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Private Health Insurance (Prostheses) Rules 2011 (No. 1)

- F2011L00176
No longer in force
View Series

Rules/Other as made

These Rules revoke the Private Health Insurance (Prostheses) Rules 2010 (No. 2) and remakes the Rules to determine benefits for listed prostheses and medical treatments.

Administered by: Health

Unincorporated Amendments
- Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 1) - F2011L00274
  - r 3

Registered

03 Feb 2011

Tabling History	Date
Tabled HR	08-Feb-2011
Tabled Senate	09-Feb-2011

Date of repeal

22 Aug 2011

Repealed by

Private Health Insurance (Prostheses) Rules 2011 (No. 2)

Private Health Insurance (Prostheses) Rules 2011 (No. 1)

I, PENNY SHAKESPEARE, delegate of the Minister for Health and Ageing, make these Rules under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007.

Dated 31st January 2011

P Shakespeare__________

Penny Shakespeare

Assistant Secretary

Private Health Insurance Branch,

Medical Benefits Division

Department of Health and Ageing

Part 1 Preliminary 3

1. Name of Rules 3

2. Commencement 3

3. Revocation 3

4. Definitions 3

Part 2 Benefit requirements 5

5. Listing of, and benefits for, prostheses 5

5A. Circumstances in which a prosthesis is provided other than circumstances in which a medicare benefit is payable 6

5B. Conditions in relation to provision of listed prostheses 6

6. Benefits for prostheses provided as part of hospital treatment 6

7. Benefits for prostheses provided as part of hospital-substitute treatment 7

Part 3 Other 8

8. Timing of applications to have a prosthesis listed 8

9. Minister may have regard to recommendations and advice 8

10. Listing criteria for prostheses to be listed on Part C of the Schedule 8

Part 1 Preliminary

1. Name of Rules

These Rules are the Private Health Insurance (Prostheses) Rules 2011 (No. 1).

2. Commencement

These Rules commence on 21 February 2011.

3. Revocation

These Rules revoke the Private Health Insurance (Prostheses) Rules 2010 (No. 2) as amended by the Private Health Insurance (Prostheses) Amendment Rules 2010 (No. 1) and the Private Health Insurance (Prostheses) Amendment Rules 2010 (No. 2).

4. Definitions

Note: Terms used in these Rules have the same meaning as in the Act―see section 13 of the Legislative Instruments Act 2003. These terms include:

complying health insurance policy
hospital-substitute treatment
hospital treatment
medicare benefit

In these Rules:

accredited podiatrist has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

Act means the Private Health Insurance Act 2007.

certified overnight Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.

certified Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.

consultant physician has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

gap permitted prosthesis means a prosthesis of a kind listed in the Schedule where an amount is set out for that kind of prosthesis in the column under the heading 'Minimum Benefit' and a different amount is set out in the column under the heading 'Maximum Benefit'.

implantable cardiac event recorder includes a component of an implantable cardiac event recorder.

insulin infusion pump includes a component of an insulin infusion pump.

listed prosthesis means a kind of prosthesis listed in the Schedule to these Rules.

listing application has the same meaning as in subsection 72-10(6) of the Act.

listing criteria has the same meaning as in subsection 72-10(6) of the Act.

no gap prosthesis means a prosthesis of a kind listed in the Schedule where an amount is set out for that kind of prosthesis in the column under the heading 'Minimum Benefit' and no amount is set out in the column under the heading 'Maximum Benefit'.

private hospital means a hospital in respect of which there is in force a statement under subsection 121-5 (8) of the Act that the hospital is a private hospital.

Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.

professional attendance has the same meaning as in clause 1.2.3 of the General Medical Services Table being the table prescribed under section 4 of the Health Insurance Act 1973.

professional service has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

public hospital means a hospital in respect of which there is in force a statement under subsection 121-5(8) of the Act that the hospital is a public hospital.

Schedule means the Schedule in these Rules.

Part 2 Benefit requirements

5. Listing of, and benefits for, prostheses

For item 4 of the table in subsection 72-1 (2) of the Act:

(a) the Schedule lists the kinds of prostheses:

(i) in relation to which the Minister has granted an application for listing under subsection 72-10 (5) of the Act; or

(ii) which are listed in accordance with section 12 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007; and

Note: Section 12 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the listing of a prosthesis that was a no gap prosthesis or a gap permitted prosthesis for the purposes of the National Health Act 1953 immediately before the commencement of the Act.

(aa) circumstances in which a listed prosthesis is provided for the purposes of paragraph (d) of item 4 of the table in subsection 72-1(2) are set out in rule 5A; and

(ab) conditions that must be satisfied in relation to the provision of a listed prosthesis for the purposes of paragraphs (c) and (d) of item 4 of the table in subsection 72-1(2) are set out in rule 5B; and

(b) rule 6 sets out the method for working out the minimum benefit and maximum benefit for hospital treatment, covered under a complying private health insurance policy, that is the provision of a listed prosthesis; and

(c) rule 7 sets out the method for working out the minimum benefit and maximum benefit for hospital-substitute treatment, covered under a complying private health insurance policy, that is the provision of a listed prosthesis.

5A. Circumstances in which a prosthesis is provided other than circumstances in which a medicare benefit is payable

For purposes of paragraph (d) of item 4 of the table in subsection 72-1(2) of the Act, the following circumstances are set out:

(a) the provision of a listed prosthesis which is associated with podiatric treatment by an accredited podiatrist.

Note: Paragraph (c) of Item 4 of subsection 72-1(2) deals with the provision of a listed prosthesis in circumstances in which a medicare benefit is payable.

5B. Conditions in relation to the provision of listed prostheses

For the purposes of paragraph (c) and (d) of item 4 of the table in subsection 72-1(2) of the Act, conditions that must be satisfied in relation to the provision of a listed prosthesis in the circumstances covered by paragraph (c) or (d) of that item, as the case may be, are:

(a) in relation to any kind of prosthesis where there is a statement of a requirement under the heading 'Condition' in the Schedule under the listing for that kind of prosthesis, that requirement; and

(b) in relation to a listed prosthesis that is an insulin infusion pump, also:

(i) the professional service associated with the provision of the insulin infusion pump must be a professional attendance by a consultant physician in the practice of his or her specialty; and

(ii) the professional service must be provided as a certified Type C procedure or certified overnight Type C procedure; and

(iii) the insulin infusion pump must be provided for the purpose of administering insulin.

Note: Item 4 of the table in subsection 72-1(2) of the Act states other requirements in relation to benefits for the provision of prostheses that a policy that covers hospital treatment must meet. These requirements relate to benefits for hospital treatment and, if the policy covers hospital-substitute treatment, to the benefits of that coverage as well.

6. Benefits for prostheses provided as part of hospital treatment

(1) For a no gap prosthesis provided as part of an episode of hospital treatment by a private hospital, the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’.

(2) For a gap permitted prosthesis provided as part of an episode of hospital treatment by a private hospital:

(a) the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and

(b) the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’.

(3) For a no gap prosthesis provided as part of an episode of hospital treatment by a public hospital:

(a) the minimum benefit is the lesser of the following amounts:

(i) the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or

(ii) the amount of the insured person’s liability to the public hospital for that prosthesis; and

(b) the maximum benefit is the amount for that prosthesis listed in the column under the heading 'Minimum Benefit'.

(4) For a gap permitted prosthesis provided as part of an episode of hospital treatment by a public hospital:

(a) the minimum benefit is the lesser of the following amounts:

(i) the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or

(ii) the amount of the insured person’s liability to the public hospital for that prosthesis; and

(b) the maximum benefit is the amount for that prosthesis listed in the column under the heading ‘Maximum Benefit’ in the Schedule.

Note: Paragraphs (d) and (e) of subsection 72-10(5) of the Act deal with the fixing of minimum and maximum benefits when the Minister is making or varying the Private Health Insurance (Prostheses) Rules.

7. Benefits for prostheses provided as part of hospital-substitute treatment

(1) For a no gap prosthesis provided as part of an episode of hospital-substitute treatment the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’.

(2) For a gap permitted prosthesis provided as part of an episode of hospital-substitute treatment:

(a) the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and

(b) the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’.

Note 1: Private health insurers cannot cover, as part of hospital-substitute treatment, a service for which medicare benefit is payable unless the service is specified in the Private Health Insurance (Health Insurance Business) Rules ―see paragraph 121-10 (3) (a) of the Act.

Note 2: Paragraphs (d) and (e) of subsection 72-10(5) of the Act deal with the fixing of minimum and maximum benefits when the Minister is making or varying the Private Health Insurance (Prostheses) Rules.

Part 3 Other

8. Timing of applications to have a prosthesis listed

As a matter of normal administrative practice, applications made under subsection 72-10 (2) of the Act will be considered after they have been received and, if the Minister decides to grant the application, the kind of prosthesis will be listed in the Schedule the next time the Minister makes or varies the Rules.

Note 1: Under subsection 72-10 (5) of the Act the Minister must list the kind of prosthesis, set out the minimum benefit and, if the Minister considers it appropriate, the maximum benefit for the prosthesis in these Rules on the next occasion that the Minister makes or varies the Rules after he or she grants an application and the applicant has paid to the Commonwealth any initial listing fee within 14 days of being informed of the Minister's decision to grant the application.

Note 2: Under subsection 72-15 (3) of the Act, the Minister may remove a kind of prosthesis from the list in the Rules if the applicant fails to pay an ongoing listing fee.

9. Minister may have regard to recommendations and advice

(1) In making the decision under subsection 72-10 of the Act, the Minister may have regard to a recommendation from the Prostheses List Advisory Committee.

(2) In setting the minimum and the maximum (if any) benefits for a kind of prosthesis, the Minister may have regard to the benefits as negotiated between the Negotiating Oversight Committee and the applicant.

10. Listing criteria for prostheses to be listed in Part C of the Schedule

For a listing application to be granted to list a kind of prosthesis in Part C of the Schedule, the listing criterion is that the kind of prosthesis is an:

(i) insulin infusion pump; or

(ii) implantable cardiac event recorder.

Note: 1. The power to make listing criteria is in subsection 72-10(6) of the Act.

2. Under subsection 72-10(7) of the Act the Minister must not grant a listing application if any applicable listing criteria are not satisfied in relation to the application.

3. Under the Act the Minister may refuse to grant a listing application even if the listing criteria are satisfied. See Note to subsection 72-10(7) of the Act.

Note

1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See www.frli.gov.au

Part A - Prostheses February 2011

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Group 1- Cardiothoracic Mechanical Valves

Group 1c - Bi-Leaflet, rotatable

Medtronic Australasia Pty Ltd

MC292 Advantage Heart Valve - Aortic Model A7760 - Pyrolytic carbon, PET Diameter 19-31 mm $6,000.00

A7760

MC324 Advantage Supra Aortic Heart Valve Mechanical Heart Valve Pyrolite Carbon Diameter (mm): 19 - 25 $6,000.00

leaflets Pyrolite carbon ring

MC681 Advantage Mitral Mechanical Heart Valve 23mm-33mm $6,000.00

MC980 Open Pivot Heart Valve (Model 500FA) Pyrolythic Carbon, Double Velour 16-33mm $6,000.00

Polyester, Titanium

Open Pivot Heart Valve (Model 500DM)

MC981 Open Pivot Heart Valve (Model Pyrolythic Carbon, Double Velour 16-33mm $6,000.00

501DA) Polyester, Titanium

Open Pivot Heart Valve (Model 501DM)

Reid Healthcare

RH001 Aortic On-X Prosthetic Heart Valve 27-29mm, 19mm, 21mm, $6,000.00

Models ONXA-19; ONXA-21; 23mm, 25mm, 25-33mm, 27-

ONXA-23; ONXA-25; ONXA-27/29; 29mm, 31-33mm, 23mm,

ONXM-23; ONXM-25; ONXM- 25mm

27/29; ONXM31/33; ONXMC25/33

Sorin Group

SA129 Optiform Mechanical Valve 19mm to 33mm $6,000.00

St Jude Medical Australia Pty Ltd

SJ037 St Jude Medical Aortic Expanded Cuff Aortic Expanded Cuff, Aortic Aortic Expanded 19 -31mm, $6,000.00

Heart Valve; St Jude Medical Aortic Hemodynamic Plus Cuff, Mitral Aortic Hemodynamic 17 -

Hemodynamic Plus Cuff Heart Valve; St Hemodynamic Cuff, Aortic & Mitral 27mm, Mitral Hemodynamic 17

Jude Medical Mitral Hemodynamic Plus Rotatable Cuff -27mm, Rotatable 17 - 33mm

Cuff Heart Valve; St Jude Medical

Mechanical Heart Valve Masters Series

Prostheses List by Category, Groups and Sponsor Page 1 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

SJ039 Regent Prosthestic Heart Valves Standard Cuff - Model 17AGFN-751 - Standard cuff - 17-23mm, Flex $6,500.00

23AGFN-751, Flex Cuff - Mode cuff - 17-23mm

17AGFN-756 - 23AGFN-756

SJ116 Regent Prosthestic Heart Valves Standard Cuff - Model 25AGFN-751 - Standard cuff - 25-29mm, Flex $6,000.00

29AGFN-751, Flex Cuff - Mode cuff - 25-29mm

25AGFN-756 - 29AGFN-756

Group 1e - Tilting Disc, rotatable

Medtronic Australasia Pty Ltd

MC013 Medtronic Hall Heart Valve Aortic A7700/M7700 Titanium. Pyrolite. Dacron, A7700 - Diameter 20-31mm, $5,100.00 $5,625.00

Model A7700, Medtronic Hall Heart A7700EZ/M7700EZ Titanium. Pyrolite. M7700 - Diameter 23-33mm,

Valve Mitral Model M7700, Hall Easy PET A7700EZ - Diameter 19-

Fit Aortic Heart Valve Model A7700, 29mm, M7700EZ - Diameter

Hall Easy Fit Mitral Heart Valve Model 23-31mm

M7700

Group 1: Single Chamber ICD's

Generation 3

Guidant Australia Pty Ltd

GU148 Vitality 2 EL VR - Model T177 Single Chamber ICD 35cc; 90g $40,560.00

GU151 Vitality 2 VR - Model T 175 Single Chamber ICD 30cc; 82g $40,560.00

Sorin Group

SA139 OVATIO VR 6250 Titanium, single chamber, sterile, VR 29cc $40,560.00

6250, 34J

Sorin Group

SA149 PARADYM VR 8250 Single Chamber implantable cardioverter Dimensions: 58.4 x 73.4 x $42,640.00

defibrillator with rate response 11mm; Weight: 90 grams;

Volume: 32.6cc

St Jude Medical Australia Pty Ltd

SJ066 Atlas + VR - C Model V-193C ICD Single chamber implantable cardio-verter 38cc, 77g $42,640.00

defibrillator

SJ114 Atlas II VR-168 Single chamber cardioverter defibrillator 38cc, 77g $42,640.00

