Private Health Insurance (Prostheses) Rules 2011 (No. 2)

As amended

Made under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007. 

This compilation was prepared on 5 November 2011 taking into account amendments up to the Private Health Insurance (Prostheses) Amendment Rules 2011 (No.3).

Prepared by the Department of Health and Ageing, Canberra.

Contents

Part 1 Preliminary 

1. Name of Rules 

2. Commencement 

3. Revocation 

4. Definitions 

Part 2 Benefit requirements 

5. Listing of, and benefits for, prostheses 

5A. Circumstances in which a prosthesis is provided other than circumstances in which a medicare benefit is payable             

5B. Conditions in relation to the provision of listed prostheses 

6. Benefits for prostheses provided as part of hospital treatment 

7. Benefits for prostheses provided as part of hospital-substitute treatment 

Part 3 Other 

8. Timing of applications to have a prosthesis listed 

9. Minister may have regard to recommendations and advice 

10. Listing criteria for prostheses to be listed in Part C of the Schedule 

Notes 

Part 1 Preliminary

1.                     Name of Rules

These Rules are the Private Health Insurance (Prostheses) Rules 2011 (No. 2).

2.                     Commencement

These Rules commence on 22 August 2011.

3.                     Revocation

These Rules revoke the Private Health Insurance (Prostheses) Rules 2011 (No. 1) as amended by the Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 1).

4.                     Definitions

Note: Terms used in these Rules have the same meaning as in the Act―see section 13 of the Legislative Instruments Act 2003.  These terms include:

 complying health insurance policy
hospital-substitute treatment
hospital treatment
medicare benefit

In these Rules:

accredited podiatrist means a podiatric surgeon who holds specialist registration in the specialty of podiatric surgery under the National Law.

Note: The registration requirements for an accredited podiatrist for the purpose of these Rules is the same registration requirements for podiatric surgeons as set out in rule 8 of the current Private Health Insurance (Accreditation) Rules as made from time to time under section 333-20 of the Act.

Act means the Private Health Insurance Act 2007.

certified overnight Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.

certified Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.

consultant physician has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

gap permitted prosthesis means a prosthesis of a kind listed in the Schedule where an amount is set out for that kind of prosthesis in the column under the heading 'Minimum Benefit' and a different amount is set out in the column under the heading 'Maximum Benefit'.

implantable cardiac event recorder includes a component of an implantable cardiac event recorder.

insulin infusion pump includes a component of an insulin infusion pump.

listed prosthesis means a kind of prosthesis listed in the Schedule to these Rules.

listing application has the same meaning as in subsection 72-10(6) of the Act.

listing criteria has the same meaning as in subsection 72-10(6) of the Act.

National Law means:

(a) for a State or Territory other than Western Australia — the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) as it applies (with or without modification) as law of the State or Territory; or

(b) for Western Australia — the legislation enacted by the Health Practitioner Regulation National Law (WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.

Note: The Intergovernmental Agreement for a National Registration and Accreditation Scheme for the Health Professions that was made on 26 March 2008 provides for the enactment of the State and Territory legislation mentioned in this definition.

no gap prosthesis means a prosthesis of a kind listed in the Schedule where an amount is set out for that kind of prosthesis in the column under the heading 'Minimum Benefit' and no amount is set out in the column under the heading 'Maximum Benefit'.

private hospital means a hospital in respect of which there is in force a statement under subsection 121-5 (8) of the Act that the hospital is a private hospital.

Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.

professional attendance has the same meaning as in clause 1.2.3 of the General Medical Services Table being the table prescribed under section 4 of the Health Insurance Act 1973.

professional service has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

public hospital means a hospital in respect of which there is in force a statement under subsection 121-5(8) of the Act that the hospital is a public hospital.

Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.

Schedule means the Schedule in these Rules.
 

Part 2  Benefit requirements

5.                    Listing of, and benefits for, prostheses

For item 4 of the table in subsection 72-1 (2) of the Act:

(a)                   the Schedule lists the kinds of prostheses:

(i)          in relation to which the Minister has granted an application for listing under subsection 72-10 (5) of the Act; or

(ii)        which are listed in accordance with section 12 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007; and

Note: Section 12 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the listing of a prosthesis that was a no gap prosthesis or a gap permitted prosthesis for the purposes of the National Health Act 1953 immediately before the commencement of the Act.

(aa) circumstances in which a listed prosthesis is provided for the purposes of paragraph (d) of item 4 of the table in subsection 72-1(2) are set out in rule 5A; and

(ab) conditions that must be satisfied in relation to the provision of a listed prosthesis for the purposes of paragraphs (c) and (d) of item 4 of the table in subsection 72-1(2) are set out in rule 5B; and

(b)                  rule 6 sets out the method for working out the minimum benefit and maximum benefit for hospital treatment, covered under a complying private health insurance policy, that is the provision of a listed prosthesis; and 

(c)                   rule 7 sets out the method for working out the minimum benefit and maximum benefit for hospital-substitute treatment, covered under a complying private health insurance policy, that is the provision of a listed prosthesis.

5A. Circumstances in which a prosthesis is provided other than circumstances in which a medicare benefit is payable

For the purposes of paragraph (d) of item 4 of the table in subsection 72-1(2) of the Act, the following circumstances are set out:

(a) the provision of a listed prosthesis which is associated with podiatric treatment by an accredited podiatrist.

Note: Paragraph (c) of Item 4 of subsection 72-1(2) deals with the provision of a listed prosthesis in circumstances in which a medicare benefit is payable.

5B. Conditions in relation to the provision of listed prostheses

For the purposes of paragraphs (c) and (d) of item 4 of the table in subsection 72-1(2) of the Act, conditions that must be satisfied in relation to the provision of a listed prosthesis in the circumstances covered by paragraph (c) or (d) of that item, as the case may be, are:

(a) in relation to any kind of prosthesis where there is a statement of a requirement under the heading 'Condition' in the Schedule under the listing for that kind of prosthesis, that requirement; and

(b) in relation to a listed prosthesis that is an insulin infusion pump, also:

(i) the professional service associated with the provision of the insulin infusion pump must be a professional attendance by a consultant physician in the practice of his or her specialty; and

(ii) the professional service must be provided as a certified Type C procedure or certified overnight Type C procedure; and

(iii) the insulin infusion pump must be provided for the purpose of administering insulin.

Note: Item 4 of the table in subsection 72-1(2) of the Act states other requirements in relation to benefits for the provision of prostheses that a policy that covers hospital treatment must meet.  These requirements relate to benefits for hospital treatment and, if the policy covers hospital-substitute treatment, to the benefits of that coverage as well.

6.                    Benefits for prostheses provided as part of hospital treatment

(1)       For a no gap prosthesis provided as part of an episode of hospital treatment by a private hospital, the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’.

(2)       For a gap permitted prosthesis provided as part of an episode of hospital treatment by a private hospital:

(a)                   the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and

(b)                  the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’.

(3)       For a no gap prosthesis provided as part of an episode of hospital treatment by a public hospital:

(a)                   the minimum benefit is the lesser of the following amounts:

(i)                      the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or

(ii)                   the amount of the insured person’s liability to the public hospital for that prosthesis; and

(b)                  the maximum benefit is the amount for that prosthesis listed in the column under the heading 'Minimum Benefit'.

(4)       For a gap permitted prosthesis provided as part of an episode of hospital treatment by a public hospital:

(a)                   the minimum benefit is the lesser of the following amounts:

(i)                      the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or

(ii)                   the amount of the insured person’s liability to the public hospital for that prosthesis; and

(b)                  the maximum benefit is the amount for that prosthesis listed in the column under the heading ‘Maximum Benefit’ in the Schedule.

Note: Paragraphs (d) and (e) of subsection 72-10(5) of the Act deal with the fixing of minimum and maximum benefits when the Minister is making or varying the Private Health Insurance (Prostheses) Rules.

7.                    Benefits for prostheses provided as part of hospital-substitute treatment

(1)       For a no gap prosthesis provided as part of an episode of hospital-substitute treatment the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’.

(2)       For a gap permitted prosthesis provided as part of an episode of hospital-substitute treatment:

(a)                   the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and

(b)                  the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’.

Note 1:  Private health insurers cannot cover, as part of hospital-substitute treatment, a service for which medicare benefit is payable unless the service is specified in the Private Health Insurance (Health Insurance Business) Rules ―see paragraph 121-10 (3) (a) of the Act.

Note 2: Paragraphs (d) and (e) of subsection 72-10(5) of the Act deal with the fixing of minimum and maximum benefits when the Minister is making or varying the Private Health Insurance (Prostheses) Rules.

Part 3  Other

8.                    Timing of applications to have a prosthesis listed

As a matter of normal administrative practice, applications made under subsection 72-10 (2) of the Act will be considered after they have been received and, if the Minister decides to grant the application, the kind of prosthesis will be listed in the Schedule the next time the Minister makes or varies the Rules.

Note 1:  Under subsection 72-10 (5) of the Act the Minister must list the kind of prosthesis, set out the minimum benefit and, if the Minister considers it appropriate, the maximum benefit for the prosthesis in these Rules on the next occasion that the Minister makes or varies the Rules after he or she grants an application and the applicant has paid to the Commonwealth any initial listing fee within 14 days of being informed of the Minister's decision to grant the application.

Note 2: Under subsection 72-15 (3) of the Act, the Minister may remove a kind of prosthesis from the list in the Rules if the applicant fails to pay an ongoing listing fee.

9.                      Minister may have regard to recommendations and advice

(1)        In making the decision under subsection 72-10 of the Act, the Minister may have regard to a recommendation from the Prostheses List Advisory Committee.

(2)        In setting the minimum and the maximum (if any) benefits for a kind of prosthesis, the Minister may have regard to the benefits as negotiated between the Negotiating Oversight Committee and the applicant.

10.                  Listing criteria for prostheses to be listed in Part C of the Schedule

For a listing application to be granted to list a kind of prosthesis in Part C of the Schedule, the listing criterion is that the kind of prosthesis is an:

(i) insulin infusion pump; or

(ii) implantable cardiac event recorder.

 Note: 1.  The power to make listing criteria is in subsection 72-10(6) of the Act.

  2.  Under subsection 72-10(7) of the Act the Minister must not grant a listing application if any applicable listing criteria are not satisfied in relation to the application.

  3.  Under the Act the Minister may refuse to grant a listing application even if the listing criteria are satisfied.  See Note to subsection 72-10(7) of the Act.

             Notes

                     The Private Health Insurance (Prostheses) Rules 2011 (No.2) as shown in this compilation are

  amended as indicated in the tables below.

