EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Private Health Insurance Act 2007
Private Health Insurance (Prostheses) Amendment Rules 2007 (No.1)
Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Prostheses) Rules, providing for matters required or permitted by Part 3-3 of the Act, or necessary or convenient in order to carry out or give effect to Part 3-3 of the Act.
Item 4 of the table in subsection 72-1(2) of Part 3-3 of the Act provides for requirements that a complying health insurance policy that covers hospital treatment must meet. There must be a minimum benefit for the provision of a prosthesis of a kind listed in the Private Health Insurance (Prostheses) Rules.
If the complying health insurance policy also covers hospital-substitute treatment, the same requirements apply.
The Private Health Insurance (Prostheses) Rules 2007 (No.2) (the Rules) commenced on 1 June 2007.
The Private Health Insurance (Prostheses) Amendment Rules 2007 (No.1) (the Amendment Rules) commence on 1 July 2007 and amend the Schedule to the Rules.
The Schedule to the Rules has two parts:
- Part A – Prostheses; and
- Part B – Human Tissue List.
The Amendment Rules update Part A of the Schedule to the Rules by:
- adding 3 items as no gap prostheses or gap permitted prostheses (Attachment 2);
- deleting one item, billing code CY001;
- changing the descriptions of prostheses or sponsor names to reflect new sponsor arrangements in relation to 8 items (Attachment 3); and
- changing the minimum benefit and/or maximum benefit of 58 items (Attachment 4).
The Amendment Rules update Part B of the Schedule to the Rules by:
- adding 7 items (Attachment 5); and
- changing product name and/or billing code of 3 items (Attachment 6).
CONSULTATION
The Amendment Rules have been made in consultation with sponsors.
The Amendment Rules have also been made having regard to recommendations made by the Prostheses and Devices Committee (PDC), a ministerially appointed committee comprised of nominees from health funds, hospitals, clinicians, prostheses and devices suppliers, and consumer representatives.
In making their recommendations, the PDC were advised by Clinical Advisory Groups, other clinical experts, and benefits negotiators, all appointed by the PDC.
Details of the Amendment Rules are set out in Attachments 1 to 6.
The Amendment Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Authority: Section 333-20 of the
Private Health Insurance
Act 2007
ATTACHMENT 1
DETAILS OF THE PRIVATE HEALTH INSURANCE (PROSTHESES) AMENDMENT RULES 2007 (No.1)
1. Name of Rules
Rule 1 provides that the title of the Rules is the Private Health Insurance (Prostheses) Amendment Rules 2007(No.1).
2. Commencement
Rule 2 provides for the Rules to commence on 1 July 2007.
3. Amendment of the Schedule to the Private Health Insurance (Prostheses) Rules 2007 (No.2)
Rule 3 provides for the amendments to the Schedule to the Private Health Insurance (Prostheses) Rules 2007(No.2). The detail of these amendments is outlined in Attachments 2, 3, 4, 5 and 6.
New Products for Prostheses List July 2007 Attachment 2
Billing Code Product Further Description Size
Bio Excel Pty Ltd
Cardio-thoracic
DA001 S-Stent SRX1 316L Stainless Steel SRX1 - 2510 2.5 x 8.5mm; SRX1 - 3010 3.0 x 8.5mm; SRX1 - 3510L
3.5 x 8.5mm; SRX1 - 4010L 4.0 x 8.5mm; SRX1- 2512 2.5 x 11mm;
SRX1 23012 3.0 x 11mm; SRX1 - 3512L 3.5 x 11mm; SRX1 - 4012L
4.0 x 11mm; SRX1 - 2515 2.5 x 14.4mm; SRX1 - 3015 3.0 x 14.4mm;
SRX1 - 3515L 3
Insight Surgical Pty Ltd
Ophthalmic
IS007 OII PMMA Capsular Tension Ring Capsular Tension Ring - PMMA 12mm and 13mm
Taylor Bryant Pty Ltd
Orthopaedic
TB343 Precifix Titanium Diameter: 2-2.5mm, Length 22-40mm
New Products for Prostheses List Report Page 1 of 1
Changed Detail Items for Prostheses List July 2007 Attachment 3
Billing Code Product Name Further Description Size Explanation of Change
Abbott Australasia Pty Ltd
Cardio-thoracic
GU102 Stents ACS Multilink Coronary Stent; ACS Megalink 1.5mm - 8.0mm Change of sponsor
Peripheral Stent; ACS RX Herculink Peripheral
