The November 2023 Prescribed List of Medical Devices and Human Tissue Products (Prescribed List) has been amended to clarify the condition placed on the billing codes listed in Part A for surgical guides and biomodels and to correct the technological, data entry, and editorial errors in the benefits for six billing codes and references to the sections of the Rules.
The delegate of the Minister for Health and Aged Care has made the Private Health Insurance (Medical Devices and Human Tissue Products) Amendment Rules (No. 2) 2023 (MDHTP Amendment Rules). The MDHTP Amendment Rules were registered on the Federal Register of Legislation on 10 November 2023 and will commence on 11 November 2023.
Condition on surgical guides and biomodels
The MDHTP Amendment Rules repeal the condition applied to 37 billing codes for surgical guides and biomodels listed in Part A, and applied a revised condition with more clarity on the circumstances in which benefits are intended to be payable and with the delayed commencement date on 1 February 2024.
Specifically, the revised condition provides that:
Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction & Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.
These amendments mean that no condition is placed on the 37 billing codes from 11 November 2023 (the day on which the MDHTP Amendment Rules commence) and until 31 January 2024. The delayed start will allow the scheduled procedures using the devices to go ahead without patients incurring unexpected out-of-pocket costs.
The MDHTP Amendment Rules also amend the benefits for billing codes incorrectly recorded in the MDHTP Rules:
In Part B, the benefit for billing code CAA23 - ENHANCE® Demineralized Cortical Fiber, 10cc, Dehydrated, Non-Irradiated (supplied by ConMed Linvatec Australia Pty Ltd) was recorded as $217. The correct benefit is $3,155.
In Part D, the benefit for 5 billing codes: DE603 (PleuraFlow Active Clearance Technology), FN002 (Pleurx), ME207 (TRU-CLOSE THORACIC VENT), MS065 (ASEPT Pleural Drainage System), and RK001 (Rocket IPC Pleural/Peritoneal Tunnelled Catheter Insertion Kit) were recorded as $121. The correct benefit is $384.
For further information refer the Explanatory Statement for the Amendment Rules.
The XML document will not be updated to reflect these changes as the update would overwrite the other changes made in the November 2023 PL.