We implemented the assurance function as part of the reforms to the Prescribed List 2021–2025.
This function aims to ensure that devices and human tissue products continue to be eligible for listing on the Prescribed List (PL). We do this by making sure that devices and human tissue products comply with the PL criteria for listing and other applicable requirements.
We also correct the billing codes incorrectly listed on the PL.
Post-listing reviews
Private health insurers must continue to pay the PL benefits for devices listed on the PL which are subject to a post-listing review or recorded on the annual PL post-listing reviews work plan.
Any changes to benefits that are a result of a post-listing review apply only after the change has been included in the Private Health Insurance (Medical Devices and Human Tissue) Rules and those Rules have commenced.
We periodically review devices and products on the PL to ensure they continue to comply with the criteria for listing.
We undertake all post-listing reviews according to the post-listing review framework, to promote a consistent approach for all reviews.
Annual workplan
We maintain an annual workplan of devices or groupings that are planned for a post-listing review. The workplan is not a list of active reviews.
The table below shows the annual workplan for 2025–2026.
| Topic | Groups/Billing codes | Review trigger | Proposed review | Proposed timeframe |
|---|---|---|---|---|
| Spinal fusion cages | 13.10.01.01 – Interbody, Integral Fixation – Cervical; 13.10.01.02 – Interbody, Integral Fixation – ThoracoLumbar / Lumbar; 13.10.02.01 – Interbody, No Integral Fixation – Cervical; 13.10.02.02 - Interbody, No Integral Fixation – ThoracoLumbar / Lumbar; 13.05.01.01 – Plate – Integral Fixation – Cervical (without suffix and with suffix >55mm); 13.05.01.02 – Plate – Integral Fixation – ThoracoLumbar / Lumbar / Lumbosacral; 13.05.02.01 – Plate – No Integral Fixation – Cervical (without suffix and with suffix >55mm); and 13.05.02.02 – Plate – No Integral Fixation – ThoracoLumbar | Stakeholder concerns about recent changes to PL groupings do not represent the clinical value of some innovative devices. | Focused HTA review of comparative clinical and cost effectiveness of spinal cages. | Project plan and scope planned for Q4 2025 Consultation with stakeholders planned for Q4 2025 |
| Shoulder humeral components/humeral trays and inserts | 06.02.04.05 – Shoulder–Humeral – Modular humeral component – metaphyseal, uncemented 06.02.04.14 – Shoulder–Humeral – Humeral cup; 06.02.05.04 – Shoulder – Glenoid – Glenoid insert; and 06.02.06.07 – Shoulder – Accessories – Reverse humeral tray. | There are a mix of different devices listed in the same subgroups. | Review the current subgroups, suffixes and benefits of shoulder humeral component devices. | Project plan and scope planned for Q1 2026 Consultation with stakeholders planned for Q1 2026 |
| Sternal fixation and deformity correction devices | 06 – Specialist Orthopaedic 07 – Plastic and Reconstructive; 09 – Cardiothoracic. | There are at least 41 sternal fixation devices listed in 3 different categories on the PL, with similar devices listed across different groupings. Review of the relevant billing codes to achieve consistency and clarity in the grouping structure of these devices, including consideration whether these devices should be listed in the same PL category. | Review the current groups, subgroups, suffices and benefits for sternal fixation devices. | Project plan and scope planned for Q2 2026 Consultation with stakeholders planned for Q2 2026 |
| Craniomaxillofacial (CMF) surgical splints | 07.02 – Craniomaxillofacial (CMF) Implants. | Surgical splints are listed in kits as items that can be claimed under surgical guides and biomodels billing codes. | Internal review of catalogue items under each applicable billing code. Review of comparative clinical effectiveness and benefits payable for splints. | Commence after review of surgical guides and biomodels is complete. |
| External fixateurs and bone graft substitutes | 06.03.11 – Specialist Orthopaedic – Skeletal Reconstruction – External Fixateurs 06.03.15 – Specialist Orthopaedic – Skeletal Reconstruction – Bone Graft Substitute | Review of the categories/listing and benefits for external fixateurs and bone graft substitutes | A review of comparative cost-effectiveness and benefits payable on the PL. The department will seek further input from SOECAG. | Project plan and scope planned for Q3 2026. |
Active reviews
- Spinal cord stimulators
Learn about our review into spinal cord stimulators. - Surgical guides and biomodels
Learn about our review into surgical guides and biomodels – stage 2. - Spinal fusion cages
Learn about our review into spinal fusion cages.
Completed reviews
- Metal-backed patellae
Learn about the outcome and implementation of the review into metal-backed patellae. - Urogynaecological mesh devices
Learn about the outcome and implementation of the review into urogynaecological mesh (mid-urethral sling) devices. - Surgical guides and biomodels
Learn about the outcome and implementation of the review into surgical guides and biomodels – stage 1.
Post-listing review framework
We prepared a post-listing review framework to promote a consistent approach for all post-listing reviews.
The framework outlines how we:
- identify devices that may be appropriate for a post-listing review
- prioritise devices identified as appropriate for a post-listing review
- determine the scope of a post-listing review
- undertake a post-listing review
- inform and consult with stakeholders and sponsors during the post-listing review
- action the outcomes and actions arising from a post-listing review.
Contact