      Table of Instruments

Table of Amendments

1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See www.frli.gov.au

Part A - Prostheses List August 2011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.1.1 Aphakic

 1.1.1.1 Rigid

 Alcon Laboratories (Aust.) Pty Ltd

AL003 MTA2UO - MTA6UO PMMA +5 to +30 D $156.00

 Bausch & Lomb (Australia) Pty Ltd

BL005 Storz (Coburn) Intraocular Lens   PMMA Anterior Chamber Intraocular lens 13.75mm length. 6.0mm optic  $156.00

 121UV; L122UV PMMA Anterior   1 piece size, diopter range 3-30d.

 Chamber Lens L122UV: 6.0mm optic,

 13.75mm length, power range;

 5.0 to 30.0 Diopters

 Emagin Pty Ltd

EG009 Artisan Anterior Chamber Intraocular  Aphakia ModelComposition: PMMA 5.00mm Optic Diameter x 8.5  $156.00

 Lens in overall length

 ifc

 AMO Australia Pty Ltd

AO019 Verisyse AC IOL Aphakic Model 5mm Optic Diameter x 8.5  $250.00

 overall length

 m

 AMO Australia Pty Ltd

AO001 Intraocular Lens: Model  AC 51L Duralens  PMMA, Anterior Chamber IOL 6.00 mm Optic Diameter x  $198.00

 13.0mm in overall length

1.1.2 Phakic

 1.1.2.1 Rigid

 AMO Australia Pty Ltd

AO016 Verisyse AC IOL Phakic Intraocular Lens: Model Myopia.   5mm Optic Diameter x 8.5  $680.00

 Composition: PMMA overall length; 6mm Optic

 Diameter x 8.5 overall length

AO017 Verisyse AC IOL Phakic Intraocular Lens: Model  5mm Optic Diameter x 8.5  $680.00

 Hyperopia.  Composition: PMMA overall length

Prostheses List by Category, Groups and Sponsor Page 1 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Emagin Pty Ltd

EG012 Artisan Anterior Chamber IOL Phakic Intraocular Lens Myopic /  5.00mm Optic Diameter x 8.5  $680.00

 Hyperopic in overall length;

 t1

 AMO Australia Pty Ltd

AO030 Verisyse Toric (Custom) Phakic intraocular lens: Model toric 5mm Optic Diameter x 7.5mm  $1,056.00

 overall length

 Emagin Pty Ltd

EG008 Artisan Anterior Chamber Intraocular  Phakic Intraocular Lens: Model Toric 5.00mm Optic Diameter x 7.5  $1,056.00

 Lens Composition: PMMA in overall length

 t2

 AMO Australia Pty Ltd

AO029 Verisyse Toric (Custom) Phakic intraocular lens: Model toric 5mm Optic Diameter x 7.5mm  $1,358.00

 overall length

 1.1.2.2 Foldable

 Alcon Laboratories (Aust.) Pty Ltd

AL034 AcrySof Cachet Phakic Lens Anterior chamber foldable, acrylic, single  -6.0 to -16.5 diopters, in 0.5  $723.00

 piece phakic lens diopter increments

 AMO Australia Pty Ltd

AO025 VeriFlex Foldable Phakic IOL Anterior chamber foldable phakic silicone  -2  to -14.5d in 0.5d  $723.00

 intraocular lens increments.  Overall diameter

 8.5mm. Optic 6.0mm

 Emagin Pty Ltd

EG010 Artiflex Anterior Chamber Intraocular  Optic: Hydrophobic Polysiloxane. Haptic:  6mm optic diameter x 8.5 in  $723.00

 Lens PMMA overall length

1.2.1 Rigid

 Alcon Laboratories (Aust.) Pty Ltd

AL002 Models MZ60BD, MC50BD, CZ70BD Other:PMMA Range of Powers:-10 to +34 D $156.00

Prostheses List by Category, Groups and Sponsor Page 2 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Bausch & Lomb (Australia) Pty Ltd

BL006 Posterior chamber IOLS model P359  PMMA Posterior Chamber lens 1 piece; 12.25mm to 13.75mm length.  $156.00

 UV, P399 UV, 68 UV, 95 BUV, or  5.5mm to 7mm optic size,

 lolab PC One Piece, model 6741B,  diopter range -4.5 - 45d to 10

 8591B, 8191B; Model EZE-Fit 65 - 34d; EZE-Fit 65: 6.5mm

 optic, 13.35mm length, Power

 range: 10.0 to 30.0 Diopter

1.2.2 Foldable

 1.2.2.1 Microincision

 at

 Carl Zeiss Pty Ltd

CZ016 CT ASPHINA 409M Aberration corrected, optimized aspheric  Overall length 11.0mm Optic  $364.00

 foldable square-edged single-piece  size 6.0mm

 intraocular lens for capsular bag fixation

CZ017 CT ASPHINA 509M CT ASPHINA 509M (MICS Aspheric  Overall length 11.00mm Optic  $364.00

 Foldable IOL) size 6.0mm

 at, pl

 Bausch & Lomb (Australia) Pty Ltd

BL026 Akreos AO Micro Incision Lens Micro Incision, posterior chamber,  6mm optic overall diameter  $374.00

 foldable acrylic, aphakic, anterior &  11.0mm(10D-15D), 10.7mm

 posterior edge modification, preloaded,  (15.50-22D), 10.5mm (22.50-

 with aberration contro, intraocular lens 30D)

 Carl Zeiss Pty Ltd

CZ028 CT ASPHINA 409MP Preloaded, micro incision, aspheric  Diopter range: 0.0 to 32.0D;  $374.00

 (aberration neutral), foldable square-edged Optic size: 6.0mm; Overall

  single piece inraocular lens for capsular  length: 11.0mm

 bag fixation.

 at, pl, t1

 Carl Zeiss Pty Ltd

CZ031 AT TORBI 709MP (Standard Range) Bitoric, preloaded, micro incision, aspheric Diopter range: Sph -10.0 to  $760.00

  (aberration neutral), foldable, square- 32.0, Cyl +1.0 to 6.5

 edged, single-piece IOL for capsular bag  Optic size: 6.0mm, Overall

 fixation length: 11.0mm

Prostheses List by Category, Groups and Sponsor Page 3 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 at, pl, t2

 Carl Zeiss Pty Ltd

CZ032 AT TORBI 709MP (high cyl) Bitoric, preloaded, micro incision, aspheric Diopter range: Sph -10.0 to  $1,061.00

  (aberration neutral), foldable, square- 32.0, Cyl +7.0 to 12.0, Optic

 edged, single-piece IOL for capsular bag  size: 6.0mm. Overall Length

 fixation 11.0mm

 t1

 Carl Zeiss Pty Ltd

CZ020 AT TORBI 709M AT TORBI 709M (MICS Bitoric  Overall length 11.00mm Optic  $740.00

 Aspheric Foldable IOL) Foldable IOL size 6.00mm

 +6.0D +32.0D inclusive in

 0.5D increments Cylinder +1.0

 to 6.5D inclusive

CZ026 AT TORBI™709M AT TORBI™709M (MICS Bitoric  Overall length 11.00mm Optic  $740.00

 Aspheric Foldable IOL) size 6.0mm -10.00 to +5.50D

 inclusive in 0.5D increments

 Cylinder +1.0D to 6.5D

 inclusive in 0.5D increments

 t2, at

 Carl Zeiss Pty Ltd

CZ027 AT TORBI 709M AT TORBI 709M (MICS Bitoric  Overall length 11.00mm Optic  $1,041.00

 Aspheric Foldable IOL) size 6.0mm -10.00 to +32.0D

 inclusive in 0.5D increments

 Cylinder +7.0D to 12.0D

 inclusive in 0.5D increments

 1.2.2.2 No edge modification

 ConceptVision Australia Pty Ltd

CS003 Staar foldable silicone intraocular lens:  Polyimide haptics 6.3mm optic - low  14.0mm length $281.00

 Model AQ 5010V diopters

Prostheses List by Category, Groups and Sponsor Page 4 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 t1

 ConceptVision Australia Pty Ltd

CS002 Staar Toric foldable silicone intraocular  Plate haptics 6.0mm optic 10.8mm - 11.2mm length $579.00

 lens: Model AA4203TF; Model

 AA4203TL

 1.2.2.3 Edge modification

 Alcon Laboratories (Aust.) Pty Ltd

AL004  Acrysof Multipiece Models MA50BM,  Foldable Acrylic Multi-piece Lens  -5 D to +30 D $322.00

 MA60AC

AL011 Acrysof Model SA60AT Foldable Acrylic Single-piece Lens,  Range of Powers: +6 to +40 D $322.00

 asymmetric optic/consistent edge

 AMO Australia Pty Ltd

AO002 Sensar  AR40 Monofocal Acrylic IOL,   Soft Acrylic, Foldable, UV Absorbing,  6 mm Optic Diameter x 13mm  $322.00

 Sensar OptiEdge AR40e Foldable  Posterior in overall length.     

 Acrylic IOL

AO006 Clariflex, Model CLRFLXB Posterior  Foldable Silicone IOL with OptiEdge  One size only $322.00

 Chamber Intraocular Lens design

 Bausch & Lomb (Australia) Pty Ltd

BL020 Akreos Adapt acrylic foldable posterior  Composition: Hydrophilic acrylic polymer.  10.0 to 15.0 Diopter in 1.0  $322.00

 chamber intraocular lens  Packaged in lens folding device in a sterile Diopter increments15.0 to

  vial.  Four haptic design 25.0 Diopter in 0.5 Diopter

 increments25.0 to 30.0

 Diopter in 1.0 Diopter

 increments

BL021 SoflexSE, Intraocular lenses, Posterior  Composition: silicone, Lenses - foldable,  Range of powers: 5.0 to 30.0  $322.00

 Chamber posterior chamber intraocular lenses Diopter - Optic diameter

 6.0mm; 13.0mm length

 Carl Zeiss Pty Ltd

CZ003  Intraocular Lens: Model Bigbag  Hydrophilic acrylic, foldable, PC, single  6.5mm optic diameter x 10.35  $322.00

 piece, Tri-haptic, square edge design, UV  overall diameter

 blocker

CZ029 CT 53N Foldable, 3-piece, monofocal, square- Diopter range: 0.0 to 40.0,  $322.00

 edged, hydrophilic acrylic (with  Optic size: 6.0mm, Overall

 hydrophobic surface properties)  length: 13.0mm

 intraocular lens for capsular bag or sulcus

 fixation.

