
Medtronic Australasia Pty Ltd
MC246 DF-I Y-Adaptor/Extender Model 6726 Silicone Lengths 25cm, 37cm $537.00
25cm & 37cm
Prostheses List by Category, Groups and Sponsor Page 22 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC778 Oscor Adaptor Adaptor for LV-1 lead to unipolar and 10cm, 17cm and 40cm $500.00
bipolar IS-1
MC832 Adaptor Kit Model 5866-24M, 5866- Silicone 14cm $530.00
40M, 5866-37M, Bipolar Lead Adaptor
Kit Model 2872
Limited Functionality ICDs
Generation 2
Biotronik Australia Pty Ltd
BT052 Cardiac Airbag Single chamber ICD rate responsive One size only. $15,600.00
Pacemaker leads
Group 1 - Non-transvenous, Bi-Polar, Steroid
Medtronic Australasia Pty Ltd
MC011 Capsure EPI steroid eluting bipolar Silicone 25 - 60cm $1,716.00
epicardial lead Model 4968 - ventricle
St. Jude Medical Australia Pty Ltd
SJ132 Myodex 1084T Steroid-Eluting Bipolar Sutureless 35cm and 54cm $1,716.00
Myocardial Pacing Lead with Titanium
Nitride Electrodes
SJ140 Myodex 1084T and FasTac Flex Lead Steroid -Eluting Bipolar Sutureless 35cm and 54cm, Lead implant $1,966.00
Implant Tool Myocardial Pacing Lead with Titanium tool - 44cm
Nitride Electrodes and Lead implant tool
with articulating distal end.
Group 11 - Transvenous, Bi-Polar, Passive, Steroid, Left Ventricular
Biotronik Australia Pty Ltd
BT095 Corox OTW BP Coronary Sinus bipolar steroid 77, 87 cm length $6,240.00
Prostheses List by Category, Groups and Sponsor Page 23 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Guidant Australia Pty Ltd
GU138 Easytrak 2, Model 4514,4515, 4516, The Easytrak 2 lead is a dual electrode . $6,240.00
4517, 4518, 4519, 4520 version of 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
GU153 Easytrak 2 Is-1 Lead - Models 4542, Implantable left ventricular pacemaker lead 80 to 100cm $6,240.00
4543 & 4544
GU156 Easytrak 3 Lead - Models 4521, 4522, Implantable left ventricular pacemaker lead 80 to 100cm $6,240.00
4523, 4524, 4525, 4526 and 4527
GU162 Easytrak 3 IS-1 Lead Models 4548, 4549 and 4550. Silicone Sizes 80 to 100cm $6,240.00
and polyurethane insulation and
polyurethane protective sleeve
GU165 Acuity Steerable Lead Steerable IS-1 bipolar CS LV Lead 80cm, 90 cm, 100cm $6,240.00
Models 4554, 4555, 4556
Medtronic Australasia Pty Ltd
MC699 Attain OTW Model 4194 Lead Model 4194 78cm, 88cm $6,240.00
St. Jude Medical Australia Pty Ltd
SJ099 QuickSite 1056T Bipolar Steroid-Eluting, Titanium Nitride 75cm, 6F and 86cm, 6F $6,240.00
Coated Electrodes Guidewire/Stylet-
Placed Keft Heart Lead with Fast-Pass
Group 13 - Transvenous, Bi-Polar, Active, Steroid, Left Ventricular
St. Jude Medical Australia Pty Ltd
SJ126 QuickSite XL 1058T Bipolar, Steroid-Eluting, Titanium Nitride 75-86cm $6,240.00
Coated Electrodes, Guidewire/Stylet-
Placed Left Heart Lead with Fast-Pass
Group 2 - Non-transvenous, Uni-Polar, Steroid
Medtronic Australasia Pty Ltd
MC053 Capsure EPI steroid eluting unipolar Silicone 25 - 50cm $1,544.00
epicardial lead Model 4965 ventricle
Prostheses List by Category, Groups and Sponsor Page 24 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 3 - Non-Transvenous, Uni-Polar, Non-Steroid
Guidant Australia Pty Ltd
GU037 Myocardial Pacing Lead Model 4312 and 4316 54cm and 35cm $1,144.00
Medtronic Australasia Pty Ltd
MC009 Medtronic Epicardial Pacing Leads IS-1 Silicone 35 - 53cm $1,144.00
Model 5071
Group 4 - Transvenous, Uni-Polar, Passive, Steroid, Right Ventricular/Atrial
Medtronic Australasia Pty Ltd
MC254 CapSure Sense pacemaker lead Models Titanium Nitride 30 - 85cm $1,248.00
St. Jude Medical Australia Pty Ltd
SJ078 IsoFlex S, Models 1645K, 1643K, Endocardial, Steroid Eluting, Silicone, 34cm, 40cm, 46cm, 52cm, $1,248.00
Passive Fixation Leads with Fast-Pass 58cm, 85cm, 7F
Group 5 - Transvenous, Uni-Polar, Passive, Non- Steroid, Left Ventricular
St. Jude Medical Australia Pty Ltd
SJ033 Aescula LV Model 1055K Left Ventricular Pacing Lead 75cm $2,735.00
Group 6 - Transvenous, Uni-Polar, Passive, Steroid, Left Ventricular
Biotronik Australia Pty Ltd
BT070 Corox OTW UP Steroid Coronary Sinus Lead 77, 87cm $3,000.00
Boston Scientific Australia Pty Ltd
BS133 Acuity Spiral Transvenous Left Ventricular pacing lead 80, 90 & 100cm $5,000.00
Guidant Australia Pty Ltd
GU056 Easytrak Lead Model 4510, Model 4511, Model 4512 65cm, 72cm, 80cm $3,120.00
Transvenous Coronary Sinus Lead
GU152 Easytrak IS-1 Lead, Models 4535 to 4538 Implantable left ventricular pacemaker lead 80 - 90cm $3,120.00
Medtronic Australasia Pty Ltd
MC225 Attain Over the Wire Model 4193 Titanium, polyurethane 78-88cm $3,120.00
MC730 Attain StarFix LV Lead Over the wire left Ventrucular Lead 78, 88, 103cm $5,000.00 $6,240.00
Prostheses List by Category, Groups and Sponsor Page 25 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
St. Jude Medical Australia Pty Ltd
SJ079 QuickSite Model 1056K Unipolar, Steroid Eluting, Titanium Nitride 75cm, 6F and 86cm, 6F $3,120.00
Electrode, Guidewire/Stylet-placed Left
Heart Lead with Fast-Pass Coating
Group 8 - Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT066 Selox ST Transvenous Bipolar Passive Steroid 53 and 60cm lengths $1,248.00
Ventricular Pacing Lead, fractal coated
BT067 Selox JT Fractal coated steroid electrode 45 and 53cm lengths $1,248.00
Guidant Australia Pty Ltd
GU009 Fineline II Sterox IROX Lead Model 4458, Model 4459 52cm, 58cm $1,248.00
GU011 Fineline II Sterox IROX Lead Model 4456, Model 4457 52cm, 58cm $1,248.00
GU012 Fineline II Sterox IROX Lead Model 4479, Model 4480 45cm, 52cm $1,248.00
GU023 Guidant Aust Selute Picotip Steroid Model 4033, Model 4034, Model 4035, 45cm , 52cm, 59cm $1,248.00
Eluting Bipolar Lead Model 4063, Model 4064
Medtronic Australasia Pty Ltd
MC010 Medtronic Capsure SP Novus Model Silicone Polyurethane 45 -110cm $1,144.00
