Private Health Insurance (Prostheses) Rules 2011 (No. 2) (Cth)

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Private Health Insurance (Prostheses) Rules 2011 (No. 2)

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 5 November 2011 taking into account amendments up to the Private Health Insurance (Prostheses) Amendment Rules 2011 (No.3).

Prepared by the Department of Health and Ageing, Canberra .

Contents

Part 1Preliminary

1.Name of Rules

These Rules are the Private Health Insurance (Prostheses) Rules 20 11 (No. 2).

2.Commencement

These Rules commence on 22 August 2011.

3.Revocation

These Rules revoke the Private Health Insurance (Prostheses) Rules 2011 (No. 1) as amended by the Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 1).

4.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 means a podiatric surgeon who holds specialist registration in the specialty of podiatric surgery under the National Law.

Note: The registration requirements for an accredited podiatrist for the purpose of these Rules is the same registration requirements for podiatric surgeons as set out in rule 8 of the current Private Health Insurance (Accreditation) Rulesas made from time to time under section 333-20 of the Act.

Act means the Private Health Insurance Act 2007.

certified overnight Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.

certified Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.

consultant physician has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

gap permitted prosthesis means a prosthesis of a kind listed in the Schedule where an amount is set out for that kind of prosthesis in the column under the heading 'Minimum Benefit' and a different amount is set out in the column under the heading 'Maximum Benefit'.

implantable cardiac event recorderincludes a component of an implantable cardiac event recorder.

insulin infusion pump includes a component of an insulin infusion pump.

listed prosthesis means a kind of prosthesis listed in the Schedule to these Rules.

listing application has the same meaning as in subsection 72-10(6) of the Act.

listing criteriahas the same meaning as in subsection 72-10(6) of the Act.

National Lawmeans:

(a) for a State or Territory other than Western Australia — the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld)as it applies (with or without modification) as law of the State or Territory; or

(b) for Western Australia — the legislation enacted by the Health Practitioner Regulation National Law (WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.

Note: The Intergovernmental Agreement for a National Registration and Accreditation Scheme for the Health Professions that was made on 26 March 2008 provides for the enactment of the State and Territory legislation mentioned in this definition.

no gap prosthesis means a prosthesis of a kind listed in the Schedule where an amount is set out for that kind of prosthesis in the column under the heading 'Minimum Benefit' and no amount is set out 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 withthe status ofcertainhospitals for which a declaration had been made before the commencement of the Act.

professional attendance has the same meaning as in clause 1.2.3 of the General Medical Services Table being the table prescribed under section 4 of the Health Insurance Act 1973.

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 withthe status ofcertainhospitals for which a declaration had been made before the commencement of the Act.

Schedule means the Schedule in these Rules.

Part 2Benefit requirements

5.Listing of, and benefits for, prostheses

For item 4 of the table in subsection 72-1 (2) of the Act:

  1. (a)

    the Schedule lists the kinds of prostheses:

    1. (i)

      in relation to which the Minister has granted an application for listing under subsection 72-10 (5) of the Act; or

    2. (ii)

      which are listed in accordance with 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.

(aa) circumstances in which a listed prosthesis is provided for the purposes of paragraph (d) of item 4 of the table in subsection 72-1(2) are set out in rule 5A; and

(ab) conditions that must be satisfied in relation to the provision of a listed prosthesis for the purposes of paragraphs (c) and (d) of item 4 of the table in subsection 72-1(2) are set out in rule 5B; and

  1. (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; and

  2. (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.

5A.Circumstances in which a prosthesis is provided other than circumstances in which a medicare benefit is payable

For the purposes of paragraph (d) of item 4 of the table in subsection 72-1(2) of the Act, the following circumstances are set out:

(a) the provision of a listed prosthesis which is associated with podiatric treatment by an accredited podiatrist.

Note: Paragraph (c) of Item 4 of subsection 72-1(2) deals with the provision of a listed prosthesis in circumstances in which a medicare benefit is payable.

5B.Conditions in relation to the provision of listed prostheses

For the purposes of paragraphs (c) and (d) of item 4 of the table in subsection 72-1(2) of the Act, conditions that must be satisfied in relation to the provision of a listed prosthesis in the circumstances covered by paragraph (c) or (d) of that item, as the case may be, are:

(a) in relation to any kind of prosthesis where there is a statement of a requirement under the heading 'Condition' in the Schedule under the listing for that kind of prosthesis, that requirement; and

(b) in relation to a listed prosthesis that is an insulin infusion pump, also:

(i) the professional service associated with the provision of the insulin infusion pump must be a professional attendance by a consultant physician in the practice of his or her specialty; and

(ii) the professional service must be provided as a certified Type C procedure or certified overnight Type C procedure; and

(iii) the insulin infusion pump must be provided for the purpose of administering insulin.

Note: Item 4 of the table in subsection 72-1(2) of the Act states other requirements in relation to benefits for the provision of prostheses that a policy that covers hospital treatment must meet. These requirements relate to benefits for hospital treatment and, if the policy covers hospital-substitute treatment, to the benefits of that coverage as well.

6.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, 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:

(a) the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and

  1. (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:

(a) the minimum benefit is the lesser of the following amounts:

  1. (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:

(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.

Note: Paragraphs (d) and (e) of subsection 72-10(5) of the Act deal with the fixing of minimum and maximum benefits when the Minister is making or varying the Private Health Insurance (Prostheses) Rules.

7.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 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:

(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 1: 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 ― see paragraph 121-10 (3) (a) of the Act.

Note 2: Paragraphs (d) and (e) of subsection 72-10(5) of the Act deal with the fixing of minimum and maximum benefits when the Minister is making or varying the Private Health Insurance (Prostheses) Rules.

Part3Other8.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 kind of 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 kind of prosthesis from the list in the Rules if the applicant fails to pay an ongoing listing fee.

9.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 List Advisory Committee.

  1. (2)

    In setting the minimum and the maximum (if any) benefits for a kind of prosthesis, the Minister may have regard to the benefits as negotiated between the Negotiating Oversight Committee and the applicant.

10.Listing criteria for prostheses to be listed in Part C of the Schedule

For a listing application to be granted to list a kind of prosthesis in Part C of the Schedule, the listing criterion is that the kind of prosthesis is an:

(i) insulin infusion pump; or

(ii) implantable cardiac event recorder.

  1. Note:

    1. The power to make listing criteria is in subsection 72-10(6) of the Act.

  2. 2.

    Under subsection 72-10(7) of the Act the Minister must not grant a listing application if any applicable listing criteria are not satisfied in relation to the application.

  3. 3.

    Under the Act the Minister may refuse to grant a listing application even if the listing criteria are satisfied. See Note to subsection 72-10(7) of the Act.

Notes

The Private Health Insurance (Prostheses) Rules 2011 (No.2) as shown in this compilation are

amended as indicated in the tables below.

Table of Instruments

Instrument

Date of FRLI registration

Date of commencement

Application, saving or transitional provision

Private Health Insurance (Prostheses) Rules 2011 (No.2)

10 August 2011

(see F2011L01617

22 August 2011

Private Health Insurance (Prostheses) Amendment Rules 2011 (No.2)

2 September 2011

(see F2011L01802)

5 September 2011

Private Health Insurance (Prostheses) Amendment Rules 2011 (No.3)

4 November 2011

(see F2011L02240)

5 November 2011

Table of Amendments

  1. ad. = added or inserted

    am. = amended rep. = repealed rs. = repealed and substituted

Provision affected

How affected

Schedule

  1. am. 2011 No.

    F2011L01802

Part 1 Preliminary

am. 2011 No. F2011L02240

Note

1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003.See A - Prostheses List August 2011

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.1.1 Aphakic

1.1.1.1 Rigid

Alcon Laboratories (Aust.) Pty Ltd

AL003 MTA2UO - MTA6UO PMMA +5 to +30 D $156.00

Bausch & Lomb (Australia) Pty Ltd

BL005 Storz (Coburn) Intraocular Lens PMMA Anterior Chamber Intraocular lens 13.75mm length. 6.0mm optic $156.00

121UV; L122UV PMMA Anterior 1 piece size, diopter range 3-30d.

Chamber Lens L122UV: 6.0mm optic,

13.75mm length, power range;

5.0 to 30.0 Diopters

Emagin Pty Ltd

EG009 Artisan Anterior Chamber Intraocular Aphakia ModelComposition: PMMA 5.00mm Optic Diameter x 8.5 $156.00

Lens in overall length

ifc

AMO Australia Pty Ltd

AO019 Verisyse AC IOL Aphakic Model 5mm Optic Diameter x 8.5 $250.00

overall length

m

AMO Australia Pty Ltd

AO001 Intraocular Lens: Model AC 51L Duralens PMMA, Anterior Chamber IOL 6.00 mm Optic Diameter x $198.00

13.0mm in overall length

1.1.2 Phakic

1.1.2.1 Rigid

AMO Australia Pty Ltd

AO016 Verisyse AC IOL Phakic Intraocular Lens: Model Myopia. 5mm Optic Diameter x 8.5 $680.00

Composition: PMMA overall length; 6mm Optic

Diameter x 8.5 overall length

AO017 Verisyse AC IOL Phakic Intraocular Lens: Model 5mm Optic Diameter x 8.5 $680.00

Hyperopia.

Composition: PMMA overall length

Prostheses List by Category, Groups and Sponsor Page 1 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Emagin Pty Ltd

EG012 Artisan Anterior Chamber IOL Phakic Intraocular Lens Myopic / 5.00mm Optic Diameter x 8.5 $680.00

Hyperopic in overall length;

t1

AMO Australia Pty Ltd

AO030 Verisyse Toric (Custom) Phakic intraocular lens: Model toric 5mm Optic Diameter x 7.5mm $1,056.00

overall length

Emagin Pty Ltd

EG008 Artisan Anterior Chamber Intraocular Phakic Intraocular Lens: Model Toric 5.00mm Optic Diameter x 7.5 $1,056.00

Lens Composition: PMMA in overall length

t2

AMO Australia Pty Ltd

AO029 Verisyse Toric (Custom) Phakic intraocular lens: Model toric 5mm Optic Diameter x 7.5mm $1,358.00

overall length

1.1.2.2 Foldable

Alcon Laboratories (Aust.) Pty Ltd

AL034 AcrySof Cachet Phakic Lens Anterior chamber foldable, acrylic, single -6.0 to -16.5 diopters, in 0.5 $723.00

piece phakic lens diopter increments

AMO Australia Pty Ltd

AO025 VeriFlex Foldable Phakic IOL Anterior chamber foldable phakic silicone -2 to -14.5d in 0.5d $723.00

intraocular lens increments. Overall diameter

8.5mm. Optic 6.0mm

Emagin Pty Ltd

EG010 Artiflex Anterior Chamber Intraocular Optic: Hydrophobic Polysiloxane. Haptic: 6mm optic diameter x 8.5 in $723.00

Lens PMMA overall length

1.2.1 Rigid

Alcon Laboratories (Aust.) Pty Ltd

AL002 Models MZ60BD, MC50BD, CZ70BD Other:PMMA Range of Powers :-10 to +34 D $156.00

Prostheses List by Category, Groups and Sponsor Page 2 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Bausch & Lomb (Australia) Pty Ltd

BL006 Posterior chamber IOLS model P359 PMMA Posterior Chamber lens 1 piece; 12.25mm to 13.75mm length. $156.00

UV, P399 UV, 68 UV, 95 BUV, or 5.5mm to 7mm optic size,

lolab PC One Piece, model 6741B, diopter range -4.5 - 45d to 10

8591B, 8191B; Model EZE-Fit 65 - 34d; EZE-Fit 65: 6.5mm

optic, 13.35mm length, Power

range: 10.0 to 30.0 Diopter

1.2.2 Foldable

1.2.2.1 Microincision

at

Carl Zeiss Pty Ltd

CZ016 CT ASPHINA 409M Aberration corrected, optimized aspheric Overall length 11.0mm Optic $364.00

foldable square-edged single-piece size 6.0mm

intraocular lens for capsular bag fixation

CZ017 CT ASPHINA 509M CT ASPHINA 509M (MICS Aspheric Overall length 11.00mm Optic $364.00

Foldable IOL) size 6.0mm

at, pl

Bausch & Lomb (Australia) Pty Ltd

BL026 Akreos AO Micro Incision Lens Micro Incision, posterior chamber, 6mm optic overall diameter $374.00

foldable acrylic, aphakic, anterior & 11.0mm(10D-15D), 10.7mm

posterior edge modification, preloaded, (15.50-22D), 10.5mm (22.50-

with aberration contro, intraocular lens 30D)

Carl Zeiss Pty Ltd

CZ028 CT ASPHINA 409MP Preloaded, micro incision, aspheric Diopter range: 0.0 to 32.0D; $374.00

(aberration neutral), foldable square-edged Optic size: 6.0mm; Overall

single piece inraocular lens for capsular length: 11.0mm

bag fixation.

at, pl, t1

Carl Zeiss Pty Ltd

CZ031 AT TORBI 709MP ( Standard Range ) Bitoric, preloaded, micro incision, aspheric Diopter range: Sph -10.0 to $760.00

(aberration neutral), foldable, square- 32.0, Cyl +1.0 to 6.5

edged, single-piece IOL for capsular bag Optic size: 6.0mm, Overall

fixation length: 11.0mm

Prostheses List by Category, Groups and Sponsor Page 3 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

at, pl, t2

Carl Zeiss Pty Ltd

CZ032 AT TORBI 709MP (high cyl) Bitoric, preloaded, micro incision, aspheric Diopter range: Sph -10.0 to $1,061.00

(aberration neutral), foldable, square- 32.0, Cyl +7.0 to 12.0, Optic

edged, single-piece IOL for capsular bag size: 6.0mm. Overall Length

fixation 11.0mm

t1

Carl Zeiss Pty Ltd

CZ020 AT TORBI 709M AT TORBI 709M (MICS Bitoric Overall length 11.00mm Optic $740.00

Aspheric Foldable IOL) Foldable IOL size 6.00mm

+6.0D +32.0D inclusive in

0.5D increments Cylinder +1.0

to 6.5D inclusive

CZ026 AT TORBI™709M AT TORBI™709M (MICS Bitoric Overall length 11.00mm Optic $740.00

Aspheric Foldable IOL) size 6.0mm -10.00 to +5.50D

inclusive in 0.5D increments

Cylinder +1.0D to 6.5D

inclusive in 0.5D increments

t2, at

Carl Zeiss Pty Ltd

CZ027 AT TORBI 709M AT TORBI 709M (MICS Bitoric Overall length 11.00mm Optic $1,041.00

Aspheric Foldable IOL) size 6.0mm -10.00 to +32.0D

inclusive in 0.5D increments

Cylinder +7.0D to 12.0D

inclusive in 0.5D increments

1.2.2.2 No edge modification

ConceptVision Australia Pty Ltd

CS003 Staar foldable silicone intraocular lens: Polyimide haptics 6.3mm optic - low 14.0mm length $281.00

Model AQ 5010V diopters

Prostheses List by Category, Groups and Sponsor Page 4 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

t1

ConceptVision Australia Pty Ltd

CS002 Staar Toric foldable silicone intraocular Plate haptics 6.0mm optic 10.8mm - 11.2mm length $579.00

lens: Model AA4203TF; Model

AA4203TL

1.2.2.3 Edge modification

Alcon Laboratories (Aust.) Pty Ltd

AL004 Acrysof Multipiece Models MA50BM, Foldable Acrylic Multi-piece Lens -5 D to +30 D $322.00

MA60AC

AL011 Acrysof Model SA60AT Foldable Acrylic Single-piece Lens, Range of Powers: +6 to +40 D $322.00

asymmetric optic/consistent edge

AMO Australia Pty Ltd

AO002 Sensar AR40 Monofocal Acrylic IOL, Soft Acrylic, Foldable, UV Absorbing, 6 mm Optic Diameter x 13mm $322.00

Sensar OptiEdge AR40e Foldable Posterior in overall length.