Prostheses List by Category, Groups and Sponsor Page 5 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 ConceptVision Australia Pty Ltd

CS007 Staar foldable silicone IOLs: Models  Plate haptics 6.0mm; Polymide haptics 5.5 10.8mm 0 13.5mm length $322.00

 AQ2010V, AQ2017V and AO2003V  or 6.3mm optic;

 Kevin Grundy (IBD) Pty Ltd

KG001 Rayner C-Flex Hydrophilic HEMA-MMA copolymer,  5.75mm dia optic, 12.00mm  $322.00

 foldable with injector dia overall

KG002 Superflex Hydrophilic HEMA-MMA copolymer,  6.25mm dia optic, 12.5mm dia  $322.00

 foldable with injector overall

 at

 AMO Australia Pty Ltd

AO014 TECNIS™ Intraocular Lens (Z9002 &  Foldable Intraocular Lenses - Ultraviolet  5-10 dioptre in 1.0 dioptre  $364.00

 ZA9003) light absorbing posterior chamber  increments; 10.5 - 30 dioptre in

 intraocular lenses, Silicone/Acrylic  0.5 increments

AO024 Tecnis™ One Piece (ZCB00) One piece intraocular lens with edge  +6 diopters to +30 diopters in  $364.00

 modification and 360 degree square edge 0.5d increments

 Bausch & Lomb (Australia) Pty Ltd

BL022 SofPort Advanced Optic (AO) Posterior chamber, foldable silicone IOL  0 D to 30.0 D $364.00

 with anterior optic-haptic square edge,

 posteriof optic-haptic square edge, 360-

 degree optic square edge and asperic optic

  for aberration control

BL023 Akreos Advanced Optic Posterior chamber, foldable acrylic IOL,  0 D to 30.0 D $364.00

 with anterior optic-haptic square edge,

 posterior optic-haptic square edge, 360

 degree optic square edge and aspheric

 optic for aberration control

BL030 enVista The enVista, Model MX60, is an ultra- Overall diameter 12.5mm, optic $364.00

 violet-absorbing, posterior chamber,   body diameter 6.0mm in

 hydrophobic acrylic one-piece intraocular  dioptric powers ranging from

 lens (IOL)  Has an aspheric lens optic,  +0.0 to +34D

 square posterior edge, modified C haptics  0.0D to 10.0D in 1 Diopter

 and available in dioptric powers ranging  increments

 from +0.0 to +34.0D. 11.0D to 30.0D in 0.5 Diopter

 increments

 31.0D to 34.0D in 1 Diopter

 increments

Prostheses List by Category, Groups and Sponsor Page 6 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Carl Zeiss Pty Ltd

CZ030 CT ASPHINA 404 Small incision, foldable, single piece,  Diopter range: -10.0 to 42.0,  $364.00

 monofocal, aspheric (aberration neutral),  Optic size: 6.0mm, Overall

 square-edged, hydrophilic acrylic (with  length: 11.0mm

 hydrophobic surface properties)

 intraocular lens for capsular bag fixation.

 (Monofocal lens for powers outside

 standard 409MP MICS range).

 IQ Medical

IQ004 Softec Acrylic, single piece, foldable intraocular  Available in dioptric powers  $364.00

 lens with anterior and posterior optic- from -5.0 to +36.0, 1D steps: -

 haptic square edge, 360 degree optic  5.0 to +10.0 and +31.0 to

 square edge design, precision power  +36.0; 0.5D steps: +10.5 to

 calculation and aberration technology +18.0 and +25.0 to +29.5;

 0.25D steps: +18.0 to +25.0

 Kevin Grundy (IBD) Pty Ltd

KG012 Rayner "C-Flex" and Superflex"  Aspheric Intra Ocular Lenses with Amon- C-Flex -970C + 22.5D to  $364.00

 Aspheric IOL Apple enhanced 360 Degree square edge,  +34D Superflex-920H - 10D

 Anti-vaulting Haptics to +22D

 at, pl

 Carl Zeiss Pty Ltd

CZ011 CT ASPHINA 603P Hydrophilic Acrylic, Foldable, PC, Single  6.0mm Optic x 10.5mm Overall $374.00

 Piece, Square Edge Design, UV Blocker,   Diameter

 Trihaptic, Quad Haptic, Aspheric Optic,

 Pre-Loaded

 ConceptVision Australia Pty Ltd

CS008 Preloaded Aspheric Intraocular Lens Silicone intraocular lens 6.0mm $374.00

 at, pl, t1, vblf

 Design for Vision Pty Ltd

DV253 HOYA AF-1 351 Toric T3/T4/T5 Preloaded injector system, correct corneal  IOL Power: + 6.0D to 30.0D  $800.00

 astigmatism micro-incision, ashperic, blue- (0.5 steps), IOL Cylinder

 blocker, single piece hydophobic. power: 1.50D (T3), 2.25D

 (T4), 3.00D (T5).

Prostheses List by Category, Groups and Sponsor Page 7 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 at, pl, vblf

 Alcon Laboratories (Aust.) Pty Ltd

AL024 AcrySert model SN60WS Foldable Acrylic Single-piece Lens with  +6 to +30 D $405.00

 Blue light protection and aspheric

 correction, in cartridge.

AL031 AcrySert C Model SN6CWS Posterior chamber, UV absorbing,  +6.0 to +30.0 D $405.00

 foldable, acrylic, single piece lens with blue

  light protection and aspheric correction, in

  cartridge

 Design for Vision Pty Ltd

DV250 Hoya-PS AF-1 (UY) PY-60AD Preloaded in cartridge, Aspheric, Blue  +6.0D to +30.0D (0.5D steps) $405.00

 blocker, Foldable, Single-Piece,

 Hydrophobic Acrylic

DV252 HOYA iSert® 251 Preloaded injector system, Micro-incision,  +6.0D to 30.0D (5 steps) $405.00

 Aspheric, Blue-Blocker, Single Piece,

 Hydrophobic

 at, t1

 AMO Australia Pty Ltd

AO031 TECNIS® Toric 1-Piece IOL 1-piece IOL Posterior chamber  +5.0 to +34.0 diopter powers  $740.00

 Intraocular lens, incorporates a proprietary in 0.5 diopter increments. 

  wavefront designed toric aspheric optic  Cylinder power: 1.00 diopter,

 with a squared posterior optic edge  1.50 diopter, 2.25 diopter,

 designed to provide a 360 degree barrier.  3.00 diopter and 4.00 diopter

 The edge of the optic has a frosted design  (as measured at the IOL plane).

 to reduce potential edge glare effects.  Overall diameter 13mm, Optic

 size 6mm.

 at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

AL021 Alcon AcrySof SN60WF Foldable Acrylic Single-piece Lens with  + 6.0 D to +30.0 D $385.00

 Blue Light Protection and Aspheric

 Correction

 Bausch & Lomb (Australia) Pty Ltd

BL025 SofPort Advanced Optic (AO) Violet  Posterior chamber, aphakic, foldable  6mm optic 13mm overall length $385.00

 Shield silicone, anterior & posterior edge  Modified  C 5 degree

 modification intraocular lens with  angulation 0-30D, 0.5D steps

 aberration technology, a violet light

Prostheses List by Category, Groups and Sponsor Page 8 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Design for Vision Pty Ltd

DV247 HOYA AF-1  iMics1 NY-60 Mini Incision, Aspheric, Blue-blocker,  +6.0D to 30.0D (0.5 steps) $385.00

 Single-piece, Hydrophobic

 IQ Medical

IQ009 Softec HDY Acrylic, single piece, foldable intraocular  Available in dioptric powers  $385.00

 lens with anterior and posterior optic- from -5.0 to + 36.0, 1D steps:

 haptic square edge, 360 degree optic  -5.0 to +10.0 and +31.0 to

 square edge design, precision power  +36.0; 0.5D steps: +10.5 to

 calculation, aberration technology and blue +18.0 and +25.0 to 29.5;

  light filter 0.25D steps: + 18.0 to +25.0

 pl

 ConceptVision Australia Pty Ltd

CS009 Staar KS-Xs Preloaded Acrylic  Preloaded acrylic lens with anterior and  Optic diameter 6.0mm, overall  $332.00

 Intraocular Lens posterior edge modification length 12.5mm, diopter range

 +10 to +28.0

 t1

 Bausch & Lomb (Australia) Pty Ltd

BL028 Akreos Toric Astigmatism- Correcting  Single piece, foldable, acrylic intraocular  The overall diameter is 11  $698.00

 Lens lens with a toric optic on the posterior  millimetres for the entire lens

 surface and axis marks on the posterior  power range (spherical

 optic's flat meridian. equivalent powers from +10.0

 to +30.0 diopters in 0.5 diopter

  steps and cylinder powers of

 +1.25, +2.00 & +2.75

 diopters).

 Kevin Grundy (IBD) Pty Ltd

KG003 Rayner Standard Toric C-Flex Hydrophilic HEMA-MMA copolymer,  5.00mm dia optic, 12.00mm  $698.00

 foldable with injector dia overall, cyls 2.0D to 6.0D in

  2D increments

 t1, at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

AL032 AcrySof IQ Toric IOL Posterior chamber, UV absorbing,  +6 to +30 D spherical; 1.00 to  $780.00

 foldable, acrylic, toric, single piece lens  6.00 D cylinder.

 with blue light protection and aspheric

 correction

Prostheses List by Category, Groups and Sponsor Page 9 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Design for Vision Pty Ltd

DV251 HOYA AF - 1 311 Toric T3/T4/T5 Correct Corneal Astigmatism, Micro- lOL Power: 6.0D to 30.0D  $780.00

 incision,Aspheric, Blue-Blocker, Single  (0.5 steps)lOL Cylinder

 Piece, Hydrophobic Power: 1.50D (311T3), 2.25D

 (311T4), 3.00D (311T5)

 t1, vblf

 Alcon Laboratories (Aust.) Pty Ltd

AL023 Alcon AcrySof Toric PC IOL Models Posterior chamber, UV absorbing,  +6 to +34 D spherical; 1.50 to  $740.00

 foldable, acrylic, toric, single piece lens  6.00 D cylinder

 with blue light protection

 t2

 Kevin Grundy (IBD) Pty Ltd

KG004 Rayner Premium Toric C-Flex HEMA-MMA copolymer, foldable with  5.75mm dia optic, 12.00mm  $1,000.00

 injector dia overall, cyls 1.5D to 11.0D

 in 0.5D increments

KG013 Rayner Super Premium Toric I.O.L. Acrylic foldable toric single piece I.O.L -10.0D to 0.00D Sphere: 1D to $1,000.00

  11.00D Cylinder in 0.25 steps

           +31.00D to +35.00 Spit:

  1D to 11.00D Cylinder in

 0.25steps

 vblf

 Alcon Laboratories (Aust.) Pty Ltd

AL016 Alcon Acrysof Natural Model SN60AT Foldable Acrylic Single-piece Lens,  +6 to +40D $364.00

 asymmetric optic/consistent edge, with

 blue light protection

AL025 AcrySof Multipiece Models MN60MA,  Foldable Acrylic multi-piece Lens with  - 5 D to + 30 D $364.00

 MN60AC Blue light Protection

 1.2.2.4 Multifocal or bifocal

 AMO Australia Pty Ltd

AO020 ReZoom Acrylic Multifocal Intraocular  Acrylic, foldable, posterior chamber,  6.0mm Optic Diameter x  $780.00

 Lens intraocular lens 13.0mm overall length

Prostheses List by Category, Groups and Sponsor Page 10 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

AO023 TECNIS™ Multifocal Intraocular Lens  Tecnis Multifocal foldable Posterior  +5.0 Diopter to 34.0 Diopter in $780.00

 (ZM900) Chamber Diffractive Intraocular Lens   0.5 diopter increments

 Model ZM900.  Posterior Chamber lens

 with UV light-absorbing, foldable, silicone,

  3 piece with a diffractive posterior optic

 and a Modified Prolate Anterior Surface

 Technology

 at

 AMO Australia Pty Ltd

AO026 TECNIS™ Multifocal Intraocular Lens  Posterior chamber lens with UV light- +5 diopters to +34 diopters in  $822.00

 (ZMA00) absorbing, foldable acrylic, 3-piece with a  0.5d increments

 diffractive posterior optic and a modified

 anterior surface technology with edge

 modification and 360 degree square edge.