5092; Capsure 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
MC229 Medtronic Capsure SP Novus Model Silicone, platinum 30-100cm $1,144.00
5594 Lead 30cm
MC336 Medtronic Capsure Z Novus Model Silicone; Contents: 1 x lead with 45-58cm $1,248.00
5054 Pacing Lead anchoring sleeve, stylet & guide, 1 x vein
lifter, 2 x fixation tools, extra stylets
MC337 Medtronic Capsure Z Novus Model Silicone; Contents: 1 x lead with 45-58cm $1,248.00
5554 Pacing Lead anchoring sleeve, stylet & guide, 1 x vein
lifter, 2 x fixation tools, extra stylets
Prostheses List by Category, Groups and Sponsor Page 26 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC371 Medtronic Capsurefix Model 6940 Silicone Polyurethane 30 - 85cm $1,144.00
Pacing Lead; 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; Capsure SP
Novus Pacing Lead Model 4092;
MC372 CapSure Sense pacemaker lead Models Titanium Nitride CapSure Sense Lead Model $1,248.00
4074 & 4574 4074 - 30cm to 85cm; CapSure
Sense Lead Model 4574 - 30cm
St. Jude Medical Australia Pty Ltd
SJ024 PASSIVE PLUS DX 1342T, 1343K, Single, passive fixation, steroid eluting, 46-58cm $1,248.00
1345K, 1346T low polarisation lead; Models: Bipolar
Atrial Lead, IS-1 Unipolar Atrial Lead, IS-
1 Unipolar Ventricular Lead, IS-1 or
Bipolar Ventricular Lead, IS-1
SJ082 Isoflex S, Models 1646T, 1642T and endocardial, Steroid Eluting, Silicone, 34cm, 40cm, 46cm, 52cm, $1,248.00
Passive Fixation Pacing Leads with Fast- 58cm, 85cm, 7F, 120cm 8F
Pass Coating
SJ097 Isoflex P 1644T and 1648T Endocardial, Steroid Eluting, 1648T - 34-85cm 1644T - 34- $1,248.00
Polyurethane, Passive-Fixation Bipolar
Pacing Leads with Fast-Pass Coating
Group 9 - Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT063 Selox SR Lead, pacemaker, implantable, 45, 53, 60cm length $1,248.00
BT083 Setrox S Bipolar active fixation lead with fractal length 45, 53, 60cm $1,248.00
coated and steroid eluting electrode
BT097 Dextrus (marketed by Boston Scientific) Bipolar, silicone, active fixation, steroid 7Fr, with 45cm, 53cm and $1,248.00
eluting, pacing lead 60cm length options
Guidant Australia Pty Ltd
GU013 Fineline II EZ Sterox IROX Lead Model 4472, Model 4473 & Model 4474 45cm, 52cm, 58cm $1,248.00
GU016 Fineline II EZ Sterox IROX Lead Model 4469, Model 4470 & Model 4471 45cm, 52cm, 58cm $1,248.00
Prostheses List by Category, Groups and Sponsor Page 27 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
GU122 Flextend Lead Models 4086, 4087 & Bipolar, steroid eluting, transvenous 45,52,59cm $1,248.00
silicon pace/sense leads with an
extendable/retractable active fixation for
implantation into the atrium or ventricle
Medtronic Australasia Pty Ltd
MC008 Medtronic Capsurefix Model 5568 Silicone Polyurethane 30 - 85cm $1,144.00
Pacing Leads
MC338 Medtronic Capsurefix Novus Model Silicone; Contents: 1 x lead with 45-85cm $1,248.00
5076 Pacing Lead anchoring sleeve, stylet & guide, 1 x vein
lifter, 2 x fixation tools, extra stylets
St. Jude Medical Australia Pty Ltd
SJ023 TENDRIL SDX 1488T, 1388T Single, Active Fixation, Steroid Eluting, 46cm-58cm $1,248.00
Low Polarisation Lead, IS-1
SJ073 Tendril SDX Models 1688T and Endocardial Steroid-Eluting Active 100cm, 25cm, 34cm, 40cm, $1,248.00
Fixation Pacing Lead 46cm, 52cm, 58cm, 85cm, 7F
SJ118 OptiSense 1699T/1699TC Endocardial, Bi-polar Active-fixation 40-58cm $1,248.00
Pacing Leads with Optim Insulation
SJ125 Tendril ST 1788T/TC and 1782TC Endocardial Bipolar Steroid-Eluting Active 40cm, 46cm, 52cm, 58cm, 65cm $1,248.00
Fixation Pacing Leads
SJ129 Tendril ST 1888TC and 1882TC Endocardial Bi-polar Steroid-Eluting 46-65cm $1,248.00
Active Fixation Pacing Leads
Pacemaker/ICD Extenders
Medtronic Australasia Pty Ltd
MC831 Medtronic Lead Extender Kit Model: Silicone 37 - 50cm $530.00
6984M, 6981M, 6985M,6986m
Prostheses List by Category, Groups and Sponsor Page 28 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Pacemaker/Lead Accessories
Medtronic Australasia Pty Ltd
MC036 Medtronic Lead End Cap Kit Model: Pin Plug Kits to Seal Unused Pacemaker One Size Per Model $80.00
5867-3M; Medtronic DF-1 Port Pin or Defibrillator Port; Sizing Sleeve -
Plug Kit: Model 6719, Medtronic IS-1 Silicone or Polyurethane
Port Pin Plug Kit: Model 6725;
Medtronic Upsizing Sleeve: Model 5866-
Recorders, Long Term, ECG, Implantable
Medtronic Australasia Pty Ltd
MC028 Medtronic Reveal ILR Model 9525, Titanium 8cc $3,635.00
Implantable Cardiogram Recorder;
Reveal Plus Implantable Loop Recorder
Model 9526
MC763 Reveal XT Reveal XT Insertable Cardiac Monitor 61 x 19 x 8 mm with a volume $3,900.00
of 9cc
MC768 Reveal DX Insertable Cardiac Monitor 61 x 19 x 8 mm with a volume $3,900.00
of 9cc
Single Chamber ICDs
Generation 2
Biotronik Australia Pty Ltd
BT054 Lexos VR Single chamber ICD, Rate responsive One size only. $36,400.00
Generation 3
Biotronik Australia Pty Ltd
BT075 Lumos VR-T Single Chamber ICD with home one size only $40,560.00
monitoring and IEGM online
BT087 Lumax 300 VR-T ICD-VR with bidirectional Home One Size Only $40,560.00
Monitoring. Single chamber
Prostheses List by Category, Groups and Sponsor Page 29 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BT098 Lumax 340 VR-T XL ICD-VR with 40 J output, bidirectional One Size Only $42,640.00
Home Monitoring and High Longevity
Guidant Australia Pty Ltd
GU110 Ventak Prizm II VR Model 1860, titanium, single chamber, One size only $40,560.00
adaptive rate
GU133 Vitality VR Model 1870 This device acts to defibrillate the heart Model 1870 Vitality VR Single $40,560.00
chambers when the patient enters into an Chamber Rate Responsive
arrhythmia or uses shocks or anti tachy Pacemaker/Defibrillator
pacing to revert Ventricular Tachycardia
(VT) or Ventricular Fibrillation (VF).