Acrylic IOL

AO006 Clariflex, Model CLRFLXB Posterior Foldable Silicone IOL with OptiEdge One size only $322.00

Chamber Intraocular Lens design

Bausch & Lomb (Australia) Pty Ltd

BL020 Akreos Adapt acrylic foldable posterior Composition: Hydrophilic acrylic polymer. 10.0 to 15.0 Diopter in 1.0 $322.00

chamber intraocular lens Packaged in lens folding device in a sterile Diopter increments15.0 to

vial.

Four haptic design 25.0 Diopter in 0.5 Diopter

increments25.0 to 30.0

Diopter in 1.0 Diopter

increments

BL021 SoflexSE, Intraocular lenses, Posterior Composition: silicone, Lenses - foldable, Range of powers: 5.0 to 30.0 $322.00

Chamber posterior chamber intraocular lenses Diopter - Optic diameter

6.0mm; 13.0mm length

Carl Zeiss Pty Ltd

CZ003 Intraocular Lens: Model Bigbag Hydrophilic acrylic, foldable, PC, single 6.5mm optic diameter x 10.35 $322.00

piece, Tri-haptic, square edge design, UV overall diameter

blocker

CZ029 CT 53N Foldable, 3-piece, monofocal, square- Diopter range: 0.0 to 40.0, $322.00

edged, hydrophilic acrylic (with Optic size: 6.0mm, Overall

hydrophobic surface properties) length: 13.0mm

intraocular lens for capsular bag or sulcus

fixation.

Prostheses List by Category, Groups and Sponsor Page 5 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

ConceptVision Australia Pty Ltd

CS007 Staar foldable silicone IOLs: Models Plate haptics 6.0mm; Polymide haptics 5.5 10.8mm 0 13.5mm length $322.00

AQ2010V, AQ2017V and AO2003V or 6.3mm optic;

Kevin Grundy (IBD) Pty Ltd

KG001 Rayner C-Flex Hydrophilic HEMA-MMA copolymer, 5.75mm dia optic, 12.00mm $322.00

foldable with injector dia overall

KG002 Superflex Hydrophilic HEMA-MMA copolymer, 6.25mm dia optic, 12.5mm dia $322.00

foldable with injector overall

at

AMO Australia Pty Ltd

AO014 TECNIS™ Intraocular Lens (Z9002 & Foldable Intraocular Lenses - Ultraviolet 5-10 dioptre in 1.0 dioptre $364.00

ZA9003) light absorbing posterior chamber increments; 10.5 - 30 dioptre in

intraocular lenses, Silicone/Acrylic 0.5 increments

AO024 Tecnis™ One Piece (ZCB00) One piece intraocular lens with edge +6 diopters to +30 diopters in $364.00

modification and 360 degree square edge 0.5d increments

Bausch & Lomb (Australia) Pty Ltd

BL022 SofPort Advanced Optic (AO) Posterior chamber, foldable silicone IOL 0 D to 30.0 D $364.00

with anterior optic-haptic square edge,

posteriof optic-haptic square edge, 360-

degree optic square edge and asperic optic

for aberration control

BL023 Akreos Advanced Optic Posterior chamber, foldable acrylic IOL, 0 D to 30.0 D $364.00

with anterior optic-haptic square edge,

posterior optic-haptic square edge, 360

degree optic square edge and aspheric

optic for aberration control

BL030 enVista The enVista, Model MX60, is an ultra- Overall diameter 12.5mm, optic $364.00

violet-absorbing, posterior chamber, body diameter 6.0mm in

hydrophobic acrylic one-piece intraocular dioptric powers ranging from

lens (IOL)

Has an aspheric lens optic, +0.0 to +34D

square posterior edge, modified C haptics 0.0D to 10.0D in 1 Diopter

and available in dioptric powers ranging increments

from +0.0 to +34.0D. 11.0D to 30.0D in 0.5 Diopter

increments

31.0D to 34.0D in 1 Diopter

increments

Prostheses List by Category, Groups and Sponsor Page 6 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Carl Zeiss Pty Ltd

CZ030 CT ASPHINA 404 Small incision, foldable, single piece, Diopter range: -10.0 to 42.0, $364.00

monofocal, aspheric (aberration neutral), Optic size: 6.0mm, Overall

square-edged, hydrophilic acrylic (with length: 11.0mm

hydrophobic surface properties)

intraocular lens for capsular bag fixation.

(Monofocal lens for powers outside

standard 409MP MICS range).

IQ Medical

IQ004 Softec Acrylic, single piece, foldable intraocular Available in dioptric powers $364.00

lens with anterior and posterior optic- from -5.0 to +36.0, 1D steps: -

haptic square edge, 360 degree optic 5.0 to +10.0 and +31.0 to

square edge design, precision power +36.0; 0.5D steps: +10.5 to

calculation and aberration technology +18.0 and +25.0 to +29.5;

0.25D steps: +18.0 to +25.0

Kevin Grundy (IBD) Pty Ltd

KG012 Rayner "C-Flex" and Superflex" Aspheric Intra Ocular Lenses with Amon- C-Flex -970C + 22.5D to $364.00

Aspheric IOL Apple enhanced 360 Degree square edge, +34D Superflex-920H - 10D

Anti-vaulting Haptics to +22D

at, pl

Carl Zeiss Pty Ltd

CZ011 CT ASPHINA 603P Hydrophilic Acrylic, Foldable, PC, Single 6.0mm Optic x 10.5mm Overall $374.00

Piece, Square Edge Design, UV Blocker, Diameter

Trihaptic, Quad Haptic, Aspheric Optic,

Pre-Loaded

ConceptVision Australia Pty Ltd

CS008 Preloaded Aspheric Intraocular Lens Silicone intraocular lens 6.0mm $374.00

at, pl, t1, vblf

Design for Vision Pty Ltd

DV253 HOYA AF-1 351 Toric T3/T4/T5 Preloaded injector system, correct corneal IOL Power: + 6.0D to 30.0D $800.00

astigmatism micro-incision, ashperic, blue- (0.5 steps), IOL Cylinder

blocker, single piece hydophobic. power: 1.50D (T3), 2.25D

(T4), 3.00D (T5).

Prostheses List by Category, Groups and Sponsor Page 7 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

at, pl, vblf

Alcon Laboratories (Aust.) Pty Ltd

AL024 AcrySert model SN60WS Foldable Acrylic Single-piece Lens with +6 to +30 D $405.00

Blue light protection and aspheric

correction, in cartridge.

AL031 AcrySert C Model SN6CWS Posterior chamber, UV absorbing, +6.0 to +30.0 D $405.00

foldable, acrylic, single piece lens with blue

light protection and aspheric correction, in

cartridge

Design for Vision Pty Ltd

DV250 Hoya-PS AF-1 (UY) PY-60AD Preloaded in cartridge, Aspheric, Blue +6.0D to +30.0D (0.5D steps) $405.00

blocker, Foldable, Single-Piece,

Hydrophobic Acrylic

DV252 HOYA iSert® 251 Preloaded injector system, Micro-incision, +6.0D to 30.0D (5 steps) $405.00

Aspheric, Blue-Blocker, Single Piece,

Hydrophobic

at, t1

AMO Australia Pty Ltd

AO031 TECNIS® Toric 1-Piece IOL 1-piece IOL Posterior chamber +5.0 to +34.0 diopter powers $740.00

Intraocular lens, incorporates a proprietary in 0.5 diopter increments.

wavefront designed toric aspheric optic Cylinder power: 1.00 diopter,

with a squared posterior optic edge 1.50 diopter, 2.25 diopter,

designed to provide a 360 degree barrier. 3.00 diopter and 4.00 diopter

The edge of the optic has a frosted design (as measured at the IOL plane).

to reduce potential edge glare effects. Overall diameter 13mm, Optic

size 6mm.

at, vblf

Alcon Laboratories (Aust.) Pty Ltd

AL021 Alcon AcrySof SN60WF Foldable Acrylic Single-piece Lens with + 6.0 D to +30.0 D $385.00

Blue Light Protection and Aspheric

Correction

Bausch & Lomb (Australia) Pty Ltd

BL025 SofPort Advanced Optic (AO) Violet Posterior chamber, aphakic, foldable 6mm optic 13mm overall length $385.00

Shield silicone, anterior & posterior edge Modified C 5 degree

modification intraocular lens with angulation 0-30D, 0.5D steps

aberration technology, a violet light

Prostheses List by Category, Groups and Sponsor Page 8 of 911

1 - OPHTHALMIC

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Billing Code Product Name Description Size Benefit Benefit Notations

Design for Vision Pty Ltd

DV247 HOYA AF-1 iMics1 NY-60 Mini Incision, Aspheric, Blue-blocker, +6.0D to 30.0D (0.5 steps) $385.00

Single-piece, Hydrophobic

IQ Medical

IQ009 Softec HDY Acrylic, single piece, foldable intraocular Available in dioptric powers $385.00

lens with anterior and posterior optic- from -5.0 to + 36.0, 1D steps:

haptic square edge, 360 degree optic -5.0 to +10.0 and +31.0 to

square edge design, precision power +36.0; 0.5D steps: +10.5 to

calculation, aberration technology and blue +18.0 and +25.0 to 29.5;

light filter 0.25D steps: + 18.0 to +25.0

pl

ConceptVision Australia Pty Ltd

CS009 Staar KS-Xs Preloaded Acrylic Preloaded acrylic lens with anterior and Optic diameter 6.0mm, overall $332.00

Intraocular Lens posterior edge modification length 12.5mm, diopter range

+10 to +28.0

t1

Bausch & Lomb (Australia) Pty Ltd

BL028 Akreos Toric Astigmatism- Correcting Single piece, foldable, acrylic intraocular The overall diameter is 11 $698.00

Lens lens with a toric optic on the posterior millimetres for the entire lens

surface and axis marks on the posterior power range (spherical

optic's flat meridian. equivalent powers from +10.0

to +30.0 diopters in 0.5 diopter

steps and cylinder powers of

+1.25, +2.00 & +2.75

diopters).

Kevin Grundy (IBD) Pty Ltd

KG003 Rayner Standard Toric C-Flex Hydrophilic HEMA-MMA copolymer, 5.00mm dia optic, 12.00mm $698.00

foldable with injector dia overall, cyls 2.0D to 6.0D in

2D increments

t1, at, vblf

Alcon Laboratories (Aust.) Pty Ltd

AL032 AcrySof IQ Toric IOL Posterior chamber, UV absorbing, +6 to +30 D spherical; 1.00 to $780.00

foldable, acrylic, toric, single piece lens 6.00 D cylinder.

with blue light protection and aspheric

correction

Prostheses List by Category, Groups and Sponsor Page 9 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Design for Vision Pty Ltd

DV251 HOYA AF - 1 311 Toric T3/T4/T5 Correct Corneal Astigmatism, Micro- lOL Power: 6.0D to 30.0D $780.00

incision,Aspheric, Blue-Blocker, Single (0.5 steps)lOL Cylinder

Piece, Hydrophobic Power: 1.50D (311T3), 2.25D

(311T4), 3.00D (311T5)

t1, vblf

Alcon Laboratories (Aust.) Pty Ltd

AL023 Alcon AcrySof Toric PC IOL Models Posterior chamber, UV absorbing, +6 to +34 D spherical; 1.50 to $740.00

foldable, acrylic, toric, single piece lens 6.00 D cylinder

with blue light protection

t2

Kevin Grundy (IBD) Pty Ltd

KG004 Rayner Premium Toric C-Flex HEMA-MMA copolymer, foldable with 5.75mm dia optic, 12.00mm $1,000.00

injector dia overall, cyls 1.5D to 11.0D

in 0.5D increments

KG013 Rayner Super Premium Toric I.O.L. Acrylic foldable toric single piece I.O.L -10.0D to 0.00D Sphere: 1D to $1,000.00

11.00D Cylinder in 0.25 steps

+31.00D to +35.00 Spit:

1D to 11.00D Cylinder in

0.25steps

vblf

Alcon Laboratories (Aust.) Pty Ltd

AL016 Alcon Acrysof Natural Model SN60AT Foldable Acrylic Single-piece Lens, +6 to +40D $364.00

asymmetric optic/consistent edge, with

blue light protection

AL025 AcrySof Multipiece Models MN60MA, Foldable Acrylic multi-piece Lens with - 5 D to + 30 D $364.00

MN60AC Blue light Protection

1.2.2.4 Multifocal or bifocal

AMO Australia Pty Ltd

AO020 ReZoom Acrylic Multifocal Intraocular Acrylic, foldable, posterior chamber, 6.0mm Optic Diameter x $780.00

Lens intraocular lens 13.0mm overall length

Prostheses List by Category, Groups and Sponsor Page 10 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

AO023 TECNIS™ Multifocal Intraocular Lens Tecnis Multifocal foldable Posterior +5.0 Diopter to 34.0 Diopter in $780.00

(ZM900) Chamber Diffractive Intraocular Lens 0.5 diopter increments

Model ZM900.

Posterior Chamber lens

with UV light-absorbing, foldable, silicone,

3 piece with a diffractive posterior optic

and a Modified Prolate Anterior Surface

Technology

at

AMO Australia Pty Ltd

AO026 TECNIS™ Multifocal Intraocular Lens Posterior chamber lens with UV light- +5 diopters to +34 diopters in $822.00

(ZMA00) absorbing, foldable acrylic, 3-piece with a 0.5d increments

diffractive posterior optic and a modified

anterior surface technology with edge

modification and 360 degree square edge.

AO027 Tecnis Multifocal 1-Piece Lens, Model A multifocal posterior chamber lens with 6.0mm Optic Diameter x $822.00

ZMB00 UV-blocking, foldable acrylic, 1-piece 13.0mm in overall length. +5.0

with a diffractive posterior optic and a Diopter to +34.0 Diopter in 0.5

modified anterior surface technology with Diopter increments.

edge modification and a 360 degree

square edge.

Carl Zeiss Pty Ltd

CZ015 AT LISA 809M Foldable aspheric single-piece intraocular Overall length 11.0mm Optic $822.00

lens with an aspheric front and an aspheric size 6.0mm

bifocal back surface, asymmetric light

distribution 65 percent distance and 35

percent near, with 3.75D addition in the

near foucs.

Kevin Grundy (IBD) Pty Ltd

KG009 Rayner "M-Flex" Mulitfocal Foldable IOL Acrylic, Foldable, Single piece multi-zoned 6.5mm Optic-Overall diameter $822.00

refractive aspheric multifocal with Amon- 12.5mm: +3D or + 4D

Apple 360 Degree Square edge, Anti Addition: +14D to +25D in

Vaulting Haptics 1.0D increments: +8.5D to

+23.5D in 0.5D increments

Prostheses List by Category, Groups and Sponsor Page 11 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

at, pl

Carl Zeiss Pty Ltd

CZ033 AT LISA 809MP Preloaded, micro incision, aspherical Diopter range: 0.0 to 32.0 $842.00

bifocal, square edged, single-piece IOL for Optic size: 6.0mm. Overall

capsular bag fixation. The anterior length: 11.0mm

aspheric bifocal surface has an asymmetric

light distribution 65/35 for distance/near

vision, and 3.75D add for the near focus.

at, vblf

Alcon Laboratories (Aust.) Pty Ltd

AL028 AcrySof IQ ReSTOR SN6AD3 Posterior Chamber, UV absorbing, +6 D to + 34 D $864.00

foldable, acrylic, single piece lens with

apodised diffractive optic and blue light

protection

AL030 AcrySof IQ ReSTOR SN6AD1 and Posterior Chamber, UV absorbing, +6 D to + 34 D $864.00

MN6AD1 foldable, acrylic, single and multiple lenses

with apodised diffractive optic and blue

light protection

Design for Vision Pty Ltd

DV248 HOYA PY-60MV Preloaded in cartridge, Multifocal, +14.0D to 27.0D (0.5 steps) $864.00

Aspheric, Blue-blocker, Single Piece,

Hydrophobic

t1, at

Carl Zeiss Pty Ltd

CZ025 AT LISA toric 909M Foldable aspheric single-piece intraocular Overall length 11.00mm Optic $1,198.00

lens with an aspheric toric front and an size 6.0mm -10.00 to +32.0D

aspheric bifocal back surface, asymmetric inclusive in 0.5D increments

light distribution 65 percent distance and Cylinder +1.0D to 6.5D

35 percent near, with 3.75D addition in inclusive in 0.5D increments

the near focus.

