Private Health Insurance (Prostheses) Rules 2012 (No. 2) (Cth)
Private Health Insurance (Prostheses) Rules 2012 (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 16 April 2013 taking into account amendments up to and including the Private Health Insurance (Prostheses) Amendment Rules 2013 (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 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
Part 1 Preliminary
1.Name of Rules
These Rules are the Private Health Insurance (Prostheses) Rules 2012 (No.2).
2.Commencement
These Rules commence on 30 August 2012.
3.Revocation
These Rules revoke the Private Health Insurance (Prostheses) Rules 2012 (No. 1).
4.Definitions
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 purposes of these Rules are the same registration requirements for podiatric surgeons as set out in rule 8 of the Private Health Insurance (Accreditation) Rules.
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.
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
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
(iii)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
(iii)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. Minister may have regard to recommendations and advice
9.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. Minister may have regard to recommendations and advice
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.
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.
Part A - Prostheses List February 2013
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
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 13.75mm length. 6.0mm $156.00
121UV; L122UV PMMA Anterior lens 1 piece optic size, diopter range 3-
Chamber Lens 30d. L122UV: 6.0mm optic,
13.75mm length, power
range; 5.0 to 30.0 Diopters
Emagin Pty Ltd
EG009 Artisan Anterior Chamber Aphakia ModelComposition: PMMA 5.00mm Optic Diameter x $156.00
Intraocular Lens 8.5 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 6.00 mm Optic Diameter x $198.00
IOL 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 5mm Optic Diameter x 8.5 $680.00
Myopia. Composition: PMMA overall length; 6mm Optic
Diameter x 8.5 overall
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 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Emagin Pty Ltd
EG012 Artisan Anterior Chamber IOL Phakic Intraocular Lens Myopic / 5.00mm Optic Diameter x $680.00
Hyperopic 8.5 in overall length;
t1
AMO Australia Pty Ltd
AO030 Verisyse Toric (Custom) Phakic intraocular lens: Model toric 5mm Optic Diameter x $1,056.00
7.5mm overall length
Emagin Pty Ltd
EG008 Artisan Anterior Chamber Phakic Intraocular Lens: Model Toric 5.00mm Optic Diameter x $1,056.00
Intraocular Lens Composition: PMMA 7.5 in overall length
t2
AMO Australia Pty Ltd
AO029 Verisyse Toric (Custom) Phakic intraocular lens: Model toric 5mm Optic Diameter x $1,358.00
7.5mm overall length
1.1.2.2 - Foldable
Alcon Laboratories (Aust.) Pty Ltd
AL034 AcrySof Cachet Phakic Lens Anterior chamber foldable, acrylic, -6.0 to -16.5 diopters, in 0.5 $723.00
single piece phakic lens diopter increments
AMO Australia Pty Ltd
AO025 VeriFlex Foldable Phakic IOL Anterior chamber foldable phakic -2 to -14.5d in 0.5d $723.00
silicone intraocular lens increments. Overall
diameter 8.5mm. Optic
6.0mm
Emagin Pty Ltd
EG010 Artiflex Anterior Chamber Optic: Hydrophobic Polysiloxane. 6mm optic diameter x 8.5 in $723.00
Intraocular Lens Haptic: 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 $156.00
D
Prostheses List by Category, Groups and Sponsor Page 2 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Bausch & Lomb (Australia) Pty Ltd
BL006 Posterior chamber IOLS model PMMA Posterior Chamber lens 1 12.25mm to 13.75mm $156.00
P359 UV, P399 UV, 68 UV, 95 length. 5.5mm to 7mm optic
BUV, or lolab PC One Piece, model size, diopter range -4.5 -
6741B, 8591B, 8191B; Model EZE- 45d to 10 - 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 ZEISS Micro Incision Aaspheric 6mm optic, 11mm overall $364.00
(aberration neutral) IOL: Foldable, diameter. Diopter range 0.0
square-edged, single piece IOL for to +32.0D (0.5D steps from
capsular bag fixation 10.0 to 30.0D, 1.0D outside
this range)
CZ017 CT ASPHINA 509M ZEISS Micro Incision Aspheric 6mm Optic, 11mm overall $364.00
(aberration correcting) IOL: Foldable, diameter. Diopter range 0.0
square-edged, single piece IOL for to +32.0D (0.5D steps from
capsular bag fixation 10.0 to 30.0D, 1.0D outside
this range)
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, (15.50-22D), 10.5mm
preloaded, with aberration contro, (22.50-30D)
Carl Zeiss Pty Ltd
CZ028 CT ASPHINA 409MP Preloaded, micro incision, aspheric Diopter range: 0.0 to $374.00
(aberration neutral), foldable square- 32.0D; Optic size: 6.0mm;
edged single piece inraocular lens for Overall length: 11.0mm
capsular bag fixation.
CZ037 CT ASPHINA 509MP Preloaded, micro incision, aspheric Diopter range: 0.0 to + $374.00
(aberration correcting), foldable 32.0D; Optic Size: 6.0mm;
square-edged single-piece intraocular Overall length: 11.0mm
lens for capsular bag fixation
Prostheses List by Category, Groups and Sponsor Page 3 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
at, pl, t1
Carl Zeiss Pty Ltd
CZ031 AT TORBI 709MP (Standard Bitoric, preloaded, micro incision, Diopter range: Sph -10.0 to $760.00
aspheric (aberration neutral), foldable, 32.0, Cyl +1.0 to 6.5
square-edged, single-piece IOL for Optic size: 6.0mm, Overall
capsular bag fixation length: 11.0mm
at, pl, t2
Carl Zeiss Pty Ltd
CZ032 AT TORBI 709MP (high cyl) Bitoric, preloaded, micro incision, Diopter range: Sph -10.0 to $1,061.00
aspheric (aberration neutral), foldable, 32.0, Cyl +7.0 to 12.0,
square-edged, single-piece IOL for Optic size: 6.0mm. Overall
capsular bag fixation Length 11.0mm
at, t1
Carl Zeiss Pty Ltd
CZ020 AT TORBI 709M STANDARD RANGE BITORIC - 6mm optic, 11mm overall $740.00
ZEISS Micro Incision Aspheric diameter. Diopter range:
(abberation neutral) IOL: Foldable, Sph -10.0 to +32.0D, Cyl
square-edged, single piece IOL for +1.0 to 6.5D (all 0.5D
capsular bag fixation
t2, at
Carl Zeiss Pty Ltd
CZ027 AT TORBI 709M HIGH CYLINDER BITORIC - ZEISS 6mm optic, 11mm overall $1,041.00
Micro Incision Aspheric (aberration diameter. Diopter range:
neutral) IOL: Foldable square edged, Sph -10.0 to +32.0D, +7.0
single piece IOL for capsular bag to 12.0D (all 0.5D steps)
fixation
1.2.2.2 - No edge modification
Ellex Australia Pty Ltd
XE002 Staar foldable silicone intraocular Polyimide haptics 6.3mm optic - low 14.0mm length $281.00
lens: Model AQ 5010V diopters
t1
Ellex Australia Pty Ltd
XE001 Staar Toric foldable silicone Plate haptics 6.0mm optic 10.8mm - 11.2mm length $579.00
intraocular lens: Model AA4203TF;
Model AA4203TL
Prostheses List by Category, Groups and Sponsor Page 4 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
1.2.2.3 - Edge modification
Alcon Laboratories (Aust.) Pty Ltd
AL004 Acrysof Multipiece Models Foldable Acrylic Multi-piece Lens -5 D to +30 D $322.00
MA50BM, 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 Soft Acrylic, Foldable, UV 6 mm Optic Diameter x $322.00
IOL, Sensar OptiEdge AR40e Absorbing, Posterior 13mm in overall length.
Foldable Acrylic IOL
AO006 Clariflex, Model CLRFLXB Foldable Silicone IOL with OptiEdge One size only $322.00
Posterior Chamber Intraocular Lens design
Bausch & Lomb (Australia) Pty Ltd
BL020 Akreos Adapt acrylic foldable Composition: Hydrophilic acrylic 10.0 to 15.0 Diopter in 1.0 $322.00
posterior chamber intraocular lens polymer. Packaged in lens folding Diopter increments15.0 to
device in a sterile vial. Four haptic 25.0 Diopter in 0.5 Diopter
design increments25.0 to 30.0
Diopter in 1.0 Diopter
increments
BL021 SoflexSE, Intraocular lenses, Composition: silicone, Lenses - Range of powers: 5.0 to $322.00
Posterior Chamber foldable, posterior chamber 30.0 Diopter - Optic
intraocular lenses diameter 6.0mm; 13.0mm
Carl Zeiss Pty Ltd
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.
Device Technologies Australia Pty Ltd
DE398 Oculentis LENTIS L-302-1 Foldable one-piece monofocal C loop Optic Size 6.0mm, Overall $322.00
acrylic IOL. Length 12.00mm. +-0.0D to
+35.0D (1.0D steps) and
+15.5D to +26.5D (0.5D
steps).