While also acting as a single chamber
GU148 Vitality 2 EL VR - Model T177 Implantable Cardiac Defibrillator 35cc 90g $40,560.00
GU151 Vitality 2 VR - Model T 175 Implantable cardiac defibrillator 30cc; 82g $40,560.00
Medtronic Australasia Pty Ltd
MC365 EnTrust Model D153VRC, Single chamber, 30J 33cc, 63g $40,560.00
Sorin Group
SA139 OVATIO VR 6250 Titanium, single chamber, sterile, VR 29cc $40,560.00
6250, 34J
St. Jude Medical Australia Pty Ltd
SJ048 Epic Plus VR Model V-196 Implantable Single Chamber sensing and bradycardia 32cc $40,560.00
Cardioverter Defibrillator pacing
SJ093 Epic II VR V-158 Implantable Cardiac Single Chamber Cardioverter Defibrillator 34cc, 70g $40,560.00
Defibrillator
Biotronik Australia Pty Ltd
BT100 LUMAX 540 VR-T High Energy, Single-Chamber ICD Diamensions: 66*55*13 mm $42,640.00
(Implantable Cardiac Defibrillator) with Volume/Weight : 37.2cc/92g
Advanced Patient Management Via unique
Home Monitoring Technology
incorporatin Automatic Threshold
Monitoring and Extended Longevity.
Boston Scientific Australia Pty Ltd
BS132 Teligen 100 HE VR 4-SITE High energy single chamber ICD with 4- 30.5cc, 9.9mm $43,390.00 $44,640.00
SITE inline RV connector (GDT-LLHH)
BS136 TELIGEN 100 HE VR DF-1/IS-1 High energy single chamber ICD with 31.5cc, 9.9mm $42,640.00
DF-1/IS-1 connector
Medtronic Australasia Pty Ltd
MC813 Secura VR Fully Automatic, Wireless Implantable 37cc $42,640.00
Prostheses List by Category, Groups and Sponsor cardioverter defibrillator with high energy Page 30 of 857
capability and therapies for ventricular tachyarrhythmia
MC814 Secura DR Fully Automatic, Wireless Implantable cardioverter 37cc $45,760.00
defibrillator with high energy capability and therapies
for ventricular and atrial tachyarrhythmia
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
A: high energy
St. Jude Medical Australia Pty Ltd
SJ124 Current RF VR 1207-36 Single Chamber Cardioverter Defibrillator 79g, 41cc $42,640.00
with RF Telemetry
Single Chamber Pacemakers
Generation 1
St. Jude Medical Australia Pty Ltd
SJ053 Verity Adx Model XL SC 5056 Single Chamber multi-programmable rate- 10.5cc, 23g $4,264.00
implantable pacemaker adaptive pacing device with extended
longevity
Generation 2
St. Jude Medical Australia Pty Ltd
SJ076 Verity Adx Model XL SR 5157 M/S Single Chamber multi-programmable 11cc, 23g $5,928.00
implantable pacemaker rate-adaptive pacing devices with
extended longevity
Generation 3
Biotronik Australia Pty Ltd
BT046 Protos VR/CLS Single chamber rate responsive, closed One size only $5,928.00
loop system.
BT062 Philos II SR Multiprogrammable, Rate Responsive, One size only $5,928.00
SSIR pacemaker
BT080 Cylos VR single chamber dual sensor rate responsive one size only $5,700.00
Boston Scientific Australia Pty Ltd
BS124 Insignia AVT 1192 Single chamber pacemaker 10cc, 23.4g $6,000.00
Guidant Australia Pty Ltd
GU124 Insignia Entra SR Models 1195 & 1198 Single Chamber Rate Responsive One size only $5,928.00
Permanent Pacemaker
GU126 Insignia Plus SR Model 1194 Single Chamber Rate Responsive One size only $5,928.00
Permanent Pacemaker
GU139 Insignia Ultra SR Lodel 1190 Implantable Cardiac Pacemaker One size only $5,928.00
Prostheses List by Category, Groups and Sponsor Page 31 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC321 EnPulse SR Series: Model E2SR01, EnPulse SR - Pacemakers - with IS1 One size only $6,000.00
Model E2SR03, Model E2SR06 connector; with 3.2mm low profile
connector; with 5mm connector.
