PHI 73/19 Prostheses List benefit reduction – February 2020

This circular provides information for stakeholders about the February 2020 Prostheses List benefit reductions.

Date published:
PHI circular type:
Prescribed List announcement
Audience:
Health sector

As per the Government-MTAA agreement, the final round of benefit reductions payable by private health insurers for devices on the Prostheses List will take effect 1 February 2020. The reduction is calculated on the basis of the Prostheses List benefit on 31 January 2020. The following groups are exempt: 03.01.01, 08.17.01, 08.18.01 and 08.18.02.

The table shows the reduction percentages that apply.

Benefit reductions effective 1 February 2020
 

Ophthalmic
–5%

Except groups
 

Foldable
–8.5%

Viscoelastic
–10%

Ears nose throat
–5%

Except groups (cochlear implants, speech processors, sound processor accessory kits, implantable bone conduction hearing system)

General miscellaneous
–5%

Except groups (infusion pumps, balloon based; sponges; pliable patches, internal adhesives, ligating devices; staples and tackers)
–7%

Neurosurgical
–5%

Urogenital

Specialist ortho

Except groups (screws; surgical accessories; bone cement)
–3%

Plastic and reconstructive

Cardiac
–7.5%

Except group (cardiac defect occluders)
–10%

Cardiothoracic

Vascular
–5%

Except assessment bodies (vascular patches; arterial closure devices; long term vascular access devices);

and groups (occlusion devices particle; coil, peripheral; polymer; delivery device for occlusion media)
–10%

Hip
–4.5%

Knee
–2.5%

Spinal
–3.75%

Additional information on the benefit reductions can be found at:

Draft Prostheses List available to sponsors via PLMS
18 November 2019

Deadline for feedback
25 November 2019

February 2020 Prostheses List published
2 December 2019

February 2020 Prostheses List effective
1 February 2020