Prostheses List by Category, Groups and Sponsor Page 5 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Ellex Australia Pty Ltd
XE003 Staar foldable silicone IOLs: Plate haptics 6.0mm; Polymide 10.8mm 0 13.5mm length $322.00
Models AQ2010V, AQ2017V and haptics 5.5 or 6.3mm optic;
Kevin Grundy (IBD) Pty Ltd
KG001 Rayner C-Flex Hydrophilic HEMA-MMA 5.75mm dia optic, 12.00mm $322.00
copolymer, foldable with injector dia overall
KG002 Superflex Hydrophilic HEMA-MMA 6.25mm dia optic, 12.5mm $322.00
copolymer, foldable with injector dia overall
at
AMO Australia Pty Ltd
AO014 TECNIS™ Intraocular Lens (Z9002 Foldable Intraocular Lenses - 5-10 dioptre in 1.0 dioptre $364.00
& ZA9003) Ultraviolet light absorbing posterior increments; 10.5 - 30
chamber intraocular lenses, dioptre in 0.5 increments
Silicone/Acrylic
AO024 Tecnis™ One Piece (ZCB00) One piece intraocular lens with edge +5 diopters to +34 diopters $364.00
modification and 360 degree square in 0.5d increments
edge
Bausch & Lomb (Australia) Pty Ltd
BL022 SofPort Advanced Optic (AO) Posterior chamber, foldable silicone 0 D to 30.0 D $364.00
IOL 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 0 D to 30.0 D $364.00
IOL, with anterior optic-haptic square
edge, posterior optic-haptic square
edge, 360 degree optic square edge
and aspheric optic for aberration
BL030 enVista The enVista, Model MX60, is an ultra- Overall diameter 12.5mm, $364.00
violet-absorbing, posterior chamber, optic body diameter 6.0mm
hydrophobic acrylic one-piece in dioptric powers ranging
intraocular lens (IOL) Has an from +0.0 to +34D
aspheric lens optic, square posterior 0.0D to 10.0D in 1 Diopter
edge, modified C haptics and available increments
in dioptric powers ranging from +0.0 11.0D to 30.0D in 0.5
to +34.0D. Diopter increments
31.0D to 34.0D in 1
Diopter increments
Prostheses List by Category, Groups and Sponsor Page 6 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Carl Zeiss Pty Ltd
CZ030 CT ASPHINA 404 Small incision, foldable, single piece, Diopter range: -10.0 to $364.00
monofocal, aspheric (aberration 42.0, Optic size: 6.0mm,
neutral), square-edged, hydrophilic Overall length: 11.0mm
acrylic (with hydrophobic surface
properties) intraocular lens for
capsular bag fixation. (Monofocal lens
for powers outside standard 409MP
MICS range).
Device Technologies Australia Pty Ltd
DE399 Oculentis LENTIS L-312 Foldable one-piece monofocal acrylic Optic size 6.0mm, Overall $364.00
C Loop IOL Length 12.00mm. Central
Thickness 1.02mm
(+22.0D). Available
Diopters: -10.0D to35.0D
(1.0D steps). +10.5D to
DE400 Oculentis LENTIS L-313 Foldable one-piece monofocal acrylic Optic size 6.0mm, Overall $364.00
plate haptic IOL Length 11.00mm. Available
Diopters: +-0.0D to 35.0D
(1.0D steps). +10.5D to
29.5D (0.5D steps)
DE401 Oculentis LENTIS L-402 Foldable three piece monofocal acrylic Optic Size 6.0mm, Overall $364.00
IOL. Length 13.00mm. +-0.0D to
+35.0D (1.0D) + 15.5D to
+26.5D (0.5D). Minus range
on demand.
IQ Medical
IQ004 Softec Acrylic, single piece, foldable Available in dioptric $364.00
intraocular lens with anterior and powers from -5.0 to +36.0,
posterior optic-haptic square edge, 1D steps: -5.0 to +10.0 and
360 degree optic square edge design, +31.0 to +36.0; 0.5D steps:
precision power calculation and +10.5 to +18.0 and +25.0 to
aberration technology +29.5; 0.25D steps: +18.0
to +25.0
IQ010 PreciSAL 302AC Acrylic, single piece, foldable Available in dioptric $364.00
intraocular lens with anterior and powers from 0.0 to +30.0.
posterior optic-haptic square edge, 1D steps: 0.0 to +10.0;
360 degree optic square edge design, 0.5D steps: +10.5 to + 17.5
precision power calculation, and +28.5 to +30.0; 0.25D
aberration technology and UV light steps: +18.0 to +28.0
Prostheses List by Category, Groups and Sponsor Page 7 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Kevin Grundy (IBD) Pty Ltd
KG012 Rayner "C-Flex" and Superflex" Aspheric Intra Ocular Lenses with C-Flex -970C + 22.5D to $364.00
Aspheric IOL Amon-Apple enhanced 360 Degree +34D Superflex-920H - 10D
square edge, Anti-vaulting Haptics to +22D
at, pl
AMO Australia Pty Ltd
AO034 TECNIS® 1-Piece Pre-Loaded IOL 1-piece IOL Posterior Chamber +5.0 to +34.0 diopter $374.00
Intraocular lens, incorporates a powers in 0.5 diopter
proprietary wavefront-designed increments. Overall
aspheric optic with a squared diameter 13mm, Optic size
posterior optic edge designed to
provide a 360 degree barrier. The edge
of the optic has a frosted design to
reduce potential edge glare effects.
Supplied pre-loaded in a screw style
disposable injector.
Ellex Australia Pty Ltd
XE004 Preloaded Aspheric Intraocular Silicone intraocular lens 6.0mm $374.00
at, pl, t1, vblf
Design for Vision Pty Ltd
DV253 HOYA AF-1 351 Toric Preloaded injector system, correct IOL Power: + 10.0 to 30.0 $800.00
T3/T4/T5/T6/T7/T8/T9 corneal astigmatism micro-incision, (0.5 steps), IOL Cylinder
ashperic, blue-blocker, single piece power: 1.50D (351T3),
hydophobic. 2.25D (351T4), 3.00D
(351T5), 3.75D (351T6),
4.50D (351T7), 5.25D
(351T8), 6.00D (351T9)
at, pl, vblf
Alcon Laboratories (Aust.) Pty Ltd
AL024 AcrySert model SN60WS Foldable Acrylic Single-piece Lens +6 to +30 D $405.00
with 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
Prostheses List by Category, Groups and Sponsor Page 8 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
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 $405.00
blocker, Foldable, Single-Piece,
Hydrophobic Acrylic
DV252 HOYA iSert® 251 Preloaded injector system, Micro- +6.0D to 30.0D (5 steps) $405.00
incision, 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 $740.00
Intraocular lens, incorporates a powers in 0.5 diopter
proprietary wavefront designed toric increments. Cylinder
aspheric optic with a squared power: 1.00 diopter, 1.50
posterior optic edge designed to diopter, 2.25 diopter, 3.00
provide a 360 degree barrier. The edge diopter and 4.00 diopter (as
of the optic has a frosted design to measured at the IOL plane).
reduce potential edge glare effects. Overall diameter 13mm,
Optic size 6mm.
Bausch & Lomb (Australia) Pty Ltd
BL032 enVista Toric The enVista toric (Model MX60T) is a Overall diameter is 12.5mm $740.00
one-piece glistening-free for the entire lens power
hydrophobic IOL. The enVista Toric, range, with spherical
model MX60T IOL has a Toric equivalent powers from +6.0
aspheric lens optic, a square posterior to +30.0 Diopters in 0.5
edge and modified C haptics, an Diopter steps and cylinder
overall diameter of 12.5mm and an powers from +1D to 6D
optic body of 6.0mm. It is available in Diopters (at the IOL plane).
multiple spherical and cylindrical
powers.
