Private Health Insurance (Prostheses) Rules 2012 (No. 2)

As amended

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

This compilation was prepared on 16 April 2013 taking into account amendments up to and including the Private Health Insurance (Prostheses) Amendment Rules 2013 (No.3).

Prepared by the Department of Health and Ageing, Canberra

Contents

Part 1 Preliminary

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 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

Part 1  Preliminary

1. Name of Rules

These Rules are the Private Health Insurance (Prostheses) Rules 2012 (No.2).

2.                  Commencement

These Rules commence on 30 August 2012.

3.                  Revocation

These Rules revoke the Private Health Insurance (Prostheses) Rules 2012 (No. 1).

4.                  Definitions

In these Rules:

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

Note: The registration requirements for an accredited podiatrist for the purposes of these Rules are the same registration requirements for podiatric surgeons as set out in rule 8 of the Private Health Insurance (Accreditation) Rules.

Act means the Private Health Insurance Act 2007.

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

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

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

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

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

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

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

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

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

National Law means:

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

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

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

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

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

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

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

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

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

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

Schedule means the Schedule in these Rules.

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

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

Part 2  Benefit requirements

5.     Listing of, and benefits for, prostheses

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

(a)                  the Schedule lists the kinds of prostheses:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

6.              Benefits for prostheses provided as part of hospital treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Part 3  Other

8.                    Timing of applications to have a prosthesis listed

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

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

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

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

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

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

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

(i) insulin infusion pump; or

(ii) implantable cardiac event recorder.

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

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

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

Part A - Prostheses List February 2013

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

1.1.1 - Aphakic

 1.1.1.1 - Rigid

 Alcon Laboratories (Aust.) Pty Ltd

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

 Bausch & Lomb (Australia) Pty Ltd

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

 121UV; L122UV PMMA Anterior  lens 1 piece optic size, diopter range 3-

 Chamber Lens 30d. L122UV: 6.0mm optic,

 13.75mm length, power

 range; 5.0 to 30.0 Diopters

 Emagin Pty Ltd

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

 Intraocular Lens 8.5 in overall length

 ifc

 AMO Australia Pty Ltd

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

 overall length

 m

 AMO Australia Pty Ltd

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

 IOL 13.0mm in overall length

1.1.2 - Phakic

 1.1.2.1 - Rigid

 AMO Australia Pty Ltd

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

 Myopia.  Composition: PMMA overall length; 6mm Optic

 Diameter x 8.5 overall

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

 Hyperopia.  Composition: PMMA overall length

Prostheses List by Category, Groups and Sponsor Page 1 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Emagin Pty Ltd

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

 Hyperopic 8.5 in overall length;

 t1

 AMO Australia Pty Ltd

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

 7.5mm overall length

 Emagin Pty Ltd

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

 Intraocular Lens Composition: PMMA 7.5 in overall length

 t2

 AMO Australia Pty Ltd

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

 7.5mm overall length

 1.1.2.2 - Foldable

 Alcon Laboratories (Aust.) Pty Ltd

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

 single piece phakic lens  diopter increments

 AMO Australia Pty Ltd

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

 silicone intraocular lens increments.  Overall

 diameter 8.5mm. Optic

 6.0mm

 Emagin Pty Ltd

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

 Intraocular Lens Haptic: PMMA overall length

1.2.1 - Rigid

 Alcon Laboratories (Aust.) Pty Ltd

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

  D

Prostheses List by Category, Groups and Sponsor Page 2 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Bausch & Lomb (Australia) Pty Ltd

BL006 Posterior chamber IOLS model  PMMA Posterior Chamber lens 1  12.25mm to 13.75mm  $156.00

 P359 UV, P399 UV, 68 UV, 95  length. 5.5mm to 7mm optic

 BUV, or lolab PC One Piece, model  size, diopter range -4.5 -

 6741B, 8591B, 8191B; Model EZE- 45d to 10 - 34d; EZE-Fit

 65: 6.5mm optic, 13.35mm

 length, Power range: 10.0

 to 30.0 Diopter

1.2.2 - Foldable

 1.2.2.1 - Microincision

 at

 Carl Zeiss Pty Ltd

CZ016 CT ASPHINA 409M ZEISS Micro Incision Aaspheric  6mm optic, 11mm overall  $364.00

 (aberration neutral) IOL: Foldable,  diameter. Diopter range 0.0

 square-edged, single piece IOL for  to +32.0D (0.5D steps from

 capsular bag fixation 10.0 to 30.0D, 1.0D outside

  this range)

CZ017 CT ASPHINA 509M ZEISS Micro Incision Aspheric  6mm Optic, 11mm overall  $364.00

 (aberration correcting) IOL: Foldable, diameter. Diopter range 0.0

  square-edged, single piece IOL for  to +32.0D (0.5D steps from

 capsular bag fixation 10.0 to 30.0D, 1.0D outside

  this range)

 at, pl

 Bausch & Lomb (Australia) Pty Ltd

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

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

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

 preloaded, with aberration contro,  (22.50-30D)

 Carl Zeiss Pty Ltd

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

 (aberration neutral), foldable square- 32.0D; Optic size: 6.0mm;

 edged single piece inraocular lens for  Overall length: 11.0mm

 capsular bag fixation.

CZ037 CT ASPHINA 509MP Preloaded, micro incision, aspheric  Diopter range: 0.0 to +  $374.00

 (aberration correcting), foldable  32.0D; Optic Size: 6.0mm;

 square-edged single-piece intraocular  Overall length: 11.0mm

 lens for capsular bag fixation

Prostheses List by Category, Groups and Sponsor Page 3 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 at, pl, t1

 Carl Zeiss Pty Ltd

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

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

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

 capsular bag fixation length: 11.0mm

 at, pl, t2

 Carl Zeiss Pty Ltd

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

 aspheric (aberration neutral), foldable, 32.0, Cyl +7.0 to 12.0,

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

 capsular bag fixation Length 11.0mm

 at, t1

 Carl Zeiss Pty Ltd

CZ020 AT TORBI 709M STANDARD RANGE BITORIC -  6mm optic, 11mm overall  $740.00

 ZEISS Micro Incision Aspheric  diameter. Diopter range:

 (abberation neutral) IOL: Foldable,  Sph -10.0 to +32.0D, Cyl

 square-edged, single piece IOL for  +1.0 to 6.5D (all 0.5D

 capsular bag fixation

 t2, at

 Carl Zeiss Pty Ltd

CZ027 AT TORBI 709M HIGH CYLINDER BITORIC - ZEISS  6mm optic, 11mm overall  $1,041.00

 Micro Incision Aspheric (aberration  diameter.  Diopter range:

 neutral) IOL: Foldable square edged,  Sph -10.0 to +32.0D, +7.0

 single piece IOL for capsular bag  to 12.0D (all 0.5D steps)

 fixation

 1.2.2.2 - No edge modification

 Ellex Australia Pty Ltd

XE002 Staar foldable silicone intraocular  Polyimide haptics 6.3mm optic - low  14.0mm length $281.00

 lens: Model AQ 5010V diopters

 t1

 Ellex Australia Pty Ltd

XE001 Staar Toric foldable silicone  Plate haptics 6.0mm optic 10.8mm - 11.2mm length $579.00

 intraocular lens: Model AA4203TF;

  Model AA4203TL

Prostheses List by Category, Groups and Sponsor Page 4 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 1.2.2.3 - Edge modification

 Alcon Laboratories (Aust.) Pty Ltd

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

 MA50BM, MA60AC

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

 asymmetric optic/consistent edge

 AMO Australia Pty Ltd

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

 IOL,  Sensar OptiEdge AR40e  Absorbing, Posterior 13mm in overall length.     