AO027 Tecnis Multifocal 1-Piece Lens, Model  A multifocal posterior chamber lens with  6.0mm Optic Diameter x  $822.00

 ZMB00 UV-blocking, foldable acrylic, 1-piece  13.0mm in overall length.  +5.0

 with a diffractive posterior optic and a  Diopter to +34.0 Diopter in 0.5

 modified anterior surface technology with   Diopter increments.

 edge modification and a 360 degree

 square edge.

 Carl Zeiss Pty Ltd

CZ015 AT LISA 809M Foldable aspheric single-piece intraocular  Overall length 11.0mm Optic  $822.00

 lens with an aspheric front and an aspheric  size 6.0mm

 bifocal back surface, asymmetric light

 distribution 65 percent distance and 35

 percent near, with 3.75D addition in the

 near foucs.

 Kevin Grundy (IBD) Pty Ltd

KG009 Rayner "M-Flex" Mulitfocal Foldable IOL Acrylic, Foldable, Single piece multi-zoned 6.5mm Optic-Overall diameter  $822.00

  refractive aspheric multifocal with Amon- 12.5mm: +3D or + 4D

 Apple 360 Degree Square edge, Anti  Addition: +14D to +25D in

 Vaulting Haptics 1.0D increments: +8.5D to

 +23.5D in 0.5D increments

Prostheses List by Category, Groups and Sponsor Page 11 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 at, pl

 Carl Zeiss Pty Ltd

CZ033 AT LISA 809MP Preloaded, micro incision, aspherical  Diopter range: 0.0 to 32.0 $842.00

 bifocal, square edged, single-piece IOL for Optic size: 6.0mm.  Overall

  capsular bag fixation. The anterior  length: 11.0mm

 aspheric bifocal surface has an asymmetric

 light distribution 65/35 for distance/near

 vision, and 3.75D add for the near focus.

 at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

AL028 AcrySof IQ ReSTOR SN6AD3 Posterior Chamber, UV absorbing,  +6 D to + 34 D $864.00

 foldable, acrylic, single piece lens with

 apodised diffractive optic and blue light

 protection

AL030 AcrySof IQ ReSTOR SN6AD1 and  Posterior Chamber, UV absorbing,  +6 D to + 34 D $864.00

 MN6AD1 foldable, acrylic, single and multiple lenses

 with apodised diffractive optic and blue

 light protection

 Design for Vision Pty Ltd

DV248 HOYA PY-60MV Preloaded in cartridge, Multifocal,  +14.0D to 27.0D (0.5 steps) $864.00

 Aspheric, Blue-blocker, Single Piece,

 Hydrophobic

 t1, at

 Carl Zeiss Pty Ltd

CZ025 AT LISA toric 909M Foldable aspheric single-piece intraocular  Overall length 11.00mm Optic  $1,198.00

 lens with an aspheric toric front and an  size 6.0mm -10.00 to +32.0D

 aspheric bifocal back surface, asymmetric  inclusive in 0.5D increments

 light distribution 65 percent distance and  Cylinder +1.0D to 6.5D

 35 percent near, with 3.75D addition in  inclusive in 0.5D increments

 the near focus.

Prostheses List by Category, Groups and Sponsor Page 12 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Kevin Grundy (IBD) Pty Ltd

KG010 Rayner M-Flex Toric (Standard) Acrylic, Foldable, Single Piece, Multi- 5.75mm / 12.0mm: 6.25mm /  $1,198.00

 zoned Refractive Aspheric Toric Mulitfocal 12.5mm +3.00D or +4.00D

  with Amon-Apple enhanced 360 degree  Addition FAR: +14.0D to

 Square edge, Anti Vaulting Haptics +32.00D in 0.5 STEPS:

 +2.00D +3.00D  +4.00D

 Cylinder. NEAR: +14.0D to

 27.0D in 0.5 STEPS: +2.00D

 +3.00D  +4.00D Cylinder

KG011 Rayner "M-Flex" Toric (Non Standard) Acrylic, Foldable, Single Piece, Muli- 5.75/12.0mm: 6.25/12.5mm  $1,198.00

 Zoned Refractive, Toric Multifocal with  +3.00D to +4.00D Addition

 Amon-Apple enhanced 360 Degree  FAR: +14.0D to +32.0D in

 square edge, Anti-vaulting Haptics, Patient 0.5D Increments: NEAR:

  Specific. +14.0D to +27.0D in 0.50D

 Increments Cylinder: 1.0D to

 1.5D and 2.5D to 6.00D in 0.5

 increments

 t1, at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

AL033 AcrySof IQ ReSTOR multifocal toric IOL Posterior chamber UV absorbing foldable, +6  to +34 D spherical; 1.00 to $1,240.00

  acrylic, aspheric, toric single piece lense   3.00 D cylinder

 with apodised diffractive optic and blue

 light protection.

 t2, at

 Carl Zeiss Pty Ltd

CZ024 AT LISA toric 909M Foldable aspheric single-piece intraocular  Overall length 11.00mm Optic  $1,500.00

 lens with an aspheric toric front and an  size 6.0mm -10.00 to +32.0D

 aspheric bifocal back surface, asymmetric  inclusive in 0.5D increments

 light distribution 65 percent distance and  Cylinder +7.0D to 12.0D

 35 percent near, with 3.75D addition in the inclusive in 0.5D increments

  near focus.

Prostheses List by Category, Groups and Sponsor Page 13 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 1.2.2.5 Accommodative

 pa

 Bausch & Lomb (Australia) Pty Ltd

BL027 Crystalens HD Accommodating lens with > 3 Dioptres of  10.0 to 33.0 Dioptres in .05  $780.00

 accommodation with dual mechanism of  Dioptre steps

 action: (1) forward axial movement of lens

 and (2) accommodative arching of optic. 

 Posterior chamber, polyspheric optics, 3-

 piece, plate haptic, foldable UV light

 filtering, bic

 IQ Medical

IQ003 Tetraflex Acrylic single piece, foldable  Available in dioptric powers  $780.00

 accommodating intraocular lens with sqare  from +5.0 to +36.0, 1D steps:

 edge design, custom control precision and  +31.0 to +36.0; 0.5D steps:

 closed loop haptic design +5.0 to +18.0 and +25.0 to

 +30.0; 0.2D steps; +18.0 to

 +25.0

 pa, at

 Bausch & Lomb (Australia) Pty Ltd

BL029 Crystalens AO Accommodating lens designed to provide  10.0 to 33.0 D in 0.50 Diopter  $822.00

 > 3 Diopters of accommodation with dual  steps.  10.0 - 16.5 Diopters

 mechanism of action: (1) forward axial  (12mm length) and 17.0 - 33.0

 movement of lens and (2) accommodative  Diopters (11.5mm length).

 arching of optic.  Posterior chamber,

 aspheric, aberration free optics, 3-piece,

 plate haptic, fol

 pa, pl

 AMO Australia Pty Ltd

AO028 Synchrony Accommodating IOL Synchrony Dual Optic Accommodating  5.50mm Anterior Optic,  $800.00

 Posterior Chamber IOL 6.00mm Interior Optic,

 9.80mm Overall Length,

 Diopter Range: +16.00 to

 +28.00 in 0.5D Increments

Prostheses List by Category, Groups and Sponsor Page 14 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.2.3 Pseudo-phakic, piggy-back

 1.2.3.1 Monofocal

 Design for Vision Pty Ltd

DV246 Rayner Sulcoflex Ashperic (Premium)  Pseudophakic Supplementary I.O.L.O.L. -10.0D to -5.50D in 0.5D  $323.00

 I.O.L. increments.                +5.50D

 to 10.00D in 0.5D increments

 at

 Kevin Grundy (IBD) Pty Ltd

KG008 Rayner "Sulcoflex" Pseudophakic I.O.L. Sulcoflex Aspheric Pseudophakic I.O.L -5D to +5D $365.00

 t1, at

 Kevin Grundy (IBD) Pty Ltd

KG005 Rayner Sulcoflex Aspheric Toric  Acrylic, Aspheric, Toric Pseudophakic  SE -3 to +3 in 0.5 D steps $698.00

 Pseudophakic Secondary I.O.L -  Secondary IOL :  Sulcus fixated with  Cyl +1 to +3 in 1D steps

 Standard undulating Haptics and Posterior Haptic

 Angulation (Standard)

KG007 Rayner Sulcoflex Aspheric Toric  Acrylic, Aspheric, Toric Pseudophakic  SE -6.00 to +6.00 in 0.5 D  $698.00

 Pseudophakic Secondary IOL (Premium) Secondary IOL: Sulcus fixated with  steps Syl +1.00 to +6.00 in

 undulating Haptics and Posterior Haptic  0.5D steps

 Angulation (Premium)

 1.2.3.2 Multi-focal

 at

 Kevin Grundy (IBD) Pty Ltd

KG006 Rayner "Sulcoflex" Aspheric Multi-focal  Acrylic, Aspheric Multi-focal  6.5mm / 13.5mm -  $822.00

 Pseudophakic Secondary IOL Pseudophakic Secondary IOL: Sulcus- 5.00D+5.00D sphere with  +

 Fixated with Undulating Haptics and  3.00 Addition

 Posterior Haptic Angulation

1.3.1 Viscoelastic

 Alcon Laboratories (Aust.) Pty Ltd

AL006 PROVISC VISCOELASTIC  PROVISC contains sodium hyaluronate 0.85mL pack $80.00