Prostheses List by Category, Groups and Sponsor Page 2 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

SJ121 Current VR 1107-36 Single Chamber Cardioverter Defibrillator 38cc 76g $42,640.00

a, c, d

Medtronic Australasia Pty Ltd

MC722 Virtuoso VR ModelImplantable Cardioverter 37cc, 68g $42,640.00

Defibrillator, Single Chamber

a, d

Biotronik Australia Pty Ltd

BT090 Lumax 340 VR-T ICD-VR 34 J with bidirectional Home One size only $42,640.00 $45,640.00

Monitoring. Single chamber

BT098 Lumax 340 VR-T XL ICD-VR with 40 J output, bidirectional One Size Only $42,640.00 $45,640.00

Home Monitoring and High Longevity

Boston Scientific Australia Pty Ltd

BS136 TELIGEN 100 HE VR DF-1/IS-1 Single chamber ICD, High Energy with RF 31.5cc, 9.9mm $42,640.00

Medtronic Australasia Pty Ltd

MC939 Virtuoso II VR Model - Implantable Cardioverter 37cc, 68g $42,640.00

Defibrillator, Single Chamber

St Jude Medical Australia Pty Ltd

SJ124 Current RF VR 1207-36 Single Chamber Cardioverter Defibrillator 79g, 41cc $42,640.00

with RF Telemetry

SJ142 Analyst VR CD1217-36 Single Chamber Cardioverter Defibrillator 79g, 41cc $42,640.00 $44,640.00

with RF Telemetry and ST Segment

Monitoring

a, d, e

Boston Scientific Australia Pty Ltd

BS132 Teligen 100 HE VR 4-SITE Single chamber ICD, high energy with RF 30.5cc, 9.9mm $43,390.00

Biotronik Australia Pty Ltd

BT087 Lumax 300 VR-T ICD-VR with bidirectional Home One Size Only $40,560.00 $43,560.00

Monitoring. Single chamber

Prostheses List by Category, Groups and Sponsor Page 3 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

St Jude Medical Australia Pty Ltd

SJ216 AnalyST VR CD1217-30 Single chamber cardioverter defibrillator 73g, 37cc $40,560.00 $42,560.00

with RF telemetry and ST segment

monitoring

Generation 4

a, d

Biotronik Australia Pty Ltd

BT100 LUMAX 540 VR-T High Energy, Single-Chamber ICD Diamensions: 66*55*13 mm $43,920.00 $45,640.00

(Implantable Cardiac Defibrillator) with Volume/Weight : 37.2cc/92g

Advanced Patient Management Via unique

Home Monitoring Technology

incorporatin Automatic Threshold

Monitoring and Extended Longevity.

Medtronic Australasia Pty Ltd

MC813 Secura VR Fully Automatic, Wireless Implantable 37cc $43,920.00

cardioverter defibrillator with high energy

capability and therapies for ventricular

tachyarrhythmia

MI015 PROTECTA XT VR D354VRG Single chamber implantable cardioverter Volume 37cc, Mass 68g $43,920.00

defribillator with SmartShock Technology,

OptiVol 2.0 Fluid Status Monitoring and

Complete Capture Management

Specifications (DF-1)

St Jude Medical Australia Pty Ltd

SJ147 Current Accel VR RF CD1215-36 Single Chamber Cardioverter Defibrillator 79g, 38cc $43,920.00 $44,640.00

with RF Telemetry

SJ154 AnalyST Accel VR CD1219-36 Single Chamber Cardioverter Defibrillator 79g, 41cc $43,920.00 $44,640.00

with RF Telemetry and ST Segment

Monitoring

SJ242 Fortify VR CD1233-40 Single chamber cardioverter defibrillator 35cc, 75g $43,920.00

with 40J delievered energy

SJ251 Fortify ST VR CD1235-40 Single chamber cardioverter defibrillator 35cc, 75g $43,920.00

with 40J delivered energy and ST segment

monitoring

Prostheses List by Category, Groups and Sponsor Page 4 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

a, d, e

St Jude Medical Australia Pty Ltd

SJ232 Current Accel VR CD1215-36Q Single Chamber Cardioverter Defibrillator 80g, 42cc $44,670.00

with RF Telemetry and SJ4 connector

SJ237 AnalyST Accel VR CD1219-36Q Single Chamber Cardioverter Defibrillator 79g, 41cc $44,670.00

with RF Telemetry and ST Segment

Monitoring and SJ4 connector.

SJ240 Fortify VR CD1233-40Q Single chamber cardioverter defribillator 35cc, 75g $44,670.00

with 40J delivered energy with SJ4

connector

SJ247 Fortify ST VR 1235-40Q Single chamber cardioverter defibrillator 35cc, 75g $44,670.00

with 40J delivered energy and ST segment

monitoring and SJ4 connector

St Jude Medical Australia Pty Ltd

SJ212 AnalyST Accel VR CD1219-30 Single chamber cardioverter defibrillator 73g, 37cc $41,820.00 $44,560.00

with RF telemetry and ST segment

monitoring

SJ213 Current Accel VR RF CD1215-30 Single chamber cardioverter defibrillator 73g, 37cc $41,820.00 $44,560.00

with RF telemetry

Group 10: Pacemaker/ICD Extenders

Medtronic Australasia Pty Ltd

MC831 Medtronic Lead Extender Kit Model: Silicone 37 - 50cm $530.00

6984M, 6981M, 6985M,6986m

Prostheses List by Category, Groups and Sponsor Page 5 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Group 11: Pacemaker/Lead Accessories

Medtronic Australasia Pty Ltd

MC036 Medtronic Lead End Cap Kit Model: Pin Plug Kits to Seal Unused Pacemaker One Size Per Model $80.00

5867-3M; Medtronic DF-1 Port Pin or Defibrillator Port; Sizing Sleeve -

Plug Kit: Model 6719, Medtronic IS-1 Silicone or Polyurethane

Port Pin Plug Kit: Model 6725;

Medtronic Upsizing Sleeve: Model

5866-45, Model 5866-46

Group 12: Coronary Stents

Sub-Group 1: General Purpose Drug eluting stents

Abbott Australasia Pty Ltd

AY023 Xience Everolimus Eluting Stent System Everolimus Eluting Stent System 2.25mm to 4.0mm widths, 8mm $3,450.00

to 28mm lengths

AY037 Xience PRIME LL Everolimus Eluting Coronary Artery Stent, Drug Eluting XIENCE PRIME LL 2.50; $3,450.00

Coronary Stent; Xience PRIME 2.75; 3.00; 3.50; 4.0 x 33MM;

Everolimus Eluting Coronary Stent; XIENCE PRIME LL 2.50;

Xience PRIME SV Everolimus Eluting 2.75; 3.00; 3.50; 4.0 x 38MM;

Coronary Stent XIENCE PRIME SV 2.25 x

08; 12; 15; 18; 23; 28MM;

XIENCE PRIME 2.50 x 08;

12; 15; 18; 23; 28MM;

XIENCE PRIME 2.75 x 08;

12; 15; 18; 23; 28MM;

XIENCE PRIME 3.00 x 08;

12; 15; 18; 23; 28MM;

XIENCE PRIME 3.50 x 08;

12; 15; 18; 23; 28MM;

XIENCE PRIME 4.00 x 08;

12; 15; 18; 23; 28MM

Boston Scientific Australia Pty Ltd

BS099 Taxus Liberte Paclitaxel-Eluting 316L Stainless Steel Stent with Translute 2.0mm-5.0mm & 8.0mm- $3,450.00

Coronary Stent System Polymer and Paclitaxel 38mm

Prostheses List by Category, Groups and Sponsor Page 6 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

BS125 Promus Everolimus Coronary Stent Cobalt chromium alloy stent coated with a 2.25mm to 4.0mm diameter, $3,450.00

System blended polymer mixed with Everolimus. 8mm to 28mm length

BS175 PROMUS Element Platinum chromium alloy stent coated with 8mm to 38mm with a reference $3,450.00

a blended polymer mixed with everolimus. vessel diameter of 2.25mm -

4.0mm.

BS176 Taxus Element Platinum chromium alloy stent coated with (8mm to 38mm) with a $3,450.00

a blended polymer mixed with Paclitaxel reference vessel diameter of

2.25mm - 4.5mm

Johnson & Johnson Medical Pty Ltd

JJ302 CYPHER Sirolimus-Eluting Stent & Stainless steel coronary stent with Diameter 2.25 - 5.0mm, length $3,450.00

Delivery System Model CRS - 23300, Rapamycin (an immunosuppressive and 8-33mm

08225, 08250, 08275, 08300, 28225, antiproliferative drug) bound to the stent

28250, 28275, 28300, 33225, 33250, struts

33275, 33300, 13225, 13250, 13275,

18225, 18250, 18275, 18300, 23225,

23250, 23275, 23350, 23400, 08350,

08400, 2835

JJ481 CYPHER SELECT Sirolimus-Eluting Stainless steel coronary stent with Diameter 2.25 - 5.0mm, length $3,450.00

Stent & Delivery System Sirolimus (an immunosuppressive and anti- 8 - 33mm

proliferative drug) bound to the stent by a

polymer. Model CRA-23300, 08225,

08250, 08275, 08300, 28225, 28250,

28275, 28300, 33225, 33250, 33275,

33300, 13225, 13250, 13275, 182

JJ587 CYPHER Select Plus Sirolimus Eluting Stainless steel coronary stent with Diameter 2.25 - 5.00mm, $3,450.00

Coronary Stent Sirolimus bound to the stent by a polymer Length 8 - 33mm

Medtronic Australasia Pty Ltd

MC732 Endeavour Drug Eluting Coronary Stent Cobalt Alloy, ABT - 578 Diameter: 2.25mm-4.5mm; $3,450.00

System Length: 8.00mm-38.0mm

MC769 Endeavor Sprint Drug Eluting Stent System Cobals Alloym ABT - 578 Diameter: 2.25mm-4.0mm; $3,450.00

Length: 8.0mm-30.0mm

MC816 Endeavor Resolute Drug Eluting Cobalt Alloy, ABT - 578, BioLinx Polymer Diameter:2.25mm-4.0mm; $3,450.00

Coronary Stent System Length: 8.00mm-30.0mm

Prostheses List by Category, Groups and Sponsor Page 7 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Sub-Group 2: General Purpose Bare metal stents

Abbott Australasia Pty Ltd

AY025 Stents ACS Multilink Coronary Stent; ACS 1.5mm - 8.0mm $1,248.00

Megalink Peripheral Stent; ACS RX

Herculink Peripheral Stent. Stainless steel

AY026 Multilink Coronary Stent System Stainless Steel Length 1.5mm - 8.0mm $1,248.00

AY028 Multilink Coronary Stent System - Vision Cobalt chrome stent 2.25mm to 4.0mm widths, 8mm $1,248.00

to 38mm lengths

AY039 MULTI-LINK 8 Coronary Stent The MULTI-LINK 8, MULTI-LINK 8 MULTI-LINK 8: Diam: 2.5, $1,248.00

System, MULTI-LINK 8 SV Coronary SV, MULTI-LINK 8 LL Coronary Stent 2.75, 3.0, 3.5, 4.0mm, Stent

Stent System and MULTI-LINK 8 LL System (CSS) is comprised of two main Length: 8, 12, 15, 18, 23,

Coronary Stent System components: the cobalt chromium (CoCr) 28mm; MULTI-LINK 8 SV

stent and the balloon expandable delivery CSS: Diam: 2.25mm, Stent

system. Length: 8, 12, 15, 18, 23,

28mm; MULTI-LINK 8 LL

CSS: Diam: 2.5, 2.75, 3.0, 3.5,

4.0mm, Stent Length: 33 and

38mm

Atrium Australia - Pacific Rim Pty Limited

AC030 Cinatra Cobalt Chromium Coronary The Cinatra Cobalt Chromium Coronary Diameter range: 2.5mm - $1,248.00 $1,372.00

Stent System Stent System consists of a balloon 3.5mm. Length range: 8mm -

expandable Cobalt Chromium stent 25mm

premounted on a rapid exchange system

Bio Excel Australia Pty Ltd

BE001 Gazelle Coronary Stent Stainless Steel Diam 2.25-4.0mm Length 8- $1,248.00

28mm

Biotronik Australia Pty Ltd

BT082 PRO-Kinetic Cobalth Chromium coronary stent system 8-40mm length 2-5mm $1,200.00

diameter

Prostheses List by Category, Groups and Sponsor Page 8 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

BT107 PRO-Kinetic Energy The PRO-Kinetic Energey stent is a The PRO-Kinetic Energy stent $1,248.00

tubular, balloon-expandable stent sculpted is available in 66 different

by laser from a single tube of L-605 cobalt diameter/length combinations.

chromium (CoCr) alloy. The stent It is available in lengths from

consists of circular segments at each end 8mm to 40mm. It is

followed by a transition zone and premounted on a delivery

helicoidally arranged struts in the middle. system which has nominal

Each loop of the helix is connected to the balloon diameters between

next loop by 3 longitudinal struts. The 2.0mm and 5.0mm.

stent surface is fully coated with a layer of

amorphous hydrogen-rich silicon carbide

(aSiC:H). This material has

semiconducting properties that efficiently

prevent the electron transfer from

fibrinogen to the metal surface in vitro.

Thereby the conversion from fibrinogen to

fibrin and it's depoisition at the stent

surface is reduced. Additionally, aSiC:H -

coated stents exhibit a lower adhesion and

activation of blood platelets and

leucocytes. Finally, the release of

potentially allergenic ions from a silicon

carbide coated stent is substantially

reduced in comparison to an uncoated

metal stent3. This coating is used on all

Biotronik coronary stents producedso far

and was subject to extensive clinical testing.