MC728 Adapta Pacemaker SR Pacemaker 9.7 - 11.0cc $5,928.00 $6,188.00
Models ADSR01, ADSR06, ADSR03 21.5 - 22.5g
Sorin Group
SA137 Symphony SR Titanium one size only $5,928.00
St. Jude Medical Australia Pty Ltd
SJ055 Integrity ADx Model SR 5160 Single Chamber multi-programmable rate- 8cc, 17g $5,928.00
implantable pacemaker adaptive pacing device
SJ060 Identity ADx Model SR 5180 Single Chamber multi-programmable rate- 8cc, 18g $5,928.00
implantable pacemaker adaptive pacing device
SJ077 Verity Adx Models XL SR 5156 Single Chamber multi-programmable 11cc, 23g $5,928.00
implantable pacemaker rate-adaptive pacing devices with
extended longevity
SJ090 Victory SR 5610 single chamber rate responsive 41x44x46mm 17g 8cc $5,928.00
SJ105 Zephyr SR 5620 Single Chamber Rate-Responsive 8cc, 17g $5,928.00
SJ131 Zephyr XL SR 5626 Single-Chamber Rate-Responsive 23.5g and 10.4cc $5,928.00
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 70 cm $4,680.00
is used in addition to an Endotak
endocardial leads for patients with a high
DFT (Defibrillation Threshold)
Medtronic Australasia Pty Ltd
MC251 Implantable Subcutaneous Defibrillator Silicone and Platinum Alloy Lengths 41-85cm inclusive $4,680.00
Lead Model 6996SQ 41cm, 58cm,
Prostheses List by Category, Groups and Sponsor Page 32 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 7 - Epicardial Patches
Medtronic Australasia Pty Ltd
MC027 Model 6721 Unipolar Epicardial Patch Model 6721S-50, Model 6721M-50, 370, 660, 840mm $2,340.00
Leads S/M/L Model 6721L-50; Silicone
Special Purpose Dual Chamber Pacemaker - Custom Header
Generation 3
Medtronic Australasia Pty Ltd
MC332 Medtronic Kappa Pacemaker KDR 903 Cardiac Pacemaker, Titanium 13cc, 14.2cc $9,048.00
and KDR 906
Special Purpose ICDs - High energy products
Generation 2
Guidant Australia Pty Ltd
GU107 Ventak Prizm HE DR Model 1853 & Model 1858, titanium, dual One size only $40,560.00
chamber, adaptive rate
Generation 3
Biotronik Australia Pty Ltd
BT074 Xelos DR-T High energy ICD with home monitoring. Packed in one small size $45,760.00
Dual chamber
BT086 Lumax 340 DR-T ICD-DR 34 J with bidirectional Home One Size Only $45,760.00
Monitoring. Dual chamber
BT090 Lumax 340 VR-T ICD-VR 34 J with bidirectional Home One size only $42,640.00
Monitoring. Single chamber
Medtronic Australasia Pty Ltd
MC362 EnTrust Model D154DRG, dual chamber, VT 35cc, 68g $45,760.00
Therapies, 35J
MC366 EnTrust Model D154VRC, Single chamber, 35J 35cc, 68g $42,640.00
MC722 Virtuoso VR Model 37cc, 68g $42,640.00
Implantable Cardioverter Defibrillator,
Single Chamber
Prostheses List by Category, Groups and Sponsor Page 33 of 857
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
St. Jude Medical Australia Pty Ltd
SJ011 Atlas DR Model V-240 Dual chamber implantable cardioverter 37cc $45,760.00
defibrillator with rate response
SJ012 Atlas VR Model V-199 Single chamber implantable cardioverter 36cc $42,588.00
Bard Australia Pty Ltd
BA181 PowerPort Sterile Titanium or MRI, subcutaneous One size, OF Catheter $630.00
implanted port with attachable radiopaque
open ended ChronoFlex polyurethane
catheter, intermediate kit
Denward Dell Pty Ltd
DW003 Jet Port Plus Set - Vascular Access Port Implantable injection / infusion port Port: Diameter: 28.0mm, $375.00
system: port chamber with silicone Height: 12.3mm; Catheter: 6.6
membrane; connectable polyurethane French, Length: 750mm
catheter; and introducer kit.
Prostheses List by Category, Groups and Sponsor Page 855 of 857
VASCULAR
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DW004 Jet Port Plus Low Profile Peripheral Set Implantable injection / infusion port Port: Length: 24.0mm, Width: $420.00
- Vascular Access Port system: low profile port chamber with 20.5mm, Height: 10.3mm
silicone membrane; connectable Catheter: 6.6 French, Length:
polyurethane catheter; and introducer kit 750mm
DW006 T-Port Contrast set - Vascular access Injection infusion port system: titanium 6163653077: Port Base 27mm x $580.00
port chamber with silicone membrane: 13mm, Catheter Diameter 1.3 x
connectable polyurethane catheter; 2.2mm, Catheter Length 75cm.
introducer kit. 6163652087: Port Base 27mm x
13mm, Catheter Diameter 1.6 x
2.6mm, Catheter Length 75cm.
6163663077: Port Base 23mm x
10mm, Catheter Diameter 1.3 x
2.2mm, Catheter Length
75cm.6163662087: Port Base
23mm x 10mm, Catheter
Diameter 1.6 x 2.6mm, Catheter
Length 75cm.
Tuta Healthcare Pty Ltd
TT001 Paragon Ambulatory Drug Infusion The top of the Paragon infuser is made of Infuser - 100mL Administration $988.00
acetyl with stainless steel parts; the Sets - 0.50mL, 1mL, 2mL,
bottom is made of clear polycarbonate. 4mL, 10mL, 50mL, 100mL, or
Diam: 10cm Height: 5.8cm.
Administration Sets - made from PVC
TT003 Sidekick Ambulatory Disposable Spring infusor made from high impact Infuser - 50mL or 100mL, $467.00
Delivery System plastics. Administration Sets - made Administration Sets - 50mL,
from PVC and acrylic components. 100mL or 200mL/hr
Group 9d - Infuser Ports - multiple chambers
Denward Dell Pty Ltd
DW005 Dual Port Set - Vascular Access Port Implantable injection / infusion port Port: Length: 53.0mm, Width: $580.00
system: dual port chamber with silicone 20.0mm, Height: 13.5mm
membranes; connectable double lumen (chamber 1), 15.5mm (chamber
polyurethane catheter; and introducer kit. 2); Catheter: Length: 500mm,
internal diameter double D,
external diameter 3mm
Prostheses List by Category, Groups and Sponsor Page 856 of 857
VASCULAR
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Internal embolization, intravascular
Device Technologies Australia Pty Ltd
DE275 DC Bead Drug delivery embolisation system 100-300, 300-500, 500-700, $1,650.00 $1,950.00 Product only to be used for
700-900 (microns) embolic procedures.
