The Prostheses List

Benefits payable in respect of surgically implanted prostheses, human tissue items and other medical devices list.

Page last updated: 28 April 2017

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 as part of hospital treatment or hospital substitute treatment, and there is a Medicare benefit payable for the professional service.

The Prostheses List is a schedule to the Private Health Insurance (Prostheses) Rules (the Prostheses Rules). The Prostheses Rules are available at Government's legislation website.

The Prostheses Rules are made by the Minister for Health. In making the Rules, the Minister can have regard to advice from the Prostheses List Advisory Committee, and its sub-committees.

Consumer-specific information on private health insurance cover for prostheses can be found at this webpage - Prostheses - Information for consumers.

Cost Recovery Implementation Statement

Administration of the Prostheses List - 1 July 2016 to 30 June 2017

Prostheses List Cost Recovery Implementation Statement (CRIS)

Administration of the prostheses listing arrangements is fully cost recovered by the imposition of fees for submitting applications to list prostheses and fees to list prostheses on the Prostheses List.

The attached Cost Recovery Implementation Statement – Administration of the Prostheses List sets out the current cost recovery arrangements:

PDF version: Cost Recovery Implementation Statement – Administration of the Prostheses List (PDF 245 KB)
Word version: Cost Recovery Implementation Statement – Administration of the Prostheses List (Word 121 KB)

Applications to list new prostheses and requests to change listings

Medical device sponsors and suppliers who want to list their prostheses on the Prostheses List make applications and requests via the Prostheses List Management System (PLMS) or by completing a form available on this website and sending it to the Department of Health.

Prostheses List Guide

The Prostheses List – guide to listing and benefits for prostheses provides information for stakeholders on the prostheses arrangements and guidance for applicants on the process to get a prosthesis listed.

Word version: Prostheses List Guide (Word 977 KB)
PDF version: Prostheses List Guide (PDF 502 KB)

The Trans Aortic Valve Implantation Clinical Advisory Group (TAVICAG) guideline is to be read in conjunction with the Prostheses List Guide.

PDF version: TAVICAG Guideline (PDF 27 KB)
Word version: TAVICAG Guideline (Word 28 KB)

Any feedback or queries should be emailed to Prostheses@health.gov.au, with “Prostheses List Guide feedback” in the subject line.

Prostheses List Database

The current Prostheses List is published for the use of stakeholders to update their claims and payments systems. It is also provided in MS Access, PDF and Excel format. Download the Current Prostheses List

Contacts for further information

Please check the Prostheses List Guide first as the information might be available there.M

If you cannot find the information you need, contact the Prostheses secretariat:
by email at Prostheses@health.gov.au
by phone on (02) 6289 9463.

Other relevant information

Publications

Private Health Insurance (PHI) Circulars and Prostheses List Bulletins