 Foldable Acrylic IOL

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

 Posterior Chamber Intraocular Lens  design

 Bausch & Lomb (Australia) Pty Ltd

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

 posterior chamber intraocular lens polymer.  Packaged in lens folding  Diopter increments15.0 to

 device in a sterile vial.  Four haptic   25.0 Diopter in 0.5 Diopter

 design  increments25.0 to 30.0

 Diopter in 1.0 Diopter

 increments

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

 Posterior Chamber foldable, posterior chamber  30.0 Diopter - Optic

 intraocular lenses diameter 6.0mm; 13.0mm

 Carl Zeiss Pty Ltd

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

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

 hydrophobic surface properties)  length: 13.0mm

 intraocular lens for capsular bag or

 sulcus fixation.

 Device Technologies Australia Pty Ltd

DE398 Oculentis LENTIS L-302-1 Foldable one-piece monofocal C loop  Optic Size 6.0mm, Overall  $322.00

 acrylic IOL. Length 12.00mm. +-0.0D to

 +35.0D (1.0D steps) and

 +15.5D to +26.5D (0.5D

 steps).

Prostheses List by Category, Groups and Sponsor Page 5 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Ellex Australia Pty Ltd

XE003 Staar foldable silicone IOLs:  Plate haptics 6.0mm; Polymide  10.8mm 0 13.5mm length $322.00

 Models AQ2010V, AQ2017V and  haptics 5.5 or 6.3mm optic;

 Kevin Grundy (IBD) Pty Ltd

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

 copolymer, foldable with injector dia overall

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

 copolymer, foldable with injector dia overall

 at

 AMO Australia Pty Ltd

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

 & ZA9003) Ultraviolet light absorbing posterior  increments; 10.5 - 30

 chamber intraocular lenses,  dioptre in 0.5 increments

 Silicone/Acrylic

AO024 Tecnis™ One Piece (ZCB00) One piece intraocular lens with edge  +5 diopters to +34 diopters  $364.00

 modification and 360 degree square  in 0.5d increments

 edge

 Bausch & Lomb (Australia) Pty Ltd

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

 IOL with anterior optic-haptic square

 edge, posteriof optic-haptic square

 edge, 360-degree optic square edge

 and asperic optic for aberration control

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

 IOL, with anterior optic-haptic square

  edge, posterior optic-haptic square

 edge, 360 degree optic square edge

 and aspheric optic for aberration

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

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

 hydrophobic acrylic one-piece  in dioptric powers ranging

 intraocular lens (IOL)  Has an  from +0.0 to +34D

 aspheric lens optic, square posterior  0.0D to 10.0D in 1 Diopter

 edge, modified C haptics and available increments

  in dioptric powers ranging from +0.0  11.0D to 30.0D in 0.5

 to +34.0D. Diopter increments

 31.0D to 34.0D in 1

 Diopter increments

Prostheses List by Category, Groups and Sponsor Page 6 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Carl Zeiss Pty Ltd

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

 monofocal, aspheric (aberration  42.0, Optic size: 6.0mm,

 neutral), square-edged, hydrophilic  Overall length: 11.0mm

 acrylic (with hydrophobic surface

 properties) intraocular lens for

 capsular bag fixation. (Monofocal lens

  for powers outside standard 409MP

 MICS range).

 Device Technologies Australia Pty Ltd

DE399 Oculentis LENTIS L-312 Foldable one-piece monofocal acrylic  Optic size 6.0mm, Overall  $364.00

 C Loop IOL Length 12.00mm. Central

 Thickness 1.02mm

 (+22.0D). Available

 Diopters: -10.0D to35.0D

 (1.0D steps). +10.5D to

DE400 Oculentis LENTIS L-313 Foldable one-piece monofocal acrylic  Optic size 6.0mm, Overall  $364.00

 plate haptic  IOL Length 11.00mm. Available

 Diopters: +-0.0D to 35.0D

 (1.0D steps). +10.5D to

 29.5D (0.5D steps)

DE401 Oculentis LENTIS L-402 Foldable three piece monofocal acrylic Optic Size 6.0mm, Overall  $364.00

  IOL. Length 13.00mm. +-0.0D to

 +35.0D (1.0D) + 15.5D to

 +26.5D (0.5D). Minus range

  on demand.

 IQ Medical

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

 intraocular lens with anterior and  powers from -5.0 to +36.0,

 posterior optic-haptic square edge,  1D steps: -5.0 to +10.0 and

 360 degree optic square edge design,  +31.0 to +36.0; 0.5D steps:

 precision power calculation and  +10.5 to +18.0 and +25.0 to

 aberration technology +29.5; 0.25D steps: +18.0

 to +25.0

IQ010 PreciSAL 302AC Acrylic, single piece, foldable  Available in dioptric  $364.00

 intraocular lens with anterior and  powers from 0.0 to +30.0.

 posterior optic-haptic square edge,  1D steps: 0.0 to +10.0;

 360 degree optic square edge design,  0.5D steps: +10.5 to + 17.5

 precision power calculation,  and +28.5 to +30.0; 0.25D

 aberration technology and UV light  steps: +18.0 to +28.0

Prostheses List by Category, Groups and Sponsor Page 7 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Kevin Grundy (IBD) Pty Ltd

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

 Aspheric IOL Amon-Apple enhanced 360 Degree  +34D Superflex-920H - 10D

 square edge, Anti-vaulting Haptics  to +22D

 at, pl

 AMO Australia Pty Ltd

AO034 TECNIS® 1-Piece Pre-Loaded IOL 1-piece IOL Posterior Chamber  +5.0 to +34.0 diopter  $374.00

 Intraocular lens, incorporates a  powers in 0.5 diopter

 proprietary wavefront-designed  increments.  Overall

 aspheric optic with a squared  diameter 13mm, Optic size

 posterior optic edge designed to

 provide a 360 degree barrier. The edge

  of the optic has a frosted design to

 reduce potential edge glare effects.

 Supplied pre-loaded in a screw style

 disposable injector.

 Ellex Australia Pty Ltd

XE004 Preloaded Aspheric Intraocular  Silicone intraocular lens 6.0mm $374.00

 at, pl, t1, vblf

 Design for Vision Pty Ltd

DV253 HOYA AF-1 351 Toric  Preloaded injector system, correct  IOL Power: + 10.0 to 30.0  $800.00

 T3/T4/T5/T6/T7/T8/T9 corneal astigmatism micro-incision,  (0.5 steps), IOL Cylinder

 ashperic, blue-blocker, single piece  power: 1.50D (351T3),

 hydophobic. 2.25D (351T4), 3.00D

 (351T5), 3.75D (351T6),

 4.50D (351T7), 5.25D

 (351T8), 6.00D (351T9)

 at, pl, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

 with Blue light protection and

 aspheric correction, in cartridge.

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

 foldable, acrylic, single piece lens

 with blue light protection and

 aspheric correction, in cartridge

Prostheses List by Category, Groups and Sponsor Page 8 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Design for Vision Pty Ltd

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

  blocker, Foldable, Single-Piece,

 Hydrophobic Acrylic

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

 incision, Aspheric, Blue-Blocker,

 Single Piece, Hydrophobic

 at, t1

 AMO Australia Pty Ltd

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

 Intraocular lens, incorporates a  powers in 0.5 diopter

 proprietary wavefront designed toric  increments.  Cylinder

 aspheric optic with a squared  power: 1.00 diopter, 1.50

 posterior optic edge designed to  diopter, 2.25 diopter, 3.00

 provide a 360 degree barrier. The edge diopter and 4.00 diopter (as

  of the optic has a frosted design to  measured at the IOL plane).

 reduce potential edge glare effects. Overall diameter 13mm,

 Optic size 6mm.

 Bausch & Lomb (Australia) Pty Ltd

BL032 enVista Toric The enVista toric (Model MX60T) is a  Overall diameter is 12.5mm  $740.00

 one-piece glistening-free  for the entire lens power

 hydrophobic IOL. The enVista Toric,  range, with spherical

 model MX60T IOL has a Toric  equivalent powers from +6.0

 aspheric lens optic, a square posterior   to +30.0 Diopters in 0.5

 edge and modified C haptics, an  Diopter steps and cylinder

 overall diameter of 12.5mm and an  powers from +1D to 6D 

 optic body of 6.0mm.  It is available in Diopters (at the IOL plane).

  multiple spherical and cylindrical

 powers.