 SOLUTION

Prostheses List by Category, Groups and Sponsor Page 15 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

AL007 VISCOAT Viscoelastic Fluid Chondroitin sulfate and sodium hyaluronate 0.75mL $80.00

AL015 Cellugel viscoelastic fluid Hypromellose 2% . $80.00

AL029 DisCoVisc Ophthalmic Viscosurgical  Sodium hyaluronate 17 mg/mL and  0.5 mL and 1.0 mL $80.00

 Device chondroitin sulfate 40mg/mL

 AMO Australia Pty Ltd

AO008 Healon, Intraocular Viscoelastic Fluid Sodium Hyaluronate 10mg/ml Healon 0.4ml, 0.55ml & 0.85ml $80.00

 Bausch & Lomb (Australia) Pty Ltd

BL008 Ocucoat Intraocular Fluid 20mg/mL hydroxypropylmethyl cellulose  1mL sterile $80.00

 for intraocular use

BL015 Amvisc Plus injection 15mg/mL Sodium Hyaluronate for  0.5mL and 0.8mL $80.00

 intraocular use

 Carl Zeiss Pty Ltd

CZ012 Ophthalin Viscoelastic Ophthalin; Viscoelastic Solution - sodium  Volume 1.0ml $80.00

 hyaluronate 10mg/ml.  Preloaded in sterile

 syringe with a 27G cannula for injection

CZ013 Ophthalin Plus Viscoelastic Ophthalin Plus; Viscoelastic Solution -  Volume 1.0ml $80.00

 sodium hyaluronate 15mg/ml.  Preloaded

 in sterile syringe with a 27G cannula for

 injection

CZ022 VISTHESIA 1.5% VISTHESIA viscoelastic solution contains  Total volume 0.8ml $80.00

 1.5% hyaluronate (NaHA) and 1% of non

 preserved lidocaine hydrochloride. Plus

 two ampoules containing 0.3ml sodium

 hyaluronate and lidocaine hydrochloride

 20ml

 IQ Medical

IQ002 Ocuvis and Ocumax 2%  20mg/mL hydroxypropylmethyl cellulose  2mL sterile $80.00

 Hydroxypropylmethylcellulose for intraocular use. Pre-loaded in a sterile

 syringe with one cannula for injection, in a

 sterile Tyvek pouch

 hmw

 AMO Australia Pty Ltd

AO009 Healon 5, Intraocular Viscoelastic Fluid HEALON5- Sodium hyaluronate 23mg/ml 0.6ml $80.00

  .

Prostheses List by Category, Groups and Sponsor Page 16 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

AO010 Healon GV Intraocular Viscoelastic Fluid Sodium Hyaluronate 14mg/mL 0.5mm and 0.85ml $80.00

 1.3.1.1 Dual Fluids

 Alcon Laboratories (Aust.) Pty Ltd

AL005 DUOVISC VISCOELASTIC  PROVISC contains sodium hyaluronate,  Small & large packs $110.00

 SYSTEM VISCOAT contains chondroitin sulfate

 and sodium hyaluronate

 Carl Zeiss Pty Ltd

CZ019 TwinVisc Viscoelastic Twinvisc Viscoelastic Solution - Ophthalin  Total volume 1.4 ml $110.00

 contains sodium Hyaluronate 1%/ Endogel

 contains sodum Hyaluronate 2.2%

 Preloaded in sterile syringe with a 25G

 cannula for injection

1.3.2 Non Viscous

 Design for Vision Pty Ltd

DV231 Vision Blue Trypan blue dye for ophthalmic applications 0.5ml syringe $48.00

1.4.1 Simple

 Alcon Laboratories (Aust.) Pty Ltd

AL001 Capsular Tension Rings - 10.0 - 12.0 compressed,  12.3  $159.00

 - 14.5 uncompressed

 AMO Australia Pty Ltd

AO021 Stabileyes Capsular Tension Ring Polymethylmethacrylate (PMMA) Implant 12mm ring, and 13mm ring $159.00

 Carl Zeiss Pty Ltd

CZ002 Tensiobag: Capsular Tension Ring PMMA Diameter 10 - 14mm $159.00

 Design for Vision Pty Ltd

DV009 Morcher Capsular Tension Ring PMMA Implant 14, 14A, 14C $159.00

Prostheses List by Category, Groups and Sponsor Page 17 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Emagin Pty Ltd

EG001 Capsular Tension Rings Clear PMMA Implant 10/08, 12/10, 13/11mm $159.00

 pl

 Design for Vision Pty Ltd

DV029 Eyejet CRT Capsular tension ring made of PMMA  14 (10mm), 14C (11mm), 14A $243.00

 per-load on disposable injector  (12mm)

 Insight Surgical Pty Ltd

IS001 Preloaded Capsulan Tension Ring Capsular tension ring preloaded (acrylic) 13/11mm $243.00

1.4.2 Complex

 Design for Vision Pty Ltd

DV010 Morcher Coloboma Diaphram  PMMA Implant 96G, 96L $334.00

1.5.1 Long Tube

 AMO Australia Pty Ltd

AO012 Baerveldt Glaucoma Implant BG 101- Non-valved artificial drainage device,  Surface area 250, 350, 425mm2 $425.00

 350, Baerveldt Glaucoma Implant BG  composition silicone - smooth, tumble-

 103-425, Baerveldt Glaucoma Implant  polished finish

 BG 103-250

 Design for Vision Pty Ltd

DV020 Molteno Implant Double plate - dual chamber One size only $425.00

DV242 Molteno Implant Glaucoma Drainage Device - Single  N/A $425.00

 Plate/Single Plate-Dual Chamber/Double

 Plate

 v

 Design for Vision Pty Ltd

DV230 Molteno 3 Drainage implant for glaucoma, made of  2 Sizes: *230 mm square  $625.00

 silicon *175mm square

Prostheses List by Category, Groups and Sponsor Page 18 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.5.2 Short Tube

 1.5.2.1 Cannulated

 Alcon Laboratories (Aust.) Pty Ltd

AL037 ExPress Minature Glaucoma Shunt Miniature Glaucoma Shunt 50 & 200 microns $715.00

1.6.1 Spacers

 Spectrum Surgical

SO017 FCI Ptose-up Expanded PTFE 15cm long x 2 or 3mm wide x  $348.00

 0.35mm thick

1.6.2 Weights

 1.6.2.1 Gold <1.8 grams

 Device Technologies Australia Pty Ltd

DE183 Lid Load Gold Eyelid Weights; Gold 0.6, 0.8, 1.0, 1.2, 1.4, 1.6  $425.00

 grams

 1.6.2.2 Gold ≥1.8 grams

 Device Technologies Australia Pty Ltd

DE182 Lid Load Gold Eyelid Weights; Gold 1.8, 2.0, 2.2, 2.4, 2.6, 2.8  $800.00

 grams

 1.6.2.3 Platinum

 CoreMed Pty Ptd

RC001 LIDCHAIN Platinum Eyelid Implant Platinum Weights - 0.8, 1.0, 1.2, 1.4,  $1,300.00

 1.6, 1.8 grams

Prostheses List by Category, Groups and Sponsor Page 19 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.7.1 Intracanilicular

 Design for Vision Pty Ltd

DV022 Eyetec DCR Tubes Stainless steel, silicone tubing, Bodkin  30cm $135.00

 lacrimal intubation set

DV241 Eyetec DCR Tubes Crawford and Cannaliculus Intubation Sets N/A $135.00

 Device Technologies Australia Pty Ltd

DE191 Canaliculus Intubation Sets  Silicone, SS & Nylon 17.7 x .064 x 29cm, 15.5 x  $135.00

 .051 x 33cm

DE278 BD Visitec Lacrimal Intubation Sets Stainless steel probes with solid silicone  1. Probes 0.90mm x 4.5cm,  $135.00

 rods or silicone tubing - packaged sterile rod 40cm x 0.80mm. 2. Probes

  0.40mm x 11cm, tubing 35cm

 x 0.64mm. Probes 0.60mm x

 11mm, tubing 35cm x 0.30mm.

 Spectrum Surgical

SO021 FCI Lacrimal Intubation Set PVP Coated Silicone Tubing/PVP Coated PVP Bika: 0.64mm O.D.  $135.00

  Silicone Plug/Metal Probes/Polypropylene Tube/80 x 0.8mm probes, PVP

  Thread  Differential Bika: 0.64 &

 1.18mm O.D. Tube/40 x

 1.2mm probes, PVP Bika for

 DCR: 0.94mm O.D. Tube/50 x

  0.8mm probes, PVP Infant

 Bika 0.64mm O.D. Tube/55 x

 0.7mm probes, PVP Infant

 Bika II: 0.64mm O.D. Tube/

SO043 FCI Bi-Canalicular Lacrimal Intubation  Silicone tubing swaged, imbedded into or  Probes: 40mm to 120mm x  $135.00

 Set around malleable and flexible stainless steel 0.7mm to 1.2mm.  Tube:

  probes. PEEK thread. 0.64mm to 1.18mm x 25mm to

 400mm.  PEEK Thread: 0.2mm

  to 0.4mm x 500mm.

Prostheses List by Category, Groups and Sponsor Page 20 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 mc

 Spectrum Surgical

SO044 FCI Mono-Canalicular Lacrimal  Silicone tubing with plug swaged,  Probes: 40mm to 120mm x  $180.00

 Intubation Set imbedded into or around malleable or  0.7mm to 1.2mm.  Tube:

 flexible stainless steel probes or guides.  0.64mm to 1.18mm x 30mm to

 PEEK thread. Introducer. 350mm.  PEEK Thread: 0.2mm

  to 0.4mm x 500mm.  Plug

 Collar: 2mm to 4mm.

