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:
February 2018 Prostheses List – commenced 14 March 2018
The Department of Health publishes the current Prostheses List for the use of stakeholders to update their claims and payments systems.
The complete Prostheses List is provided in MS Access format. Other formats are available below.
MPORTANT NOTE: From March 2019, 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.
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
Part A – New Prostheses Items
PDF version: New Prostheses Items (Rules 2018 No. 1) (PDF 726 KB)
Excel version: New Prostheses Items (Rules 2018 No. 1) (Excel 102 KB)
Part A – Deleted Prostheses Items
PDF version: Deleted Prostheses Items (Rules 2018 No. 1) (PDF 233 KB)
Excel version: Deleted Prostheses Items (Rules 2018 No. 1) (Excel 51 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 the Microsoft Excel versions 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 email@example.com