Prostheses List by Category, Groups and Sponsor Page 12 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Kevin Grundy (IBD) Pty Ltd

KG010 Rayner M-Flex Toric (Standard) Acrylic, Foldable, Single Piece, Multi- 5.75mm / 12.0mm: 6.25mm / $1,198.00

zoned Refractive Aspheric Toric Mulitfocal 12.5mm +3.00D or +4.00D

with Amon-Apple enhanced 360 degree Addition FAR: +14.0D to

Square edge, Anti Vaulting Haptics +32.00D in 0.5 STEPS:

+2.00D +3.00D

+4.00D

Cylinder. NEAR: +14.0D to

27.0D in 0.5 STEPS: +2.00D

+3.00D

+4.00D Cylinder

KG011 Rayner "M-Flex" Toric (Non Standard) Acrylic, Foldable, Single Piece, Muli- 5.75/12.0mm: 6.25/12.5mm $1,198.00

Zoned Refractive, Toric Multifocal with +3.00D to +4.00D Addition

Amon-Apple enhanced 360 Degree FAR: +14.0D to +32.0D in

square edge, Anti-vaulting Haptics, Patient 0.5D Increments: NEAR:

Specific. +14.0D to +27.0D in 0.50D

Increments Cylinder: 1.0D to

1.5D and 2.5D to 6.00D in 0.5

increments

t1, at, vblf

Alcon Laboratories (Aust.) Pty Ltd

AL033 AcrySof IQ ReSTOR multifocal toric IOL Posterior chamber UV absorbing foldable, +6 to +34 D spherical; 1.00 to $1,240.00

acrylic, aspheric, toric single piece lense 3.00 D cylinder

with apodised diffractive optic and blue

light protection.

t2, at

Carl Zeiss Pty Ltd

CZ024 AT LISA toric 909M Foldable aspheric single-piece intraocular Overall length 11.00mm Optic $1,500.00

lens with an aspheric toric front and an size 6.0mm -10.00 to +32.0D

aspheric bifocal back surface, asymmetric inclusive in 0.5D increments

light distribution 65 percent distance and Cylinder +7.0D to 12.0D

35 percent near, with 3.75D addition in the inclusive in 0.5D increments

near focus.

Prostheses List by Category, Groups and Sponsor Page 13 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.2.2.5 Accommodative

pa

Bausch & Lomb (Australia) Pty Ltd

BL027 Crystalens HD Accommodating lens with > 3 Dioptres of 10.0 to 33.0 Dioptres in .05 $780.00

accommodation with dual mechanism of Dioptre steps

action: (1) forward axial movement of lens

and (2) accommodative arching of optic.

Posterior chamber, polyspheric optics, 3-

piece, plate haptic, foldable UV light

filtering, bic

IQ Medical

IQ003 Tetraflex Acrylic single piece, foldable Available in dioptric powers $780.00

accommodating intraocular lens with sqare from +5.0 to +36.0, 1D steps:

edge design, custom control precision and +31.0 to +36.0; 0.5D steps:

closed loop haptic design +5.0 to +18.0 and +25.0 to

+30.0; 0.2D steps; +18.0 to

+25.0

pa, at

Bausch & Lomb (Australia) Pty Ltd

BL029 Crystalens AO Accommodating lens designed to provide 10.0 to 33.0 D in 0.50 Diopter $822.00

> 3 Diopters of accommodation with dual steps. 10.0 - 16.5 Diopters

mechanism of action: (1) forward axial (12mm length) and 17.0 - 33.0

movement of lens and (2) accommodative Diopters (11.5mm length).

arching of optic.

Posterior chamber,

aspheric, aberration free optics, 3-piece,

plate haptic, fol

pa, pl

AMO Australia Pty Ltd

AO028 Synchrony Accommodating IOL Synchrony Dual Optic Accommodating 5.50mm Anterior Optic, $800.00

Posterior Chamber IOL 6.00mm Interior Optic,

9.80mm Overall Length,

Diopter Range: +16.00 to

+28.00 in 0.5D Increments

Prostheses List by Category, Groups and Sponsor Page 14 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.2.3 Pseudo-phakic, piggy-back

1.2.3.1 Monofocal

Design for Vision Pty Ltd

DV246 Rayner Sulcoflex Ashperic (Premium) Pseudophakic Supplementary I.O.L.O.L. -10.0D to -5.50D in 0.5D $323.00

I.O.L. increments. +5.50D

to 10.00D in 0.5D increments

at

Kevin Grundy (IBD) Pty Ltd

KG008 Rayner "Sulcoflex" Pseudophakic I.O.L. Sulcoflex Aspheric Pseudophakic I.O.L -5D to +5D $365.00

t1, at

Kevin Grundy (IBD) Pty Ltd

KG005 Rayner Sulcoflex Aspheric Toric Acrylic, Aspheric, Toric Pseudophakic SE -3 to +3 in 0.5 D steps $698.00

Pseudophakic Secondary I.O.L - Secondary IOL: Sulcus fixated with Cyl +1 to +3 in 1D steps

Standard undulating Haptics and Posterior Haptic

Angulation (Standard)

KG007 Rayner Sulcoflex Aspheric Toric Acrylic, Aspheric, Toric Pseudophakic SE -6.00 to +6.00 in 0.5 D $698.00

Pseudophakic Secondary IOL (Premium) Secondary IOL: Sulcus fixated with steps Syl +1.00 to +6.00 in

undulating Haptics and Posterior Haptic 0.5D steps

Angulation (Premium)

1.2.3.2 Multi-focal

at

Kevin Grundy (IBD) Pty Ltd

KG006 Rayner "Sulcoflex" Aspheric Multi-focal Acrylic, Aspheric Multi-focal 6.5mm / 13.5mm - $822.00

Pseudophakic Secondary IOL Pseudophakic Secondary IOL: Sulcus- 5.00D+5.00D sphere with +

Fixated with Undulating Haptics and 3.00 Addition

Posterior Haptic Angulation

1.3.1 Viscoelastic

Alcon Laboratories (Aust.) Pty Ltd

AL006 PROVISC VISCOELASTIC PROVISC contains sodium hyaluronate 0.85mL pack $80.00

SOLUTION

Prostheses List by Category, Groups and Sponsor Page 15 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

AL007 VISCOAT Viscoelastic Fluid Chondroitin sulfate and sodium hyaluronate 0.75mL $80.00

AL015 Cellugel viscoelastic fluid Hypromellose 2%. $80.00

AL029 DisCoVisc Ophthalmic Viscosurgical Sodium hyaluronate 17 mg/mL and 0.5 mL and 1.0 mL $80.00

Device chondroitin sulfate 40mg/mL

AMO Australia Pty Ltd

AO008 Healon, Intraocular Viscoelastic Fluid Sodium Hyaluronate 10mg/ml Healon 0.4ml, 0.55ml & 0.85ml $80.00

Bausch & Lomb (Australia) Pty Ltd

BL008 Ocucoat Intraocular Fluid 20mg/mL hydroxypropylmethyl cellulose 1mL sterile $80.00

for intraocular use

BL015 Amvisc Plus injection 15mg/mL Sodium Hyaluronate for 0.5mL and 0.8mL $80.00

intraocular use

Carl Zeiss Pty Ltd

CZ012 Ophthalin Viscoelastic Ophthalin; Viscoelastic Solution - sodium Volume 1.0ml $80.00

hyaluronate 10mg/ml.

Preloaded in sterile

syringe with a 27G cannula for injection

CZ013 Ophthalin Plus Viscoelastic Ophthalin Plus; Viscoelastic Solution - Volume 1.0ml $80.00

sodium hyaluronate 15mg/ml.

Preloaded

in sterile syringe with a 27G cannula for

injection

CZ022 VISTHESIA 1.5% VISTHESIA viscoelastic solution contains Total volume 0.8ml $80.00

1.5% hyaluronate ( NaHA ) and 1% of non

preserved lidocaine hydrochloride. Plus

two ampoules containing 0.3ml sodium

hyaluronate and lidocaine hydrochloride

20ml

IQ Medical

IQ002 Ocuvis and Ocumax 2% 20mg/mL hydroxypropylmethyl cellulose 2mL sterile $80.00

Hydroxypropylmethylcellulose for intraocular use. Pre-loaded in a sterile

syringe with one cannula for injection, in a

sterile Tyvek pouch

hmw

AMO Australia Pty Ltd

AO009 Healon 5, Intraocular Viscoelastic Fluid HEALON5- Sodium hyaluronate 23mg/ml 0.6ml $80.00

.

Prostheses List by Category, Groups and Sponsor Page 16 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

AO010 Healon GV Intraocular Viscoelastic Fluid Sodium Hyaluronate 14mg/mL 0.5mm and 0.85ml $80.00

1.3.1.1 Dual Fluids

Alcon Laboratories (Aust.) Pty Ltd

AL005 DUOVISC VISCOELASTIC PROVISC contains sodium hyaluronate, Small & large packs $110.00

SYSTEM VISCOAT contains chondroitin sulfate

and sodium hyaluronate

Carl Zeiss Pty Ltd

CZ019 TwinVisc Viscoelastic Twinvisc Viscoelastic Solution - Ophthalin Total volume 1.4 ml $110.00

contains sodium Hyaluronate 1%/ Endogel

contains sodum Hyaluronate 2.2%

Preloaded in sterile syringe with a 25G

cannula for injection

1.3.2 Non Viscous

Design for Vision Pty Ltd

DV231 Vision Blue Trypan blue dye for ophthalmic applications 0.5ml syringe $48.00

1.4.1 Simple

Alcon Laboratories (Aust.) Pty Ltd

AL001 Capsular Tension Rings - 10.0 - 12.0 compressed, 12.3 $159.00

- 14.5 uncompressed

AMO Australia Pty Ltd

AO021 Stabileyes Capsular Tension Ring Polymethylmethacrylate (PMMA) Implant 12mm ring, and 13mm ring $159.00

Carl Zeiss Pty Ltd

CZ002 Tensiobag: Capsular Tension Ring PMMA Diameter 10 - 14mm $159.00

Design for Vision Pty Ltd

DV009 Morcher Capsular Tension Ring PMMA Implant 14, 14A, 14C $159.00

Prostheses List by Category, Groups and Sponsor Page 17 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Emagin Pty Ltd

EG001 Capsular Tension Rings Clear PMMA Implant 10/08, 12/10, 13/11mm $159.00

pl

Design for Vision Pty Ltd

DV029 Eyejet CRT Capsular tension ring made of PMMA 14 (10mm), 14C (11mm), 14A $243.00

per-load on disposable injector (12mm)

Insight Surgical Pty Ltd

IS001 Preloaded Capsulan Tension Ring Capsular tension ring preloaded (acrylic) 13/11mm $243.00

1.4.2 Complex

Design for Vision Pty Ltd

DV010 Morcher Coloboma Diaphram PMMA Implant 96G, 96L $334.00

1.5.1 Long Tube

AMO Australia Pty Ltd

AO012 Baerveldt Glaucoma Implant BG 101- Non-valved artificial drainage device, Surface area 250, 350, 425mm2 $425.00

350, Baerveldt Glaucoma Implant BG composition silicone - smooth, tumble-

103-425, Baerveldt Glaucoma Implant polished finish

BG 103-250

Design for Vision Pty Ltd

DV020 Molteno Implant Double plate - dual chamber One size only $425.00

DV242 Molteno Implant Glaucoma Drainage Device - Single N/A $425.00

Plate/Single Plate-Dual Chamber/Double

Plate

v

Design for Vision Pty Ltd

DV230 Molteno 3 Drainage implant for glaucoma, made of 2 Sizes: *230 mm square $625.00

silicon *175mm square

Prostheses List by Category, Groups and Sponsor Page 18 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.5.2 Short Tube

1.5.2.1 Cannulated

Alcon Laboratories (Aust.) Pty Ltd

AL037 ExPress Minature Glaucoma Shunt Miniature Glaucoma Shunt 50 & 200 microns $715.00

1.6.1 Spacers

Spectrum Surgical

SO017 FCI Ptose-up Expanded PTFE 15cm long x 2 or 3mm wide x $348.00

0.35mm thick

1.6.2 Weights

1.6.2.1 Gold <1.8 grams

Device Technologies Australia Pty Ltd

DE183 Lid Load Gold Eyelid Weights; Gold 0.6, 0.8, 1.0, 1.2, 1.4, 1.6 $425.00

grams

1.6.2.2 Gold ≥1.8 grams

Device Technologies Australia Pty Ltd

DE182 Lid Load Gold Eyelid Weights; Gold 1.8, 2.0, 2.2, 2.4, 2.6, 2.8 $800.00

grams

1.6.2.3 Platinum

CoreMed Pty Ptd

RC001 LIDCHAIN Platinum Eyelid Implant Platinum Weights - 0.8, 1.0, 1.2, 1.4, $1,300.00

1.6, 1.8 grams

Prostheses List by Category, Groups and Sponsor Page 19 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.7.1 Intracanilicular

Design for Vision Pty Ltd

DV022 Eyetec DCR Tubes Stainless steel, silicone tubing, Bodkin 30cm $135.00

lacrimal intubation set

DV241 Eyetec DCR Tubes Crawford and Cannaliculus Intubation Sets N/A $135.00

Device Technologies Australia Pty Ltd

DE191 Canaliculus Intubation Sets Silicone, SS & Nylon 17.7 x .064 x 29cm, 15.5 x $135.00

.051 x 33cm

DE278 BD Visitec Lacrimal Intubation Sets Stainless steel probes with solid silicone 1. Probes 0.90mm x 4.5cm, $135.00

rods or silicone tubing - packaged sterile rod 40cm x 0.80mm. 2. Probes

0.40mm x 11cm, tubing 35cm

x 0.64mm. Probes 0.60mm x

11mm, tubing 35cm x 0.30mm.

Spectrum Surgical

SO021 FCI Lacrimal Intubation Set PVP Coated Silicone Tubing/PVP Coated PVP Bika: 0.64mm O.D. $135.00

Silicone Plug/Metal Probes/Polypropylene Tube/80 x 0.8mm probes, PVP

Thread Differential Bika: 0.64 &

1.18mm O.D. Tube/40 x

1.2mm probes, PVP Bika for

DCR: 0.94mm O.D. Tube/50 x

0.8mm probes, PVP Infant

Bika 0.64mm O.D. Tube/55 x

0.7mm probes, PVP Infant

Bika II: 0.64mm O.D. Tube/

SO043 FCI Bi-Canalicular Lacrimal Intubation Silicone tubing swaged, imbedded into or Probes: 40mm to 120mm x $135.00

Set around malleable and flexible stainless steel 0.7mm to 1.2mm. Tube:

probes. PEEK thread. 0.64mm to 1.18mm x 25mm to

400mm.

PEEK Thread: 0.2mm

to 0.4mm x 500mm.

Prostheses List by Category, Groups and Sponsor Page 20 of 911

1 - OPHTHALMIC

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Billing Code Product Name Description Size Benefit Benefit Notations

mc

Spectrum Surgical

SO044 FCI Mono-Canalicular Lacrimal Silicone tubing with plug swaged, Probes: 40mm to 120mm x $180.00

Intubation Set imbedded into or around malleable or 0.7mm to 1.2mm. Tube:

flexible stainless steel probes or guides. 0.64mm to 1.18mm x 30mm to

PEEK thread. Introducer. 350mm. PEEK Thread: 0.2mm

to 0.4mm x 500mm.

Plug

Collar: 2mm to 4mm.