Stent. Stainless steel
GU105 Multilink Coronary Stent System Stainless Steel Length 1.5mm - 8.0mm Change of sponsor
Vascular
GU058 Dynalink Peripheral Self Expanding Stent System - Lengths 80cm and 120cm, Sizes range Change of sponsor
from 5mm x 28mm to 10mm x 56mm
GU071 ACCULINK Peripheral Stent System Nickel-Titanium Intra-vascular stent 4-10mm diameter, 13-56mm length Change of sponsor
Boston Scientific Pty Ltd
Endoscopic Products
BS117 WallFlex Biliary RX Stent TTS, closed cell, catheter delivery system, Lengths up to 10cm Product name changed due to
administrative error
Corin Australia Pty Ltd
Orthopaedic
CR100 Integrale Modular Stem HA Coated 7 Sizes Product name changed due to administrative
error
Medical Device Alliance Pty Ltd
Plastic and Reconstructive
MP041 Tissue Expander Double Chamber, Smooth, 320-850 Product name changed as a result of
Remote port administrative error
Model # 730
Plus Orthopedics Australia Pty Ltd
Orthopaedic
Changed Detail Items for Prostheses List Report Page 1 of 2
Billing Code Product Name Further Description Size Explanation of Change
PL106 PLUS Hip Joint Prosthesis System MPF Cup - Acetabular shell 46 - 68mm Size changed due to administrative error
Changed Detail Items for Prostheses List Report Page 2 of 2
Changed Benefit Items for Prostheses July 2007 Attachment 4
Billing Code Product Name Further Description Size Explanation of Change
Advanced Biomedical Pty Ltd
Cardio-thoracic
AB001 ATS Medical open pivot aortic valved graft model Pyrolythic Carbon, Double Velour Polyester, 21- 33mm Benefit changed to correct an
502AG Titanium administrative error.
Alcon Laboratories (Aust.) Pty Ltd
Ophthalmic
AL021 Alcon AcrySof SN60WF Foldable Acrylic Single-piece Lens with Blue +16.0 D to +26.0 D Benefit changed to correct an
Light Protection and Aspheric Correction administrative error
Boston Scientific Pty Ltd
General/Miscellaneous
BS103 Dynamic (Y) Stent Bifurcated Tracheobronchial stent. Bronchial Stent inner diameters up to 15mm, stent Sponsor previously requested removal
Limbs made of silicone and tracheal stem made limb lengths up to 110mm of gap.
of silicone with embedded stainless steel c-
shape rings.
Genzyme Australasia Pty Ltd
General/Miscellaneous
GE007 SEPRAMesh IP Bioresorbable Coating/Permanent Polypropylene & polyglycolic acid polymer 3 x 6 inch Removal of MaxBenefit to correct an
Mesh mesh coated with a biopolymer: a bioresorbable administrative error
coating of modified sodium hyaluronate,
carboxymethylcellulose & polyethylene glycol
based hydrogel.
GE008 SEPRAMesh IP Bioresorbable Coating/Permanent Polypropylene & polyglycolic acid polymer 4 x 8 inch Removal of MaxBenefit to correct an
Mesh mesh coated with a biopolymer: a bioresorbable administrative error
coating of modified sodium hyaluronate,
carboxymethylcellulose & polyethylene glycol
based hydrogel.
GE009 SEPRAMesh IP Bioresorbable Coating/Permanent Polypropylene & polyglycolic acid polymer 6 x 8 inch Removal of MaxBenefit to correct an
Mesh mesh coated with a biopolymer: a bioresorbable administrative error
coating of modified sodium hyaluronate,
carboxymethylcellulose & polyethylene glycol
based hydrogel.
Changed Benefit Items for Prostheses List Report Page 1 of 6
Billing Code Product Name Further Description Size Explanation of Change
GE010 SEPRAMesh IP Bioresorbable Coating/Permanent Polypropylene & polyglycolic acid polymer 8 x 12 inch Removal of MaxBenefit to correct an
Mesh mesh coated with a biopolymer: a bioresorbable administrative error
coating of modified sodium hyaluronate,
carboxymethylcellulose & polyethylene glycol
based hydrogel.
Johnson & Johnson Medical Pty Ltd
Vascular
JJ485 Trufill DCS Orbit detachable coil Helical Fill 2mm - 12mm, 2cm - 30cm Sponsor previously requested removal
of gap.
JJ486 Trufill DCS Orbit detachable coil Complex Standard 6mm - 20mm, 15cm - 30cm Sponsor previously requested removal
of gap.
JJ487 Trufill DCS Orbit detachable coil Complex Mini 2mm - 12mm, 1.5cm - 30cm Sponsor previously requested removal
of gap.
