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. The first element of the benefit reductions (that became effective on 1 February 2018) is included in the Private Health Insurance (Prostheses) Rules 2018 No. 1. Further prostheses benefit reductions are scheduled for August 2018 and February 2020. Additional information is available at:
Private health insurance reforms: Prostheses List benefit reductions
Agreement between the Government and the Medical Technology Association of Australia (MTAA)
Current Prostheses List
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.
Prostheses List in parts
Part A – Prostheses List
Part A – New Prostheses Items
Part A – Deleted Prostheses Items
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 firstname.lastname@example.org