 Device Technologies Australia Pty Ltd

DE390 Oculentis LENTIS Tplus LU-313T Patient Specific: Foldable one-piece  Optic Size 6.0mm, overall  $740.00

 monofocal toric acrylic IOL length 11.0mm. Sph +/-0.0D

  to +35.0D (in 0.01D

 increments) Cyl +0.25 to

 +6.99D cyl (in 0.01D

 increments)

Prostheses List by Category, Groups and Sponsor Page 9 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

DE397 Oculentis LENTIS Tplus LS-313  Foldable one-piece monofocal toric  Optic Size 6.0mm, Overall  $740.00

 T1-T6 acrylic IOL. Length 11.00mm. Available

 diopters: +10.0D to +30.0D

  (0.5D). Cyl: (T1 +1.5D) (T2

  +2.25D) (T3 +3.0D) (T4

 +3.75D) (T5 +4.5D) (T6

 +5.25D)

 at, t1, vblf

 Device Technologies Australia Pty Ltd

DE392 Oculentis LENTIS LU-313-TY Patient Specific: Foldable one-piece  Optic Size: 6.0mm, overall  $780.00

 monofocal toric acrylic IOL. Violet  length 11.00mm. Sph +/-

 Light Filter 0.0D to +35.0D (in 0.01D

 increments) Cyl +0.25D to

 +6.99D cyl (in 0.01D

 increments)

 at, t2

 Device Technologies Australia Pty Ltd

DE391 Oculentis LENTIS Tplus LU-313T Patient Specific: Foldable one-piece  Optic Size: 6.0mm, overall  $1,042.00

 monofocal toric acrylic IOL length 11.00mm. Sph +/-

 0.0D to +35.0D (in 0.01D

 increments) Cyl +6.99D to

 +12.0D cyl (in 0.01D

 increments)

 at, t2, vblf

 Device Technologies Australia Pty Ltd

DE393 Oculentis LENTIS T plus LU-313-TY Patient Specific: Foldable one-piece  Optic Size: 6.0mm, overall  $1,084.00

 monofocal toric acrylic IOL. Violet  length 11.00mm. Available

 Light Filter. diopters: Cyl +7.00D to

 +12.0D inclusive in 0.01D

 increments.

 at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

 with Blue Light Protection and

 Aspheric Correction

Prostheses List by Category, Groups and Sponsor Page 10 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Bausch & Lomb (Australia) Pty Ltd

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

 Violet Shield silicone, anterior & posterior edge  lengthModified  C 5

 modification intraocular lens with  degree angulation 0-30D,

 aberration technology, a violet light 0.5D steps

 Design for Vision Pty Ltd

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

 blocker, Single-piece, Hydrophobic

 Device Technologies Australia Pty Ltd

DE402 Oculentis LENTIS LS-312Y Foldable one-piece monofocal C Loop Optic Size 6.0mm, Overall  $385.00

  Acrylic IOL. Violet Light filter. Length 12.0mm. Available

 Diopters: +-0.0D to 35.0D

 (1.0D steps) +15.5D to

 26.5D (0.5D steps).

DE403 Oculentis LENTIS LS-313Y Foldable one-piece monofocal acrylic  Optic Size 6.0mm, Overall  $385.00

 plate haptic IOL. Violet Light Filter Length 11.00mm. Available

 Diopters: +-0.0D to 35.0D

 (1.0D steps). +15.5D to

 26.5D (0.5D steps).

 IQ Medical

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

 intraocular lens with anterior and  powers from -5.0 to + 36.0,

 posterior optic-haptic square edge,  1D steps: -5.0 to +10.0 and

 360 degree optic square edge design,  +31.0 to +36.0; 0.5D steps:

 precision power calculation,  +10.5 to +18.0 and +25.0 to

 aberration technology and blue light  29.5; 0.25D steps: + 18.0 to

  +25.0

IQ011 PreciSAL 302A Acrylic, single piece, foldable  Available in dioptric  $385.00

 intraocular lens with anterior and  powers from 0.0 to +30.0.

 posterior optic-haptic square edge,  1D steps: 0.0 to +10.0;

 360 degree optic square edge design,  0.5D steps: +10.5 to +17.5

 precision power calculation,  and +28.5 to +30.0; 0.25D

 aberration technology and blue light  steps: +18.0 to +28.0

 pl

 Ellex Australia Pty Ltd

XE005 Staar KS-Xs Preloaded Acrylic  Preloaded acrylic lens with anterior  Optic diameter 6.0mm,  $332.00

 Intraocular Lens and posterior edge modification overall length 12.5mm,

 diopter range +10 to +28.0

Prostheses List by Category, Groups and Sponsor Page 11 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 t1

 Bausch & Lomb (Australia) Pty Ltd

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

 Correcting Lens intraocular lens with a toric optic on  millimetres for the entire

 the posterior surface and axis marks on lens power range (spherical

  the posterior optic's flat meridian. equivalent powers from

 +10.0 to +30.0 diopters in

 0.5 diopter steps and

 cylinder powers of +1.25,

 +2.00 & +2.75 diopters).

 Kevin Grundy (IBD) Pty Ltd

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

 copolymer, foldable with injector dia overall, cyls 2.0D to

 6.0D in 2D increments

 t1, at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

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

 lens with blue light protection and

 aspheric correction

 Design for Vision Pty Ltd

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

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

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

 2.25D (311T4), 3.00D

 (311T5)

 t1, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

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

 lens with blue light protection

 t2

 Kevin Grundy (IBD) Pty Ltd

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

 with injector dia overall, cyls 1.5D to

 11.0D in 0.5D increments

Prostheses List by Category, Groups and Sponsor Page 12 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

  to 11.00D Cylinder in 0.25

 steps                                           

                +31.00D to +35.00

 Spit: 1D to 11.00D

 Cylinder in 0.25steps

 vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

 SN60AT asymmetric optic/consistent edge,

 with blue light protection

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

 MN60MA, MN60AC with Blue light Protection

 1.2.2.4 - Multifocal or bifocal

 AMO Australia Pty Ltd

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

 Intraocular Lens intraocular lens 13.0mm overall length

 at

 AMO Australia Pty Ltd

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

 Lens (ZMA00) absorbing, foldable acrylic, 3-piece  in 0.5d increments

 with a diffractive posterior optic and a

  modified anterior surface technology

 with edge modification and 360

 degree square edge.

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

 Model ZMB00 with UV-blocking, foldable acrylic, 1- 13.0mm in overall length. 

 piece with a diffractive posterior optic +5.0 Diopter to +34.0

  and a modified anterior surface  Diopter in 0.5 Diopter

 technology with edge modification  increments.

 and a 360 degree square edge.

 Carl Zeiss Pty Ltd

CZ015 AT LISA 809M ZEISS micro incision, aspheric  6mm optic, 11mm diameter.   $822.00

 multifocal IOL.  Diffractive bifocal  Diopter range 0.0D to

 anterior surface with asymmetric light  +32.0D (0.5D steps)

 distribution (65% distance / 35%

 near), 3.75D addition for near focus.

Prostheses List by Category, Groups and Sponsor Page 13 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Device Technologies Australia Pty Ltd

DE396 Oculentis LENTIS Mplus LS-313  Foldable one-piece multifocal plate  Overall Length 11.0mm and  $822.00

 haptic acrylic IOL. Optic Size 6.0mm Available

 diopters +-0.0D to +36.0D

 (0.05D steps)

 Kevin Grundy (IBD) Pty Ltd

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

 Foldable IOL zoned refractive aspheric multifocal  diameter 12.5mm: +3D or +

 with Amon-Apple 360 Degree Square  4D Addition: +14D to

 edge, Anti Vaulting Haptics +25D in 1.0D increments:

 +8.5D to +23.5D in 0.5D

 at, pl

 Carl Zeiss Pty Ltd

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

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

 IOL for capsular bag fixation. The  length: 11.0mm

 anterior aspheric bifocal surface has an

  asymmetric light distribution 65/35

 for distance/near vision, and 3.75D

 add for the near focus.