Link Orthopaedic Australia
Orthopaedic
LO127 T.A.C.K. Cementless Knee Joint System Tibial Components, Cruciate Retaining, with Small 1, Small 2, Large 1, Large2 Benefit changed to correct an
HX Coating administrative error.
Mathys Orthopaedics Pty Ltd
Orthopaedic
MA422 Articula Shoulder Prosthesis Articula Humeral Head Bionit Ceramic (A1203) 44mm, 46mm, 48mm Benefit changed to correct an
administrative error as advised by
Orthotech Pty Ltd
Neurosurgical
OH255 Hartshill Cancellous bone screws for 6.5mm diam - 25 - 30mm length, 5.5mm Orthotech submitted an application to
Horseshoes/STALIF each diam - 25 - 30mm length transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
OH260 Hartshill Wire (packet 10) stainless steel 1.2mm diam & 0.9mm diam Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent for two
identical products
Changed Benefit Items for Prostheses List Report Page 2 of 6
Billing Code Product Name Further Description Size Explanation of Change
OH264 Hartshill: Ransford Occipito-cervical - Titanium loop 100 degree 9mm - 20mm Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH265 Hartshill: Ransford Extra long cross linked - titanium loop 100 degree 45cm x 15mm Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH266 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam 3-5cm length Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH267 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam 6 - 8cm length Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH268 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam 9 - 11cm length Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH269 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam 12 - 14cm length Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
Changed Benefit Items for Prostheses List Report Page 3 of 6
Billing Code Product Name Further Description Size Explanation of Change
OH270 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar 6mm diam 15 - 19cm length Orthotech submitted an application to
fusion system transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH271 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar 6mm diam 20 - 24cm length Orthotech submitted an application to
fusion system transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH272 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar 6mm diam 25 - 30cm length Orthotech submitted an application to
fusion system transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH273 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar 6mm diam 31 - 36cm length Orthotech submitted an application to
fusion system transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH274 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar 6mm diam 37 - 44cm length Orthotech submitted an application to
fusion system transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
Sirtex Medical Limited
General/Miscellaneous
SE001 SIR-Spheres including Delivery Apparatus Biocompatible microspheres 20-60mm One size only Benefit changed as a result of the June
(microns) in diameter containing yttrium-90. 2007 review.
Delivery apparatus is PVC tubing, ABS
stopcocks, acrylic holders and stainless steel
Smith & Nephew Surgical Pty Ltd
Orthopaedic
Changed Benefit Items for Prostheses List Report Page 4 of 6
Billing Code Product Name Further Description Size Explanation of Change
SN727 Genesis II High Flex PS Insert, UHMWPE 1-8, 9-25mm thickness Sponsor previously requested removal
of gap.
Stryker Australia Pty Ltd (3)
Orthopaedic
SR052 Active Uni Compartmental Knee Uni compartmental knee resurfacing All sizes for Femoral Component Benefit changed to correct an
prostheses, consisting of a Femoral component administrative error.
manufactured from Chrome Cobalt
SR053 Active Uni Compartmental Knee Uni compartmental Knee resurfacing All sizes for Tibial Component Benefit changed to correct an
prostheses, consisting of a Femoral component administrative error.
manufactured from Chrome Cobalt
Synthes Australia Pty Ltd
Neurosurgical
SY250 Universal Spine System Low Profile Transconnector 18-83mm length Sponsor previously requested removal
of gap.
SY365 Cervical Spine Locking Plate (CSLP) System VA Plate Length 23 - 109mm Sponsor previously requested removal
of gap.
SY382 Axon Occipital Fusion System Occipital Clamp Titanium Alloy 1 or 2 holes Sponsor previously requested removal
of gap.
SY383 Synmesh Locking Screw, Low Profile, For Synmesh End Small, Large Sponsor previously requested removal
Rings of gap.
Taylor Bryant Pty Ltd
Neurosurgical
TB363 Unity Lumbar Plate Unity Plate 17-28mm Sponsor previously requested removal
of gap.
TB364 Unity Lumbar Plate Unity Bone Screw 6-7mm Sponsor previously requested removal
of gap.
Orthopaedic
TB064 Groupe Lepine Bipolar Heads 42 - 60mm in 1mm increments Sponsor requested removal of gap.
TB204 Ulnar Head Implants Ulna Head - CoCr Stem: 2,3,4 Head: 2,3,4 Benefit reviewed as a result of sponsor
submission.
Zimmer
Orthopaedic
ZI104 Miller Galante II Other Tibial Tray:Porous Flat (revision) - Ti A - K Sponsor previously requested removal
of gap.