Morton Surgical Pty Ltd t/a Matrix Surgical Company
MG030 Haemostatic Ligating Clips Titanium Ligating Clips small - large $8.00
MG031 Haemostatic Ligating Clips Titanium Ligating Clips small, medium (24 clips per pouch) $32.00
Neurointerventional Coils
ev3 Australia Pty Ltd
EE023 Axium Detachable Coil System Platinum alloy coils attached to a Diameter: 1.5 - 25mm; Length: $1,950.00
composite implant delivery pusher with a 1 - 50cm
radiopaque positioning marker. The
proximal end of the pusher is loaded into
the Actuator which detaches the coil.
Grand Total: 9492 Records
Prostheses List by Category, Groups and Sponsor Page 857 of 857
PART B - Human Tissue List
Cardio-thoracic
Benefit
Billing Code Institute Product Name Amou
QHV01 The Prince Charles Hospital - Queensland Heart Valve Bank Heart Valve - Aortic $5,499.00
QHV02 The Prince Charles Hospital - Queensland Heart Valve Bank Heart Valve - Pulmonary $5,499.00
QHV03 The Prince Charles Hospital - Queensland Heart Valve Bank Mitral Valve Patch $1,448.00
QHV04 The Prince Charles Hospital - Queensland Heart Valve Bank Tricuspid Valve Patch $1,448.00
QHV05 The Prince Charles Hospital - Queensland Heart Valve Bank Pericardium Patch $1,448.00
QHV06 The Prince Charles Hospital - Queensland Heart Valve Bank Pulmonary Conduit - Small $1,448.00
QHV07 The Prince Charles Hospital - Queensland Heart Valve Bank Pulmonary Conduit - Large $1,448.00
QHV08 The Prince Charles Hospital - Queensland Heart Valve Bank Pulmonary Valved Conduit For Patch use $5,499.00
QHV09 The Prince Charles Hospital - Queensland Heart Valve Bank Aortic Valved Conduit Patch $5,499.00
QHV10 The Prince Charles Hospital - Queensland Heart Valve Bank Mitral Valve $5,499.00
QHV11 The Prince Charles Hospital - Queensland Heart Valve Bank Thoracic Aorta $1,450.00
RPH01 Royal Perth Hospital T/A Heart Valve Bank Heart Valve - Aortic $3,833.00
RPH02 Royal Perth Hospital T/A Heart Valve Bank Heart Valve - Pulmonary $3,833.00
SHV01 Sydney Heart Valve Bank, St. Vincent's Hospital Heart Valve - Aortic $5,350.00
SHV02 Sydney Heart Valve Bank, St. Vincent's Hospital Heart Valve - Pulmonary $5,350.00
SHV03 Sydney Heart Valve Bank, St. Vincent's Hospital Arterial Graft/Conduit $987.00
TBV01 Donor Tissue Bank of Victoria Heart Valve - Aortic $5,923.00
TBV02 Donor Tissue Bank of Victoria Heart Valve - Pulmonary $5,923.00
TBV03 Donor Tissue Bank of Victoria Pulmonary Conduit $909.00
TBV50 Donor Tissue Bank of Victoria Pericardium $440.00
Human Tissue List by Category Page 1 of 10
Ophthalmic
Benefit
Billing Code Institute Product Name Amou
AUB01 Australian Biotechnologies Amnion Corneal Graft $800.00
LEM01 Lions Eye Donation Service Cornea $2,000.00
LEM02 Lions Eye Donation Service Cornea for Sclera $150.00
LEM03 Lions Eye Donation Service Human Amniotic Membrane for Transplantation $770.00
LEN01 Lions Eye Bank of NSW, Sydney Hospital Cornea $1,000.00
LEN02 Lions Eye Bank of NSW, Sydney Hospital Cornea for Sclera $150.00
LEN03 Lions Eye Bank of NSW, Sydney Hospital Cornea For Lamellar $600.00
LEW01 Lions Eye Bank of Western Australia Cornea $2,500.00
LEW02 Lions Eye Bank of Western Australia Sclera $250.00
QEB01 Queensland Eye Bank Cornea $1,755.00
QEB02 Queensland Eye Bank Sclera $285.00
SAE01 The Eye Bank of South Australia Cornea $1,000.00
SAE02 The Eye Bank of South Australia Cornea for Sclera $60.00
TBV04 Donor Tissue Bank of Victoria Cornea $800.00
Human Tissue List by Category Page 2 of 10
Orthopaedic
Benefit
Billing Code Institute Product Name Amou
ACT01 ACT Bone Bank Femoral Head $2,113.00
APH01 The Avenue Private Hospital Bone Bank Femoral Head $1,131.00
AUB02 Australian Biotechnologies Femoral Head - Milled $2,318.00
AUB03 Australian Biotechnologies Femoral Head - Whole $2,013.00
CSA01 Rachel Forster Bone Bank Femoral Head $802.00
DHR01 Barwon Health Bone Bank Femoral Head $2,113.00
HBB01 The Hobart Private Hospital Bone Bank Femoral Head $2,113.00
LPH01 Lingard Private Hospital Bone Bank Femoral Head $1,103.00
MMH01 Mater Misericordiae Hospital Bone Bank Theatres Femoral Head $400.00
MTE01 Mercy Tissue Engineering Pty Ltd Autologous Chondrocyte Transplantation $9,996.00
MTE03 Mercy Tissue Engineering Pty Ltd Autologous Chondrocyte Transplantation $11,349.0
MVS02 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Femur - Distal (Shaft & Condyles) $2,290.00
MVS03 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Femur - Entire $2,290.00
MVS04 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Femur - Proximal (shaft, trochanter, neck) $2,290.00
MVS05 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Femoral Head $1,595.00
MVS07 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Fibula - Entire $2,290.00
MVS08 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Hemipelvis - Complete $2,290.00
MVS09 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Humerus - Proximal with rotator cuff $2,290.00
MVS11 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Tibia - Proximal: half $2,290.00