CZ034 AT LISA tri 839MP Trifocal (aspheric) micro incision,  Diopter range: 0.0 to  $842.00

 single-piece IOL for capsular bag  +32.0D (0.5D increments).

 fixation, implantable with preloaded  Optic size: 6.0mm. Overall

 injector system.  The trifocal (anterior) Length: 11.0mm

  optic provides two diffractive focal

 points (+3.33D near focus and +1.66D

  intermediate focus) with asymmetric

 light distribution 50% distance / 20%

  intermediate / 30% near vision.

 at, pl, t1

 Carl Zeiss Pty Ltd

CZ035 AT LISA toric 909MP ZEISS pre-loaded, micro incision,  6mm optic, 11mm diameter.  $1,218.00

 multifocal toric IOL. Aspheric toric  Diopter range: Sph +6.0D

 anterior surface, diffractive bifocal  to 24.0D, Cyl +1.0 to 4.0D

 posterior surface with asymmetric  (all 0.5D steps)

 light distribution (65% distance/ 35%

  near), and 3.75D addition for near

Prostheses List by Category, Groups and Sponsor Page 14 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 at, t1

 AMO Australia Pty Ltd

AO033 Tecnis Multifocal Toric Toric Multifocal Intraocular Lens +5.0 Diopters to +34.0  $1,198.00

 Diopters in 0.5 Diopter

 increments.  Cylinder

 powers 1.50D, 2.25D,

 3.00D and 4.00D

 Device Technologies Australia Pty Ltd

DE388 Oculentis LENTIS Mplus Toric LU- Patient specific one-piece multifocal- Overall Length 11.0mm and  $1,198.00

 313MFT toric plate haptic acrylic IOL Optic Size 6.0mm + 0.0D to

 +36.0D inclusive in 0.01D

 increments. Cyl +0.25 to

 +6.99D inclusive in 0.01D

 increments

 at, t1, vblf

 Device Technologies Australia Pty Ltd

DE394 Oculentis LENTIS Mplus Toric LU- Patient specific one-piece multifocal- Overall Length 11.0mm and  $1,240.00

 313 MF30TY toric plate haptic acrylic IOL. Optic Size 6.0mm, +-0.0D to

  +36.0D inclusive in 0.01D

 increments. Cyl +0.25D to

 +6.99D inclusive in 0.01D

 increments.

 at, t2

 Device Technologies Australia Pty Ltd

DE389 Oculentis LENTIS Mplus LU- Patient specific one-piece multifocal- Overall Length 11.0mm and  $1,500.00

 313MFT toric acrylic plate haptic IOL Optic size 6.0mm +-0.0D to

 +36.0D inclusive in 0.01D

 increments. Cyl +6.99D to

 +12.0D inclusive in 0.01D

 increments

 at, t2, vblf

 Device Technologies Australia Pty Ltd

DE395 Oculentis LENTIS Mplus LU-313  Patient specific one-piece multifocal  Overall Length 11.00mm  $1,542.00

 MFTY toric plate haptic acrylic IOL. Violet  and Optic Size 6.0mm +-

 Light Filter 0.0D to +36.0D inclusive in

  0.01D increments.  Cyl

 +7.00D to +12.0D inclusive

  in 0.01D increments.

Prostheses List by Category, Groups and Sponsor Page 15 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

 foldable, acrylic, single piece lens

 with apodised diffractive optic and

 blue light protection

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

 SV25T0 and MN6AD1 foldable, acrylic, single piece lens

 with apodised diffractive optic and

 blue light protection

 Design for Vision Pty Ltd

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

 Aspheric, Blue-blocker, Single Piece,

 Hydrophobic

 at,pl,t1

 Carl Zeiss Pty Ltd

CZ036 AT LISA tri Toric 939MP Trifocal (aspheric), bitoric, micro  Diopter range: + 6.00 to  $1,218.00

 incision, single-piece IOL for  24.0 DS and + 1 to +4 DC;

 capsular bag fixation, implantable  Optic size: 6.0mm; Overall

 with preloaded injector system. The  length: 11.0mm

 trifocal (anterior) optic provides two

 diffractive focal points (+3.33D near

 focus and + 1.66D intermediate focus)

 with asymmetric light distribution

 50% distance / 20% intermediate /

 30% near vision,

 t1, at

 Carl Zeiss Pty Ltd

CZ025 AT LISA toric 909M ZEISS micro incision, multifocal toric  6mm optic, 11mm diameter.   $1,198.00

 IOL (standard cyl range). Aspheric  Diopter range: Sph -10.0D

 toric anterior surface, diffractive  to +32.0D, Cyl +1.0 to 6.5D

 bifocal posterior surface with   (all 0.5D steps)

 asymmetric light distribution (65%

 distance / 35% near), 3.75D addition

 for near focus.

Prostheses List by Category, Groups and Sponsor Page 16 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Kevin Grundy (IBD) Pty Ltd

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

 Multi-zoned Refractive Aspheric  12.5mm +3.00D or +4.00D

 Toric Mulitfocal with Amon-Apple  Addition FAR: +14.0D to

 enhanced 360 degree Square edge,  +32.00D in 0.5 STEPS:

 Anti Vaulting Haptics +2.00D +3.00D  +4.00D

 Cylinder. NEAR: +14.0D to

  27.0D in 0.5 STEPS:

 +2.00D +3.00D  +4.00D

 Cylinder

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

 Standard) Zoned Refractive, Toric Multifocal  +3.00D to +4.00D Addition

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

 Degree square edge, Anti-vaulting  0.5D Increments: NEAR:

 Haptics, Patient Specific. +14.0D to +27.0D in 0.50D

 Increments Cylinder: 1.0D

 to 1.5D and 2.5D to 6.00D

 in 0.5 increments

 t1, at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

  IOL (SND1T2-5; SV25T2-6) foldable, acrylic, aspheric, toric single  to 3.00 D cylinder

  piece lens with apodised diffractive

 optic and blue light protection.

 t2, at

 Carl Zeiss Pty Ltd

CZ024 AT LISA toric 909M ZEISS micro incision, multifocal toric  6mm optic, 11mm diameter.   $1,500.00

 IOL (high cyl range). Aspheric toric  Diopter range: Sph -10.0D

 anterior surface, diffractive bifocal  to +32.0D, Cyl +7.0 to

 posterior surface with asymmetric  12.0D (all 0.5D steps)

 light distribution (65% distance /

 35% near), 3.75D addition for near

Prostheses List by Category, Groups and Sponsor Page 17 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 1.2.2.5 - Accommodative

 at, pa, pl

 AMO Australia Pty Ltd

AO035 Synchrony Vu Accommodating IOL Synchrony Vu Dual Optic  5.50mm Anterior Optic,  $822.00

 Accommodating Posterior Chamber  6.00mm Interior Optic,

 IOL 9.80mm Overall Length,

 Diopter Range: +16.00 to

 +28.00 in 0.5D Increments

 at, pa, t1

 Bausch & Lomb (Australia) Pty Ltd

BL031 Crystalens Toric The Crystalens Toric IOL, Models  Overall diameter is 11.5mm  $1,198.00

 BL1AT/BL2AT and BL1UT/BL2UT  (BL1AT/BL1UT) or 12.0mm

 is an accommodating IOL   (BL2AT/BL2UT) for the

 incorporating a toroidal posterior  entire lens power range.

 surface. The Crystalens toric IOL has a Spherical equivalent

  square posterior edge with polyimide powers range from +5.0 to

  footplates and is available in multiple +33.0 Diopters in 0.5

  spherical and cylindrical powers. Diopter steps and cylinder

 powers of +1.25, +2.00 and

 +2.75 Diopters (at the IOL

 plane).

 pa

 Bausch & Lomb (Australia) Pty Ltd

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

 Dioptres of accommodation with dual  Dioptre steps

 mechanism of action: (1) forward axial

 movement of lens and (2)

 accommodative arching of optic. 