Boston Scientific Australia Pty Ltd

BS069 Liberte Coronary Stent System Consists of a balloon expandable stent, Stent lengths: 8,12,16,20,24,28 $1,248.00

pre-mounted on a Maverick 2 Monorail & 32 mm Stent diameters:

delivery catheter. 2.25, 2.5, 2.75, 3.0, 3.5, 4.0,

4.5 & 5.0 mm

Prostheses List by Category, Groups and Sponsor Page 9 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Imaxeon Pty Ltd

IX001 Amazonia CroCo Balloon expandable intracoronary cobalt Lengths: 8mm, 12mm, 16mm, $1,248.00

chromium stent premounted onto a rapid 20mm, 24mm, 28mm, 32, 36,

exchange delivery catheter and 40mm. Diameters:

2.25mm, 2.5mm, 2.75mm,

3.0mm, 3.5mm, 4.0mm, 4.50

and 5.00 mm in all lengths

Johnson & Johnson Medical Pty Ltd

DY534 Presillion Plus CoCr Coronary Stent on Cobalt Chromium, bare metal coronary Stent length 8 - 40mm x Stent $1,248.00

RX System stent Diameter 2.5 - 5.0 mm

JJ026 BX Velocity with Hepacoat System Balloon expandable, stainless steel, heparin . $1,220.00

coated

JJ200 BX Velocity Stent and Delivery System Stainless steel stent Diameter: 2.25-5.0 mm; Length $1,220.00

8 - 33 mm

JJ239 BX Sonic Stainless steel coronary stent mounted on a Dia 2.25 - 4.0mm, lengths 8 - $1,220.00

balloon delivery system 33mm

JJ670 Presillion CoCr Coronary Stent on RX Cobalt Chromium, bare metal coronary Stent Length (mm) x Stent $1,248.00

System stent Diameter (mm) 8 x 2.50, 2.75,

3.0, 3.50, 4.0; 12 x 2.50, 2.75,

3.0, 3.50, 4.0; 17 x 2.50,

2.75, 3.0, 3.50, 4.0; 24 x 2.75,

3.0, 3.50, 4.0; 33 x 2.75, 3.0,

3.50, 4.0;

Medical Specialties Australia Pty Ltd

MS058 Arthos Pico Stent Implantation System Cobalt Chromium Stent Premounted on a Diameter: 2-4mm; Length: 8- $1,248.00

Rapid Exchange Delivery System 38mm

Medtronic Australasia Pty Ltd

MC329 Medtronic Driver, Micro Driver Cobalt Alloy Driver Stent: diameter (2.25 - $1,248.00

Coronary Stent System 4.5mm), length (8-30mm);

Micro-Driver Stent: diameter

(2.25 - 2.75mm), length (8 -

24mm)

MC932 Driver Sprint Coronary Stent System Cobalt Alloy Diameter: 2.25 - 4.5 mm; $1,248.00

Length: 8-30mm

MC956 Integrity Coronary Stent System Cobalt Alloy Coronary Stent Diameter: 2.25 - 4.5mm; $1,248.00

Length: 8 - 30mm

Prostheses List by Category, Groups and Sponsor Page 10 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

OrbusNeich Medical Pty Ltd

NM004 Blazer Coronary Stent Delivery System L605 Cobalt Chromium alloy balloon Expanded Stent Diameter 2.5 $1,248.00

expandable vascular prosthesis to 4.0mm, Stent Length 9 to

33mm

Terumo Corporation Australia

TU001 Tsunami Gold Stainless Steel mounted on balloon catheter Diameter 2.0mm - 4.0mm, $1,248.00

Length 8mm - 30mm length

TU044 Kaname Coronary Stent System BMS Coronary Stent Diameter: 2.5mm; 2.75mm; $1,248.00

3.0mm; 3.5mm; 4.0mm x

Lengths : 9mm; 12mm; 15mm;

18mm; 24mm; 28mm.

Sub-Group 3: Bare metal stents for specific indications

a, b

Abbott Australasia Pty Ltd

AY012 JoStent Coronary Stent Graft Stainless Steel/PTFE 9 - 26 mm x 2.5 - 5 mm $3,222.00

c.1

Abbott Australasia Pty Ltd

AY027 Multilink Coronary Stent System - 316L Stainless steel stent Length 1.5 - 8.0mm $2,200.00

Frontier

c.2

Imaxeon Pty Ltd

IX002 Nile CroCo Intracoronary stent pre-mounted on two Diameter : 2.50 - 3.50mm. $1,750.00

rapid exchange delivery systems for MB and 2.00-3.00mm SB

bifurcation lesions treatment Lengths 18 mm and 24 mm

c.3

Imaxeon Pty Ltd

IX003 Minvasys Nile Delta Coronary Stent Balloon expandable Amazonia Nile Delta 2.50mm diameter x $1,248.00

System intracoronary cobalt chromium stent 8mm length; Nile Delta 3.00mm

premounted onto a rapid exchange diameter x 8mm length

delivery catheter with tapered balloon.

Prostheses List by Category, Groups and Sponsor Page 11 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Group 13: Special Purpose Percutaneous Cardiovascular Devices

Sub-Group 1: Intracardiac Defect Occluders

J T Medical Pty Ltd

JT001 Occlutech Figulla Flex ASD Occluder The Occlutech Figulla® Flex ASD 6, 7.5, 9, 10.5, 12, 15, 18, 21, $10,000.00

occluder is an implant for closure of an 24, 27, 30, 33, 36, 39, 40

Atrial Septal Defect of the heart (ASD

II=ASD of the Secundum Type) and is

deployed via a minimally invasive catheter

delivery system.

The Occlutech Figulla® Flex ASD is

intended for patients with substantiated

Left-Right-Shunt and a clear indication for

closure of the defect.

JT002 Occlutech Figulla Flex PFO Occluder The Figulla® Flex PFO is an implant for 16/18, 23/25, 27/30 and 31/35 $10,000.00

closure of a patent foramen ovale (PFO)

defect in the heart and is deployed via a

minimally invasive catheter delivery system.

The Figulla® Flex PFO is intended for

patients with substantiated Right-Left-

Shunt in the contrast agent

echocardiography under Valsalva

maneuver and presence of a "cryptogenic",

paradoxical thromboembolism.

Medtel Australia Pty Ltd

ME065 Amplatzer Duct Occluder Nitinol Wire Mesh 5 - 24mm $10,200.00

ME066 Amplatzer Septal Occluder Nitinol Wire Mesh 4mm - 40mm $10,200.00

ME067 Amplatzer Muscular VSD Occluder Nitinol Wire Mesh 4 - 24mm $10,200.00

ME068 Amplatzer PFO Occluder Nitinol Wire Mesh 25mm & 35mm $10,200.00

ME074 Amplatzer Membranous VSD Occluder Nitinol wire mesh, double disc occluder 4-24mm, Length 7-10mm $10,200.00

and delivery system

ME187 AMPLATZER Duct Occluder II Self expandable multiple Nitinol wire mesh Waist diameter 3-6mm, $10,200.00

PDA occlusion device Nominal length 4-6mm

Prostheses List by Category, Groups and Sponsor Page 12 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Pacing Importers Pty Ltd - Life Systems

PI020 'STARflex Rapid Transport Plus System The STARFlex Rapid Transport Plus 23mm, 28mm, 33mm and $10,200.00

System consists of two primary 38mm

components: 1) The device, a permanent

implant, which is constructed primarily of a

metal MP35N framework to which

polyester fabric is attached, and 2) The

delivery catheter, a Pebax based catheter

designed specifically to facilitate

attachment, loading, delivery and

deployment of the device to the defect.

The device and delivery catheter can be

packaged separately or pre-attached as a

single end item.

St Jude Medical Australia Pty Ltd

SJ091 Premere PFO Closure System Percutaneous, transcatheter, self- Left Atrial Anchor diameter $10,036.00

expanding, dual anchor, occlusion and 20mm, 25mm and 30mm

apposition device

W L Gore & Associates

GT223 Helex 1.5 Septal Occluder The GORE HELEX Septal Occluder Diameters: 15, 20, 25, 30 and $10,200.00

consists of an implantable endoprosthesis 35mm

and a catheter delivery system. The

Occluder is comprised of a nickel-titanium

(Nitinol) wire frame covered with

expanded polytetrafluoroethylene

(ePTFE). The ePTFE is treated with

Abbott Australasia Pty Ltd

AY038 Coherex FlatStent EF PFO Closure In-tunnel PFO closure device and delivery 13mm & 19mm $10,200.00

System system

Prostheses List by Category, Groups and Sponsor Page 13 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Sub-Group 3: Vascular Occlusion Devices

Denward Dell Pty Ltd TA Surimex

DW001 Nit-Occlud PDA Occlusion System Nitinol spiral coil and delivery system for Distal x Proximal Coil Diameter: $1,900.00

transcatheter occlusion of PDA 4x4mm, 5x4mm, 6x5mm,

10x6mm, 12x6mm, 14x6mm;

Introducer Sheath: 4F, 5F;

Length Introducer: 85cm,

105cm; Coil Length

configurated +-0.5mm: 3.5mm,

6.0mm, 6.5mm

DW002 Nit-Occlud PDA Occlusion System Nitinol spiral coil and delivery system for Distal x Proximal Coil Diameter: $1,650.00

(Medium) transcatheter occlusion of PDA 7 x 6mm, 9 x 6mm, 11 x 6mm,

12 x 6mm, 14 x 6mm;

Introducer Sheath: 5F; Length

Introducer: 85cm, 105cm; Coil

Length configurated +-0.5mm:

4.5; 5.0; 6.0

Group 14: Implantable Cardiac Event Recorders

Medtronic Australasia Pty Ltd

MC763 Reveal XT Reveal XT Insertable Cardiac Monitor 61 x 19 x 8 mm with a volume $3,900.00

of 9cc

MC768 Reveal DX Insertable Cardiac Monitor 61 x 19 x 8 mm with a volume $3,900.00

of 9cc

St Jude Medical Australia Pty Ltd

SJ152 SJM Confirm Model DM2102 Implantable cardiac monitor with atrial 6.5cc, 12g $3,900.00

fibrillation monitoring.

SJ159 SJM Confirm Model DM2100 Implantable cardiac monitor 6.5cc, 12g $3,900.00

Prostheses List by Category, Groups and Sponsor Page 14 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Group 15: Endovascular Therapeutic Devices

Sub- Group 2: Embolic Protection Devices

St Jude Medical Australia Pty Ltd

SJ127 Proxis Embolic Protection System - Proximal embolic protection device and 6F and 7F $2,100.00

Long Sheath delivery system

Group 2 - Cardiothoracic Tissue Valves

Edwards Lifesciences Pty Ltd

EL032 Baxter Edwards Prima Plus Stentless Edwards Prima Plus. Porcine Valve; 19mm-29mm $4,841.00

Bioprosthesis Model 2500P Prosthetic Woven Polyester Cloth.

Heart Valve

Group 2a - Stented

Medtronic Australasia Pty Ltd

MC950 Mosaic Ultra Cinch II Small Aortic Root Bioprosthesis 19mm - 29mm $4,445.00 $5,650.00

MC962 Mosaic Cinch II Aortic Bioprosthesis 19mm -29mm $4,445.00 $5,345.00

St Jude Medical Australia Pty Ltd

SJ141 SJM Epic Supra Valve triple composite Bioprosthetic heart valve Tissue Annulus Diameter - 19- $4,445.00

for supra-annular placement in the aortic 23mm

position Total Height - 14-16mm

SJ156 SJM Epic Valve Triple composite bioprosthetic heart valve Aortic valve 21-29mm tissue $4,445.00

annulus diameter

14-20 total height

Mitral Valves 25-33mm tissue

annulus diameter

15-20mm total height

Prostheses List by Category, Groups and Sponsor Page 15 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

(p)

St Jude Medical Australia Pty Ltd

SJ069 St Jude Medical Biocor Porcine St Jude Medical Biocor Porcine Prosthetic Aortic Valves - Tissue Annulus $4,445.00

Prosthetic Heart Valve Heart Valve is manufactured from Diameter - 21-29mm, Implant

selected procine aortic valve cusps that Height - 11-15c; Mitral Valves

have been cross-linked with a - Tissue Annulus Diameter -

glutaraldehyde solution 25-35mm, Implant Height - 8-

10mm

SJ136 SJM Biocor Heart Valve Stented Porcine tissue valve Aortic Valves - Tissue Annulus $4,445.00

Diameter - 21 - 29mm

Mitral Valves - Tissue

Annulus Diameter - 25-35mm

SJ192 Epic Flexfit Triple-composite Bioprosthetic heart valve Aortic Valves 21-29mm tissue $4,445.00

annulus diameter, 14-20mm

total height. Mitral Valves 25-

33mm tissue annulus diameter,

15-20mm total height.

SJ201 Epic FlexFit Supra Triple-composite Bioprosthetic heart valve Tissue Annulus Diameter - $4,445.00

for supra-annular placement in the aortic 19mm-23mm. Total Height

position 14mm-16mm.

B (Bovine), E (Equine), P (Porcine)

Edwards Lifesciences Pty Ltd

EL030 CE Supra Annular Aortic Valve Model Carpentier-Edwards SAV Bioprosthesis. 19mm-33mm $4,445.00

2650 Carpentier-Edwards S.A.V Composition: Porcine Valve; Elgiloy Alloy;

Bioprosthesis Model 6650 Mitral Valve Silicone Rubber, Polytetrafluoroethylene

Medtronic Australasia Pty Ltd

MC701 Mosaic Cinch, Aortic, Mitral Models 305cxx, 310cxx 19mm - 35mm $4,445.00 $5,345.00

MC771 Mosaic Ultra Small Aortic Root Bioprosthesis 19mm-29mm $4,445.00 $5,650.00

Medtronic Australasia Pty Ltd

MI007 Hancock II Aortic Valve Aortic bioprosthesis 21mm to 29mm $4,445.00

MI008 Hancock II Mitral Valve Mitral bioprosthesis 25mm to 33mm $4,445.00

Prostheses List by Category, Groups and Sponsor Page 16 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

MI009 Hancock II Ultra Aortic Valve Small aortic root bioprosthesis 21mm to 29mm $4,445.00

Group 2b - Stented, pericardial

Edwards Lifesciences Pty Ltd

EL056 Magna Mitral Carpentier-Edwards PERIMOUNT 25, 27, 29, 31 and 33mm $5,000.00 $5,690.00

Magna Mitral Bioprosthesis, Model

7000TFX

Sorin Group

SA130 Mitroflow Pericardial Bioprosthesis 19-27mm $5,000.00

(p) Pericardial

Edwards Lifesciences Pty Ltd

EL058 Magna Ease Carpentier - Edwards PERIMOUNT 19, 21, 23, 25, 27 and 29mm $5,000.00 $6,100.00

Magna Ease Bioprosthesis, Model

3300TFK

B (Bovine)

Sorin Group

SA155 Mitroflow Mitroflow Aortic Pericardial Heart Valve 19, 21, 23, 25, 27mm $5,000.00

(Model LX)

B (Bovine), E (Equine), P (Porcine)

Edwards Lifesciences Pty Ltd

EL031 Carpentier-Edwards Perimount Carpentier-Edwards Pericardial Models 2900/6900 19-33mm, $5,000.00

Pericardial Bioprosthesis - Models Bioprosthesis. Composition: Bovine Model 6900P 25, 27, 29, 31,

2900/6900 Carpentier-Edwards Pericardium; Elgiloy Alloy; Silicone 33mm

Perimount Plus Pericardial Bioprosthesis Rubber, Polytetrafluoroethylene

Mitral - Model 6900P

EL039 Edwards Perimount Magna Model 3000 Carpentier-Edwards Perimount Magna 19MM Aortic Pericardial $5,000.00 $5,690.00

composition: Glutaraldehyde treated Tissue Valve; 21MM Aortic

bovine pericardium/elgiloy wireform Pericardial Tissue Valve;

stent/polyester band/silicone rubber suture 23MM Aortic Pericardial

ring/polytetrafluoroethylene cloth/polyester Tissue Valve; 25MM Aortic

cloth. Pericardial Tissue Valve;

