PHI 23/15

This circular issued by the Private Health Insurance Branch contains information about the Prostheses List

Page last updated: 15 April 2015

Printable version of 23/15 (PDF 165 KB)

15 April 2015

Amendment to February 2015 Prostheses List

The delegate of the Minister for Health has made the Private Health Insurance (Prostheses) Amendment Rules 2015 No. 1 (the Amendment Rules) to make changes to listings on the February 2015 Prostheses List to correct administrative errors.

It is expected that the Amendment Rules will be published on the Federal Register of Legislative Instruments (FRLI) on or about 17 April 2015, and will be effective on 1 May 2015.
The changes to the February 2015 Prostheses List are detailed in the table attached. Briefly:
  • 2 new prostheses are added – SO076 – HumanOptics Artificial Iris and SA170 – Perceval S Sutureless Aortic Heart Valve;
  • 2 prostheses are deleted – EH004 and EH005, as the former sponsor is no longer in business;
  • the suffix “Wireless enabled” has been added to CO073 – Cochlear™ BahaŽ 4 Sound Processor, and the benefit increased to $6,825.
The Amendment Rules also reinstates billing code JJ789 – Gynecare Gynemesh that was deleted from the February 2015 Prostheses List in error. Private health insurers are asked to consider paying benefits in respect of these prostheses supplied during the period between the commencement of the February 2015 Prostheses List and the commencement of the Amendment Rules.
Change
Billing Code

Product Name

Sponsor

Category

SubCategory

Group

SubGroup

Suffix

Benefit

New prosthesis

SO076

HumanOptics Artificial Iris

Spectrum Ophthalmics

01 – Ophthalmic

10 – Artificial Iris

01 - Foldable

$6,213.00

New prosthesis

SA170

Perceval S Sutureless Aortic Heart Valve

Sorin Group Australia Pty Ltd

09 – Cardiothoracic

02 – Tissue Valves

04 – Rapid Deployment Valve with dedicated single use tools

$9,450.00

Group change and benefit change

CO073

Cochlear™ BahaŽ 4 Sound Processor

Cochlear Limited

02 – Ear, Nose and Throat

01 - EAR

04 - Implantable Bone Conduction Hearing System

01 - Sound Processor

Programmable, Wireless enabled

$6,500.00

$6,825.00


Billing code reinstated

JJ789

GYNECARE GYNEMESH

Johnson & Johnson Medical Pty Ltd

05 – Urogenital

04 - Reconstructive Material

01 - Synthetic

02 - ≥500 sq cm

$677.00

Description:

Pelvic floor reconstructive material, lightweight mesh


Size:

25 x 25 cm


Billing code deleted

EH004

ELIZ Bone Graft Substitute

Eupharma

06 – Specialist Orthopaedic

03 - SKELETAL RECONSTRUCTION

15 - Bone Graft Substitute

03 - Ceramic, >10cc - 20cc

$1,500.00

Billing code deleted

EH005

ELIZ Bone Graft Substitute

Eupharma

06 – Specialist Orthopaedic

03 - SKELETAL RECONSTRUCTION

15 - Bone Graft Substitute

04 - Ceramic, >20cc

$1,560.00
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 2015 Private Health Insurance (PHI) Circulars.

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