 Posterior chamber, polyspheric

 optics, 3-piece, plate haptic, foldable

 UV light filtering, bic

 IQ Medical

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

 accommodating intraocular lens with  powers from +5.0 to +36.0,

 sqare edge design, custom control  1D steps: +31.0 to +36.0;

 precision and closed loop haptic  0.5D steps: +5.0 to +18.0

 and +25.0 to +30.0; 0.2D

 steps; +18.0 to +25.0

Prostheses List by Category, Groups and Sponsor Page 18 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 pa, at

 Bausch & Lomb (Australia) Pty Ltd

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

 provide > 3 Diopters of  Diopter steps.  10.0 - 16.5

 accommodation with dual mechanism  Diopters (12mm length) and

 of action: (1) forward axial movement   17.0 - 33.0 Diopters

 of lens and (2) accommodative arching (11.5mm length).

  of optic.  Posterior chamber, aspheric,

 aberration free optics, 3-piece, plate

 haptic, fol

 pa, pl

 AMO Australia Pty Ltd

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

 Accommodating Posterior Chamber  6.00mm Interior Optic,

 9.80mm Overall Length,

 Diopter Range: +16.00 to

 +28.00 in 0.5D Increments

1.2.3 - Pseudo-phakic, piggy-back

 1.2.3.1 - Monofocal

 Design for Vision Pty Ltd

DV246 Rayner Sulcoflex Ashperic  Pseudophakic Supplementary  -10.0D to -5.50D in 0.5D  $323.00

 (Premium) I.O.L. I.O.L.O.L. increments.                +5.50D

 to 10.00D in 0.5D

 at

 Kevin Grundy (IBD) Pty Ltd

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

 I.O.L.

 t1, at

 Kevin Grundy (IBD) Pty Ltd

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

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

 Standard Sulcus fixated with undulating

 Haptics and Posterior Haptic

Prostheses List by Category, Groups and Sponsor Page 19 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 Pseudophakic Secondary IOL  Pseudophakic Secondary IOL: Sulcus steps Syl +1.00 to +6.00 in

 (Premium)  fixated with undulating Haptics and  0.5D steps

 Posterior Haptic Angulation

 1.2.3.2 - Multi-focal

 at

 Kevin Grundy (IBD) Pty Ltd

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

 focal Pseudophakic Secondary IOL Pseudophakic Secondary IOL:  5.00D+5.00D sphere with 

 Sulcus-Fixated with Undulating  + 3.00 Addition

 Haptics and Posterior Haptic

 at, t1

 Design for Vision Pty Ltd

DV254 Rayner Premium Sulcoflex  653Z-Premium Multifocal Toric  -7D to +7D (Spherical  $1,198.00

 Multifocal Toric Supplementary IOL Supplementary IOL Equivalent) Cylinder 1D,

 4D, 5D, 6D Addition 3.5D

DV255 Rayner Standard Sulcoflex  653Z-Standard Multifocal Toric  -3D to +3D (Spherical  $1,198.00

 Multifocal Toric Supplementary IOL Supplementary IOL Equivalent) Cylinders 2D

 and 3D Addition 3.5D

1.3.1 - Viscoelastic

 Alcon Laboratories (Aust.) Pty Ltd

AL006 PROVISC VISCOELASTIC  PROVISC contains sodium  0.85mL pack $80.00

 SOLUTION

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

 hyaluronate

AL015 Cellugel viscoelastic fluid Hypromellose 2% . $80.00

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

 Viscosurgical Device chondroitin sulfate 40mg/mL

 AMO Australia Pty Ltd

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

 0.85ml

AO032 Healon Endocoat Viscoelastic 0.85ml $80.00

Prostheses List by Category, Groups and Sponsor Page 20 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Bausch & Lomb (Australia) Pty Ltd

BL008 Ocucoat Intraocular Fluid 20mg/mL hydroxypropylmethyl  1ml and 2ml Sterile $80.00

 cellulose for intraocular use

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

 intraocular use

 Carl Zeiss Pty Ltd

CZ012 Z-HYALIN Viscoelastic Cohesive Viscoelastic Solution -  Volume 1.0ml $80.00

 sodium hyaluronate 10mg/ml. 

 (previously called Ophthalin)

CZ013 Z-HYALIN Plus Viscoelastic Cohesive Viscoelastic Solution -  Volume 1.0ml $80.00

 sodium hyaluronate 15mg/ml. 

 (previously called Opthalin Plus)

CZ022 VISTHESIA 1.5% VISCOANAESTHETIC syringe  0.8ml syringe & 2x0.3ml  $80.00

 contains sodium hyaluronate (NaHA,  ampoules

 1.5%) and lidocaine hydrochloride

 (1%). Also contains two topical

 ampoules with NaHA (0.3%) and

 lidocaine (2%)

 IQ Medical

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

 Hydroxypropylmethylcellulose cellulose for intraocular use. Pre-

 loaded in a sterile syringe with one

 cannula for injection, in a sterile

 Tyvek pouch

 hmw

 AMO Australia Pty Ltd

AO009 Healon 5, Intraocular Viscoelastic  HEALON5- Sodium hyaluronate  0.6ml $85.00

 Fluid 23mg/ml .

AO010 Healon GV Intraocular Viscoelastic  Sodium Hyaluronate 14mg/mL 0.5mm and 0.85ml $85.00

 Fluid

 1.3.1.1 - Dual Fluids

 Alcon Laboratories (Aust.) Pty Ltd

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

 hyaluronate, VISCOAT contains

 chondroitin sulfate and sodium

 hyaluronate

Prostheses List by Category, Groups and Sponsor Page 21 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Carl Zeiss Pty Ltd

CZ019 TWINVISC Viscoelastic TWINVISC includes a cohesive and a  Total volume 1.4 ml $110.00

 dispersive viscoelastic in one

 syringe, separated by a valve. 

 Dispersive: sodium hyaluronate

 (2.2%).  Cohesive: sodium

1.3.2 - Non Viscous

 Design for Vision Pty Ltd

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

 applications

1.4.1 - Simple

 Alcon Laboratories (Aust.) Pty Ltd

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

 12.3 - 14.5 uncompressed

 AMO Australia Pty Ltd

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

 Implant

 Carl Zeiss Pty Ltd

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

 Design for Vision Pty Ltd

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

 Emagin Pty Ltd

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

 pl

 Design for Vision Pty Ltd

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

 per-load on disposable injector 14A (12mm)

Prostheses List by Category, Groups and Sponsor Page 22 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Insight Surgical Pty Ltd

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

 (acrylic)

1.4.2 - Complex

 Design for Vision Pty Ltd

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

1.5.1 - Long Tube

 AMO Australia Pty Ltd

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

 101-350, Baerveldt Glaucoma  composition silicone - smooth,  425mm2

 Implant BG 103-425, Baerveldt  tumble-polished finish

 Glaucoma Implant BG 103-250

 Design for Vision Pty Ltd

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

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

 Plate/Single Plate-Dual

 Chamber/Double Plate

 v

 Design for Vision Pty Ltd

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

 of silicon *175mm square

1.5.2 - Short Tube

 1.5.2.1 - Cannulated

 Alcon Laboratories (Aust.) Pty Ltd

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

Prostheses List by Category, Groups and Sponsor Page 23 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

1.6.1 - Spacers

 Spectrum Surgical

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

 x 0.35mm thick

1.6.2 - Weights

 1.6.2.1 - Gold <1.8 grams

 Device Technologies Australia Pty Ltd

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

 grams

 1.6.2.2 - Gold ≥1.8 grams

 Device Technologies Australia Pty Ltd

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

 grams

 1.6.2.3 - Platinum

 CoreMed Pty Ptd

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

 1.6, 1.8 grams

1.7.1 - Intracanalicular

 Design for Vision Pty Ltd

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

 Bodkin lacrimal intubation set

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

 Intubation Sets

DV256 LIS 052 "StenTube" Large Diameter Lachrymal Intubation  1.32mm Tube diameter $135.00

 Set

Prostheses List by Category, Groups and Sponsor Page 24 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Device Technologies Australia Pty Ltd

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

 .051 x 33cm

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

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

 packaged sterile Probes 0.40mm x 11cm,

 tubing 35cm x 0.64mm.