Changed Benefit Items for Prostheses List Report Page 5 of 6
Billing Code Product Name Further Description Size Explanation of Change
ZI137 NexGen Knee Articulating Surfaces CCK - UHMWPE 10 - 35mm Sponsor previously requested removal
of gap.
ZI140 NexGen Knee Tibial Augments Half Wedge - Ti 1 - 10 Sponsor previously requested removal
of gap.
ZI141 NexGen Knee Tibial Augments Full Wedge - Ti 1 - 10 Sponsor previously requested removal
of gap.
ZI142 NexGen Knee Tibial Augments One Third Wedge - Ti 1 - 10 Sponsor previously requested removal
of gap.
ZI143 NexGen Knee Tibial Augments Half Block - Ti 1 - 10 Sponsor previously requested removal
of gap.
ZI144 NexGen Knee Femoral Augments Dist.,Ant or Post - Ti A - H Sponsor previously requested removal
of gap.
ZI145 NexGen Knee Femoral Augments Dist + Post 1 - 10 Sponsor previously requested removal
of gap.
ZI266 Continuum knee system Hedrocel augment - patella prosthesis Small, medium, large and x-large Sponsor previously requested removal
of gap.
ZI305 Nexgen Rotating Hinge Femur Cobalt chrome femoral component for rotating B-F Sponsor previously requested removal
hinge knee, available left to right of gap.
ZI307 Nexgen Rotating Hinge Articulating Surface Ultra high molecular weight polyethylene 12-26mm, sizes B-F Sponsor previously requested removal
articulating tibial insert of gap.
ZI308 Nexgen Rotating Hinge Tibia Cobalt chrome rotating platform tibial plate 1-6 Sponsor previously requested removal
of gap.
ZI309 Nexgen Rotating Hinge Replacement Hinge Rotating hinge replacement bushing for hinge B-F Sponsor previously requested removal
of gap.
ZI404 Natural Knee System Tibial Spacers - special metal alloy 4 to 8mm Size 00 to 5 Sponsor previously requested removal
of gap.
ZI416 Natural Knee Revision -Tibial Baseplate - Ti alloy 0 to 5 Sponsor previously requested removal
of gap.
ZI417 Natural Knee Revision -Tibial Stem - Ti alloy 60 to 215mm Sponsor previously requested removal
of gap.
ZI422 Natural Knee Femoral Spacer Lug - Ti alloy 4 to 12mm Sponsor previously requested removal
of gap.
ZI423 Natural Knee Revision - Femur Porous -Ti/CoCr alloy Size 00 to 4 (left & right), Sponsor previously requested removal
of gap.
ZI424 Natural Knee Revision - Femur Stem, Ti alloy 10.5mm/125mm to 16.5mm/250mm Sponsor previously requested removal
of gap.
ZI426 Natural Knee Femoral Stem Screw - metal alloy One size only Sponsor previously requested removal
of gap.
ZI427 Natural Knee Revision Posterior Stabilising Bar - CoCr alloy One size only Sponsor previously requested removal
of gap.
Changed Benefit Items for Prostheses List Report Page 6 of 6
New Human Tissue Items July 2007 Attachment 5
ORTHOPAEDIC
Billing Code Facility
Cancellous Crunch - 15cc
NBB62 New South Wales Bone Bank
Cancellous Crunch - 30cc
NBB61 New South Wales Bone Bank
Cancellous Crunch - 60cc
NBB60 New South Wales Bone Bank
Cortico-Cancellous Crunch (40/60) - 15cc
NBB65 New South Wales Bone Bank
Cortico-Cancellous Crunch (40/60) - 30cc
NBB64 New South Wales Bone Bank
Cortico-Cancellous Crunch (40/60) - 60cc
NBB63 New South Wales Bone Bank
Femur - Hemicondyle
NBB59 New South Wales Bone Bank
New Human Tissue Items Report Page 1 of 1
Changed Human Tissue Items July 2007 Attachment 6
Billing Code Facility Change Explanation
CARDIO-THORACIC
Arterial Graft/Conduit
SHV03 Sydney Heart Valve Bank, Darlinghurst NSW Item changed at sponsor request
ORTHOPAEDIC
Cancellous Bone Matrix (CBM) - 40cc
TBV52 Victorian Institute of Forensic Medicine Prostheses List application 190a, VIM01 billing code
changed to TVB52.
Cancellous Bone Matrix (CBM) - 80cc
TBV53 Victorian Institute of Forensic Medicine Prostheses List application 190b, VIM02 billing code
changed to TBV53.
Changed Human Tissues Items Report Page 1 of 1