27MM Aortic Pericardial

Tissue Valve; 29MM Aortic

Pericardial Tissue Valve

Prostheses List by Category, Groups and Sponsor Page 17 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Group 2c - Non-Stented

Medtronic Australasia Pty Ltd

MC015 Freestyle bioprosthesis Models 995xx, 995MSxx 19 - 35mm $5,110.00 $5,350.00

St Jude Medical Australia Pty Ltd

SJ038 St Jude Medical Toronto SPV Valve Tissue Heart Valves, Bioimplant TSPV: 21 - 29mm, Bioimplant $4,900.00

Model SPA-101, St Jude Medical Aortic: 21-27mm, Bioimplant

Bioimplant Heart Valve Mitral: 27-32mm

Medtronic Australasia Pty Ltd

MC982 3f Aortic Bioprosthesis (Model 1000) Model 1000 - EQUINE Pericardium 19 - 29 mm $5,000.00

Bioprostheseis (non stented)

Group 2: Dual Chamber ICD's

Generation 3

Guidant Australia Pty Ltd

GU149 Vitality 2 DR - Model T165 Dual Chamber ICD 30cc; 82g $43,680.00

GU150 Vitality 2 EL DR - Model T167 Dual Chamber ICD 30cc; 82g $43,680.00

Sorin Group

SA140 OVATIO DR 6550 Titanium dual chamber ICD, 29 cc 29cc $43,680.00

Boston Scientific Australia Pty Ltd

BS128 Confient RF HE Dual chamber ICD, high energy with RF 44cc, 87.5g $45,760.00

Sorin Group

SA147 Paradym DR 8550 Dual Chamber, High Energy, Implantable Weight: 90 grams; Volume: $45,760.00

Cardioverter Defibrillator with rate response 32.6cc; Dimensions: 58.4 x

73.4 x 11mm

St Jude Medical Australia Pty Ltd

SJ115 Atlas II+ DR V-268 Dual Chamber Cardioverter Defibrillator 39cc, 78g $45,760.00

Prostheses List by Category, Groups and Sponsor Page 18 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

SJ123 Current DR 2107 Dual Chamber Cardio-verter Defibrillator 39cc 78g $45,760.00

a, c, d

Medtronic Australasia Pty Ltd

MC721 Virtuoso DR ModelImplantable Cardioverter 37cc, 68g $45,760.00

Defibrillator, Dual Chamber

MC938 Virtuoso II DR Model - Implantable Cardioverter 37cc, 68g $45,760.00

Defibrillator, Dual Chamber

a, d

Biotronik Australia Pty Ltd

BT086 Lumax 340 DR-T ICD-DR 34 J with bidirectional Home One Size Only $45,760.00 $48,760.00

Monitoring. Dual chamber

BT101 Lumax 540 DR-T High Energy, Dual-Chamber ICD Diamensions: 66*55*13mm, $45,760.00 $48,760.00

(Implantable Cardiac Defibrillator) with Volume/Weight: 37.2cc/92g

Advanced Patient Management Via unique

Home Monitoring Technology

incorporating Automatic Ventricular

Threshold Monitoring

Boston Scientific Australia Pty Ltd

BS135 Teligen 100 DR DF-1/IS-1 Dual chamber ICD, high energy with RF 31.5cc, 9.9mm $45,760.00

St Jude Medical Australia Pty Ltd

SJ120 Current DR RF 2207 Dual Chamber Cardioverter Defibrillator 80g, 42cc $45,760.00

with RF Telemetry

SJ144 AnalyST DR Model CD2217-36 Dual Chamber cardioverter defibrillator 80g, 42cm $45,760.00 $47,760.00

with RF telemetry and ST Segment

Monitoring

a, d, e

Boston Scientific Australia Pty Ltd

BS134 TELIGEN 100 HE DR 4-SITE Dual Chamber ICD, high energy with RF 31.55cc, 9.9mm $46,510.00

IS4

Guidant Australia Pty Ltd

GU157 Vitality AVT - Model A155 Dual Chamber ICD with atrial therapies 30cc $43,680.00

Prostheses List by Category, Groups and Sponsor Page 19 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Biotronik Australia Pty Ltd

BT091 Lumax 300 DR-T ICD-DR with bidirectional Home One size only $43,680.00 $46,680.00

Monitoring

St Jude Medical Australia Pty Ltd

SJ215 AnalyST DR CD2217-30 Dual chamber cardioverter defribillator 74g, 38cc $43,680.00 $45,680.00

with RF telemetry and ST segment

monitoring

Generation 4

a, c, d

Medtronic Australasia Pty Ltd

MC814 Secura DR Fully Automatic, Wireless Implantable 37cc $47,130.00

cardioverter defibrillator with high energy

capability and therapies for ventricular and

atrial tachyarrhythmia

MI016 PROTECTA XT DR D354DRG Dual chamber implantable cardioverter Volume 37cc, Mass 68g $47,130.00

defribillator with SmartShock Technology,

OptiVol 2.0 Fluid Status Monitoring and

Complete Capture Management

Specifications (DF-1)

a, d

St Jude Medical Australia Pty Ltd

SJ143 AnalyST Accel DR CD2219-36 Dual Chamber cardioverter defibrillator 80g, 42cc $47,130.00 $48,480.00

with RF telemetry and ST Segment

Monitoring

SJ153 Current Accel DR RF CD2215-36 Dual Chamber Cardioverter Defibrillator 80g, 42cc $47,130.00 $48,480.00

with RF Telemetry

SJ241 Fortify DR CD2233-40 Dual chamber cardioverter defibrillator 35cc, 76g $47,130.00

with 40J delivered energy

SJ248 Fortify ST DR CD2235-40 Dual chamber cardioverter defibrillator 35cc, 76g $47,130.00

with 40J delivered energy and ST segment

monitoring

Prostheses List by Category, Groups and Sponsor Page 20 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

a, d, e

St Jude Medical Australia Pty Ltd

SJ235 AnalyST Accel DR CD2219-36Q Dual chamber cardioverter defibrillator 80g, 41cc $47,880.00

with RF telemetry and ST segment

monitoring and SJ4 connector

SJ239 Current Accel DR CD2215-36Q Dual Chamber Cardioverter Defibrillator 80g, 41cc $47,880.00

with RF Telemetry and SJ4 connector

SJ249 Fortify DR CD2233-40Q Dual chamber cardioverter defibrillator 35cc, 76g $47,880.00

with 40J delivered energy

SJ250 Fortify ST DR CD2235-40Q Dual chamber cadioverter defibrillator with 35cc, 75g $47,880.00

40J delivered energy and ST segment

monitoring

St Jude Medical Australia Pty Ltd

SJ214 Current Accel DR RF CD2215-30 Dual chamber cardioverter defribillator 74g, 38cc $46,030.00

with RF telemetry

SJ217 AnalyST Accel DR CD2219-30 Dual Chamber cardioverter defibrillator 74g, 38cc $46,030.00

with RF telemetry and ST segment

monitoring

Group 3 - Cardiothoracic Valve Conduits

Group 3a - Mechanical Valve

Medtronic Australasia Pty Ltd

MC198 Medtronic Hall rotatable aortic valved Titanium, pyrolite, dacron 20 - 33mm $6,950.00

collagen impregnated conduit Model

R7700

MC979 Open Pivot Aortic Valved Graft (Model Pyrolythic Carbon, Double Velour 21- 33mm $6,950.00

502AG) Polyester, Titanium

Prostheses List by Category, Groups and Sponsor Page 21 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Sorin Group

SA128 CarboSeal Ascending Aortic Prosthesis, Mechanical Conduit AP 21-33mm, CP 21 - 33mm $6,950.00

sterile, CarboSeal Ascending Aortic

Prosthesis with Handle Model AP21,

Model AP23, Model AP25, Model

AP27, Model AP29, Model AP31,

Model AP33, Carboseal Valsalva

St Jude Medical Australia Pty Ltd

SJ036 St Jude Medical Coated Aortic Valved Coated Aortic Valved Graft 21mm - 33mm $6,950.00

Graft

SJ104 SJM Masters Series Aortic Valved St Jude Medical Mechanical Heart Valve Annulus Diameter 19-29mm $6,950.00

Prosthesis - VAVGJ sewn into the base of a woven polyester

fibre graft which has been impregnated

with bovine-derived gelatin

Group 3b - Tissue Valve, stented porcine

Medtronic Australasia Pty Ltd

MC012 Medtronic Hancock Valved Conduit Porcine bioprosthesis, dacron 12, 14, 16, 18, 20, 22, 25, $5,900.00 $6,800.00

Model 100/150 30mm.

Group 3: ICD's with CRT

Generation 2

Boston Scientific Australia Pty Ltd

BS129 LIVIAN CRT-D CRT-D with RF 40cc, 79.5g, 14.5mm $45,760.00

Guidant Australia Pty Ltd

GU147 Contak Renewal 4 CRT-D Model CRT-D One Size only $45,760.00

H190, Model H195

Sorin Group

SA138 OVATIO CRT-D 6750 Titanium, dual chamber ICD with CRT 30cc $45,760.00

Boston Scientific Australia Pty Ltd

BS130 LIVIAN CRT-D HE CRT-D, high energy with RF 44cc, 87.5g, 14.5mm $47,840.00

Prostheses List by Category, Groups and Sponsor Page 22 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Guidant Australia Pty Ltd

GU144 Contak Renewal 4 HE CRT-D Model CRT-D high energy One size only $47,840.00

H197, Model H199

Sorin Group

SA145 PARADYM CRT-D 8750 Implantable Cardioverter Defibrillator with 34cc, 94 grams; 61.8 x 73.4 x $47,840.00

Cardiac Resynchronisation therapy, High 11mm

Energy

St Jude Medical Australia Pty Ltd

SJ109 Atlas II+ HF V-367 Cardiac Resynchronisation Therapy 41cc, 79g $47,840.00

Defibrillator with V-V Timing

Programmability

SJ117 Promote CRT-D 3107 Cardiac Resynchronisation Therapy 41cc, 80g $47,840.00

Defibrillator

a, c

Guidant Australia Pty Ltd

GU155 Contak Renewal 4 AVT HE CRT - D - Implantable Cardioverter Defibrillator with 40cc; 89g $47,840.00

Model M177, M179 cardiac resynchronisation Therapy

a, c, d

Medtronic Australasia Pty Ltd

MC720 Concerto CRT-D Implantable Cardioverter Defibrillator with 38cc $47,840.00 $50,000.00

Cardiac Resynchronisation Therapy

MC937 Concerto II Fully automatic, wireless implantable 38cc $50,000.00

cardioverter defibrillator with Cardiac

Resynchronisation Therapy (CRT), and

therapies for ventricular and atrial

tachyarrhythmia.

a, d

Biotronik Australia Pty Ltd

BT089 Lumax 340 HF-T CRT-D 34 J with bidirectional Home One Size Only $47,840.00 $53,000.00

Monitoring

Prostheses List by Category, Groups and Sponsor Page 23 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

BT102 Lumax 540 HF-T High Energy, Three Chamber ICD Diamensions: 66*59*13 mm, $47,840.00 $53,000.00

(Implantable Cardiac Defibrillator) with Volume/Weight: 39.8cc/94g

Advanced Patient Management Via unique

Home Monitoring Technology

incorporating Automatic RV/LV Threshold

Monitoring and Extended Longevity.

Boston Scientific Australia Pty Ltd

BS139 COGNIS 100 HE (DF-1/IS-1 & DF- CRT-D high energy with RF 32.5cc, 9.9mm $47,840.00

1/LV-1)

St Jude Medical Australia Pty Ltd

SJ128 Promote RF CRT-D 3213 Cardiac Resynchronisation Therapy 43cc, 82g $47,840.00 $49,840.00

Defibrillator with RF Telemetry

a, d, e

Boston Scientific Australia Pty Ltd

BS138 COGNIS 100 HE 4-SITE CRT-D high energy with RF IS4 32cc, 9.9mm $48,590.00

Guidant Australia Pty Ltd

GU154 Contak Renewal 4 AVT CRT -D - Implantable Cardioverter Defibrillator with 37cc; 89g $45,760.00

Model M170 and M175 Cardiac Resynchronisation Therapy

Biotronik Australia Pty Ltd

BT088 Lumax 300 HF-T CRT-D with bidirectional Home Monitoring One size only $45,760.00 $48,760.00

Generation 3

a, c, d

Medtronic Australasia Pty Ltd

MC812 Consulta CRT-D Fully Automatic, Wireless Implantable 38cc $52,000.00

cardioverter defibrillator with cardiac

resynchronization therapy (CRT), and

therapies for ventricular and atrial

tachyarrhythmia

Prostheses List by Category, Groups and Sponsor Page 24 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

MI017 Protecta XT CRT-D D354TRG Implantable Cardioverter Defibrillator with Volume 38cc, Mass 68g $52,000.00

Cardiac Resynchronisation therapy,

SmartShock Technology, OptiVol 2.0

Fluid Status Monitoring and Complete

Capture Management Specifications (DF-

a, d

St Jude Medical Australia Pty Ltd

SJ150 Promote Accel RF CD3215-36 Cardiac Resynchronisation Therapy 82g, 43cc $52,000.00

Defibrillator with RF Telemetry

SJ246 Unify CRT CD3235-40 Cardiac Resynchronisation Therapy 36cc, 78g $52,000.00

Defibrillator with 40J delivered

a, d, e

St Jude Medical Australia Pty Ltd

SJ236 Promote Accel CD3215-36Q Cardiac Resynchronisation Therapy 82g, 43cc $52,750.00

Defibrillator with RF Telemetry and SJ4

connector

SJ244 Unify CRT CD3235-40Q Cardiac Resynchronisation Therapy 36cc, 77g $52,750.00

Defibrillator with 40J delivered energy and

SJ4 connector

St Jude Medical Australia Pty Ltd

SJ145 Promote Accel CD3215-30 Cardiac Resyncronisation Therapy 76g, 39cc $49,760.00

Defibrillator with RF Telemetry

Prostheses List by Category, Groups and Sponsor Page 25 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Group 4 - Cardiothoracic Atrio-Ventricular Rings and Bands

Group 4a - Ring, Standard

Edwards Lifesciences Pty Ltd

EL028 Baxter Sterile Grafts, Implants & Carpentier-Edwards Classic Annuloplasty 24mm-40mm $2,200.00

Prostheses, Non-Animal Origin Ring. Composition: Titanium Alloy;

Annuloplasty: Ring-Mitral Ring with Silicone Rubber; Polyester Fabric

Holder; Mitral Cosgrove-Edwards Carpentier-Edwards Physio Annuloplasty

Annuloplasty System Model 4600; Ring. Composition: Elgiloy Bands;

Classic Annuloplasty Ring-Tricuspid Polyester Film Strips; Silicone Rubber;

Polyester Cloth, Cosgrove-Edwards

Annuloplasty Band. Composition: Silicone

Rubber; Polyester Cloth. Carpentier-

Edwards Tricuspid Ring. Composition:

Titanium Alloy; Silicone Rubber; Polyester

Fabric

Medtronic Australasia Pty Ltd

MC005 Medtronic Duran Annuloplasty Ring; Annuloplasty Devices - Models 610R & Model 610R 25-35mm & $2,200.00

Duran Ancore Ring 620R; Duran 620R Silicone / Barium Sulphate, Dacron. Model 620R 23-35mm

Ancore Chordal Model 620RG

Sorin Group

SA127 AnnuloFlo Annuloplasty System Annuloflex Ring or AnnuloFlo Ring 26-36mm $2,200.00

St Jude Medical Australia Pty Ltd

SJ035 SJM Tailor Annuloplasty Ring Fully Flexible 25mm - 35mm $2,200.00

Group 4b - Ring, with modification

Edwards Lifesciences Pty Ltd

EL049 Edwards Etlogix Annuloplasty Ring Titanium/silicon/dacron polyester 24mm/26mm/28mm/30mm/32 $2,400.00

cloth/plastic template Mitral valve annular mm/34mmd

repair device designed specifically for

patients with Ischemic Mitral regurgitation

EL057 Geoform Geoform annuloplasty ring Model 4200 26, 28, 30 and 32mm $2,400.00

with Holder

Prostheses List by Category, Groups and Sponsor Page 26 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

EL059 Carpentier-Edwards PHYSIO ll Mitral PHYSIO II is a semi rigid mitral 24, 26, 28, 30, 32, 34, 36, 38, $2,400.00

Annuloplasty Ring annuloplasty ring, with an improved saddle 40mm

shape and global disease based design

Medtronic Australasia Pty Ltd

MC745 CG Future Composite Ring Semi-rigid mitral annuloplasty ring, with 24, 26, 28, 30, 32, 34, 36 & $2,400.00

anterior flexibility 38mm

MC844 Profile 3D Annuloplasty Ring 3D, rigid annuloplasty ring with physiologic Diameter (mm) 24 - 40mm $2,400.00

mitral valve shape

Sorin Group

SA150 MEMO 3D Memo 3D Semirigid Mitral Annuloplasty 24-38mm $2,400.00

Ring, with 3D flexibility and coasted with

Carbofilm

St Jude Medical Australia Pty Ltd

SJ087 St Jude Medical Rigid Saddle Ring Rigid Annuloplasty Ring 24 - 34mm $2,400.00

SJ195 Attune Flexible Adjustable Annuloplasty Flexible annuloplasty ring 25mm - 43mm $2,200.00

Ring

Group 4c - Band, Standard

Edwards Lifesciences Pty Ltd

EL050 Edwards MC3 Tricuspid Annuloplasty Annuloplasty Ring, 26mm to 36mm in 2mm $2,400.00

System titanium/silicone/polyester velour increment

cloth/plastic template

Group 4d - Band, with modification

Medtronic Australasia Pty Ltd

MC709 Posterior Annuloplasty Band; Colvin - Annuloplasty - Model 610B & 620B Model 610B: 25-35mm; $2,200.00

Galloway Future Band Model 638B; Silicone / Barium Sulphate, Dacron. Models 620B & 620BG: 23-

Duran Ancore Band 620B; Duran Models 638B semi-regid metal alloy core, 35mm, Model 638B - 26-

Ancore Chordal Model 620BG silicone coating, polyester knit fabric, kit 38mm

includes-band, malleable handle, template

with suture markers, sizers

Prostheses List by Category, Groups and Sponsor Page 27 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Reid Healthcare

RH002 Kalangos Mitral Ring KALANGOS Mitral Ring is intended for Diameter 16mm - 36mm, $2,200.00 $2,500.00

heart valve repair. Each device is Height 10.62mm - 24.61mm

characterized by a resorbable polymeric Thickness 1.3mm - 1.5mm

curved segment, processed in poly-1,4-

dioxanone, moulded around a PVDF

suture itself ended by swaged stainless

steel needles. These three constituents are

assembled in such a way that they cannot

be shared or dismounted after assembly

without irremediably destroying the device.

For these reasons, KALANGOS Mitral

Ring should be considered as a single

device. Each extremity of the polymeric

segment is terminated by a sharp end

prolonged by the PVDF suture with a

swaged stainless steel needle on both sides.

Prostheses List by Category, Groups and Sponsor Page 28 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

RH003 Kalangos Tricuspid Ring KALANGOS Tricuspid Ring is intended TRK16 5.10 Radius 1 (mm) $2,200.00 $2,500.00

for heart valve repair. Each device is 9.31 Radius 2 (mm) 3.1 Radius

characterized by a resorbable polymeric 3 (mm) 5.44 Height (mm) 1.30

curved segment, processed in poly-1,4- Thickness (mm)

dioxanone, moulded around a PVDF TRK18 6.1 Radius 1 (mm)

suture itself ended by swaged stainless 10.44 Radius 2 (mm) 4.1

steel needles. These three constituents are Radius 3 (mm) 7.98 Height

assembled in such a way that they cannot (mm) 1.30 Thickness (mm)

be shared or dismounted after assembly TRK20 7.1 Radius 1 (mm)

without irremediably destroying the device. 8.92 Radius 2 (mm) 5.1 Radius

For these reasons, KALANGOS 3 (mm) 8.96 Height (mm) 1.30

Tricuspid Ring should be considered as a Thickness (mm)

single device. Each extremity of the TRK22 8.1 Radius 1 (mm)

polymeric segment is terminated by a sharp 9.27 Radius 2 (mm) 6.1 Radius

end prolonged by the PVDF suture with a 3 (mm) 10.05 Height (mm)

swaged stainless steel needle on both 1.30 Thickness (mm)

sides. TRK24 9.1 Radius 1 (mm)

11.21 Radius 2 (mm) 7.1

Radius 3 (mm) 10.97 Height

(mm) 1.30 Thickness (mm)

TRK26 10 Radius 1 (mm)

11.21 Radius 2 (mm) 8 Radius

3 (mm) 10.37 Height (mm)

1.50 Thickness (mm)

TRK28 10.5 Radius 1 (mm)

16.71 Radius 2 (mm) 9 Radius

3 (mm) 11.02 Height (mm)

1.50 Thickness (mm)

TRK30 12 Radius 1 (mm) 11.9

Radius 2 (mm) 10 Radius 3

(mm) 12.83 Height (mm) 1.50

Thickness (mm)

TRK32 13 Radius 1 (mm)

15.45 Radius 2 (mm) 11

Radius 3 (mm) 13.15 Height

(mm) 1.50 Thickness (mm)

TRK34 14 Radius 1 (mm)

16.25 Radius 2 (mm) 12

Radius 3 (mm) 13.5 Height

(mm) 1.50 Thickness (mm)

TRK36 15 Radius 1 (mm)

15.85 Radius 2 (mm) 13

Radius 3 (mm) 16.09 Height

(mm) 1.50 Thickness (mm)

Prostheses List by Category, Groups and Sponsor Page 29 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

St Jude Medical Australia Pty Ltd

SJ088 SJM Tailor Annuloplasty Band Flexible double-velour, polyester fabric 25 - 35mm $2,200.00

Group 4: Single Chamber Pacemakers

Generation 1

St Jude Medical Australia Pty Ltd

SJ053 Verity Adx Model XL SC 5056 Single Chamber multi-programmable rate- 10.5cc, 23g $4,264.00

implantable pacemaker adaptive pacing device with extended

longevity

Generation 2

St Jude Medical Australia Pty Ltd

SJ076 Verity Adx Model XL SR 5157 M/S Single Chamber multi-programmable rate- 11cc, 23g $5,928.00

implantable pacemaker adaptive pacing devices with extended

longevity

Generation 3

Biotronik Australia Pty Ltd

BT062 Philos II SR Multiprogrammable, Rate Responsive, One size only $5,928.00

SSIR pacemaker

BT080 Cylos VR single chamber dual sensor rate responsive one size only $5,928.00

BT106 Cylos 990 SR Single-chamber pacemaker with Closed 57 x 39 x 6mm / 27g $5,928.00

Loop Stimulation (CLS)

BT109 Entovis SR Fully automatic, extended longevity, single 53 x 39 x 6.5W x H x D [mm], $5,928.00

cFully automatic, extended longevity, single Size 1 [cm3], 25 Mass[g]

chamber pacemaker with Closed Loop

Stimulation.

BT113 Evia SR Fully automatic, extended longevity, single 53 x 39 x 6.5 W x H x D [mm], $5,928.00

chamber pacemaker with Closed Loop Size 10[cm3], 25 Mass [g]

Stimulation.

Boston Scientific Australia Pty Ltd

BS124 Insignia AVT 1192 Single chamber rate responsive pacemaker 10cc, 23.4g $5,928.00

Prostheses List by Category, Groups and Sponsor Page 30 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

BS145 Altrua 20 SR Single chamber rate responsive pacemaker 10cc - 15cc $5,928.00

BS147 Altrua 40 SR Single chamber rate responsive pacemaker 10cc - 15cc $5,928.00

BS149 Altrua 50 SR Single chamber rate responsive pacemaker 10cc - 15cc $5,928.00

BS152 Altrua 60 SR Single chamber rate responsive pacemaker 10cc - 15cc $5,928.00

Guidant Australia Pty Ltd

GU124 Insignia Entra SR Models 1195 & 1198 Single Chamber Rate Responsive One size only $5,928.00

Permanent Pacemaker

GU126 Insignia Plus SR Model 1194 Single Chamber Rate Responsive One size only $5,928.00

Permanent Pacemaker

GU139 Insignia Ultra SR Model 1190 Single Chamber Rate Responsive One size only $5,928.00

Pacemaker

Medtronic Australasia Pty Ltd

MC728 Adapta Pacemaker SR PacemakerModels ADSR01, 9.7 - 11.0cc21.5 - 22.5g $5,928.00

ADSR06, ADSR03

Sorin Group

SA137 Symphony SR Titanium one size only $5,928.00

SA142 Reply™ SR Single chamber permenent pacemaker with 37 x 41.5 x 6.1mm $5,928.00

rate response modulation 19 Grams

7.5 cm3

SA143 ESPRIT SR Single Chamber Permanent Pacemaker Dimensions: 37.4 x 41.5 x $5,928.00

with Rate Response Modulation 6.1mm Weight : 19grams.

Volume: 7.5 cm3

St Jude Medical Australia Pty Ltd

SJ060 Identity ADx Model SR 5180 Single Chamber multi-programmable rate- 8cc, 18g $5,928.00

implantable pacemaker adaptive pacing device

SJ077 Verity Adx Models XL SR 5156 Single Chamber multi-programmable rate- 11cc, 23g $5,928.00

implantable pacemaker adaptive pacing devices with extended

longevity

SJ090 Victory SR 5610 single chamber rate responsive pacemaker 41x44x46mm 17g 8cc $5,928.00

SJ105 Zephyr SR 5620 Single Chamber Rate-Responsive 8cc, 17g $5,928.00

Pacemaker

Prostheses List by Category, Groups and Sponsor Page 31 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

SJ131 Zephyr XL SR 5626 Single-Chamber Rate-Responsive 23.5g and 10.4cc $5,928.00

Pacemaker

SJ205 Accent SR PM 1110 Single Chamber Rate Responsive 18g, 9.5cc $5,928.00

Pacemaker

St Jude Medical Australia Pty Ltd

SJ027 St Jude Medical Microny II SR+ Model Single Chamber Rate Responsive Volume 5.9cc, Weight 12.8gm $5,928.00

2525T Pacemaker Pacemaker

Biotronik Australia Pty Ltd

BT108 Entovis SR-T Fully automatic, extended longevity, single 53 x 39 x 6.5 W x H x D [mm], $5,928.00 $8,928.00

chamber pacemaker with Closed Loop Size 11 [cm3], 24 mass[g]

Stimulation & BIOTRONIK Home

Monitoring

BT110 Evia SR-T Fully automatic, extended longevity, single 53 x 39 x 6.5 W x H x D [mm], $5,928.00 $8,928.00

chamber pacemaker with Closed Loop Size 11 [cm3], 24 Mass [g]

Stimulation & BIOTRONIK Home

Monitoring

St Jude Medical Australia Pty Ltd

SJ200 Accent SR RF PM1210 Single Chamber Pacemaker with RF 23g, 12.8cc $5,928.00 $7,928.00

telemetry

Group 5 - Cardiothoracic Membranes and Patches

Group 5a - Tissue

Advanced Biomedical Pty Ltd

AB066 Supple Peri-Guard (10 x 16cm) Model No PC1016SN - 10 x 16 Bovine 10 x 16cm $760.00

pericardium patch

AB067 Supple Peri-Guard (8 x 14cm) Nodel No PC0814SN - 8 x 14 Bovine 8 x 14cm $700.00

pericardium patch

AB068 Supple Peri-Guard (6 x 8cm) Model No PC0608SN -6 x 8cm Bovine 6 x 8cm $610.00

pericardium patch

AB069 Supple Peri-Guard (4 x 4cm) Model No PC0404SN - 4 x 4cm Bovine 4 x 4cm $350.00

pericardium patch

Prostheses List by Category, Groups and Sponsor Page 32 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Edwards Lifesciences Pty Ltd

EL033 Baxter Augmentation / Substitution Edwards Pericardial Patch. Bovine 10cm x 16cm $760.00

Material, Human or Animal Origin, Pericardium.

Sterile Pericardial Patch.