MVS13 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Fibula - Segment (6cm) $2,290.00
MVS14 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Fibula - Segment (12cm) $2,290.00
MVS15 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Ulna $2,290.00
MVS16 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Tibia - Whole $2,290.00
MVS17 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Tibia - Distal $2,290.00
MVS18 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Radius $2,290.00
MVS19 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Humerus - Distal $2,290.00
MVS20 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Humerus - Entire $2,290.00
MVS21 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Rib (5cm) $382.00
MVS22 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Autologous Chondrocyte Transplantation $9,538.00
MVS23 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank Autologous Skull Flap $1,396.00
Human Tissue List by Category Page 3 of 10
Orthopaedic
Benefit
Billing Code Institute Product Name Amou
NBB01 New South Wales Bone Bank Achilles Tendon $1,560.00
NBB02 New South Wales Bone Bank Achilles Tendon with Bone Plug $1,995.00
NBB05 New South Wales Bone Bank Dowel Plug $1,188.00
NBB06 New South Wales Bone Bank Radius $2,807.00
NBB07 New South Wales Bone Bank Ulna $2,587.00
NBB09 New South Wales Bone Bank Fascia Lata - Small (>10cm x >5cm) $882.00
NBB10 New South Wales Bone Bank Femur - Distal Half $2,555.00
NBB11 New South Wales Bone Bank Femur - Distal third $2,456.00
NBB12 New South Wales Bone Bank Femur - Entire $6,107.00
NBB13 New South Wales Bone Bank Femur - Middle third $2,363.00
NBB14 New South Wales Bone Bank Femur - Proximal third $1,196.00
NBB15 New South Wales Bone Bank Femur - Proximal half $2,755.00
NBB16 New South Wales Bone Bank Femoral Head $2,013.00
NBB17 New South Wales Bone Bank Femoral Rings $1,470.00
NBB18 New South Wales Bone Bank Fibula - Entire $3,680.00
NBB21 New South Wales Bone Bank Hemipelvis - Acetabulum $2,831.00
NBB22 New South Wales Bone Bank Hemipelvis - IIliac crest $2,437.00
NBB23 New South Wales Bone Bank Hemipelvis -Tricortical iliac wedge $1,106.00
NBB24 New South Wales Bone Bank Hemipelvis - Complete $6,422.00
NBB25 New South Wales Bone Bank Distal Humerus $1,380.00
NBB26 New South Wales Bone Bank Humeral Head Addition $1,490.00
NBB27 New South Wales Bone Bank Proximal Humerus $1,741.00
NBB28 New South Wales Bone Bank Humerus - Proximal half with rotator cuff $2,625.00
NBB29 New South Wales Bone Bank Humerus - Entire $3,000.00
NBB30 New South Wales Bone Bank Humerus - Whole with rotator cuff $3,089.00
NBB31 New South Wales Bone Bank Medial Ligament $1,605.00
NBB33 New South Wales Bone Bank Patella tendon with Bone Plugs $1,425.00
NBB35 New South Wales Bone Bank Tibia - Plateau (prox 1/3) $2,374.00
NBB36 New South Wales Bone Bank Proximal Tibia $2,405.00
NBB37 New South Wales Bone Bank Tibia - Whole $3,870.00
Human Tissue List by Category Page 4 of 10
Orthopaedic
Benefit
Billing Code Institute Product Name Amou
NBB38 New South Wales Bone Bank Ulna - Shaft $2,310.00
NBB40 New South Wales Bone Bank Ulna - Ring $1,764.00
NBB41 New South Wales Bone Bank Tibia - Shaft Whole $3,638.00
NBB42 New South Wales Bone Bank Tibia - Shaft Third $2,493.00
NBB43 New South Wales Bone Bank Tibia - Shaft Half $2,310.00
NBB44 New South Wales Bone Bank Tibia - Whole with Patella Tendon $5,296.00
NBB45 New South Wales Bone Bank Tibia - Ring $1,365.00
NBB46 New South Wales Bone Bank Tibia - Proximal with Patella Tendon $3,870.00
NBB47 New South Wales Bone Bank Radius - Shaft $2,888.00
NBB49 New South Wales Bone Bank Radius - Ring $1,764.00
NBB50 New South Wales Bone Bank Humerus - Shaft Whole $3,000.00
NBB51 New South Wales Bone Bank Humerus - Shaft Half $1,575.00
NBB53 New South Wales Bone Bank Humerus - Ring $1,365.00
NBB54 New South Wales Bone Bank Fibula - Segment $2,214.00
NBB55 New South Wales Bone Bank Femur - Shaft Third $1,500.00
NBB56 New South Wales Bone Bank Femur - Segment $1,500.00
NBB57 New South Wales Bone Bank Femur - Shaft Half $2,656.00
NBB59 New South Wales Bone Bank Femur - Hemicondyle $2,205.00
NBB60 New South Wales Bone Bank Cancellous Crunch - 60cc $2,425.00
NBB61 New South Wales Bone Bank Cancellous Crunch - 30cc $1,599.00
NBB62 New South Wales Bone Bank Cancellous Crunch - 15cc $877.00
NBB63 New South Wales Bone Bank Cortico-Cancellous Crunch (40/60) - 60cc $2,425.00
NBB64 New South Wales Bone Bank Cortico-Cancellous Crunch (40/60) - 30cc $1,599.00
NBB65 New South Wales Bone Bank Cortico-Cancellous Crunch (40/60) - 15cc $877.00
NBB66 New South Wales Bone Bank Tri Cortical Osteotomy $1,106.00
NBB67 New South Wales Bone Bank Anterior Tibialis Tendon $2,000.00
NBB68 New South Wales Bone Bank Patella Tendon - Machined Conical Bone Plug $1,925.00
NBB69 New South Wales Bone Bank Achilles Tendon - Machined Conical Bone Plug $2,495.00
NBB70 New South Wales Bone Bank Semi Tendinosis Tendon $2,000.00
ORT01 Orthogen Australia Pty Ltd Autologous Chondrocytes Implant and Matrix $11,400.0