1.7.2 Extracanilicular

 Device Technologies Australia Pty Ltd

DE177 Lester Jones Tear Duct Tubes Glass 3 x 9 to 16mm, 3.5 x 9 to  $84.00

 18mm, 4.0 x 9 to 24mm, 5.0 x

 9mm

1.8.1 Intrascleral

 Device Technologies Australia Pty Ltd

DE188 Acrylic Implant Acrylic 12, 14, 16, 18, 20mm. $55.00

DE202 John Weiss Glass Mule Globes Glass No: 12, 14, 16, 18, 20mm $55.00

 Spectrum Surgical

SO040 FCI Orbital Implants Silicone - Sterile 12mm to 22mm $55.00

 vp

 Spectrum Surgical

SO006 FCI Orbital Implants Orbital Implant, Bioceramic (Aluminium  Bioceramic diameter, 12, 14,  $1,200.00

 Oxide)/Hydroxyapatite (Synthetic) 16, 18, 20, 21, 22mm;

 Synthetic Diameter, 10, 12, 14,

  16, 18, 20, 22mm

Prostheses List by Category, Groups and Sponsor Page 21 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.8.2 Extrascleral

 1.8.2.1 Complex and permeable

 Stryker Australia Pty Ltd

SK521 Sphere Orbital Sphere Models 6316, 6326, 6327, Orbital Sphere Models 6316:  $785.00

  6317 and 6322 8702-8704. COI implant, 14mm, 6326: 16mm, 6327:

  models 7222, 7223 & 80026. MCOI  18mm, 6317: 20mm, 6322:

 implant, models 7207 - 7209 Quad  22mm, 8702: 19mm, 8703:

 Motility Implants 9866 - 9868 & 80022 21mm, 8704: 23mm, COI

 Implants 7222: Approx 4ml,

 7223: Approx 5ml, 80026:

 Approx 6ml, MCOI 7207:

 Approx 3ml, 7208: Approx

 4.2ml,  7209: Approx 5.6ml,

 QUAD Motility Small 16ml,

 Medium: 18ml, Large: 20ml,

 Extra Large: 22ml.

 ha

 Spectrum Surgical

SO007 FCI Orbital Implants Mesh wrapped orbital implant: mesh  Bioceramic diameter: 16, 18,  $1,600.00

 wrapped bioceramic (aluminium oxide),  20, 22mm; Synthetic

 mesh wrapped hydroxyapatite (synthetic),  Hydroxyapatite diameter: 16,

 mesh wrap (polyglycolic acid) 18, 20, 22mm

 1.8.2.2 Multi-component

 Spectrum Surgical

SO019 FCI Orbital Implants Peg & Sleeve Standard Large $863.00

1.8.3 Fascial - solid and permeable

 Device Technologies Australia Pty Ltd

DE277 Frontalis Suspension Set Stainless steel needles with solid silicone  needles 0.90mm x 6.5cm, rod  $315.00

 rods and silicone tubing - packaged sterile 40cm - 0.80mm, sleeve 10 x

 2mm

Prostheses List by Category, Groups and Sponsor Page 22 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Spectrum Surgical

SO045 FCI Ptosis Probes Stainless steel needle probes swaged with  80mm x 0.8mm needle probes,  $315.00

 silicone tubing. 280mm 0.64mm tubing.

1.9.1 Buckles, bands, tyres and sponges

 Austmed Pty Limited

AP003 Mira: Scleral Implants Solid Silicone- Tires-Mira 286 Wendel  $45.00

 Tire/Meridional/Wedge/Pad. Retinal  Symmetrical Oval Tire 6mm,

 Implant used in Scleral Buckling  Mira Symmetrical Oval Tire

 (Dimethylmethylvinyl Siloxane Copolymer) 7mm, Mira 287WG Murray

 wide (3.5mm) grooved

 symmetrical tire, 10mm wide,

 Mira 288 ross symmetrical

 grooved tire, low profile 10mm

 wide by 2.5mm, Mira 289

 Symmetrical oval tire 10m

AP004 Mira: Scleral Implants Solid Silicone-Sleeve. Retinal Implant used Sleeves-Mira 70 Sleeve 1mm  $45.00

  in Scleral Buckling (Dimethylmethylvinyl  I.D., Mira 71 Sleeve 1mm I.D.,

 Siloxane Copolymer)  Mira 72 McNutt Sleeve

 1.57mm I.D., Mira 270 Sleeve

 0.76mm I.D.

AP006 Mira: Scleral Implants Solid Silicone-Band/Strip/Boat/Clip.  Bands-Mira 40 Circling Band  $45.00

 Retinal Implant used in Scleral Buckling  2mm, Mira 240 Circling Band

 (Dimethylmethylvinyl Siloxane Copolymer) 2.5mm. Strips-Mira 41 Strip

 3.5mm, Mira 42 Strip 4mm,

 Mira 20 Strip 4mm, Mira 219

 Strip 4.5mm, Mira 31 Strip

 4.5mm, Mira 32 Strip 5mm,

 Mira 225 Oval Strip 5mm,

 Mira 220 Strip 6mm. Boats-

 Mira 60 Boat

 Device Technologies Australia Pty Ltd

DE179 Silicon Retinal Implant Tire  7.0, 9.0, 12.5, 6.0, 8.5, 10.0mm $45.00

Prostheses List by Category, Groups and Sponsor Page 23 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

DE181 Silicon Retinal Implant Band 0.75 x 2.0 x 125mm, 0.60 x  $45.00

 2.5 x 125mm, 0.75 x 2.5 x

 125mm

 Spectrum Surgical

SO009 FCI Scleral Buckling Devices Band/strip: solid silicone Band - 2.0 x 0.75mm Type 40, $45.00

  3.5 x 0.75mm Type 41, 4.0 x

 1.25mm Type 42, 2.5 x 0.6mm

  Type 240, Morin 3.5 x 0.6mm

 Strip - 5.7mm Type 20,

 7.2mm Type 31, 9.2mm Type

 32, 6mm Type 219, 7.5mm

 Type 220, 8mm Type 225

SO011 FCI Scleral Buckling Devices Tire: Solid Silicone Symmetrical: (2.5 mm Groove,  $45.00

 7 to 9mm wide), Biconvex:

 (2.5mm Groove, 7 to 10mm

 wide), Asymetrical: (2.5mm

 Groove, 7 to 10mm wide)

SO013 FCI Scleral Buckling Devices Strip: Solid Silicone Strip: 1.4 x 4.4 x 100mm,  $45.00

 Morin Strip: 7mm wide x

 100mm long, Caputo Zip Strip:

 7 to 9mm wide x 120mm long,

 Korobelnik Oval Strip: 2 x

 5mm

 1.9.1.1 Sponges

 Austmed Pty Limited

AP002 Mira: Scleral Implants Silicone Sponge- Retinal Implant Used in  Sponge- Mira 502 Cylinder  $90.00

 Scleral Buckling (Silicone Elastomer  2mm, Mira 5025 Cylinder

 Sponge) 2.5mm, Mira 503 Cylinder

 3mm, Mira 504 Cylinder 4mm,

 Mira 505 Cylinder 5mm, Mira

 505G Grooved cylinder 5mm,

 Mira 505T Packer tunnel

 cylinder 5mm, Mira 510 Half

 cylinder 5mm, Mira 515

 Brucker two-thirds cyl

Prostheses List by Category, Groups and Sponsor Page 24 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Device Technologies Australia Pty Ltd

DE178 Silicon Retinal Implant Sponge 2.5 x 4.0 x 80mm, 3.0 x 5.0 x  $90.00

 100mm, 3.25 x 7.0 x 80mm,

 5.5 x 7.5 x 80mm, 1.5 x 80mm,

  2.0 x 80mm, 2.5 x 80mm, 3.0

 x 80mm, 4.0 x 80mm, 5.0 x

 80mm, 7.0 x 80mm

 Spectrum Surgical

SO012 FCI Scleral Buckling Devices Sponge/Cord: Silicone Cord: 1.0 to 5.0mm O.D. x  $90.00

 150mm length; Half Cord:

 3.0mm to width x1.5mm to

 2.5mm height x150mm;

 Circular Sponge: 3 to 5mm;

 Oval Sponge: 2 to 5.5mm x 4

 to 12mm; Half Sponge: 2 to

 3.1mm x 4 to 7.5mm; Grooved

 Sponge: 3 to 5mm x 5 to 

 12mm; Gain Sponge: 6 x

1.9.2 Clips and tacks

 Device Technologies Australia Pty Ltd

DE201 Labtician Tantalum Clips Tantalum 2, 2.5mm $50.00

1.9.3 Sleeves

 Device Technologies Australia Pty Ltd

DE180 Silicon Retinal Implant Sleeve 1mm, .76mm, 1.5mm $25.00

 Spectrum Surgical

SO010 FCI Scleral Buckling Devices Fixation Sleeve: Solid silicone O.D: 1.65 to 2.41mm, Length  $25.00

 30mm

Prostheses List by Category, Groups and Sponsor Page 25 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

1.9.4 Intraocular Gases

 Alcon Laboratories (Aust.) Pty Ltd

AL035 ISPAN Retinal Gases for Constellation® Tamponade gases for retinal surgery C3F8 125g cylinder, dispensed in  $75.00

  Vision System  and SF6 single dose syringe

AL036 ISPAN retinal gases Tamponade gases for retinal surgery C3F8 125 g cylinder, dispensed in  $75.00

  and SF6 single dose syringe

 Device Technologies Australia Pty Ltd

DE284 Single Dose Ophthalmic Gases Single dose tamponading gas for retinal  30ml $75.00

 surgery

1.9.5 Intraocular Heavy Liquids

 Alcon Laboratories (Aust.) Pty Ltd

AL013 Perfluoron Kits Perfluoro-n-octane for use as a retinal  5mL $240.00

 surgery additive

AL014 Perfluoron Kits Perfluoro-n-octane for use as a retinal  7mL $240.00

 surgery additive

 Bausch & Lomb (Australia) Pty Ltd

BL017 Perfluo-octane (Oktaline) Okta-Line Perfluorocarbon Liquid  for use as a retinal 5mL $240.00

  surgery additive

BL018 DK Line 100% purified perfluorodecalin Perfluorodecalin 7ml $240.00

 Design for Vision Pty Ltd

DV244 D.O.R.C. Eftiar Eftiar Decaline and Octane 5ml 5ml $240.00

 Device Technologies Australia Pty Ltd

DE204 Arcaline (Perfluorodecaline) Liquid perfluorocarbon aid for retinal  3ml, 5ml, 7ml $240.00

 surgery, operative device for retinal

 surgery, in particular retinal detachment

 (RD), RD with giant tear etc.

Prostheses List by Category, Groups and Sponsor Page 26 of 911

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

DE205 Arcotane (Perfloro-N-Octane) Liquid perfluoro-N-Octane aid for retinal  5ml, 7ml $240.00

 surgery, pre-operative device for retinal

 surgery, in particular retinal detachment

 (RD), RD with giant tear, RD with

 proliferative vitreal retinopathy (PVR) etc.

