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:
August 2018 Prostheses List – commenced 14 September 2018
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.
The complete Prostheses List is provided in MS Access format. Other formats are available below.
These documents reflect the Private Health Insurance (Prostheses) Rules 2018 (No 2) and the changes made by the Private Health Insurance Prostheses (Amendment) Rules 2018 (No 3) (Amendment Rules). Both Rules commence from 14 September 2018. More information about the changes in the Amendment Rules is in Private Health Insurance Circular 50/18.
MS Access version: August 2018 – Prostheses List (MBD 7.8 MB)
IMPORTANT NOTE: From March 2019, the Prostheses List will no longer be provided as a Microsoft Access version. Instead, the Prostheses List will be provided in Extensible Markup Language (XML) format. The XML file and XML Schema document are attached. Notify the appropriate areas in your organisation so they can use these files to prepare for any necessary system changes. The Excel and PDF versions will continue to be provided.
Feedback and queries on the XML Schema should be directed to Prostheses@health.gov.au with “Prostheses List XML Schema” in the Subject line.
Prostheses List in parts
Part A – Prostheses List
PDF version: Prostheses List - Part A (Rules 2018 No. 2) (PDF 40 MB)
Excel version: Prostheses List - Part A (Rules 2018 No. 2) (Excel 3.8 MB)
Part A – New Prostheses Items
PDF version: New Prostheses Items (Rules 2018 No. 2) (PDF 3.5 MB)
Excel version: New Prostheses Items (Rules 2018 No. 2) (Excel 322 KB)
Part A – Deleted Prostheses Items
PDF version: Deleted Prostheses Items (Rules 2018 No. 2) (PDF 1.2 MB)
Excel version: Deleted Prostheses Items (Rules 2018 No. 2) (Excel 271 KB)
Part A – Changed Items for Prostheses List
Part B – Human Tissue
Part C – Other
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