The Private Health Insurance (Prostheses) Amendment Rules (No. 5) 2019 were registered on the Federal Register of Legislation on 6 August 2019 and commence on 7 August 2019. The Amendment Rules were made to remove five billing codes for textured breast implant prostheses from Part A of the Prostheses List, as per the details in PHI Circular 51/19.
Private Health Insurance (Prostheses) RulesThe Private Health Insurance (Prostheses) Rules provide the legal basis on which the Prostheses List operates.
The Prostheses List is the list of surgically implanted prostheses, human tissue items and other medical devices that private health insurers must pay benefits for when:
- they are provided to a patient with appropriate health insurance cover
- they are provided as part of hospital treatment or hospital substitute treatment, and
- there is a Medicare benefit payable for the service.
Prostheses Benefit ReductionsOn Friday 13 October 2017 the Minister for Health announced that the minimum benefits payable by private health insurers for devices on the Prostheses List would be reduced. Additional information is available at:
Private health insurance reforms: Prostheses List benefit reductions
Agreement between the Government and the Medical Technology Association of Australia (MTAA)
Benefit Changes from 1 March 2019Private Health Insurance Circular 09/19 informs stakeholders about changes to benefits that appear in the March 2019 Prostheses List:
- Benefits for 464 groupings of prostheses were either increases or decreased by $1 to address an issue with incorrect rounding of benefits when they were reduced in August 2018;
- Benefits for 24 groupings of prostheses were reduced by removal of the benefit premium for “superior clinical performance”, under the Government Agreement with the Medical Technology Association of Australia.
July 2019 Prostheses List – commencing 1 July 2019The Department of Health publishes the current Prostheses List for the use of stakeholders to update their claims and payments systems.
While care has been taken in the preparation of these documents, the information they contain does not take precedence over the latest copy of the Private Health Insurance (Prostheses) Rules registered and in force on the Federal Register of Legislation.
These documents reflect the Private Health Insurance (Prostheses) Rules (No. 2) 2019 (as amended by the Amendment Rules).
Prostheses List in parts
Part A – Prostheses ListProstheses List - Part A (Rules 2019) (PDF 15.6 MB)
Prostheses List - Part A (Rules 2019) (Excel 1.2 MB)
Part A – New Prostheses ItemsNew Prostheses Items (Rules 2019) (PDF 474 KB)
New Prostheses Items (Rules 2019) (Excel 52 KB)
Part A – Deleted Prostheses ItemsDeleted Prostheses Items (Rules 2019) (PDF 290 KB)
Deleted Prostheses Items (Rules 2019) (Excel 30 KB)
Part A – Changed Items for Prostheses ListChanged Items for Prostheses List (Rules 2019) (PDF 195 KB)
Changed Items for Prostheses List (Rules 2019) (Excel 20 KB)
Part B – Human TissueHuman Tissue (Rules 2019) (PDF 381 KB)
Human Tissue (Rules 2019) (Excel 43 KB)
Part B – New Human Tissue ItemsNew Human Tissue Items (PDF 79 KB)
New Human Tissue Items (Excel 10 KB)
Part B – Deleted Human Tissue ItemsDeleted Human Tissue Items (PDF 72 KB)
Deleted Human Tissue Items (Excel 9 KB)
Part B – Changed Human Tissue ItemsChanged Human Tissue Items (PDF 92 KB)
Changed Human Tissue Items (Excel 12 KB)
Part C – OtherOther (Rules 2019) (PDF 169 KB)
Other (Rules 2019) (Excel 18 KB)
Part C – New OtherNew Other (PDF 79 KB)
New Other (Excel 11 KB)
Part C – Deleted OtherDeleted Other (PDF 79 KB)
Deleted Other (Excel 9 KB)
Part C – Changed OtherChanged Other (PDF 74 KB)
Changed Other (Excel 9 KB)
XML fileProstheses List - XML version (XML 11 MB)
Contacts for further information
The Department of Health has made every effort to ensure these documents meet accessibility requirements. If you are experiencing difficulty accessing the information contained within this webpage, or cannot find the information you need, please contact the Prostheses secretariat by email at firstname.lastname@example.org