Device Technologies Australia Pty Ltd
DE390 Oculentis LENTIS Tplus LU-313T Patient Specific: Foldable one-piece Optic Size 6.0mm, overall $740.00
monofocal toric acrylic IOL length 11.0mm. Sph +/-0.0D
to +35.0D (in 0.01D
increments) Cyl +0.25 to
+6.99D cyl (in 0.01D
increments)
Prostheses List by Category, Groups and Sponsor Page 9 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
DE397 Oculentis LENTIS Tplus LS-313 Foldable one-piece monofocal toric Optic Size 6.0mm, Overall $740.00
T1-T6 acrylic IOL. Length 11.00mm. Available
diopters: +10.0D to +30.0D
(0.5D). Cyl: (T1 +1.5D) (T2
+2.25D) (T3 +3.0D) (T4
+3.75D) (T5 +4.5D) (T6
+5.25D)
at, t1, vblf
Device Technologies Australia Pty Ltd
DE392 Oculentis LENTIS LU-313-TY Patient Specific: Foldable one-piece Optic Size: 6.0mm, overall $780.00
monofocal toric acrylic IOL. Violet length 11.00mm. Sph +/-
Light Filter 0.0D to +35.0D (in 0.01D
increments) Cyl +0.25D to
+6.99D cyl (in 0.01D
increments)
at, t2
Device Technologies Australia Pty Ltd
DE391 Oculentis LENTIS Tplus LU-313T Patient Specific: Foldable one-piece Optic Size: 6.0mm, overall $1,042.00
monofocal toric acrylic IOL length 11.00mm. Sph +/-
0.0D to +35.0D (in 0.01D
increments) Cyl +6.99D to
+12.0D cyl (in 0.01D
increments)
at, t2, vblf
Device Technologies Australia Pty Ltd
DE393 Oculentis LENTIS T plus LU-313-TY Patient Specific: Foldable one-piece Optic Size: 6.0mm, overall $1,084.00
monofocal toric acrylic IOL. Violet length 11.00mm. Available
Light Filter. diopters: Cyl +7.00D to
+12.0D inclusive in 0.01D
increments.
at, vblf
Alcon Laboratories (Aust.) Pty Ltd
AL021 Alcon AcrySof SN60WF Foldable Acrylic Single-piece Lens + 6.0 D to +30.0 D $385.00
with Blue Light Protection and
Aspheric Correction
Prostheses List by Category, Groups and Sponsor Page 10 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Bausch & Lomb (Australia) Pty Ltd
BL025 SofPort Advanced Optic (AO) Posterior chamber, aphakic, foldable 6mm optic 13mm overall $385.00
Violet Shield silicone, anterior & posterior edge lengthModified C 5
modification intraocular lens with degree angulation 0-30D,
aberration technology, a violet light 0.5D steps
Design for Vision Pty Ltd
DV247 HOYA AF-1 iMics1 NY-60 Mini Incision, Aspheric, Blue- +6.0D to 30.0D (0.5 steps) $385.00
blocker, Single-piece, Hydrophobic
Device Technologies Australia Pty Ltd
DE402 Oculentis LENTIS LS-312Y Foldable one-piece monofocal C Loop Optic Size 6.0mm, Overall $385.00
Acrylic IOL. Violet Light filter. Length 12.0mm. Available
Diopters: +-0.0D to 35.0D
(1.0D steps) +15.5D to
26.5D (0.5D steps).
DE403 Oculentis LENTIS LS-313Y Foldable one-piece monofocal acrylic Optic Size 6.0mm, Overall $385.00
plate haptic IOL. Violet Light Filter Length 11.00mm. Available
Diopters: +-0.0D to 35.0D
(1.0D steps). +15.5D to
26.5D (0.5D steps).
IQ Medical
IQ009 Softec HDY Acrylic, single piece, foldable Available in dioptric $385.00
intraocular lens with anterior and powers from -5.0 to + 36.0,
posterior optic-haptic square edge, 1D steps: -5.0 to +10.0 and
360 degree optic square edge design, +31.0 to +36.0; 0.5D steps:
precision power calculation, +10.5 to +18.0 and +25.0 to
aberration technology and blue light 29.5; 0.25D steps: + 18.0 to
+25.0
IQ011 PreciSAL 302A Acrylic, single piece, foldable Available in dioptric $385.00
intraocular lens with anterior and powers from 0.0 to +30.0.
posterior optic-haptic square edge, 1D steps: 0.0 to +10.0;
360 degree optic square edge design, 0.5D steps: +10.5 to +17.5
precision power calculation, and +28.5 to +30.0; 0.25D
aberration technology and blue light steps: +18.0 to +28.0
pl
Ellex Australia Pty Ltd
XE005 Staar KS-Xs Preloaded Acrylic Preloaded acrylic lens with anterior Optic diameter 6.0mm, $332.00
Intraocular Lens and posterior edge modification overall length 12.5mm,
diopter range +10 to +28.0
Prostheses List by Category, Groups and Sponsor Page 11 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
t1
Bausch & Lomb (Australia) Pty Ltd
BL028 Akreos Toric Astigmatism- Single piece, foldable, acrylic The overall diameter is 11 $698.00
Correcting Lens intraocular lens with a toric optic on millimetres for the entire
the posterior surface and axis marks on lens power range (spherical
the posterior 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 5.00mm dia optic, 12.00mm $698.00
copolymer, 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 $780.00
foldable, acrylic, toric, single piece to 6.00 D cylinder.
lens with blue light protection and
aspheric correction
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, (0.5 steps)lOL Cylinder
Single 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 $740.00
foldable, acrylic, toric, single piece to 6.00 D cylinder
lens with blue light protection
t2
Kevin Grundy (IBD) Pty Ltd
KG004 Rayner Premium Toric C-Flex HEMA-MMA copolymer, foldable 5.75mm dia optic, 12.00mm $1,000.00
with injector dia overall, cyls 1.5D to
11.0D in 0.5D increments
Prostheses List by Category, Groups and Sponsor Page 12 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
KG013 Rayner Super Premium Toric I.O.L. Acrylic foldable toric single piece -10.0D to 0.00D Sphere: 1D $1,000.00
to 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 Foldable Acrylic Single-piece Lens, +6 to +40D $364.00
SN60AT asymmetric optic/consistent edge,
with blue light protection
AL025 AcrySof Multipiece Models Foldable Acrylic multi-piece Lens - 5 D to + 30 D $364.00
MN60MA, MN60AC with Blue light Protection
1.2.2.4 - Multifocal or bifocal
AMO Australia Pty Ltd
AO020 ReZoom Acrylic Multifocal Acrylic, foldable, posterior chamber, 6.0mm Optic Diameter x $780.00
Intraocular Lens intraocular lens 13.0mm overall length
at
AMO Australia Pty Ltd
AO026 TECNIS™ Multifocal Intraocular Posterior chamber lens with UV light- +5 diopters to +34 diopters $822.00
Lens (ZMA00) absorbing, foldable acrylic, 3-piece in 0.5d increments
with a diffractive posterior optic and a
modified anterior surface technology
with edge modification and 360
degree square edge.
AO027 Tecnis Multifocal 1-Piece Lens, A multifocal posterior chamber lens 6.0mm Optic Diameter x $822.00
Model ZMB00 with UV-blocking, foldable acrylic, 1- 13.0mm in overall length.
piece with a diffractive posterior optic +5.0 Diopter to +34.0
and a modified anterior surface Diopter in 0.5 Diopter
technology with edge modification increments.
and a 360 degree square edge.
Carl Zeiss Pty Ltd
CZ015 AT LISA 809M ZEISS micro incision, aspheric 6mm optic, 11mm diameter. $822.00
multifocal IOL. Diffractive bifocal Diopter range 0.0D to
anterior surface with asymmetric light +32.0D (0.5D steps)
distribution (65% distance / 35%
near), 3.75D addition for near focus.
Prostheses List by Category, Groups and Sponsor Page 13 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Device Technologies Australia Pty Ltd
DE396 Oculentis LENTIS Mplus LS-313 Foldable one-piece multifocal plate Overall Length 11.0mm and $822.00
haptic acrylic IOL. Optic Size 6.0mm Available
diopters +-0.0D to +36.0D
(0.05D steps)
Kevin Grundy (IBD) Pty Ltd
KG009 Rayner "M-Flex" Mulitfocal Acrylic, Foldable, Single piece multi- 6.5mm Optic-Overall $822.00
Foldable IOL zoned refractive aspheric multifocal diameter 12.5mm: +3D or +
with Amon-Apple 360 Degree Square 4D Addition: +14D to
edge, Anti Vaulting Haptics +25D in 1.0D increments:
+8.5D to +23.5D in 0.5D
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 Optic size: 6.0mm. Overall
IOL for capsular bag fixation. The length: 11.0mm
anterior aspheric bifocal surface has an
asymmetric light distribution 65/35
for distance/near vision, and 3.75D
add for the near focus.