 IQ Medical

IQ005 Densiron Heavy Tamponade Liquid Medium,  10 ml, Sterile $240.00

 Postoperative

IQ008 Octane & Decalin Perfluorocarbon retinal tamponade  5ml & 7ml, Sterile $240.00

 medium, intraoperative

 Spectrum Surgical

SO023 FCI - DECA, FCI - OCTA FCI - DECA: Purified perfluorodecalin,  5ml $240.00

 FCI - OCTA: Purified perfluoro-N-octane

SO024 FCI - DECA, FCI - OCTA FCI - DECA: Purified perfluorodecalin,  7ml $240.00

 FCI - OCTA: Purified perfluoro-N-

 Octane

1.9.6 Intraocular Silicone Oils

 Bausch & Lomb (Australia) Pty Ltd

BL016 Oxane LMWC Fractioned Silicone Oil Purified fractioned silicone oil 10mL $195.00

BL024 Oxane HD Silicone oil - RMN3 mixture 10ml $195.00

 Design for Vision Pty Ltd

DV243 D.O.R.C. Silicon Oil D.O.R.C. Silicon Oil 1000/5000CS 10ml $195.00

 Device Technologies Australia Pty Ltd

DE228 LSO Silicone Oil Silicone oil for tamponade use in  10ml, vial or syringe $195.00

 vitreoretinal surgery

 IQ Medical

IQ006 Siluron 1000 & Siluron 5000 Silicone Oils 10 ml, Sterile $195.00

 Spectrum Surgical

SO022 FCI Purified Silicone Oil (Solvent Free) Viscosity: 1000 cst/5000 cst: solvent free  10ml $195.00

 purified silicone oil

Prostheses List by Category, Groups and Sponsor Page 27 of 911

11 - HIP

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

11.1.1 - Cemented

 11.1.1.1 - Unpolished

 B Braun Australia Pty Ltd

BB275 Excia Hip System Cemented stem cobalt chromium 9mm-18mm $1,850.00

 Biomet Australia Pty Ltd

BI039 Integral Hip System  Femoral Stem, Chrome Cobalt,  9-17mm $1,850.00

 Cemented unpolished

BI047 Echo FX Stem  Femoral Stem, Chrome Cobalt,  7-17mm $1,850.00

 Cemented unpolished

BI050 Bi-Metric Hip System Titanium unpolished cemented  7-17mm $1,850.00

BI063 Bimetric Hip System Chrome Cobalt Cemented, unpolished 7-17mm $1,850.00

BI069 Biomet Taperloc Hip System Titanium unpolished 7.5mm to 20mm diameter $1,850.00

BI132 Mallory Head Hip System  Cobalt Chrome, Unpolished 7-19mm $1,850.00

 DJO Australasia Pty Ltd

DD006 Foundation Hip System 450, 460 Foundation Non-porous, cemented Stem 8, 9, 10.5, 12, 13.5, 15, and  $1,850.00

 16.5

 ESKA Australia

EK080 Adapter GHE Femoral Stem Cemented  CoCr, non polished 160mm & 180mm $1,850.00

 Exactech Australia

EX012 Exotech Novation C femoral stem Femoral stem cemented unpolished 1-8 $1,850.00

EX053 Novation Cemented Plus Femoral Stem The Exatech Novation Cemented Femoral  Size 10, 11, 12, 13, 14, 15, 17 $1,850.00

 Stems are a line addition to the AcuMatch

 C-Series Cemented femoral stems, as

 follows: The trapezoidal cross-sectional

 area was modified to a circulo-trapezoidal

 geometry. A change to the sizing range and

  neck length.

 Johnson & Johnson Medical Pty Ltd

DP180 Charnley Standard Femoral Stem Stainless steel, (Ortron 90) fixed &  Sizes less than 200mm $1,850.00

 attachable femoral heads

DP203 Elite Plus Femoral Stem Stainless steel, Ortron 90, cemented  CDH, Size 1-7 and all offsets $1,850.00

 femoral stem, unpolished

Prostheses List by Category, Groups and Sponsor Page 28 of 911

11 - HIP

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

JJ573 Summit Cemented Femoral Stem CoCr, tapered, unpolished Sizes 0-10, with various offsets $1,850.00

 Link Orthopaedics  Australia

LO015 LINK Lubinus SPII Hip Prosthesis Stem Left & right 01-5 $1,850.00

 Mathys Orthopaedics Pty Ltd

MA016 CCA Cemented Femoral Stem CoCr, straight, not polished 7.50mm -17.5mm $1,850.00

 Orthotech Pty Ltd

OH226 Exotech Novation C femoral stem Femoral stem cemented unpolished 1-8 $1,850.00

 Smith & Nephew Surgical Pty Ltd

SN010 Basis Femoral Component Hip stem, Cobalt Chromium Grit Blast Length 115 - 135mm $1,850.00

SN301 Spectron and Synergy Femoral Stem Non Porous Offset 1- 20 $1,850.00

 Stryker Australia Pty Ltd

SR017 Omnifit hip system OMNIFIT cemented femoral component - Stem sizes 4-11 $1,850.00

  cobalt chrome

SR018 Omnifit hip system OMNIFIT 'C' stem - cemented  cobalt  Stem sizes 4-11 $1,850.00

 chrome, collared and collarless, 132

 degree offset

ST576 Stryker Omnifit Cemented Stem Cemented  femoral component Cobal  Stem sizes 4-11 $1,850.00

 Chrome

 Zimmer Pty Ltd

ZI015 Zimmer 'VerSys  Hip Systems Femoral  Cemented - Cobalt Chrome unpolished 11 - 17 $1,850.00

 Stem

ZI337 Natural Hip System Unpolished, straight, Femoral Stem, CoCr 140 - 160mm $1,850.00

 Removable Neck

 DJO Australasia Pty Ltd

DD026 R120 Cemented Femoral Stem CoCr, unpolished, tapered, collared,  Size 1 to 6 $1,850.00

 separate neck

 ESKA Australia

EK031 Adapter Cemented Femoral Stem CoCr, unpolished, tapered, fixed proximal  Femoral stem 1-7 $1,850.00

 cement centralisers and distal centraliser

 included

Prostheses List by Category, Groups and Sponsor Page 29 of 911

11 - HIP

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Global Orthopaedic Technology

GO134 R120 Cemented Femoral Stem CoCr, unpolished, tapered, collared,  Size 1 to 6 $1,850.00

 separate neck

 11.1.1.2 - Unpolished - precoat

 Orthotech Pty Ltd

OH397 Furlong Hemi Range Cemented femoral stem XXS, XS, S, M & L $2,100.00

 Stryker Australia Pty Ltd

HW031 Definition PM Femoral Component Femoral Stem -  Vitallium Stem sizes 1 - 7 $2,100.00

 11.1.1.3 - Polished

 Austofix

AX068 Experion Hip System Polished, stainless steel, tapered stem Sizers 1-4, Offsets 35.5 - 44mm $2,100.00

 B Braun Australia Pty Ltd

BB240 BiContact cemented Cemented stem cobal chrome 8-18 $2,100.00

 Biomet Australia Pty Ltd

BI066 Stanmore Total Hip System Polished Femoral Stem - Standard and  Size 1-5  $2,100.00

 Straight, Chrome Cobalt

BI925 Mallory Head Hip System Femoral Stem, Cobalt Chrome, Polished 7-19mm $2,100.00

 Corin Australia Pty Ltd

CR024 Taper Fit Femoral Stem Double taper stainless steel femoral stem sizes 0-4 with 4 different offsets $2,100.00

 Global Orthopaedic Technology

GO164 Global Cemented Femoral Stem CoCr, polished, double taper,  Sizes 0-4, various offsets $2,100.00

 Johnson & Johnson Medical Pty Ltd

DP546 C- Stem & C- Stem AMT Femoral  Stainless steel Ortron 90, highly polished,  Size 1-8 standard, Size 1-8  $2,100.00

 Stems triple taper High Offset, CDH and 0A to

 3A sizes

JJ786 Corail Hip System Cemented Femoral  Stainless steel cemented, polished femoral  Size 8 - 20 $2,100.00

 Stem stem, standard and high offsets

Prostheses List by Category, Groups and Sponsor Page 30 of 911

11 - HIP

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Lima Orthopaedics Australia Pty Ltd

LC005 Lima Friendly Stem  Femoral Stem Cemented, tapered,  0, 1, 2, 3 $2,100.00

 polished

LC026 Lima Accent Hip System Femoral Stem Cemented, tapered,  1 -6 $2,100.00

 polished

 Mathys Orthopaedics Pty Ltd

MA463 twinSys Cemented Femoral Stem stainless steel, highly polished, triple tapered 8 sizes in standard and lateral  $2,100.00

 version (Size 9, 10, 11, 12, 13,

 14, 15, 16)

 Medacta Australia Pty Ltd

MU001 CONE Cemented Femoral Stem CoCr, highly polished, triple taper Standard sizes 1 to 8,  $2,100.00

 Lateralized sizes 2 to 7

MU004 Quadra Hip Cemented Femoral Stem High nitrogen stainless steel alloy, highly  Std 0 to 7 $2,100.00

 polished, double taper Lat 1 to 7

 Smith & Nephew Surgical Pty Ltd

SN268 CPCS Femoral Stem Polished Non Porous, Std  1 - 5 $2,100.00

 and High Offset

 Zimmer Pty Ltd

ZI023 Zimmer Heritage Hip Systems Femoral   Cobalt Chrome, polished, straight  11 - 17 $2,100.00

 Stem

ZI373 MS-30 Hip prosthesis Stainless steel, polished tapered 6 to 16 $2,100.00

 Removable Neck

 Global Manufacturing Technology Pty Ltd

GM149 Absolut Cemented Femoral Stem CoCr, highly polished, tapered, with neck 0 to 14 $2,100.00

 Lifehealthcare Pty Ltd

LH067 Groupe Lepine Total Hip Replacement Cemented Stainless steel polished Size 6, 7, 9, 9, 10, 11 $2,100.00

 Wright Medical Australia

WR085 Profemur Xm Femoral Stem Femoral Stem, CoCr, Cemented, Polished 0, 1, 2, 3, 4 $2,100.00

Prostheses List by Category, Groups and Sponsor Page 31 of 911

11 - HIP

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 SCP

 Stryker Australia Pty Ltd

HW041 Exeter Hip System Stainless Steel (Orthinox) Stem Sizes 0-6, Offsets 30, 33, $2,500.00

  35.5, 37.5, 44, 50 & 56mm

 Zimmer Pty Ltd

ZI009 Zimmer CPT Hip Systems Femoral Stem Co Cr (Zimaloy), polished and tapered Sizes 1 - 5 $2,500.00

11.1.10 - Uncemented, Modular, HA Coated, Long Lengths (Stem

 11.1.10.1 - Grit Blast

 Spacer

 Wright Medical Australia

WR107 Profemur R Hip System Revision Hip Proximal Body Extension  L52 x D21mm;  $2,615.00

