About the Prescribed List

About the Prescribed List

From 1 July 2023, the Prostheses List was renamed to the Prescribed List of Medical Devices and Human Tissue Products.

The law requires private health insurers to pay a benefit for a medical device or human tissue product if:

• a Medicare benefit is payable for a service associated with the use of the device or product
• the device or product is on the Prescribed List
• the device or product has been used for or implanted into a patient as part of hospital treatment or hospital substitute treatment
• the patient has appropriate health insurance to cover for the treatment.

The Prescribed List specifies the minimum benefits insurers must pay for a listed device or product and includes:

• a billing code for a device or product
• the Part of the Prescribed List the billing code is listed in
• name, description and size describing the device or product listed under the billing code
• the device or product groupings
• the device or product associated benefit
• Australian Register of Therapeutic Goods entries associated with the billing code.

Groupings

We categorise devices on the Prescribed List by their function, design, performance, and expected outcomes.

There are:

• categories
• sub-categories
• groups
• sub-groups
• suffixes, where applicable. 

See the Prostheses List groupings.

Find out what we’re doing to create a strong and fit-for-purpose Prescribed List, including our reforms, post-listing reviews and stakeholder consultations.

How to apply

You must submit all Prescribed List applications via the Health Products Portal.

See the Prescribed List Guide for:

• how to apply
• what evidence to provide when you apply
• application and listing fees you must pay.

Watch our training miniclips for guidance on how to apply. In the future, we will be adding more videos to the series.

See the Trans-Aortic Valve Implantation Clinical Advisory Group Guideline.

Updates to the Prescribed List

We usually update the Prescribed List 3 times a year, in March, July and November.

See our Private Health Insurance circulars for changes to the list.

Related committees and groups

Medical Devices and Human Tissue Product Advisory Committee (MDHTAC) 

The MDHTAC makes recommendations and provides advice about:

• suitability of devices or products for listing on the Prescribed List
• associated benefits for devices or products
• amending the details of an existing billing code (for the devices or products already listed on the Prescribed List)
• any other post-listing activities as required.

The MDHTAC members are appointed by the Minister.

Find out more about the MDHTAC.

Expert Clinical Advisory Groups (ECAGs)

ECAGs are subcommittees of the MDHTAC that assess the clinical functions and comparative clinical effectiveness of devices or products:

• for new applications submitted through Tier 2 and Tier 3 pathways
• for variation of the existing listed item (billing code) or in different circumstances as required.

Find out more about the ECAGs.

Cost recovery

Learn more about cost recovery fees and charges.

Legislation

The Prescribed List is a schedule to the Private Health Insurance (Medical Devices and Human Tissue Products) Rules 2024. This is a legislative instrument made under the Private Health Insurance Act 2007 to provide:

• requirements to list medical devices and human tissue products
• eligibility criteria
• cost recovery fees.

Learn more

See all our Prescribed List resources. 

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