1.7.2 Extracanilicular

Device Technologies Australia Pty Ltd

DE177 Lester Jones Tear Duct Tubes Glass 3 x 9 to 16mm, 3.5 x 9 to $84.00

18mm, 4.0 x 9 to 24mm, 5.0 x

9mm

1.8.1 Intrascleral

Device Technologies Australia Pty Ltd

DE188 Acrylic Implant Acrylic 12, 14, 16, 18, 20mm. $55.00

DE202 John Weiss Glass Mule Globes Glass No: 12, 14, 16, 18, 20mm $55.00

Spectrum Surgical

SO040 FCI Orbital Implants Silicone - Sterile 12mm to 22mm $55.00

vp

Spectrum Surgical

SO006 FCI Orbital Implants Orbital Implant, Bioceramic (Aluminium Bioceramic diameter, 12, 14, $1,200.00

Oxide)/Hydroxyapatite (Synthetic) 16, 18, 20, 21, 22mm;

Synthetic Diameter, 10, 12, 14,

16, 18, 20, 22mm

Prostheses List by Category, Groups and Sponsor Page 21 of 911

1 - OPHTHALMIC

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Billing Code Product Name Description Size Benefit Benefit Notations

1.8.2 Extrascleral

1.8.2.1 Complex and permeable

Stryker Australia Pty Ltd

SK521 Sphere Orbital Sphere Models 6316, 6326, 6327, Orbital Sphere Models 6316: $785.00

6317 and 6322 8702-8704. COI implant, 14mm, 6326: 16mm, 6327:

models 7222, 7223 & 80026. MCOI 18mm, 6317: 20mm, 6322:

implant, models 7207 - 7209 Quad 22mm, 8702: 19mm, 8703:

Motility Implants 9866 - 9868 & 80022 21mm, 8704: 23mm, COI

Implants 7222: Approx 4ml,

7223: Approx 5ml, 80026:

Approx 6ml, MCOI 7207:

Approx 3ml, 7208: Approx

4.2ml,

7209: Approx 5.6ml,

QUAD Motility Small 16ml,

Medium: 18ml, Large: 20ml,

Extra Large: 22ml.

ha

Spectrum Surgical

SO007 FCI Orbital Implants Mesh wrapped orbital implant: mesh Bioceramic diameter: 16, 18, $1,600.00

wrapped bioceramic (aluminium oxide), 20, 22mm; Synthetic

mesh wrapped hydroxyapatite (synthetic), Hydroxyapatite diameter: 16,

mesh wrap (polyglycolic acid) 18, 20, 22mm

1.8.2.2 Multi-component

Spectrum Surgical

SO019 FCI Orbital Implants Peg & Sleeve Standard Large $863.00

1.8.3 Fascial - solid and permeable

Device Technologies Australia Pty Ltd

DE277 Frontalis Suspension Set Stainless steel needles with solid silicone needles 0.90mm x 6.5cm, rod $315.00

rods and silicone tubing - packaged sterile 40cm - 0.80mm, sleeve 10 x

2mm

Prostheses List by Category, Groups and Sponsor Page 22 of 911

1 - OPHTHALMIC

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Billing Code Product Name Description Size Benefit Benefit Notations

Spectrum Surgical

SO045 FCI Ptosis Probes Stainless steel needle probes swaged with 80mm x 0.8mm needle probes, $315.00

silicone tubing. 280mm 0.64mm tubing.

1.9.1 Buckles, bands, tyres and sponges

Austmed Pty Limited

AP003 Mira: Scleral Implants Solid Silicone- Tires-Mira 286 Wendel $45.00

Tire/Meridional/Wedge/Pad. Retinal Symmetrical Oval Tire 6mm,

Implant used in Scleral Buckling Mira Symmetrical Oval Tire

(Dimethylmethylvinyl Siloxane Copolymer) 7mm, Mira 287WG Murray

wide (3.5mm) grooved

symmetrical tire, 10mm wide,

Mira 288 ross symmetrical

grooved tire, low profile 10mm

wide by 2.5mm, Mira 289

Symmetrical oval tire 10m

AP004 Mira: Scleral Implants Solid Silicone-Sleeve. Retinal Implant used Sleeves-Mira 70 Sleeve 1mm $45.00

in Scleral Buckling (Dimethylmethylvinyl I.D., Mira 71 Sleeve 1mm I.D.,

Siloxane Copolymer) Mira 72 McNutt Sleeve

1.57mm I.D., Mira 270 Sleeve

0.76mm I.D.

AP006 Mira: Scleral Implants Solid Silicone-Band/Strip/Boat/Clip. Bands-Mira 40 Circling Band $45.00

Retinal Implant used in Scleral Buckling 2mm, Mira 240 Circling Band

(Dimethylmethylvinyl Siloxane Copolymer) 2.5mm. Strips-Mira 41 Strip

3.5mm, Mira 42 Strip 4mm,

Mira 20 Strip 4mm, Mira 219

Strip 4.5mm, Mira 31 Strip

4.5mm, Mira 32 Strip 5mm,

Mira 225 Oval Strip 5mm,

Mira 220 Strip 6mm. Boats-

Mira 60 Boat

Device Technologies Australia Pty Ltd

DE179 Silicon Retinal Implant Tire 7.0, 9.0, 12.5, 6.0, 8.5, 10.0mm $45.00

Prostheses List by Category, Groups and Sponsor Page 23 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

DE181 Silicon Retinal Implant Band 0.75 x 2.0 x 125mm, 0.60 x $45.00

2.5 x 125mm, 0.75 x 2.5 x

125mm

Spectrum Surgical

SO009 FCI Scleral Buckling Devices Band/strip: solid silicone Band - 2.0 x 0.75mm Type 40, $45.00

3.5 x 0.75mm Type 41, 4.0 x

1.25mm Type 42, 2.5 x 0.6mm

Type 240, Morin 3.5 x 0.6mm

Strip - 5.7mm Type 20,

7.2mm Type 31, 9.2mm Type

32, 6mm Type 219, 7.5mm

Type 220, 8mm Type 225

SO011 FCI Scleral Buckling Devices Tire: Solid Silicone Symmetrical: (2.5 mm Groove, $45.00

7 to 9mm wide), Biconvex:

(2.5mm Groove, 7 to 10mm

wide), Asymetrical: (2.5mm

Groove, 7 to 10mm wide)

SO013 FCI Scleral Buckling Devices Strip: Solid Silicone Strip: 1.4 x 4.4 x 100mm, $45.00

Morin Strip: 7mm wide x

100mm long, Caputo Zip Strip:

7 to 9mm wide x 120mm long,

Korobelnik Oval Strip: 2 x

5mm

1.9.1.1 Sponges

Austmed Pty Limited

AP002 Mira: Scleral Implants Silicone Sponge- Retinal Implant Used in Sponge- Mira 502 Cylinder $90.00

Scleral Buckling (Silicone Elastomer 2mm, Mira 5025 Cylinder

Sponge) 2.5mm, Mira 503 Cylinder

3mm, Mira 504 Cylinder 4mm,

Mira 505 Cylinder 5mm, Mira

505G Grooved cylinder 5mm,

Mira 505T Packer tunnel

cylinder 5mm, Mira 510 Half

cylinder 5mm, Mira 515

Brucker two-thirds cyl

Prostheses List by Category, Groups and Sponsor Page 24 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Device Technologies Australia Pty Ltd

DE178 Silicon Retinal Implant Sponge 2.5 x 4.0 x 80mm, 3.0 x 5.0 x $90.00

100mm, 3.25 x 7.0 x 80mm,

5.5 x 7.5 x 80mm, 1.5 x 80mm,

2.0 x 80mm, 2.5 x 80mm, 3.0

x 80mm, 4.0 x 80mm, 5.0 x

80mm, 7.0 x 80mm

Spectrum Surgical

SO012 FCI Scleral Buckling Devices Sponge/Cord: Silicone Cord: 1.0 to 5.0mm O.D. x $90.00

150mm length; Half Cord:

3.0mm to width x1.5mm to

2.5mm height x150mm;

Circular Sponge: 3 to 5mm;

Oval Sponge: 2 to 5.5mm x 4

to 12mm; Half Sponge: 2 to

3.1mm x 4 to 7.5mm; Grooved

Sponge: 3 to 5mm x 5 to

12mm; Gain Sponge: 6 x

1.9.2 Clips and tacks

Device Technologies Australia Pty Ltd

DE201 Labtician Tantalum Clips Tantalum 2, 2.5mm $50.00

1.9.3 Sleeves

Device Technologies Australia Pty Ltd

DE180 Silicon Retinal Implant Sleeve 1mm, .76mm, 1.5mm $25.00

Spectrum Surgical

SO010 FCI Scleral Buckling Devices Fixation Sleeve: Solid silicone O.D: 1.65 to 2.41mm, Length $25.00

30mm

Prostheses List by Category, Groups and Sponsor Page 25 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.9.4 Intraocular Gases

Alcon Laboratories (Aust.) Pty Ltd

AL035 ISPAN Retinal Gases for Constellation® Tamponade gases for retinal surgery C3F8 125g cylinder, dispensed in $75.00

Vision System and SF6 single dose syringe

AL036 ISPAN retinal gases Tamponade gases for retinal surgery C3F8 125 g cylinder, dispensed in $75.00

and SF6 single dose syringe

Device Technologies Australia Pty Ltd

DE284 Single Dose Ophthalmic Gases Single dose tamponading gas for retinal 30ml $75.00

surgery

1.9.5 Intraocular Heavy Liquids

Alcon Laboratories (Aust.) Pty Ltd

AL013 Perfluoron Kits Perfluoro-n-octane for use as a retinal 5mL $240.00

surgery additive

AL014 Perfluoron Kits Perfluoro-n-octane for use as a retinal 7mL $240.00

surgery additive

Bausch & Lomb (Australia) Pty Ltd

BL017 Perfluo-octane (Oktaline) Okta-Line Perfluorocarbon Liquid for use as a retinal 5mL $240.00

surgery additive

BL018 DK Line 100% purified perfluorodecalin Perfluorodecalin 7ml $240.00

Design for Vision Pty Ltd

DV244 D.O.R.C. Eftiar Eftiar Decaline and Octane 5ml 5ml $240.00

Device Technologies Australia Pty Ltd

DE204 Arcaline (Perfluorodecaline) Liquid perfluorocarbon aid for retinal 3ml, 5ml, 7ml $240.00

surgery, operative device for retinal

surgery, in particular retinal detachment

(RD), RD with giant tear etc.

Prostheses List by Category, Groups and Sponsor Page 26 of 911

1 - OPHTHALMIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

DE205 Arcotane (Perfloro-N-Octane) Liquid perfluoro-N-Octane aid for retinal 5ml, 7ml $240.00

surgery, pre-operative device for retinal

surgery, in particular retinal detachment

(RD), RD with giant tear, RD with

proliferative vitreal retinopathy (PVR) etc.

IQ Medical

IQ005 Densiron Heavy Tamponade Liquid Medium, 10 ml, Sterile $240.00

Postoperative

IQ008 Octane & Decalin Perfluorocarbon retinal tamponade 5ml & 7ml, Sterile $240.00

medium, intraoperative

Spectrum Surgical

SO023 FCI - DECA, FCI - OCTA FCI - DECA: Purified perfluorodecalin, 5ml $240.00

FCI - OCTA: Purified perfluoro-N-octane

SO024 FCI - DECA, FCI - OCTA FCI - DECA: Purified perfluorodecalin, 7ml $240.00

FCI - OCTA: Purified perfluoro-N-

Octane

1.9.6 Intraocular Silicone Oils

Bausch & Lomb (Australia) Pty Ltd

BL016 Oxane LMWC Fractioned Silicone Oil Purified fractioned silicone oil 10mL $195.00

BL024 Oxane HD Silicone oil - RMN3 mixture 10ml $195.00

Design for Vision Pty Ltd

DV243 D.O.R.C. Silicon Oil D.O.R.C. Silicon Oil 1000/5000CS 10ml $195.00

Device Technologies Australia Pty Ltd

DE228 LSO Silicone Oil Silicone oil for tamponade use in 10ml, vial or syringe $195.00

vitreoretinal surgery

IQ Medical

IQ006 Siluron 1000 & Siluron 5000 Silicone Oils 10 ml, Sterile $195.00

Spectrum Surgical

SO022 FCI Purified Silicone Oil (Solvent Free) Viscosity: 1000 cst/5000 cst: solvent free 10ml $195.00

purified silicone oil

Prostheses List by Category, Groups and Sponsor Page 27 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

11.1.1 - Cemented

11.1.1.1 - Unpolished

B Braun Australia Pty Ltd

BB275 Excia Hip System Cemented stem cobalt chromium 9mm-18mm $1,850.00

Biomet Australia Pty Ltd

BI039 Integral Hip System Femoral Stem, Chrome Cobalt, 9-17mm $1,850.00

Cemented unpolished

BI047 Echo FX Stem Femoral Stem, Chrome Cobalt, 7-17mm $1,850.00

Cemented unpolished

BI050 Bi-Metric Hip System Titanium unpolished cemented 7-17mm $1,850.00

BI063 Bimetric Hip System Chrome Cobalt Cemented, unpolished 7-17mm $1,850.00

BI069 Biomet Taperloc Hip System Titanium unpolished 7.5mm to 20mm diameter $1,850.00

BI132 Mallory Head Hip System Cobalt Chrome, Unpolished 7-19mm $1,850.00

DJO Australasia Pty Ltd

DD006 Foundation Hip System 450, 460 Foundation Non-porous, cemented Stem 8, 9, 10.5, 12, 13.5, 15, and $1,850.00

16.5

ESKA Australia

EK080 Adapter GHE Femoral Stem Cemented CoCr, non polished 160mm & 180mm $1,850.00

Exactech Australia

EX012 Exotech Novation C femoral stem Femoral stem cemented unpolished 1-8 $1,850.00

EX053 Novation Cemented Plus Femoral Stem The Exatech Novation Cemented Femoral Size 10, 11, 12, 13, 14, 15, 17 $1,850.00

Stems are a line addition to the AcuMatch

C-Series Cemented femoral stems, as

follows: The trapezoidal cross-sectional

area was modified to a circulo-trapezoidal

geometry. A change to the sizing range and

neck length.

Johnson & Johnson Medical Pty Ltd

DP180 Charnley Standard Femoral Stem Stainless steel, (Ortron 90) fixed & Sizes less than 200mm $1,850.00

attachable femoral heads

DP203 Elite Plus Femoral Stem Stainless steel, Ortron 90, cemented CDH, Size 1-7 and all offsets $1,850.00

femoral stem, unpolished

Prostheses List by Category, Groups and Sponsor Page 28 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

JJ573 Summit Cemented Femoral Stem CoCr, tapered, unpolished Sizes 0-10, with various offsets $1,850.00

Link Orthopaedics

Australia

LO015 LINK Lubinus SPII Hip Prosthesis Stem Left & right 01-5 $1,850.00

Mathys Orthopaedics Pty Ltd

MA016 CCA Cemented Femoral Stem CoCr, straight, not polished 7.50mm -17.5mm $1,850.00

Orthotech Pty Ltd

OH226 Exotech Novation C femoral stem Femoral stem cemented unpolished 1-8 $1,850.00

Smith & Nephew Surgical Pty Ltd

SN010 Basis Femoral Component Hip stem, Cobalt Chromium Grit Blast Length 115 - 135mm $1,850.00

SN301 Spectron and Synergy Femoral Stem Non Porous Offset 1- 20 $1,850.00

Stryker Australia Pty Ltd

SR017 Omnifit hip system OMNIFIT cemented femoral component - Stem sizes 4-11 $1,850.00

cobalt chrome

SR018 Omnifit hip system OMNIFIT 'C' stem - cemented cobalt Stem sizes 4-11 $1,850.00

chrome, collared and collarless, 132

degree offset

ST576 Stryker Omnifit Cemented Stem Cemented femoral component Cobal Stem sizes 4-11 $1,850.00

Chrome

Zimmer Pty Ltd

ZI015 Zimmer 'VerSys Hip Systems Femoral Cemented - Cobalt Chrome unpolished 11 - 17 $1,850.00

Stem

ZI337 Natural Hip System Unpolished, straight, Femoral Stem, CoCr 140 - 160mm $1,850.00

Removable Neck

DJO Australasia Pty Ltd

DD026 R120 Cemented Femoral Stem CoCr, unpolished, tapered, collared, Size 1 to 6 $1,850.00

separate neck

ESKA Australia

EK031 Adapter Cemented Femoral Stem CoCr, unpolished, tapered, fixed proximal Femoral stem 1-7 $1,850.00

cement centralisers and distal centraliser

included

Prostheses List by Category, Groups and Sponsor Page 29 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Global Orthopaedic Technology