 Piece, Titanium

 Stem

 Corin Australia Pty Ltd

CR113 Extreme Hip System Femoral Stem Stem component of modular femoral stem, 4 lengths - 250 to 400mm, 6  $5,020.00

  titanium, HA, with distal screw holes diameters

 Johnson & Johnson Medical Pty Ltd

DP009 Reef Hip Femoral Stem Titanium modular femoral stem with  Length 225 - 375mm $5,020.00

 optional distal locking, grit blast and full

 HA coating

 Link Orthopaedics  Australia

LO138 Link MP Reconstruction Hip Prosthesis Stem, titanium, grit blast, HA 14 - 25mm x 210, 250, 290 &  $5,020.00

 330mm; 12 x 160, 180, 210,

 250 - MP; 14 x 160, 180 -MP;

  16 x 160, 180 - MP; 18 x

 160, 180 - MP; 20 x 160, 180

 - MP; 22.5 x 160, 180 -MP;

 25 x 160, 180 - MP

 Orthotech Pty Ltd

OH378 Securus Modular Revision Hip System Curved Femoral Stem 250 - 300mm $5,020.00

Prostheses List by Category, Groups and Sponsor Page 32 of 911

11 - HIP

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 11.1.10.4 - Plasma

 Body

 Corin Australia Pty Ltd

CR156 Extreme Revision Hip Monobloc  Combined metaphyseal and epiphyseal  4 sizes $4,520.00

 Epiphysis Metaphyseal Section sections, adjustable rotation, anodized

 titanium with HA coating

 Stryker Australia Pty Ltd

SK056 Stryker Modular Revision Hip System Milled Proximal Body Titanium Plasma  Dia 19-25mm with 2 mill  $4,520.00

 Spray, HA Depths; 27-29mm with 3 Mill

 Depths

SK060 Stryker Modular Revision Hip System Broached Proximal Body Titanium Plasma  1-8 $4,520.00

 Spray, HA

SK061 Stryker Modular Hip System Cone Proximal Body Titanium Plasma  Dia 19-31mm, Heights  $4,520.00

 Spray, HA +0,+10,+20,+30

SK062 Stryker Modular Revision Hip System Calcar Proximal Body Titanium Plasma  Diameter 19-29mm, 3 Heights  $4,520.00

 Spray each

 Stem

 Biomet Australia Pty Ltd

BI120 Mallory Head Hip System Femoral Stem, titanium plasma HA   220mm, Size 9-19mm $5,920.00

BI121 Mallory Head Hip System Femoral Stem, Calcar, HAP Coated,  250 - 260mm, Size 9-19mm $5,920.00

 Titanium

BI138 Mallory Head Hip System Femoral Stem, Revision, HAP Coated,  300mm, size 7 to 19mm $5,920.00

 Titanium

 Stryker Australia Pty Ltd

SR045 Stryker Modular Revision Hip System Modular Long Bowed Titanium Plasma  Length 217mm, 267mm and  $5,920.00

 HA Stem 317mm. Diameter 11mm - 26mm

11.1.11 - Calcar Replacement

 11.1.11.1 - Short and Standard Length

 Biomet Australia Pty Ltd

BI051 Bi-Metric Hip System Head Neck calcar Femoral Stem, Chrome 9-15mm  $3,700.00

  Cobalt, Cemented, unpolished 200 and

 250 lengths

Prostheses List by Category, Groups and Sponsor Page 33 of 911

11 - HIP

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Smith & Nephew Surgical Pty Ltd

SN273 Echelon/Spectron Revision Hip Stem - Non-porous 135-200mm $3,700.00

 Stryker Australia Pty Ltd

ST586 Osteonics omnifit head/neck hip stem  Cobal Chrome, Unpolished, standard and  Stem sizes  5, 7 & 9 $3,700.00

 long with calcar

 11.1.11.2 - Long Length (≥200mm)

 Johnson & Johnson Medical Pty Ltd

DP121 Solution Calcar Replacement Femoral  CoCr calcar replacement stem,  Size 7-10 inch (175 - 250mm) $6,900.00

 Stem uncemented, beaded (Porocoat)

 Smith & Nephew Surgical Pty Ltd

SN271 Echelon Revision Hip Stem – Non-porous  225mm-300mm $6,900.00

 Stryker Australia Pty Ltd

ST589 Osteonics hip prostheses Restoration cacar replacement stem 15mm 205mm length - stem sizes 8-14 $6,900.00

   titanium - HA coated

11.1.12 - Thrust Plates

 11.1.12.1 - Thrust Plate

 Zimmer Pty Ltd

ZI349 Thrust Plate Prosthesis Allopro Thrust Plate - Ti alloy 38 to 44mm $1,773.00

 11.1.12.2 - Lateral Plate

 Zimmer Pty Ltd

ZI350 Thrust Plate Prosthesis Allopro Lateral Plate - Ti alloy Std & Long (15 & 25 deg) $1,450.00

 11.1.12.3 - Thrust Plate Bolt

 Zimmer Pty Ltd

ZI351 Thrust Plate Prosthesis Allopro Threaded bolt - CoCr alloy 70 to 89mm $1,177.00

Prostheses List by Category, Groups and Sponsor Page 34 of 911

11 - HIP

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

11.1.13 - Monoblock Hemis

 Biomet Australia Pty Ltd

BI060 Austin Moore Self Locking Hip  Straight Standard Femoral Prostheses,  38-55mm $615.00

 Prosthesis System Titanium

BI062 FR Thompson Hip Prosthesis System Modular Curved Femoral Stem, Titanium. 38mm - 55mm  $615.00

 Johnson & Johnson Medical Pty Ltd

DP167 Thompson Hip Stainless steel (Ortron 90), Thompson  head size 40-54 $615.00

 unipolar monoblock femoral component

DP168 Austin Moore Hip Prosthesis Stainless steel (Ortron 90), AMP unipolar  Head size 38-60mm $615.00

 monoblock femoral component

 Orthotech Pty Ltd

OH285 JRI Austin Moore Total Hip System Cementless femoral stem Head sizes range from 39mm -  $615.00

 56mm

OH299 JRI Total Hip System JRI Austin Moore Standard Stems  Head Sizes range from 39mm -  $615.00

 Hemiarthroplasty. These prusct has an all- 56mm

 in-one head and stem

 Smith & Nephew Surgical Pty Ltd

SM037 Fracture Head Unipolar Femoral Head Stainless Steel or CoCr 38-60 S/M $615.00

SN277 Endoprosthesis CoCr 38 - 54mm $615.00

 Stryker Australia Pty Ltd

HW025 Austin Moore Endoprosthesis Long Stem - Vitallium cobalt chrome  Head size 38 to 63 $615.00

HW026 Austin Moore Endoprosthesis Standard Stem - Vitallium 105-165mm length, Head size:  $615.00

 38 to 57

SK196 Exeter Hip System - ETS  Orthinox Stainless Steel Endoprosthesis  40mm Offset body with  $615.00

 (endoprosthesis trauma stem) unipolar monoblock monoblock head sizes 38mm,

 40mm, 41mm, 42mm, 43mm,

 44mm, 45mm, 46mm, 47mm,

 48mm, 49mm, 50mm, 52mm,

 54mm, 56mm

 Zimmer Pty Ltd

ZI008 Zimmer Austin Moore  Stainless Steel Sizes 38 - 60 $615.00

Prostheses List by Category, Groups and Sponsor Page 35 of 911

11 - HIP

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

11.1.14 - Femoral Neck

 B Braun Australia Pty Ltd

BB296 Metha - Modular neck adaptors Modular neck adaptors made from CoCr   CCD - 130°, 135 °, 140°;  $1,227.00

 Offset  - 0mm, -5mm ,+5mm;

 Version - 7.5° left ante/right

 retro, 0 °, 7.5 ° left retro/right

 ante

 Corin Australia Pty Ltd

CR101 Modular Neck for Acor & Integrale  Titanium neck, with varying alignments &  4 sizes $1,227.00

 Femoral Stems tapers

 DJO Australasia Pty Ltd

DD028 R120 Femoral Neck CoCr, varying offsets & versions 32-38mm length, varying  $1,227.00

 degrees

 Electus Ortho Pty Ltd

EZ007 Modula SC Neck The complete series of MODULA SC  OX, OY, OZ, OA, OB, OC,  $1,227.00

 necks, all patented, consists of 15 sizes  9X, 9Y, 9Z, 9A, 9B, 9C, 9AA,

 and makes it possible to optimise the   9BB, 9CC

 reciprocal position of the stem and neck

 cup on the basis of the articular needs of

 the patient, by restoring the physiological

 off-set and le

 ESKA Australia

EK034 Adapter Femoral Neck CoCr, varying versions & offsets One Size $1,227.00

 FOL Technology PTY Ltd

FO021 Multifit Modular Neck Modular Neck S, M, L $1,227.00

 Global Orthopaedic Technology

GO139 R120 Femoral Neck CoCr, varying offsets & versions 32-38mm length, varying  $1,227.00

 degrees

 Lifehealthcare Pty Ltd

LH184 Modular U Necks Cobalt chrome Standard, varus, valgus,  $1,227.00

 antiverted right, antiverted left

Prostheses List by Category, Groups and Sponsor Page 36 of 911

11 - HIP

 Minimum  Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

 Lima Orthopaedics Australia Pty Ltd

LC004 Lima F2L modular neck  Titanium Short & Long (Straight &  $1,227.00

 Angled)

LC014 Sam-Fit modular neck Modular neck S1-S6, L1-L6 $1,227.00

LC029 H-Max Femoral neck Modular neck 1-6 $1,227.00

 Smith & Nephew Surgical Pty Ltd

SN898 MDF Revision System Modular Neck - CoCr highly polished  24mm - 36.5mm $1,227.00

 trapezoidal for MDF stem/MIS stem

 multiple options of version height and neck

 length

 Stryker Australia Pty Ltd

SK444 ABG II Modular Hip System Neck for the ABGII  stem   Long & Short $1,227.00

SK446 Rejuvinate SPT Femoral Hip System Neck for Rejuvinate SPT Stem  30-38mm $1,227.00

 Wright Medical Australia

WR139 Profemur Modular Neck Titanium and CoCr Femoral Necks Length 27 - 38.5mm; Neutral  $1,227.00

 to Ante/Retro - Varus Valgus 2

 Zimmer Pty Ltd

ZI553 M/L Taper Kinectiv Neck Neck component for M/L taper stem size K, S, A, E, P, X, B, G, R,  $1,227.00

 C, J, D, K1, S1, AA, E1, P1,

 X1, K2, E2, BB, G1, R1 ,S2,

 P2, G2, CC, J1, X2, R2, J2, DD

 Complex

 Corin Australia Pty Ltd

CR114 Extreme Hip System Extended Neck Femoral neck with extension for locking  4 sizes $1,727.00

 screw for stem

 Exactech Australia

EX024 Exactech M Series body  Titanium, complex neck segment  32 - 49mm, -5 - +30mm $1,727.00