National Health Act 1953 - Determination made under subsections 73AAG(6) and (7) (HIB 30/2006)

Administered by Department of Health, Disability and Ageing

Legislation au F2006L03312 Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

Issued by Authority of the Minister for Health and Ageing

National Health Act 1953

Determination under subsections 73AAG (6) and (7)

(HIB 30/2006)

 

Subsection 73AAG(6) of the National Health Act 1953 (the Act) provides that the Minister may determine in writing the prostheses that are no gap prostheses and the benefit amount for each no gap prosthesis.

Subsection 73AAG(7) provides that the Minister may determine in writing the prostheses that are gap permitted prostheses, and the minimum and maximum benefit amounts for each gap permitted prosthesis.

This determination amends the determination signed by the delegate of the Minister on 12 September 2006 (HIB 22/2006). 

This determination commences on 13 October 2006.

The Schedule to this determination has two parts:

  • Part A – Prostheses; and
  • Part B – Human Tissue List.

This determination updates the previous Prostheses List by:

  • amending the minimum and maximum benefit amounts of 316 prostheses in Part A, as detailed at Attachment A;
  • amending the product descriptions of 47 prostheses in Part A, as detailed at Attachment B;
  • deleting 14 prostheses from Part A, as detailed at Attachment C;
  • adding 40 prostheses to Part A, as detailed at Attachment D; and
  • adding seven items to Part B, as detailed at Attachment E.

The determination is consistent with the recommendations of the Prostheses and Devices Committee.

 

CONSULTATION

This Determination has been made having regard to advice provided by the Prostheses and Devices Committee (PDC), a ministerially appointed committee comprised of nominees from health funds, hospitals, clinicians, prostheses and devices suppliers, the Commonwealth, and consumer representatives.

This determination and this Explanatory Statement have been registered on the Federal Register of Legislative Instruments.

 

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

OCTOBER 2006

 

 

Benefit(s) Updated Items for Prostheses List  August 2006  Attachment A

 Billing  Product Name Description Size MinBenefit MaxBenefit

 Advanced Surgical Technologies

 Orthopaedic

 AD227 Osteoset MIIG X3 Injectable Calcium Sulphate Bone Void Filler,  5cc $1,795.00

 Includes Syringe

 American Medical Systems

 Urogenital

 AM005 Penile Implant - Malleable AMS 600M, AMS 650 Cylinders range: 12 -20cm $3,305.40

 AM019 MONARC Sling System Product includes - mesh and two needles with  One Size Only $850.00 $990.00

 handles attached

 AM031 AMS 800 Artificial Urinary Sphincter Deactivation  Implantable plugs x 3 & straight connector One Size $132.00

 Package

 Auto Suture Company, Australia T/A Tyco Healthcare Pty

 Mechanical Internal Wound Closure Products

 AS025 TA* Reloading Units; DST Series* Linear Stapler  Premium Multifire TA* Disposable Surgical  30mm (2.5, 3.5, 4.8mm); DST TA90-3.5  $243.49

 Disposable Loading Units Stapler and Loading Unit; Titanium staples  DLU; DST TA90-4.8 DLU; DST TA45-

 used for hemostatic closure of specific organs  3.5 DLU; DST TA45-4.8 DLU; DST

 and blood vessels (ex bowel, stomach and lung) TA60-3.5 DLU; DST TA60-4.8 DLU;

 DST TA30-3.5 DLU; DST TA30-4.8

 DLU; DST TA30V3 DLU.

 AS115 DST Series* GIA* Linear Cutter Stapler and single  Single use, reloadable stapler 80mm length; Sizes 3.8 and 4.8mm $470.00

 use loading units

 AS117 DST Series* GIA* Linear Cutter Stapler and single  Single use, reloadable stapler 100mm length: Sizes 3.8 and 4.8mm $460.00

 use loading units

 B Braun Australia Pty Ltd

 Neurosurgical

 BB007 Spine System Evolution Clamp for Cross Plate For 5.2 and 6mm rods $480.00

 BB108 Aneurysm Clip Yasargil 4.5mm x 150g to 25.0mm x 200g $215.00 $230.00

 BB159 Bone Screw MACS Polyaxial & Stabilisation, Titanium Dia 6.5 - 7mm, length 30 - 50mm $541.82

 BB160 Bone Screw HMA Polyaxial, Titanium Dia 12mm, length 26 - 38mm $1,800.00

 BB161 Bone Screw HMA Monoaxial, Titanium Dia 12mm, length 26 - 38mm $1,150.00

 Benefit(s) Updated Items for Prostheses List Report  Page 1 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 BB174 MACS TL Bone Screws Polyaxial screw - XL 30mm and 40mm $1,800.00

 BB211 KLA Anterior Lumbar Cage System Anterior Lumbar Cage - PEEK 9mm x 5 degrees, 11mm x 5 degrees,  $4,250.00

 13mm x 5 degrees, 11mm x 9 degrees,

 13mm x 9 degrees, 15mm x 9 degrees,

 13mm X 13 degrees, 15mm X 13 degrees

 BB219 S4 Spinal System S4 Straight Rod - Titanium 35mm - 60mm $600.00

 BB220 S4 Spinal System S4 Straight Rod - Titanium 70mm - 180mm $600.00

 BB224 S4 Spinal System Polyaxial Screw - titanium various sizes Diameter 4.5mm & 5mm - all lengths 25 - $1,550.00

  60mm

 BB225 S4 Spinal System Polyaxial Screw - Titanium various sizes Diameter 6.0mm, 7.0mm & 8.0mm - all  $1,550.00

 lengths 25 - 60mm

 BB226 S4 Spinal System Monoaxial Screw - titanium various sizes Diameter 4.5mm & 5mm  - all lengths 25  $1,200.00

 - 60mm

 BB227 S4 Spinal System Monoaxial Screw - titanium various sizes Diameter 6.0mm, 7.0mm & 8.0mm - all  $1,200.00

 lengths 25 - 60mm

 BB228 S4 Spinal System S4 Cross Connector - titanium Rigid 22mm - 41mm $1,250.00

 BB229 S4 Spinal System S4 Cross Connector - titanium Variable 43mm - 75mm $1,500.00

 BB230 S4 Spinal System Set Screw - titanium one size $225.00

 Vascular

 BB027 Vascular Uni - Graft - Bifurcated Vascular graft 12x7 to 12x12 $375.00

 Bard Australia Pty Ltd

 Vascular

 BA090 Impra PTFE Vascular Grafts  ePTFE Cardiovascular, Patch 0.6mm, Circular 100 x 150mm $748.00

 Biomet Australia Pty Ltd

 Orthopaedic

 BI937 GPS Bone Biologics TCP Granules/GPS, TCP 20ml $2,150.00

 BI942 Peritrochanteric Nail System Trochanteric Nail Ti 24cm - 48cm $2,060.00

 Plastic and Reconstructive

 BI397 Lactosorb Resorbable Craniomaxillofacial Fixation  Bone Screw, Lactosorb 1.5mm, 2mm system;  (1.5, 2.0, 2.5, 2.8) x (3 - 17mm) $360.00

 System pkt 2, PGA/PLA

 BI415 Lactosorb Resorbable Craniomaxillofacial Fixation  Bone Screw,  2 Pack, Endobrow, Lactosorb.  2 x 5mm $160.00

 System PGA/PLA

 Benefit(s) Updated Items for Prostheses List Report  Page 2 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 BI602 Lactosorb Resorbable Craniomaxillofacial Fixation  Bone Screw, Lactosorb, 4 pack. PGA/PLA (1.5, 2.0mm) x (3, 4, 5 ,7mm) $444.00

 System

 BI791 Lactosorb Resorbable Craniomaxillofacial Fixation  Screw, 1.5mm System, PLLA/PGA Length 3-5mm (pack 10) $910.00

 System

 Biotronik Australia Pty Ltd

 Vascular

 BT035 PEIRON Flexible coated stent with delivery system Dia 5-8mm, length 18-38mm $2,500.00

 Boston Scientific Pty Ltd

 General/Miscellaneous

 BS101 Polyflex Airway Stent Poylester braided material encapsulated with  Stent inner diameters up to 22mm, stent  $2,040.00

 silicone, self expanding stent lengths up to 80mm

 BS102 Polyflex Oesophageal Stent Poylester braided material encapsulated with  Stent inner diameters up to 22mm, stent  $2,040.00

 silicone, self expanding stent lengths up to 80mm

 Urogenital

 BS086 Polaris Ultra Ureteral Stent This ureteral stent is made from Percuflex  Sizes up to 7Fr, lengths up to 30cm $315.00

 material with a Hydro Plus Coating

 Vascular

 BS035 Expandable Endovascular Wallstent Wallstent - Easy Wallstent, Iliac Wallstent (A  Stent Diameter x Stent Length: 6-16mm x  $1,800.00

 self-expanding stent that has a cylindrical  18-70mm

 braided structure composed of 24 wires with

 core of either tantalum or platinum).