CZ034 AT LISA tri 839MP Trifocal (aspheric) micro incision, Diopter range: 0.0 to $842.00
single-piece IOL for capsular bag +32.0D (0.5D increments).
fixation, implantable with preloaded Optic size: 6.0mm. Overall
injector system. The trifocal (anterior) Length: 11.0mm
optic provides two diffractive focal
points (+3.33D near focus and +1.66D
intermediate focus) with asymmetric
light distribution 50% distance / 20%
intermediate / 30% near vision.
at, pl, t1
Carl Zeiss Pty Ltd
CZ035 AT LISA toric 909MP ZEISS pre-loaded, micro incision, 6mm optic, 11mm diameter. $1,218.00
multifocal toric IOL. Aspheric toric Diopter range: Sph +6.0D
anterior surface, diffractive bifocal to 24.0D, Cyl +1.0 to 4.0D
posterior surface with asymmetric (all 0.5D steps)
light distribution (65% distance/ 35%
near), and 3.75D addition for near
Prostheses List by Category, Groups and Sponsor Page 14 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
at, t1
AMO Australia Pty Ltd
AO033 Tecnis Multifocal Toric Toric Multifocal Intraocular Lens +5.0 Diopters to +34.0 $1,198.00
Diopters in 0.5 Diopter
increments. Cylinder
powers 1.50D, 2.25D,
3.00D and 4.00D
Device Technologies Australia Pty Ltd
DE388 Oculentis LENTIS Mplus Toric LU- Patient specific one-piece multifocal- Overall Length 11.0mm and $1,198.00
313MFT toric plate haptic acrylic IOL Optic Size 6.0mm + 0.0D to
+36.0D inclusive in 0.01D
increments. Cyl +0.25 to
+6.99D inclusive in 0.01D
increments
at, t1, vblf
Device Technologies Australia Pty Ltd
DE394 Oculentis LENTIS Mplus Toric LU- Patient specific one-piece multifocal- Overall Length 11.0mm and $1,240.00
313 MF30TY toric plate haptic acrylic IOL. Optic Size 6.0mm, +-0.0D to
+36.0D inclusive in 0.01D
increments. Cyl +0.25D to
+6.99D inclusive in 0.01D
increments.
at, t2
Device Technologies Australia Pty Ltd
DE389 Oculentis LENTIS Mplus LU- Patient specific one-piece multifocal- Overall Length 11.0mm and $1,500.00
313MFT toric acrylic plate haptic IOL Optic size 6.0mm +-0.0D to
+36.0D inclusive in 0.01D
increments. Cyl +6.99D to
+12.0D inclusive in 0.01D
increments
at, t2, vblf
Device Technologies Australia Pty Ltd
DE395 Oculentis LENTIS Mplus LU-313 Patient specific one-piece multifocal Overall Length 11.00mm $1,542.00
MFTY toric plate haptic acrylic IOL. Violet and Optic Size 6.0mm +-
Light Filter 0.0D to +36.0D inclusive in
0.01D increments. Cyl
+7.00D to +12.0D inclusive
in 0.01D increments.
Prostheses List by Category, Groups and Sponsor Page 15 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
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, Posterior Chamber, UV absorbing, +6 D to + 34 D $864.00
SV25T0 and MN6AD1 foldable, acrylic, single piece lens
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
at,pl,t1
Carl Zeiss Pty Ltd
CZ036 AT LISA tri Toric 939MP Trifocal (aspheric), bitoric, micro Diopter range: + 6.00 to $1,218.00
incision, single-piece IOL for 24.0 DS and + 1 to +4 DC;
capsular bag fixation, implantable Optic size: 6.0mm; Overall
with preloaded injector system. The length: 11.0mm
trifocal (anterior) optic provides two
diffractive focal points (+3.33D near
focus and + 1.66D intermediate focus)
with asymmetric light distribution
50% distance / 20% intermediate /
30% near vision,
t1, at
Carl Zeiss Pty Ltd
CZ025 AT LISA toric 909M ZEISS micro incision, multifocal toric 6mm optic, 11mm diameter. $1,198.00
IOL (standard cyl range). Aspheric Diopter range: Sph -10.0D
toric anterior surface, diffractive to +32.0D, Cyl +1.0 to 6.5D
bifocal posterior surface with (all 0.5D steps)
asymmetric light distribution (65%
distance / 35% near), 3.75D addition
for near focus.
Prostheses List by Category, Groups and Sponsor Page 16 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Kevin Grundy (IBD) Pty Ltd
KG010 Rayner M-Flex Toric (Standard) Acrylic, Foldable, Single Piece, 5.75mm / 12.0mm: 6.25mm / $1,198.00
Multi-zoned Refractive Aspheric 12.5mm +3.00D or +4.00D
Toric Mulitfocal with Amon-Apple Addition FAR: +14.0D to
enhanced 360 degree Square edge, +32.00D in 0.5 STEPS:
Anti Vaulting Haptics +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 Acrylic, Foldable, Single Piece, Muli- 5.75/12.0mm: 6.25/12.5mm $1,198.00
Standard) Zoned Refractive, Toric Multifocal +3.00D to +4.00D Addition
with Amon-Apple enhanced 360 FAR: +14.0D to +32.0D in
Degree square edge, Anti-vaulting 0.5D Increments: NEAR:
Haptics, Patient 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 Posterior chamber UV absorbing +6 to +34 D spherical; 1.00 $1,240.00
IOL (SND1T2-5; SV25T2-6) foldable, acrylic, aspheric, toric single to 3.00 D cylinder
piece lens with apodised diffractive
optic and blue light protection.
t2, at
Carl Zeiss Pty Ltd
CZ024 AT LISA toric 909M ZEISS micro incision, multifocal toric 6mm optic, 11mm diameter. $1,500.00
IOL (high cyl range). Aspheric toric Diopter range: Sph -10.0D
anterior surface, diffractive bifocal to +32.0D, Cyl +7.0 to
posterior surface with asymmetric 12.0D (all 0.5D steps)
light distribution (65% distance /
35% near), 3.75D addition for near
Prostheses List by Category, Groups and Sponsor Page 17 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
1.2.2.5 - Accommodative
at, pa, pl
AMO Australia Pty Ltd
AO035 Synchrony Vu Accommodating IOL Synchrony Vu Dual Optic 5.50mm Anterior Optic, $822.00
Accommodating Posterior Chamber 6.00mm Interior Optic,
IOL 9.80mm Overall Length,
Diopter Range: +16.00 to
+28.00 in 0.5D Increments
at, pa, t1
Bausch & Lomb (Australia) Pty Ltd
BL031 Crystalens Toric The Crystalens Toric IOL, Models Overall diameter is 11.5mm $1,198.00
BL1AT/BL2AT and BL1UT/BL2UT (BL1AT/BL1UT) or 12.0mm
is an accommodating IOL (BL2AT/BL2UT) for the
incorporating a toroidal posterior entire lens power range.
surface. The Crystalens toric IOL has a Spherical equivalent
square posterior edge with polyimide powers range from +5.0 to
footplates and is available in multiple +33.0 Diopters in 0.5
spherical and cylindrical powers. Diopter steps and cylinder
powers of +1.25, +2.00 and
+2.75 Diopters (at the IOL
plane).
pa
Bausch & Lomb (Australia) Pty Ltd
BL027 Crystalens HD Accommodating lens with > 3 10.0 to 33.0 Dioptres in .05 $780.00
Dioptres of accommodation with dual Dioptre steps
mechanism of 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 $780.00
accommodating intraocular lens with powers from +5.0 to +36.0,
sqare edge design, custom control 1D steps: +31.0 to +36.0;
precision and closed loop haptic 0.5D steps: +5.0 to +18.0
and +25.0 to +30.0; 0.2D
steps; +18.0 to +25.0
Prostheses List by Category, Groups and Sponsor Page 18 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
pa, at
Bausch & Lomb (Australia) Pty Ltd
BL029 Crystalens AO Accommodating lens designed to 10.0 to 33.0 D in 0.50 $822.00
provide > 3 Diopters of Diopter steps. 10.0 - 16.5
accommodation with dual mechanism Diopters (12mm length) and
of action: (1) forward axial movement 17.0 - 33.0 Diopters
of lens and (2) accommodative arching (11.5mm length).
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 5.50mm Anterior Optic, $800.00
Accommodating Posterior Chamber 6.00mm Interior Optic,
9.80mm Overall Length,
Diopter Range: +16.00 to
+28.00 in 0.5D Increments
1.2.3 - Pseudo-phakic, piggy-back
1.2.3.1 - Monofocal
Design for Vision Pty Ltd
DV246 Rayner Sulcoflex Ashperic Pseudophakic Supplementary -10.0D to -5.50D in 0.5D $323.00
(Premium) I.O.L. I.O.L.O.L. increments. +5.50D
to 10.00D in 0.5D
at
Kevin Grundy (IBD) Pty Ltd
KG008 Rayner "Sulcoflex" Pseudophakic Sulcoflex Aspheric Pseudophakic I.O.L -5D to +5D $365.00
I.O.L.
