Private Health Insurance (Prostheses) Rules 2011 (No. 2) (Cth)
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 1 Preliminary 3
1.Name of Rules 3
2.Commencement 3
3.Revocation 3
4.Definitions 3
Part 2 Benefit requirements 5
5.Listing of, and benefits for, prostheses 5
5A.Circumstances in which a prosthesis is provided other than circumstances in which a medicare benefit is payable 6
5B.Conditions in relation to the provision of listed prostheses 6
6.Benefits for prostheses provided as part of hospital treatment 6
7.Benefits for prostheses provided as part of hospital-substitute treatment 7
Part 3 Other 8
8.Timing of applications to have a prosthesis listed 8
9.Minister may have regard to recommendations and advice 8
10.Listing criteria for prostheses to be listed in Part C of the Schedule 8
Notes 9
Part 1 Preliminary
Name of Rules
These Rules are the Private Health Insurance (Prostheses) Rules 2011 (No. 2).
Commencement
These Rules commence on 22 August 2011.
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).
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) Rules as 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 recorder includes 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 criteria has the same meaning as in subsection 72-10(6) of the Act.
National Law means:
(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 with the status of certain hospitals 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 with the status of certain hospitals for which a declaration had been made before the commencement of the Act.
Schedule means the Schedule in these Rules.
Part 2 Benefit requirements
5. Listing of, and benefits for, prostheses
For item 4 of the table in subsection 72-1 (2) of the Act:
(a)the Schedule lists the kinds of prostheses:
(i)in relation to which the Minister has granted an application for listing under subsection 72-10 (5) of the Act; or
(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
(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
(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
(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:
(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.
Part 3 Other
8. 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.
(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.
Note: 1. The power to make listing criteria is in subsection 72-10(6) of the Act.
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. 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 | 22 August 2011 | |
| Private Health Insurance (Prostheses) Amendment Rules 2011 (No.2) | 2 September 2011 | 5 September 2011 | |
| Private Health Insurance (Prostheses) Amendment Rules 2011 (No.3) | 4 November 2011 | 5 November 2011 |
Table of Amendments
| ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted | |
| Provision affected | How affected |
| Schedule | 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
Minimum Maximum
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
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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
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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
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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
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
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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
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