The Prostheses List

The Private Health Insurance (Prostheses) Rules (No. 2) 2019 were registered on the Federal Register of Legislation on 20 June 2019 and commence on 1 July 2019. Schedule 1 to these Rules is commonly known as the July 2019 Prostheses List.

Page last updated: 30 August 2019

The Private Health Insurance (Prostheses) Amendment Rules (No. 6) 2019 were registered on the Federal Register of Legislation on 28 August 2019 and commence on 29 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 56/19.

Private Health Insurance (Prostheses) Rules

The 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.
The list is aimed at Private Health Insurers, prostheses device manufacturers and other sponsors. To find consumer-specific information on private health insurance cover for prostheses go to the Private Health Insurance - Cover for Prostheses page.

Prostheses Benefit Reductions

On 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 2019

Private 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.
These benefit changes are reflected in the report of Part A - Changed Items for Prostheses List below.

July 2019 Prostheses List – commencing 1 July 2019

The 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 List

Prostheses List - Part A (Rules 2019) (PDF 16051 KB)
Prostheses List - Part A (Rules 2019) (Excel 1257 KB)

Part A – New Prostheses Items

New Prostheses Items (Rules 2019) (PDF 474 KB)
New Prostheses Items (Rules 2019) (Excel 52 KB)

Part A – Deleted Prostheses Items

Deleted Prostheses Items (Rules 2019) (PDF 290 KB)
Deleted Prostheses Items (Rules 2019) (Excel 30 KB)

Part A – Changed Items for Prostheses List

Changed Items for Prostheses List (Rules 2019) (PDF 195 KB)
Changed Items for Prostheses List (Rules 2019) (Excel 20 KB)

Part B – Human Tissue

Human Tissue (Rules 2019) (PDF 609 KB)
Human Tissue (Rules 2019) (Excel 42 KB)

Part B – New Human Tissue Items

New Human Tissue Items (PDF 79 KB)
New Human Tissue Items (Excel 10 KB)

Part B – Deleted Human Tissue Items

Deleted Human Tissue Items (PDF 72 KB)
Deleted Human Tissue Items (Excel 9 KB)

Part B – Changed Human Tissue Items

Changed Human Tissue Items (PDF 92 KB)
Changed Human Tissue Items (Excel 12 KB)

Part C – Other

Other (Rules 2019) (PDF 169 KB)
Other (Rules 2019) (Excel 18 KB)

Part C – New Other

New Other (PDF 79 KB)
New Other (Excel 11 KB)

Part C – Deleted Other

Deleted Other (PDF 79 KB)
Deleted Other (Excel 9 KB)

Part C – Changed Other

Changed Other (PDF 74 KB)
Changed Other (Excel 9 KB)

XML file

Prostheses List - XML version (XML 11308 KB)

XML Schema document (PDF 754 KB)
XML Schema document (Word 129 KB)

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 prostheses@health.gov.au


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