 BS056 Carotid Wall Stent Model SCH64371, SCH64377, SCH64378,  Fully open diameter 6.0 - 10.0mm, Fully  $1,800.00

 SCH64379, SCH64382, SCH64383,  open length 22 - 37mm

 SCH64384, Elgiloy (cobalt chromium), flexible

 low profile, self expanding

 Corin Australia Pty Ltd

 Orthopaedic

 CR057 AMC Uni Condylar Tibial Component - Bonit Coat Tibial Base Plate, Cobalt Chrome, Titanium  1-8 $2,524.00

 Nitrate Ceramic Coated, Bonit (Calcium

 Phosphate) Ingrowth Surface

 CR061 AMC Uni Condylar, Cemented Tibial Base Plate AMC Uni Condylar Tibial Component (CoCr)  Sizes 1 - 8 inclusive $1,732.00

 Cemented with Titanium Nitrite Ceramic

 De Puy Australia

 Neurosurgical

 DP299 Moss Miami (Stainless Steel) Hooks - Pedicle One size only $820.00

 Benefit(s) Updated Items for Prostheses List Report  Page 3 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 DP300 Moss Miami (Stainless Steel) Hooks - Laminar as Wide or Narrow or Angled  One size only $820.00

 or Reduced Distance Supra-laminar or Offset or

  Extended Body

 DP410 Moss Miami (Titanium) Hooks - Pedicle 3-5 mm $820.00

 DP411 Moss Miami (Titanium) Hooks - Laminar as Wide or Narrow or Angled  One size only $820.00

 or Reduced Distance Supra-laminar or Offset or

  Extended Body

 DP464 Isola System (Titanium) Closed Hooks 1/4" x 3/16" x 5-11mm $820.00 $901.00

 DP472 Isola System (Stainless Steel) Open Hook Cap or Open 1/4" & 3/16" x 5-11mm $820.00

 DP567 Peak Polyaxial Anterior Cervical Plate System Graft Screw or Safety Locking Screw 4mm x 9 -15mm $944.00

 DP843 Moss Miami (Titanium) Sacral Extender 5mm x 5 - 20mm length $710.00

 DP845 Moss Miami 4mm Anterior System (SS) Hooks 4mm $820.00

 DY317 Isola System (Stainless Steel) Band Clamp Connector or Tandem Connector 1/4" & 3/16" $1,268.00

 DY333 Summit Cervical Rod System Occipital Bone Screw 4.5 - 5.25 Dia x 6 -16mm length $198.00

 DY356 SB Charite Disc Prosthesis End Plates Parallel & Oblique 1 - 5 $4,200.00

 Orthopaedic

 DP040 Bone Screw Screw Cancellous Titanium Dia 3.5 or 5 or 6.5 or 7mm length 15 - $91.00

 110mm

 DP766 Small / Large Fragment Set S/S Cancellous Screw 32 Thread - Stainless Steel Dia 6.5mm x 130-140mm $54.27

 DP859 Songer Cable System  - Stainless Steel Isola Single Cable & Crimp (Pkt 6) One size only $2,005.00

 DY164 Small / Large Fragment Set Low Profile Cannulated Cancellous Screw,  4mm x 10 - 50mm Length $182.85

 Fully Thread

 DY165 Fragment Set Small/Large Low Profile Cannulated Cancellous Screw,  4mm x 55 - 75mm $225.00

 Fully Thread

 DY361 Conduit TCP Conduit Blocks Size 1.  15x15x20mm to 25x25x20mm $1,882.00

 DY403 Modular Cathcart Unipolar Spacers -3 to +10mm $1,035.00

 Device Technologies Australia Pty Ltd

 Ophthalmic

 DE263 MicroCryl Acrylic Introcular lenses Foldable Monobloc Micrincision Posterior  6.D-40.0D $310.00

 Chamber Lens

 MC611M1

 DE264 MicroCryl Acrylic Introcular lenses Foldable Monobloc Posterior Chamber Lens 6.0D-40.0D $350.00 $390.00

 MCX11ASP

 Benefit(s) Updated Items for Prostheses List Report  Page 4 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 Plastic and Reconstructive

 DE100 McGhan Style 150 Biodimensional Biocell Textured Full height, Short Height 9.5 - 16cm width x 8 - 17cm height x 4.2 - $2,294.00

  Expand Gel/Saline Filled Mammary Implant, Low   7.1cm projection

 Vascular

 DE006 Onyx System DSMO/Liquid Embolic Material 18, 20, 34 (formulations) $2,300.00

 Edwards Lifesciences Pty Ltd

 Cardio-thoracic

 EL031 Carpentier-Edwards Perimount Pericardial  Carpentier-Edwards Pericardial Bioprosthesis.  Models 2900/6900 19-33mm, Model  $4,900.00 $5,144.00

 Bioprosthesis - Models 2900/6900  Carpentier- Composition: Bovine Pericardium; Elgiloy  6900P 25, 27, 29, 31, 33mm

 Edwards Perimount Plus Pericardial Bioprosthesis  Alloy; Silicone Rubber, Polytetrafluoroethylene

 Mitral - Model 6900P

 EL039 Edwards Perimount Magna Model 3000 Carpentier-Edwards Perimount Magna  19MM Aortic Pericardial Tissue Valve;  $4,900.00 $5,690.00

 composition: Glutaraldehyde treated bovine  21MM Aortic Pericardial Tissue Valve;

 pericardium/elgiloy wireform stent/polyester  23MM Aortic Pericardial Tissue Valve;

 band/silicone rubber suture  25MM Aortic Pericardial Tissue Valve;

 ring/polytetrafluoroethylene cloth/polyester  27MM Aortic Pericardial Tissue Valve;

 29MM Aortic Pericardial Tissue Valve

 Vascular

 EL045 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items  Stent Length 19mm - 27mm, 0.018  $2,533.33

 included in delivery system: nylon balloon,  compatible

 stent and deployment system

 EL048 Lifestent Peripheral Stent Stent: Nitinol composition with tanilum  6-8mm Diameter, length 20-90mm $2,250.00

 markers, Items included in the delivery system:

 Stent, deployment system

 Endotec Australia Pty Ltd

 Orthopaedic

 EA036 BPU Revision Total Ankle Prostheses Tibial componenet ceramic coated titanium 1-6 $3,850.00

 EA037 Buechel-Pappas Total Ankle Prosthesis - Primary  Polyethylene mobile bearing 3mm - 11mm $925.00

 Endotherapeutics Pty Ltd

 Ear, Nose & Throat

 ET031 Serenocem Cement Reaction bonded polymer composite formed by One size only - box of 2 $1,560.00

  the neutralisation gelletation of a basic

 inorganic ionomer

 General/Miscellaneous

 ET001 Ferx Ella Esophageal Stent Kit includes esophageal stent, introducer,  Diam 20mm, Length 80 - 160mm $3,500.00

 balloon catheter

 Benefit(s) Updated Items for Prostheses List Report  Page 5 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 ET042 Soft Gastric Banding System Sterile long term implant for the treatment of  One size only $3,264.00

 obesity.  Supplied in kit format with catheter,

 port and huber needles

 Urogenital

 ET011 Macroplastique Sterile, textured, highly cross linked  1.3 ml & 2.5 ml $988.00

 polydimethylsiloxane elastomer implants

 suspended in a bio-excretable carrier gel.

 Vascular

 ET006 Embospheres - 2ml per implant $610.00

 ESKA Australia

 Orthopaedic

 EK028 ESKA Modular Shoulder System Humeral Stem Universal $2,295.00

 ev3 Australia Pty Ltd

 Vascular

 EE007 Nexus Detachable Coils Nexus Tetris Diam 3-19mm, Length 4-29cm $1,850.00

 EE008 Nexus Detachable Coils Nexus Multi Diameter Diam 2-10mm, Length 1-30cm $1,850.00

 Femcare Australia Pty Ltd

 General/Miscellaneous

 FE003 Filshie Clips - Sterishot With Disposable Applicator One Size $155.00 $440.00

 Gyrus Australasia Pty Ltd

 General/Miscellaneous

 GY083 SprayGel Adhesion Barrier Polymer Kit PK-A-6010 SprayGel Polymer Kit; PK-A- One size only; PK-A-4210 - 5 Kits/Box $300.00

 4210 SprayGel Open Surgery Polymer Kit

 Howmedica

 Neurosurgical

 HW385 Xia Spine System Monoaxial Screw Dia 4.5 - 8.5mm Length 25 - 60mm $1,225.00

 HW393 Xia Spine System Bone Screw One size only $577.00

 Incision Pty Ltd

 Vascular

 IP011 Jotec Flowline Bipore Vascular Graft Thin Wall with Spiral Reinforcement 40 & 50cm $1,700.00

 Benefit(s) Updated Items for Prostheses List Report  Page 6 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 IP012 Jotec Flowline Bipore Vascular Graft Thin Wall 40 & 50cm $1,100.00

 IP013 Jotec Flowline Bipore Vascular Graft Standard Wall with Spiral Reinforcement 70 & 80cm $1,300.00

 IP014 Jotec Flowline Bipore Vascular Graft Standard Wall 80cm $850.00

 IP015 Jotec Flow Weave Vascular Graft Flow Weave 30cm $550.00

 IP016 Jotec Flow Weave Vascular Graft Flow Weave 60cm $700.00

 IP017 Jotec Flow Weave Vascular Graft Flow Weave BioSeal 15cm $600.00

 IP018 Jotec Flow Weave Vascular Graft Flow Weave BioSeal 30cm $750.00

 IP019 Jotec Flow Weave Vascular Graft Flow Weave BioSeal 60cm $1,000.00

 IP020 Jotec Flowline Bipore Heparin ePTFE Vascular  ePTFE Vascular Graft with microporous  All sizes up to 50cm in length $950.00

 Graft Straight, Standard Wall structure. Standard Wall with Heparin

 IP021 Jotec Flowline Bipore Heparin ePTFE Vascular  ePTFE Vascular Graft with microporous  All sizes at over 50cm in length $1,300.00

 Graft Straight, Standard Wall structure. Standard Wall with Heparin

 IP022 Jotec Flowline Bipore Heparin ePTFE Vascular  ePTFE Vascular Graft with microporous  All sizes up to 50cm Length $1,100.00

 Graft Straight, Standard Wall with Reinforcement structure. Standard Wall with Heparin and

