PHI 57/11

This circular issued by the Private Health Insurance Branch contains information on August 2011 Prostheses List

Page last updated: 02 November 2012

Printable version of 57/11 (PDF 28 KB)

8 August 2011

August 2011 Prostheses List


The purpose of this Circular is to inform the health industry that:
  • the delegate of the Minister for Health and Ageing has made rules giving effect to a new version of the Prostheses List (August 2011); and
  • the August 2011 Prostheses List commences on 22 August 2011.
The Private Health Insurance (Prostheses) Rules 2011 (No. 2) ('the Rules') are now available on the Department's website. Please note that the Rules have been registered on the Federal Register of Legislative Instruments (FRLI) with a commencement date of 22 August 2011.

Variations from the previous Prostheses List – Part A (Prostheses)

The August 2011 Prostheses List (Part A) contains the following changes:
  • 566 new billing codes (239 for new products, 138 resulting from expansions, 156 resulting from transfers, 19 resulting from compressions and 14 duplications).
  • 3,078 billing codes have had amendments to one or more of the following: benefit/s, product information text, product groups/subgroups; and
  • 605 billing codes have been removed (354 at the request of the sponsor, 42 as a result of compressions, 54 as a result of expansions and155 as a result of transfers).

Part B - Human Tissue List

No applications were received for new listings for Part B Human Tissue of the Prostheses List.

Applications were received for benefit variations to 35 items on Part B Human Tissue List of the Prostheses List.

Gap permitted products

There are 1,542 (16.5%) products with potential gaps in part A of the August 2011 Prostheses List.

This is a decrease of 7.9 percentage points from the February 2011 Prostheses List, primarily a result of implementation of the HTA review. Human tissue prostheses in Part B of the Prostheses List do not have gap permitted products.

The August 2011 Prostheses List and associated reports are available on the Department’s website.

Part C

Circular 25/10 advised that the Private Health Insurance Act 2007 had been amended to facilitate the implementation of Part C of the Prostheses List. It was anticipated that Part C would be implemented for the August 2011 Prostheses List.

PHI Circular 47/11 indicated that implementation had been delayed. However, products that have been identified for listing on Part C (insulin infusion pumps and cardiac event recorders) will be so listed for the August 2011 Prostheses List. 16 products on Part A of the Prostheses List that meet the Part C listing criteria have been transferred from Part A to Part C.

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 2011 Private Health Insurance (PHI) Circulars.

Changing your e-mail address? No longer want circulars? Please email Private Health Insurance Branch