GO134 R120 Cemented Femoral Stem CoCr, unpolished, tapered, collared, Size 1 to 6 $1,850.00

separate neck

11.1.1.2 - Unpolished - precoat

Orthotech Pty Ltd

OH397 Furlong Hemi Range Cemented femoral stem XXS, XS, S, M & L $2,100.00

Stryker Australia Pty Ltd

HW031 Definition PM Femoral Component Femoral Stem - Vitallium Stem sizes 1 - 7 $2,100.00

11.1.1.3 - Polished

Austofix

AX068 Experion Hip System Polished, stainless steel, tapered stem Sizers 1-4, Offsets 35.5 - 44mm $2,100.00

B Braun Australia Pty Ltd

BB240 BiContact cemented Cemented stem cobal chrome 8-18 $2,100.00

Biomet Australia Pty Ltd

BI066 Stanmore Total Hip System Polished Femoral Stem - Standard and Size 1-5 $2,100.00

Straight, Chrome Cobalt

BI925 Mallory Head Hip System Femoral Stem, Cobalt Chrome, Polished 7-19mm $2,100.00

Corin Australia Pty Ltd

CR024 Taper Fit Femoral Stem Double taper stainless steel femoral stem sizes 0-4 with 4 different offsets $2,100.00

Global Orthopaedic Technology

GO164 Global Cemented Femoral Stem CoCr, polished, double taper, Sizes 0-4, various offsets $2,100.00

Johnson & Johnson Medical Pty Ltd

DP546 C- Stem & C- Stem AMT Femoral Stainless steel Ortron 90, highly polished, Size 1-8 standard, Size 1-8 $2,100.00

Stems triple taper High Offset, CDH and 0A to

3A sizes

JJ786 Corail Hip System Cemented Femoral Stainless steel cemented, polished femoral Size 8 - 20 $2,100.00

Stem stem, standard and high offsets

Prostheses List by Category, Groups and Sponsor Page 30 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Lima Orthopaedics Australia Pty Ltd

LC005 Lima Friendly Stem Femoral Stem Cemented, tapered, 0, 1, 2, 3 $2,100.00

polished

LC026 Lima Accent Hip System Femoral Stem Cemented, tapered, 1 -6 $2,100.00

polished

Mathys Orthopaedics Pty Ltd

MA463 twinSys Cemented Femoral Stem stainless steel, highly polished, triple tapered 8 sizes in standard and lateral $2,100.00

version (Size 9, 10, 11, 12, 13,

14, 15, 16)

Medacta Australia Pty Ltd

MU001 CONE Cemented Femoral Stem CoCr, highly polished, triple taper Standard sizes 1 to 8, $2,100.00

Lateralized sizes 2 to 7

MU004 Quadra Hip Cemented Femoral Stem High nitrogen stainless steel alloy, highly Std 0 to 7 $2,100.00

polished, double taper Lat 1 to 7

Smith & Nephew Surgical Pty Ltd

SN268 CPCS Femoral Stem Polished Non Porous, Std 1 - 5 $2,100.00

and High Offset

Zimmer Pty Ltd

ZI023 Zimmer Heritage Hip Systems Femoral Cobalt Chrome, polished, straight 11 - 17 $2,100.00

Stem

ZI373 MS-30 Hip prosthesis Stainless steel, polished tapered 6 to 16 $2,100.00

Removable Neck

Global Manufacturing Technology Pty Ltd

GM149 Absolut Cemented Femoral Stem CoCr, highly polished, tapered, with neck 0 to 14 $2,100.00

Lifehealthcare Pty Ltd

LH067 Groupe Lepine Total Hip Replacement Cemented Stainless steel polished Size 6, 7, 9, 9, 10, 11 $2,100.00

Wright Medical Australia

WR085 Profemur Xm Femoral Stem Femoral Stem, CoCr, Cemented, Polished 0, 1, 2, 3, 4 $2,100.00

Prostheses List by Category, Groups and Sponsor Page 31 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

SCP

Stryker Australia Pty Ltd

HW041 Exeter Hip System Stainless Steel (Orthinox) Stem Sizes 0-6, Offsets 30, 33, $2,500.00

35.5, 37.5, 44, 50 & 56mm

Zimmer Pty Ltd

ZI009 Zimmer CPT Hip Systems Femoral Stem Co Cr (Zimaloy), polished and tapered Sizes 1 - 5 $2,500.00

11.1.10 - Uncemented, Modular, HA Coated, Long Lengths (Stem

11.1.10.1 - Grit Blast

Spacer

Wright Medical Australia

WR107 Profemur R Hip System Revision Hip Proximal Body Extension L52 x D21mm; $2,615.00

Piece, Titanium

Stem

Corin Australia Pty Ltd

CR113 Extreme Hip System Femoral Stem Stem component of modular femoral stem, 4 lengths - 250 to 400mm, 6 $5,020.00

titanium, HA, with distal screw holes diameters

Johnson & Johnson Medical Pty Ltd

DP009 Reef Hip Femoral Stem Titanium modular femoral stem with Length 225 - 375mm $5,020.00

optional distal locking, grit blast and full

HA coating

Link Orthopaedics

Australia

LO138 Link MP Reconstruction Hip Prosthesis Stem, titanium, grit blast, HA 14 - 25mm x 210, 250, 290 & $5,020.00

330mm; 12 x 160, 180, 210,

250 - MP; 14 x 160, 180 -MP;

16 x 160, 180 - MP; 18 x

160, 180 - MP; 20 x 160, 180

- MP; 22.5 x 160, 180 -MP;

25 x 160, 180 - MP

Orthotech Pty Ltd

OH378 Securus Modular Revision Hip System Curved Femoral Stem 250 - 300mm $5,020.00

Prostheses List by Category, Groups and Sponsor Page 32 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

11.1.10.4 - Plasma

Body

Corin Australia Pty Ltd

CR156 Extreme Revision Hip Monobloc Combined metaphyseal and epiphyseal 4 sizes $4,520.00

Epiphysis Metaphyseal Section sections, adjustable rotation, anodized

titanium with HA coating

Stryker Australia Pty Ltd

SK056 Stryker Modular Revision Hip System Milled Proximal Body Titanium Plasma Dia 19-25mm with 2 mill $4,520.00

Spray, HA Depths; 27-29mm with 3 Mill

Depths

SK060 Stryker Modular Revision Hip System Broached Proximal Body Titanium Plasma 1-8 $4,520.00

Spray, HA

SK061 Stryker Modular Hip System Cone Proximal Body Titanium Plasma Dia 19-31mm, Heights $4,520.00

Spray, HA +0,+10,+20,+30

SK062 Stryker Modular Revision Hip System Calcar Proximal Body Titanium Plasma Diameter 19-29mm, 3 Heights $4,520.00

Spray each

Stem

Biomet Australia Pty Ltd

BI120 Mallory Head Hip System Femoral Stem, titanium plasma HA 220mm, Size 9-19mm $5,920.00

BI121 Mallory Head Hip System Femoral Stem, Calcar, HAP Coated, 250 - 260mm, Size 9-19mm $5,920.00

Titanium

BI138 Mallory Head Hip System Femoral Stem, Revision, HAP Coated, 300mm, size 7 to 19mm $5,920.00

Titanium

Stryker Australia Pty Ltd

SR045 Stryker Modular Revision Hip System Modular Long Bowed Titanium Plasma Length 217mm, 267mm and $5,920.00

HA Stem 317mm. Diameter 11mm - 26mm

11.1.11 - Calcar Replacement

11.1.11.1 - Short and Standard Length

Biomet Australia Pty Ltd

BI051 Bi-Metric Hip System Head Neck calcar Femoral Stem, Chrome 9-15mm $3,700.00

Cobalt, Cemented, unpolished 200 and

250 lengths

Prostheses List by Category, Groups and Sponsor Page 33 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Smith & Nephew Surgical Pty Ltd

SN273 Echelon/Spectron Revision Hip Stem - Non-porous 135-200mm $3,700.00

Stryker Australia Pty Ltd

ST586 Osteonics omnifit head/neck hip stem Cobal Chrome, Unpolished, standard and Stem sizes 5, 7 & 9 $3,700.00

long with calcar

11.1.11.2 - Long Length (≥200mm)

Johnson & Johnson Medical Pty Ltd

DP121 Solution Calcar Replacement Femoral CoCr calcar replacement stem, Size 7-10 inch (175 - 250mm) $6,900.00

Stem uncemented, beaded (Porocoat)

Smith & Nephew Surgical Pty Ltd

SN271 Echelon Revision Hip Stem – Non-porous 225mm-300mm $6,900.00

Stryker Australia Pty Ltd

ST589 Osteonics hip prostheses Restoration cacar replacement stem 15mm 205mm length - stem sizes 8-14 $6,900.00

titanium - HA coated

11.1.12 - Thrust Plates

11.1.12.1 - Thrust Plate

Zimmer Pty Ltd

ZI349 Thrust Plate Prosthesis Allopro Thrust Plate - Ti alloy 38 to 44mm $1,773.00

11.1.12.2 - Lateral Plate

Zimmer Pty Ltd

ZI350 Thrust Plate Prosthesis Allopro Lateral Plate - Ti alloy Std & Long (15 & 25 deg) $1,450.00

11.1.12.3 - Thrust Plate Bolt

Zimmer Pty Ltd

ZI351 Thrust Plate Prosthesis Allopro Threaded bolt - CoCr alloy 70 to 89mm $1,177.00

Prostheses List by Category, Groups and Sponsor Page 34 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

11.1.13 - Monoblock Hemis

Biomet Australia Pty Ltd

BI060 Austin Moore Self Locking Hip Straight Standard Femoral Prostheses, 38-55mm $615.00

Prosthesis System Titanium

BI062 FR Thompson Hip Prosthesis System Modular Curved Femoral Stem, Titanium. 38mm - 55mm $615.00

Johnson & Johnson Medical Pty Ltd

DP167 Thompson Hip Stainless steel (Ortron 90), Thompson head size 40-54 $615.00

unipolar monoblock femoral component

DP168 Austin Moore Hip Prosthesis Stainless steel (Ortron 90), AMP unipolar Head size 38-60mm $615.00

monoblock femoral component

Orthotech Pty Ltd

OH285 JRI Austin Moore Total Hip System Cementless femoral stem Head sizes range from 39mm - $615.00

56mm

OH299 JRI Total Hip System JRI Austin Moore Standard Stems Head Sizes range from 39mm - $615.00

Hemiarthroplasty. These prusct has an all- 56mm

in-one head and stem

Smith & Nephew Surgical Pty Ltd

SM037 Fracture Head Unipolar Femoral Head Stainless Steel or CoCr 38-60 S/M $615.00

SN277 Endoprosthesis CoCr 38 - 54mm $615.00

Stryker Australia Pty Ltd

HW025 Austin Moore Endoprosthesis Long Stem - Vitallium cobalt chrome Head size 38 to 63 $615.00

HW026 Austin Moore Endoprosthesis Standard Stem - Vitallium 105-165mm length, Head size: $615.00

38 to 57

SK196 Exeter Hip System - ETS Orthinox Stainless Steel Endoprosthesis 40mm Offset body with $615.00

(endoprosthesis trauma stem) unipolar monoblock monoblock head sizes 38mm,

40mm, 41mm, 42mm, 43mm,

44mm, 45mm, 46mm, 47mm,

48mm, 49mm, 50mm, 52mm,

54mm, 56mm

Zimmer Pty Ltd

ZI008 Zimmer Austin Moore Stainless Steel Sizes 38 - 60 $615.00

Prostheses List by Category, Groups and Sponsor Page 35 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

11.1.14 - Femoral Neck

B Braun Australia Pty Ltd

BB296 Metha - Modular neck adaptors Modular neck adaptors made from CoCr CCD - 130°, 135 °, 140°; $1,227.00

Offset

- 0mm, -5mm ,+5mm;

Version - 7.5° left ante/right

retro, 0 °, 7.5 ° left retro/right

ante

Corin Australia Pty Ltd

CR101 Modular Neck for Acor & Integrale Titanium neck, with varying alignments & 4 sizes $1,227.00

Femoral Stems tapers

DJO Australasia Pty Ltd

DD028 R120 Femoral Neck CoCr, varying offsets & versions 32-38mm length, varying $1,227.00

degrees

Electus Ortho Pty Ltd

EZ007 Modula SC Neck The complete series of MODULA SC OX, OY, OZ, OA, OB, OC, $1,227.00

necks, all patented, consists of 15 sizes 9X, 9Y, 9Z, 9A, 9B, 9C, 9AA,

and makes it possible to optimise the 9BB, 9CC

reciprocal position of the stem and neck

cup on the basis of the articular needs of

the patient, by restoring the physiological

off-set and le

ESKA Australia

EK034 Adapter Femoral Neck CoCr, varying versions & offsets One Size $1,227.00

FOL Technology PTY Ltd

FO021 Multifit Modular Neck Modular Neck S, M, L $1,227.00

Global Orthopaedic Technology

GO139 R120 Femoral Neck CoCr, varying offsets & versions 32-38mm length, varying $1,227.00

degrees

Lifehealthcare Pty Ltd

LH184 Modular U Necks Cobalt chrome Standard, varus, valgus, $1,227.00

antiverted right, antiverted left

Prostheses List by Category, Groups and Sponsor Page 36 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Lima Orthopaedics Australia Pty Ltd

LC004 Lima F2L modular neck Titanium Short & Long (Straight & $1,227.00

Angled)

LC014 Sam-Fit modular neck Modular neck S1-S6, L1-L6 $1,227.00

LC029 H-Max Femoral neck Modular neck 1-6 $1,227.00

Smith & Nephew Surgical Pty Ltd

SN898 MDF Revision System Modular Neck - CoCr highly polished 24mm - 36.5mm $1,227.00

trapezoidal for MDF stem/MIS stem

multiple options of version height and neck

length

Stryker Australia Pty Ltd

SK444 ABG II Modular Hip System Neck for the ABGII stem Long & Short $1,227.00

SK446 Rejuvinate SPT Femoral Hip System Neck for Rejuvinate SPT Stem 30-38mm $1,227.00

Wright Medical Australia

WR139 Profemur Modular Neck Titanium and CoCr Femoral Necks Length 27 - 38.5mm; Neutral $1,227.00

to Ante/Retro - Varus Valgus 2

Zimmer Pty Ltd

ZI553 M/L Taper Kinectiv Neck Neck component for M/L taper stem size K, S, A, E, P, X, B, G, R, $1,227.00

C, J, D, K1, S1, AA, E1, P1,

X1, K2, E2, BB, G1, R1 ,S2,

P2, G2, CC, J1, X2, R2, J2, DD

Complex

Corin Australia Pty Ltd

CR114 Extreme Hip System Extended Neck Femoral neck with extension for locking 4 sizes $1,727.00

screw for stem

Exactech Australia

EX024 Exactech M Series body Titanium, complex neck segment 32 - 49mm, -5 - +30mm $1,727.00

Global Manufacturing Technology Pty Ltd

GM091 Apex Global & K2 & MSA Femoral Titanium and CoCr with lateral extension 25mm - 35mm to 35mm - 50mm $1,727.00

Neck for stem connection

Prostheses List by Category, Groups and Sponsor Page 37 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Global Orthopaedic Technology

GO014 UniSyn Hip Complex Neck Titanium, with lateral extension for stem 30-36mm non calcar, 45- $1,727.00

connection, includes calcar & non calcar 55mm for calcar

replacement necks, separate locking bolt

Orthotech Pty Ltd

OH061 Exactech M Series body Titanium, complex neck segment 32 - 49mm, -5 - +30mm $1,727.00

Wright Medical Australia

WR165 Guardian Limb Salvage System Guardian Femoral Neck One Size Only $1,727.00

11.1.2 - Cemented, Long Lengths (≥200mm)

11.1.2.1 - Polished and Unpolished, Conventional

ESKA Australia

EK081 Adapter GHE Femoral Long Stem CoCr, non polished, long stem 200mm - 350mm $3,550.00

Cemented

Johnson & Johnson Medical Pty Ltd

DP013 Wroblewski Resection femoral Stem Stainless steel, polished, includes 200mm-250mm $3,550.00

segmental support rings x 3

DP175 Charnley Hip Long Femoral Stem Stainless steel Ortron 90 stem 10"- 15" (250-375mm) $3,550.00