t1, at
Kevin Grundy (IBD) Pty Ltd
KG005 Rayner Sulcoflex Aspheric Toric Acrylic, Aspheric, Toric SE -3 to +3 in 0.5 D steps $698.00
Pseudophakic Secondary I.O.L - Pseudophakic Secondary IOL : Cyl +1 to +3 in 1D steps
Standard Sulcus fixated with undulating
Haptics and Posterior Haptic
Prostheses List by Category, Groups and Sponsor Page 19 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
KG007 Rayner Sulcoflex Aspheric Toric Acrylic, Aspheric, Toric SE -6.00 to +6.00 in 0.5 D $698.00
Pseudophakic Secondary IOL Pseudophakic Secondary IOL: Sulcus steps Syl +1.00 to +6.00 in
(Premium) fixated with undulating Haptics and 0.5D steps
Posterior Haptic Angulation
1.2.3.2 - Multi-focal
at
Kevin Grundy (IBD) Pty Ltd
KG006 Rayner "Sulcoflex" Aspheric Multi- Acrylic, Aspheric Multi-focal 6.5mm / 13.5mm - $822.00
focal Pseudophakic Secondary IOL Pseudophakic Secondary IOL: 5.00D+5.00D sphere with
Sulcus-Fixated with Undulating + 3.00 Addition
Haptics and Posterior Haptic
at, t1
Design for Vision Pty Ltd
DV254 Rayner Premium Sulcoflex 653Z-Premium Multifocal Toric -7D to +7D (Spherical $1,198.00
Multifocal Toric Supplementary IOL Supplementary IOL Equivalent) Cylinder 1D,
4D, 5D, 6D Addition 3.5D
DV255 Rayner Standard Sulcoflex 653Z-Standard Multifocal Toric -3D to +3D (Spherical $1,198.00
Multifocal Toric Supplementary IOL Supplementary IOL Equivalent) Cylinders 2D
and 3D Addition 3.5D
1.3.1 - Viscoelastic
Alcon Laboratories (Aust.) Pty Ltd
AL006 PROVISC VISCOELASTIC PROVISC contains sodium 0.85mL pack $80.00
SOLUTION
AL007 VISCOAT Viscoelastic Fluid Chondroitin sulfate and sodium 0.75mL $80.00
hyaluronate
AL015 Cellugel viscoelastic fluid Hypromellose 2% . $80.00
AL029 DisCoVisc Ophthalmic Sodium hyaluronate 17 mg/mL and 0.5 mL and 1.0 mL $80.00
Viscosurgical Device chondroitin sulfate 40mg/mL
AMO Australia Pty Ltd
AO008 Healon, Intraocular Viscoelastic Sodium Hyaluronate 10mg/ml Healon 0.4ml, 0.55ml & $80.00
0.85ml
AO032 Healon Endocoat Viscoelastic 0.85ml $80.00
Prostheses List by Category, Groups and Sponsor Page 20 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Bausch & Lomb (Australia) Pty Ltd
BL008 Ocucoat Intraocular Fluid 20mg/mL hydroxypropylmethyl 1ml and 2ml Sterile $80.00
cellulose 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 Z-HYALIN Viscoelastic Cohesive Viscoelastic Solution - Volume 1.0ml $80.00
sodium hyaluronate 10mg/ml.
(previously called Ophthalin)
CZ013 Z-HYALIN Plus Viscoelastic Cohesive Viscoelastic Solution - Volume 1.0ml $80.00
sodium hyaluronate 15mg/ml.
(previously called Opthalin Plus)
CZ022 VISTHESIA 1.5% VISCOANAESTHETIC syringe 0.8ml syringe & 2x0.3ml $80.00
contains sodium hyaluronate (NaHA, ampoules
1.5%) and lidocaine hydrochloride
(1%). Also contains two topical
ampoules with NaHA (0.3%) and
lidocaine (2%)
IQ Medical
IQ002 Ocuvis and Ocumax 2% 20mg/mL hydroxypropylmethyl 2mL sterile $80.00
Hydroxypropylmethylcellulose cellulose 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 HEALON5- Sodium hyaluronate 0.6ml $85.00
Fluid 23mg/ml .
AO010 Healon GV Intraocular Viscoelastic Sodium Hyaluronate 14mg/mL 0.5mm and 0.85ml $85.00
Fluid
1.3.1.1 - Dual Fluids
Alcon Laboratories (Aust.) Pty Ltd
AL005 DUOVISC VISCOELASTIC SYSTEM PROVISC contains sodium Small & large packs $110.00
hyaluronate, VISCOAT contains
chondroitin sulfate and sodium
hyaluronate
Prostheses List by Category, Groups and Sponsor Page 21 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Carl Zeiss Pty Ltd
CZ019 TWINVISC Viscoelastic TWINVISC includes a cohesive and a Total volume 1.4 ml $110.00
dispersive viscoelastic in one
syringe, separated by a valve.
Dispersive: sodium hyaluronate
(2.2%). Cohesive: sodium
1.3.2 - Non Viscous
Design for Vision Pty Ltd
DV231 Vision Blue Trypan blue dye for ophthalmic 0.5ml syringe $48.00
applications
1.4.1 - Simple
Alcon Laboratories (Aust.) Pty Ltd
AL001 Capsular Tension Rings - 10.0 - 12.0 compressed, $159.00
12.3 - 14.5 uncompressed
AMO Australia Pty Ltd
AO021 Stabileyes Capsular Tension Ring Polymethylmethacrylate (PMMA) 12mm ring, and 13mm ring $159.00
Implant
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
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), $243.00
per-load on disposable injector 14A (12mm)
Prostheses List by Category, Groups and Sponsor Page 22 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Insight Surgical Pty Ltd
IS001 Preloaded Capsulan Tension Ring Capsular tension ring preloaded 13/11mm $243.00
(acrylic)
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 Non-valved artificial drainage device, Surface area 250, 350, $425.00
101-350, Baerveldt Glaucoma composition silicone - smooth, 425mm2
Implant BG 103-425, Baerveldt tumble-polished finish
Glaucoma Implant 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 2 Sizes: *230 mm square $625.00
of silicon *175mm square
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
Prostheses List by Category, Groups and Sponsor Page 23 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
1.6.1 - Spacers
Spectrum Surgical
SO017 FCI Ptose-up Expanded PTFE 15cm long x 2 or 3mm wide $348.00
x 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
1.7.1 - Intracanalicular
Design for Vision Pty Ltd
DV022 Eyetec DCR Tubes Stainless steel, silicone tubing, 30cm $135.00
Bodkin lacrimal intubation set
DV241 Eyetec DCR Tubes Crawford and Cannaliculus N/A $135.00
Intubation Sets
DV256 LIS 052 "StenTube" Large Diameter Lachrymal Intubation 1.32mm Tube diameter $135.00
Set
Prostheses List by Category, Groups and Sponsor Page 24 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
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 1. Probes 0.90mm x 4.5cm, $135.00
silicone rods or silicone tubing - rod 40cm x 0.80mm. 2.
packaged sterile 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 PVP Bika: 0.64mm O.D. $135.00
Coated Silicone Plug/Metal Tube/80 x 0.8mm probes,
Probes/Polypropylene Thread PVP 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 Silicone tubing swaged, imbedded Probes: 40mm to 120mm x $135.00
Intubation Set into or around malleable and flexible 0.7mm to 1.2mm. Tube:
stainless steel probes. PEEK thread. 0.64mm to 1.18mm x 25mm
to 400mm. PEEK Thread:
0.2mm to 0.4mm x 500mm.
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 0.64mm to 1.18mm x 30mm
guides. PEEK thread. Introducer. to 350mm. PEEK Thread:
0.2mm to 0.4mm x 500mm.
Plug Collar: 2mm to 4mm.
Prostheses List by Category, Groups and Sponsor Page 25 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
1.7.2 - Extracanalicular
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
1.7.3 - Balloon Dilatation Catheters
Design for Vision Pty Ltd
DV258 Lacricath Lachrymal Duct Balloon Unilateral Lachrymal Duct Balloon 2mm, 3mm & 5mm $485.00
Catheter Catheter system including inflation
device
bilateral
Design for Vision Pty Ltd
DV257 Lacricath Lachrymal Duct Balloon Bilateral Lachrymal Duct Balloon 2mm, 3mm and 5mm $879.00
Catheter Catheter System including inflation
device.
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 Bioceramic diameter, 12, 14, $1,200.00
(Aluminium Oxide)/Hydroxyapatite 16, 18, 20, 21, 22mm;
(Synthetic) Synthetic Diameter, 10, 12,
14, 16, 18, 20, 22mm
Prostheses List by Category, Groups and Sponsor Page 26 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
1.8.2 - Extrascleral
1.8.2.1 - Complex and permeable
Stryker Australia Pty Ltd
SK521 Sphere Orbital Sphere Models 6316, 6326, Orbital Sphere Models $785.00
6327, 6317 and 6322 8702-8704. 6316: 14mm, 6326: 16mm,
COI implant, models 7222, 7223 & 6327: 18mm, 6317: 20mm,
80026. MCOI implant, models 7207 - 6322: 22mm, 8702: 19mm,
7209 Quad Motility Implants 9866 - 8703: 21mm, 8704: 23mm,
9868 & 80022 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 20, 22mm; Synthetic
oxide), mesh wrapped hydroxyapatite Hydroxyapatite diameter:
(synthetic), mesh wrap (polyglycolic 16, 18, 20, 22mm
acid)
vp
Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW002 Biopore Sphere An implantable device made of high- 14mm, 16mm, 18mm, 20mm, $1,930.00
density polyethylene material with an 22mm, 24mm (diameter)
interconnecting pore structure that
supports tissue ingrowth. The device
is available in sizes to meet the
patient's specific needs. Used for
orbital reconstruction following
enucleation and evisceration
procedure.
Prostheses List by Category, Groups and Sponsor Page 27 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
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 needles 0.90mm x 6.5cm, rod $315.00
silicone rods and silicone tubing - 40cm - 0.80mm, sleeve 10 x
packaged sterile 2mm
Spectrum Surgical
SO045 FCI Ptosis Probes Stainless steel needle probes swaged 80mm x 0.8mm needle $315.00
with silicone tubing. probes, 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 7mm, Mira 287WG Murray
Copolymer) 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 Sleeves-Mira 70 Sleeve 1mm $45.00
used in Scleral Buckling I.D., Mira 71 Sleeve 1mm
(Dimethylmethylvinyl Siloxane I.D., Mira 72 McNutt Sleeve
Copolymer) 1.57mm I.D., Mira 270
Sleeve 0.76mm I.D.