Human Tissue List by Category Page 5 of 10
Orthopaedic
Benefit
Billing Code Institute Product Name Amou
PBT01 Perth Bone and Tissue Bank Achilles Tendon $2,100.00
PBT02 Perth Bone and Tissue Bank Anterior Cruciate Ligament Unit $1,750.00
PBT03 Perth Bone and Tissue Bank Bone Plug/Dowel - Cancellous $500.00
PBT06 Perth Bone and Tissue Bank Cortical Struts 10-15cm $1,716.00
PBT07 Perth Bone and Tissue Bank Cortical Struts>15 - 20cm $2,048.00
PBT08 Perth Bone and Tissue Bank Milled Bone <30g $1,680.00
PBT09 Perth Bone and Tissue Bank Milled Bone 30 - 50g $2,153.00
PBT10 Perth Bone and Tissue Bank Milled Bone >50g $2,468.00
PBT11 Perth Bone and Tissue Bank Cartilage (costal) segments $300.00
PBT13 Perth Bone and Tissue Bank Radius $1,800.00
PBT14 Perth Bone and Tissue Bank Ulna $1,500.00
PBT15 Perth Bone and Tissue Bank Fascia Lata - Large (15cm x 10cm) $1,450.00
PBT16 Perth Bone and Tissue Bank Fascia Lata - Small (10cm x 5cm) $800.00
PBT17 Perth Bone and Tissue Bank Femur - Distal (shaft & condyles) $2,950.00
PBT18 Perth Bone and Tissue Bank Femur - Entire $5,000.00
PBT19 Perth Bone and Tissue Bank Shaft - Femur / Tibia Middle third $2,550.00
PBT20 Perth Bone and Tissue Bank Femur - Proximal (shaft, trochanter, neck) $2,950.00
PBT21 Perth Bone and Tissue Bank Femoral Condyle $1,950.00
PBT22 Perth Bone and Tissue Bank Femoral Head $2,100.00
PBT24 Perth Bone and Tissue Bank Femoral Rings $1,450.00
PBT25 Perth Bone and Tissue Bank Fibula - Entire $2,150.00
PBT28 Perth Bone and Tissue Bank Fibula segment (prox / distal) $1,250.00
PBT29 Perth Bone and Tissue Bank Hemipelvis - Acetabulum $2,500.00
PBT30 Perth Bone and Tissue Bank Hemipelvis - Complete $4,600.00
PBT31 Perth Bone and Tissue Bank Hemipelvis - IIliac crest $1,100.00
PBT32 Perth Bone and Tissue Bank Hemipelvis -Tricortical iliac wedge $600.00
PBT33 Perth Bone and Tissue Bank Humerus - Whole $3,050.00
PBT34 Perth Bone and Tissue Bank Humerus - Proximal with rotator cuff $2,550.00
PBT35 Perth Bone and Tissue Bank Humerus - Proximal w'out rotator cuff $1,100.00
PBT37 Perth Bone and Tissue Bank Freeze Dried Milled Bone <30gm $750.00
Human Tissue List by Category Page 6 of 10
Orthopaedic
Benefit
Billing Code Institute Product Name Amou
PBT38 Perth Bone and Tissue Bank Freeze Dried Milled Bone 30 - 50gm $900.00
PBT40 Perth Bone and Tissue Bank Patellar unit whole with tibial block $2,300.00
PBT41 Perth Bone and Tissue Bank Rib (5cm) $300.00
PBT44 Perth Bone and Tissue Bank Tibia - Proximal: with Patella & Tendon $3,500.00
PBT45 Perth Bone and Tissue Bank Tibia - Proximal: without Patella $2,350.00
PBT46 Perth Bone and Tissue Bank Tendon Unit $1,800.00
PBT47 Perth Bone and Tissue Bank Meniscal Graft $1,800.00
PBT48 Perth Bone and Tissue Bank Cortical struts>20cm $2,310.00
QBB01 The Queensland Bone Bank Achilles Tendon $1,830.00
QBB02 The Queensland Bone Bank Tibial Shaft (Freeze Dried) $630.00
QBB03 The Queensland Bone Bank Milled Bone FD 20gm $2,415.00
QBB04 The Queensland Bone Bank Disc (Freeze Dried) $682.00
QBB05 The Queensland Bone Bank Meniscus $1,340.00
QBB08 The Queensland Bone Bank Tibia Proximal + Patella $2,680.00
QBB09 The Queensland Bone Bank Freeze-dried Cancellous Cubes (6) $1,540.00
QBB10 The Queensland Bone Bank Freeze-Dried Cancellous Strips (2) $650.00
QBB11 The Queensland Bone Bank Fascia Lata (per sq cm) $5.00
QBB12 The Queensland Bone Bank Cartilage (costal) segments $200.00
QBB14 The Queensland Bone Bank Elbow - joint $2,100.00
QBB15 The Queensland Bone Bank Radius $2,150.00
QBB16 The Queensland Bone Bank Ulna $2,150.00
QBB20 The Queensland Bone Bank Femur - Distal Half $2,680.00
QBB22 The Queensland Bone Bank Femur - Entire $4,065.00
QBB23 The Queensland Bone Bank Femoral Shaft $2,150.00
QBB25 The Queensland Bone Bank Femur - Proximal half $2,890.00
QBB27 The Queensland Bone Bank Femoral Head $2,060.00
QBB28 The Queensland Bone Bank Femoral Head - Whole (Freeze Dried) $800.00
QBB30 The Queensland Bone Bank Femoral Rings $1,515.00
QBB31 The Queensland Bone Bank Femoral Rings - (Freeze Dried) $650.00
QBB32 The Queensland Bone Bank Fibula - Entire $2,525.00
Human Tissue List by Category Page 7 of 10
Orthopaedic
Benefit
Billing Code Institute Product Name Amou
QBB33 The Queensland Bone Bank Hemipelvis - Acetabulum $2,630.00
QBB34 The Queensland Bone Bank Hemipelvis - IIliac crest $2,360.00
QBB35 The Queensland Bone Bank Hemipelvis - Tricortical Iliac Wedge $1,160.00
QBB36 The Queensland Bone Bank Hemipelvis - Tricortical Iliac Wedge (Freeze Dried) $700.00
QBB37 The Queensland Bone Bank Hemipelvis - Complete $4,065.00
QBB39 The Queensland Bone Bank Humeral Shaft $1,535.00
QBB43 The Queensland Bone Bank Humerus - Entire $2,890.00
QBB45 The Queensland Bone Bank Milled Bone - 20gm $1,935.00
QBB47 The Queensland Bone Bank Patella $750.00
QBB48 The Queensland Bone Bank Patella tendon $1,995.00
QBB51 The Queensland Bone Bank Tibia - Distal $1,802.00
QBB52 The Queensland Bone Bank Tibia - Strut $420.00
QBB53 The Queensland Bone Bank Tibia Shaft $945.00
QBB54 The Queensland Bone Bank Tibia Proximal $2,365.00
