PHI 50/18 Private Health Insurance (Prostheses) Amendment Rules 2018 No. 3 – Prostheses List

Page last updated: 14 September 2018

PHI 50/18 Private Health Insurance (Prostheses) Amendment Rules 2018 No. 3 – Prostheses List (PDF 157 KB)

The delegate of the Minister for Health has made the Private Health Insurance (Prostheses) Amendment Rules 2018 (No. 3) (the Amendment Rules).
The Amendment Rules have been made to correct errors and omissions in the Private Health Insurance (Prostheses) Rules 2018 (No. 2):

    • Two billing codes were added to Part A:
    • One billing code was amended to add sizes to the listing
    • Benefits for 17 billing codes on Part B were corrected; and
    • Billing codes for two human tissue items on Part B were changed.
The errors and omissions arose largely from unforeseen errors in processing within the Prostheses List database (PRADA).

On 21 September 2018, PRADA is scheduled to be de-commissioned and the Prostheses List Management System (PLMS) will take over as the end-to-end processing and listing system. These unforeseen errors should no longer occur, and the new system will feature validation checks throughout the process to support the quality and reliability of data.

The Amendment Rules have been registered on the Federal Register of Legislation and come into effect on 14 September 2018, immediately following the commencement of the Private Health Insurance (Prostheses) Rules 2018 (No. 2).
A spreadsheet at the end of this circular provides information on the changes made in the Amendment Rules.

The updated Prostheses List will be available on the Department of Health Prostheses List webpage.

Notes:
The information provided on the Prostheses List webpage is for the use of stakeholders and in formats useful for their purposes. While care has been taken in the preparation of these documents, the information contained therein does not take precedence over the latest Private Health Insurance (Prostheses) Rules registered and in force on the Federal Register of Legislation.

The next Prostheses List will be provided in Extensible Markup Language (XML) format – replacing the Microsoft Access database version. The Excel and PDF versions will continue to also be provided. Further details are provided on the Department of Health Prostheses List webpage.


Billing CodeSponsor / FacilityProduct NameDescriptionSizeCategorySubCategoryGroupSubGroup Suffix/esBenefitChange
Part A - Prostheses
GT261W L Gore & AssociatesConformable GORE TAG Thoracic EndoprosthesisConformable GORE TAGDiameters (mm): 21, 26, 28, 31, 34, 37, 40, 45
Length (cm): 20
10 - Vascular02 - Stent Grafts01 - Tube (Thoracic Aorta)02 - ≥180mm length
13775
Added sizes 21, 26, 28, 31 mm diameter
OH642Orthotech Pty LtdKLS Martin - Radial Plating SystemsmartDrive Screw3.0 x 8-30mm06 - Specialist Orthopaedic03 - SKELETAL RECONSTRUCTION04 - Screws02 - Small (2.71mm – 4.49mm)
82
Expanded from OH469
MI291Medtronic Australasia Pty LtdCD HorizonCrosslink Plates - Adjustable10 to 200mm13 - Spinal03 - Connector03 - Transverse (Rod-to-Rod)
1310
Compressed from MI247, MI249
Part B - Human Tissue
AAA14AUSTRALIAN TISSUE DONATION NETWORK LIMITEDMorsellised Bone (10-20 cc/g)
2707
Benefit change
AAA28AUSTRALIAN TISSUE DONATION NETWORK LIMITEDMorsellised Bone (Freeze Dried) (6-10cc)
2707
Benefit change
AAA39AUSTRALIAN TISSUE DONATION NETWORK LIMITEDMorsellised Bone Super Critical Fluid CO2 Treated (10-20g)
2761
Benefit change
AAA66AUSTRALIAN TISSUE DONATION NETWORK LIMITEDMorsellised Bone (Freeze Dried) (1-5cc)
2432
Benefit change
AAA78AUSTRALIAN TISSUE DONATION NETWORK LIMITEDCervical Spacers - Parallel Super Critical Fluid CO2Treated 5mm-9mm
2065
Benefit change
AAA86AUSTRALIAN TISSUE DONATION NETWORK LIMITEDMorsellised Bone – Super Critical Fluid CO2 Treated (1-4g)
2314
Benefit change
AAA90AUSTRALIAN TISSUE DONATION NETWORK LIMITEDMorsellised Bone (1-4 cc/g)
2268
Benefit change
ABB28AUSTRALIAN TISSUE DONATION NETWORK LIMITEDCervical Spacers – Lordotic Super Critical Fluid CO2Treated 5mm-9mm
2065
Benefit change
ABB29AUSTRALIAN TISSUE DONATION NETWORK LIMITEDMorsellised Bone Super Critical Fluid CO2 Treated (Freeze Dried) (11-20cc)
2482
Benefit change
ABB50AUSTRALIAN TISSUE DONATION NETWORK LIMITEDUnicortical Cancellous Block
1674
Benefit change
ABB70AUSTRALIAN TISSUE DONATION NETWORK LIMITEDCortical Ring Super Critical Fluid CO2 Treated 5mm-9mm
2065
Benefit change
ABB86AUSTRALIAN TISSUE DONATION NETWORK LIMITEDMorsellised Bone – Super Critical Fluid CO2 Treated (1-4g)
2314
Benefit change
ABB94AUSTRALIAN TISSUE DONATION NETWORK LIMITEDMorsellised Bone (5-9 cc/g)
2432
Benefit change
QBB70Queensland Tissue BankTendon - Semitendinosus
2517
Benefit change
TBV54Donor Tissue Bank of VictoriaBone - Demineralised Bone Matrix, Lyophilised 5cc
1557
Benefit change
TBV55Donor Tissue Bank of VictoriaBone - Demineralised Bone Matrix, Lyophilised 10cc
2306
Benefit change
TBV64Donor Tissue Bank of VictoriaBone - Cancellous Bone Matrix Lyophilised 1 - 5cc
1495
Benefit change
QBB76The Queensland Bone BankEngineered Bone
4150
correcting billing code
QBB77The Queensland Bone BankMilled Bone <15g
2088
correcting billing code