Prostheses List by Category, Groups and Sponsor Page 28 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
AP006 Mira: Scleral Implants Solid Silicone-Band/Strip/Boat/Clip. Bands-Mira 40 Circling $45.00
Retinal Implant used in Scleral Band 2mm, Mira 240
Buckling (Dimethylmethylvinyl Circling Band 2.5mm.
Siloxane Copolymer) 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
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 $45.00
40, 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 0.6mmStrip - 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 $45.00
Groove, 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
Prostheses List by Category, Groups and Sponsor Page 29 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
1.9.1.1 - Sponges
Austmed Pty Limited
AP002 Mira: Scleral Implants Silicone Sponge- Retinal Implant Sponge- Mira 502 Cylinder $90.00
Used in Scleral Buckling (Silicone 2mm, Mira 5025 Cylinder
Elastomer 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
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
Prostheses List by Category, Groups and Sponsor Page 30 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
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, $25.00
Length 30mm
1.9.4 - Intraocular Gases
Alcon Laboratories (Aust.) Pty Ltd
AL035 ISPAN Retinal Gases for Tamponade gases for retinal surgery 125g cylinder, dispensed in $75.00
Constellation® Vision System C3F8 and SF6 single dose syringe
AL036 ISPAN retinal gases Tamponade gases for retinal surgery 125 g cylinder, dispensed $75.00
C3F8 and SF6 in single dose syringe
Device Technologies Australia Pty Ltd
DE284 Single Dose Ophthalmic Gases Single dose tamponading gas for 30ml $75.00
retinal surgery
IQ Medical
IQ012 EasyGas Endotamponade Gases for Retinal 60ml dispensed in a single $75.00
Surgery, EasyGas SF6, C2F6 or C3F8, dose, sterile syringe
each supplied in a 60ml syringe,
Prostheses List by Category, Groups and Sponsor Page 31 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
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- Perfluorocarbon Liquid for use as a 5mL $240.00
retinal surgery additive
BL018 DK Line 100% purified Perfluorodecalin 7ml $240.00
perfluorodecalin
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.
DE205 Arcotane (Perfloro-N-Octane) Liquid perfluoro-N-Octane aid for 5ml, 7ml $240.00
retinal 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 5ml $240.00
perfluorodecalin, FCI - OCTA:
Purified perfluoro-N-octane
Prostheses List by Category, Groups and Sponsor Page 32 of 1011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
SO024 FCI - DECA, FCI - OCTA FCI - DECA: Purified 7ml $240.00
perfluorodecalin, FCI - OCTA:
Purified perfluoro-N-Octane
1.9.6 - Intraocular Silicone Oils
Bausch & Lomb (Australia) Pty Ltd
BL016 Oxane LMWC Fractioned Silicone Purified fractioned silicone oil 10mL $195.00
Oil
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 Viscosity: 1000 cst/5000 cst: solvent 10ml $195.00
Free) free purified silicone oil
Prostheses List by Category, Groups and Sponsor Page 33 of 1011
10 - VASCULAR
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
10.1.1 - Bare Metal Stents
10.1.1.1 - Balloon Expandable
Abbott Australasia Pty Ltd
AY022 Cobalt Chromium Balloon Cobalt Chromium Diameter 4-10mm, Length $1,800.00
Expandable Peripheral Stent 12-58mm
AY024 Omnilink Stainless Steel Balloon Stainless Steel Balloon Expandable 018 & 035 system: 5-10mm $1,800.00
Deployable Peripheral Stent Peripheral Stent on 018/035 system diameter by 12, 16, 18, 28,
38, 58mm length
B Braun Australia Pty Ltd
BB244 Coroflex Blue Cobalt Chromium Alloy L605 2-4mm diameter, 8-25mm $1,800.00
length
Bard Australia Pty Ltd
BA218 Lifestent Valeo Stainless Steel Balloon Expandable 6-10mm diameter 17-56mm $1,800.00
Peripheral Stent length
Biotronik Australia Pty Ltd
BT094 Dynamic PTA Balloon Expandable Stent Diameters: 5-10mm, $1,800.00
Lengths: 15, 25, 38, 56mm
Boston Scientific Australia Pty Ltd
BS059 Express Vascular LD Stent; Express Stainless Steel, Balloon Expanding Stent Diameters up to 10mm $1,800.00
Vascular SD Stent Stent and lengths up to 60mm
Cook Medical Australia Pty Ltd
WC234 Formula 414 Rx Renal Stent System Balloon Expandable Vasc/Biliary Rapid exchange 014/018, $1,800.00
80-135cm delivery system.
Diameters 4-10mm, lengths
0.8 - 4cm
Johnson & Johnson Medical Pty Ltd
JJ057 Palmaz Balloon Expandable Stent Stainless steel stent Diameter 4-12mm, length $1,800.00
20-30mm
JJ058 Palmaz Balloon Expandable Stent Stainless steel stent Extra-large $1,800.00
JJ305 Palmaz Genesis Peripheral Stent Stainless steel balloon expandable Diameter 4-8mm, length 12- $1,800.00
and Delivery System on Opta Pro stent mounted on an Opta Pro 39mm
JJ306 Palmaz Genesis Peripheral Stent Stainless steel peripheral stent Diameter 4-12mm, length $1,800.00
11-79mm
Prostheses List by Category, Groups and Sponsor Page 34 of 1011
10 - VASCULAR
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
JJ567 PALMAZ® BLUE™ .018 L605 Cobalt Chromium Alloy 12, 15, 18, 24mm length 4, $1,800.00
Peripheral Stent System Balloon Expandable Stent 5, 6, 7mm diameter
JJ688 Palmaz Blue .014 Renal Stent CoCr balloon expandable stent 12, 15, 18, 24mm Lengths $1,800.00
System (on Aviator Plus) 40, 50,
60, 70mm diameters
80, 142cm shaft
lengths
MD Solutions Pty Ltd
MB009 ArchStent Ostial System The ArchStent Ostial System is a 7Fr: 5mm x 16mm x 135mm. $1,800.00
0.14" guidewire-compatible, rapid 7Fr: 6mm x 16mm x 135mm
exchange balloon expandable stent
system for the treatment of
atherosclerotic stenosis at the renal-
ostial junction. It consists of a 316L
stainless steel stent with flaring of the
proximal 1/5 segment, and a dual
balloon delivery catheter featuring a
Locator balloon that enables the
operator to precisely position and
conform the stent to aorto-ostial
anomalies.
Medtronic Australasia Pty Ltd
MC328 Racer Renal Stent System Cobalt Alloy Diameter: 4-7mm; Lengths: $1,800.00
12 &18mm
MC773 Assurant Cobalt Stent Iliac balloon expandable stent system Diameter: 6 - 10mm , $1,800.00
Length: 20 - 80mm
MC959 Hippocampus Renal Stent System Hippocampus Renal Rapid Exchange Diameter 4.0mm - 7.00mm $1,800.00
Stainless Steel Stent system, 5F Length: 10mm - 24mm
sheath, 0.014" guide wire compatible
silicate substituted synthetic bone
< = 3cc
Global Orthopaedic Technology
GO161 Actifuse ABX Easyfill Actifuse ABX Easyfill - A silicate 1.5mL to 4mL $1,080.00 $1,200.00
substituted synthetic bone graft
6.7.5.2.3 Bone Substitute, >5cc or 5gm, <=12cc or 12gm
Global Orthopaedic Technology
GO163 Actifuse ABX Easyfill Putty Actifuse ABX Easyfill Putty - A 10ml $2,300.00
silicate substituted synthetic bone
6.7.7 Limb preservation, resection and lengthening systems
6.7.7.2.2 Limb preservation and lengthening, proximal femur
cementless
Johnson & Johnson Medical Pty Ltd
DY187 Limb Preservation System Beaded, 'Porocoat' Standard & Neutral, 15deg Left & Right $6,990.00
Trochanter Replacement in both styles
Bone matrix implant, artificial
Global Orthopaedic Technology
GO177 ACTIFUSE ABX Putty Actifuse AVX Putty - A silicated 20ml $4,600.00
substituted synthetic bone graft.