QBB55 The Queensland Bone Bank Tibia - Whole $4,065.00
QBB56 The Queensland Bone Bank Autologous Skull Flap - processed $1,900.00
QBB57 The Queensland Bone Bank Tendon Tibialis Posterior $1,830.00
QBB58 The Queensland Bone Bank Tendon Tibialis Anterior $1,830.00
QBB59 The Queensland Bone Bank Tendon Gracilis $1,830.00
QBB60 The Queensland Bone Bank Autologous Skull Flap -unprocessed $1,500.00
QBB61 The Queensland Bone Bank Femoral Head - Autologous $2,060.00
QBB62 The Queensland Bone Bank Tendon Achilles No Block $1,830.00
QBB63 The Queensland Bone Bank Tendon Patella Hemi $1,495.00
QBB64 The Queensland Bone Bank Tibia Whole with Patella $4,065.00
QBB65 The Queensland Bone Bank Tendon Achilles Hemi $1,365.00
QBB66 The Queensland Bone Bank Femoral Shaft - (Freeze Dried) $2,690.00
QBB67 The Queensland Bone Bank Rongeured Bone Chips (Freeze Dried) $2,415.00
QBB68 The Queensland Bone Bank Rongeured Bone Chips $1,935.00
QBB69 The Queensland Bone Bank Tendon EHL $1,830.00
QBB70 The Queensland Bone Bank Tendon Semitendinous $1,830.00
Human Tissue List by Category Page 8 of 10
Orthopaedic
Benefit
Billing Code Institute Product Name Amou
RNB01 Hunter New England Bone Bank Femoral Head $1,870.00
RNB02 Hunter New England Bone Bank Autologous Skull Flap $1,470.00
SVN01 Mater Hospital Femoral Head $731.00
TBV05 Donor Tissue Bank of Victoria Achilles Tendon $904.00
TBV06 Donor Tissue Bank of Victoria Achilles Tendon with Bone Plug $1,841.00
TBV07 Donor Tissue Bank of Victoria Bone Plug/Dowel - Cancellous $610.00
TBV08 Donor Tissue Bank of Victoria Bone Plug/Dowel - Tricortical $673.00
TBV09 Donor Tissue Bank of Victoria Bone - Chips/cubes 40cc $874.00
TBV10 Donor Tissue Bank of Victoria Bone - Chips/cubes 80cc $1,663.00
TBV11 Donor Tissue Bank of Victoria Milled Bone - 40cc $1,046.00
TBV12 Donor Tissue Bank of Victoria Milled Bone - 80cc $1,870.00
TBV13 Donor Tissue Bank of Victoria Cortical Struts (2 struts) $1,370.00
TBV14 Donor Tissue Bank of Victoria Cortical Struts (1 strut) $685.00
TBV17 Donor Tissue Bank of Victoria Cartilage (costal) segments $350.00
TBV18 Donor Tissue Bank of Victoria Elbow - joint $4,710.00
TBV19 Donor Tissue Bank of Victoria Radius $2,796.00
TBV20 Donor Tissue Bank of Victoria Ulna $2,577.00
TBV21 Donor Tissue Bank of Victoria Fascia Lata $724.00
TBV22 Donor Tissue Bank of Victoria Femur - Distal (shaft & condyles) $3,460.00
TBV23 Donor Tissue Bank of Victoria Femur - Entire $5,794.00
TBV24 Donor Tissue Bank of Victoria Femur - Middle third $1,887.00
TBV25 Donor Tissue Bank of Victoria Femur - Proximal without femoral head $3,434.00
TBV26 Donor Tissue Bank of Victoria Femoral head $2,113.00
TBV27 Donor Tissue Bank of Victoria Fibula - Entire $6,041.00
TBV28 Donor Tissue Bank of Victoria Fibula - Segment (6cm) $610.00
TBV29 Donor Tissue Bank of Victoria Fibula - Segment (12cm) $932.00
TBV30 Donor Tissue Bank of Victoria Fibula - Shaft $1,968.00
TBV31 Donor Tissue Bank of Victoria Hemipelvis - Acetabulum $2,686.00
TBV32 Donor Tissue Bank of Victoria Hemipelvis - Complete $6,093.00
TBV33 Donor Tissue Bank of Victoria Hemipelvis - IIliac crest $2,428.00
Human Tissue List by Category Page 9 of 10
Orthopaedic
Benefit
Billing Code Institute Product Name Amou
TBV34 Donor Tissue Bank of Victoria Hemipelvis -Tricortical iliac wedge $920.00
TBV35 Donor Tissue Bank of Victoria Humerus - Proximal with rotator cuff $2,336.00
TBV36 Donor Tissue Bank of Victoria Humerus - Proximal w'out rotator cuff $2,485.00
TBV37 Donor Tissue Bank of Victoria Humeral Head $1,484.00
TBV38 Donor Tissue Bank of Victoria Medial Ligament $1,599.00
TBV39 Donor Tissue Bank of Victoria Meniscus with Ligaments $1,927.00
TBV40 Donor Tissue Bank of Victoria Meniscus without Ligaments $1,046.00
TBV41 Donor Tissue Bank of Victoria Patella $915.00
TBV42 Donor Tissue Bank of Victoria Patella Tendon and Patella $1,927.00
TBV43 Donor Tissue Bank of Victoria Rib (5cm) $437.00
TBV44 Donor Tissue Bank of Victoria Tibia - Proximal: 7-15cm $2,299.00
TBV45 Donor Tissue Bank of Victoria Tibia - Proximal: 16-25cm $2,215.00
TBV46 Donor Tissue Bank of Victoria Femur- 1 Condyle only $1,065.00
TBV47 Donor Tissue Bank of Victoria Tibia - Condyles only $1,491.00
TBV48 Donor Tissue Bank of Victoria Tibia - Distal $1,922.00
TBV49 Donor Tissue Bank of Victoria Humerus - Distal $1,979.00
TBV51 Donor Tissue Bank of Victoria Femur - Proximal with femoral head $3,332.00
TBV52 Victorian Institute of Forensic Medicine Cancellous Bone Matrix (CBM) - 40cc $556.00
TBV53 Victorian Institute of Forensic Medicine Cancellous Bone Matrix (CBM) - 80cc $1,110.00
TBV54 Donor Tissue Bank of Victoria Demineralised Bone Matrix - 5g $480.00
TBV55 Donor Tissue Bank of Victoria Demineralised Bone Matrix - 10g $960.00
VAP01 Verigen Australia Pty Ltd Autologous Chondrocyte Transplantation $10,989.0
VAP02 Verigen Australia Pty Ltd Primary MACI plus 1/2 $12,525.0
Membrane
Grand Total: 267 Records
Human Tissue List by Category Page 10 of 10
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