PHI 61/10

This circular issued by the Private Health Insurance Branch contains information regarding Private Health Insurance (Prostheses) Amendment Rules 2010 (No. 1)

Page last updated: 24 September 2010

PDF Printable version of 61/10 (PDF 56KB)

22 September 2010

Private Health Insurance (Prostheses) Amendment Rules 2010 (No. 1)

Purpose

The purpose of this Circular is to inform stakeholders of an amendment to the Private Health Insurance (Prostheses) Rules 2010 (No. 2), the August Prostheses List. The amendment will commence on 5 October 2010.

Amendments to Part A

The Private Health Insurance (Prostheses) Amendment Rules 2010 (No. 1) amend Part A of the Schedule to the Rules as follows:
  • changing the ‘size’ of Billing Code CZ020, as outlined in the table below;
    Billing CodeNew Size
    CZ020Overall length 11.00mm Optic Foldable IOL size 6.00mm +6.0D +32.0D inclusive in 0.5D increments Cylinder +1.0 to 6.5D inclusive
  • deleting twelve (12) Billing Codes GL007, SK046, SK120, SK121, SK122, SK123, SK124, SK125, SK186, SR047, SR048 and SR049.
  • transferring four (4) Billing Codes from Orthotech Pty Ltd to Biomet Australia Pty Ltd. These changes were effected by deleting Billing Codes OH240, OH241, OH123 and OH347 and replacing them with Billing Codes BH103, BH104, BH105 and BH106. These amendments are outlined in the table below:
    Previous
    Billing Code
    New Billing CodeProduct NameDescriptionSizeMin BenefitMax Benefit
    OH240BH103Vuelock (Anterior Cervical Plate)Vuelock (Anterior Cervical Plate)Level 1-4, 12mm – 92mm$1,400.00$2,600.00
    OH241BH104Vuelock (Anterior Cervical Plate)Vuelock Bone Screws12mm – 16mm$200.00$350.00
    OH123BH105GEO Structure Vertebral Cage - PLIF3 dimensional titanium intervertebral cageOne size only$3,000.00$4,100.00
    OH347BH106Ibex Interbody CageLumbar Cage7mm-17mm$2,503.00$3,500.00
  • changing three (3) Billing Codes from PU057, PU058 and ST988 to PU059, PU060 and SK510 as outlined in the table below. The Billing Codes PU057, PU058 and ST988 were incorrectly given to three new products in the Rules. These billing codes had been used before for other products that were subsequently deleted.
    Previous
    Billing Code
    New Billing Code
    Product Name
    Description
    Size
    Min Benefit
    Max Benefit
    PU057PU059Gelfoam Sterile SpongeSterile, pliable, nonantigenic surgical sponge prepared from specially treated purified gelatine solution12 - 20mm x 60mm x 7mm, individually packaged for use
    $17.00
    PU058PU060Gelfoam Sterile SpongeSterile, pliable, nonantigenic surgical sponge prepared from specially treated purified gelatine solution100 - 80mm x 125mm x 10mm in individual packet
    $30.00
    ST988SK510Stryker Locked Plate SystemPeriarticular variable angle locking plate - fibula.1-16 holes.
    $1,300.00
    $1,800.00
  • reinstating three (3) items that were incorrectly removed when the Rules were made, Billing Codes SY060, SY071 and SY270, as outlined in the table below:
    Billing Code
    Product Name
    Description
    Size
    Min Benefit
    Max Benefit
    SY060AO/ASIF Intermedullary NailsCannulated and Solid Tibial Nail7.0mm-19mm diameter 200mm-600mm length
    $910.00
    SY071AO/ASIF Screws SteelCannulated screws2.7mm-4.49mm
    $175.00
    SY270AO/ASIF Intramedullary NailsAntegrade/Retrograde Femoral NailDiameter 6.5mm-18mm, Length 30mm-500mm
    $1,030.00
  • duplicating five (5) Billing Codes under an additional sponsor with the addition of BH100, BH101, BH102, BH107 and BH108, as outlined in the table below:
    New
    Billing Code
    Product Name
    Description
    Size
    Min Benefit
    Max Benefit
    BH100Interpore Bone Plate SystemTPS Bone Plate20cm – 56cm
    $2,300.00
    $3,500.00
    BH101Interpore Bone Plate SystemTPS Screw14mm – 22mm
    $250.00
    $850.00
    BH102Interpore Bone Plate SystemTPS Locked Nut3mm
    $177.00
    $650.00
    BH107Anterior Cervical Plate SystemTitanium Locking Plate20mm - 140mm
    $1,400.00
    $2,600.00
    BH108Anterior Cervical Plate SystemTitanium Cancellous Bone Screw4mm – 20mm
    $200.00
    $260.00
  • removing any redundant headings as a result of deletion of various Billing Codes.

If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to Private Health Insurance Branch

For more information visit 2010 Private Health Insurance (PHI) Circulars.

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