DP212 Elite Plus Long Femoral Stem Stainless steel, Ortron 90, cemented Sizes 3-5 (200-250mm) $3,550.00

femoral stem, unpolished

DP550 C- Stem & C- Stem AMT Femoral Stainless steel Ortron 90, highly polished, Size 3-8 x 200-240mm length $3,550.00

Stem triple taper, long stem

Link Orthopaedics

Australia

LO012 LINK Endo - Model Saddle Prosthesis Cobal Chrome, unpolished and long 170mm / Sizes 01-5 $3,550.00

Stryker Australia Pty Ltd

HW040 Exeter Hip System Stainless Steel (Orthinox) polished long 37.5 and 44mm offsets $3,550.00

ST584 Osteonics omnifit cemented long stem cobalt chrome unpolished long Stem sizes 5-11, stem length $3,550.00

200, 250 AND 300mm

Zimmer Pty Ltd

ZI025 Zimmer VerSys CRC Hip Systems Cobalt Chrome, unpolished long stem 13 - 19 $3,550.00

Femoral Stem with calcar attachment option

ZI301 CPT Hip System Cobalt Chrome, polished, tapered, long Sizes 1 - 4 $3,550.00

stems

Prostheses List by Category, Groups and Sponsor Page 38 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Tumour

Lima Orthopaedics Australia Pty Ltd

LC001 Lima RPS Femoral System Cemented tumor Stem 130, 165, 200mm $7,176.00

11.1.3 - Uncemented

11.1.3.1 - Grit Blast

Biomet Australia Pty Ltd

BI932 PPF Hip System grit blast non HA 00 thru 12 $3,870.00

BI980 Echo Hip System Press Fit Femoral Component, titanium 7 - 17mm $3,870.00

DJO Australasia Pty Ltd

DD007 Foundation Hip System, 440, 470, 480 Foundation Porous, Press Fit, fracture 8, 9, 10.5, 12, 13.5, 15, 16.5, $3,870.00

Stem with or without collar 18.0

DD048 CLP Hip System - Femoral Component, Non modular femoral hip stem, designed 14 x standard offset $3,870.00

Ti, Grit Blast, non HA, standard and for uncemented use, and to be used with components and 12 lateral

lateral offset CoCro or Ceramic heads in total hip offset components

arthroplasty, or Bipolar heads in hemi-

arthroplasty

ESKA Australia

EK092 SCR Revision Stem Femoral Stem for Revision of THR 1 size (195mm) $3,870.00

(Double-tapered straight Stem with

rectangular profile)

Finsbury Orthopeadics Australia Pty Ltd

FI021 Adept Hip System Femoral Hip Stem, cementless, titanium, 12 standard sizes and 7 $3,870.00

long stem, grit blast lateralised sizes

FI044 Finsbury Type S Stem Tapered, Titanium, Uncemented Femoral Sizes 5 through 20. Standard & $3,870.00

Stem Lateralised

Lima Orthopaedics Australia Pty Ltd

LC011 Lima C2 Femoral Stem Femoral Stem, titanium, grit blast, non HA 1-8 $3,870.00

Link Orthopaedics

Australia

LO107 Beta-Cone Cementless Hip Prosthesis Titanium, grit blast, non HA 9 Stem sizes 1-9 plus additional $3,870.00

9 stems with XL neck length.

Total 18 sizes

Prostheses List by Category, Groups and Sponsor Page 39 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Mathys Orthopaedics Pty Ltd

MA019 CBC Non Cemented Femoral Stem Titanium, grit blast, non HA, 5-20mm $3,870.00

MA427 CBH Non Cemented Femoral Stem Titanium, grit blast, non HA, 00-12 $3,870.00

Medacta Australia Pty Ltd

MU025 Quadra S Femoral Stem Titanium, grit blast, non HA, Standard #0 to #10 and #0 to $3,870.00

#3 with a shorter neck.

Lateralized #1 to #7 and #1 to

#3 with a shorter neck.

Smith & Nephew Surgical Pty Ltd

SM012 SL & SLR Plus Femoral Stem Titanium, grit blast, non HA, Sizes 01-12 for SL & 1-6 for $3,870.00

SLR

SM126 SL Plus MIA Femoral Stem Titanium, grit Blasted, double tapered 01-12 various offsets $3,870.00

SN842 Platform Hip Stem Titanium grit blasted stem 0-12 $3,870.00

Stryker Australia Pty Ltd

SR056 Hipstar™ TMZF® Hip Stem Titanium, grit blast and HA Size 0 through to 12 $3,870.00

Zimmer Pty Ltd

ZI338 Natural Hip System Femoral Stem Porous, Titanium 140 - 160mm $3,870.00

ZI376 Cone Hip prosthesis Titanium, grit blast, non HA 13 to 24mm $3,870.00

ZI397 Variall Hip System Titanium, grit blast, non HA sizes 0 to 11, $3,870.00

Removable Neck

DJO Australasia Pty Ltd

DD027 R120 Uncemented Femoral Stem Femoral Stem porous/HA coated, Size 1 to 6 $3,870.00

Modular, CrCo, standard lengths

Global Orthopaedic Technology

GO135 R120 Uncemented Femoral Stem Femoral Stem porous/HA coated, Size 1 to 6 $3,870.00

Modular, CrCo, standard lengths

Wright Medical Australia

WR136 Profemur Z Hip System Profemur Z, Titanium Tapered Femoral Standard Length Sizes 1 - 9 $3,870.00

Stem

WR142 Profemur E Hip System Profemur E Stem - without HA grit blasted 1 Standard - 9 Standard $3,870.00

'Titanium

Prostheses List by Category, Groups and Sponsor Page 40 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

SCP

Zimmer Pty Ltd

ZI462 Alloclassic Hip Stem Titanium, grit blast, non HA, standard and 1 - 14 $4,270.00

high offset

ZI463 Alloclassic Hip Stem Zweymuller, Ti alloy, Short Cone, Slender 01, 0, 1, 10-13 $4,270.00

Neck

ZI468 CLS Cementless Hip Titanium, grit blast, non HA 5 - 20 $4,270.00

11.1.3.2 - Beaded

DJO Australasia Pty Ltd

DD001 Linear Hip Stem Linear Hip Stem Standard or Lateral Sizes 5, 6, 7, 8, 9, 10, 11, 12, $4,350.00

Offset (reduced neck) 13, 14, 15, 17 and 19

(standard and lateral offsets)

DD047 Revelation Hip System - Femoral Non modular femoral hip stem, designed 16 stems: 8 sizes Left & 8 sizes $4,350.00

Component, Ti, Grit Blast, non HA, for uncemented use, left & right specific Right - 8.0, 9.0, 10.5, 12.0,

standard & lateral offset with 130 degree neck angle & 12 degrees 13.5, 15.0 & 16.5

of built-in anteversion.

Proximal

circumferential "3D" beading, a highly

polished neck & highly polished distal stem

Johnson & Johnson Medical Pty Ltd

DY516 Solution Implantable Hip System Revision Standard & MMA 8 straight or 6 inch (150mm) size 10.5 - 22.5 $4,350.00

bowed porous coated collarless, coxa vara

or high offset uncemented stem

JJ604 Tri-lock Femoral Stem Titanium, proximally beaded, (porocoat) Sizes 0-10 with various offsets $4,350.00

not HA,

JJ813 Summit Femoral Hip Titanium, beaded proximally, distal grit 0-12 $4,350.00

blast

Smith & Nephew Surgical Pty Ltd

SM171 MIS Stem Short, tapered, uncemented "press fit" Size 1-9 (73mm -101mm) $4,350.00

femoral stem with modular neck

functionality

SN270 Echelon Femoral Stem Porous Co Cr, Std and 9 - 19 $4,350.00

High Offset

SN305 Synergy Femoral stem Beaded Titanium Alloy, Std 9-20 $4,350.00

and High Offset

Prostheses List by Category, Groups and Sponsor Page 41 of 911

11 - HIP

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Zimmer Pty Ltd

ZI022 Zimmer Hip Systems Femoral Stem VerSys Beaded Fullcoat - Cobalt 11 - 20 $4,350.00

Chrome, Short & Standard

11.1.3.3 - Mesh

ESKA Australia

EK086 Adapter Uncemented Femoral Stem Co Cr, Titanium Spray, 3 Dimensional Femoral Stem 1 - 7 $4,450.00

Metal,

Johnson & Johnson Medical Pty Ltd

JJ777 Tri-Lock Gription Femoral Stem Titanium, Femoral stem, GRIPTION coated Size 0-12 standard and high $4,450.00

offset

Zimmer Pty Ltd

ZI006 Mayo Hip Titanium, mesh (fibre metal), non HA Small, medium, large and extra $4,450.00

large.

ZI016 Zimmer 'VerSys Hip Systems Femoral Titanium, mesh (fibre metal), non HA 9 - 18 $4,450.00

Stem

ZI492 Trabecular Metal Femoral Stem Titanium, porous tantalum Sizes 9 to 18 with standard and $4,450.00

and lumen configurations) with Dual Lumen CS-25402 - 4Fr

antimicrobial impregnation (chlorhexidine x 8cm, Dual Lumen CS-25502

and silver sulphadiazine) on the external - 5Fr x 12cm, Dual Lumen

surface of the polyurethane catheter CS-22702E - 7Fr x 16cm,

material Double Lumen CS-26702 -

7Fr x 20cm, Double Lumen

CS-27702E - 7Fr x 20cm,

Double Lumen CS-25553 -

5.5Fr x 8cm, Triple Lumen CS-

22703E - 7Fr x 16cm, Triple

Lumen CS-26553 -5.5Fr x

13cm, Triple Lumen CS-

24703E - 7Fr x 30cm, Triple

Lumen

CS-25703E - 7Fr x 20cm,

Triple Lumen

CM019 ARROWg+ard Blue Plus QUAD Lumen Central Venous Catheters (of Various CS-42854E - 8.5Fr x 16cm, $170.00

Central Venous Catheters lengths, sizes and lumen configurations with Quad Lumen CS-45854E -

antimicrobial impregnation on:1. The 8.5Fr x 20cm, Quad Lumen

external indwelling surface of catheter

material (chorhexidine and silver

sulphadiazine) 2. The entire internal fluid

pathway including catheter, extension-lines

and hubs (chlorhexidine acetate)

Prostheses List by Category, Groups and Sponsor Page 905 of 911

VASCULAR CAG

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

CM020 ARROWg+ard Blue Plus Double & Double & Triple Lumen Central Venous CS-45802E - 8 Fr x 20cm, $120.00

Triple Lumen Central Venous Catheters Catheters (of various lengths sizes and Dual Lumen CS-46702E - 7Fr

lumen configurations) with antimicrobial x 20cm, Dual Lumen CS-

impregnation on: 1. The external indwelling 47702E - 7Fr x 20cm, Dual

surface of catheter material (chlorhexidine Lumen CS-42703E - 7Fr x

and silver sulphadiazine) 2. The entire 16cm, Triple Lumen CS-

internal fluid pathway including catheter, 45703E - 7Fr x 20cm, Triple

extension-lines and hubs (chlorhexidine Lumen

acetate)

pi

Bard Australia Pty Ltd

BA182 PowerPICC Triple Lumen Power Injector Catheter 6F, 55cm length $230.00

BA183 PowerPICC Dual Lumen Power Injector Catheters 5F, 6F, 55cm Length $225.00

Cook Medical Australia Pty Ltd

WC280 Turbo-Ject Peripherally Inserted Central 4/5 Fr Double Lumen Polyurethane PICC 4 and 5 French, 60 cm $225.00

Catheter Set ( Double Lumen) with Micropuncture Peel-Away Sheath Catheter length, double lumen

Introducer and Echogenic needle catheter

Mayo group

CM021 Arrow double lumen pressure injectable Arrow double lumen pressure injectable 5Fr x 50cm, Double Lumen $225.00

peripherally inserted central catheter PICC (peripherally inserted central

(PICC) set catheter) set

CM024 Arrow Pressure Injectable Triple-Lumen Pressure injectable triple lumen PICC 6Fg x 50cm, triple lumen $230.00

PICC. (Peripherally Inserted Central Catheter) Set

Group 9b2: Percutaneous Catheters – Multiple lumen for haemodialysis

Bard Australia Pty Ltd

BA211 Haemodialysis Catheters Haemodialysis Catheters, multiple lumen 11Fr - 13.5Fr $130.00

Kendall Australasia Pty Ltd TA Covidien Pty Ltd

KA007 Mahurkar Subclavian Catheter Kit Chronic haemodialysis, long term vascular 36, 40cm $184.00

access for haemodialysis and apheresis.

Constructed of radiopaque silicone rubber.

Prostheses List by Category, Groups and Sponsor Page 906 of 911

VASCULAR CAG

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

KA012 Mahurkar Subclavian Catheter Kit Acute haemodialysus, short term vascular 11.5 Fr, 13.5cm Straight Exten, $130.00

access. Catheters constructed of 11.5 Fr, 16cm Straight Exten,

radiopaque polyurethane. Tips are made of 11.5 Fr 19.5cm Straight Exten,

polyvinyl chloride and are more 10 Fr 12cm Curved Exten, 10

radiopaque than the rest of the catheter. Fr 15cm Curved Exten, 11.5 Fr

16cm Curved Exten, 11.5 Fr

16cm Curved Exten, 11.5 Fr

19.5cm Curved Exten

KA014 Mahurkar Maxid Catheters Catheters constructed of radiopaque Size, 38, 43, 48, 53cm $305.00

polyurethans, high kink resistant.

The

arterial lumen is shorter than the venous

lumen at the catheter's distal end in order

to reduce recirculation during haemodialysis

cu

Bard Australia Pty Ltd

BA040 VitaCuff, Hickman Catheter Dialysis/Apheresis catheter, dual lumen, 36-45cm overall length $349.00 $359.00

silicone

BA140 HemoGlide Long Term Haemodialysis Dialysis Catheter, Multiple Lumen 14.5 Fr $357.00 $368.00

Catheter

BA159 HemoSplit Long Term Haemodialysis HemoSplit is a carbothane long term dual Standard Kit (straight 15cm to $485.00 $500.00

catheter lumen catheter used to provide vascular 42cm and pre-curved 19cm to

access for haemodialysis. 31cm), Microintroducer Kits

(straight 19cm to 42cm & pre-

curved 19cm to 31cm)

Kendall Australasia Pty Ltd TA Covidien Pty Ltd

KA011 Permcath Dual Lumen Catheter Chronic Haemodialysis, long term vascular 36cm, 40cm $330.00

access for haemodialysis and aphaeresis.

Constructed of radiopaque silicone rubber.

KA013 Permcath Dual Lumen Catheter Chronic haemodialysis, long term vascular 28, 36, 40cm $290.00

access for haemodialysis and aphaeresis.

Constructed of radiopaque silicone rubber.