 Probes 0.60mm x 11mm,

 tubing 35cm x 0.30mm.

 Spectrum Surgical

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

 Coated Silicone Plug/Metal  Tube/80 x 0.8mm probes,

 Probes/Polypropylene Thread PVP Differential Bika: 0.64

 & 1.18mm O.D. Tube/40 x

 1.2mm probes, PVP Bika for

 DCR: 0.94mm O.D. Tube/50

  x 0.8mm probes, PVP Infant

 Bika 0.64mm O.D. Tube/55

 x 0.7mm probes, PVP Infant

 Bika II: 0.64mm O.D. Tube/

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

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

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

 to 400mm.  PEEK Thread:

 0.2mm to 0.4mm x 500mm.

 mc

 Spectrum Surgical

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

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

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

 guides. PEEK thread. Introducer. to 350mm.  PEEK Thread:

 0.2mm to 0.4mm x 500mm. 

 Plug Collar: 2mm to 4mm.

Prostheses List by Category, Groups and Sponsor Page 25 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

1.7.2 - Extracanalicular

 Device Technologies Australia Pty Ltd

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

 18mm, 4.0 x 9 to 24mm, 5.0 x

  9mm

1.7.3 - Balloon Dilatation Catheters

 Design for Vision Pty Ltd

DV258 Lacricath Lachrymal Duct Balloon  Unilateral Lachrymal Duct Balloon  2mm, 3mm & 5mm $485.00

 Catheter Catheter system including inflation

 device

 bilateral

 Design for Vision Pty Ltd

DV257 Lacricath Lachrymal Duct Balloon  Bilateral Lachrymal Duct Balloon  2mm, 3mm and 5mm $879.00

 Catheter Catheter System including inflation

 device.

1.8.1 - Intrascleral

 Device Technologies Australia Pty Ltd

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

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

 Spectrum Surgical

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

 vp

 Spectrum Surgical

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

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

 (Synthetic) Synthetic Diameter, 10, 12,

 14, 16, 18, 20, 22mm

Prostheses List by Category, Groups and Sponsor Page 26 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

1.8.2 - Extrascleral

 1.8.2.1 - Complex and permeable

 Stryker Australia Pty Ltd

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

 6327, 6317 and 6322 8702-8704.  6316: 14mm, 6326: 16mm,

 COI implant, models 7222, 7223 &  6327: 18mm, 6317: 20mm,

 80026. MCOI implant, models 7207 -  6322: 22mm, 8702: 19mm,

 7209 Quad Motility Implants 9866 -  8703: 21mm, 8704: 23mm,

 9868 & 80022 COI Implants 7222: Approx

  4ml, 7223: Approx 5ml,

 80026: Approx 6ml, MCOI

 7207: Approx 3ml, 7208:

 Approx 4.2ml,  7209:

 Approx 5.6ml, QUAD

 Motility Small 16ml,

 Medium: 18ml, Large: 20ml,

  Extra Large: 22ml.

 ha

 Spectrum Surgical

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

 wrapped bioceramic (aluminium   20, 22mm; Synthetic

 oxide), mesh wrapped hydroxyapatite  Hydroxyapatite diameter:

 (synthetic), mesh wrap (polyglycolic  16, 18, 20, 22mm

 acid)

 vp

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW002 Biopore Sphere An implantable device made of high- 14mm, 16mm, 18mm, 20mm,  $1,930.00

 density polyethylene material with an 22mm, 24mm (diameter)

  interconnecting pore structure that

 supports tissue ingrowth. The device

 is available in sizes to meet the

 patient's specific needs.  Used for

 orbital reconstruction following

 enucleation and evisceration

 procedure.

Prostheses List by Category, Groups and Sponsor Page 27 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 1.8.2.2 - Multi-component

 Spectrum Surgical

SO019 FCI Orbital Implants Peg & Sleeve Standard Large $863.00

1.8.3 - Fascial - solid and permeable

 Device Technologies Australia Pty Ltd

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

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

 packaged sterile 2mm

 Spectrum Surgical

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

 with silicone tubing. probes, 280mm 0.64mm

 tubing.

1.9.1 - Buckles, bands, tyres and sponges

 Austmed Pty Limited

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

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

 Implant used in Scleral Buckling  Mira Symmetrical Oval Tire

 (Dimethylmethylvinyl Siloxane  7mm, Mira 287WG Murray

 Copolymer) wide (3.5mm) grooved

 symmetrical tire, 10mm

 wide, Mira 288 ross

 symmetrical grooved tire,

 low profile 10mm wide by

 2.5mm, Mira 289

 Symmetrical oval tire 10m

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

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

 (Dimethylmethylvinyl Siloxane  I.D., Mira 72 McNutt Sleeve

 Copolymer)  1.57mm I.D., Mira 270

 Sleeve 0.76mm I.D.

Prostheses List by Category, Groups and Sponsor Page 28 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 Retinal Implant used in Scleral  Band 2mm, Mira 240

 Buckling (Dimethylmethylvinyl  Circling Band 2.5mm.

 Siloxane Copolymer) Strips-Mira 41 Strip 3.5mm,

 Mira 42 Strip 4mm, Mira 20

 Strip 4mm, Mira 219 Strip

 4.5mm, Mira 31 Strip 4.5mm,

  Mira 32 Strip 5mm, Mira

 225 Oval Strip 5mm, Mira

 220 Strip 6mm. Boats-Mira

 60 Boat

 Device Technologies Australia Pty Ltd

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

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

 2.5 x 125mm, 0.75 x 2.5 x

 125mm

 Spectrum Surgical

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

 40, 3.5 x 0.75mm Type 41,

 4.0 x 1.25mm Type 42, 2.5 x

 0.6mm Type 240, Morin 3.5

 x 0.6mmStrip - 5.7mm Type

  20, 7.2mm Type 31, 9.2mm

 Type 32, 6mm Type 219,

 7.5mm Type 220, 8mm Type

 225

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

 Groove, 7 to 9mm wide),

 Biconvex: (2.5mm Groove, 7

  to 10mm wide),

 Asymetrical: (2.5mm

 Groove, 7 to 10mm wide)

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

 Morin Strip: 7mm wide x

 100mm long, Caputo Zip

 Strip: 7 to 9mm wide x

 120mm long, Korobelnik

 Oval Strip: 2 x 5mm

Prostheses List by Category, Groups and Sponsor Page 29 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 1.9.1.1 - Sponges

 Austmed Pty Limited

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

 Used in Scleral Buckling (Silicone  2mm, Mira 5025 Cylinder

 Elastomer Sponge) 2.5mm, Mira 503 Cylinder

 3mm, Mira 504 Cylinder

 4mm, Mira 505 Cylinder

 5mm, Mira 505G Grooved

 cylinder 5mm, Mira 505T

 Packer tunnel cylinder 5mm,

  Mira 510 Half cylinder

 5mm, Mira 515 Brucker two-

 thirds cyl

 Device Technologies Australia Pty Ltd

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

 100mm, 3.25 x 7.0 x 80mm,

 5.5 x 7.5 x 80mm, 1.5 x

 80mm, 2.0 x 80mm, 2.5 x

 80mm, 3.0 x 80mm, 4.0 x

 80mm, 5.0 x 80mm, 7.0 x 80mm

 Spectrum Surgical

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

 150mm length; Half Cord:

 3.0mm to width x1.5mm to

 2.5mm height x150mm;

 Circular Sponge: 3 to 5mm;

 Oval Sponge: 2 to 5.5mm x

 4 to 12mm; Half Sponge: 2

 to 3.1mm x 4 to 7.5mm;

 Grooved Sponge: 3 to 5mm

 x 5 to  12mm; Gain Sponge:

 6 x

Prostheses List by Category, Groups and Sponsor Page 30 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

1.9.2 - Clips and tacks

 Device Technologies Australia Pty Ltd

DE201 Labtician Tantalum Clips Tantalum 2, 2.5mm $50.00

1.9.3 - Sleeves

 Device Technologies Australia Pty Ltd

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

 Spectrum Surgical

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

 Length 30mm

1.9.4 - Intraocular Gases

 Alcon Laboratories (Aust.) Pty Ltd

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

 Constellation® Vision System C3F8 and SF6  single dose syringe

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

 C3F8 and SF6 in single dose syringe

 Device Technologies Australia Pty Ltd

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

 retinal surgery

 IQ Medical

IQ012 EasyGas Endotamponade Gases for Retinal  60ml dispensed in a single  $75.00

 Surgery, EasyGas SF6, C2F6 or C3F8, dose, sterile syringe

  each supplied in a 60ml syringe,

Prostheses List by Category, Groups and Sponsor Page 31 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

1.9.5 - Intraocular Heavy Liquids

 Alcon Laboratories (Aust.) Pty Ltd

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

 surgery additive

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

 surgery additive

 Bausch & Lomb (Australia) Pty Ltd

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

 retinal surgery additive

BL018 DK Line 100% purified  Perfluorodecalin 7ml $240.00

 perfluorodecalin

 Design for Vision Pty Ltd

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

 Device Technologies Australia Pty Ltd

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

 surgery, operative device for retinal

 surgery, in particular retinal

 detachment (RD), RD with giant tear

 etc.

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

 retinal surgery, pre-operative device

 for retinal surgery, in particular retinal

  detachment (RD), RD with giant tear,

 RD with proliferative vitreal

 retinopathy (PVR) etc.

 IQ Medical

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

 Postoperative

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

 medium, intraoperative

 Spectrum Surgical

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

 perfluorodecalin, FCI - OCTA:

 Purified perfluoro-N-octane

Prostheses List by Category, Groups and Sponsor Page 32 of 1011

1 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 perfluorodecalin, FCI - OCTA:

 Purified perfluoro-N-Octane

1.9.6 - Intraocular Silicone Oils

 Bausch & Lomb (Australia) Pty Ltd

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

 Oil

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

 Design for Vision Pty Ltd

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

 Device Technologies Australia Pty Ltd

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

 vitreoretinal surgery

 IQ Medical

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

 Spectrum Surgical

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

 Free)  free purified silicone oil

Prostheses List by Category, Groups and Sponsor Page 33 of 1011

10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

10.1.1 - Bare Metal Stents

 10.1.1.1 - Balloon Expandable

 Abbott Australasia Pty Ltd

AY022 Cobalt Chromium Balloon  Cobalt Chromium Diameter 4-10mm, Length  $1,800.00

 Expandable Peripheral Stent 12-58mm

AY024 Omnilink Stainless Steel Balloon  Stainless Steel Balloon Expandable  018 & 035 system: 5-10mm  $1,800.00

 Deployable Peripheral Stent Peripheral Stent on 018/035 system diameter by 12, 16, 18, 28,

 38, 58mm length

 B Braun Australia Pty Ltd

BB244 Coroflex Blue Cobalt Chromium Alloy L605 2-4mm diameter, 8-25mm  $1,800.00

 length

 Bard Australia Pty Ltd

BA218 Lifestent Valeo Stainless Steel Balloon Expandable  6-10mm diameter 17-56mm  $1,800.00

 Peripheral Stent length

 Biotronik Australia Pty Ltd

BT094 Dynamic PTA Balloon Expandable Stent Diameters: 5-10mm,  $1,800.00

 Lengths: 15, 25, 38, 56mm

 Boston Scientific Australia Pty Ltd

BS059 Express Vascular LD Stent; Express  Stainless Steel, Balloon Expanding  Stent Diameters up to 10mm  $1,800.00

 Vascular SD Stent Stent and lengths up to 60mm

 Cook Medical Australia Pty Ltd

WC234 Formula 414 Rx Renal Stent System Balloon Expandable Vasc/Biliary  Rapid exchange 014/018,  $1,800.00

 80-135cm delivery system.

 Diameters 4-10mm, lengths

 0.8 - 4cm

 Johnson & Johnson Medical Pty Ltd

JJ057 Palmaz Balloon Expandable Stent Stainless steel stent Diameter 4-12mm, length  $1,800.00

 20-30mm

JJ058 Palmaz Balloon Expandable Stent Stainless steel stent Extra-large $1,800.00

JJ305 Palmaz Genesis Peripheral Stent  Stainless steel balloon expandable  Diameter 4-8mm, length 12- $1,800.00

 and Delivery System on Opta Pro stent mounted on an Opta Pro  39mm

JJ306 Palmaz Genesis Peripheral Stent Stainless steel peripheral stent Diameter 4-12mm, length  $1,800.00

 11-79mm

Prostheses List by Category, Groups and Sponsor Page 34 of 1011

10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

JJ567 PALMAZ® BLUE™ .018  L605 Cobalt Chromium Alloy  12, 15, 18, 24mm length 4,  $1,800.00

 Peripheral Stent System Balloon Expandable Stent 5, 6, 7mm diameter

JJ688 Palmaz Blue .014 Renal Stent  CoCr balloon expandable stent 12, 15, 18, 24mm Lengths      $1,800.00

 System (on Aviator Plus)                                    40, 50,

 60, 70mm diameters                

                    80, 142cm shaft

 lengths

 MD Solutions Pty Ltd

MB009 ArchStent Ostial System The ArchStent Ostial System is a  7Fr: 5mm x 16mm x 135mm.  $1,800.00

 0.14" guidewire-compatible, rapid  7Fr: 6mm x 16mm x 135mm

 exchange balloon expandable stent

 system for the treatment of

 atherosclerotic stenosis at the renal-

 ostial junction. It consists of a 316L

 stainless steel stent with flaring of the

  proximal 1/5 segment, and a dual

 balloon delivery catheter featuring a

 Locator balloon that enables the

 operator to precisely position and

 conform the stent to aorto-ostial

 anomalies.

 Medtronic Australasia Pty Ltd

MC328 Racer Renal Stent System Cobalt Alloy Diameter: 4-7mm; Lengths:  $1,800.00

 12 &18mm

MC773 Assurant Cobalt Stent Iliac balloon expandable stent system Diameter:  6 - 10mm ,  $1,800.00

 Length:  20 - 80mm

MC959 Hippocampus Renal Stent System Hippocampus Renal Rapid Exchange  Diameter 4.0mm - 7.00mm  $1,800.00

 Stainless Steel Stent system, 5F  Length: 10mm - 24mm

 sheath, 0.014" guide wire compatible

MC977 Chromis deep cobalt Chromium,  Chromis deep - Cobalt Chromium, pre- Diameter: 2.0 mm 4.0mm  $1,800.00

 infrapopliteal OTW stent mounted balloon expandable, 0.014"  Length: 10mm - 76mm

 compatable stent

 10.1.1.2 - Self Expandable, <150mm

 Abbott Australasia Pty Ltd

AY015 Xact/ Xact Flex Carotid Stent Nitinol Self-Expanding stent on rapid Diameter 7-10mm Length 20 $1,800.00

  exchange delivery system  + 30mm Straight; Diameter

 8-6, 9-7, 10-8mm Length 20

 + 30mm Tapered

Prostheses List by Category, Groups and Sponsor Page 35 of 1011

10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

AY021 Nitinol Self Expanding Peripheral  Nitinol Diameter 3-10mm $1,800.00

 Stent

AY031 Xpert Xpert is a laser cut nitinol self  3 - 8mm in diameter, 20 -  $1,800.00

 expanding stent, used to treat  80mm in length

 peripheral vessel disease, Xpert is a

 low profile system designed for small

 vessels and is 4 french.