Grafts, Bone
Zimmer Pty Ltd
ZI265 Continuum hip system Hedrocel AVN Rod 3mm - 12mm block $3,208.00
Prostheses List by Category, Groups and Sponsor Page 1009 of 1011
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Hip F - Accessory
Group 30h - Mesh
Stryker Australia Pty Ltd
HW044 Exeter Hip System X-Change Revision Mesh - Stainless Acetabular, Femoral and $889.00
Steel Flat Mesh
HW045 Exeter Hip System X-Change Revision Mesh -Rim - Small $886.00
Stainless Steel
HW046 Exeter Hip System X-Change Revision Mesh - Rim - Large $855.00
Stainless Steel
Zimmer Pty Ltd
ZI329 CPT Impaction Grafting Mesh Titanium Femoral or acetabular mesh 6 sizes acetabular rim (small $3,367.00
and large), medial wall
(small and large), flat and
femoral meshes
Prostheses List by Category, Groups and Sponsor Page 1010 of 1011
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
Bone Matrix Implants, Artificial
Biomet Australia Pty Ltd
BI487 Mimix Calcium Phosphate Bone Calcium Phosphate 5 grams $1,004.00
Void Filler
BI488 Mimix Calcium Phosphate Bone Calcium Phosphate 10 grams $1,900.00
Void Filler
BI489 Mimix Calcium Phosphate Bone Calcium Phosphate 20 grams $2,300.00
Void Filler
Grand Total: 9851 Records
Prostheses List by Category, Groups and Sponsor Page 1011 of 1011
PART B - Human Tissue List February 2013
Billing Code Facility Minimum Benefit Maximum Benefit
1 - OPHTHALMIC
Amniotic Membrane
LEM03 Lions Eye Donation Service $770.00
Cornea
LEM01 Lions Eye Donation Service $2,000.00
LEN01 Lions NSW Eye Bank $2,026.00
LEW01 Lions Eye Bank of Western Australia $2,500.00
QEB01 Queensland Eye Bank $2,100.00
SAE01 The Eye Bank of South Australia $1,838.00
Cornea for Endothelial Keratoplasty
LEW03 Lions Eye Bank of Western Australia $3,000.00
Cornea for Endothelial Lamellar Keratoplasty
LEM04 Lions Eye Donation Service $2,660.00
Cornea For Lamellar
LEN03 Lions NSW Eye Bank $1,216.00
Sclera
LEM02 Lions Eye Donation Service $150.00
LEN02 Lions NSW Eye Bank $304.00
LEW02 Lions Eye Bank of Western Australia $250.00
QEB02 Queensland Eye Bank $298.00
SAE02 The Eye Bank of South Australia $196.00
CARDIO-THORACIC
Conduit - Aortic
TBV56 Donor Tissue Bank of Victoria $1,117.00
Conduit - Aortic + Valve
QHV09 The Prince Charles Hospital - Queensland Heart Valve Bank $6,300.00
Conduit - Arterial
SHV03 Sydney Heart Valve Bank, St. Vincent's Hospital $987.00
Conduit - Pulmonary
TBV03 Donor Tissue Bank of Victoria $1,116.00
Page 1 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
Conduit - Pulmonary + Valve
QHV08 The Prince Charles Hospital - Queensland Heart Valve Bank $6,600.00
Conduit - Pulmonary large
QHV07 The Prince Charles Hospital - Queensland Heart Valve Bank $1,915.00
Patch - Mitral
QHV03 The Prince Charles Hospital - Queensland Heart Valve Bank $1,743.00
Patch - Pericardium
QHV05 The Prince Charles Hospital - Queensland Heart Valve Bank $1,915.00
Patch - Tricuspid
QHV04 The Prince Charles Hospital - Queensland Heart Valve Bank $1,743.00
Pericardium
TBV50 Donor Tissue Bank of Victoria $540.00
Thoracic Aorta
QHV11 The Prince Charles Hospital - Queensland Heart Valve Bank $1,915.00
Valve - Aortic
QHV01 The Prince Charles Hospital - Queensland Heart Valve Bank $6,600.00
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 $7,278.00
Valve - Mitral
QHV10 The Prince Charles Hospital - Queensland Heart Valve Bank $6,300.00
Valve - Pulmonary
QHV02 The Prince Charles Hospital - Queensland Heart Valve Bank $6,600.00
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 $7,278.00
DERMATOLOGIC
Skin 100cm² - frozen skin graft from human origin
QBB72 The Queensland Bone Bank $477.00
Skin 200cm² - frozen skin graft from human origin
QBB73 The Queensland Bone Bank $705.00
Skin 50cm² - frozen skin graft from human origin
Page 2 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
QBB71 The Queensland Bone Bank $248.00
ORTHOPAEDIC
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 $683.00
Bone - Cancellous Bone Matrix, Lyophilised 80cc
TBV53 Victorian Institute of Forensic Medicine $1,364.00
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 $1,073.00
Bone - Chips/cubes 80cc
TBV10 Donor Tissue Bank of Victoria $2,044.00
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 14
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 $1,157.00
Bone - Demineralised Bone Matrix, Lyophilised 5g
TBV54 Donor Tissue Bank of Victoria $578.00
Bone - Milled <30g Freeze Dried
PBT37 Perth Bone and Tissue Bank $750.00
Bone - Milled <30gr (60cc equivalent)
PBT08 Perth Bone and Tissue Bank $2,409.00
Bone - Milled >50gr (100cc equivalent)
PBT10 Perth Bone and Tissue Bank $3,445.00
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 $3,030.00
Bone - Milled 30-50g Freeze Dried
PBT38 Perth Bone and Tissue Bank $900.00
Bone - Milled 40cc
TBV11 Donor Tissue Bank of Victoria $1,285.00
Bone - Milled 80cc
TBV12 Donor Tissue Bank of Victoria $2,299.00
Bone - Milled Femoral Head
AUB02 Australian Biotechnologies $2,457.00
Bone - Ronguered Chips
QBB68 The Queensland Bone Bank $2,022.00
Bone - Ronguered Chips Freeze Dried
QBB67 The Queensland Bone Bank $2,524.00
Page 4 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
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 $762.00
Bone Plug/Dowel - Tricortical
TBV08 Donor Tissue Bank of Victoria $827.00
Cartilage - costal segments
PBT11 Perth Bone and Tissue Bank $300.00
QBB12 The Queensland Bone Bank $210.00
TBV17 Donor Tissue Bank of Victoria $430.00
Cortical Strut
AUB05 Australian Biotechnologies $2,451.00
QBB52 The Queensland Bone Bank $441.00
TBV14 Donor Tissue Bank of Victoria $842.00
Cortical Strut >15 - 20cm
PBT07 Perth Bone and Tissue Bank $2,364.00
Cortical Strut >20cm
PBT48 Perth Bone and Tissue Bank $2,732.00
Cortical Struts 10-15cm
PBT06 Perth Bone and Tissue Bank $1,981.00
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 $5,787.00
Fascia Lata
NBB09 New South Wales Bone Bank $922.00
TBV21 Donor Tissue Bank of Victoria $889.00
Fascia Lata - Large (15cm x 10cm)
PBT15 Perth Bone and Tissue Bank $1,590.00
Fascia Lata - per sq cm
QBB11 The Queensland Bone Bank $5.00
Page 5 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
Fascia Lata - Small (10cm x 5cm)
PBT16 Perth Bone and Tissue Bank $854.00
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 $3,028.00
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 $2,370.00
NBB16 New South Wales Bone Bank $2,354.00
PBT22 Perth Bone and Tissue Bank $2,632.00
QBB27 The Queensland Bone Bank $2,163.00
RNB01 Hunter New England Bone Bank $2,250.00
SVN01 Mater Hospital $731.00
TBV26 Donor Tissue Bank of Victoria $2,596.00
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 $2,295.00
TBV46 Donor Tissue Bank of Victoria $1,330.00
Femoral Rings
NBB17 New South Wales Bone Bank $1,606.00
PBT24 Perth Bone and Tissue Bank $1,662.00
QBB30 The Queensland Bone Bank $1,591.00
Femoral Rings - Freeze Dried
QBB31 The Queensland Bone Bank $670.00
Femoral Shaft
Page 6 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
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 $2,357.00
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 $3,471.00
TBV22 Donor Tissue Bank of Victoria $4,251.00
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
TBV23 Donor Tissue Bank of Victoria $7,120.00
Femur - Entire head removed
PBT18 Perth Bone and Tissue Bank $5,882.00
Femur - Proximal (shaft, trochanter, neck)
MVS04 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
Page 7 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
PBT20 Perth Bone and Tissue Bank $3,471.00
TBV25 Donor Tissue Bank of Victoria $4,220.00
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 $4,095.00
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 $2,667.00
QBB32 The Queensland Bone Bank $2,651.00
TBV27 Donor Tissue Bank of Victoria $6,863.00
Fibula - Segment
NBB54 New South Wales Bone Bank $2,359.00
PBT28 Perth Bone and Tissue Bank $1,472.00
Fibula - Segment (12cm)
MVS14 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
TBV29 Donor Tissue Bank of Victoria $1,164.00
Fibula - Segment (6cm)
MVS13 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
TBV28 Donor Tissue Bank of Victoria $762.00
Fibular Shaft
TBV30 Donor Tissue Bank of Victoria $2,419.00
Hemipelvis - Acetabulum
NBB21 New South Wales Bone Bank $2,905.00
PBT29 Perth Bone and Tissue Bank $2,940.00
QBB33 The Queensland Bone Bank $2,762.00
TBV31 Donor Tissue Bank of Victoria $3,300.00
Hemipelvis - Complete
MVS08 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
Page 8 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
NBB24 New South Wales Bone Bank $6,500.00
PBT30 Perth Bone and Tissue Bank $5,411.00
QBB37 The Queensland Bone Bank $4,268.00