 Reinforcement

 IP023 Jotec Flowline Bipore Heparin ePTFE Vascular  ePTFE Vascular Graft with microporous  All sizes at over 50cm in Length $1,500.00

 Graft Straight, Standard Wall with Reinforcement structure. Standard Wall with Heparin and

 Reinforcement

 IP024 Jotec Flowline Bipore ePTFE Vascular Graft,  ePTFE Vascular Graft with microporous  All sizes up to 50cm in Length $870.00

 Straight, Thin Wall structure.  Thin Wall

 IP025 Jotec Flowline Bipore ePTFE Vascular Graft,  ePTFE Vascular Graft with microporous  All sizes at over 50cm in length $1,100.00

 Straight, Thin Wall structure.  Thin Wall

 IP026 Jotec Flow Nit Bioseal Polyester Vascular Grafts,  Flow Nit Bioseal Straight grafts are texturised  For all diameters in 30cm lengths $430.00

 Straight Grafts exterior yarns for superior tissue incorporation

 and healing characteristics, with the new

 Bioseal impregnation to make the grafts blood

 IP027 Jotec Flow Nit Bioseal Polyester Vascular Grafts,  Flow Nit Bioseal Straight grafts are texturised  For all diameters in 15cm lengths $540.00

 Straight Grafts exterior yarns for superior tissue incorporation

 and healing characteristics, with the new

 Bioseal impregnation to make the grafts blood

 Johnson & Johnson Medical Pty Ltd

 Neurosurgical

 JJ252 BIOPLATE Bone screw Titanium alloy long screw, 1 per pack,  Dia 1.5mm, length 3, 4, 5, 6, 8, 10mm $44.00

 packaged non-sterile

 JJ253 BIOPLATE Bone screw Titanium alloy emergency screws, 5 per pack,  Dia 1.8, length 6mm; Dia 2.3mm, length  $66.00

 packaged non-sterile 5mm

 Benefit(s) Updated Items for Prostheses List Report  Page 7 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 Orthopaedic

 JJ532 LCS Complete Revision System LCS Complete Revision VVC insert small-large+, 10 - 25mm $1,900.00

 Urogenital

 JJ070 TVT (Tension-Free Vaginal Tape) Single use device Undyed Prolene (polypropylene)  11 x 450mm $850.00

 nonabsorbable tape

 JJ478 Gynecare Prolift Pelvic Floor Repair System Pre-cut gynemesh PS and single use  PFRP01 $1,295.00

 instruments for mesh placement

 Mathys Orthopaedics Pty Ltd

 Orthopaedic

 MA422 Articula Shoulder Prosthesis Articula Humeral Head Bionit Ceramic (A1203) 44mm, 46mm, 48mm $5,650.00

 Medical & Optical  Instruments Australia Pty Ltd

 Orthopaedic

 MO272 Acumed Tap-Loc Variable angle locking plate system medial; left and right, lateral Olecranon  $1,550.00

 Left and right 6-20 holes

 Medical Device Alliance Pty Ltd

 Plastic and Reconstructive

 MP043 Silimed Tissue Expanders Double Chamber Model # 730, 20739 140/180-400/450ml $1,244.00 $1,800.00

 Medimen Australia Pty Ltd T/A Alpha Medical Services

 Orthopaedic

 MM001 MOJE Toe and Finger Implants Includes distal and proximal implants $1,500.00

 Medtel Australia Pty Ltd

 Vascular

 ME133 Micrus ACT Platinum Microcoil Delivery System Cerecyte Helical Cerecyte - 2mm x 2cm - 10mm x  $1,850.00 $1,950.00

 30cm

 ME134 Micrus ACT Platinum Microcoil Delivery System Cerecyte Helical Soft Stretch Resistant Cerecyte -  $1,850.00 $1,950.00

 2mm x 1cm - 4mm x 8cm

 ME135 Micrus ACT Platinum Microcoil Delivery System Cerecyte Spherical Cerecyte - 2mm x 2.5cm -  $1,850.00 $1,950.00

 19mm x 30cm

 ME136 Micrus ACT Platinum Microcoil Delivery System Cerecyte Straight Cerecyte - 4mm x 10cm - 6mm x  $1,850.00 $1,950.00

 30cm

 Medtronic Australasia Pty Ltd

 Benefit(s) Updated Items for Prostheses List Report  Page 8 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 Cardio-thoracic

 MC013 Medtronic Hall Heart Valve Aortic Model A7700,  A7700/M7700 Titanium. Pyrolite. Dacron,  A7700 - Diameter 20-31mm, M7700 -  $5,000.00

 Medtronic Hall Heart Valve Mitral Model M7700,  A7700EZ/M7700EZ Titanium. Pyrolite. PET Diameter 23-33mm, A7700EZ - Diameter

 Hall Easy Fit Aortic Heart Valve Model A7700,   19-29mm, M7700EZ - Diameter 23-31mm

 Hall Easy Fit Mitral Heart Valve Model M7700

 MC198 Medtronic Hall rotatable aortic valved collagen  Titanium, pyrolite, dacron 20 - 33mm $6,800.00

 impregnated conduit Model R7700

 MC292 Advantage Heart Valve - Aortic Model A7760 A7760 - Pyrolytic carbon, PET Diameter 19-31 mm $5,909.00

 MC324 Advantage Supra Aortic  Heart Valve Mechanical Heart Valve Pyrolite Carbon  Diameter (mm): 19 - 25 $5,909.00

 leaflets Pyrolite carbon ring

 MC681 Advantage Mitral Mechanical Heart Valve 23mm-33mm $5,909.00

 MC701 Mosaic Cinch, Aortic, Mitral Models 305cxx, 310cxx 19mm - 35mm $4,350.00

 Ear, Nose & Throat

 MC275 Vent Tube Fluroplastic, Silicone 1.14 - 1.27mm x 0.9 - 3.0mm $14.00

 Neurosurgical

 MC382 Colorado Spinal System Colorado 2 Rod 5.0mm and 5.5mm, length range 50 -  $444.00

 600mm

 MC402 CD Horizon Pedicle Screws Diameter 5.5 - 7.5  Lengths 25 - 80mm $1,037.00

 MC421 Atlantis Anterior Cervical Plate Plate 80.0 -   95.0mm $1,550.00

 MC449 Pyramesh Angled 25 - 150mm $3,605.00

 MC450 Pyramesh Curved 130mm $3,605.00

 MC451 Pyramesh Ovoid 8 - 70mm $3,605.00

 MC490 Orion Anterior Cervical System Locking screw One size only $126.36

 MC503 CD Horizon Fixed Angle Screw (Titanium) 25 - 90mm $1,037.00

 MC504 CD Horizon Breakoff Set Screw 25 - 55mm $155.00

 MC542 Vertex Spinal System Connector Length 10 - 13mm; diameter 3.2 -  $1,385.00

 MC544 Vertex Spinal System Rod 80 - 240mm $491.00

 MC546 Vertex Spinal System Set screw One size only $155.00

 MC579 CD Horizon Spondylolisthesis Screw Diameter: 4.5 - 7.5, Length: 25mm -  $1,500.00 $1,600.00

 MC586 CD Horizon Sextant Percutaneous Cannulated  Cannulated titanium percutaneous multi axial  Dia 3.5 to 9.5mm, Length 15 to 65mm $1,530.00

 Multi Axial Screw screw

 Benefit(s) Updated Items for Prostheses List Report  Page 9 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 MC589 Affinity Anterior cervical cage System The Affinity Cage is constructed of titanium  6 x 12mm; 6 x 14mm; 7 x 12mm; 7 x  $1,949.00

 alloy - kit includes trials, reamers and inserters. 14mm; 8 x 12mm; 8 x 14mm; 9 x 12mm; 9

  x 14mm; 10 x 12mm; 10 x 14mm; 11 x

 12mm; 11 x 14mm; 12 x 12mm; 12 x 14mm

 MC590 Vertex Reconstruction System Crosslink Bar Composition -  titanium alloy. The system  One size only $990.00

 allows for the adaptation of components from

 other Sofamor Danek systems to provide for

 constructs tailor made for individual cases.

 MC591 Vertex Reconstructive System Laminar Hook Composition -  titanium alloy 4.5mm / 5.5mm $820.00

 MC598 Equation Spinal System Screw Length 25-55mm $1,037.00

 MC608 TSRH 3D Connector Small, Medium, Large $1,020.00

 MC616 Atlantis System Element Express Kit Includes Plate, 4 Screws,  Plate 23 - 45mm $2,968.00

 Screwdriver Shaft, Screwdriver Handle

 MC635 CD Horizon Legacy In-Line Connector Length 40-110mm $1,600.00

 MC636 CD Horizon Eclipse Dual Head Screws 20-60mm $1,037.00

 MC637 CD Horizon Spire Plate One size $1,398.00

 MC667 SiLo Set Screw One Size only $155.00

 MC690 Neurostimulation System - Octad Leads Octad Standard Lead Kit without Percutaneous  45, 60 & 75cm $4,230.00

 Extension Model 3777,

 Urogenital

 MC180 Sacral Nerve Stimulation Unilateral Interstim  stimulation lead Models 3080 &  28 cm $3,330.00

 3886. Platinum / Iridium, polyurethane.

 MC719 InterStim Neurostimulator Model 3023 Titanium 42g $9,350.00

 Vascular

 MC715 Interceptor Plus Filter System Braided Nitol Filter: 3.5 - 6.5mm; Length: 180cm;  $2,022.00

 Profile: 0.032 - 0.036"

 Morton Surgical Pty Ltd

 Orthopaedic

 MG022 Surgimesh WN / Surgimesh WN non-adherent Sugimesh WN non-adherent Tintra L 30x30x20cm $1,300.00

 Nobel Biocare

 Plastic and Reconstructive

 NR001 Branemark Abutments Abutment, complete 3.5, 4.5, 5.0, 6.0, 7.0mm Diameter $96.00 $260.00

 Benefit(s) Updated Items for Prostheses List Report  Page 10 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 NR009 NobelDirect Implant Dental Implant Endosseous incorporating  10mm, 13mm, 16mm $617.00 $625.00

 abutment, Titanium

 Orthocare Pty Limited

 General/Miscellaneous

 OC006 Breg Paincare 3000 100ml Continuous Infusion device (delivers  100cc reservoir $370.00

 2ml/hr) with additional 4ml bolus.  Code # 10314 L=10.4cm, D=3.0cm, W=7.4cm

 OC007 Breg Paincare 3200 200ml Continuous Infusion device (delivers  200cc reservoir $265.00 $395.00

 4ml/hr) with additional 4ml bolus Code # 11030 L=10.4cm, D=6.5cm, W=7.4cm

 OC008 Breg Paincare 4200 200ml Continuous Infusion device (delivers  200cc reservoir $265.00 $395.00

 2ml/hr) with additional 4ml bolus Code # 11090 L=10.4cm, D=6.0cm, W=7.0cm

 Orthotech Pty Ltd

 Neurosurgical

 OH045 Synergy Spinal System Infant Hooks 4.75mm $772.00

 OH046 Synergy Spinal System Washers Single/Double 16mm - 21mm $1,040.00

 OH054 Interpore Bone Plate System TPS Locked Nut 3mm $500.00

 OH058 Synergy Spinal System Growth Rod 30 - 60cm $1,345.00

 OH130 Non-Fusion Spine Stabilising Device Titanium or PEEK Height 8 - 16mm $5,000.00

 OH178 Omega 21 Spine Fixation System Screw, Spondylolisthesis, 4.75mm, 5.5mm,  25mm - 65mm $1,480.00

 6.35mm, 7.5mm diameter

 OH185 Spinelink Spinal Fixation System End Cap, Titanium One size only $360.00

 OH186 OMEGA 21 Spine Fixation System Multidirection Coupling, Titanium One size only $780.00

 OH190 Omega 21 Spine Fixation System Screw, Expandable, 5.5mm, 6.35mm, 7mm,  25mm - 65mm $1,480.00

 Orthopaedic

 OH203 Altius Occipito-Cervico-Thoracic (OCT) System Rod 8 to 24cm x 3.5mm Occipital and  Curved $759.00

  Rod

 Pacific Medical

 Ear, Nose & Throat

 PM074 Tympo Vent Otological ventilation tubes,  paparella with tab Length 2.2mm $17.83

 Pacing Importers Pty Ltd

 Vascular

 PI004 Stentself Stent Phynox construction, adapted sizes &  Dia 5 - 9mm  Length: 20 - 100mm $1,800.00

 Benefit(s) Updated Items for Prostheses List Report  Page 11 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 Plus Orthopedics Australia Pty Ltd

 Orthopaedic

 PL140 POLAR CUP ACETABULAR CUP SYSTEM DUAL MOBILITY SHELL TITANIUM VPS 43-67MM $2,350.00 $2,600.00

 Portland Orthopaedics (Aust) Pty Ltd

 Orthopaedic

 PD021 M-COR Modular Hip System M-COR Uncemented Femoral Stem, Ti6AI4V 29-9Z to 47-17A $2,400.00

 PD022 M-COR Modular Hip System M-COR Uncemented Femoral Neck, Ti6AI4V 31Z to 51A $1,500.00

 Roche Diagnostics Australia Pty Ltd

 General/Miscellaneous

 RO003 Disetronic Administration Sets and Accessories Adaptor D-Tron plus 10/box $13.00

 RO004 "Disetronic Infusion Sets" Tender II 17/30 Pack 10/10 $7.70 $22.90

 RO006 Disetronic Administration Sets and Accessories Plastic Cartridge (H-Tron) 3.15mL 25/box $7.80 $11.96

 RO007 Disetronic Administration Sets Plastic Cartridge (D-Tron plus) 3.0mL 5/box $13.00

 RO010 "Disetronic Infusion Sets" Tender II 17/60 Pack 10/10 $7.70 $29.90

 RO011 "Disetronic Infusion Sets" Tender II 17/80 Pack 10/10 $7.70 $29.90

 RO012 "Disetronic Infusion Sets" Tender I 17/60 Pack 10 $7.70 $21.90

 Scient'x Australia

 Neurosurgical

 SX001 Isobar TTL Monoaxial Screw D: 4.5 - 8mm, L: 25 - 50mm $1,037.00

 SX002 Isobar TTL Polyaxial Screw D: 4.5 - 8mm, L: 30 - 55mm $1,600.00

 SX003 Isobar TTL Rod L: 45-450mm $419.00

 SX004 Isobar TTL Nut Blocker, Hemispherical $550.00

 SX006 Isobar TTL Hooks Small, Large, offset $820.00

 SX007 Antelys Cage H: 9-15mm $2,750.00

 SX008 Antelys Plate H: 19-23mm $1,271.00

 SX009 Antelys Screw D: 5mm, L: 32.5 to 50mm $250.00

 SX010 PCB Plate-Cage Titanium cervical plate-cage L: 14-16mm, W: 12-15mm, Cage Height:  $3,000.00

 4.5-8mm, Plate Height: 23-29mm

 Benefit(s) Updated Items for Prostheses List Report  Page 12 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 SX011 Stella Anterior cervical plate - titanium L: 21-121mm $1,550.00

 SX012 Stella Screw D: 4-4.5mm, L: 12-20mm $190.00

 SX014 CBK Cage PEEK L: 15mm, W: 13mm, H: 4.5-9mm $2,120.00

 SX015 Easys Connector Bar - titanium L: 40-100mm $660.00

 SX016 Easys Straddler - titanium alloy one size $900.00

 Smith & Nephew Surgical Pty Ltd

 Orthopaedic

 SN376 Profix I/M Peg Femoral or Tibial 10-20mm x 100mm. 10-20x150mm 10-20 $1,254.00

  x 200mm

 SN834 Competitor Deuce Patello Femoral Oxinium Sm, Med Lg, XLg $3,000.00

 SN838 Trigen InterTAN Nail Nail, Titanium diameter 10-13mm $1,350.00

 length 18-46cm

 Angle 125°-135°

 SN842 Platform Hip Stem Titanium grit blasted stem 0-12 $3,450.00

 St. Jude Medical Australia Pty Ltd

 Cardio-thoracic

 SJ036 St Jude Medical Coated Aortic Valved Graft Coated Aortic Valved Graft  21mm - 33mm $6,800.00 $7,800.00

 SJ037 St Jude Medical Aortic Expanded Cuff Heart Valve;  Aortic Expanded Cuff, Aortic Hemodynamic  Aortic Expanded 19 -31mm, Aortic  $5,909.00 $6,050.00

 St Jude Medical Aortic Hemodynamic Plus Cuff  Plus Cuff, Mitral Hemodynamic Cuff, Aortic & Hemodynamic 17 - 27mm, Mitral

 Heart Valve; St Jude Medical Mitral Hemodynamic   Mitral Rotatable Cuff Hemodynamic 17 -27mm, Rotatable 17 -

 Plus Cuff Heart Valve; St Jude Medical Mechanical  33mm

 Heart Valve Masters Series

 SJ039 St Jude Medical Regent Prosthetic Heart Valves Standard Cuff - Model 17AGN-751 - 29AGN- Standard cuff - 17-29mm, Flex cuff - 17- $5,909.00 $6,990.00

 751, Flex Cuff - Model 17AGFN-756 -  29mm

 29AGFN-756

 SJ069 St Jude Medical Biocor Porcine Prosthetic Heart  St Jude Medical Biocor Porcine Prosthetic  Aortic Valves - Tissue Annulus Diameter $4,350.00 $5,000.00

 Heart Valve is manufactured from selected   - 21-29mm,  Implant Height - 11-15c; 

 procine aortic valve cusps that have been cross- Mitral Valves - Tissue Annulus Diameter

 linked with a glutaraldehyde solution  - 25-35mm, Implant Height - 8-10mm

 Vascular

 SJ043 Intergard W Woven Aortic Arch 24mm x 10mm x 8mm x 8mm x 50cm -  $1,950.00

 30mm x 10mm x 8mm x 8mm

 Stryker Australia Pty Ltd

 Neurosurgical

 Benefit(s) Updated Items for Prostheses List Report  Page 13 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 ST687 Dimso/Stryker Implants Diapason Screw -long arm 5.5, 6.7, 7.7mm by 30-60mm by 5mm  $879.00

 increment

 Orthopaedic

 ST971 TenXor External Fixation System Anodized metal alloy, with sliding clamp One size only $250.00

 Plastic and Reconstructive

 ST163 Leibinger Titanium Implant System Leibinger Steinhauser plate: L-shape, right/left,  5 holes, 8mm bar, 0.55mm height $200.00

 with bar Titanium

 ST311 Leibinger Titanium Implant System Plate - Leibinger Low Profile Osteosynthesis  4 holes $110.00

 System: mini, non-compression / compression,

 straight, regular / extended, medium / long

 Titanium

 ST346 Leibinger Screws  Leibinger Micro Screws: cross-slot, self- 1.2x2mm, 1.2x5mm $65.00

 tapping  Titanium

 ST362 Leibinger Screws  Leibinger - Salzburg Lag Screws Titanium 2x13mm, 2x15mm.  Pack of 10 $50.00

 Stryker Australia Pty Ltd (2)

 Neurosurgical

 SK224 Oasys-Occipito Cervico Thoracic System Ti-6A1-4V 3.5mm Rod (Length 80mm); 3.5mm Rod  $722.00

 (Length 120mm); 3.5mm Rod (Length

 240mm)

 Orthopaedic

 SK055 Matta Pelvic System Straight acetabular plate 10-14 Holes $368.00

 SK057 Matta Pelvic System Straight acetabular plate 15-20 Holes $160.00

 SK067 Matta Pelvic System Curved Pelvic Plate Radius 108 4-9 Holes $53.00

 SK069 Matta Pelvic System Curved Pelvic Plate Radius 108 10-14 Holes $32.00

 SK071 Matta Pelvic System Curved Pelvic Plate Radius 88 4-9 Holes $61.00

 Plastic and Reconstructive

 SK422 Orthodontic Skeletal Anchor Screw Anchor Screw for Mandibular Maxillary  1.7mm $110.00

 Fixation Screw, Self-Drilling

 SK423 Orthodontic Skeletal Anchor Screw Anchor Screw for Mandibular Maxillary  2.0mm $110.00

 Fixation Screw, Self-Drilling

 Surgical House

 Neurosurgical

 SU002 Rod 3.5mm CVD Titanium alloy; component of the Olerud  120mm $419.00

 Cervical System

 Benefit(s) Updated Items for Prostheses List Report  Page 14 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 SU003 Rod 3.5mm CVD Titanium alloy; component of the Olerud  40mm $419.00

 Cervical System

 SU004 Rod 3.5mm CVD Titanium alloy; component of the Olerud  80mm $419.00

 Cervical System

 SU072 OGP posterior lumbar rigid screw fixation system OGP clamp 10,12,14,16,18mm $1,386.00

 SU074 Olerud spinal system: Threaded rod  Hook/screw & rod spinal system component 35mm - 180mm x 7mm $492.00

 SU083 Rod straight 40mm Hook/screw & rod Spinal system component 3.5mm diam $419.00

 SU084 Rod straight 80mm Hook/screw & rod spinal system component 3.5mm diam $419.00

 SU085 Rod straight 120mm Hook/screw & rod spinal system component 3.5mm diam $419.00

 SU089 Occiput rod 120mm Hook/screw & rod spinal system component 3.5mm diam $2,888.00

 SU095 Songer cable system  Double loop titanium spinal cable plus crimps One size only $464.00

 SU096 Hartshill: Ransford Occipito-cervical - titanium loop 100 degree 9mm-20mm $3,364.00

 SU098 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam 3-5cm length $804.00

 SU099 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam  6-8cm length $1,027.00

 SU100 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam  9-11cm length $1,239.00

 SU101 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam  12-14cm length $1,471.00

 SU102 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar  6mm diam 15-19cm length $1,972.00

 fusion system

 SU103 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar  6mm diam 20-24cm length $2,316.00

 fusion system

 SU104 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar  6mm diam 25-30cm length $2,700.00

 fusion system

 SU105 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar  6mm diam  31-36cm length $2,980.00

 fusion system

 SU106 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar  6mm diam 37-44cm length $3,473.00

 fusion system

 SU172 Stalif Interbody Spinal Fusion Implant:   37mm x 11, 13, 15mm; 41mm x 11, 13,  $5,036.00

 Retroperitoneal/Transperitoneal 15mm; 45mm x 11, 13, 15mm; 37mm x

 17mm, 41mm x 17mm, 45mm x 17mm

 SU173 Intext Cervical Plate/Intext Screws Intext cervical plate, including (2-part) fixation  Screws/Revision Screws - dia 4.4mm,  $744.00

 screws length 11 - 18mm - Pack of 3

 SU198 Olerud ME-Connector Titanium. For polyaxial connection of Olerud  for use with 3mm and 4mm Olerud  $743.00

 cervical pedicle screws to rod, claws etc for

 fixation of the cervical spine.

 Benefit(s) Updated Items for Prostheses List Report  Page 15 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 SU199 Olerud PF Blocks Titanium, Threaded or Non-threaded, 0, 10,  To suit 7mm Olerud PF Rods $1,200.00

 13mm offset

 Surgical Specialties Pty Ltd

 Orthopaedic

 SQ001 Rearfoot Plate - RPS Titanium 6-14 holes $750.00

 Surgical Synergies Pty Ltd

 General/Miscellaneous

 SS004 PainBuster Kit includes catheter, introducer needle, flow  270ml volume x 5 ml per hour $300.00

 restrictor, filter

 Synthes Australia Pty Ltd

 Neurosurgical

 SY150 Universal Spine System (USS) Washers Pointed, Flat, 4.2 - 7mm $431.00

 SY175 Universal Spine System (USS) Pedicle Screw - USSII 25 - 140mm $1,350.00

 SY250 Universal Spine System Low Profile Transconnector 18-83mm length $1,100.00 $2,565.00

 SY276 Spine Cable System Single Lead One size only $412.00

 SY289 USS llio-Sacral Fixation system Polyaxial screw 20mm to 140mm $1,390.50

 SY291 Anterior Tension Band Locking Screw 22mm to 36mm $275.00

 SY295 Synmesh End rings round/oblong $1,133.00 $1,200.00

 SY325 Universal Spine System Hook Small, Medium, Large, Lamina, Thoracic,  $970.26

 Pedicle

 SY364 Cervical Spine Locking Plate (CSLP) System Eepansion Head Screw Dia 3.5 - 4.5mm, Length 12 - 25mm $298.00

 Orthopaedic

 SY056 Cortex Screws 2.7mm - 5.00mm diameter, 5mm -  $92.70

 100mm Length

 SY065 Cortex Screw Cortex Screws 1.0mm - 2.6mm diameter, 5mm - 100mm  $67.00

 Length

 SY081 AO/ASIF Screws 4.0mm Cancellous Screws 29.0 - 70.0mm $48.93

 SY105 AO/ASIF Plates - Steel Condylar & small condylar, angled plate 5 - 24 hole, blade length 50 - 90mm, 95  $974.00

 degree

 SY189 ChronOS Cylinder Osteoconductive Bone Substitute 8.5, 9.5, 10.5, 12.5 & 14cm $980.20

 SY224 Orthopaedic External Fixator Systems External fixator clamp components, angled  3.5-11.0mm $1,167.30

 Benefit(s) Updated Items for Prostheses List Report  Page 16 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 SY352 Cortex Screws Cortex Screws pack of four 1.00mm 2.6mm diameter, 5mm - 100mm  $268.00

 length

 SY353 Cortex Screws Cortex Screws pack of four 2.7mm - 5.0mm diameter, 5.0mm -  $370.80

 100mm Length

 Tag Medical

 Cardio-thoracic

 TM039 Mitroflow Pericardial Bioprosthesis 19-27mm $4,445.00 $4,950.00

 Taylor Bryant Pty Ltd

 General/Miscellaneous

 TB137 Curaspon Absorbable Gelatin Sponge CUR-ST-1258001-10C Absorb Sterile Gelatin  100mm, Bx /10 $41.00

 Sponges

 Neurosurgical

 TB192 Blackstone Medical Inc Anterior Cervical Plate  Titanium alloy plate 4.4mm Diameter x 14mm length $2,050.00

 TB241 Spinal Fixation System Rod - Titanium 40mm to 100mm in 10mm increments $260.00

 TB273 Blackstone - Posterior Cervical System Double  Loop Cable w/Four Crimps - Titanium One size only $464.00

 TB293 Wafer Cartridge Assemby, Composition: Peek 8 x 20/25/30mm $2,700.00

 Terumo Corporation Australia

 Vascular

 TU036 Gelweave Valsalva Graft Woven vascular prosthesis, polyester, gelatin  Diameter 26 - 32 mm, Overall length 18.6 $3,250.00 $3,528.50

 sealed  - 19.2 cm

 W L Gore & Associates

 Vascular

 GT002 Gore-Tex Axillo-Bifemoral Vascular Graft ePTFE 70 - 40cm Length 8 x 8mm Diameter $1,900.00

 GT003 Gore-Tex Axillo-Bifemoral Vascular Graft with  ePTFE 70 - 40cm Length 8 x 8mm Diameter $1,900.00

 Removable Rings

 GT006 Gore-Tex Bifurcated Graft ePTFE 12x6mm to 24x12mm 40-50cm long $930.00

 GT010 Gore-Tex  Vascular Graft THIN Wall Grafts TAPERED (ePTFE) 4.5-6.5 & 6-8mm Diameter x 80-90cm  $1,320.00

 Lengths

 GT020 Viabahn/Hemobahn Endoprosthesis Endoluminal Graft System Viabahn 2.5mm - 8mm Diameter, 5cm  $3,270.00

 Length; Hemobahn 6 - 13mm Diameter,

 5cm Length

 Benefit(s) Updated Items for Prostheses List Report  Page 17 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 GT021 Viabahn/Hemobahn Endoprosthesis Endoluminal Graft System Viabahn 2.5mm - 8mm Diameter, 10cm  $3,995.00

 Length; Hemobahn 6 - 13mm Diameter,

 10cm Length

 GT022 Viabahn/Hemobahn Endoprosthesis Endoluminal Graft System Viabahn 2.5mm - 8mm Diameter, 15cm  $4,530.00

 Length; Hemobahn 6 - 11mm Diameter,

 15cm Length

 GT023 Excluder Endovascular Prostheses Thoracic Stent Graft Nitinol & ePTFE 26-40mm Diameter x 15-20cm Lengths $14,500.00

 GT029 Gore Tips Endoprosthesis ePTFE 8-12mm Diameter 4-8cm Graft-Lined  $4,120.00

 Length 2cm Unlined Length

 GT134 Gore-tex Vascular Grafts Standard Wall Grafts (ePTFE) Diameter 6 - 10mm, Length 50cm $690.00

 GT147 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 12 - 24mm, Length 30cm $525.00

 GT175 Gore-tex Vascular Grafts Ringed Grafts Removable Standard Wall  4-7 mm x 70cm - Rings 30cm  Length $1,300.00

 Tapered (ePTFE)

 GT190 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Iliac  Diameter 10 - 14.5mm, Length 7cm $3,700.00

 Extender

 GT191 Excluder Endovascular Prostheses Thoracic Stent Graft Nitinol & ePTFE Diameter 26-40mm x  10cm Length $13,400.00

 GT216 Gore-tex Axillobifemoral Vascular Graft Stretch vascular graft with removable rings  Diameter 8mm $1,950.00

 (ePTFE)

 GT218 Gortex Propaten Vascular Graft Stretch Thin Wall Graft (ePTFE) 6mm diameter 30cm Removable Ring -  $1,870.00

 70cm length

 GT220 Gortex Propaten Vascular Graft Stretch Thin Wall Graft (ePTFE) 6-8mm diameter 60-70 Removable Ring -  $1,920.00

 80cm length

 GT222 Gortex Propaten Vascular Graft Stretch Thin Wall Graft (ePTFE) 6-8mm diameter Non-Ringed 80cm length $1,260.00

 William A Cook Aust Pty Ltd

 General/Miscellaneous

 WC078 Cook Biliary Stents Composition Plastic, includes Stent, Wireguide  French 7.0, length 4cm $245.00

 & Positioner

 WC199 Cook Gastronomy Tubes Russell Gastronomy Set 14fr, 17cm $284.98

 Urogenital

 WC162 Cook Ureteral Stent - Tarkington Urethral Stent Stent, Wire 8 fr $79.00

 WC171 Urinary Tract Stent set Endo-Sof Multilength Ureteral Stent and  5, 6, 7 fr, Length: 22-32cm $180.00

 Positioner Only

 Vascular

 WC045 Cook H & L-B - Endostent  Converter Diameter 20 thru 36 Length 80-85 $817.88

 WC061 Detachable Coil System Microembolisation Coils - Platinum 011/018 2-20mm diameter, 2 - 50cm length $785.90

 Benefit(s) Updated Items for Prostheses List Report  Page 18 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 WC076 Flipper-Patient Ducts Arteriosus-Occluding System Detachable Coil for PDA Closure Coil Diameter 3,5,6.5 & 8 mm Number of $233.95

  Loops (3,4,5)

 WC094 Cook Implantable Injection/Infusion Ports Mini Single Chamber Titanium with Standard  5.0fr, 6.5fr, 7.5fr, 8.5fr Pre-attached or  $523.00

 Introducer Set; Petite Single Chamber Titanium  Detached Catheter

 with Standard Introducer Set; Petite Single

 Chamber Titanium with Micropuncture

 Introducer Set; Standard Single Chamber

 Titanium with Standard Introducer Set

 WC111 Cook Central Venous Catheterisation Kit Single lumen peripherally inserted catheter set,  Fr 3, 4, 5 and Length 50 and 60cm $132.55

 includes catheter, needle, J-wire and introducer

 WC112 Cook Central Venous Catheterisation Kit Double lumen peripherally inserted catheter  Fr 6, 7 and Length 50cm $199.50

 set, includes catheter, needle, wire or J-wire and

  introducer

 WC115 Cook Implantable Injection/Infusion Port Mini Single Chamber Titanium with  5.2fr Detached Catheter $639.00

 Micropuncture Introducer Set

 WC153 Zenith AAA Endovascular Graft Composite One size only $12,500.00

 WC156 Zenith AAA Endovascular Graft ZFEN-1000 Fenestrated One size only $15,800.00

 WC157 Zenith TAA Endovascular Graft Thoracic - TX2 One size only $17,600.00

 WC159 Zenith TAA Endovascular Graft Thoracic - TX1 One size only $10,800.00

 WC160 Zenith TAA Endovascular Graft Thoracic Proximal Extension Dia 22 Length 77; Dia 24 Length 77;Dia  $6,150.00

 26 Length 77; Dia 28 Length 80; Dia 30

 Length 80; Dia 32 Length 80; Dia 34

 Length 77; Dia 36 Length 77; Dia 38

 Length 77; Dia 40 Length 81

 Diameter 42 Length 81

 WC164 Cook Implantable Injection/Infusion Ports Dual Chamber Titanium Port 7.5 fr, 11.5 fr Pre-Attached or Detached  $746.00

 Catheter with Standard or Micropuncture

  Introducer

 WC173 Cook Embolisation Coils Nester Platinum Diameters: .018 and .035, Extended  $241.85

 Lengths: 14cm, Coil Diameters: 3mm to

 10mm

 WC186 ZenithThoracic Endovascular Graft Thoracic Proximal Graft 22mm to 42mm diameter; 115mm to  $8,800.00

 216mm length

 WC187 Zenith Thoracic Endovascular Graft Thoracic Distal Graft 26mm to 42mm diameter; 127mm to  $8,800.00

 207mm length

 WC188 Zenith Thoracic Endovascular Graft Thoracic Body Extension 22mm to 42mm diameter; 77mm to  $6,000.00

 81mm length

 WC192 Detachable Mreye Embolization Coils Jackson Mreye Diameters: .035 and .038 Extended  $133.90

 Lengths:  4cm to 6cm Coil Diameters:

 3mm to 12mm

 Benefit(s) Updated Items for Prostheses List Report  Page 19 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 WC201 Cook Central Venous Catherisation Kits Turbo-Flo Peripherally Inserted Central  4Fr - 60cm and 5Fr - 60cm $132.55

 Venous Catheter Set, Single Lumen

 Polyurethane with Micropuncture Peel-Away

 Sheath Introducer and Wire Guide

 WC204 Cook Central Venous Catheterisation Kits Turbo-Flo Over-The-Wire Peripherally  4Fr - 60cm and 5Fr -60cm $132.55

 Inserted Central Venous Catheter Set, Single

 Lumen Polyurethane with Micropuncture Peel-

 Away Sheath Introducer and Wire Guide

 WC206 Cook Central Venous Catheterisation Kits PICC Peripherally Inserted Central Venous  3Fr - 50cm and 4Fr and 5Fr - 60cm $238.99

 Catheter Set, Single Lumen Silicone with

 Micropuncture Peel-Away Sheath Introducer

 and Nitinol Wire Guide

 WC207 Cook Central Venous Catheterisation Kits PICC Peripherally Inserted Central Venous  3Fr - 50cm and 4Fr and 5Fr - 60cm $132.55

 Catheter Set, Catheter without Clamp, Single

 Lumen Silicone with Micropuncture Peel-

 Away Sheath Introducer and Wire Guide

 WC208 Cook Central Venous Catheterisation Kits PICC Peripherally Inserted Central Venous  4Fr - 60cm and 5Fr - 60cm $241.25

 Catheter Set, Catheter without Clamp, Single

 Lumen Silicone with Micropuncture Peel-

 Away Sheath Introducer and Nitinol Wire Guide

 WC210 Zenith Fenestrated AAA Endovascular Graft Distal Fenestrated Body Diameter 12-24mm, 1st length 28-62mm,  $4,700.00

 2nd length 76-121mm

 Zimmer

 Neurosurgical

 ZI330 Trabecular Metal Spinal Devices Composition - Trabecular Metal Various heights, sizes and diameters $6,200.00

 ZI334 Dynesys Cord Composition: Sulene 100 or 200 mm long $2,669.00

 ZI479 Silhouette Spinal System Implants Nut, Locking, Polyaxial 1 size $170.00

 ZI483 Spine-Tech BAK "L" Cage Lumbar Cage 9 x 20mm, 9 x 24mm, 11 x 20mm, 13 x  $1,719.00

 20mm, 13 x 24mm, 15 x 20mm, 15 x

 24mm, 17 x 24mm, 17 x 28mm

 ZI487 Trinica Screw Titanium Screws, fixed and variable angle. 4.2mm x 12/14/16/18mm; 4.6mm x  $195.00

 12/14/16/18mm

 Orthopaedic

 ZI510 Optima Spinal System - Transverse Link Assembly Small, Medium, Large $936.00

 ZI511 Optima Spinal System - Set Screw One size only $312.00

 ZI512 Optima Spinal System - Rod Dia 5-7mm, length 40-400mm $513.00

 ZI513 Optima Spinal System - Monoaxial Pedicle Screw  Dia 4-8mm, length 20-60mm $936.00

 System

 Benefit(s) Updated Items for Prostheses List Report  Page 20 of 21


 Billing  Product Name Description Size MinBenefit MaxBenefit

 ZI514 Optima Spinal System - Polyaxial Pedicle Screw  Dia 4-8mm, length 20-60mm $1,300.00

 System

 Benefit(s) Updated Items for Prostheses List Report  Page 21 of 21

Changed Items for Prostheses  August 2006  Attachment B

 Billing  Product Name  Description Size Explanation of Change

 Advanced Biomedical Pty Ltd

 Cardio-thoracic

 AB002 ATS medical open pivot heart valve model 500FA  Pyrolythic Carbon, Double Velour Polyester,  16-33mm Expanded into AB064. Change of

 standard flexi-cuff aortic valve series, ATS medical  Titanium product name.

 open pivot heart valve model 500DM standard

 flexi-cuff mitral valve series

 AB064 ATS medical open pivot heart valve model 501DA  Pyrolythic Carbon, Double Velour Polyester,  16-33mm Expansion from AB002. Change of

 advanced performance (AP) aortic valve series, ATS Titanium product name.

  medical open pivot heart valve model 501DM

 advanced performance (AP) mitral valve series

 Atrium Australia-Pacific Rim Pty Ltd

 Vascular

 AC002 Atrium PTFE Vascular Graft Straight PTFE Standard Wall 6mm x 10cm - 10mm x 90cm Group Changed to VPCAG 3a

 Boston Scientific Pty Ltd

 Urogenital

 BS086 Polaris Ultra Ureteral Stent This ureteral stent is made from Percuflex  Sizes up to 7Fr, lengths up to 30cm Added ARTG number 50859

 material with a Hydro Plus Coating

 BS091 Percuflex; Percuflex Plus; Percuflex Tail; Percuflex  Each Stent contains a ureteral stent with  Size: 4Fr to 14Fr, Length: 10cm to 95cm Expanded from BS038. Change of

 Tail Plus Ureteral Stents. attached suture and stent positioner product name

 BS092 Contour Ureteral Stents Each Stent contains a ureteral stent with  Size: 4Fr to 14Fr, Length: 10cm to 95cm Expanded from BS038. Change of

 attached suture and a stent positioner .  If  product name.

 packaged as a set, the set will contain the

 ureteral stent, stent positionerand guidewire

 BS093 Retromax Plus Ureteral Stent Each Stent contains a uretera stent with  Size: 4Fr to 14Fr, Length: 10cm to 95cm Expanded from BS038. Change of

 attached suture and stent poitioner. product name

 BS094 Contour VL; Stretch VL Flexima; Ureteral Stents Each Stent contains a ureteral stent with  Size: 4Fr to 14Fr, Length: 10cm to 95cm Expanded from of BS038. Change of

 attached suture and a stent positioner product name

 BS095 Urinary Diversion Stents Each Stent contains a ureteral stent with  Size: 4Fr to 14Fr, Length: 10cm to 95cm Expanded from BS038. Change of

 attached suture and a stent positioner product name

 

 

 Changed Items for Prostheses List Report  Page 1 of 4


 Billing  Product Name  Description Size Explanation of Change

 Cochlear Limited

 Ear, Nose & Throat

 CO027 BAHA - Bone Anchored Hearing Aids Flange fixture 4mm and 3mm Change to product size

 CO030 BAHA - Bone Anchored Hearing Aids Flange Fixture - Titanium Self Tapping 4mm and 3mm Change to product size

 CO032 BAHA - Bone Anchored Hearing Aids Flange Fixture - Titanium Self Tapping 4mm and 3mm with BAHA Change to product size

  Abutment

 Corin Australia Pty Ltd

 Orthopaedic

 CR016 Cormet 2000 - Modular Endo Head CoCr alloy >32mm Change to product size

 CR063 Ceramic Insert for Alpha Cera Fit Cup Biolox Forte 28-36mm Change to product size

 CR065 Ball Heads 12 - 14 Taper (Alumina) Alumina Ball Head (28mm) >32mm Change to product size

 CR073 Alpha Lock, (UHMWPE) Inlays UHMWPE 22-32mm Change to product size

 CR086 Tri-Fit Hip Titanium stem proximally coated with titanium  5-20mm Change to product size

 plasma spray and Hydroxyapartite

 De Puy Australia

 Neurosurgical

 DY069 Codman Anterior Cervical Plate System Anterior Cervical Plate 50 - 70mm Category changed to Neurosurgical

 Edwards Lifesciences Pty Ltd

 Cardio-thoracic

 EL033 Baxter Augmentation / Substitution Material,  Edwards Pericardial Patch. Bovine Pericardium. 10cm x 16cm Group Changed to CPCAG 5a

 Human or Animal Origin, Sterile Pericardial Patch.

 Endotec Australia Pty Ltd

 Orthopaedic

 EA036 BPU Revision Total Ankle Prostheses Tibial componenet ceramic coated titanium 1-6 EA001 expanded into EA036

 EA037 Buechel-Pappas Total Ankle Prosthesis - Primary  Polyethylene mobile bearing 3mm - 11mm EA002 expanded into EA037

 Howmedica

 Orthopaedic

 HW017 Stryker Biolox Forte Alumina Femoral Head 28, 32mm ST928, SK011 and SK012 have been

 compressed into HW017

 HW032 Stryker CoCr Femoral Head 22, 26, 28, 30, 32mm HW018, HW027, HW058, HW059,

 ST567, ST598 were compressed into

 HW032

 

 Changed Items for Prostheses List Report  Page 2 of 4

 

 Billing  Product Name  Description Size Explanation of Change

 IQ Medical

 Ophthalmic

 

 IQ003 Tetraflex Acrylic single piece, foldable accommodating  Available in dioptric powers from +5.0 to Changed group to LPCAG 5c with suffix

 intraocular lens with sqare edge design, custom   +36.0, 1D steps: +31.0 to +36.0; 0.5D   (P).

 control precision and closed loop haptic design steps: +5.0 to +18.0 and +25.0 to +30.0;

 0.2D steps; +18.0 to +25.0

 Medtronic Australasia Pty Ltd

 Cardio-thoracic

 MC005 Medtronic Duran Annuloplasty Ring; Duran  Annuloplasty Devices - Models 610R & 620R  Model 610R 25-35mm & Model 620R  Expanded into Billing code MC709.

 Ancore Ring 620R; Duran Ancore Chordal Model  Silicone / Barium Sulphate, Dacron. 23-35mm Product name, description and size

 changed

 MC709 Posterior Annuloplasty Band;  Colvin - Galloway  Annuloplasty - Model 610B & 620B Silicone /  Model 610B: 25-35mm; Models 620B &  Expanded from MC005. Product name,

 Future Band Model 638B; Duran Ancore Band  Barium Sulphate, Dacron. Models 638B semi- 620BG: 23-35mm, Model 638B - 26-38mm description and size changed.

 620B; Duran Ancore Chordal Model 620BG regid metal alloy core, silicone coating,

 polyester knit fabric, kit includes-band,

 malleable handle, template with suture markers,

 Neurosurgical

 MC375 Colorado Spinal System Colorado 2 Hook, Pedicular hook - small and  MC375 was expanded into MC724 due

 large, Laminar hook - small, medium and large,  to two groupings. Product description

 Staple for pedicular hooks,

 Open laminar thoracic hook, Supra laminar

 median hook,

 Narrow laminar - 1 size, Open laminar - 1 size

 MC710 Neurostimulation System - Octad Leads Octad Standard Lead Kit with Percutaneous  45, 60 & 75cm Expanded from MC690 into  MC710,

 extension model 3877 MC711 and MC712. Product

 description changed

 MC712 Neurostimulation System - Octad Leads Octad Compact Lead Kit with Percutaneous  45, 60 & 75cm Expanded from MC690 into  MC710,

 Extension Model 3878 MC711 and MC712. Product desription

  changed.

 Urogenital

 MC180 Sacral Nerve Stimulation Unilateral Interstim  stimulation lead Models 3080 &  28 cm Temporary test removed from further

 3886. Platinum / Iridium, polyurethane. description. Product description changed

 Vascular

 MC715 Interceptor Plus Filter System Braided Nitol Filter: 3.5 - 6.5mm; Length: 180cm;  Product name changed

 Profile: 0.032 - 0.036"

 

 Changed Items for Prostheses List Report  Page 3 of 4


 Billing  Product Name  Description Size Explanation of Change

 Roche Diagnostics Australia Pty Ltd

 General/Miscellaneous

 RO003 Disetronic Administration Sets and Accessories Adaptor D-Tron plus 10/box    Added text under field “Notation”

 RO004 "Disetronic Infusion Sets" Tender II 17/30 Pack 10/10    Added text under field “Notation”

 RO006 Disetronic Administration Sets and Accessories Plastic Cartridge (H-Tron) 3.15mL 25/box   Added text under field “Notation”

 RO007 Disetronic Administration Sets Plastic Cartridge (D-Tron plus) 3.0mL 5/box    Added text under field “Notation”

 RO010 "Disetronic Infusion Sets" Tender II 17/60 Pack 10/10    Added text under field “Notation”

 RO011 "Disetronic Infusion Sets" Tender II 17/80 Pack 10/10    Added text under field “Notation”

 RO012 "Disetronic Infusion Sets" Tender I 17/60 Pack 10    Added text under field “Notation”

 Smith & Nephew Surgical Pty Ltd

 Orthopaedic

 SN831 Peri-Loc UE Locking plates SS: Distal Radius, Olecrannon,  2.5-4.5mm, 3-14 holes Product name changed

 Humerus, Clavicle

 SN832 Peri-Loc UE Self Tapping Cortex Locking Screw 2.5-2.7mm, 10-60mm length Product name changed

 SN833 Peri-Loc UE Self Tapping Cortex Non Locking Screw 2.5mm, 10-30mm length Product name changed

 Southern Surgical Distribution Pty Ltd

 Urogenital

 DS001 Serasis TO Stress Incontinence system Blue Polypropylene monofilament tape with  55 cm tape    Sponsor Changed

 (Trans obturator approach) looped edges. Tape only

 Stryker Australia Pty Ltd

 Orthopaedic

 HW394 Stryker Bilox Forte Alumina Femoral Head 36mm Compressed billing code - SR001

 Stryker Australia Pty Ltd (2)

 Neurosurgical

 SK425 VBOSS/VLIFT Titanium Available from 10 to 25mm in Diameter  Expanded from SK338

 and from 8 to 120mm in Length

 Stryker Australia Pty Ltd (3)

 Orthopaedic

 SR023 Stryker Revision Femoral Head, Biolox Forte  With pre assembled titanium sleeve 28, 32mm Compressed billing code - SR010

 SR025 C-Taper CoCr HeadStryker CoCr Femoral Heads,  36mm SR019 and ST929 have been compressed

 LFIT treatment  into SR025

 Synthes Australia Pty Ltd

 Orthopaedic

 SY180 Cervical Spine Locking Plate (CSLP) System Small Stature Plate Length 20-77mm reinstated 15/10/06 after accidentally

 deleted in August 06. Previous Benefit

 amount retained.

Changed Items for Prostheses List Report  Page 4 of 4

Deleted Items for Prostheses List August 2006  Attachment C

Billing  Product  Description Size Explanation of Change

Boston Scientific Pty Ltd

General/Miscellaneous

 

NG033 Polyflex Airway Stent Poylester braided material encapsulated with silicone,  Stent inner diameters up to 22mm, stent lengths up to  transferred sponsorship from

 self expanding stent 80mm N Stenning to Boston Scientific

  Pty Ltd NG033-deleted, then

 BS101 and BS102 added

Howmedica

Orthopaedic

 

HW018 ABG Hip System ABG1 Metal femoral head - Francobal 22mm,28mm,32mm Dia Was compressed into HW032

HW027 Contemporary Hip System Range Femoral Head. Vitallium 22, 26, 28, 32mm Was compressed into HW032

HW058 PCA Hip System  Femoral Head -  Vitallium 22mm,26mm,28mm, 32mm Dia Was compressed into HW032

HW059 PCA Hip System  Revision (+15mm) Head -  Vitallium 26mm,28mm,32mm Dia Was compressed into HW032

Stryker Australia Pty Ltd

Orthopaedic

 

ST567 Osteonics hip prostheses  Femoral head,  cobalt chrome 22, 26, 28, 32mm  dia Was compressed into HW032

ST598 Peritia Metal head  cobalt chrome 12-14 and 14-16 taper 28 & 32mm dia Was compressed into HW032

ST928 ABG 1 Revision Femoral Head Composition - Alumina ceramic with pre assembled  32mm with OD with a std (0mm) #465700 and (+5mm) Was Compressed into HW017

 titanium sleeve  #465703 neck length options

ST929 V40 LFIT CoCr Femoral Heads Composition - Ion Implanted V40 Chrome Cobalt Heads Dia 22mm: Std (0), +3mm, +8mm neck lengths. Dia  Was compressed into SR025

 26mm: -3mm, Std (0), +4mm, +8mm, +12mm, +16mm

 neck lengths. Dia 28mm: -4mm, Std (0), +4mm, +6mm,

 +8mm, +12mm, +16mm. 32mm: -4mm, Std (0), +4mm,

 +8mm, +12mm, +16mm

Stryker Australia Pty Ltd (2)

Orthopaedic

 

SK011 PCA Revision Femoral Head 32mm OD with a std, +5mm neck length options Was Compressed into HW017

SK012 C-taper Ceramic Biolox Head 22 -28mm Diameter Was Compressed into HW017

 

 

 

Deleted Items for Prostheses List Report Page 1 of 2

 

Billing  Product  Description Size Explanation of Change

 

Stryker Australia Pty Ltd (3)

Orthopaedic

 

SR001 Stryker Biolox Forte Alumina  36mm Was compressed into HW394

 Femoral Head

SR010 PCA Revision Femoral Head 32mm OD with a std, +5mm neck length options Was compressed into SR023

SR015 Stryker CoCr Femoral Heads, LFIT 36mm Was compressed into SR025

  Treatment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Deleted Items for Prostheses List Report             Page 2 of 2

 

Items Added to the Prostheses List August 2006  Attachment D

Billing  Product  Description Size MinBenefit  MaxBenefit

 

 Sponsor : Boston Scientific Pty Ltd

 

BS101 Polyflex Airway Stent Poylester braided material encapsulated with silicone,  Stent inner diameters up to 22mm, stent  $2,040.00

 self expanding stent lengths up to 80mm

BS102 Polyflex Oesophageal Stent Poylester braided material encapsulated with silicone,  Stent inner diameters up to 22mm, stent  $2,040.00

 self expanding stent lengths up to 80mm

 Sponsor : De Puy Australia

DP060 VSP System (Stainless Steel) Sacral Connector - Left & Right Offset One size only $521.00

DP099 Coventry Screw System S/S Cannulated Screws 7.00 mm dia $495.00

DP102 Coventry Screw system  Cannulated Screws 4mm and 4.50 mm $258.00

DP170 Austin Moore Hip Prosthesis Ortron Custom sizes $591.00

DP205 Elite Modular Hip System Stem Ortron Custom size $3,700.00

DP222 Thackray Hip System Poly Liner Custom Made to order $1,200.00

DP252 Acroflex Lumbar Artificial Disc Lumbar Disc Replacement Device One size only $951.00

DP296 Cementraliser Cementraliser  Size 10 -13 $207.00

DP298 Centralisers Centraliser  Size 11 - 18 $207.00

DP505 Anterior Isola System (SS) Rod with Hex End 1/4" x 18" $325.00

DP549 C- Stem  C-Stem Heads Ortron Size -3 to +8 $700.00

DP837 Peak Channelled Plate System Cortical Bone Screw 3.5mm $114.00

DP842 Moss Miami (Stainless Steel) Sacral Extender 5mm x 5 - 20mm length $600.00

Items Added to the Prostheses List Page 1 of 3


Billing  Product  Description Size MinBenefit  MaxBenefit

 

 

 

DP848 Moss Miami 4mm Anterior System Screws - Polyaxial 6mm x 25 - 55mm $1,330.00 $1,619.00

  (SS)

DP849 Moss Miami 4mm Anterior System Washer or Staple or 12 sided outie One size only $255.00 $337.00

  (SS)

DP889 AMK Chrome CobaltTray Cobalt Chrome Tibial TEX  or TX FX Tray Size 1-5 $4,488.00

DP969 SROM Total Hip System UHMWPE Constrained  0Deg, 10 Deg, 28mm, 32mm, $2,341.00

DP980 SROM Total Hip System  Stem STD 14 x 09 x 130 NK36mm to 24 x 19 x 175 $4,428.00

  NK42mm

DP988 SROM Total Hip System  Unipolar  38-66mm $863.00

DP999 SROM Total Hip System  Unipolar Adaptor Sleeve +10 $593.00

DY107 Carbon Fibre Cages Stackable Cage Titanium Interface Screw Nuts One size only $815.00 $857.00

DY147 C-Stem End Cap One size only $132.00

DY167 G2 Hip System G2 Stem Cemented 1 - 11L $2,000.00

DY168 G2 Hip System Distal Centraliser 1 - 11 $409.00

DY198 Carbon Fibre Cages ALIF 1 C/F Cage 5 - 10 deg Sm to Lg 10 - 18 mm $3,080.00 $3,128.00

DY280 Pinnacle Acetabular Cup System Pinnacle GVF +4 or Neutral or 10 Degree or Lipped  38-80mm x 22.225 or 26 or 28 or 32 or 36mm $900.00

DY304 Monarch Spinal System Hooks - Open (Pedicle/Narrow Tapered/Wide Blade) 5-11mm $725.00

DY313 Monarch Spinal System Rods - Pre Cut/Lordosed 6.35 & 5.5mm x 45 - 95mm $329.00

DY321 Codman Anterior Cervical Plate  Rescue screw 12 & 15mm $178.00

 System

DY322 Carbon Fibre Interbody Fusion  Stackable C/F Cage System Wedges 11 Degree Small-Large $3,305.00 $3,407.00

 Device

DY350 RECO Spinal System Set Screw One size only $79.00

Items Added to the Prostheses List Page 2 of 3


Billing  Product  Description Size MinBenefit  MaxBenefit

 

 

DY351 RECO Spinal System Tranverse Connector 4 or 6mm $900.00

DY401 Monarch Monoaxial Pedicle Screw 4.75mm - 8.5mm x 25 to 80mm length $1,004.00 $1,782.00

DY450 Swift Spine System Titanium Anterior Cervical Plate System - various size  Level 4 size 60 - 100mm $2,700.00 $2,822.00

 Plates

DY454 Swift Spine System Titanium Anterior Cervical Plate System - 3.8mm  10 - 28mm $850.00

 Bicortical Screw

DY455 Swift Spine System Titanium Anterior Cervical Plate System - Graft Screw 10mm $850.00

DY501 SROM Total Hip System  ZT/HA Small / Large /XX Large  size 14B-24F $2,750.00

 Sponsor : Synthes Australia Pty Ltd

SY180 Cervical Spine Locking Plate  Small Stature Plate Length 20-77mm $1,250.00

 (CSLP) System

Items Added to the Prostheses List Page 3 of 3

PART B - Human Tissue List August 2006  Attachment E

 

 ORTHOPAEDIC

 Billing Code Facility Benefit Amount

 Cancellous Crunch - 15cc

 NBB62 New South Wales Bone Bank $795.00

 Cancellous Crunch - 30cc

 NBB61 New South Wales Bone Bank $1,450.00

 Cancellous Crunch - 60cc

 NBB60 New South Wales Bone Bank $2,200.00

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

 NBB65 New South Wales Bone Bank $795.00

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

 NBB64 New South Wales Bone Bank $1,450.00

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

 NBB63 New South Wales Bone Bank $2,200.00

 Femur - Hemicondyle

 NBB59 New South Wales Bone Bank $2,000.00

 Page 1 of 1

 

Interactions

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.