Group 5b - Synthetic, Cardiovascular

Tag Medical

TM040 Repel - CV Bioresorbable Adhesion Barrier 18cmx13.5cmx137 microns $550.00

W L Gore & Associates

GT117 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm Thickness 2 x 9cm $240.00

GT118 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm - 3 x 6cm $280.00

0.6mm - 2.5cm x 15cm & 5cm

x 7.5cm

GT120 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 5 x 15cm $521.00

GT121 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 10 x 15cm $945.00

GT126 Acuseal Cardiovascular Patch Vascular ePTFE 0.5mm Thickness 1 x 9cm; 0.8 $223.00

x 7.5cm

GT127 Acuseal Cardiovascular Patch Cardiac ePTFE 0.5mm Thickness 3 x 6cm & 5 $270.00

x 7.5cm

Group 5c - Synthetic, Non-cardiovascular

W L Gore & Associates

GT122 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 6 x 12cm $360.00

GT123 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 8 x 16cm $643.00

GT124 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 12 x 12cm $748.00

GT125 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 15 x 20cm $1,455.00

Group 5: Dual Chamber Pacemakers

Generation 1

Boston Scientific Australia Pty Ltd

BS123 Insignia AVT 882 Dual chamber VDD pacemaker 10.0cc, 23.5g $5,200.00

BS150 Altrua 50 VDD Dual chamber VDD pacemaker 10cc - 15cc $5,200.00

Prostheses List by Category, Groups and Sponsor Page 33 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

St Jude Medical Australia Pty Ltd

SJ050 Verity ADx Model XL DC 5256 Dual - Dual Chamber multi-programmable rate- 11cc, 23.5g $5,200.00

Chamber pacemaker adaptive pacing devices with extended

longevity

SJ061 Identity Adx Model XL DC 5286 Dual Identity ADx Model XL DC Model 5286 11cc, 23.5g $5,200.00

Chamber Pacemaker is an implantable, multi-programmable

rate-adaptive pacing device with AF

suppression

Generation 2

Medtronic Australasia Pty Ltd

MC713 Adapta Pacemaker VDDR PacemakerModels ADVDD01 11.1cc23.6g $6,760.00

St Jude Medical Australia Pty Ltd

SJ054 Identity ADx Model VDR 5480 Single Chamber multi-programmable rate- 8cc, 18g $6,760.00

implantable pacemaker adaptive pacing device with extended

longevity

SJ057 Verity ADx Model XL VDR 5456 Single Chamber multi-programmable rate- 11cc, 23.5g $6,760.00

implantable pacemaker adaptive pacing device with extended

longevity

Generation 3

Biotronik Australia Pty Ltd

BT060 Philos II DR Multiprogrammable, rate responsive, DDDR One size only $9,360.00

BT104 Cylos 990 DR Dual-chamber pacemaker with Closed 57* 43* 6mm/28g $9,360.00

Loop Stimulation (CLS)

BT105 Cylos 990 DR-T Dual-chamber pacemaker with Closed 57*43*6mm/28g $9,360.00 $12,360.00

Loop Stimulation (CLS) and Biotronik

Home Monitoring Technology

Boston Scientific Australia Pty Ltd

BS126 Insignia AVT 1292 Dual chamber rate responsive pacemaker 10.8cc, 25.4g $9,360.00

BS144 Altrua 20 DR Dual chamber rate responsive pacemaker 10cc - 15cc $9,360.00

Prostheses List by Category, Groups and Sponsor Page 34 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

BS146 Altrua 40 DR Dual chamber rate responsive pacemaker 10cc - 15cc $9,360.00

BS148 Altrua 50 DR Dual chamber rate responsive pacemaker 10cc - 15cc $9,360.00

BS151 Altrua 60 DR Dual chamber rate responsive pacemaker 10cc - 15cc $9,360.00

Guidant Australia Pty Ltd

GU120 Insignia Plus DR Model 1297, Insignia Dual Chamber Rate Responsive One size only $9,360.00

Plus DR Model 1298 Permanent Pacemaker

GU121 Insignia Entra DR Models Dual Chamber Rate Responsive One size only $9,360.00

1294,1295,1296 Permanent Pacemaker

GU140 Insignia Ultra DR Model 1291 Dual Chamber Rate Responsive One size only $9,360.00

Pacemaker

GU141 Insignia Ultra DR Model 1290 Dual Chamber Rate Responsive One size only $9,360.00

Pacemaker

Sorin Group

SA136 Symphony DR 2550 Active Implantable pacemaker 1 size only $9,360.00

SA141 Reply™ DR Dual Chamber permanent Pacemaker with 8cc, Weight: 20grams, $9,360.00

Rate Response Modulation Dimensions:41.2 x 41.5 x 6.1mm

SA144 ESPRIT DR Dual Chamber Permanent Pacemaker with 8cc, Weight: 20grams, $9,360.00

Rate Response Modulation Dimensions:41.2 x 41.5 x 6.1mm

St Jude Medical Australia Pty Ltd

SJ051 Verity Adx Implantable Pacemaker, Dual - Chamber, multi-programmable, 45x52x6mm,11cc, 23g, 5mm $9,360.00

Models XL DR 5356 and XL DR rate-responsive pacemaker withAF or 6mm M/S

5357M/S suppression

SJ059 Identity ADx Models DR 5380 and XL Dual-Chamber, multi-programmable, rate- ADx DR 5380: 43x44x6mm, $9,360.00

DR 5386 adaptive pacing devices with AF 18g and 8ccADx XL DR

suppression 5386: 44x52x6mm, 23.5g and

11cc

SJ089 Victory XL DR 5816 and DR 5810 Dual Chamber Rate Responsive 44x52x6mm; 23.5g; 11cc $9,360.00

Pacemakers

Prostheses List by Category, Groups and Sponsor Page 35 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Medtronic Australasia Pty Ltd

MC360 EnRhythm Model P150 1DR, Rate Responsive dual 21g, 13cc $11,440.00

chamber pacemaker with Anti-

Tachycardia functions: DDDRP

MC935 EnRhythm MRI SureScan Model EMDR01, MRI Conditional, Rate 13cc, 22g $11,440.00

Responsive Dual Chamber Pacemaker

with Anti-Tachycardia functions and MVP

Biotronik Australia Pty Ltd

BT071 Philos II DR-T Dual Chamber Rate Responsive with One size only $9,360.00 $12,360.00

Home Monitoring

BT079 Cylos DR-T Dual chamber dual sensor rate responsive one size $9,360.00 $12,360.00

with home monitoring system option

Generation 4

Biotronik Australia Pty Ltd

BT111 Entovis DR Fully automatic, extended longevity, Dual 53 x 43 x 6.5W x H x D [mm], $11,440.00

Chamber Pacemaker with Closed Loop Size 11 [cm3], 26 Mass [g]

stimulation & Vp Suppression

BT112 Evia DR Fully automatic, extended longevity, Dual 53 x 43 x 6.5 W x H x D [mm], $11,440.00

Chamber Pacemaker with Closed Loop Size 11 [cm3], 26 Mass [g]

stimulation & Vp Suppression.

Medtronic Australasia Pty Ltd

MC726 Adapta Pacemaker DR PacemakerModels ADDR01, 11.1-14.2cc23.6g-31.3g $11,440.00

ADDRS1, ADDRL1, ADDR06,

ADDR03

St Jude Medical Australia Pty Ltd

SJ103 Zephyr XL DR 5826 and DR 5820 Dual Chamber Rate-Responsive 5826 - 23.5g, 11cc and 5820 - $11,440.00

Pacemaker 18g, 8.5cc

SJ193 Accent DR PM 2112 Dual Chamber Pacemaker 19g, 10.5cc $11,440.00

Prostheses List by Category, Groups and Sponsor Page 36 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Medtronic Australasia Pty Ltd

MC933 Advisa DR MRI SureScan Model A3DR01 Digital dual chamber 13cc, 22g $11,780.00

pacemaker with SureScan Technology

(OAE-DDDR) MR Conditional with MVP

Mode, Complete Capture Management

Diagnostic (ACM, RVCM), AT/AF Suite

Diagnostics and Therapies, OptiVol Fluid

Status Monitoring, and Therapy Guide

Feature

MC934 Advisa DR Model A5DR01 Digital dual chamber 13cc, 22g $11,780.00

pacemaker (OAE-DDDR) MVP mode

with Complete Capture Management

Diagnostic (ACM, RVCM) AT/AF Suite

Diagnostics and Therapies, OptiVol Fluid

Status Monitoring, and Therapy Guide

Feature

Biotronik Australia Pty Ltd

BT114 Evia DR-T Fully automatic, extended longevity, Dual 53 x 44.5 x 6.5 W x H x D $11,440.00 $14,440.00

Chamber Pacemaker with Closed Loop [mm], Size 12 [cm3], 25 Mass

stimulation, Vp Suppression and [g]

BIOTRONIK Home Monitoring

BT115 Entovis DR-T Fully automatic, extended longevity, Dual 53 x 44.5 x 6.5 W x H x D $11,440.00 $14,440.00

Chamber Pacemaker with Closed Loop [mm], Size 12 [cm3], 25 Mass

stimulation, Vp Suppression and [g]

BIOTRONIK Home Monitoring

St Jude Medical Australia Pty Ltd

SJ196 Accent DR RF PM2212 Dual chamber Pacemaker with RF 236, 12.8cc $11,440.00 $13,440.00

telemetry

Group 6 - Cardiothoracic Assisted Anastomic Devices

Medtronic Australasia Pty Ltd

MC680 Spyder Proximal Anastomotic Device 6-clip assembly $590.00

Prostheses List by Category, Groups and Sponsor Page 37 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Group 6: CRT Pacemakers

Generation 2

Guidant Australia Pty Ltd

GU142 Contak Renewal TR2 CRT - P Model CRT-P 45x54x8.5mm, 14cc, 26gm $12,480.00

H140, Model H145

Medtronic Australasia Pty Ltd

MC226 Medtronic Insync III Triple Chamber Titanium One size only $12,480.00

Pacemaker Model 8042

St Jude Medical Australia Pty Ltd

SJ072 Frontier II - Model 5596 Biventricular Cardiac Resynchronisation 49mm(h) x 52(1) x 6(t), 25g $12,480.00

Device with AF suppression algorithm -

Titanum

Biotronik Australia Pty Ltd

BT085 Stratos LV-T Multiprogrammable Biventricular DDDRV One size only $12,480.00 $15,480.00

with Home Monitoring

Generation 3

St Jude Medical Australia Pty Ltd

SJ194 Anthem PM3112 CRT Pacemaker Cardiac Resynchronisation Therapy 21g, 11.5cc $13,520.00 $14,560.00

Pacemaker

Medtronic Australasia Pty Ltd

MI012 Consulta CRT-P Cardiac Resynchronisation Therapy One size only $13,520.00

Pacemaker, Model C3TR01

St Jude Medical Australia Pty Ltd

SJ207 Anthem RF PM3212 CRT Pacemaker with RF telemetry 25g, 13.7cc $13,520.00 $14,560.00

Prostheses List by Category, Groups and Sponsor Page 38 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Group 7 - Cardiothoracic Assisted Fixation Devices

Group 7a Valvular

Medtronic Australasia Pty Ltd

MC714 U-Clips (Valve Repair) Double Arm, Mitral Valve Repair 2-packs $510.00

Group 7b Related to anastomosis

Medtronic Australasia Pty Ltd

MC765 U-Clips Nitinol Clips, 8-pack Needle Lengths: 6.5mm - $336.00

9.5mm, 8-pack

MC772 U-Clips Nitinol Clips, 2-pack Needle Lengths: 6.5mm - $84.00

9.5mm, 2-Pack

Group 7c Related to skeletal fixation

Advanced Biomedical Pty Ltd

AB074 FLEXIGRIP (Various Sizes) Nitinol Sternal Closure Clips - various sizes 20mm - 40mm $80.00 $140.00

Group 7: ICD Leads

Sub -Group 1: Coronary Sinus Leads

Medtronic Australasia Pty Ltd

MC026 Medtronic Transvene SVC Lead Model Model 6937-35, Model 6937-52, Model 35 - 110cm x 660mm $2,340.00

6937; 6937-58, Model 6937-110; Silicone;

Sub -Group 2: Subcutaneous Leads

Guidant Australia Pty Ltd

GU123 Endotak SQ Array XP Lead Model 0085 Sub-Q Array for high DFT 70cm $4,680.00

Medtronic Australasia Pty Ltd

MC251 Implantable Subcutaneous Defibrillator Silicone and Platinum Alloy Lengths 41-85cm inclusive $4,680.00

Lead Model 6996SQ 41cm, 58cm, 85cm

Prostheses List by Category, Groups and Sponsor Page 39 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Sub -Group 5: Transvenous/ Steroid/ Passive Leads

Biotronik Australia Pty Ltd

BT092 Linox TD Fractal and steroid coated passive fixation 65, 74 or 100cm length and 16 $9,360.00

quadripolar ICD lead or 18mm electrode spacing

BT093 Linox T Passive fix RV bipolar fractal coated 65, 75cm length $9,360.00

steroid ICD lead

BT119 Linox SMART TD Linox SMART TD is a family of ICD Length: Linox SMART TD $9,360.00

leads with an active fixation helix. The 65/16 65cm, Linox SMART

fixation helix is comprised of platinum TD 65/18 65cm, Linox

iridium alloy. SMART TD 75/18 75cm;

Lead Body Diameter: 7.8Fr

Guidant Australia Pty Ltd

GU115 Endotak Reliance Lead Passive Dual Coil 59cm, 64cm, 90cm $9,360.00

GU158 Endotak Reliance SG Passive Passive Single Coil wih GORE ePTFE 54cm - 90cm $9,360.00

covered coils

GU159 Endotak Reliance G Passive Passive Dual Coil with GORE ePTFE 54cm - 90cm $9,360.00

covered coils

Medtronic Australasia Pty Ltd

MC002 Medtronic Sprint Quattro Lead Model Silicone and polyurethane 65-100cm $9,360.00

6944RV/SVC 65cm; Model

6944RV/SVC 75cm; or Model

6944RV/SVC 100cm; Medtronic Sprint

Quattro Lead Model 6944RV/SVC

58cm

Sorin Group

SA148 ISOLINE 2CT Passive fixation, steroid eluting, intergrated Lead body is 7.8 French $9,360.00

bipolar, dual shock coil defibrillation lead. diameter whilst 65cm in length

St Jude Medical Australia Pty Ltd

SJ110 Riata ST Transvenous Tachyarrhythmia Riata ST 7040/41 Passive-Fixation True- 60 - 75cm, 6.3 Fr, 7 Fr $9,360.00

Leads 7040/41/42 and 7050/51/52 Bipolar, Dual-Coil, Steroid-eluting, Introducer

Endocardial Defibrillation Leads, 7042 -

Single Coil, 7050/51 - Integrated Bipolar,

Dual Coil, 7052 - Integrated Bipolar,

Single Coil

Prostheses List by Category, Groups and Sponsor Page 40 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

SJ130 Riata ST Optim 7070/1 Passive Fixation, True bipolar, Dual Coil, 60, 65 and 70cm length, 7Fr $9,360.00

Steroid Eluting, Endocardial Defibrillation introducer

Leads with Optim insulation overlay

SJ158 Durata 7170, 7171 Passive fixation, true bipolar, dual coil, 60, 65 and 70cm $9,360.00

steroid eluting, endocardial defibrillation

leads with Optium insulation overlay

Boston Scientific Australia Pty Ltd

BS170 Endotak Reliance S 4-SITE Passive fixation single coil defibrillation 50-70cm $9,360.00

leads & 4-SITE connector.

BS180 Endotak Reliance G 4-SITE Passive fixation dual coil defibrillation leads 50-70cm $9,360.00

with ePTFE covered coils & 4-SITE

connector

BS181 Endotak Reliance SG 4-SITE Passive fixation single coil defibrillation 50-70 $9,360.00

leads with ePTFE covered coil & 4-SITE

connector

BS183 Endotak Reliance 4-SITE Passive fixation dual coil defibrillation leads 50-70cm $9,360.00

with 4-SITE connector

St Jude Medical Australia Pty Ltd

SJ245 Durata 7170Q, 7171Q and 7172Q 7170Q/7171Q - passive fixation, bipolar, 52, 58 and 65cm, 7F $9,360.00

dual coil, 7172Q - passive fixation, bipolar introducer

- single coil steroid eluting endocardial

defibrillation leads with Optim insulation

overlay and SJ4 quadripolar lead connector

Sub -Group 6: Transvenous/ Steroid/ Active Leads

Biotronik Australia Pty Ltd

BT084 Linox SD Fractal coated and steroid electrode, 65, 75cm length, 16, 18mm $9,000.00 $9,360.00

active fixation quadrapolar elec dis

BT096 Linox S Active fix RV bipolar fractal coated steroid 65, 75cm length $9,000.00 $9,360.00

IC lead

Prostheses List by Category, Groups and Sponsor Page 41 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

BT120 Linox SMART SD Linox SMART SD is a family of ICD Length: Linnox SMART SD $9,000.00

leads with an active fixation helix for the 60/16 61.2cm; Linnox SMART

therapy of tachycardia arrhythmia. The SD 65/16 65cm; Linnox

active fixation helix is comprised of SMART SD 65/18 65cm;

platinum iridium alloy. Linnox SMART SD 75/18

75cm; Lead Body Diameter:

7.8Fr

Guidant Australia Pty Ltd

GU163 ENDOTAK RELIANCE G Active Active Dual Coil with GORE ePTFE 59-90cm $9,000.00

covered coils

GU164 ENDOTAK RELIANCE SG Active Active Single coil with GORE ePTFE 59-90cm $9,000.00

covered coils

Medtronic Australasia Pty Ltd

MC208 Medtronic Sprint Quattro Secure Lead Leads, Defibrillator, Implantable, Silicone, 58-100cm $9,000.00

Model 6947 58cm; Model 6947 65cm; polyurethane, platinized tantalum coils,

Model 6947 75cm; Model 6947 100cm steroid eluting tip

MC834 Sprint Quattro Secure S Model 6935, Active Fixation Single Coil 52 - 100cm $9,000.00

Defibrillation Lead

Sorin Group

SA146 ISOLINE 2CR Active fixation, steroid eluting, integrated Lead body is 7.8 French $9,000.00 $9,360.00

bipolar, dual coil defibrillation lead diameter whilst 65cm in length

St Jude Medical Australia Pty Ltd

SJ074 Riata Transvenous tachyarrhythmia Tri-polar Active - Fixation, Steroid- 60cm, 65cm, 8F introducer $9,000.00 $9,360.00

Leads Model 1582 Eluting, Single shock Coil

Tachyarrhythmia; Lead

SJ075 Riata Transvenous Tachyarrhythmia Quadripolar, dual-coil, steroid eluting, One size only $9,000.00 $9,360.00

Lead Model 1580, Model 1581 active fixation tachyarrhythmia leads

SJ081 Riata i Transvenous Tachyarrhythmia Active fixation leads, Steroid Eluting, Dual 60cm, 65cm, 75cm, 8F $9,000.00 $9,360.00

Leads Model 1590/1591 Shock Coil Defibrillation Lead introducer

SJ084 Riata i Transvenous Tachyarrhythmia Active Fixation, Steroid Eluting, Single 60cm, 65cm, 75cm, 8F $9,000.00 $9,360.00

Lead Model 1592 Shock Coil Defibrillation Lead introducer

SJ096 Riata ST 7000/7001/7002 Active-Fixation True-Bipolar, Dual-Coil, 60, 65cm 7F introducer $9,000.00 $9,360.00

(7002 - Single-Coil) Steroid-Eluting

Steroid Eluting, Endocardial Defibrillation

Leads

Prostheses List by Category, Groups and Sponsor Page 42 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

SJ122 Riata ST Optim 7020/1/2 and 7030/1 7020/1 - Active fixation, true bipolar, 60, 65 and 75cm length and $9,000.00 $9,360.00

7022 - Active fixation, true bipolar - single 7Fr introducer

coil, 7030/1 - Active fixation, integrated

bipolar, dual coil steroid eluting

endocardial defibrillation leads with Optim

insulation overlay

SJ157 Durata 7120, 7121, 7122, 7130, 7131 Active fixation bipolar, dual-coil/single coil 60, 65, 75cm $9,000.00 $9,360.00

Steroid-eluting Endocardial Defibrillation

Leads

Boston Scientific Australia Pty Ltd

BS174 Endotak Reliance SG 4-SITE Active fixation single coil defibrillation 50-70cm $9,000.00

leads with ePTFE covered coil & 4-SITE

connector.

BS178 Endotak Reliance 4-SITE Active fixation dual coil defibrillation leads 50-70cm $9,000.00

with 4-SITE connector

BS179 Endotak Reliance S 4-SITE Active fixation single coil defibrillation 50-70mm $9,000.00

leads & 4-SITE connector

BS182 Endotak Reliance G 4-SITE Active fixation dual coil defibrillation leads 50-70cm $9,000.00

with ePTFE covered coils & 4-SITE

connector.

St Jude Medical Australia Pty Ltd

SJ230 Durata 7120Q, 7121Q and 7122Q 7120/1Q - Adtive fixation, true bipolar; 52cm, 58cm and 65cm $9,000.00 $9,360.00

7122Q - Active fixation true bipolar -

single coil steroid eluting endocardial

defibrillation leads with Optim insulation

overlay and SJ4 quadripolar lead

connector.

SJ233 Riata ST Optim 7020Q, 7021Q, 7022Q 7020/1Q - Active fixation, true bipolar; 52cm, 58cm and 65cm $9,000.00 $9,360.00

7022Q - Active fixation true bipolar -

single coil steroid eluting endocardial

defibrillation leads with Optim insulation

overlay and SJ4 quadripolar lead

connector.

Prostheses List by Category, Groups and Sponsor Page 43 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Sub -Group 7: Epicardial Patches

Medtronic Australasia Pty Ltd

MC027 Model 6721 Unipolar Epicardial Patch Model 6721S-50, Model 6721M-50, 370, 660, 840mm $2,340.00

Leads S/M/L Model 6721L-50; Silicone

Group 8 - Cardiothoracic Grafts (Proximal Aorta)

Group 8b Modified Tube

Terumo Corporation Australia

TU036 Gelweave Valsalva Graft Woven vascular prosthesis, polyester, Diameter 24 - 34 mm, Overall $3,320.00

gelatin sealed length 18.4 - 19.6cm

Group 8c Tube with one side branch

Terumo Corporation Australia

TU038 Gelweave Graft Straight Thoracic Graft, with antiflo side 20 -34 mm x 20-40 cm $1,715.00

branch, Polyester, woven, gelatin sealed

Group 8d Tube with multiple side branches (more than 1)

Terumo Corporation Australia

TU037 Gelweave Plexus Graft Multi Branched, for Aortic Arch 20 - 34 mm x 40 cm $2,150.00

reconstruction, Polyester, Woven, gelatin

sealed

Group 8: Pacemaker Leads

St Jude Medical Australia Pty Ltd

SJ243 Quartet 1458Q Quadripolar, Left Ventricular Pacing Lead 75, 86 and 92cm, 5 French $6,240.00

with Optim Lead Insulation introducer

Prostheses List by Category, Groups and Sponsor Page 44 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Sub-Group 1: Non-transvenous, Bi-Polar, Steroid

Boston Scientific Australia Pty Ltd

BS153 Myopore Bipolar sutureless myocardial pacing lead 25-54cm $1,716.00

Medtronic Australasia Pty Ltd

MC011 Capsure EPI steroid eluting bipolar Silicone 25 - 60cm $1,716.00

epicardial lead Model 4968 - ventricle

St Jude Medical Australia Pty Ltd

SJ132 Myodex 1084T Steroid-Eluting Bipolar Sutureless 35cm and 54cm $1,716.00

Myocardial Pacing Lead with Titanium

Nitride Electrodes

SJ140 Myodex 1084T and FasTac Flex Lead Steroid -Eluting Bipolar Sutureless 35cm and 54cm, Lead implant $1,716.00 $1,966.00

Implant Tool Myocardial Pacing Lead with Titanium tool - 44cm

Nitride Electrodes and Lead implant tool

with articulating distal end.

Sub-Group 11: Transvenous, Bi-Polar, Passive, Steroid, Left Ventricular

Medtronic Australasia Pty Ltd

MI013 Attain Ability Plus 4296 Over the wire electrode left ventricular lead 78cm, 88cm $6,240.00

MI014 Attain Ability Straight 4396 Over the wire dual left ventricular lead 78cm, 88cm $6,240.00

Sub-Group 11: Transvenous, Multi-Polar, Passive Steroid, Left Ventricular

Biotronik Australia Pty Ltd

BT095 Corox OTW BP; Corox OTW-S BP; Coronary Sinus bipolar steroid 77, 87 cm length $6,240.00

Guidant Australia Pty Ltd

GU138 Easytrak 2, Model 4514, 4515, 4516, Bipolar, passive fixation . $6,240.00

4517, 4518, 4519, 4520

GU153 Easytrak 2 Is-1 Lead - Models 4542, Bipolar, passive fixation 80 to 100cm $6,240.00

4543 & 4544

GU156 Easytrak 3 Lead - Models 4521, 4522, Bipolar, passive fixation 80 to 100cm $6,240.00

4523, 4524, 4525, 4526 and 4527

GU162 Easytrak 3 IS-1 Lead Bipolar, passive fixation Sizes 80 to 100cm $6,240.00

Prostheses List by Category, Groups and Sponsor Page 45 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

GU165 Acuity Steerable Lead Bipolar, passive fixation 80cm, 90cm ,100cm $6,240.00

Medtronic Australasia Pty Ltd

MC699 Attain OTW Model 4194 Lead Model 4194 78cm, 88cm $6,240.00

MC811 Attain Ability 4196 LV Lead Over the wire dual electrode left 78, 88, and 103 cm $6,240.00

ventricular lead

St Jude Medical Australia Pty Ltd

SJ099 QuickSite 1056T Bipolar Steroid-Eluting, Titanium Nitride 75cm, 6F and 86cm, 6F $6,240.00

Coated Electrodes Guidewire/Stylet-

Placed Keft Heart Lead with Fast-Pass

Coating

SJ126 QuickSite XL 1058T Bipolar, Steroid-Eluting, Titanium Nitride 75-86cm $6,240.00

Coated Electrodes, Guidewire/Stylet-

Placed Left Heart Lead with Fast-Pass

Coating

SJ139 Quickflex 1156T and XL 1158T Bipolar, Steroid-Eluting, Titanium Nitride Length 75 and 86cm $6,240.00

Coated Elextrodes, Guidewire/Stylet-

Placed Left Heart Lead with Fast-PassTM

Coating

St Jude Medical Australia Pty Ltd

SJ208 Quick Flex µ 1258T 4F Bipolar Left Ventricular Pacing Lead 75cm, 86cm, 92cm $6,240.00

Sub-Group 13: Transvenous, Active, Steroid, Left Ventricular

Medtronic Australasia Pty Ltd

MC730 Attain StarFix LV Lead Over the wire left Ventricular Lead 78, 88, 103cm $5,000.00

Sub-Group 2: Non-transvenous, Uni-Polar, Steroid

Medtronic Australasia Pty Ltd

MC053 Capsure EPI steroid eluting unipolar Silicone 25 - 50cm $1,544.00

epicardial lead Model 4965 ventricle

Prostheses List by Category, Groups and Sponsor Page 46 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Sub-Group 3: Non-transvenous, Uni-Polar, Non-Steroid

Medtronic Australasia Pty Ltd

MC009 Medtronic Epicardial Pacing Leads IS-1 Silicone 35 - 53cm $1,144.00

Model 5071

Sub-Group 4: Transvenous, Uni-Polar, Passive, Steroid, Right Ventricular/Atrial

Medtronic Australasia Pty Ltd

MC254 CapSure Sense pacemaker lead Models Titanium Nitride 30 - 85cm $1,248.00

4073

St Jude Medical Australia Pty Ltd

SJ078 IsoFlex S, Models 1645K, 1643K, Endocardial, Steroid Eluting, Silicone, 34cm, 40cm, 46cm, 52cm, $1,248.00

1635K Passive Fixation Leads with Fast-Pass 58cm, 85cm, 7F

Coating

Sub-Group 5: Transvenous, Uni-Polar, Passive, Non-Steroid, Left Ventricular

St Jude Medical Australia Pty Ltd

SJ033 Aescula LV Model 1055K Left Ventricular Pacing Lead 75cm $2,735.00

Sub-Group 6: Transvenous, Uni-Polar, Passive, Steroid, Left Ventricular

Biotronik Australia Pty Ltd

BT070 Corox OTW UP Steroid Coronary Sinus Lead 77, 87cm $3,120.00

Boston Scientific Australia Pty Ltd

BS133 Acuity Spiral Unipolar passive fixation 80, 90 & 100cm $3,120.00

Medtronic Australasia Pty Ltd

MC225 Attain Over the Wire Model 4193 Titanium, polyurethane 78-88cm $3,120.00

St Jude Medical Australia Pty Ltd

SJ079 QuickSite Model 1056K Unipolar, Steroid Eluting, Titanium Nitride 75cm, 6F and 86cm, 6F $3,120.00

Electrode, Guidewire/Stylet-placed Left

Heart Lead with Fast-Pass Coating

Prostheses List by Category, Groups and Sponsor Page 47 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Sub-Group 8: Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atrial

Biotronik Australia Pty Ltd

BT066 Selox ST Transvenous Bipolar Passive Steroid 53 and 60cm lengths $1,248.00

Ventricular Pacing Lead, fractal coated

BT067 Selox JT Fractal coated steroid electrode 45 and 53cm lengths $1,248.00

BT117 Siello JT The Siello JT is a family of sub 6F, steroid- Length: Siello T 45 cm; Siello T $1,248.00

eluting, transvenous, endocardial, bipolar 53 cm; Diameter: 5.6Fr

passive-fixation leads that carries a j-

shaped distal end.

BT118 Siello T The Siello T is a family of sub 6F, steroid- Length: Siello T 53cm; Siello T $1,248.00

eluting, transvenous, endocardail, bipolar 60cm Diameter: 5.6Fr

passive-fixation leads that carries a j-

shaped distal end.

Guidant Australia Pty Ltd

GU009 Fineline II Sterox IROX Lead Bipolar passive fixation 52cm, 58cm $1,248.00

GU011 Fineline II Sterox IROX Lead Bipolar passive fixation 52cm, 58cm $1,248.00

GU012 Fineline II Sterox IROX Lead Bipolar, passive fixation 45cm, 52cm $1,248.00

GU023 Guidant Aust Selute Picotip Steroid Model 4035, Model 4064 45cm, 52cm, 59cm $1,248.00

Eluting Bipolar Lead

Medtronic Australasia Pty Ltd

MC010 Medtronic Capsure SP Novus Model Silicone Polyurethane 45 -110cm $1,144.00

5092; Capsure SP Novus Lead Model

5592; Medtronic Capsure Model 4023

Lead; Medtronic Capsure Model 4024

Lead (med.dexamethasone) Medtronic

Capsure Model 4523(MED) Medtronic

Capsure Model 4524 Lead; Medtronic

Capsure Model

MC229 Medtronic Capsure SP Novus Model Silicone, platinum 30-100cm $1,180.00

5594 Lead 30cm

MC336 Medtronic Capsure Z Novus Model Silicone; Contents: 1 x lead with anchoring 45-58cm $1,248.00

5054 Pacing Lead sleeve, stylet & guide, 1 x vein lifter, 2 x

fixation tools, extra stylets

Prostheses List by Category, Groups and Sponsor Page 48 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

MC337 Medtronic Capsure Z Novus Model Silicone; Contents: 1 x lead with anchoring 45-58cm $1,248.00

5554 Pacing Lead sleeve, stylet & guide, 1 x vein lifter, 2 x

fixation tools, extra stylets

MC372 CapSure Sense pacemaker lead Models Titanium Nitride CapSure Sense Lead Model $1,248.00

4074 & 4574 4074 - 30cm to 85cm;

CapSure Sense Lead Model

4574 - 30cm to 53cm

Sorin Group

SA152 Refino ER Series Steroid eluting passive fixation pacing lead. The lead comes in 44, 48, 52 $1,248.00

Permanent pacing lead, Model Refino and 58cm lengths and has a

ER, is indicated for the pacing and sensing 6.0F (polyurethane 6.3F

of the ventricle. This permanent pacing (silicone) lead body

lead is used in conjunction with an IS-1

compatible implantable pulse generator

(pacemaker). Pernanent pacing leads,

Models Refino ERJ and ERJU are

indicated for the pacing and sensing of the

atrium. This permanent pacing lead is used

in conjunction with and IS-1 compatible

implantable pulse generator (pacemaker).

SA154 Petite ER Series Steroid eluting passive fixation pacing lead. The lead comes in 44, 48, 52, $1,248.00

Permanent pacing lead, Petite ER series, 58, 70 and 78cm lengths and

is indicated for the pacing and sensing of has a 4.8 F lead body.

the ventricle. This permanent pacing lead

is used in conjunction with an IS-1

compatible implantable pulse generator

(pacemaker). Permanent pacing lead,

Petite ERJ series, is indicated for the

pacing and sensing of the atrium. This

permanent pacing lead is used in

conjunction with an IS-1 compatible

implantable pulse generator (pacemaker).

St Jude Medical Australia Pty Ltd

SJ082 Isoflex S, Models 1646T, 1642T and endocardial, Steroid Eluting, Silicone, 34cm, 40cm, 46cm, 52cm, $1,248.00

1636T Passive Fixation Pacing Leads with Fast- 58cm, 85cm, 7F, 120cm 8F

Pass Coating

Prostheses List by Category, Groups and Sponsor Page 49 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

SJ097 Isoflex P 1644T and 1648T Endocardial, Steroid Eluting, Polyurethane, 1648T - 34-85cm 1644T - 34- $1,248.00

Passive-Fixation Bipolar Pacing Leads 42cm

with Fast-Pass Coating

SJ146 Isoflex 1944T & 1948T Passive-Fixation, Bipolar, Steriod Eluting, 46cm, 52cm, 58cm $1,248.00

Endocardial Pacing Lead with Optim

insulation

Guidant Australia Pty Ltd

GU028 Guidant Aust Selute Picotip VDD Lead VDD bipolar, passive fixation . $1,544.00

Medtronic Australasia Pty Ltd

MC052 Medtronic Capsure VDD2 Model 5038 Silicone; Contents: 1 x lead with anchoring 11.5cm, 13.5cm, 15.5cm $1,544.00

AV Pacing Lead sleeve, stylet & guide, 1 x vein lifter, 2 x

fixation tools, extra stylets

Sub-Group 9: Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atrial

Biotronik Australia Pty Ltd

BT063 Selox SR Lead, pacemaker, implantable, endocardial 45, 53, 60cm length $1,248.00

BT083 Setrox S Bipolar active fixation lead with fractal length 45, 53, 60cm $1,248.00

coated and steroid eluting electrode

BT097 Dextrus (marketed by Boston Scientific) Bipolar, silicone, active fixation, steroid 7Fr, with 45cm, 53cm and $1,248.00

eluting, pacing lead 60cm length options

BT116 Siello S The Siello S is a family of sub 6F, steroid- Length: Siello S45 cm; Siello $1,248.00

eluting, trasvenous, endocardial, bipolar S53 cm; Siello S 60 cm;

active-fixation leads with an Diameter: 5.6Fr

extendable/retractible, electrically active

screw.

Guidant Australia Pty Ltd

GU013 Fineline II EZ Sterox IROX Lead Bipolar, active fixation 45cm, 52cm, 58cm $1,248.00

GU016 Fineline II EZ Sterox IROX Lead Bipolar, active fixation 45cm, 52cm, 58cm $1,248.00

GU122 Flextend Lead Models 4086, 4087 & Bipolar, active fixation 45,52,59cm $1,248.00

4088

Prostheses List by Category, Groups and Sponsor Page 50 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

Medtronic Australasia Pty Ltd

MC008 Medtronic Capsurefix Model 5568 Silicone Polyurethane 30 - 85cm $1,215.00

Pacing Leads

MC338 Medtronic Capsurefix Novus Model Silicone; Contents: 1 x lead with anchoring 45-85cm $1,248.00

5076 Pacing Lead sleeve, stylet & guide, 1 x vein lifter, 2 x

fixation tools, extra stylets

MC833 CapSureFix Novus Model 4076 Pacing Active fixation pacemaker lead 45 - 85cm $1,248.00

Lead

MC936 CapSure Fix MRI Pacing Lead Model 5086, MRI Conditional 42, 52, 58 cm $1,248.00

Sorin Group

SA151 Physique ER Series Steroid eluting active fixation pacing lead. The lead comes in 44, 48, 52 $1,248.00

Permanent pacing lead, Model Physique and 58cm lengths and has a

ER is indicated for the pacing and sensing 4.8F lead body

of the ventricle or atrium. This permanent

pacing lead is used in conjunction with a

compatible implantable pulse generator.

Permanent pacing lead, Model Physique

ERJ is indicated for the pacing and sending

of the atrium. This permanent pacing lead

is used in conjunction with a compatible

implantable pulse generator (pacemaker)

IS-1.

SA153 PY2-ER Series Steroid eluting active fixation pacing lead. The lead comes in 44, 48, 52, $1,248.00

Permanent pacing lead PY2-ER series, is 58cm lengths and has a 6.3F

indicated for pacing and sensing of the lead body

ventricle and/or atrium of the heart. This

lead is used in conjunction with a

compatible implantable pulse generator

(Pacemaker)

St Jude Medical Australia Pty Ltd

SJ073 Tendril SDX Models 1688T and 1688TC Endocardial Steroid-Eluting Active 100cm, 25cm, 34cm, 40cm, $1,248.00

Fixation Pacing Lead 46cm, 52cm, 58cm, 85cm, 7F

SJ118 OptiSense 1699T/1699TC Endocardial, Bi-polar Active-fixation 40-58cm $1,248.00

Pacing Leads with Optim Insulation

Prostheses List by Category, Groups and Sponsor Page 51 of 920

CARDIO-THORACIC

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

SJ125 Tendril ST 1788T/TC and 1782TC Endocardial Bipolar Steroid-Eluting Active 40cm, 46cm, 52cm, 58cm, 65cm $1,248.00

Fixation Pacing Leads

SJ129 Tendril ST 1888TC and 1882TC Endocardial Bi-polar Steroid-Eluting 46-65cm $1,248.00

Active Fixation Pacing Leads

SJ151 OptiSense Model 1999 Active-Fixation Bipolar, Steroid Eluting, 40, 46 & 52cm $1,248.00

endocardial, atrial pacing lead with Optim

insulation

SJ238 Tendril STS 1988TC and 2088TC Endocardial Bi-polar Steroid-Eluting 46cm, 52cm and 58cm $1,248.00

Adtive Fixation Pacing Leads

Medtronic Australasia Pty Ltd

MC301 Model 3830 PACING LEADS Active fixation pacemaker lead 59 - 75 cm $2,600.00

Composition: Insulation is polyurethane,

Electrodes are Titanium Nitride coated

Platinum, the screw is steriod-coated

Group 9: Pacemaker/ICD Adaptors

Medtronic Australasia Pty Ltd

MC246 DF-I Y-Adaptor/Extender Model 6726 Silicone Lengths 25cm, 37cm $500.00

25cm & 37cm

MC778 Oscor Adaptor Adaptor for LV-1 lead to unipolar and 10cm, 17cm and 40cm $500.00

bipolar IS-1

MC832 Adaptor Kit Model 5866-24M, 5866- Silicone 14cm $500.00

40M, 5866-37M, Bipolar Lead Adaptor

Kit Model 2872

Prostheses List by Category, Groups and Sponsor Page 52 of 920

EAR, NOSE & THROAT

Minimum Maximum

Billing Code Product Name Description Size Benefit Benefit Notations

2.1.2 Cochlear Implants

2.1.2.4 Cochlear Implants - Implantable Auditory Stimulator - Generation 4

Boston Scientific Australia Pty Ltd

BS159 Harmony ™ HiResolution® Bionic Ear The HiRes 90K with HiFocus 1j Electrode Straight array (1j). 56.0mm (L) $12,570.00

System - HiRes 90K Implant Cochlear is the implanted component of the x 28.0mm (W) x 3.0mm (D)

Stimulator with HiFocus 1j Electrode HiResolution Bionic Ear System. It

receives information through an RF

transmission coil, processes the information

and then sends the resulting signal to an

electrode array implanted in the cochlea. It

consists of receiving/transmitting coil,

Stimulator electrodes and HiFocus 1j

Electrode array.

BS160 Harmony ™ HiResolution® Bionic Ear - The HiRes 90K with HiFocus Helix Helix (coiled) electrode array - $13,570.00

HiRes 90K Implant Cochlear Stimulator Electrode is the implanted component of 56.0mm (L) x 28.0mm (W) x

with HiFocus Helix Electrode the HiResoulution Bionic Ear System. It 3.0mm (D)

receives information through an RF

tranmission coil, precesses the information

and then sends the resulting signal to an

electrode array implanted in the cochlea. It

consists of receiving/transmitting coil,

Stimulator electronics and HiFocus Helix

Electrode array

Cochlear Limited

CO024 Nucleus Freedom Implant with Straight Speech processor and accessories - Initial One size only $12,570.00

Electrode

Pacing Importers Pty Ltd - Life Systems

PI011 Sonata Ti 100 Cochlear Implant Cochlear implant, titanium casing, 24 45.7mm length, width at coil $12,570.00

independent current sources, sequential 29.0mm, width at stimulator

and parallel stimulation modes up to 24.8mm, thickness at coil

50,074 pulses per sec, 19 or 24 oval- 3.7mm, thickness at stiulator

shaped platinium electrodes, different sizes 5.9mm. Standard Electrode -

length 31.5mm, spacing 2.4mm;

Medium - length: 20.9mm,

Spacing 1.9mm; Compressed

(short) - length 12.1mm, Electro

Prostheses List by Category, Groups and Sponsor Page 53 of 920

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Billing Code Product Name Description Size Benefit Benefit Notations

Electroacoustic, Hybrid Technology

Pacing Importers Pty Ltd - Life Systems

PI018 Sonata TI with FLEX EAS electrode Cochlear Implant with atraumatic electrode One size $12,570.00

specifically designed for partial deafness

& hearing preservation surgery

Hybrid Technology

Cochlear Limited

CO043 Nucleus Hybrid L 24 Implant A Nucleus Freedom cochlear implant One size $12,570.00 $13,570.00

featuring a special 16mm, 22 contact point

electrode array

Perimodiolar

Cochlear Limited

CO021 Nucleus Freedom Implant with Contour Model C124RE (CA), Generation 4 one size only $13,570.00

Advance Electrode Cochlear implant with perimodiolar

electrode array. Titanium casing,

removable magnet, 22 half-banded

platinum electrodes, moulded in a durable

silicone seal

CO046 Cochlear™ Nucleus® CI512 Cochlear Model CI512, 5th generation cochlear One Size $13,570.00

Implants with Contour Advance Electrode implant with perimodiloar electrode array.

Titanium casing, removable magnet, 22

half-banded platinum electrodes, moulded

in a durable silicone seal.

CO055 Cochlear Nucleus Cl513 cochlear Model Cl513, 5th generation cochlear One Size $13,570.00

implant with Contour Advance Electrode implant with enhanced perimodiolar

electrode array. Titanium casing,

removable magnet. 22 platinum

intracochlear electrodes, moulded with a

silicone elastomer carrier, and spaced over

a 15mm active array. Diameter of

electrodes: 0.8mm at the basal end,

tapering to 0.5mm at the apical electrode

band.

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Billing Code Product Name Description Size Benefit Benefit Notations

2.1.3 Speech Processors

2.1.3.4 Initial - Generation 4

Boston Scientific Australia Pty Ltd

BS161 Harmony™ HiResolution® Bionic Ear The Auria Harmony Processor is an Sound Processor Size 54 mm $11,500.00

System - Behind The Ear Sound external component of the HiRes Bionic (H) x 13mm (TH) x 21 mm

Processor - Auria Harmony Sound Ear System. This processor is intended to (w). Headpiece Diameter: 28.1

Processor (INITIAL Order) deliver HiResolution sound to a cochlear mm

implant by converting sound waves

(received via a microphone) into an

electrical signal which is then transmitted to

the implant via a headpiece. This listing

includes sound processor, headpiece,

earhooks, powercels, rechargers, cables

and essential accessories.

BS164 Harmony™ HiResolution® Bionic Ear The Platinum Sound Processor is a body PSP only one size; 2.69' x $11,500.00

System -Body worn sound processor - worn component of the HiRes Bionic Ear 2.19" x 0.81"

Platinum Series Processor (PSP) System. This processor is intended to Headpiece cable : options 18,

INITIAL Order deliver HiResolution sount to a cochlear 24, 32, 42 and 48 inches

implant by converting soundwaves

(received via a microphone in the Platinum

Headpiece) into an electrical signal that is

then transmitted to the implant via the

headpiece. This listing consists of the

sound processor, headpiece, connecting

cables, and essential accessory kit.

Cochlear Limited

CO022 Nucleus Freedom Speech Processor - Speech processor (modular) and One size only $11,500.00

Initial accessories

CO048 Cochlear™ Nucleus® CP810 Sound The ear level sound processor of the One size $11,500.00

Processor - INITIAL Nucleus 5 cochlear implant system with

multiple wearing options and a remote

control.

Prostheses List by Category, Groups and Sponsor Page 55 of 920

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Billing Code Product Name

Federal Register of Legislation - Australian Government

Primary content

Contents

1. Name of Rules

6. Benefits for prostheses provided as part of hospital treatment

8. Timing of applications to have a prosthesis listed