TBV32 Donor Tissue Bank of Victoria $7,487.00
Hemipelvis - iliac crest
NBB22 New South Wales Bone Bank $2,705.00
PBT31 Perth Bone and Tissue Bank $1,174.00
QBB34 The Queensland Bone Bank $2,478.00
TBV33 Donor Tissue Bank of Victoria $2,984.00
Hemipelvis - Tricortical iliac wedge
NBB23 New South Wales Bone Bank $1,195.00
PBT32 Perth Bone and Tissue Bank $1,067.00
QBB35 The Queensland Bone Bank $1,195.00
TBV34 Donor Tissue Bank of Victoria $1,149.00
Hemipelvis - Tricortical iliac wedge Freeze Dried
QBB36 The Queensland Bone Bank $735.00
Humeral Head
TBV37 Donor Tissue Bank of Victoria $1,823.00
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
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 $2,472.00
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
Page 9 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
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 $1,174.00
TBV36 Donor Tissue Bank of Victoria $3,054.00
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 $2,886.00
TBV35 Donor Tissue Bank of Victoria $2,919.00
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 $1,964.00
Meniscal Graft
PBT47 Perth Bone and Tissue Bank $1,921.00
Meniscus
QBB05 The Queensland Bone Bank $1,400.00
TBV40 Donor Tissue Bank of Victoria $1,306.00
Meniscus with Ligaments
TBV39 Donor Tissue Bank of Victoria $2,368.00
Osteotomy Wedge
PBT60 Perth Bone and Tissue Bank $1,267.00
Patella
QBB47 The Queensland Bone Bank $788.00
TBV41 Donor Tissue Bank of Victoria $1,125.00
Patellar unit whole with or without tibial block
PBT40 Perth Bone and Tissue Bank $2,654.00
Page 10 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
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 $3,436.00
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 $537.00
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
QBB62 The Queensland Bone Bank $1,922.00
TBV05 Donor Tissue Bank of Victoria $1,129.00
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 $2,300.00
Tendon - Achilles with bone plug
AUB09 Australian Biotechnologies $2,228.00
Tendon - Achilles with machined conical bone block
Page 11 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
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 $2,368.00
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
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 $2,398.00
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 $2,300.00
Tendon - Tibialis Posterior
NBB71 New South Wales Bone Bank $2,184.00
QBB57 The Queensland Bone Bank $1,922.00
Page 12 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
Tibia - Condyles only
TBV47 Donor Tissue Bank of Victoria $1,832.00
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 $2,401.00
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 $2,722.00
Tibia - Proximal 7-15cm
TBV44 Donor Tissue Bank of Victoria $2,826.00
Tibia - Proximal half
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 $4,118.00
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
Page 13 of 14
Billing Code Facility Minimum Benefit Maximum Benefit
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
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 $3,167.00
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 14 of 14
Part C - Other Prostheses February 2013
3 - GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
3.2.3 - Infusion Pumps, Battery Powered
3.2.3.2 - Insulin infusion pump (as 3.2.3.1) with integral calculator to determine boluses and
Managing Diabetes Pty Ltd
DF001 DANAIIS Insulin Pump Continuous insulin infusion pump 75mm x 45mm x 19mm $4,000.00
DE, SS
Australasian Medical & Scientific Ltd
AN011 Animas Vibe Insulin Pump & CGM Ambulatory insulin infusion pump Pump/Monitor: 8.26 x 5.08 $8,950.00
System with real-time continuous glucose x 2.18cm
monitoring (CGM) capability Sensor/Transmitter: 3.8 x
2.3 x 1.3cm
Managing Diabetes Pty Ltd
DF002 DANAR Insulin Pump The DANAR Insulin Pump is a small 75 x 45 x 19mm, 60grams $8,950.00
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.
Roche Diagnostics Australia Pty Ltd
RO044 Accu-Chek Combo System Insulin delivery device capable of The Accu-Chek Combo $8,950.00
remotely receiving and acting on System is only available in
information about blood glucose one size.
levels, performing bolus calculation
and bolus advice on additional
parameters than what is normally
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 $7,750.00
Insulin Pump" - each
Page 1 of 3
3 - GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
3.2.3.3 - Device has capability to automatically adjust the insulin delivery based on continuous
DE, SS
Medtronic Australasia Pty Ltd
MC839 Medtronic MiniMed Insulin Paradigm Veo Model MMT-554. 5.1 x 7.6 x 2.0cm $9,500.00
Infusion Pump 'Smart' Insulin Pump with REAL-
Time continuous glucose monitoring
capability, incorporating a low
glucose suspend and with remote
MC840 Medtronic MiniMed Insulin Paradigm Veo Model MMT-754. 5.1 x 9.4 x 2.0cm $9,500.00
Infusion Pump 'Smart' Insulin Pump with REAL-
Time continuous glucose monitoring
capability, incorporating a low
glucose suspend and with remote
Page 2 of 3
8 - CARDIAC
Minimum Maximum
Billing Code Product Description Size Benefit Benefit Condition
8.14.1 - Implantable Cardiac Event Recorders
Medtronic Australasia Pty Ltd
MC763 Reveal XT Reveal XT Insertable Cardiac Monitor 61 x 19 x 8 mm with a $3,900.00
volume of 9cc
MC768 Reveal DX Insertable Cardiac Monitor 61 x 19 x 8 mm with a $3,900.00
volume of 9cc
St Jude Medical Australia Pty Ltd
SJ152 SJM Confirm Model DM2102 Implantable cardiac monitor with 6.5cc, 12g $3,900.00
atrial fibrillation monitoring.
SJ159 SJM Confirm Model DM2100 Implantable cardiac monitor 6.5cc, 12g $3,900.00
Grand Total: 12 Records
Page 3 of 3
Endnotes
Endnote 1 – Legislation history
This endnote sets out the details of the legislation history of the Private Health Insurance (Prostheses) Rules 2012 (No. 2).
| Instrument | Date of FRLI registration | Date of commencement | Application, saving or transitional provision |
| Private Health Insurance (Prostheses) Rules 2012 (No.2) | 21 August 2012 | 30 August 2012 | |
| Private Health Insurance (Prosthesis) Amendment Rules 2012 (No. 3) | 30 August 2013 | 30 August 2012 | _ |
| Private Health Insurance | 15 February 2013 | 5 March 2013 | _ |
| Private Health Insurance (Prostheses) Amendment Rules 2013 (No. 2) | 22 February 2013 | 5 March 2013 | _ |
| Private Health Insurance (Prostheses) Amendment Rules 2013 (No. 3) | 4 April 2013 | 9 April 2013 | _ |
Endnote 2 – Amendment history
This endnote sets out the amendment history of the Private Health Insurance (Prostheses) Rules 2012 (No. 2).
| ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted | |
| Provision affected | How affected |
| Schedule, Part A Schedule, Part B Schedule, Part C | am. F2012L01788; rs. F2013L00203; am. F2013L00265; am. F2013L00614 rs. F2013L00203 rs. F2013L00203 |
11.
12.
13.
Endnote 3—Application, saving and transitional provisions
This endnote sets out application, saving and transitional provisions for amendments of the Private Health Insurance (Prostheses) Rules 2012 (No. 2).
There are no application, saving or transitional provisions.
Endnote 4—Uncommenced amendments
This endnote sets out amendments of the Private Health Insurance (Prostheses) Rules 2012 (No. 2) that have not yet commenced. For commencement details see Endnote 1.
There are no uncommenced amendments.
Endnote 5—Misdescribed amendments
This endnote sets out amendments of the Private Health Insurance (Prostheses) Rules 2012 (No. 2) that have been misdescribed.
| Amending Instrument | Misdescribed amendment |
| Private Health Insurance (Prostheses) Amendment Rules 2012 (No.3) | at page 56 of 975, after the “Sponsor” column starting “Atrium Australia – Pacific Rim Pty Ltd”, under the heading “Billing Code” insert, “AC082”, under the heading “Product Name” insert, “Interflow Ultrathin Radially Supported”, under the heading “Description” insert, “ePTFE vascular graft with radial support”, under the heading “Size” insert, “6-8mm x 40cm”, under the heading “Minimum Benefit” insert, “$1,520.00”. |
| Private Health Insurance (Prostheses) Amendment Rules 2012 (No.3) | at page 320 of 975, after the “Sponsor” column starting “National Surgical Pty Ltd”, under the heading “Billing Code” insert, “NK007”, under the heading “Product Name” insert, “Spider Cervical Plating System - Spider Screw”, under the heading “Description” insert, “Titanium, Self Tapping and Self Drilling”, under the heading “Size” insert, “4.0 - 4.25mm, lengths 12-16mm”, under the heading “Minimum Benefit” insert, “$200.00”. |
0
0
0