Prostheses List by Category, Groups and Sponsor Page 907 of 911

VASCULAR CAG

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

KA018 Palindrome Haemodialysis catheter 14.5Fr. 19, 23, 28, 33, 55cm $485.00 $600.00

Insertion Lengths, with 36, 40,

45, 50, 72cm Overall length,

with side slots, symmetric tip

Mayo group

CM023 Arrow Cannon II Plus Chronic Dual Lumen, Retrograde Tunneled, 15Fg x 24 - 55cm $450.00

Haemodialysis Catheter Set Cuffed, Tip First, Chronic Haemodialysis

Catheter Set

Tekmed Pty Ltd

TK005 Medcomp Long Term Catheter sets for ASH, TESIO-BioFlex with cuff 10, 14 French 24,28,32 & $450.00

Haemodialysis 36cm lengths

TK006 Medcomp Long Term Catheter sets for HemoFlow HFS-Carbothane with cuff 14.5 French 24,28,32 & $295.00

Haemodialysis 36cm lengths

i

Mayo group

CM015 ARROWg+ard Blue Haemodialysis Haemodialysis Catheters (of various CS-22122 - 12Fr 16cm, Dual $195.00

Catheters lengths, sizes and lumen confiurations) with Lumen CS-22123 – 12Fr

antimicrobial impregnation (chlorhexidine 16cm, Triple Lumen CS-25122

and silver sulphadiazine) on the external – 12Fr x 20cm, Dual Lumen

surface of the polyurethane catheter CS-22142CF – 14Fr x 15cm,

material. Dual Lumen, Curved, Firm CS-

22142F – 14Fr x 15cm, Dual

Lumen Firm CS-25122 – 12Fr

x 20cm, Double Lumen CS-

25123 – 12Fr x 20cm, Triple

Lumen CS- 25142CF – 14Fr x

20cm, Double Lumen, Curve,

Firm CS-25142F – 14Fr x

20cm, Double Lumen, Firm

CS-26142F – 14Fr x 25cm,

Double Lumen, Firm

CU-

22122 – 12Fr x 16cm, Double

Lumen, Curved CU-23122 –

12Fr x 13cm, Double Lumen,

Curved CU-25122 – 12Fr x

20cm, Double Lumen, Curved

Prostheses List by Category, Groups and Sponsor Page 908 of 911

VASCULAR CAG

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Group 9c: Infuser Ports – single chamber

B Braun Australia Pty Ltd

BB170 Celsite Access Port for pain relief Composition - polysulphone. Kit includes Diameter of septum:11.7mm. $495.00

tunnelling rod, filter, connectors, needles, Height: 11.5mm. Dimension:

syringe, tuohy needle 25.8 x 37.8mm

Bard Australia Pty Ltd

BA056 Subcutaneous Ports Titanium or MRI Implantable Port, Open- 6FR - 9.6Fr $500.00

Ended Catheter Single Chamber

BA057 Groshong Subcutaneous Ports Titanium or MRI Implatable Port, Closed- 7Fr - 8 Fr $521.00

Ended Catheter, Single Chamber

BA060 Subcutaneous Ports Low-Profile Titanium or MRI Implantable 6 - 6.6 French Catheter $534.00 $653.00

Port, Open-Ended Catheter Single

Chamber

BMDi Tuta Healthcare Pty Ltd

TT001 Paragon Ambulatory Drug Infusion System The top of the Paragon infuser is made of Infuser - 100mL Administration $534.00

acetyl with stainless steel parts; the bottom Sets - 0.50mL, 1mL, 2mL,

is made of clear polycarbonate. Diam: 4mL, 10mL, 50mL, 100mL, or

10cm Height: 5.8cm.

Administration Sets 200mL/hr

- made from PVC and acrylic

components.

Cook Medical Australia Pty Ltd

WC093 Cook Implantable Injection/Infusion Ports Petite or Standard, single or multiple 3 - 12 Fr pre-attached or $500.00

chamber Polysulfone Port which may detached catheter or valve system

include micropuncture or standard

introducer set

WC094 Cook Implantable Injection/Infusion Ports Mini or Petite or Standard, single or 3 - 12 Fr pre-attached or $534.00

multiple chamber titanium Port which may detached catheter or valve system

include micropuncture or standard

introducer set

WC115 Cook Implantable Injection/Infusion Port Mini, single or multiple chamber titanium 3 - 12 Fr pre-attached or $534.00 $652.00

Port which may include micropuncture detached catheter or valve

introducer set system

Prostheses List by Category, Groups and Sponsor Page 909 of 911

VASCULAR CAG

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Denward Dell Pty Ltd TA Surimex

DW003 Jet Port Plus Set - Vascular Access Port Implantable injection / infusion port system: Port: Diameter: 28.0mm, $375.00

port chamber with silicone membrane; Height: 12.3mm; Catheter: 6.6

connectable polyurethane catheter; and French, Length: 750mm

introducer kit.

DW004 Jet Port Plus Low Profile Peripheral Set Implantable injection / infusion port system: Port: Length: 24.0mm, Width: $420.00

- Vascular Access Port low profile port chamber with silicone 20.5mm, Height: 10.3mm

membrane; connectable polyurethane Catheter: 6.6 French, Length:

catheter; and introducer kit 750mm

Medical Specialties

Australia Pty Ltd

MS014 Injection/Infusion Ports Sterile Plastic/titanium, single lumen 5-15F $771.00

MS016 Injection/Infusion Ports Sterile Plastic/titanium, paediatric 5, 6, 7,8, 9.6F $771.00

pi

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

BA208 PowerPort with Groshong Catheter Titanium or MRI implantable Port, 8Fr $630.00 $750.00

Closed-Ended Catheter, Single Chamber

Denward Dell Pty Ltd TA Surimex

DW006 T-Port Contrast set - Vascular access Injection infusion port system: titanium port 6163653077: Port Base 27mm $630.00

port. chamber with silicone membrane: x 13mm, CD 1.3 x 2.2mm, CL

connectable polyurethane catheter; 75cm. 6163652087: PB

introducer kit. 27mm x 13mm, CD 1.6 x

2.6mm, CL 75cm.

6163663077: PB 23mm x

10mm, CD 1.3 x 2.2mm, CL

75cm.6163662087: PB 23mm

x 10mm, CD 1.6 x 2.6mm, CL

75cm.

DW007 pfm Contrast Port High pressure injection port system: plastic Port: length 32.1mm, width $630.00

or plastic/titanium port with silicone 23.6mm, height 13.2mm.

mebrane; connectable polyurethane Catheter: 6.6 or 8.4 French,

catheter; introducer kit length 750mm

Prostheses List by Category, Groups and Sponsor Page 910 of 911

VASCULAR CAG

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Group 9d: Infuser Ports – multiple chambers

Bard Australia Pty Ltd

BA059 Dual Lumen Subcutaneous Ports Silicone, Polyurethane or ChronoFlex 7 - 10 French Catheter $805.00

Open-ended Catheter

Cook Medical Australia Pty Ltd

WC164 Cook Implantable Injection/Infusion Ports Dual or Multiple Chamber Titanium Port 3 - 12 Fr pre-attached or $762.00

which may include micropuncture or detached catheter or valve system

standard introducer set

Medical Specialties

Australia Pty Ltd

MS015 Injection/Infusion Ports Sterile Plastic/titanium, dual lumen 10, 10.5, 12F $786.00

Grand Total: 9306 Records

Prostheses List by Category, Groups and Sponsor Page 911 of 911

PART B - Human Tissue List August 2011

1 - OPHTHALMIC

Billing Code Facility Minimum Benefit Maximum Benefit

Amniotic Membrane

LEM03 Lions Eye Donation Service $770.00

Cornea

LEM01 Lions Eye Donation Service $2,000.00

LEN01 Lions NSW Eye Bank $1,633.00

LEW01 Lions Eye Bank of Western Australia $2,500.00

QEB01 Queensland Eye Bank $2,100.00

SAE01 The Eye Bank of South Australia $1,000.00

Cornea for Endothelial Lamellar Keratoplasty

LEM04 Lions Eye Donation Service $2,660.00

Cornea For Lamellar

LEN03 Lions NSW Eye Bank $980.00

Sclera

LEM02 Lions Eye Donation Service $150.00

LEN02 Lions NSW Eye Bank $245.00

LEW02 Lions Eye Bank of Western Australia $250.00

QEB02 Queensland Eye Bank $298.00

SAE02 The Eye Bank of South Australia $60.00

Conduit - Aortic

TBV56 Donor Tissue Bank of Victoria $1,013.00

Conduit - Aortic + Valve

QHV09 The Prince Charles Hospital - Queensland Heart Valve Bank $5,499.00

Conduit - Arterial

SHV03 Sydney Heart Valve Bank, St. Vincent's Hospital $987.00

Conduit - Pulmonary

TBV03 Donor Tissue Bank of Victoria $1,012.00

Conduit - Pulmonary + Valve

QHV08 The Prince Charles Hospital - Queensland Heart Valve Bank $5,499.00

Page 1 of 15

CARDIO-THORACIC

Billing Code Facility Minimum Benefit Maximum Benefit

Conduit - Pulmonary large

QHV07 The Prince Charles Hospital - Queensland Heart Valve Bank $1,448.00

Conduit - Pulmonary small

QHV06 The Prince Charles Hospital - Queensland Heart Valve Bank $1,448.00

Patch - Mitral

QHV03 The Prince Charles Hospital - Queensland Heart Valve Bank $1,448.00

Patch - Pericardium

QHV05 The Prince Charles Hospital - Queensland Heart Valve Bank $1,448.00

Patch - Tricuspid

QHV04 The Prince Charles Hospital - Queensland Heart Valve Bank $1,448.00

Pericardium

TBV50 Donor Tissue Bank of Victoria $490.00

Thoracic Aorta

QHV11 The Prince Charles Hospital - Queensland Heart Valve Bank $1,450.00

Valve - Aortic

QHV01 The Prince Charles Hospital - Queensland Heart Valve Bank $5,499.00

RPH01 Royal Perth Hospital T/A Heart Valve Bank $6,406.00

SHV01 Sydney Heart Valve Bank, St. Vincent's Hospital $5,350.00

TBV01 Donor Tissue Bank of Victoria $6,598.00

Valve - Mitral

QHV10 The Prince Charles Hospital - Queensland Heart Valve Bank $5,499.00

Valve - Pulmonary

QHV02 The Prince Charles Hospital - Queensland Heart Valve Bank $5,499.00

RPH02 Royal Perth Hospital T/A Heart Valve Bank $6,406.00

SHV02 Sydney Heart Valve Bank, St. Vincent's Hospital $5,350.00

TBV02 Donor Tissue Bank of Victoria $6,598.00

Autologous Chondrocyte Implant

MVS22 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $9,538.00

Autologous Chondrocytes Implant and Matrix

ORT01 Orthogen Australia Pty Ltd $11,400.00

VAP01 Verigen Australia Pty Ltd $11,400.00

Page 2 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

Autologous Skull Flap

MVS23 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $1,396.00

QBB60 The Queensland Bone Bank $1,568.00

RNB02 Hunter New England Bone Bank $1,470.00

Autologous Skull Flap - processed

QBB56 The Queensland Bone Bank $1,986.00

Bone - Cancellous Bone Matrix, Lyophilised 40cc

TBV52 Victorian Institute of Forensic Medicine $619.00

Bone - Cancellous Bone Matrix, Lyophilised 80cc

TBV53 Victorian Institute of Forensic Medicine $1,237.00

Bone - Cancellous Crunch 15cc

NBB62 New South Wales Bone Bank $903.00

Bone - Cancellous Crunch 30cc

NBB61 New South Wales Bone Bank $1,647.00

Bone - Cancellous Crunch 60cc

NBB60 New South Wales Bone Bank $2,498.00

Bone - Cancellous Cubes (6) Freeze Dried

QBB09 The Queensland Bone Bank $1,609.00

Bone - Cancellous Strips (2) Freeze Dried

QBB10 The Queensland Bone Bank $680.00

Bone - Chips/cubes 40cc

TBV09 Donor Tissue Bank of Victoria $973.00

Bone - Chips/cubes 80cc

TBV10 Donor Tissue Bank of Victoria $1,853.00

Bone - Cortico-Cancellous Crunch (40/60) 15cc

NBB65 New South Wales Bone Bank $903.00

Bone - Cortico-Cancellous Crunch (40/60) 30cc

NBB64 New South Wales Bone Bank $1,647.00

Bone - Cortico-Cancellous Crunch (40/60) 60cc

NBB63 New South Wales Bone Bank $2,498.00

Page 3 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

Bone – Cortico-Cancellous Crunch <20g Sterile

AUB08 Australian Biotechnologies $2,215.00

Bone – Cortico-Cancellous Crunch <30g

AUB04 Australian Biotechnologies $2,070.00

Bone - Demineralised Bone Matrix, Lyophilised 10g

TBV55 Donor Tissue Bank of Victoria $1,049.00

Bone - Demineralised Bone Matrix, Lyophilised 5g

TBV54 Donor Tissue Bank of Victoria $524.00

Bone - Milled <30g Freeze Dried

PBT37 Perth Bone and Tissue Bank $750.00

Bone - Milled <30gr (60cc equivalent)

PBT08 Perth Bone and Tissue Bank $2,134.00

Bone - Milled >50gr (100cc equivalent)

PBT10 Perth Bone and Tissue Bank $3,135.00

Bone - Milled 20g

QBB45 The Queensland Bone Bank $1,993.00

Bone - Milled 20g Freeze Dried

QBB03 The Queensland Bone Bank $2,524.00

Bone - Milled 30 - 50gr (60 - 100cc equivalent)

PBT09 Perth Bone and Tissue Bank $2,734.00

Bone - Milled 30-50g Freeze Dried

PBT38 Perth Bone and Tissue Bank $900.00

Bone - Milled 40cc

TBV11 Donor Tissue Bank of Victoria $1,165.00

Bone - Milled 80cc

TBV12 Donor Tissue Bank of Victoria $2,084.00

Bone - Milled Femoral Head

AUB02 Australian Biotechnologies $2,457.00

Bone - Ronguered Chips

QBB68 The Queensland Bone Bank $2,022.00

Page 4 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

Bone - Ronguered Chips Freeze Dried

QBB67 The Queensland Bone Bank $2,524.00

Bone Plug/Dowel - Cancellous

NBB05 New South Wales Bone Bank $1,224.00

PBT03 Perth Bone and Tissue Bank $500.00

TBV07 Donor Tissue Bank of Victoria $691.00

Bone Plug/Dowel - Tricortical

TBV08 Donor Tissue Bank of Victoria $750.00

Cartilage - costal segments

PBT11 Perth Bone and Tissue Bank $300.00

QBB12 The Queensland Bone Bank $210.00

TBV17 Donor Tissue Bank of Victoria $390.00

Cortical Strut

AUB05 Australian Biotechnologies $2,451.00

QBB52 The Queensland Bone Bank $441.00

TBV14 Donor Tissue Bank of Victoria $763.00

Cortical Strut >15 - 20cm

PBT07 Perth Bone and Tissue Bank $2,284.00

Cortical Strut >20cm

PBT48 Perth Bone and Tissue Bank $2,532.00

Cortical Struts 10-15cm

PBT06 Perth Bone and Tissue Bank $1,914.00

Disc - Freeze Dried

QBB04 The Queensland Bone Bank $713.00

Elbow - joint

QBB14 The Queensland Bone Bank $2,205.00

TBV18 Donor Tissue Bank of Victoria $5,247.00

Fascia Lata

NBB09 New South Wales Bone Bank $922.00

TBV21 Donor Tissue Bank of Victoria $806.00

Fascia Lata - Large (15cm x 10cm)

Page 5 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

PBT15 Perth Bone and Tissue Bank $1,590.00

Fascia Lata - per sq cm

QBB11 The Queensland Bone Bank $5.00

Fascia Lata - Small (10cm x 5cm)

PBT16 Perth Bone and Tissue Bank $825.00

Femoral Head

ACT01 ACT Bone Bank $2,432.00

APH01 The Avenue Private Hospital Bone Bank $1,131.00

AUB03 Australian Biotechnologies $2,354.00

CSA01 Rachel Forster Bone Bank $802.00

DHR01 Barwon Health Bone Bank $2,432.00

HBB01 The Hobart Private Hospital Bone Bank $2,113.00

LPH01 Lingard Private Hospital Bone Bank $1,103.00

MMH01 Mater Misericordiae Hospital Bone Bank Theatres $400.00

MVS05 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $1,595.00

NBB16 New South Wales Bone Bank $2,354.00

PBT22 Perth Bone and Tissue Bank $2,432.00

QBB27 The Queensland Bone Bank $2,163.00

RNB01 Hunter New England Bone Bank $2,050.00

SVN01 Mater Hospital $731.00

TBV26 Donor Tissue Bank of Victoria $2,354.00

Femoral Head - Autologous

QBB61 The Queensland Bone Bank $2,163.00

Femoral Head - Freeze Dried

QBB28 The Queensland Bone Bank $2,163.00

Femoral Hemi-condyle

NBB59 New South Wales Bone Bank $2,271.00

PBT21 Perth Bone and Tissue Bank $2,217.00

TBV46 Donor Tissue Bank of Victoria $1,206.00

Femoral Rings

NBB17 New South Wales Bone Bank $1,606.00

PBT24 Perth Bone and Tissue Bank $1,606.00

Page 6 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

QBB30 The Queensland Bone Bank $1,591.00

Femoral Rings - Freeze Dried

QBB31 The Queensland Bone Bank $670.00

Femoral Shaft

QBB23 The Queensland Bone Bank $2,247.00

Femoral Shaft - Freeze Dried

QBB66 The Queensland Bone Bank $2,811.00

Femoral Shaft - Half

NBB57 New South Wales Bone Bank $2,778.00

Femoral Shaft - Middle Third

NBB13 New South Wales Bone Bank $2,507.00

TBV24 Donor Tissue Bank of Victoria $2,137.00

Femoral Shaft - Segment

NBB56 New South Wales Bone Bank $1,687.00

Femoral Shaft - Third

NBB55 New South Wales Bone Bank $1,687.00

Femoral Shaft/Tibial Shaft - Middle third

PBT19 Perth Bone and Tissue Bank $2,791.00

Femur - Distal (Shaft & Condyles)

MVS02 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

PBT17 Perth Bone and Tissue Bank $3,354.00

TBV22 Donor Tissue Bank of Victoria $3,854.00

Femur - Distal Half

NBB10 New South Wales Bone Bank $2,778.00

QBB20 The Queensland Bone Bank $2,800.00

Femur - Distal third

NBB11 New South Wales Bone Bank $2,606.00

Femur - Entire

MVS03 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

NBB12 New South Wales Bone Bank $6,200.00

QBB22 The Queensland Bone Bank $4,268.00

Page 7 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

TBV23 Donor Tissue Bank of Victoria $6,455.00

Femur - Entire head removed

PBT18 Perth Bone and Tissue Bank $5,683.00

Femur - Proximal (shaft, trochanter, neck)

MVS04 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

PBT20 Perth Bone and Tissue Bank $3,354.00

TBV25 Donor Tissue Bank of Victoria $3,826.00

Femur - Proximal half

NBB15 New South Wales Bone Bank $2,921.00

QBB25 The Queensland Bone Bank $3,020.00

Femur - Proximal third

NBB14 New South Wales Bone Bank $1,306.00

Femur - Proximal with femoral head

TBV51 Donor Tissue Bank of Victoria $3,713.00

Fibula - Entire

MVS07 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

NBB18 New South Wales Bone Bank $6,041.00

PBT25 Perth Bone and Tissue Bank $2,577.00

QBB32 The Queensland Bone Bank $2,651.00

TBV27 Donor Tissue Bank of Victoria $6,222.00

Fibula - Segment

NBB54 New South Wales Bone Bank $2,359.00

PBT28 Perth Bone and Tissue Bank $1,422.00

Fibula - Segment (12cm)

MVS14 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

TBV29 Donor Tissue Bank of Victoria $1,055.00

Fibula - Segment (6cm)

MVS13 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

TBV28 Donor Tissue Bank of Victoria $691.00

Fibular Shaft

TBV30 Donor Tissue Bank of Victoria $2,193.00

Page 8 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

Hemipelvis - Acetabulum

NBB21 New South Wales Bone Bank $2,905.00

PBT29 Perth Bone and Tissue Bank $2,841.00

QBB33 The Queensland Bone Bank $2,762.00

TBV31 Donor Tissue Bank of Victoria $2,992.00

Hemipelvis - Complete

MVS08 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

NBB24 New South Wales Bone Bank $6,500.00

PBT30 Perth Bone and Tissue Bank $5,228.00

QBB37 The Queensland Bone Bank $4,268.00

TBV32 Donor Tissue Bank of Victoria $6,788.00

Hemipelvis - iliac crest

NBB22 New South Wales Bone Bank $2,705.00

PBT31 Perth Bone and Tissue Bank $1,134.00

QBB34 The Queensland Bone Bank $2,478.00

TBV33 Donor Tissue Bank of Victoria $2,705.00

Hemipelvis - Tricortical iliac wedge

NBB23 New South Wales Bone Bank $1,195.00

PBT32 Perth Bone and Tissue Bank $1,031.00

QBB35 The Queensland Bone Bank $1,195.00

TBV34 Donor Tissue Bank of Victoria $1,042.00

Hemipelvis - Tricortical iliac wedge Freeze Dried

QBB36 The Queensland Bone Bank $735.00

Humeral Head

TBV37 Donor Tissue Bank of Victoria $1,653.00

Humeral Head Addition

NBB26 New South Wales Bone Bank $1,545.00

Humeral Shaft

NBB50 New South Wales Bone Bank $3,090.00

QBB39 The Queensland Bone Bank $1,612.00

Humeral Shaft - Half

Page 9 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

NBB51 New South Wales Bone Bank $1,671.00

Humerus - Distal

MVS19 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

NBB25 New South Wales Bone Bank $2,359.00

TBV49 Donor Tissue Bank of Victoria $2,241.00

Humerus - Entire

MVS20 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

NBB29 New South Wales Bone Bank $3,142.00

QBB43 The Queensland Bone Bank $3,035.00

Humerus - Entire with rotator cuff

NBB30 New South Wales Bone Bank $3,182.00

PBT33 Perth Bone and Tissue Bank $3,343.00

Humerus - Proximal

NBB27 New South Wales Bone Bank $2,769.00

PBT35 Perth Bone and Tissue Bank $1,134.00

TBV36 Donor Tissue Bank of Victoria $2,769.00

Humerus - Proximal half with rotator cuff

NBB28 New South Wales Bone Bank $2,778.00

Humerus - Proximal with rotator cuff

MVS09 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

PBT34 Perth Bone and Tissue Bank $2,788.00

TBV35 Donor Tissue Bank of Victoria $2,646.00

Humerus - Ring

NBB53 New South Wales Bone Bank $1,448.00

Ligament - Medial

NBB31 New South Wales Bone Bank $1,781.00

TBV38 Donor Tissue Bank of Victoria $1,781.00

Meniscal Graft

PBT47 Perth Bone and Tissue Bank $1,856.00

Meniscus

QBB05 The Queensland Bone Bank $1,400.00

Page 10 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

TBV40 Donor Tissue Bank of Victoria $1,184.00

Meniscus with Ligaments

TBV39 Donor Tissue Bank of Victoria $2,147.00

Osteotomy Wedge

PBT60 Perth Bone and Tissue Bank $1,031.00

Patella

QBB47 The Queensland Bone Bank $788.00

TBV41 Donor Tissue Bank of Victoria $1,020.00

Patellar unit whole with tibial block

PBT40 Perth Bone and Tissue Bank $2,564.00

Radius

MVS18 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

NBB06 New South Wales Bone Bank $3,024.00

PBT13 Perth Bone and Tissue Bank $1,800.00

QBB15 The Queensland Bone Bank $2,258.00

TBV19 Donor Tissue Bank of Victoria $3,115.00

Radius - Ring

NBB49 New South Wales Bone Bank $1,854.00

Radius - Shaft

NBB47 New South Wales Bone Bank $2,975.00

Rib (5cm)

MVS21 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $382.00

PBT41 Perth Bone and Tissue Bank $300.00

TBV43 Donor Tissue Bank of Victoria $487.00

Spinal Ring

AUB07 Australian Biotechnologies $1,854.00

Tendon

AUB10 Australian Biotechnologies $2,184.00

Tendon - Achilles

NBB01 New South Wales Bone Bank $1,922.00

PBT61 Perth Bone and Tissue Bank $1,985.00

Page 11 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

QBB62 The Queensland Bone Bank $1,922.00

TBV05 Donor Tissue Bank of Victoria $1,024.00

Tendon - Achilles Hemi

QBB65 The Queensland Bone Bank $1,433.00

Tendon - Achilles with bone block

NBB02 New South Wales Bone Bank $2,228.00

PBT01 Perth Bone and Tissue Bank $2,301.00

QBB01 The Queensland Bone Bank $1,922.00

TBV06 Donor Tissue Bank of Victoria $2,085.00

Tendon - Achilles with bone plug

AUB09 Australian Biotechnologies $2,228.00

Tendon - Achilles with machined conical bone block

NBB69 New South Wales Bone Bank $2,728.00

Tendon - EHL

QBB69 The Queensland Bone Bank $1,922.00

Tendon - Gracilis

QBB59 The Queensland Bone Bank $1,922.00

Tendon - Patellar

QBB48 The Queensland Bone Bank $2,055.00

Tendon - Patellar Hemi

QBB63 The Queensland Bone Bank $1,570.00

Tendon - Patellar split with bone plugs

PBT02 Perth Bone and Tissue Bank $1,918.00

Tendon - Patellar with bone plugs

NBB33 New South Wales Bone Bank $2,147.00

TBV42 Donor Tissue Bank of Victoria $2,147.00

Tendon - Patellar with machined conical bone plug

NBB68 New South Wales Bone Bank $2,647.00

Tendon - Patellar with Quads

NBB72 New South Wales Bone Bank $2,184.00

Page 12 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

Tendon - Peroneus Longus

NBB73 New South Wales Bone Bank $2,184.00

Tendon - Semi tendinosis

NBB70 New South Wales Bone Bank $2,185.00

QBB70 The Queensland Bone Bank $1,922.00

Tendon - Single (ant and post tibilias, FDL, EDL, hamstring, gracilis)

PBT46 Perth Bone and Tissue Bank $2,124.00

Tendon - Tibialis Anterior

NBB67 New South Wales Bone Bank $2,184.00

QBB58 The Queensland Bone Bank $1,922.00

TBV57 Donor Tissue Bank of Victoria $2,085.00

Tendon - Tibialis Posterior

NBB71 New South Wales Bone Bank $2,184.00

QBB57 The Queensland Bone Bank $1,922.00

Tibia - Condyles only

TBV47 Donor Tissue Bank of Victoria $1,661.00

Tibia - Distal

MVS17 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

QBB51 The Queensland Bone Bank $1,892.00

TBV48 Donor Tissue Bank of Victoria $2,177.00

Tibia - Plateau (prox 1/3)

NBB35 New South Wales Bone Bank $2,518.00

Tibia - Proximal

NBB36 New South Wales Bone Bank $2,551.00

PBT45 Perth Bone and Tissue Bank $2,635.00

QBB54 The Queensland Bone Bank $2,365.00

Tibia - Proximal 16-25cm

TBV45 Donor Tissue Bank of Victoria $2,468.00

Tibia - Proximal 7-15cm

TBV44 Donor Tissue Bank of Victoria $2,562.00

Tibia - Proximal half

Page 13 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

MVS11 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

Tibia – Proximal third

AUB06 Australian Biotechnologies $2,562.00

Tibia - Proximal with Patella

QBB08 The Queensland Bone Bank $2,800.00

Tibia - Proximal with Patella & Tendon

PBT44 Perth Bone and Tissue Bank $3,979.00

Tibia - Proximal with Patellar Tendon

NBB46 New South Wales Bone Bank $3,986.00

Tibia - Ring

NBB45 New South Wales Bone Bank $1,448.00

Tibia - Whole

MVS16 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

NBB37 New South Wales Bone Bank $4,065.00

QBB55 The Queensland Bone Bank $4,248.00

Tibia - Whole with Patella

QBB64 The Queensland Bone Bank $4,268.00

Tibia - Whole with Patellar Tendon

NBB44 New South Wales Bone Bank $5,455.00

Tibia Shaft

QBB53 The Queensland Bone Bank $992.00

Tibial Shaft

NBB41 New South Wales Bone Bank $3,747.00

Tibial Shaft - half

NBB43 New South Wales Bone Bank $2,450.00

Tibial Shaft - third

NBB42 New South Wales Bone Bank $2,645.00

Tibial Shaft Freeze Dried

QBB02 The Queensland Bone Bank $872.00

Tri Cortical Osteotomy

Page 14 of 15

ORTHOPAEDIC

Billing Code Facility Minimum Benefit Maximum Benefit

NBB66 New South Wales Bone Bank $1,208.00

Ulna

MVS15 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00

NBB07 New South Wales Bone Bank $2,787.00

PBT14 Perth Bone and Tissue Bank $1,500.00

QBB16 The Queensland Bone Bank $2,258.00

TBV20 Donor Tissue Bank of Victoria $2,871.00

Ulna - Ring

NBB40 New South Wales Bone Bank $1,854.00

Ulna - Shaft

NBB38 New South Wales Bone Bank $2,450.00

Grand Total: 276 Records

Page 15 of 15

Part C - Other Prostheses August 2011

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Group 14: Implantable Cardiac Event Recorders

Medtronic Australasia Pty Ltd

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

St Jude Medical Australia Pty Ltd

SJ152 SJM Confirm Model DM2102 Implantable cardiac monitor with atrial 6.5cc, 12g $3,900.00

fibrillation monitoring.

SJ159 SJM Confirm Model DM2100 Implantable cardiac monitor 6.5cc, 12g $3,900.00

Page 1 of 3

GENERAL MISCELLANEOUS

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

3.2.3 External Infusion Pumps, Battery Powered

3.2.3.1 Insulin infusion pump, variable basal insulin rates, intermittent boluses

Roche Diagnostics Australia Pty Ltd

RO020 Accu-chek Spirit Insulin Pump Insulin infusion pump One size only $4,000.00 $5,000.00

3.2.3.2 Insulin infusion pump (as 3.2.3.1) with integral calculator to determine boluses and active

Managing Diabetes Pty Ltd

DF001 DANAIIS Insulin Pump Continuous insulin infusion pump 75mm x 45mm x 19mm $4,000.00

Roche Diagnostics Australia Pty Ltd

RO044 Accu-Chek Combo System Insulin delivery device capable of remotely The Accu-Chek Combo $8,000.00

receiving and acting on information about System is only available in one

blood glucose levels, performing bolus size.

calculation and bolus advice on additional

parameters than what is normally provided.

DE, SS

Managing Diabetes Pty Ltd

DF002 DANAR Insulin Pump The DANAR Insulin Pump is a small 75 x 45 x 19mm, 60grams $5,100.00

device about the size of a pager. It holds

up to 300 units of insulin, which is

delivered continuously through a small tube

to the patient. The DANAR Insulin Pump

also has an integrated blood glucose meter

and remote control via bluetooth

communication.

Medtronic Australasia Pty Ltd

MC353 Medtronic MiniMed Insulin Infusion Pump Paradigm Model MMT-722. 'Smart' Pump dimensions: 5.1 x 9.4 x $8,000.00 $8,950.00

Insulin Pump with REAL-Time continuous 2.0cm

glucose monitoring capability and with

remote control

MC354 Medtronic MiniMed Insulin Infusion Pump Paradigm Model MMT-522. 'Smart' Pump Dimensions: 5.1 x 7.6 x $8,000.00 $8,950.00

Insulin Pump with REAL-Time continuous 2.0cm

glucose monitoring capability and with

remote control

Page 2 of 3

GENERAL MISCELLANEOUS

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

SS

Australasian Medical & Scientific Ltd

AN005 Animas 2020 Insulin Pump. Ambulatory Insulin Infusion Pump 7.4cm x 5cm x 1.9cm $7,750.00

Medical Specialties

Australia Pty Ltd

MS031 Medical Specialties "Deltec Cozmo Ambulatory Insulin Infusion Pump Deltec Cozmo Insulin Pump - $8,000.00 $9,360.00

Insulin Pump" each

Medtronic Australasia Pty Ltd

MC351 Medtronic MiniMed Insulin Infusion Pump Paradigm Model MMT - 715 Pump Dimensions: 5.1 x 9.4 x $8,000.00

2.0cm

MC352 Medtronic MiniMed Insulin Infusion Pump Paradigm Model MMT - 515 Pump Dimensions: 5.1 x 7.6 x $8,000.00

2.0cm

3.2.3.3 Device capable of automatically adjusting insulin delivery based on continuous glucose

DE, SS

Medtronic Australasia Pty Ltd

MC839 Medtronic MiniMed Insulin Infusion Pump Paradigm Veo Model MMT-554. 'Smart' 5.1 x 7.6 x 2.0cm $8,000.00 $9,500.00

Insulin Pump with REAL-Time continuous

glucose monitoring capability,

incorporating a low glucose suspend and

with remote control.

MC840 Medtronic MiniMed Insulin Infusion Pump Paradigm Veo Model MMT-754. 'Smart' 5.1 x 9.4 x 2.0cm $8,000.00 $9,500.00

Insulin Pump with REAL-Time continuous

glucose monitoring capability,

incorporating a low glucose suspend and

with remote control.

Grand Total: 16 Records

Page 3 of 3

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