AY032 ACCULINK Peripheral Stent  Nickel-Titanium Intra-vascular stent 4-10mm diameter, 13-56mm  $1,800.00

 length

AY035 Absolute Pro (Long Length) Laser cut nitinol self expanding stent  Diameter 5mm to 10mm;  $1,800.00

 <150mm length 120mm

 Bard Australia Pty Ltd

BA178 Luminex Vascular Stent Luminex nitinol self-expanding stent 4mm - 20mm diameters, 2cm - $1,800.00

  12cm lengths

BA199 Lifestent Laser cut nitinol self expanding stent,  Diameter: 6-8mm, Length:  $1,800.00

 used to treat peripheral disease 120mm

BA216 Lifestent Lifestent cut nitinol self expanding  6-10mm diameter 20mm- $1,800.00

 120mm length

 Biotronik Australia Pty Ltd

BT072 Astron Peripheral self expanding nitinol,  Diameters: 6 - 12mm,  $1,800.00

 coated stent Lengths: 30 - 100mm

BT103 Astron Pulsar Astron Pulsar is a 4F compatible,  4-7mm by 20-80mm $1,800.00

 Nitinol self expanding stent (OTW

 design) used to treat peripheral vessel

  disease.

BT126 Pulsar 18 Peripheral self expanding  Pulsar 18  self expanding Nitinol  Stent: Ø 4- 7mm length: 20- $1,800.00

 Nitinol stent system stent system 120mm Catheter length: 90-

 135mm

BT133 Pulsar 35 Peripheral self-expanding  Pulsar 35 Peripheral self-expanding  Diameter: 5-7mm; Length:  $1,800.00

 Nitinol stent system Nitinol stent system 30-120mm; Catheter length:

  90cm

 Boston Scientific Australia Pty Ltd

BS035 Expandable Endoprosthesis Biomedical superalloy, self expanding Stent Diameters up to 30mm  $1,800.00

  stent and lengths up to 100mm

BS056 Carotid Wall Stent Elgiloy self expanding stent Stent diameters up to 10mm  $1,800.00

 and lengths up to 40mm

Prostheses List by Category, Groups and Sponsor Page 36 of 1011

10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BS137 EPIC Nitinol Stent Nitinol self expanding stent Stent diameters up to 14mm  $1,800.00

 and lengths up to 120mm

BS167 Placehit Wallstent Biomedical cobalt-based alloy, self  Stent diameters up to 19mm  $1,800.00

 expanding stent and lengths up to 100mm

BS168 Wallstent RP Tracheobronchial, Iliac, Biomedical  20-24mm; length 18-90mm $1,800.00

 Superalloy Wire, Braided Mesh,

 Stainless Steel Stent with Unistep

 Delivery System

BS189 Adapt Monorail Carotid Stent System Nitinol self expanding stent 21-40mm length, 4-9mm  $1,800.00

 diameter

BS196 Innova Self-Expanding Stent Nitinol, self expanding stent Diameters up to 8mm,  $1,800.00

 lengths less than 150mm

 Cook Medical Australia Pty Ltd

WC168 Cook Vascular/Biliary Stent Vascular/Biliary stent 5/6 Fr delivery system, 4 -  $1,800.00

 14mm diameter, 2 - 8cm

 length

WC278 Zilver Vascular Stent with Rapid  Zilver Stent Vascular Design, self- Delivery System 5Fr,  $1,800.00

 Exchange Delivery System expandable nitinol stent. Preloaded in 125cm. Stent diameter 4mm-

  a 5.0 French Rapid Exchange delivery 10mm. Stent length 2cm-8cm.

  catheter.

WC287 Zilver® Flex 35™ Vascular Stent The Zilver® Flew 35™ Stent (ZFV) is  The Zilver®  Flex 35™  $1,800.00

 a self-expandable stent made of  Stent is available in the

 nitinol.  The special laser-cut pattern  following sizes: stent outer

 of the nitinol tube provides a  diameters of 5 -10mm and

 construction with a strong radial force stent lengths of 20 -140mm.

  and high flexibility.  The stent has

 radiopaque markers at both ends.  The

 stent is supplied preloaded in a 6.0

 French inducer catheter. A radiopaque

  marker on the distal tip of the sheath

 is used to visualize deployment of the

 stent. Stent deployment is controlled

 by means of a hand held device.

WC290 Zilver®  Vena ™ Venous Stent The Zilver® Vena™ Venous Stent is a 14mm and 16mm diameters,  $1,800.00

  self-expanding, flexible, slotted-tube  and 60mm/100mm/140mm

 nitinol stent. Post-deployment, the  lengths.

 stent is designed to impart an outward

  radial force upon the inner lumen of

 the vessel, establishing patency in the

  stented region.

Prostheses List by Category, Groups and Sponsor Page 37 of 1011

10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Device Technologies Australia Pty Ltd

DE376 Supra Veritas Peripheral Vascular  Interwoven Self-Expanding Nitnol  20mm x 4,5,6,7mm $1,800.00

 Stent 30mm x 4,5,6,7mm

 60mm x 4,5,6,7mm

 80mm x 4,5,6,7mm

 100mm x 4,5,6,7mm

 120mm x 4,5,6,7mm

 Endotherapeutics Pty Ltd

ET037 SX-Ella Endovascular Stent Uncovered, self-expanding nitinol  Dia 6-16mm, length 22-77mm $1,800.00

 ev3 Australia Pty Ltd

EE006 Protégé GPS Peripheral Stent Protégé RX Peripheral Stent Diameter 6-10mm Length  $1,800.00

 20-60mm

EE024 Protégé EverFlex Peripheral Stent Protégé EverFlex is a self expanding  Diameter 5-8, Length 20- $1,800.00

 Nitinol stent premounted on an OTW  120mm

 delivery system.

 Johnson & Johnson Medical Pty Ltd

JJ419 SMART Control Peripheral Stent  SMART Control is a laser cut nitinol  Dia 6 – 14mm; Length 20 –  $1,800.00

 System self expanding stent, used to treat  100mm

 peripheral vessel disease.

JJ592 SMART Nitinol Stent System Long 120mm Stent, 6F compatible 6-8mm diameter, 120mm  $1,800.00

 stent length, 120cm

 delivery system

JJ646 Precise Pro Rx Nitinol Stent System Nitinol self expanding stent Diameter:  5, 6, 7, 8, 9,  $1,800.00

 10mm;  Length:  20, 30, 40mm

 Medtronic Australasia Pty Ltd

MC743 Complete SE Stent Nitinol 20mm - 80mm $1,800.00

MC744 Complete SE Stent Nitinol 100mm - 120mm $1,800.00

MC978 Cristallo Ideale Carotid Self  Cristallo Ideale  Nitinol, Carotid Self  Cylinder Diameter: 7.0mm -  $1,800.00

 Expanding Stent System Expanding Hybrid Stent system, 5F  11.0 mm. Taper Diameter

 introducer sheath compatible, Rapid  6.0/9.0 - 7.0/10.0. Length

 Exchange design, .014" guide wire  20mm - 40 mm.

 compatible.

MI010 Maris Plus Peripheral Self- Nitinol, self expanding, peripheral  Diameter: 6.0-12.0mm;  $1,800.00

 Expanding Stent System stent system Length: 30-120mm

Prostheses List by Category, Groups and Sponsor Page 38 of 1011

10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition