EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under subsections 73AAG (6) and (7)
(HIB 32/2006)
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.
The Schedule to this determination has two parts:
- Part A – Prostheses; and
- Part B – Human Tissue List.
The Schedule to this determination is known as the “Prostheses List”.
This determination commences on 30 November 2006. It replaces, in its entirety, the determination dated 12 September 2006 (HIB 22/2006), as amended by the determination dated 5 October 2006 (HIB 30/2006).
This determination updates 15 prostheses in Part A of the previous Prostheses List by:
- amending the benefit amounts of seven prostheses, as detailed at Attachment A;
- amending the product groups of seven prostheses and the product description of two prosthesis, as detailed at Attachment B; and
- deleting five prostheses as detailed at Attachment C.
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
NOVEMBER 2006
Prostheses Benefit Changes November 2006
CARDIO-THORACIC
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
Pacemaker leads
St. Jude Medical Australia Pty Ltd
SJ033 Aescula LV Model 1055K Left Ventricular Pacing Lead 75cm $2,735.00
Prostheses, Cardiac Valve, Artificial
St. Jude Medical Australia Pty Ltd
SJ036 St Jude Medical Coated Aortic Valved Coated Aortic Valved Graft 21mm - 33mm $6,800.00
Graft
SJ037 St Jude Medical Aortic Expanded Cuff Aortic Expanded Cuff, Aortic Aortic Expanded 19 -31mm, $5,909.00
Heart Valve; St Jude Medical Aortic Hemodynamic Plus Cuff, Mitral Aortic Hemodynamic 17 -
Hemodynamic Plus Cuff Heart Valve; St Hemodynamic Cuff, Aortic & Mitral 27mm, Mitral Hemodynamic 17
Jude Medical Mitral Hemodynamic Plus -27mm, Rotatable 17 - 33mm
Cuff Heart Valve; St Jude Medical
Mechanical Heart Valve Masters Series
SJ039 St Jude Medical Regent Prosthetic Heart Standard Cuff - Model 17AGN-751 - Standard cuff - 17-29mm, Flex $5,909.00
Valves 29AGN-751, Flex Cuff - Model cuff - 17-29mm
17AGFN-756 - 29AGFN-756
Prostheses, Cardiac Valve, Biological
St. Jude Medical Australia Pty Ltd
SJ069 St Jude Medical Biocor Porcine St Jude Medical Biocor Porcine Aortic Valves - Tissue Annulus $4,350.00
Prosthetic Heart Valve Prosthetic Heart Valve is manufactured Diameter - 21-29mm, Implant
from selected porcine aortic valve cusps Height - 11-15c; Mitral Valves -
that have been cross-linked with a Tissue Annulus Diameter - 25-
glutaraldehyde solution 35mm, Implant Height - 8-
Prostheses List Changes to Benefits Page 1 of 2
Benefit
Amount/
Minimum Maximum
Benefit Benefit
Billing Code Product Name Description Size Amount Amount Notations
OPHTHALMIC
Intraocular Lens
Device Technologies Australia Pty Ltd
DE264 MicroCryl Acrylic Introcular lenses Foldable Monobloc Posterior Chamber 6.0D-40.0D $350.00
Lens
ORTHOPAEDIC
Knee - Femoral Component Total Arthroplasty
Group 1c - Cemented, Alloy, Totally Constrained
Tornier Pty Ltd
TO008 HLS Noetos Total Knee Replacement - Femur Cemented 1 - 6 CoCr $4,000.00
Grand Total: 7 Records
Prostheses List Changes to Benefits Page 2 of 2
Prostheses Other Changes November 2006
Billing Product Name Further Description Size Explanation of Change
Corin Australia Pty Ltd
Orthopaedic
CR065 Ball Heads 12 - 14 Taper (Alumina) Alumina Ball Head >32mm Removed the words “(28mm)” from description
Endovision Pty Ltd
Urogenital
ED002 Memokath Ureteric Stent Model 051CW, Thermoexpandable, Nickel - Lengths 30mm - 100mm Group changed from 3a to 2d Nov 2006
Titanium
St. Jude Medical Australia Pty Ltd
Cardio-thoracic
SJ036 St Jude Medical Coated Aortic Valved Graft Coated Aortic Valved Graft 21mm - 33mm Group changed to 3a in Nov 2006
SJ037 St Jude Medical Aortic Expanded Cuff Heart Valve; Aortic Expanded Cuff, Aortic Hemodynamic Aortic Expanded 19 -31mm, Aortic Group changed to 1c in Nov 2006
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- Group changed to 1c in Nov 2006
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 Group changed to 2a in Nov 2006;
Heart Valve is manufactured from selected - 21-29mm, Implant Height - 11-15c; words “glutaraldehyde solution” added to end of
porcine aortic valve cusps that have been cross- Mitral Valves - Tissue Annulus Diameter product description; typographical error linked with a glutaraldehyde solution - 25-35mm, Implant Height - 8-10mm corrected
SJ091 Premere PFO Closure System Percutaneous, transcatheter, self-expanding, Left Atrial Anchor diameter 20mm and Group changed to Occluders from
dual anchor, occlusion device 25mm Catheters in Nov 2006
Tornier Pty Ltd
Orthopaedic
TO008 HLS Noetos Total Knee Replacement - Femur Femur Cemented 1 - 6 CoCr Group changed from 3f to 1c in Nov 2006
Prostheses List Changes Report Page 1 of 1
Deleted Items for Prostheses List November 2006
Billing Product Further Description Size Explanation of Change
Corin Australia Pty Ltd
Orthopaedic
CR092 Tri Fit Stem (New Sizes) Ti stem with hydroxyapatite on Ti porous coating 5mm Deleted in Nov 2006
CR093 Optimom Head (New Sizes) CoCr Large Diameter Modular Head -7.5mm & +4mm neck lengths Deleted in Nov 2006
CR094 Alpha Lock Cup Inly (New Sizes) UHMWPE Inlay 22mm and 32mm Deleted in Nov 2006
CR095 Ceramic Insert for Alpha Cera Fit Biolox Forte 32mm and 36mm Deleted in Nov 2006
Cup (New Sizes)
CR096 Alumina Head Biolox Forte 32mm Deleted in Nov 2006
Deleted Items for Prostheses List Report Page 1 of 1