Federal Register of Legislation - Australian Government

Primary content

Rules/Other as made
These rules revoke the Private Health Insurance (Prostheses) Rules 2012 (No. 1) and list the kinds of prostheses in relation to the provision of which a benefit must be paid in the conditions and circumstances specified, and set out the minimum and where applicable, maximum benefit payable.
Administered by: Health
Registered 21 Aug 2012
Tabling HistoryDate
Tabled Senate22-Aug-2012
Tabled HR22-Aug-2012
Date of repeal 31 Aug 2013
Repealed by Private Health Insurance (Prostheses) Rules 2013 (No. 1)
Table of contents.

Private Health Insurance (Prostheses) Rules 2012 (No. 2)


I, Doug Fawns, delegate of the Minister for Health, make these Rules under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007

Dated 14 August 2012

 

 

_ _______

 

 

Doug Fawns

Assistant Secretary

Medical Benefits Division

Department of Health and Ageing



 


Contents

 

 

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.           Minister may have regard to recommendations and advice                        8

9.           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 2012 (No. 2).

2.              Commencement

These Rules commence on 30 August 2012.

3.              Revocation

These Rules revoke the Private Health Insurance (Prostheses) Rules 2012 (No.1).

4.              Definitions

In these Rules:

accredited podiatrist means a podiatric surgeon who holds specialist registration in the specialty of podiatric surgery under the National Law.

Note:         The registration requirements for an accredited podiatrist for the purposes of these Rules are the same registration requirements for podiatric surgeons as set out in rule 8 of the Private Health Insurance (Accreditation) Rules.

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.

National Law means:

(a)    for a State or Territory other than Western Australia — the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) as it applies (with or without modification) as law of the State or Territory; or

(b)    for Western Australia — the legislation enacted by the Health Practitioner Regulation National Law (WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.

Note:     The Intergovernmental Agreement for a National Registration and Accreditation Scheme for the Health Professions that was made on 26 March 2008 provides for the enactment of the State and Territory legislation mentioned in this definition.

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.

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.

Schedule means the Schedule in these Rules.

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

 


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 the 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 paragraphs (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 in 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 in 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 in 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 in 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.

9.               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. Minister may have regard to recommendations and advice

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.

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 List           August 2012

1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

1.1.1 - Aphakic

     1.1.1.1 - Rigid

                 Alcon Laboratories (Aust.) Pty Ltd

AL003           MTA2UO - MTA6UO                             PMMA                                                 +5 to +30 D  $156.00

                 Bausch & Lomb (Australia) Pty Ltd

BL005           Storz (Coburn) Intraocular Lens                   PMMA Anterior Chamber Intraocular              13.75mm length. 6.0mm   $156.00

                   121UV; L122UV PMMA Anterior               lens 1 piece                                             optic size, diopter range 3-

                   Chamber Lens                                                                                                  30d. L122UV: 6.0mm optic,

                                                                                                                                      13.75mm length, power

                                                                                                                                      range; 5.0 to 30.0 Diopters

                 Emagin Pty Ltd

EG009           Artisan Anterior Chamber                          Aphakia ModelComposition: PMMA              5.00mm Optic Diameter x   $156.00

                   Intraocular Lens                                                                                                8.5 in overall length

            ifc

                 AMO Australia Pty Ltd

AO019          Verisyse AC IOL                                   Aphakic Model                                        5mm Optic Diameter x 8.5   $250.00

                                                                                                                                      overall length

            m

                 AMO Australia Pty Ltd

AO001          Intraocular Lens: Model  AC 51L                 Duralens  PMMA, Anterior Chamber              6.00 mm Optic Diameter x   $198.00

                                                                            IOL                                                      13.0mm in overall length

1.1.2 - Phakic

     1.1.2.1 - Rigid

                 AMO Australia Pty Ltd

AO016          Verisyse AC IOL                                   Phakic Intraocular Lens: Model                      5mm Optic Diameter x 8.5   $680.00

                                                                            Myopia.  Composition: PMMA                     overall length; 6mm Optic

                                                                                                                                      Diameter x 8.5 overall

AO017          Verisyse AC IOL                                   Phakic Intraocular Lens: Model                      5mm Optic Diameter x 8.5   $680.00

                                                                            Hyperopia.  Composition: PMMA                  overall length

Prostheses List by Category, Groups and Sponsor                                                                                                               Page 1 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Emagin Pty Ltd

EG012           Artisan Anterior Chamber IOL                    Phakic Intraocular Lens Myopic /                    5.00mm Optic Diameter x   $680.00

                                                                            Hyperopic                                              8.5 in overall length;

            t1

                 AMO Australia Pty Ltd

AO030          Verisyse Toric (Custom)                           Phakic intraocular lens: Model toric                 5mm Optic Diameter x   $1,056.00

                                                                                                                                      7.5mm overall length

                 Emagin Pty Ltd

EG008           Artisan Anterior Chamber                          Phakic Intraocular Lens: Model Toric               5.00mm Optic Diameter x   $1,056.00

                   Intraocular Lens                                     Composition: PMMA                                 7.5 in overall length

            t2

                 AMO Australia Pty Ltd

AO029          Verisyse Toric (Custom)                           Phakic intraocular lens: Model toric                 5mm Optic Diameter x   $1,358.00

                                                                                                                                      7.5mm overall length

     1.1.2.2 - Foldable

                 Alcon Laboratories (Aust.) Pty Ltd

AL034           AcrySof Cachet Phakic Lens                      Anterior chamber foldable, acrylic,                  -6.0 to -16.5 diopters, in 0.5  $723.00

                                                                            single piece phakic lens                               diopter increments

                 AMO Australia Pty Ltd

AO025          VeriFlex Foldable Phakic IOL                     Anterior chamber foldable phakic                    -2  to -14.5d in 0.5d   $723.00

                                                                            silicone intraocular lens                               increments.  Overall

                                                                                                                                      diameter 8.5mm. Optic

                                                                                                                                      6.0mm

                 Emagin Pty Ltd

EG010           Artiflex Anterior Chamber                         Optic: Hydrophobic Polysiloxane.                   6mm optic diameter x 8.5 in   $723.00

                   Intraocular Lens                                     Haptic: PMMA                                        overall length

1.2.1 - Rigid

                 Alcon Laboratories (Aust.) Pty Ltd

AL002           Models MZ60BD, MC50BD, CZ70BD         Other:PMMA                                          Range of Powers:-10 to +34  $156.00

                                                                                                                                       D

Prostheses List by Category, Groups and Sponsor                                                                                                               Page 2 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Bausch & Lomb (Australia) Pty Ltd

BL006           Posterior chamber IOLS model                    PMMA Posterior Chamber lens 1                   12.25mm to 13.75mm   $156.00

                   P359 UV, P399 UV, 68 UV, 95                                                                             length. 5.5mm to 7mm optic

                   BUV, or lolab PC One Piece, model                                                                         size, diopter range -4.5 -

                   6741B, 8591B, 8191B; Model EZE-                                                                        45d to 10 - 34d; EZE-Fit

                                                                                                                                      65: 6.5mm optic, 13.35mm

                                                                                                                                      length, Power range: 10.0

                                                                                                                                      to 30.0 Diopter

1.2.2 - Foldable

     1.2.2.1 - Microincision

            at

                 Carl Zeiss Pty Ltd

CZ016           CT ASPHINA 409M                               ZEISS Micro Incision Aaspheric                    6mm optic, 11mm overall   $364.00

                                                                            (aberration neutral) IOL: Foldable,                  diameter. Diopter range 0.0

                                                                            square-edged, single piece IOL for                  to +32.0D (0.5D steps from

                                                                            capsular bag fixation                                  10.0 to 30.0D, 1.0D outside

                                                                                                                                       this range)

CZ017           CT ASPHINA 509M                               ZEISS Micro Incision Aspheric                     6mm Optic, 11mm overall   $364.00

                                                                            (aberration correcting) IOL: Foldable,              diameter. Diopter range 0.0

                                                                             square-edged, single piece IOL for                 to +32.0D (0.5D steps from

                                                                            capsular bag fixation                                  10.0 to 30.0D, 1.0D outside

                                                                                                                                       this range)

            at, pl

                 Bausch & Lomb (Australia) Pty Ltd

BL026           Akreos AO Micro Incision Lens                  Micro Incision, posterior chamber,                  6mm optic overall diameter   $374.00

                                                                            foldable acrylic, aphakic, anterior &                 11.0mm(10D-15D), 10.7mm

                                                                            posterior edge modification,                          (15.50-22D), 10.5mm

                                                                            preloaded, with aberration contro,                   (22.50-30D)

                 Carl Zeiss Pty Ltd

CZ028           CT ASPHINA 409MP                             Preloaded, micro incision, aspheric                  Diopter range: 0.0 to   $374.00

                                                                            (aberration neutral), foldable square-                32.0D; Optic size: 6.0mm;

                                                                            edged single piece inraocular lens for               Overall length: 11.0mm

                                                                            capsular bag fixation.

Prostheses List by Category, Groups and Sponsor                                                                                                               Page 3 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

            at, pl, t1

                 Carl Zeiss Pty Ltd

CZ031           AT TORBI 709MP (Standard                     Bitoric, preloaded, micro incision,                   Diopter range: Sph -10.0 to   $760.00

                                                                            aspheric (aberration neutral), foldable,              32.0, Cyl +1.0 to 6.5

                                                                             square-edged, single-piece IOL for                 Optic size: 6.0mm, Overall

                                                                            capsular bag fixation                                  length: 11.0mm

            at, pl, t2

                 Carl Zeiss Pty Ltd

CZ032           AT TORBI 709MP (high cyl)                     Bitoric, preloaded, micro incision,                   Diopter range: Sph -10.0 to   $1,061.00

                                                                            aspheric (aberration neutral), foldable,              32.0, Cyl +7.0 to 12.0,

                                                                             square-edged, single-piece IOL for                 Optic size: 6.0mm. Overall

                                                                            capsular bag fixation                                  Length 11.0mm

            at, t1

                 Carl Zeiss Pty Ltd

CZ020           AT TORBI 709M                                   STANDARD RANGE BITORIC -                 6mm optic, 11mm overall   $740.00

                                                                            ZEISS Micro Incision Aspheric                     diameter. Diopter range:

                                                                            (abberation neutral) IOL: Foldable,                  Sph -10.0 to +32.0D, Cyl

                                                                            square-edged, single piece IOL for                  +1.0 to 6.5D (all 0.5D

                                                                            capsular bag fixation

            t2, at

                 Carl Zeiss Pty Ltd

CZ027           AT TORBI 709M                                   HIGH CYLINDER BITORIC - ZEISS            6mm optic, 11mm overall   $1,041.00

                                                                            Micro Incision Aspheric (aberration                 diameter.  Diopter range:

                                                                            neutral) IOL: Foldable square edged,                Sph -10.0 to +32.0D, +7.0

                                                                            single piece IOL for capsular bag                    to 12.0D (all 0.5D steps)

                                                                            fixation

     1.2.2.2 - No edge modification

                 Ellex Australia Pty Ltd

XE002           Staar foldable silicone intraocular                  Polyimide haptics 6.3mm optic - low                14.0mm length  $281.00

                   lens: Model AQ 5010V                            diopters

            t1

                 Ellex Australia Pty Ltd

XE001           Staar Toric foldable silicone                        Plate haptics 6.0mm optic                             10.8mm - 11.2mm length  $579.00

                   intraocular lens: Model AA4203TF;

                    Model AA4203TL

Prostheses List by Category, Groups and Sponsor                                                                                                               Page 4 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

     1.2.2.3 - Edge modification

                 Alcon Laboratories (Aust.) Pty Ltd

AL004           Acrysof Multipiece Models                       Foldable Acrylic Multi-piece Lens                  -5 D to +30 D  $322.00

                   MA50BM, MA60AC

AL011           Acrysof Model SA60AT                           Foldable Acrylic Single-piece Lens,                 Range of Powers: +6 to +40 D  $322.00

                                                                            asymmetric optic/consistent edge

                 AMO Australia Pty Ltd

AO002          Sensar  AR40 Monofocal Acrylic                 Soft Acrylic, Foldable, UV                           6 mm Optic Diameter x   $322.00

                   IOL,  Sensar OptiEdge AR40e                    Absorbing, Posterior                                  13mm in overall length.     

                   Foldable Acrylic IOL

AO006          Clariflex, Model CLRFLXB                       Foldable Silicone IOL with OptiEdge               One size only  $322.00

                   Posterior Chamber Intraocular Lens              design

                 Bausch & Lomb (Australia) Pty Ltd

BL020           Akreos Adapt acrylic foldable                     Composition: Hydrophilic acrylic                    10.0 to 15.0 Diopter in 1.0   $322.00

                   posterior chamber intraocular lens                 polymer.  Packaged in lens folding                  Diopter increments15.0 to

                                                                            device in a sterile vial.  Four haptic                   25.0 Diopter in 0.5 Diopter

                                                                            design                                                   increments25.0 to 30.0

                                                                                                                                      Diopter in 1.0 Diopter

                                                                                                                                      increments

BL021           SoflexSE, Intraocular lenses,                       Composition: silicone, Lenses -                      Range of powers: 5.0 to   $322.00

                   Posterior Chamber                                  foldable, posterior chamber                           30.0 Diopter - Optic

                                                                            intraocular lenses                                      diameter 6.0mm; 13.0mm

                 Carl Zeiss Pty Ltd

CZ029           CT 53N                                               Foldable, 3-piece, monofocal, square-              Diopter range: 0.0 to 40.0,   $322.00

                                                                            edged, hydrophilic acrylic (with                      Optic size: 6.0mm, Overall

                                                                            hydrophobic surface properties)                     length: 13.0mm

                                                                            intraocular lens for capsular bag or

                                                                            sulcus fixation.

                 Device Technologies Australia Pty Ltd

DE398           Oculentis LENTIS L-302-1                        Foldable one-piece monofocal C loop               Optic Size 6.0mm, Overall   $322.00

                                                                            acrylic IOL.                                             Length 12.00mm. +-0.0D to

                                                                                                                                      +35.0D (1.0D steps) and

                                                                                                                                      +15.5D to +26.5D (0.5D

                                                                                                                                      steps).

Prostheses List by Category, Groups and Sponsor                                                                                                               Page 5 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Ellex Australia Pty Ltd

XE003           Staar foldable silicone IOLs:                       Plate haptics 6.0mm; Polymide                       10.8mm 0 13.5mm length  $322.00

                   Models AQ2010V, AQ2017V and               haptics 5.5 or 6.3mm optic;

                 Kevin Grundy (IBD) Pty Ltd

KG001          Rayner C-Flex                                       Hydrophilic HEMA-MMA                          5.75mm dia optic, 12.00mm   $322.00

                                                                            copolymer, foldable with injector                    dia overall

KG002          Superflex                                             Hydrophilic HEMA-MMA                          6.25mm dia optic, 12.5mm   $322.00

                                                                            copolymer, foldable with injector                    dia overall

            at

                 AMO Australia Pty Ltd

AO014          TECNIS™ Intraocular Lens (Z9002              Foldable Intraocular Lenses -                         5-10 dioptre in 1.0 dioptre   $364.00

                   & ZA9003)                                           Ultraviolet light absorbing posterior                 increments; 10.5 - 30

                                                                            chamber intraocular lenses,                           dioptre in 0.5 increments

                                                                            Silicone/Acrylic

AO024          Tecnis™ One Piece (ZCB00)                      One piece intraocular lens with edge                +6 diopters to +30 diopters   $364.00

                                                                            modification and 360 degree square                 in 0.5d increments

                                                                            edge

                 Bausch & Lomb (Australia) Pty Ltd

BL022           SofPort Advanced Optic (AO)                    Posterior chamber, foldable silicone                 0 D to 30.0 D  $364.00

                                                                            IOL with anterior optic-haptic square

                                                                            edge, posteriof optic-haptic square

                                                                            edge, 360-degree optic square edge

                                                                            and asperic optic for aberration control

BL023           Akreos Advanced Optic                            Posterior chamber, foldable acrylic                  0 D to 30.0 D  $364.00

                                                                            IOL, with anterior optic-haptic square

                                                                             edge, posterior optic-haptic square

                                                                            edge, 360 degree optic square edge

                                                                            and aspheric optic for aberration

BL030           enVista                                                The enVista, Model MX60, is an ultra-             Overall diameter 12.5mm,   $364.00

                                                                            violet-absorbing, posterior chamber,                optic body diameter 6.0mm

                                                                            hydrophobic acrylic one-piece                        in dioptric powers ranging

                                                                            intraocular lens (IOL)  Has an                        from +0.0 to +34D

                                                                            aspheric lens optic, square posterior                 0.0D to 10.0D in 1 Diopter

                                                                            edge, modified C haptics and available              increments

                                                                             in dioptric powers ranging from +0.0              11.0D to 30.0D in 0.5

                                                                            to +34.0D.                                              Diopter increments

                                                                                                                                      31.0D to 34.0D in 1

                                                                                                                                      Diopter increments

Prostheses List by Category, Groups and Sponsor                                                                                                               Page 6 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Carl Zeiss Pty Ltd

CZ030           CT ASPHINA 404                                 Small incision, foldable, single piece,               Diopter range: -10.0 to   $364.00

                                                                            monofocal, aspheric (aberration                      42.0, Optic size: 6.0mm,

                                                                            neutral), square-edged, hydrophilic                  Overall length: 11.0mm

                                                                            acrylic (with hydrophobic surface

                                                                            properties) intraocular lens for

                                                                            capsular bag fixation. (Monofocal lens

                                                                             for powers outside standard 409MP

                                                                            MICS range).

                 Device Technologies Australia Pty Ltd

DE399           Oculentis LENTIS L-312                          Foldable one-piece monofocal acrylic               Optic size 6.0mm, Overall   $364.00

                                                                            C Loop IOL                                            Length 12.00mm. Central

                                                                                                                                      Thickness 1.02mm

                                                                                                                                      (+22.0D). Available

                                                                                                                                      Diopters: -10.0D to35.0D

                                                                                                                                      (1.0D steps). +10.5D to

DE400           Oculentis LENTIS L-313                          Foldable one-piece monofocal acrylic               Optic size 6.0mm, Overall   $364.00

                                                                            plate haptic  IOL                                       Length 11.00mm. Available

                                                                                                                                      Diopters: +-0.0D to 35.0D

                                                                                                                                      (1.0D steps). +10.5D to

                                                                                                                                      29.5D (0.5D steps)

DE401           Oculentis LENTIS L-402                          Foldable three piece monofocal acrylic              Optic Size 6.0mm, Overall   $364.00

                                                                             IOL.                                                    Length 13.00mm. +-0.0D to

                                                                                                                                      +35.0D (1.0D) + 15.5D to

                                                                                                                                      +26.5D (0.5D). Minus range

                                                                                                                                       on demand.

                 IQ Medical

IQ004           Softec                                                 Acrylic, single piece, foldable                        Available in dioptric   $364.00

                                                                            intraocular lens with anterior and                    powers from -5.0 to +36.0,

                                                                            posterior optic-haptic square edge,                   1D steps: -5.0 to +10.0 and

                                                                            360 degree optic square edge design,                +31.0 to +36.0; 0.5D steps:

                                                                            precision power calculation and                      +10.5 to +18.0 and +25.0 to

                                                                            aberration technology                                 +29.5; 0.25D steps: +18.0

                                                                                                                                      to +25.0

IQ010           PreciSAL 302AC                                   Acrylic, single piece, foldable                        Available in dioptric   $364.00

                                                                            intraocular lens with anterior and                    powers from 0.0 to +30.0.

                                                                            posterior optic-haptic square edge,                   1D steps: 0.0 to +10.0;

                                                                            360 degree optic square edge design,                0.5D steps: +10.5 to + 17.5

                                                                            precision power calculation,                          and +28.5 to +30.0; 0.25D

                                                                            aberration technology and UV light                 steps: +18.0 to +28.0

Prostheses List by Category, Groups and Sponsor                                                                                                               Page 7 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Kevin Grundy (IBD) Pty Ltd

KG012          Rayner "C-Flex" and Superflex"                  Aspheric Intra Ocular Lenses with                  C-Flex -970C + 22.5D to   $364.00

                   Aspheric IOL                                        Amon-Apple enhanced 360 Degree                 +34D Superflex-920H - 10D

                                                                            square edge, Anti-vaulting Haptics                  to +22D

            at, pl

                 Ellex Australia Pty Ltd

XE004           Preloaded Aspheric Intraocular                    Silicone intraocular lens                               6.0mm  $374.00

            at, pl, t1, vblf

                 Design for Vision Pty Ltd

DV253          HOYA AF-1 351 Toric                            Preloaded injector system, correct                   IOL Power: + 10.0 to 30.0   $800.00

                   T3/T4/T5/T6/T7/T8/T9                             corneal astigmatism micro-incision,                 (0.5 steps), IOL Cylinder

                                                                            ashperic, blue-blocker, single piece                  power: 1.50D (351T3),

                                                                            hydophobic.                                            2.25D (351T4), 3.00D

                                                                                                                                      (351T5), 3.75D (351T6),

                                                                                                                                      4.50D (351T7), 5.25D

                                                                                                                                      (351T8), 6.00D (351T9)

            at, pl, vblf

                 Alcon Laboratories (Aust.) Pty Ltd

AL024           AcrySert model SN60WS                          Foldable Acrylic Single-piece Lens                  +6 to +30 D  $405.00

                                                                            with Blue light protection and

                                                                            aspheric correction, in cartridge.

AL031           AcrySert C Model SN6CWS                      Posterior chamber, UV absorbing,                  +6.0 to +30.0 D  $405.00

                                                                            foldable, acrylic, single piece lens

                                                                            with blue light protection and

                                                                            aspheric correction, in cartridge

                 Design for Vision Pty Ltd

DV250          Hoya-PS AF-1 (UY) PY-60AD                  Preloaded in cartridge, Aspheric, Blue              +6.0D to +30.0D (0.5D   $405.00

                                                                             blocker, Foldable, Single-Piece,

                                                                            Hydrophobic Acrylic

DV252          HOYA iSert® 251                                  Preloaded injector system, Micro-                   +6.0D to 30.0D (5 steps)  $405.00

                                                                            incision, Aspheric, Blue-Blocker,

                                                                            Single Piece, Hydrophobic

Prostheses List by Category, Groups and Sponsor                                                                                                               Page 8 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

            at, t1

                 AMO Australia Pty Ltd

AO031          TECNIS® Toric 1-Piece IOL                      1-piece IOL Posterior chamber                       +5.0 to +34.0 diopter   $740.00

                                                                            Intraocular lens, incorporates a                       powers in 0.5 diopter

                                                                            proprietary wavefront designed toric                increments.  Cylinder

                                                                            aspheric optic with a squared                         power: 1.00 diopter, 1.50

                                                                            posterior optic edge designed to                      diopter, 2.25 diopter, 3.00

                                                                            provide a 360 degree barrier. The edge             diopter and 4.00 diopter (as

                                                                             of the optic has a frosted design to                  measured at the IOL plane).

                                                                            reduce potential edge glare effects.                  Overall diameter 13mm,

                                                                                                                                      Optic size 6mm.

                 Bausch & Lomb (Australia) Pty Ltd

BL032           enVista Toric                                         The enVista toric (Model MX60T) is a             Overall diameter is 12.5mm   $740.00

                                                                            one-piece glistening-free                              for the entire lens power

                                                                            hydrophobic IOL. The enVista Toric,               range, with spherical

                                                                            model MX60T IOL has a Toric                      equivalent powers from +6.0

                                                                            aspheric lens optic, a square posterior                to +30.0 Diopters in 0.5

                                                                            edge and modified C haptics, an                     Diopter steps and cylinder

                                                                            overall diameter of 12.5mm and an                  powers of +1.25, +2.00 and

                                                                            optic body of 6.0mm.  It is available in             +2.75 Diopters (at the IOL

                                                                             multiple spherical and cylindrical                    plane).

                                                                            powers.

                 Device Technologies Australia Pty Ltd

DE390           Oculentis LENTIS Tplus LU-313T               Patient Specific: Foldable one-piece                 Optic Size 6.0mm, overall   $740.00

                                                                            monofocal toric acrylic IOL                          length 11.0mm. Sph +/-0.0D

                                                                                                                                       to +35.0D (in 0.01D

                                                                                                                                      increments) Cyl +0.25 to

                                                                                                                                      +6.99D cyl (in 0.01D

                                                                                                                                      increments)

DE397           Oculentis LENTIS Tplus LS-313                 Foldable one-piece monofocal toric                  Optic Size 6.0mm, Overall   $740.00

                   T1-T6                                                 acrylic IOL.                                             Length 11.00mm. Available

                                                                                                                                      diopters: +10.0D to +30.0D

                                                                                                                                       (0.5D). Cyl: (T1 +1.5D) (T2

                                                                                                                                       +2.25D) (T3 +3.0D) (T4

                                                                                                                                      +3.75D) (T5 +4.5D) (T6

                                                                                                                                      +5.25D)

Prostheses List by Category, Groups and Sponsor                                                                                                               Page 9 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

            at, t1, vblf

                 Device Technologies Australia Pty Ltd

DE392           Oculentis LENTIS LU-313-TY                   Patient Specific: Foldable one-piece                 Optic Size: 6.0mm, overall   $780.00

                                                                            monofocal toric acrylic IOL. Violet                  length 11.00mm. Sph +/-

                                                                            Light Filter                                              0.0D to +35.0D (in 0.01D

                                                                                                                                      increments) Cyl +0.25D to

                                                                                                                                      +6.99D cyl (in 0.01D

                                                                                                                                      increments)

            at, t2

                 Device Technologies Australia Pty Ltd

DE391           Oculentis LENTIS Tplus LU-313T               Patient Specific: Foldable one-piece                 Optic Size: 6.0mm, overall   $1,042.00

                                                                            monofocal toric acrylic IOL                          length 11.00mm. Sph +/-

                                                                                                                                      0.0D to +35.0D (in 0.01D

                                                                                                                                      increments) Cyl +6.99D to

                                                                                                                                      +12.0D cyl (in 0.01D

                                                                                                                                      increments)

            at, t2, vblf

                 Device Technologies Australia Pty Ltd

DE393           Oculentis LENTIS T plus LU-313-TY           Patient Specific: Foldable one-piece                 Optic Size: 6.0mm, overall   $1,084.00

                                                                            monofocal toric acrylic IOL. Violet                  length 11.00mm. Available

                                                                            Light Filter.                                             diopters: Cyl +7.00D to

                                                                                                                                      +12.0D inclusive in 0.01D

                                                                                                                                      increments.

            at, vblf

                 Alcon Laboratories (Aust.) Pty Ltd

AL021           Alcon AcrySof SN60WF                          Foldable Acrylic Single-piece Lens                  + 6.0 D to +30.0 D  $385.00

                                                                            with Blue Light Protection and

                                                                            Aspheric Correction

                 Bausch & Lomb (Australia) Pty Ltd

BL025           SofPort Advanced Optic (AO)                    Posterior chamber, aphakic, foldable                6mm optic 13mm overall   $385.00

                   Violet Shield                                         silicone, anterior & posterior edge                   lengthModified  C 5

                                                                            modification intraocular lens with                    degree angulation 0-30D,

                                                                            aberration technology, a violet light                 0.5D steps

                 Design for Vision Pty Ltd

DV247          HOYA AF-1  iMics1 NY-60                     Mini Incision, Aspheric, Blue-                       +6.0D to 30.0D (0.5 steps)  $385.00

                                                                            blocker, Single-piece, Hydrophobic

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 10 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Device Technologies Australia Pty Ltd

DE402           Oculentis LENTIS LS-312Y                      Foldable one-piece monofocal C Loop              Optic Size 6.0mm, Overall   $385.00

                                                                             Acrylic IOL. Violet Light filter.                     Length 12.0mm. Available

                                                                                                                                      Diopters: +-0.0D to 35.0D

                                                                                                                                      (1.0D steps) +15.5D to

                                                                                                                                      26.5D (0.5D steps).

DE403           Oculentis LENTIS LS-313Y                      Foldable one-piece monofocal acrylic               Optic Size 6.0mm, Overall   $385.00

                                                                            plate haptic IOL. Violet Light Filter                 Length 11.00mm. Available

                                                                                                                                      Diopters: +-0.0D to 35.0D

                                                                                                                                      (1.0D steps). +15.5D to

                                                                                                                                      26.5D (0.5D steps).

                 IQ Medical

IQ009           Softec HDY                                          Acrylic, single piece, foldable                        Available in dioptric   $385.00

                                                                            intraocular lens with anterior and                    powers from -5.0 to + 36.0,

                                                                            posterior optic-haptic square edge,                   1D steps: -5.0 to +10.0 and

                                                                            360 degree optic square edge design,                +31.0 to +36.0; 0.5D steps:

                                                                            precision power calculation,                          +10.5 to +18.0 and +25.0 to

                                                                            aberration technology and blue light                 29.5; 0.25D steps: + 18.0 to

                                                                                                                                       +25.0

IQ011           PreciSAL 302A                                     Acrylic, single piece, foldable                        Available in dioptric   $385.00

                                                                            intraocular lens with anterior and                    powers from 0.0 to +30.0.

                                                                            posterior optic-haptic square edge,                   1D steps: 0.0 to +10.0;

                                                                            360 degree optic square edge design,                0.5D steps: +10.5 to +17.5

                                                                            precision power calculation,                          and +28.5 to +30.0; 0.25D

                                                                            aberration technology and blue light                 steps: +18.0 to +28.0

            pl

                 Ellex Australia Pty Ltd

XE005           Staar KS-Xs Preloaded Acrylic                    Preloaded acrylic lens with anterior                  Optic diameter 6.0mm,   $332.00

                   Intraocular Lens                                     and posterior edge modification                      overall length 12.5mm,

                                                                                                                                      diopter range +10 to +28.0

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 11 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

            t1

                 Bausch & Lomb (Australia) Pty Ltd

BL028           Akreos Toric Astigmatism-                        Single piece, foldable, acrylic                         The overall diameter is 11   $698.00

                   Correcting Lens                                      intraocular lens with a toric optic on                 millimetres for the entire

                                                                            the posterior surface and axis marks on             lens power range (spherical

                                                                             the posterior optic's flat meridian.                   equivalent powers from

                                                                                                                                      +10.0 to +30.0 diopters in

                                                                                                                                      0.5 diopter steps and

                                                                                                                                      cylinder powers of +1.25,

                                                                                                                                      +2.00 & +2.75 diopters).

                 Kevin Grundy (IBD) Pty Ltd

KG003          Rayner Standard Toric C-Flex                     Hydrophilic HEMA-MMA                          5.00mm dia optic, 12.00mm   $698.00

                                                                            copolymer, foldable with injector                    dia overall, cyls 2.0D to

                                                                                                                                      6.0D in 2D increments

            t1, at, vblf

                 Alcon Laboratories (Aust.) Pty Ltd

AL032           AcrySof IQ Toric IOL                              Posterior chamber, UV absorbing,                  +6 to +30 D spherical; 1.00   $780.00

                                                                            foldable, acrylic, toric, single piece                  to 6.00 D cylinder.

                                                                            lens with blue light protection and

                                                                            aspheric correction

                 Design for Vision Pty Ltd

DV251          HOYA AF - 1 311 Toric T3/T4/T5               Correct Corneal Astigmatism, Micro-               lOL Power: 6.0D to 30.0D   $780.00

                                                                            incision,Aspheric, Blue-Blocker,                    (0.5 steps)lOL Cylinder

                                                                            Single Piece, Hydrophobic                           Power: 1.50D (311T3),

                                                                                                                                      2.25D (311T4), 3.00D

                                                                                                                                      (311T5)

            t1, vblf

                 Alcon Laboratories (Aust.) Pty Ltd

AL023           Alcon AcrySof Toric PC IOL Models           Posterior chamber, UV absorbing,                  +6 to +34 D spherical; 1.50   $740.00

                                                                            foldable, acrylic, toric, single piece                  to 6.00 D cylinder

                                                                            lens with blue light protection

            t2

                 Kevin Grundy (IBD) Pty Ltd

KG004          Rayner Premium Toric C-Flex                     HEMA-MMA copolymer, foldable                 5.75mm dia optic, 12.00mm   $1,000.00

                                                                            with injector                                            dia overall, cyls 1.5D to

                                                                                                                                      11.0D in 0.5D increments

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 12 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

KG013          Rayner Super Premium Toric I.O.L.              Acrylic foldable toric single piece                    -10.0D to 0.00D Sphere: 1D  $1,000.00

                                                                                                                                       to 11.00D Cylinder in 0.25

                                                                                                                                      steps                                           

                                                                                                                                                     +31.00D to +35.00

                                                                                                                                      Spit: 1D to 11.00D

                                                                                                                                      Cylinder in 0.25steps

            vblf

                 Alcon Laboratories (Aust.) Pty Ltd

AL016           Alcon Acrysof Natural Model                     Foldable Acrylic Single-piece Lens,                 +6 to +40D  $364.00

                   SN60AT                                              asymmetric optic/consistent edge,

                                                                            with blue light protection

AL025           AcrySof Multipiece Models                        Foldable Acrylic multi-piece Lens                   - 5 D to + 30 D  $364.00

                   MN60MA, MN60AC                              with Blue light Protection

     1.2.2.4 - Multifocal or bifocal

                 AMO Australia Pty Ltd

AO020          ReZoom Acrylic Multifocal                        Acrylic, foldable, posterior chamber,                6.0mm Optic Diameter x   $780.00

                   Intraocular Lens                                     intraocular lens                                         13.0mm overall length

            at

                 AMO Australia Pty Ltd

AO026          TECNIS™ Multifocal Intraocular                 Posterior chamber lens with UV light-              +5 diopters to +34 diopters   $822.00

                   Lens (ZMA00)                                      absorbing, foldable acrylic, 3-piece                  in 0.5d increments

                                                                            with a diffractive posterior optic and a

                                                                             modified anterior surface technology

                                                                            with edge modification and 360

                                                                            degree square edge.

AO027          Tecnis Multifocal 1-Piece Lens,                   A multifocal posterior chamber lens                 6.0mm Optic Diameter x   $822.00

                   Model ZMB00                                       with UV-blocking, foldable acrylic, 1-              13.0mm in overall length. 

                                                                            piece with a diffractive posterior optic              +5.0 Diopter to +34.0

                                                                             and a modified anterior surface                      Diopter in 0.5 Diopter

                                                                            technology with edge modification                  increments.

                                                                            and a 360 degree square edge.

                 Carl Zeiss Pty Ltd

CZ015           AT LISA 809M                                     ZEISS micro incision, aspheric                      6mm optic, 11mm diameter.    $822.00

                                                                            multifocal IOL.  Diffractive bifocal                  Diopter range 0.0D to

                                                                            anterior surface with asymmetric light               +32.0D (0.5D steps)

                                                                            distribution (65% distance / 35%

                                                                            near), 3.75D addition for near focus.

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 13 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Device Technologies Australia Pty Ltd

DE396           Oculentis LENTIS Mplus LS-313                Foldable one-piece multifocal plate                  Overall Length 11.0mm and   $822.00

                                                                            haptic acrylic IOL.                                     Optic Size 6.0mm Available

                                                                                                                                      diopters +-0.0D to +36.0D

                                                                                                                                      (0.05D steps)

                 Kevin Grundy (IBD) Pty Ltd

KG009          Rayner "M-Flex" Mulitfocal                       Acrylic, Foldable, Single piece multi-               6.5mm Optic-Overall   $822.00

                   Foldable IOL                                         zoned refractive aspheric multifocal                 diameter 12.5mm: +3D or +

                                                                            with Amon-Apple 360 Degree Square              4D Addition: +14D to

                                                                            edge, Anti Vaulting Haptics                          +25D in 1.0D increments:

                                                                                                                                      +8.5D to +23.5D in 0.5D

            at, pl

                 Carl Zeiss Pty Ltd

CZ033           AT LISA 809MP                                   Preloaded, micro incision, aspherical                Diopter range: 0.0 to 32.0  $842.00

                                                                            bifocal, square edged, single-piece                   Optic size: 6.0mm.  Overall

                                                                            IOL for capsular bag fixation. The                   length: 11.0mm

                                                                            anterior aspheric bifocal surface has an

                                                                             asymmetric light distribution 65/35

                                                                            for distance/near vision, and 3.75D

                                                                            add for the near focus.

CZ034           AT LISA tri 839MP                                Trifocal (aspheric) micro incision,                   Diopter range: 0.0 to   $842.00

                                                                            single-piece IOL for capsular bag                    +32.0D (0.5D increments).

                                                                            fixation, implantable with preloaded                 Optic size: 6.0mm. Overall

                                                                            injector system.  The trifocal (anterior)              Length: 11.0mm

                                                                             optic provides two diffractive focal

                                                                            points (+3.33D near focus and +1.66D

                                                                             intermediate focus) with asymmetric

                                                                            light distribution 50% distance / 20%

                                                                             intermediate / 30% near vision.

            at, pl, t1

                 Carl Zeiss Pty Ltd

CZ035           AT LISA toric 909MP                             ZEISS pre-loaded, micro incision,                   6mm optic, 11mm diameter.   $1,218.00

                                                                            multifocal toric IOL. Aspheric toric                 Diopter range: Sph +6.0D

                                                                            anterior surface, diffractive bifocal                   to 24.0D, Cyl +1.0 to 4.0D

                                                                            posterior surface with asymmetric                   (all 0.5D steps)

                                                                            light distribution (65% distance/ 35%

                                                                             near), and 3.75D addition for near

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 14 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

            at, t1

                 AMO Australia Pty Ltd

AO033          Tecnis Multifocal Toric                             Toric Multifocal Intraocular Lens                    +5.0 Diopters to +34.0   $1,198.00

                                                                                                                                      Diopters in 0.5 Diopter

                                                                                                                                      increments.  Cylinder

                                                                                                                                      powers 1.50D, 2.25D,

                                                                                                                                      3.00D and 4.00D

                 Device Technologies Australia Pty Ltd

DE388           Oculentis LENTIS Mplus Toric LU-             Patient specific one-piece multifocal-                Overall Length 11.0mm and   $1,198.00

                   313MFT                                              toric plate haptic acrylic IOL                         Optic Size 6.0mm + 0.0D to

                                                                                                                                      +36.0D inclusive in 0.01D

                                                                                                                                      increments. Cyl +0.25 to

                                                                                                                                      +6.99D inclusive in 0.01D

                                                                                                                                      increments

            at, t1, vblf

                 Device Technologies Australia Pty Ltd

DE394           Oculentis LENTIS Mplus Toric LU-             Patient specific one-piece multifocal-                Overall Length 11.0mm and   $1,240.00

                   313 MF30TY                                        toric plate haptic acrylic IOL.                         Optic Size 6.0mm, +-0.0D to

                                                                                                                                       +36.0D inclusive in 0.01D

                                                                                                                                      increments. Cyl +0.25D to

                                                                                                                                      +6.99D inclusive in 0.01D

                                                                                                                                      increments.

            at, t2

                 Device Technologies Australia Pty Ltd

DE389           Oculentis LENTIS Mplus LU-                    Patient specific one-piece multifocal-                Overall Length 11.0mm and   $1,500.00

                   313MFT                                              toric acrylic plate haptic IOL                         Optic size 6.0mm +-0.0D to

                                                                                                                                      +36.0D inclusive in 0.01D

                                                                                                                                      increments. Cyl +6.99D to

                                                                                                                                      +12.0D inclusive in 0.01D

                                                                                                                                      increments

            at, t2, vblf

                 Device Technologies Australia Pty Ltd

DE395           Oculentis LENTIS Mplus LU-313                Patient specific one-piece multifocal                 Overall Length 11.00mm   $1,542.00

                   MFTY                                                toric plate haptic acrylic IOL. Violet                 and Optic Size 6.0mm +-

                                                                            Light Filter                                              0.0D to +36.0D inclusive in

                                                                                                                                       0.01D increments.  Cyl

                                                                                                                                      +7.00D to +12.0D inclusive

                                                                                                                                       in 0.01D increments.

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 15 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

            at, vblf

                 Alcon Laboratories (Aust.) Pty Ltd

AL028           AcrySof IQ ReSTOR SN6AD3                  Posterior Chamber, UV absorbing,                  +6 D to + 34 D  $864.00

                                                                            foldable, acrylic, single piece lens

                                                                            with apodised diffractive optic and

                                                                            blue light protection

AL030           AcrySof IQ ReSTOR SN6AD1,                  Posterior Chamber, UV absorbing,                  +6 D to + 34 D  $864.00

                   SN6AD2 and MN6AD1                           foldable, acrylic, single piece lens

                                                                            with apodised diffractive optic and

                                                                            blue light protection

                 Design for Vision Pty Ltd

DV248          HOYA PY-60MV                                  Preloaded in cartridge, Multifocal,                   +14.0D to 27.0D (0.5 steps)  $864.00

                                                                            Aspheric, Blue-blocker, Single Piece,

                                                                            Hydrophobic

            t1, at

                 Carl Zeiss Pty Ltd

CZ025           AT LISA toric 909M                               ZEISS micro incision, multifocal toric              6mm optic, 11mm diameter.    $1,198.00

                                                                            IOL (standard cyl range). Aspheric                  Diopter range: Sph -10.0D

                                                                            toric anterior surface, diffractive                     to +32.0D, Cyl +1.0 to 6.5D

                                                                            bifocal posterior surface with                          (all 0.5D steps)

                                                                            asymmetric light distribution (65%

                                                                            distance / 35% near), 3.75D addition

                                                                            for near focus.

                 Kevin Grundy (IBD) Pty Ltd

KG010          Rayner M-Flex Toric (Standard)                  Acrylic, Foldable, Single Piece,                      5.75mm / 12.0mm: 6.25mm /   $1,198.00

                                                                            Multi-zoned Refractive Aspheric                    12.5mm +3.00D or +4.00D

                                                                            Toric Mulitfocal with Amon-Apple                 Addition FAR: +14.0D to

                                                                            enhanced 360 degree Square edge,                  +32.00D in 0.5 STEPS:

                                                                            Anti Vaulting Haptics                                 +2.00D +3.00D  +4.00D

                                                                                                                                      Cylinder. NEAR: +14.0D to

                                                                                                                                       27.0D in 0.5 STEPS:

                                                                                                                                      +2.00D +3.00D  +4.00D

                                                                                                                                      Cylinder

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 16 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

KG011          Rayner "M-Flex" Toric (Non                      Acrylic, Foldable, Single Piece, Muli-              5.75/12.0mm: 6.25/12.5mm   $1,198.00

                   Standard)                                             Zoned Refractive, Toric Multifocal                  +3.00D to +4.00D Addition

                                                                            with Amon-Apple enhanced 360                     FAR: +14.0D to +32.0D in

                                                                            Degree square edge, Anti-vaulting                   0.5D Increments: NEAR:

                                                                            Haptics, Patient Specific.                             +14.0D to +27.0D in 0.50D

                                                                                                                                      Increments Cylinder: 1.0D

                                                                                                                                      to 1.5D and 2.5D to 6.00D

                                                                                                                                      in 0.5 increments

            t1, at, vblf

                 Alcon Laboratories (Aust.) Pty Ltd

AL033           AcrySof IQ ReSTOR multifocal toric            Posterior chamber UV absorbing                    +6  to +34 D spherical; 1.00  $1,240.00

                    IOL                                                   foldable, acrylic, aspheric, toric single              to 3.00 D cylinder

                                                                             piece lense with apodised diffractive

                                                                            optic and blue light protection.

            t2, at

                 Carl Zeiss Pty Ltd

CZ024           AT LISA toric 909M                               ZEISS micro incision, multifocal toric              6mm optic, 11mm diameter.    $1,500.00

                                                                            IOL (high cyl range). Aspheric toric                Diopter range: Sph -10.0D

                                                                            anterior surface, diffractive bifocal                   to +32.0D, Cyl +7.0 to

                                                                            posterior surface with asymmetric                   12.0D (all 0.5D steps)

                                                                            light distribution (65% distance /

                                                                            35% near), 3.75D addition for near

     1.2.2.5 - Accommodative

            at, pa, t1

                 Bausch & Lomb (Australia) Pty Ltd

BL031           Crystalens Toric                                     The Crystalens Toric IOL, Models                  Overall diameter is 11.5mm   $1,198.00

                                                                            BL1AT/BL2AT and BL1UT/BL2UT               (BL1AT/BL1UT) or 12.0mm

                                                                            is an accommodating IOL                              (BL2AT/BL2UT) for the

                                                                            incorporating a toroidal posterior                    entire lens power range.

                                                                            surface. The Crystalens toric IOL has a             Spherical equivalent

                                                                             square posterior edge with polyimide              powers range from +5.0 to

                                                                             footplates and is available in multiple               +33.0 Diopters in 0.5

                                                                             spherical and cylindrical powers.                   Diopter steps and cylinder

                                                                                                                                      powers of +1.25, +2.00 and

                                                                                                                                      +2.75 Diopters (at the IOL

                                                                                                                                      plane).

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 17 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

            pa

                 Bausch & Lomb (Australia) Pty Ltd

BL027           Crystalens HD                                       Accommodating lens with > 3                       10.0 to 33.0 Dioptres in .05   $780.00

                                                                            Dioptres of accommodation with dual               Dioptre steps

                                                                            mechanism of action: (1) forward axial

                                                                            movement of lens and (2)

                                                                            accommodative arching of optic. 

                                                                            Posterior chamber, polyspheric

                                                                            optics, 3-piece, plate haptic, foldable

                                                                            UV light filtering, bic

                 IQ Medical

IQ003           Tetraflex                                              Acrylic single piece, foldable                         Available in dioptric   $780.00

                                                                            accommodating intraocular lens with                powers from +5.0 to +36.0,

                                                                            sqare edge design, custom control                   1D steps: +31.0 to +36.0;

                                                                            precision and closed loop haptic                     0.5D steps: +5.0 to +18.0

                                                                                                                                      and +25.0 to +30.0; 0.2D

                                                                                                                                      steps; +18.0 to +25.0

            pa, at

                 Bausch & Lomb (Australia) Pty Ltd

BL029           Crystalens AO                                       Accommodating lens designed to                    10.0 to 33.0 D in 0.50   $822.00

                                                                            provide > 3 Diopters of                               Diopter steps.  10.0 - 16.5

                                                                            accommodation with dual mechanism               Diopters (12mm length) and

                                                                            of action: (1) forward axial movement               17.0 - 33.0 Diopters

                                                                            of lens and (2) accommodative arching             (11.5mm length).

                                                                             of optic.  Posterior chamber, aspheric,

                                                                            aberration free optics, 3-piece, plate

                                                                            haptic, fol

            pa, pl

                 AMO Australia Pty Ltd

AO028          Synchrony Accommodating IOL                  Synchrony Dual Optic                                5.50mm Anterior Optic,   $800.00

                                                                            Accommodating Posterior Chamber                 6.00mm Interior Optic,

                                                                                                                                      9.80mm Overall Length,

                                                                                                                                      Diopter Range: +16.00 to

                                                                                                                                      +28.00 in 0.5D Increments

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 18 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

1.2.3 - Pseudo-phakic, piggy-back

     1.2.3.1 - Monofocal

                 Design for Vision Pty Ltd

DV246          Rayner Sulcoflex Ashperic                         Pseudophakic Supplementary                        -10.0D to -5.50D in 0.5D   $323.00

                   (Premium) I.O.L.                                    I.O.L.O.L.                                              increments.                +5.50D

                                                                                                                                      to 10.00D in 0.5D

            at

                 Kevin Grundy (IBD) Pty Ltd

KG008          Rayner "Sulcoflex" Pseudophakic                 Sulcoflex Aspheric Pseudophakic I.O.L            -5D to +5D  $365.00

                   I.O.L.

            t1, at

                 Kevin Grundy (IBD) Pty Ltd

KG005          Rayner Sulcoflex Aspheric Toric                  Acrylic, Aspheric, Toric                              SE -3 to +3 in 0.5 D steps  $698.00

                   Pseudophakic Secondary I.O.L -                  Pseudophakic Secondary IOL :                      Cyl +1 to +3 in 1D steps

                   Standard                                              Sulcus fixated with undulating

                                                                            Haptics and Posterior Haptic

KG007          Rayner Sulcoflex Aspheric Toric                  Acrylic, Aspheric, Toric                              SE -6.00 to +6.00 in 0.5 D   $698.00

                   Pseudophakic Secondary IOL                     Pseudophakic Secondary IOL: Sulcus              steps Syl +1.00 to +6.00 in

                   (Premium)                                            fixated with undulating Haptics and                0.5D steps

                                                                            Posterior Haptic Angulation

     1.2.3.2 - Multi-focal

            at

                 Kevin Grundy (IBD) Pty Ltd

KG006          Rayner "Sulcoflex" Aspheric Multi-              Acrylic, Aspheric Multi-focal                        6.5mm / 13.5mm -   $822.00

                   focal Pseudophakic Secondary IOL               Pseudophakic Secondary IOL:                       5.00D+5.00D sphere with 

                                                                            Sulcus-Fixated with Undulating                     + 3.00 Addition

                                                                            Haptics and Posterior Haptic

            at, t1

                 Design for Vision Pty Ltd

DV254          Rayner Premium Sulcoflex                         653Z-Premium Multifocal Toric                     -7D to +7D (Spherical   $1,198.00

                   Multifocal Toric Supplementary IOL             Supplementary IOL                                   Equivalent) Cylinder 1D,

                                                                                                                                      4D, 5D, 6D Addition 3.5D

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 19 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

DV255          Rayner Standard Sulcoflex                         653Z-Standard Multifocal Toric                     -3D to +3D (Spherical   $1,198.00

                   Multifocal Toric Supplementary IOL             Supplementary IOL                                   Equivalent) Cylinders 2D

                                                                                                                                      and 3D Addition 3.5D

1.3.1 - Viscoelastic

                 Alcon Laboratories (Aust.) Pty Ltd

AL006           PROVISC VISCOELASTIC                      PROVISC contains sodium                          0.85mL pack  $80.00

                   SOLUTION

AL007           VISCOAT Viscoelastic Fluid                     Chondroitin sulfate and sodium                      0.75mL  $80.00

                                                                            hyaluronate

AL015           Cellugel viscoelastic fluid                          Hypromellose 2%                                     .  $80.00

AL029           DisCoVisc Ophthalmic                             Sodium hyaluronate 17 mg/mL and                 0.5 mL and 1.0 mL  $80.00

                   Viscosurgical Device                               chondroitin sulfate 40mg/mL

                 AMO Australia Pty Ltd

AO008          Healon, Intraocular Viscoelastic                   Sodium Hyaluronate 10mg/ml                       Healon 0.4ml, 0.55ml &   $80.00

                                                                                                                                      0.85ml

AO032          Healon Endocoat                                    Viscoelastic                                             0.85ml  $80.00

                 Bausch & Lomb (Australia) Pty Ltd

BL008           Ocucoat Intraocular Fluid                          20mg/mL hydroxypropylmethyl                     1mL sterile  $80.00

                                                                            cellulose for intraocular use

BL015           Amvisc Plus injection                               15mg/mL Sodium Hyaluronate for                  0.5mL and 0.8mL  $80.00

                                                                            intraocular use

                 Carl Zeiss Pty Ltd

CZ012           Z-HYALIN Viscoelastic                           Cohesive Viscoelastic Solution -                     Volume 1.0ml  $80.00

                                                                            sodium hyaluronate 10mg/ml. 

                                                                            (previously called Ophthalin)

CZ013           Z-HYALIN Plus Viscoelastic                     Cohesive Viscoelastic Solution -                     Volume 1.0ml  $80.00

                                                                            sodium hyaluronate 15mg/ml. 

                                                                            (previously called Opthalin Plus)

CZ022           VISTHESIA 1.5%                                  VISCOANAESTHETIC syringe                    0.8ml syringe & 2x0.3ml   $80.00

                                                                            contains sodium hyaluronate (NaHA,               ampoules

                                                                            1.5%) and lidocaine hydrochloride

                                                                            (1%). Also contains two topical

                                                                            ampoules with NaHA (0.3%) and

                                                                            lidocaine (2%)

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 20 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 IQ Medical

IQ002           Ocuvis and Ocumax 2%                            20mg/mL hydroxypropylmethyl                     2mL sterile  $80.00

                   Hydroxypropylmethylcellulose                    cellulose for intraocular use. Pre-

                                                                            loaded in a sterile syringe with one

                                                                            cannula for injection, in a sterile

                                                                            Tyvek pouch

            hmw

                 AMO Australia Pty Ltd

AO009          Healon 5, Intraocular Viscoelastic                 HEALON5- Sodium hyaluronate                    0.6ml  $85.00

                   Fluid                                                  23mg/ml .

AO010          Healon GV Intraocular Viscoelastic               Sodium Hyaluronate 14mg/mL                      0.5mm and 0.85ml  $85.00

                   Fluid

     1.3.1.1 - Dual Fluids

                 Alcon Laboratories (Aust.) Pty Ltd

AL005           DUOVISC VISCOELASTIC SYSTEM        PROVISC contains sodium                          Small & large packs  $110.00

                                                                            hyaluronate, VISCOAT contains

                                                                            chondroitin sulfate and sodium

                                                                            hyaluronate

                 Carl Zeiss Pty Ltd

CZ019           TWINVISC Viscoelastic                           TWINVISC includes a cohesive and a              Total volume 1.4 ml  $110.00

                                                                            dispersive viscoelastic in one

                                                                            syringe, separated by a valve. 

                                                                            Dispersive: sodium hyaluronate

                                                                            (2.2%).  Cohesive: sodium

1.3.2 - Non Viscous

                 Design for Vision Pty Ltd

DV231          Vision Blue                                          Trypan blue dye for ophthalmic                      0.5ml syringe  $48.00

                                                                            applications

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 21 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

1.4.1 - Simple

                 Alcon Laboratories (Aust.) Pty Ltd

AL001           Capsular Tension Rings                            -                                                          10.0 - 12.0 compressed,    $159.00

                                                                                                                                      12.3 - 14.5 uncompressed

                 AMO Australia Pty Ltd

AO021          Stabileyes Capsular Tension Ring                 Polymethylmethacrylate (PMMA)                   12mm ring, and 13mm ring  $159.00

                                                                            Implant

                 Carl Zeiss Pty Ltd

CZ002           Tensiobag: Capsular Tension Ring                PMMA                                                 Diameter 10 - 14mm  $159.00

                 Design for Vision Pty Ltd

DV009          Morcher Capsular Tension Ring                  PMMA Implant                                        14, 14A, 14C  $159.00

                 Emagin Pty Ltd

EG001           Capsular Tension Rings Clear                     PMMA Implant                                        10/08, 12/10, 13/11mm  $159.00

            pl

                 Design for Vision Pty Ltd

DV029          Eyejet CRT                                           Capsular tension ring made of PMMA             14 (10mm), 14C (11mm),   $243.00

                                                                            per-load on disposable injector                       14A (12mm)

                 Insight Surgical Pty Ltd

IS001            Preloaded Capsulan Tension Ring                Capsular tension ring preloaded                      13/11mm  $243.00

                                                                            (acrylic)

1.4.2 - Complex

                 Design for Vision Pty Ltd

DV010          Morcher Coloboma Diaphram                     PMMA Implant                                        96G, 96L  $334.00

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 22 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

1.5.1 - Long Tube

                 AMO Australia Pty Ltd

AO012          Baerveldt Glaucoma Implant BG                  Non-valved artificial drainage device,               Surface area 250, 350,   $425.00

                   101-350, Baerveldt Glaucoma                     composition silicone - smooth,                       425mm2

                   Implant BG 103-425, Baerveldt                   tumble-polished finish

                   Glaucoma Implant BG 103-250

                 Design for Vision Pty Ltd

DV020          Molteno Implant                                     Double plate - dual chamber                          One size only  $425.00

DV242          Molteno Implant                                     Glaucoma Drainage Device - Single                 N/A  $425.00

                                                                            Plate/Single Plate-Dual

                                                                            Chamber/Double Plate

            v

                 Design for Vision Pty Ltd

DV230          Molteno 3                                            Drainage implant for glaucoma, made               2 Sizes: *230 mm square   $625.00

                                                                            of silicon                                                *175mm square

1.5.2 - Short Tube

     1.5.2.1 - Cannulated

                 Alcon Laboratories (Aust.) Pty Ltd

AL037           ExPress Minature Glaucoma Shunt               Miniature Glaucoma Shunt                           50 & 200 microns  $715.00

1.6.1 - Spacers

                 Spectrum Surgical

SO017           FCI Ptose-up                                         Expanded PTFE                                       15cm long x 2 or 3mm wide   $348.00

                                                                                                                                      x 0.35mm thick

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 23 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

1.6.2 - Weights

     1.6.2.1 - Gold <1.8 grams

                 Device Technologies Australia Pty Ltd

DE183           Lid Load Gold Eyelid Weights;                    Gold                                                     0.6, 0.8, 1.0, 1.2, 1.4, 1.6   $425.00

                                                                                                                                      grams

     1.6.2.2 - Gold ≥1.8 grams

                 Device Technologies Australia Pty Ltd

DE182           Lid Load Gold Eyelid Weights;                    Gold                                                     1.8, 2.0, 2.2, 2.4, 2.6, 2.8   $800.00

                                                                                                                                      grams

     1.6.2.3 - Platinum

                 CoreMed Pty Ptd

RC001           LIDCHAIN Platinum Eyelid Implant             Platinum                                                Weights - 0.8, 1.0, 1.2, 1.4,   $1,300.00

                                                                                                                                      1.6, 1.8 grams

1.7.1 - Intracanilicular

                 Design for Vision Pty Ltd

DV022          Eyetec DCR Tubes                                  Stainless steel, silicone tubing,                       30cm  $135.00

                                                                            Bodkin lacrimal intubation set

DV241          Eyetec DCR Tubes                                  Crawford and Cannaliculus                           N/A  $135.00

                                                                            Intubation Sets

                 Device Technologies Australia Pty Ltd

DE191           Canaliculus Intubation Sets                         Silicone, SS & Nylon                                 17.7 x .064 x 29cm, 15.5 x   $135.00

                                                                                                                                      .051 x 33cm

DE278           BD Visitec Lacrimal Intubation Sets              Stainless steel probes with solid                     1. Probes 0.90mm x 4.5cm,   $135.00

                                                                            silicone rods or silicone tubing -                     rod 40cm x 0.80mm. 2.

                                                                            packaged sterile                                        Probes 0.40mm x 11cm,

                                                                                                                                      tubing 35cm x 0.64mm.

                                                                                                                                      Probes 0.60mm x 11mm,

                                                                                                                                      tubing 35cm x 0.30mm.

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 24 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Spectrum Surgical

SO021           FCI Lacrimal Intubation Set                        PVP Coated Silicone Tubing/PVP                  PVP Bika: 0.64mm O.D.   $135.00

                                                                            Coated Silicone Plug/Metal                           Tube/80 x 0.8mm probes,

                                                                            Probes/Polypropylene Thread                        PVP Differential Bika: 0.64

                                                                                                                                      & 1.18mm O.D. Tube/40 x

                                                                                                                                      1.2mm probes, PVP Bika for

                                                                                                                                      DCR: 0.94mm O.D. Tube/50

                                                                                                                                       x 0.8mm probes, PVP Infant

                                                                                                                                      Bika 0.64mm O.D. Tube/55

                                                                                                                                      x 0.7mm probes, PVP Infant

                                                                                                                                      Bika II: 0.64mm O.D. Tube/

SO043           FCI Bi-Canalicular Lacrimal                       Silicone tubing swaged, imbedded                   Probes: 40mm to 120mm x   $135.00

                   Intubation Set                                        into or around malleable and flexible                0.7mm to 1.2mm.  Tube:

                                                                            stainless steel probes. PEEK thread.                 0.64mm to 1.18mm x 25mm

                                                                                                                                      to 400mm.  PEEK Thread:

                                                                                                                                      0.2mm to 0.4mm x 500mm.

            mc

                 Spectrum Surgical

SO044           FCI Mono-Canalicular Lacrimal                   Silicone tubing with plug swaged,                   Probes: 40mm to 120mm x   $180.00

                   Intubation Set                                        imbedded into or around malleable or               0.7mm to 1.2mm.  Tube:

                                                                            flexible stainless steel probes or                      0.64mm to 1.18mm x 30mm

                                                                            guides. PEEK thread. Introducer.                    to 350mm.  PEEK Thread:

                                                                                                                                      0.2mm to 0.4mm x 500mm. 

                                                                                                                                      Plug Collar: 2mm to 4mm.

1.7.2 - Extracanilicular

                 Device Technologies Australia Pty Ltd

DE177           Lester Jones Tear Duct Tubes                     Glass                                                    3 x 9 to 16mm, 3.5 x 9 to   $84.00

                                                                                                                                      18mm, 4.0 x 9 to 24mm, 5.0 x

                                                                                                                                       9mm

1.8.1 - Intrascleral

                 Device Technologies Australia Pty Ltd

DE188           Acrylic Implant                                      Acrylic                                                  12, 14, 16, 18, 20mm.  $55.00

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 25 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

DE202           John Weiss Glass Mule Globes                   Glass                                                    No: 12, 14, 16, 18, 20mm  $55.00

                 Spectrum Surgical

SO040           FCI Orbital Implants                                Silicone - Sterile                                       12mm to 22mm  $55.00

            vp

                 Spectrum Surgical

SO006           FCI Orbital Implants                                Orbital Implant, Bioceramic                          Bioceramic diameter, 12, 14,   $1,200.00

                                                                            (Aluminium Oxide)/Hydroxyapatite                 16, 18, 20, 21, 22mm;

                                                                            (Synthetic)                                              Synthetic Diameter, 10, 12,

                                                                                                                                      14, 16, 18, 20, 22mm

1.8.2 - Extrascleral

     1.8.2.1 - Complex and permeable

                 Stryker Australia Pty Ltd

SK521           Sphere                                                Orbital Sphere Models 6316, 6326,                 Orbital Sphere Models   $785.00

                                                                            6327, 6317 and 6322 8702-8704.                   6316: 14mm, 6326: 16mm,

                                                                            COI implant, models 7222, 7223 &                 6327: 18mm, 6317: 20mm,

                                                                            80026. MCOI implant, models 7207 -              6322: 22mm, 8702: 19mm,

                                                                            7209 Quad Motility Implants 9866 -                8703: 21mm, 8704: 23mm,

                                                                            9868 & 80022                                          COI Implants 7222: Approx

                                                                                                                                       4ml, 7223: Approx 5ml,

                                                                                                                                      80026: Approx 6ml, MCOI

                                                                                                                                      7207: Approx 3ml, 7208:

                                                                                                                                      Approx 4.2ml,  7209:

                                                                                                                                      Approx 5.6ml, QUAD

                                                                                                                                      Motility Small 16ml,

                                                                                                                                      Medium: 18ml, Large: 20ml,

                                                                                                                                       Extra Large: 22ml.

            ha

                 Spectrum Surgical

SO007           FCI Orbital Implants                                Mesh wrapped orbital implant: mesh                Bioceramic diameter: 16, 18,  $1,600.00

                                                                            wrapped bioceramic (aluminium                      20, 22mm; Synthetic

                                                                            oxide), mesh wrapped hydroxyapatite               Hydroxyapatite diameter:

                                                                            (synthetic), mesh wrap (polyglycolic                16, 18, 20, 22mm

                                                                            acid)

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 26 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

            vp

                 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW002         Biopore Sphere                                      An implantable device made of high-               14mm, 16mm, 18mm, 20mm,   $1,930.00

                                                                            density polyethylene material with an               22mm, 24mm (diameter)

                                                                             interconnecting pore structure that

                                                                            supports tissue ingrowth. The device

                                                                            is available in sizes to meet the

                                                                            patient's specific needs.  Used for

                                                                            orbital reconstruction following

                                                                            enucleation and evisceration

                                                                            procedure.

     1.8.2.2 - Multi-component

                 Spectrum Surgical

SO019           FCI Orbital Implants                                Peg & Sleeve                                           Standard Large  $863.00

1.8.3 - Fascial - solid and permeable

                 Device Technologies Australia Pty Ltd

DE277           Frontalis Suspension Set                           Stainless steel needles with solid                     needles 0.90mm x 6.5cm, rod  $315.00

                                                                            silicone rods and silicone tubing -                    40cm - 0.80mm, sleeve 10 x

                                                                            packaged sterile                                        2mm

                 Spectrum Surgical

SO045           FCI Ptosis Probes                                   Stainless steel needle probes swaged                80mm x 0.8mm needle   $315.00

                                                                            with silicone tubing.                                   probes, 280mm 0.64mm

                                                                                                                                      tubing.

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 27 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

1.9.1 - Buckles, bands, tyres and sponges

                 Austmed Pty Limited

AP003           Mira: Scleral Implants                              Solid Silicone-                                         Tires-Mira 286 Wendel   $45.00

                                                                            Tire/Meridional/Wedge/Pad. Retinal                 Symmetrical Oval Tire 6mm,

                                                                            Implant used in Scleral Buckling                     Mira Symmetrical Oval Tire

                                                                            (Dimethylmethylvinyl Siloxane                      7mm, Mira 287WG Murray

                                                                            Copolymer)                                             wide (3.5mm) grooved

                                                                                                                                      symmetrical tire, 10mm

                                                                                                                                      wide, Mira 288 ross

                                                                                                                                      symmetrical grooved tire,

                                                                                                                                      low profile 10mm wide by

                                                                                                                                      2.5mm, Mira 289

                                                                                                                                      Symmetrical oval tire 10m

AP004           Mira: Scleral Implants                              Solid Silicone-Sleeve. Retinal Implant              Sleeves-Mira 70 Sleeve 1mm  $45.00

                                                                             used in Scleral Buckling                               I.D., Mira 71 Sleeve 1mm

                                                                            (Dimethylmethylvinyl Siloxane                      I.D., Mira 72 McNutt Sleeve

                                                                            Copolymer)                                             1.57mm I.D., Mira 270

                                                                                                                                      Sleeve 0.76mm I.D.

AP006           Mira: Scleral Implants                              Solid Silicone-Band/Strip/Boat/Clip.                Bands-Mira 40 Circling   $45.00

                                                                            Retinal Implant used in Scleral                       Band 2mm, Mira 240

                                                                            Buckling (Dimethylmethylvinyl                      Circling Band 2.5mm.

                                                                            Siloxane Copolymer)                                  Strips-Mira 41 Strip 3.5mm,

                                                                                                                                      Mira 42 Strip 4mm, Mira 20

                                                                                                                                      Strip 4mm, Mira 219 Strip

                                                                                                                                      4.5mm, Mira 31 Strip 4.5mm,

                                                                                                                                       Mira 32 Strip 5mm, Mira

                                                                                                                                      225 Oval Strip 5mm, Mira

                                                                                                                                      220 Strip 6mm. Boats-Mira

                                                                                                                                      60 Boat

                 Device Technologies Australia Pty Ltd

DE179           Silicon Retinal Implant                              Tire                                                      7.0, 9.0, 12.5, 6.0, 8.5, 10.0mm  $45.00

DE181           Silicon Retinal Implant                              Band                                                     0.75 x 2.0 x 125mm, 0.60 x   $45.00

                                                                                                                                      2.5 x 125mm, 0.75 x 2.5 x

                                                                                                                                      125mm

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 28 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Spectrum Surgical

SO009           FCI Scleral Buckling Devices                     Band/strip: solid silicone                              Band - 2.0 x 0.75mm Type   $45.00

                                                                                                                                      40, 3.5 x 0.75mm Type 41,

                                                                                                                                      4.0 x 1.25mm Type 42, 2.5 x

                                                                                                                                      0.6mm Type 240, Morin 3.5

                                                                                                                                      x 0.6mmStrip - 5.7mm Type

                                                                                                                                       20, 7.2mm Type 31, 9.2mm

                                                                                                                                      Type 32, 6mm Type 219,

                                                                                                                                      7.5mm Type 220, 8mm Type

                                                                                                                                      225

SO011           FCI Scleral Buckling Devices                     Tire: Solid Silicone                                    Symmetrical: (2.5 mm   $45.00

                                                                                                                                      Groove, 7 to 9mm wide),

                                                                                                                                      Biconvex: (2.5mm Groove, 7

                                                                                                                                       to 10mm wide),

                                                                                                                                      Asymetrical: (2.5mm

                                                                                                                                      Groove, 7 to 10mm wide)

SO013           FCI Scleral Buckling Devices                     Strip: Solid Silicone                                   Strip: 1.4 x 4.4 x 100mm,   $45.00

                                                                                                                                      Morin Strip: 7mm wide x

                                                                                                                                      100mm long, Caputo Zip

                                                                                                                                      Strip: 7 to 9mm wide x

                                                                                                                                      120mm long, Korobelnik

                                                                                                                                      Oval Strip: 2 x 5mm

     1.9.1.1 - Sponges

                 Austmed Pty Limited

AP002           Mira: Scleral Implants                              Silicone Sponge- Retinal Implant                    Sponge- Mira 502 Cylinder   $90.00

                                                                            Used in Scleral Buckling (Silicone                  2mm, Mira 5025 Cylinder

                                                                            Elastomer Sponge)                                    2.5mm, Mira 503 Cylinder

                                                                                                                                      3mm, Mira 504 Cylinder

                                                                                                                                      4mm, Mira 505 Cylinder

                                                                                                                                      5mm, Mira 505G Grooved

                                                                                                                                      cylinder 5mm, Mira 505T

                                                                                                                                      Packer tunnel cylinder 5mm,

                                                                                                                                       Mira 510 Half cylinder

                                                                                                                                      5mm, Mira 515 Brucker two-

                                                                                                                                      thirds cyl

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 29 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Device Technologies Australia Pty Ltd

DE178           Silicon Retinal Implant                              Sponge                                                  2.5 x 4.0 x 80mm, 3.0 x 5.0 x   $90.00

                                                                                                                                      100mm, 3.25 x 7.0 x 80mm,

                                                                                                                                      5.5 x 7.5 x 80mm, 1.5 x

                                                                                                                                      80mm, 2.0 x 80mm, 2.5 x

                                                                                                                                      80mm, 3.0 x 80mm, 4.0 x

                                                                                                                                      80mm, 5.0 x 80mm, 7.0 x 80mm

                 Spectrum Surgical

SO012           FCI Scleral Buckling Devices                     Sponge/Cord: Silicone                                Cord: 1.0 to 5.0mm O.D. x   $90.00

                                                                                                                                      150mm length; Half Cord:

                                                                                                                                      3.0mm to width x1.5mm to

                                                                                                                                      2.5mm height x150mm;

                                                                                                                                      Circular Sponge: 3 to 5mm;

                                                                                                                                      Oval Sponge: 2 to 5.5mm x

                                                                                                                                      4 to 12mm; Half Sponge: 2

                                                                                                                                      to 3.1mm x 4 to 7.5mm;

                                                                                                                                      Grooved Sponge: 3 to 5mm

                                                                                                                                      x 5 to  12mm; Gain Sponge:

                                                                                                                                      6 x

1.9.2 - Clips and tacks

                 Device Technologies Australia Pty Ltd

DE201           Labtician Tantalum Clips                           Tantalum                                                2, 2.5mm  $50.00

1.9.3 - Sleeves

                 Device Technologies Australia Pty Ltd

DE180           Silicon Retinal Implant                              Sleeve                                                   1mm, .76mm, 1.5mm  $25.00

                 Spectrum Surgical

SO010           FCI Scleral Buckling Devices                     Fixation Sleeve: Solid silicone                       O.D: 1.65 to 2.41mm,   $25.00

                                                                                                                                      Length 30mm

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 30 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

1.9.4 - Intraocular Gases

                 Alcon Laboratories (Aust.) Pty Ltd

AL035           ISPAN Retinal Gases for                           Tamponade gases for retinal surgery                125g cylinder, dispensed in  $75.00

                   Constellation® Vision System                     C3F8 and SF6                                         single dose syringe

AL036           ISPAN retinal gases                                Tamponade gases for retinal surgery                125 g cylinder, dispensed   $75.00

                                                                            C3F8 and SF6                                         in single dose syringe

                 Device Technologies Australia Pty Ltd

DE284           Single Dose Ophthalmic Gases                    Single dose tamponading gas for                    30ml  $75.00

                                                                            retinal surgery

1.9.5 - Intraocular Heavy Liquids

                 Alcon Laboratories (Aust.) Pty Ltd

AL013           Perfluoron Kits                                      Perfluoro-n-octane for use as a retinal               5mL  $240.00

                                                                            surgery additive

AL014           Perfluoron Kits                                      Perfluoro-n-octane for use as a retinal               7mL  $240.00

                                                                            surgery additive

                 Bausch & Lomb (Australia) Pty Ltd

BL017           Perfluo-octane (Oktaline) Okta-                   Perfluorocarbon Liquid  for use as a                5mL  $240.00

                                                                            retinal surgery additive

BL018           DK Line 100% purified                             Perfluorodecalin                                       7ml  $240.00

                   perfluorodecalin

                 Design for Vision Pty Ltd

DV244          D.O.R.C. Eftiar                                      Eftiar Decaline and Octane 5ml                      5ml  $240.00

                 Device Technologies Australia Pty Ltd

DE204           Arcaline (Perfluorodecaline)                       Liquid perfluorocarbon aid for retinal               3ml, 5ml, 7ml  $240.00

                                                                            surgery, operative device for retinal

                                                                            surgery, in particular retinal

                                                                            detachment (RD), RD with giant tear

                                                                            etc.

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 31 of 975


1 - OPHTHALMIC

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

DE205           Arcotane (Perfloro-N-Octane)                     Liquid perfluoro-N-Octane aid for                   5ml, 7ml  $240.00

                                                                            retinal surgery, pre-operative device

                                                                            for retinal surgery, in particular retinal

                                                                             detachment (RD), RD with giant tear,

                                                                            RD with proliferative vitreal

                                                                            retinopathy (PVR) etc.

                 IQ Medical

IQ005           Densiron                                              Heavy Tamponade Liquid Medium,                 10 ml, Sterile  $240.00

                                                                            Postoperative

IQ008           Octane & Decalin                                    Perfluorocarbon retinal tamponade                  5ml & 7ml, Sterile  $240.00

                                                                            medium, intraoperative

                 Spectrum Surgical

SO023           FCI - DECA, FCI - OCTA                        FCI - DECA: Purified                                 5ml  $240.00

                                                                            perfluorodecalin, FCI - OCTA:

                                                                            Purified perfluoro-N-octane

SO024           FCI - DECA, FCI - OCTA                        FCI - DECA: Purified                                 7ml  $240.00

                                                                            perfluorodecalin, FCI - OCTA:

                                                                            Purified perfluoro-N-Octane

1.9.6 - Intraocular Silicone Oils

                 Bausch & Lomb (Australia) Pty Ltd

BL016           Oxane LMWC Fractioned Silicone                Purified fractioned silicone oil                       10mL  $195.00

                   Oil

BL024           Oxane HD                                            Silicone oil - RMN3 mixture                         10ml  $195.00

                 Design for Vision Pty Ltd

DV243          D.O.R.C. Silicon Oil                                D.O.R.C. Silicon Oil 1000/5000CS                 10ml  $195.00

                 Device Technologies Australia Pty Ltd

DE228           LSO Silicone Oil                                    Silicone oil for tamponade use in                    10ml, vial or syringe  $195.00

                                                                            vitreoretinal surgery

                 IQ Medical

IQ006           Siluron 1000 & Siluron 5000                      Silicone Oils                                            10 ml, Sterile  $195.00

                 Spectrum Surgical

SO022           FCI Purified Silicone Oil (Solvent                Viscosity: 1000 cst/5000 cst: solvent               10ml  $195.00

                   Free)                                                  free purified silicone oil

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 32 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

10.1.1 - Bare Metal Stents

     10.1.1.1 - Balloon Expandable

                 Abbott Australasia Pty Ltd

AY022          Cobalt Chromium Balloon                          Cobalt Chromium                                      Diameter 4-10mm, Length   $1,800.00

                   Expandable Peripheral Stent                                                                                  12-58mm

AY024          Omnilink Stainless Steel Balloon                  Stainless Steel Balloon Expandable                  018 & 035 system: 5-10mm   $1,800.00

                   Deployable Peripheral Stent                        Peripheral Stent on 018/035 system                 diameter by 12, 16, 18, 28,

                                                                                                                                      38, 58mm length

                 B Braun Australia Pty Ltd

BB244           Coroflex Blue                                        Cobalt Chromium Alloy L605                       2-4mm diameter, 8-25mm   $1,800.00

                                                                                                                                      length

                 Bard Australia Pty Ltd

BA218          Lifestent Valeo                                       Stainless Steel Balloon Expandable                  6-10mm diameter 17-56mm   $1,800.00

                                                                            Peripheral Stent                                        length

                 Biotronik Australia Pty Ltd

BT094           Dynamic                                              PTA Balloon Expandable Stent                      Diameters: 5-10mm,   $1,800.00

                                                                                                                                      Lengths: 15, 25, 38, 56mm

                 Boston Scientific Australia Pty Ltd

BS059           Express Vascular LD Stent; Express              Stainless Steel, Balloon Expanding                  Stent Diameters up to 10mm   $1,800.00

                   Vascular SD Stent                                   Stent                                                     and lengths up to 60mm

                 Cook Medical Australia Pty Ltd

WC234          Formula 414 Rx Renal Stent System             Balloon Expandable Vasc/Biliary                    Rapid exchange 014/018,   $1,800.00

                                                                                                                                      80-135cm delivery system.

                                                                                                                                      Diameters 4-10mm, lengths

                                                                                                                                      0.8 - 4cm

                 Johnson & Johnson Medical Pty Ltd

JJ057            Palmaz Balloon Expandable Stent                 Stainless steel stent                                    Diameter 4-12mm, length   $1,800.00

                                                                                                                                      20-30mm

JJ058            Palmaz Balloon Expandable Stent                 Stainless steel stent                                    Extra-large  $1,800.00

JJ304            Palmaz Genesis Peripheral Stent                   Stainless steel balloon expandable                   Diameter 3-8mm, length 12-  $1,800.00

                   and Delivery System on Slalom                   stent mounted on a slalom balloon                   39mm

JJ305            Palmaz Genesis Peripheral Stent                   Stainless steel balloon expandable                   Diameter 4-8mm, length 12-  $1,800.00

                   and Delivery System on Opta Pro                 stent mounted on an Opta Pro                        39mm

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 33 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

JJ306            Palmaz Genesis Peripheral Stent                  Stainless steel peripheral stent                        Diameter 4-12mm, length   $1,800.00

                                                                                                                                      11-79mm

JJ479            PALMAZ GENESIS on CORDIS               Peripheral balloon expandable stent                 Lengths: 12, 15, 18, 24mm.   $1,800.00

                   AMIIA RX .014 Delivery System                and rapid exchange delivery system                 Diameter: 4, 4.5, 5, 5.5, 6,

                                                                                                                                      6.5, 7mm

JJ567            PALMAZ® BLUE™ .018                         L605 Cobalt Chromium Alloy                       12, 15, 18, 24mm length 4,   $1,800.00

                   Peripheral Stent System                            Balloon Expandable Stent                            5, 6, 7mm diameter

JJ688            Palmaz Blue .014 Renal Stent                      CoCr balloon expandable stent                       12, 15, 18, 24mm Lengths       $1,800.00

                   System (on Aviator Plus)                                                                                                                        40, 50,

                                                                                                                                      60, 70mm diameters                

                                                                                                                                                         80, 142cm shaft

                                                                                                                                      lengths

                 MD Solutions Pty Ltd

MB009          ArchStent Ostial System                           The ArchStent Ostial System is a                    7Fr: 5mm x 16mm x 135mm.   $1,800.00

                                                                            0.14" guidewire-compatible, rapid                   7Fr: 6mm x 16mm x 135mm

                                                                            exchange balloon expandable stent

                                                                            system for the treatment of

                                                                            atherosclerotic stenosis at the renal-

                                                                            ostial junction. It consists of a 316L

                                                                            stainless steel stent with flaring of the

                                                                             proximal 1/5 segment, and a dual

                                                                            balloon delivery catheter featuring a

                                                                            Locator balloon that enables the

                                                                            operator to precisely position and

                                                                            conform the stent to aorto-ostial

                                                                            anomalies.

                 Medical Specialties Australia Pty Ltd

MS059          Thalis Inert Stent Implantation                     Balloon-Expandable Peripheral Stent                Diameter: 5-12mm; Length:   $1,800.00

                                                                            Implantation System                                   18-58mm

                 Medical Vision Australia Cardiology Thoracic Pty Ltd

MY004          CP Stent                                              CP Stent Uncovered                                   16, 22, 28, 24, 39 & 45mm   $1,800.00

                                                                                                                                      length

MY006          CP Stent                                              CP Stent Uncovered, mounted on BIB              16, 22, 28, 24, 39 & 45mm   $1,800.00

                                                                            balloon                                                  length

                 Medtronic Australasia Pty Ltd

MC328          Racer Renal Stent System                          Cobalt Alloy                                            Diameter: 4-7mm; Lengths:   $1,800.00

                                                                                                                                      12 &18mm

MC773          Assurant Cobalt Stent                               Iliac balloon expandable stent system               Diameter:  6 - 10mm ,   $1,800.00

                                                                                                                                      Length:  20 - 80mm

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 34 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

MC959          Hippocampus Renal Stent System                Hippocampus Renal Rapid Exchange               Diameter 4.0mm - 7.00mm   $1,800.00

                                                                            Stainless Steel Stent system, 5F                      Length: 10mm - 24mm

                                                                            sheath, 0.014" guide wire compatible

MC977          Chromis deep cobalt Chromium,                  Chromis deep - Cobalt Chromium, pre-            Diameter: 2.0 mm 4.0mm   $1,800.00

                   infrapopliteal OTW stent                           mounted balloon expandable, 0.014"                Length: 10mm - 76mm

                                                                            compatable stent

     10.1.1.2 - Self Expandable, <150mm

                 Abbott Australasia Pty Ltd

AY015          Xact/ Xact Flex Carotid Stent                      Nitinol Self-Expanding stent on rapid               Diameter 7-10mm Length 20  $1,800.00

                                                                             exchange delivery system                            + 30mm Straight; Diameter

                                                                                                                                      8-6, 9-7, 10-8mm Length 20

                                                                                                                                      + 30mm Tapered

AY021          Nitinol Self Expanding Peripheral                 Nitinol                                                   Diameter 3-10mm  $1,800.00

                   Stent

AY031          Xpert                                                  Xpert is a laser cut nitinol self                        3 - 8mm in diameter, 20 -   $1,800.00

                                                                            expanding stent, used to treat                         80mm in length

                                                                            peripheral vessel disease, Xpert is a

                                                                            low profile system designed for small

                                                                            vessels and is 4 french.

AY032          ACCULINK Peripheral Stent                      Nickel-Titanium Intra-vascular stent                4-10mm diameter, 13-56mm   $1,800.00

                                                                                                                                      length

AY035          Absolute Pro (Long Length)                       Laser cut nitinol self expanding stent                Diameter 5mm to 10mm;   $1,800.00

                                                                            <150mm                                                length 120mm

                 Bard Australia Pty Ltd

BA178          Luminex Vascular Stent                            Luminex nitinol self-expanding stent                4mm - 20mm diameters, 2cm -  $1,800.00

                                                                                                                                       12cm lengths

BA199          Lifestent                                              Laser cut nitinol self expanding stent,               Diameter: 6-8mm, Length:   $1,800.00

                                                                            used to treat peripheral disease                       120mm

BA216          Lifestent                                              Lifestent cut nitinol self expanding                  6-10mm diameter 20mm-  $1,800.00

                                                                                                                                      120mm length

                 Biotronik Australia Pty Ltd

BT072           Astron                                                Peripheral self expanding nitinol,                    Diameters: 6 - 12mm,   $1,800.00

                                                                            coated stent                                             Lengths: 30 - 100mm

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 35 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

BT103           Astron Pulsar                                        Astron Pulsar is a 4F compatible,                    4-7mm by 20-80mm  $1,800.00

                                                                            Nitinol self expanding stent (OTW

                                                                            design) used to treat peripheral vessel

                                                                             disease.

BT126           Pulsar 18 Peripheral self expanding               Pulsar 18  self expanding Nitinol                    Stent: 4-7mm Stent length:   $1,800.00

                   Nitinol stent system                                 stent system                                            100-120mm Catheter

                                                                                                                                      length: 90-135mm

BT133           Pulsar 35 Peripheral self-expanding               Pulsar 35 Peripheral self-expanding                 Diameter: 5-7mm; Length:   $1,800.00

                   Nitinol stent system                                 Nitinol stent system                                   30-120mm; Catheter length:

                                                                                                                                       90cm

                 Boston Scientific Australia Pty Ltd

BS035           Expandable Endoprosthesis                        Biomedical superalloy, self expanding              Stent Diameters up to 30mm   $1,800.00

                                                                             stent                                                     and lengths up to 100mm

BS056           Carotid Wall Stent                                   Elgiloy self expanding stent                          Stent diameters up to 10mm   $1,800.00

                                                                                                                                      and lengths up to 40mm

BS077           Sentinol Nitinol Vascular Stent                    Nitinol Stent with Uniflex Delivery                 Diameter: 5 to 10mm.   $1,800.00

                   System                                                System                                                  Length: 20 to 120mm

BS137           EPIC Nitinol Stent                                  Nitinol self expanding stent                          Stent diameters up to 14mm   $1,800.00

                                                                                                                                      and lengths up to 120mm

BS167           Placehit Wallstent                                    Biomedical cobalt-based alloy, self                  Stent diameters up to 19mm   $1,800.00

                                                                            expanding stent                                        and lengths up to 100mm

BS168           Wallstent RP                                         Tracheobronchial, Iliac, Biomedical                 20-24mm; length 18-90mm  $1,800.00

                                                                            Superalloy Wire, Braided Mesh,

                                                                            Stainless Steel Stent with Unistep

                                                                            Delivery System

BS189           Adapt Monorail Carotid Stent System            Nitinol self expanding stent                          21-40mm length, 4-9mm   $1,800.00

                                                                                                                                      diameter

BS196           Innova Self-Expanding Stent                      Nitinol, self expanding stent                          Diameters up to 8mm,   $1,800.00

                                                                                                                                      lengths less than 150mm

                 Cook Medical Australia Pty Ltd

WC168          Cook Vascular/Biliary Stent                       Vascular/Biliary stent                                 5/6 Fr delivery system, 4 -   $1,800.00

                                                                                                                                      14mm diameter, 2 - 8cm

                                                                                                                                      length

WC278          Zilver Vascular Stent with Rapid                  Zilver Stent Vascular Design, self-                  Delivery System 5Fr,   $1,800.00

                   Exchange Delivery System                         expandable nitinol stent. Preloaded in               125cm. Stent diameter 4mm-

                                                                             a 5.0 French Rapid Exchange delivery             10mm. Stent length 2cm-8cm.

                                                                             catheter.

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 36 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

WC287          Zilver® Flex 35™ Vascular Stent                 The Zilver® Flew 35™ Stent (ZFV) is             The Zilver®  Flex 35™   $1,800.00

                                                                            a self-expandable stent made of                      Stent is available in the

                                                                            nitinol.  The special laser-cut pattern                 following sizes: stent outer

                                                                            of the nitinol tube provides a                         diameters of 5 -10mm and

                                                                            construction with a strong radial force              stent lengths of 20 -140mm.

                                                                             and high flexibility.  The stent has

                                                                            radiopaque markers at both ends.  The

                                                                            stent is supplied preloaded in a 6.0

                                                                            French inducer catheter. A radiopaque

                                                                             marker on the distal tip of the sheath

                                                                            is used to visualize deployment of the

                                                                            stent. Stent deployment is controlled

                                                                            by means of a hand held device.

WC290          Zilver®  Vena ™ Venous Stent                   The Zilver® Vena™ Venous Stent is a             14mm and 16mm diameters,   $1,800.00

                                                                             self-expanding, flexible, slotted-tube               and 60mm/100mm/140mm

                                                                            nitinol stent. Post-deployment, the                   lengths.

                                                                            stent is designed to impart an outward

                                                                             radial force upon the inner lumen of

                                                                            the vessel, establishing patency in the

                                                                             stented region.

                 Device Technologies Australia Pty Ltd

DE376           Supra Veritas Peripheral Vascular                 Interwoven Self-Expanding Nitnol                  20mm x 4,5,6,7mm  $1,800.00

                   Stent                                                                                                             30mm x 4,5,6,7mm

                                                                                                                                      60mm x 4,5,6,7mm

                                                                                                                                      80mm x 4,5,6,7mm

                                                                                                                                      100mm x 4,5,6,7mm

                                                                                                                                      120mm x 4,5,6,7mm

                 Endotherapeutics Pty Ltd

ET037           SX-Ella Endovascular Stent                        Uncovered, self-expanding nitinol                   Dia 6-16mm, length 22-77mm  $1,800.00

                 ev3 Australia Pty Ltd

EE006           Protégé GPS Peripheral Stent                      Protégé RX Peripheral Stent                         Diameter 6-10mm Length   $1,800.00

                                                                                                                                      20-60mm

EE024           Protégé EverFlex Peripheral Stent                 Protégé EverFlex is a self expanding                Diameter 5-8, Length 20-  $1,800.00

                                                                            Nitinol stent premounted on an OTW               120mm

                                                                            delivery system.

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 37 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Johnson & Johnson Medical Pty Ltd

JJ419            SMART Control Peripheral Stent                 SMART Control is a laser cut nitinol               Dia 6 – 14mm; Length 20 –   $1,800.00

                   System                                                self expanding stent, used to treat                    100mm

                                                                            peripheral vessel disease.

JJ463            PRECISE RX Nitinol Stent System              Nitinol self expandable stent and                     Stent Lengths 20, 30,   $1,800.00

                                                                            repid exchange delivery system                      40mm; Stent Diameter: 5, 6,

                                                                                                                                      7, 8, 9, 10mm

JJ592            SMART Nitinol Stent System                     Long 120mm Stent, 6F compatible                  6-8mm diameter, 120mm   $1,800.00

                                                                                                                                      stent length, 120cm

                                                                                                                                      delivery system

JJ646            Precise Pro Rx Nitinol Stent System              Nitinol self expanding stent                          Diameter:  5, 6, 7, 8, 9,   $1,800.00

                                                                                                                                      10mm;  Length:  20, 30, 40mm

                 Medtronic Australasia Pty Ltd

MC743          Complete SE Stent                                  Nitinol                                                   20mm - 80mm  $1,800.00

MC744          Complete SE Stent                                  Nitinol                                                   100mm - 120mm  $1,800.00

MC978          Cristallo Ideale Carotid Self                        Cristallo Ideale  Nitinol, Carotid Self                Cylinder Diameter: 7.0mm -   $1,800.00

                   Expanding Stent System                            Expanding Hybrid Stent system, 5F                 11.0 mm. Taper Diameter

                                                                            introducer sheath compatible, Rapid                 6.0/9.0 - 7.0/10.0. Length

                                                                            Exchange design, .014" guide wire                  20mm - 40 mm.

                                                                            compatible.

MI010           Maris Plus Peripheral Self-                        Nitinol, self expanding, peripheral                   Diameter: 6.0-12.0mm;   $1,800.00

                   Expanding Stent System                            stent system                                            Length: 30-120mm

                 Pyramed Pty Limited

PY028           Sinus-XL Stent                                      Self-expanding Nitinol stent                          Diameter: 16mm, 18mm.   $1,800.00

                                                                                                                                      Length: 40-100mm

                                                                                                                                      nominal; 41-100 expanded.

PY031           Optimed Sinus Stents                               Sinus-wave nitinol stent                              3-14mm Diameter x 20-  $1,800.00

                                                                                                                                      130mm Length

            LD

                 Pyramed Pty Limited

PY029           Sinus-XL Stent ≥20mm                            Self-expanding Nitinol stent                          Diameter: 20mm, 22mm,   $2,970.00

                                                                                                                                      24mm, 26mm, 28mm, 30mm,

                                                                                                                                      32mm, 34mm. Length: 30-

                                                                                                                                      100mm nominal; 32-102

                                                                                                                                      expanded.

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 38 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

     10.1.1.3 - Self Expandable, ≥150mm

                 Abbott Australasia Pty Ltd

AY036          Absolute Pro (Long Length)                       Laser cut nitinol self expanding stent                Diameter 5mm to 10mm;   $2,970.00

                                                                            ≥150                                                     length 150mm, 170mm,

                                                                                                                                      200mm

                 Bard Australia Pty Ltd

BA217          Lifestent                                              Laser cut nitinol self expanding stent                Diameter 5mm to 10mm;   $2,970.00

                                                                                                                                      length 150mm - 200mm

                 Biotronik Australia Pty Ltd

BT127           Pulsar 18 Peripheral self expanding               Pulsar 18  self expanding Nitinol                    Stent: 4-7mm Stent length:   $2,970.00

                   Nitinol stent system                                 stent system                                            150-200mm Catheter

                                                                                                                                      length: 90-135mm

BT132           Pulsar 35 Peripheral self-expanding               Pulsar 35 Peripheral self-expanding                 Diameter: 5-7mm; Length:   $2,970.00

                   Nitinol stent system                                 Nitinol stent system                                   150-200mm; Catheter

                                                                                                                                      length: 90cm, 135cm

                 Boston Scientific Australia Pty Ltd

BS197           Innova Self-Expanding Stent                      Nitinol, self expanding stent                          Diameters up to 8mm,   $2,970.00

                                                                                                                                      Lengths greater than 150mm

                 Cook Medical Australia Pty Ltd

WC285          Zilver® Flex35™ Vascular Stent                 The Zilver® Flex35™ Stent (ZFV) is a            Diameter: 5-8mm;   $2,970.00

                                                                             self-expandable stent made of nitinol.              Length:170mm and 200mm

                                                                             The special laser-cut pattern of the

                                                                            nitinol tube provides a construction

                                                                            with a strong radial force and high

                                                                            flexibility.  The stent has radiopaque

                                                                            markers at both ends.

                 Device Technologies Australia Pty Ltd

DE375           Supera Verita Peripheral Vascular                 Interwoven Self-Expanding Nitnol                  150mm x 4,5,6mm  $2,970.00

                   System                                                                                                           180mm x 4,5,6mm

                                                                                                                                      200mm x 4,5,6mm

                 ev3 Australia Pty Ltd

EE025           Protégé EverFlex Peripheral Stent                 Protégé EverFlex is a self expanding                Diameter 5-8mm, Length   $2,970.00

                                                                            Nitinol stent premounted on an OTW               150-200mm

                                                                            delivery system.

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 39 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 Johnson & Johnson Medical Pty Ltd

JJ617            SMART Nitinol Stent System                     Long 150mm stent, 6F compatible                  6-8mm diameter, 150mm   $2,970.00

                                                                                                                                      length, 120cm delivery

                                                                                                                                      system

                 Medtronic Australasia Pty Ltd

MC760          Complete SE Stent                                  Nitinol                                                   150mm  $2,970.00

MI011           Maris Plus Peripheral Self-                        Nitinol, self expanding, peripheral                   Diameter: 6.0-12.0mm;   $2,970.00

                   Expanding Stent System                            stent system                                            Length: 150mm

                 Pyramed Pty Limited

PY016           Optimed Iliac Sinus Stent - extra long            Sinus-wave nitinol stent - extra long                6-8 mm x 150-200mm  $2,970.00

10.1.2 - Drug Eluting Stents

                 Cook Medical Australia Pty Ltd

WC289          Zilver PTX                                           The Zilver PTX Drug Eluting                        6French: 5, 6, 7, 8, 9, 10mm   $2,400.00

                                                                            Peripheral Stent is a self-expanding                 diameters in 20, 30, 40, 60,

                                                                            stent made of nitinol and coated with                80, 100, 120mm lengths

                                                                            the drug Paclitaxel.  The stent is

                                                                            preloaded in a 6.0 French delivery

                                                                            catheter.  Stent deployment is

                                                                            controlled by retraction of the handle

                                                                            while holding the metal cannula

                                                                            stationary.

10.10.1 - Peritoneal Dialysis, Long Term Implantable Catheters

            cu

                 Kendall Australasia Pty Ltd TA Covidien Pty Ltd

KA001          Tenckhoff Peritoneal Dialysis                      Adult 2 cuff, Adult 1 cuff, Adult 0 Cuff            42cm to 47cm length. All   $175.00

                   Catheter                                                                                                          Peritoneal Catheters

                                                                                                                                      excluding the Swan Neck

                                                                                                                                      Fast Flow Catheter, have an

                                                                                                                                      internal diameter of 2.67mm

                                                                                                                                      and an external diameter of

                                                                                                                                      4.95 mm.

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 40 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

KA002          Tenckhoff Peritoneal Dialysis                      Paediatric 2 cuff, Paediatric 1 cuff,                  31cm to 37 cm length. All   $175.00

                   Catheter                                               Neonatal 1 cuff                                         Peritoneal Catheters

                                                                                                                                      excluding the Swan Neck

                                                                                                                                      Fast Flow Catheter, have an

                                                                                                                                      internal diameter of 2.67mm

                                                                                                                                      and an external diameter of

                                                                                                                                      4.95 mm.

KA003          Fast Flow Peritoneal Dialysis                      Swan Neck, 2 cuff                                     Int.diam: 3.2mm; ext diam   $175.00

                   Catheter                                                                                                          5.49mm.All Peritoneal

                                                                                                                                      Catheters excluding the

                                                                                                                                      Swan Neck Fast Flow

                                                                                                                                      Catheter, have an internal

                                                                                                                                      diameter of 2.67mm and an

                                                                                                                                      external diameter of 4.95 mm.

KA004          Swan Neck Curl Peritoneal Dialysis              Adult 2 cuff, left                                       62 cm length. All Peritoneal  $175.00

                    Catheter                                                                                                         Catheters excluding the

                                                                                                                                      Swan Neck Fast Flow

                                                                                                                                      Catheter, have an internal

                                                                                                                                      diameter of 2.67mm and an

                                                                                                                                      external diameter of 4.95 mm.

KA005          Swan Neck or Swan neck Tenckhoff             Adult-left, Adult-right, Adult, 2 cuff-               20 to 25cm external segment  $175.00

                   Peritoneal Dialysis Catheter                        left, Adult, 2 cuff-right                                or 43cm length. All

                                                                                                                                      Peritoneal Catheters

                                                                                                                                      excluding the Swan Neck

                                                                                                                                      Fast Flow Catheter, have an

                                                                                                                                      internal diameter of 2.67mm

                                                                                                                                      and an external diameter of

                                                                                                                                      4.95 mm.

KA006          Tenckhoff Peritoneal Dialysis                      Adult, 2 cuffs                                          57 to 62cm length. All   $175.00

                   Catheter, Curl                                                                                                   Peritoneal Catheters

                                                                                                                                      excluding the Swan Neck

                                                                                                                                      Fast Flow Catheter, have an

                                                                                                                                      internal diameter of 2.67mm

                                                                                                                                      and an external diameter of

                                                                                                                                      4.95 mm.

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 41 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

10.2.1 - Tube (Thoracic Aorta)

     10.2.1.1 - <180mm length

                 Cook Medical Australia Pty Ltd

WC238          Zenith Thoracic Endovascular Graft              Thoracic Proximal Graft                              22mm to 42mm diameter,   $11,027.00

                                                                                                                                      115mm to 179mm Length

WC240          Zenith Thoracic Endovascular Graft              Thoracic Distal Graft                                  26mm to 42mm diameter,   $11,027.00

                                                                                                                                      127mm to 179mm Length

WC275          Zenith TX2 TAA Endovascular                   Short Thoracic Proximal Graft                       Diameter 22mm - 42mm.   $11,027.00

                   Graft with Pro_Form and the Z-Trak                                                                        Length 115mm - 162mm

                   Plus Introduction System - Short

                   Proximal Component

                 Medical Specialties Australia Pty Ltd

MS052          Relay Thoracic Stent Graft                         Duralloy Nitinol Surgical Graft                      Diameter 22 - 46mm, Length  $11,027.00

                                                                            Material Braided Polyester PFTE                     103 - 179mm

                                                                            impregnated Suture Dual Sheath

                                                                            Delivery System

                 Medtronic Australasia Pty Ltd

MC206          Talent Thoracic Stent Graft                         Talent Endoluminal Stent Graft -                     22 - 46mm x 130mm  $11,027.00

                                                                            Thoracic Stent Graft System

MC747          Valiant Endovascular Stent Graft                  Nitinol and polyester system                         22-46mm diameter, 110mm   $11,027.00

                                                                                                                                      length

MC748          Valiant Endovasculat Stent Graft                  Nitinol and polyester system                         22-46mm diameter, 150mm   $11,027.00

                                                                                                                                      length

MC809          Valliant Endovascular Stent Graft                 Nitinol and polyester system                         24 - 46 diameter, up to 179mm  $11,027.00

MC952          Valiant Captivia                                      Valient Stent Graft with Captivia                    22-46mm diameter, 150mm   $11,027.00

                                                                            Delivery System                                       length

MC960          Valiant Captivia                                      Valiant Stent Graft with captivia                     22 - 46 mm diameter: 100mm  $11,027.00

                                                                            delivery system                                        length

                 W L Gore & Associates

GT191           Excluder Endovascular Prostheses                Thoracic Stent Graft Nitinol & ePTFE              Diameter 26-40mm x  10cm   $11,027.00

                                                                                                                                      Length

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 42 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

GT259           Conformable GORE TAG Thoracic              Conformable GORE TAG                           Straight Stent Grafts:  $11,027.00

                   Endoprosthesis                                                                                                 Diameters (mm): 21, 26, 28,

                                                                                                                                      31, 34, 37, 40, 45

                                                                                                                                      Length (cm): 10

                                                                                                                                      Tapered Stent Grafts:

                                                                                                                                      Diameters (mm): 26x21;

                                                                                                                                      31x26

                                                                                                                                      Lengths (cm): 10

GT260           Conformable GORE TAG Thoracic              Conformable GORE TAG                           Diameters (mm): 28, 31, 34,   $11,027.00

                   Endoprosthesis                                                                                                 37, 40, 45

                                                                                                                                      Length (cm) 15

            paed

                 Medical Vision Australia Cardiology Thoracic Pty Ltd

MY005          CP Stent                                              CP Stent Covered                                      16, 22, 28, 24, 39 & 45mm   $3,000.00

                                                                                                                                      length

MY007          CP Stent                                              CP Stent Covered, mounted on BIB                 16, 22, 28, 24, 39 & 45mm   $3,000.00

                                                                            balloon                                                  length

     10.2.1.2 - ≥180mm length

                 Cook Medical Australia Pty Ltd

WC239          Zenith Thoracic Endovascular Graft              Thoracic Proximal Grft                               22mm to 42mm diameter,   $14,500.00

                                                                                                                                      180mm to 216mm Length

WC241          Zenith Thoracic Endovascular Graft              Thoracic Distal Graft                                  26mm to 42mm diameter,   $14,500.00

                                                                                                                                      180mm to 207mm Length

WC276          Zenith TX2 TAA Endovascular                   Long Thoracic Proximal                              Diameter 28mm-42mm   $14,500.00

                   Graft with Pro-Form and the Z-Trak              Endovascular Graft                                    Length 197mm-216mm

                   Plus Introduction System - Long

                   Proximal Component

                 Medical Specialties Australia Pty Ltd

MS053          Relay Thoracic Stent Graft                         Duralloy Nitinol Surgical Graft                      Diamter 22 - 46mm,  Length   $14,500.00

                                                                            Material Braided Polyester PFTE                    180 - 271mm

                                                                            impregnated Suture Dual Sheath

                                                                            Delivery System

                 Medtronic Australasia Pty Ltd

MC810          Valliant Endovascular Stent Graft                 Nitinol and polyester system                         24 - 46 diameter, 180 -   $14,500.00

                                                                                                                                      227mm length

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 43 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

MC958          Valiant Captivia                                      Valiant Stent Graft with Captivia                    24-46mm diameter, 200mm   $14,500.00

                                                                            Delivery System                                       length

                 W L Gore & Associates

GT023           Excluder Endovascular Prostheses                Thoracic Stent Graft Nitinol & ePTFE              34, 37 & 40mm Diameter x   $14,500.00

                                                                                                                                      20cm Lengths

GT261           Conformable GORE TAG Thoracic              Conformable GORE TAG                           Diameters (mm): 34, 37, 40,   $14,500.00

                   Endoprosthesis                                                                                                 45

                                                                                                                                      Length (cm): 20

10.2.10 - Tube, Peripheral, Balloon Expandable

     10.2.10.1 - ≤12mm diameter

                 Atrium Australia - Pacific Rim Pty Limited

AC023          Advant PTFE V12 Stent Graft System           Balloon Expandable PTFE                            5mm - 12mm Diameter  $4,185.00

                                                                            Encapsulated Stainless Steel

                                                                            Peripheral Vascular Stent

     10.2.10.2 - >12mm diameter

                 Atrium Australia - Pacific Rim Pty Limited

AC027          Advanta V12 Stent Graft System                 Balloon Expandable PTFE                            12 - 16 mm diameter 29mm   $5,695.00

                                                                            Encapsulated Stainless Steel Vascular              length. 80cm and 120cm

                                                                             Stent                                                    catheter lengths

AC028          Advanta V12 Stent Graft System                 Balloon Expandable PTFE                            12 - 16 mm diameter 41mm   $5,695.00

                                                                            Encapsulated Stainless Steel Vascular              length. 80cm and 120cm

                                                                             Stent                                                    catheter lengths

AC029          Advanta V12 Stent Graft System                 Balloon Expandable PTFE                            12 - 16 mm diameter 61mm   $5,695.00

                                                                            Encapsulated Stainless Steel Vascular              length. 80cm and 120cm

                                                                             Stent                                                    catheter lengths

10.2.11 - Tube, Peripheral, Self Expandable

     10.2.11.1 - <150mm length

                 Bard Australia Pty Ltd

BA219          Encapsulated Carbon Lined Stent                  PTFE covered nitinol self-expanding                4mm - 13.5mm diameter, 2cm   $3,395.00

                   Graft                                                  stent                                                     - 12cm length

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 44 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 W L Gore & Associates

GT029           Gore Tips Endoprosthesis                          ePTFE                                                   8-12mm Diameter 4-8cm   $3,395.00

                                                                                                                                      Graft-Lined Length 2cm

                                                                                                                                      Unlined Length

            H

                 W L Gore & Associates

GT225           Gore Viabahn ® endoprosthesis                   Gore Viabahn ® endoprosthesis with               5mmx2.5cm 120cm 5mmx5cm  $3,495.00

                   with heparin bioactive surface                     heparin bioactive surface is a flexible,                120cm 6mmx2.5cm 120cm

                                                                            self expanding endoluminal device                  6mmx5cm 75cm 6mmx5cm

                                                                            consisting of an ePTFE lining with                  120cm 7mmx2.5cm 120cm

                                                                            external nitinol support                                7mmx5cm 75cm

                                                                                                                                      7mmx5cm 120cm 8mmx2.5cm

                                                                                                                                       120cm 8mmx5cm 75cm

                                                                                                                                      8mmx5cm 120cm 9mmx 5cm

                                                                                                                                      75cm 9mmx 5cm 120cm

                                                                                                                                      10mmx 5cm 75cm

                                                                                                                                      10mmx 5cm 120cm 11mmx

                                                                                                                                      5cm 75cm

                                                                                                                                      11mmx 5cm 120cm 13mmx

                                                                                                                                      5cm 75cm 13mmx 5cm

                                                                                                                                      120cm

GT227           Gore Viabahn ® endoprosthesis                   Gore Viabahn ® endoprosthesis with               5mmx 10cm 120cm 6mmx   $3,495.00

                   with heparin bioactive surface                     heparin bioactive surface is a flexible,               10cm 75cm 6mmx 10cm

                                                                            self expandinbg endoluminal device                 120cm 7mmx 10cm 75cm

                                                                            consisting of an ePTFE lining with                  7mmx 10cm 120cm 8mmx

                                                                            external nitinol support                                10cm 75cm 8mmx 10cm

                                                                                                                                      120cm

                                                                                                                                      9mmx 10cm 75cm 9mmx

                                                                                                                                      10cm 120cm

                                                                                                                                      10mmx 10cm 75cm 10mmx

                                                                                                                                      10cm 120cm

                                                                                                                                      11mmx 10cm 75cm 11mmx

                                                                                                                                      10cm 120cm

                                                                                                                                      13mmx 10cm 75cm 13mmx

                                                                                                                                      10cm 120cm

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 45 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

     10.2.11.2 - 150-249mm length

            H

                 W L Gore & Associates

GT226           Gore Viabahn ® endoprosthesis                   Gore Viabahn ® endoprosthesis with               5mmx 15cm 120cm, 6mmx   $4,125.00

                   with heparin bioactive surface                     heparin bioactive surface is a flexible,               15cm 75cm 6mmx 15cm

                                                                            self expanding endoluminal device                  120cm 7mmx 15cm 75cm

                                                                            consisting of an ePTFE lining with                  7mmx 15cm 120cm 8mmx

                                                                            external nitinol support                                15cm 75cm 8mmx 15cm

                                                                                                                                      120cm 9mmx 15cm 75cm

                                                                                                                                      9mmx 15cm 120cm 10mmx

                                                                                                                                      15cm 75cm, 10mmx 15cm

                                                                                                                                      120cm 11mmx 15cm 75cm

                                                                                                                                      11mmx 15cm 120cm 13mmx

                                                                                                                                      15cm  75cm 13mmx 15cm

                                                                                                                                      120cm

     10.2.11.3 - ≥250mm length

            H

                 W L Gore & Associates

GT262           GORE VIABAHN®                               GORE VIABAHN® Endoprosthesis               5mm x 25cm x 120CATH  $5,625.00

                   Endoprosthesis with Heparin                      with Heparin Bioactive Surface is a                 6mm x 25cm x 120CATH

                                                                            flexible, self expanding endoluminal                7mm x 25cm x 120CATH

                                                                            device consisting of an ePTFE lining                8mm x 25cm x 120CATH

                                                                            with external nitinol support

10.2.2 - Tube (Abdominal Aorta)

                 Cook Medical Australia Pty Ltd

WC232          Zenith Renu AAA Ancillary Graft -              Stent graft indicated for the repair of in             Proximal diameter 22 -   $4,850.00

                   Main Body Extension                               situ AAA stent grafts                                 36mm, Length (covered

                                                                                                                                      section) 43 - 100mm

                 Medtronic Australasia Pty Ltd

MC850          Endurant AAA Abdominal Tube                  Endurant Endoluminal Stent Graft                   23 - 36mm X 85mm  $4,850.00

                                                                            System - Abdominal Tube

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 46 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

10.2.3 - Tube (Aorto-uni-iliac)

                 Cook Medical Australia Pty Ltd

WC235          Zenith Renu AAA Ancillary Graft -              Stent graft indicated for the repair of in             Proximal diameter 22-36mm,  $10,200.00

                   Converter                                             situ AAA stent grafts                                 distal diameter 12mm,

                                                                                                                                      lengths 91-161mm

                 Medtronic Australasia Pty Ltd

MC153          Talent AAA Aorto Uni lliac Stent                 Talent Endoluminal Stent Graft                      22 - 36mm x 75 - 310mm  $10,200.00

                   Graft                                                  System - AUI  Tapered System.

MC847          Endurant Aorto-Uni-Iliac (AUI)                  Endurant Endoluminal Stent Graft                   23 - 36mm X 120mm  $10,200.00

                                                                            System - AUI

MC998          Endurant II AAA Aorto-Uni-Iliac                Endurant II Endoluminal Stent Graft                Proximal diameter: 23 to   $10,200.00

                                                                            System - AUI                                          36mm; Distal daimeter:

                                                                                                                                      14mm; Covered length:

                                                                                                                                      102mm

10.2.4 - Bifurcated

     10.2.4.1 - Body and 2 limbs

                 Terumo Corporation Australia

TU002           Anaconda Endovascular Graft System           Bifurcated Aortic System, Ultrathin                 18 - 34mm  $12,405.00

                                                                            woven polyester, nitinol ring stents,

                                                                            tantalum markers

     10.2.4.2 - Body and 1 limb

                 Medtronic Australasia Pty Ltd

MC845          Endurant AAA Stent Graft                         Endurant Endoluminal Stent Graft                   23 - 36mm x 13 - 20mm x   $8,955.00

                                                                            System - Bifurcated Graft                            135 -185mm

MC997          Endurant II AAA Stent Graft                      Endurant II Endoluminal Stent Graft                Proximal diameters: 23 to   $8,955.00

                   Bifurcation                                           System - Bifurcated Graft                            36mm; Distal diameters: 13

                                                                                                                                      to 20mm; Covered lengths:

                                                                                                                                      124 to 166mm

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 47 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

                 W L Gore & Associates

GT024           Excluder AAA Endovascular                      AAA Abdominal Stent Graft Nitinol                23-28.5mm Diameter, 14-  $8,955.00

                   Prostheses                                            & ePTFE - two piece system (1/2)                   18cm Length

                                                                            Trunk - Ipsilateral Limb

GT263           GORE EXCLUDER AAA                        The GORE EXCLUDER AAA                     Proximal Diameters (mm):   $8,955.00

                   Endoprosthesis featuring C3                       Endoprosthesis is for the                              23, 26, 28.5

                   Delivery System                                     endovascular treatment of infrarenal                 Distal Diameters (mm): 12,

                                                                            AAAs. The GORE EXCLUDER AAA            14.5

                                                                             Endoprosthesis featuring C3                         Length (cm): 12, 14, 16, 18

                                                                            Delivery System allows the trunk-                 

                                                                            ipsilateral component to be                            Proximal Diameter (mm): 31

                                                                            respositioned during deployment                   

                                                                                                                                      Distal Diameter (mm): 14.5

     10.2.4.3 - Body only

                 Cook Medical Australia Pty Ltd

WC133          Zenith Flex AAA Endovascular                   Stainless steel                                          Dia 22 - 32mm, length 82 -   $5,794.00

                   Graft - body only                                                                                               140mm

WC261          Zenith Fenestrated AAA                            Distal Bifurcated Body with Flexor                 Diameter 12 - 24mm, 1st   $5,794.00

                   Endovascular Graft with Flexor                   sheath                                                   length 28 - 62mm, 2nd

                                                                                                                                      length 76 - 121mm

WC277          Zenith Flex AAA Endovascular                   Zenith Flex with Z-trak main body -                 Diameter - 22mm - 36mm.   $5,794.00

                   Graft with the Z-Trak Introduction                AAA endovascular graft                              Length 82mm - 149mm.

                   System - main body

WC293          Zenith Low Profile AAA                           Bifurcated main body graft                           Diameter: 22-32mm,   $5,794.00

                   Endovascular Graft - Bifurcated                                                                              Length: 70-128mm

                   Main Body

10.2.5 - Branched

                 Cook Medical Australia Pty Ltd

WC233          Zenith Branch Endovascular Graft -               Bifurcated branch vessel stent graft                  Common iliac lengths 45 or   $7,500.00

                   Iliac Bifurcation                                      with openings to connect the common              61mm, external iliac lengths

                                                                             iliac, sidebranch, and external iliac                  41 or 58mm and distal cuff

                                                                            segments. Made of stainless steel and               diameters 10 or 12mm

                                                                            nitinol z-stents and woven polyester,

                                                                            mounted on H&LB one shot delivery

                                                                            system

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 48 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

10.2.6 - Fenestrated

                 Cook Medical Australia Pty Ltd

WC263          Zenith Fenestrated AAA                            Proximal Fenestrated body with                     1 or 2 internal stents, 24 -   $8,561.00

                   Endovascular Graft with Flexor                   Flexor sheath                                           36mm Diameter, 73 - 129mm

                                                                                                                                      Length

10.2.7 - Accessory Component (Aortic)

     10.2.7.1 - Thoracic

                 Cook Medical Australia Pty Ltd

WC160          Zenith TAA Endovascular Graft                  Thoracic Proximal Extension                         Dia 22 Length 77; Dia 24   $6,300.00

                                                                                                                                      Length 77;Dia 26 Length

                                                                                                                                      77; Dia 28 Length 80; Dia

                                                                                                                                      30 Length 80; Dia 32

                                                                                                                                      Length 80; Dia 34 Length

                                                                                                                                      77; Dia 36 Length 77; Dia

                                                                                                                                      38 Length 77; Dia 40

                                                                                                                                      Length 81

                                                                                                                                      Diameter 42 Length 81

WC188          Zenith Thoracic Endovascular Graft              Thoracic Body Extension                             22mm to 42mm diameter;   $6,300.00

                                                                                                                                      77mm to 81mm length

WC274          Zenith TX2 TAA Endovascular                   Thoracic Proximal Extension                         Diameter - 22mm - 42mm   $6,300.00

                   Graft with Pro-Form and the Z-Trak                                                                         Length - 77mm - 81mm

                   Plus Introduction System (thoracic

                   body extension)

WC288          Zenith Dissection Endovascular                   The Zenith Dissection Endovascular                Diameter: 46mm (designed   $6,300.00

                                                                            Stent with the H&L-B One-Shot                     for vessel diameters 24-

                                                                            Introduction System is indicated for                 38mm). Length: 82, 123,

                                                                            the endovascular treatment of patients               164mm

                                                                            with aortic dissection distal to the left

                                                                             subclavian artery.

     10.2.7.2 - Abdominal

                 Cook Medical Australia Pty Ltd

WC045          Zenith Endovascular Graft                         Converter                                               Diameter 20 through 36   $2,555.00

                                                                                                                                      Length 80-85

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 49 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

WC048          Zenith Endovascular Graft                         Body Extensions                                       Diameter 22 through 36  $2,555.00

                 Medtronic Australasia Pty Ltd

MC158          Talent Aortic Extension Stent Graft               Talent Endoluminal Stent Graft -                     22 - 36mm x 26 - 30mm  $2,555.00

                                                                            Aortic Extension

MC849          Endurant AAA Aortic Extension                  Endurant Endoluminal Stent Graft                   23 - 36mm x 60mm  $2,555.00

                                                                            System - Aortic Extension

                 Terumo Corporation Australia

TU003           Anaconda Endovascular Graft System           Aortic Extension Cuff. Ultrathin                     18 - 34mm  $2,555.00

                                                                            woven polyester, nitinol ring stents,

                                                                            tantalum markers

                 W L Gore & Associates

GT189           Excluder Endovascular Prostheses                Abdominal Stent Graft Nitinol &                    Diameter 23 - 28.5mm,   $2,555.00

                                                                            ePTFE - Aortic Extender                             Length 3.3cm

10.2.8 - Accessory Component (Other including iliac limb and

                 Cook Medical Australia Pty Ltd

WC047          Zenith Endovascular Graft                         Leg Extensions                                         Diameter 18 through 24   $3,308.00

                                                                                                                                      Length 55

WC259          Zenith AAA Endovascular Graft                  Leg extension with Captor valve                     Diameters from 8 to 24mm,   $3,308.00

                   Contralateral/Ipsilateral Iliac Legs                                                                            lengths from 37 to 122mm

WC286          Zenith® Spiral-Z AAA lliac Legs                 Zenith® Spiral-Z AAA lliac Leg                    Proximal Diameter - 13mm  $3,308.00

                   with Z-Trak™ Introduction System                                                                         Distal Diameter - 9mm to 24

                                                                                                                                      mm

                                                                                                                                      Working Length - 39 mm to

                                                                                                                                      122 mm

                 Medtronic Australasia Pty Ltd

MC846          Endurant AAA Contralateral Iliac                 Endurant Endoluminal Stent Graft                   10 - 28mm X 80 - 120mm  $3,308.00

                   Limb                                                  System - Contralateral Iliac Limb

MC848          Endurant AAA Iliac Extension                    Endurant Endoluminal Stent Graft                   10 -  28mm x 80mm  $3,308.00

                                                                            System - Iliac Extension

MC994          Endurant II AAA Contralateral Iliac              Endurant II Endoluminal Stent Graft                Proximal diameter: 16mm;   $3,308.00

                    Limb                                                  System - Contralateral Iliac Limb                    Distal diameter: 10 to

                                                                                                                                      28mm; Covered length:

                                                                                                                                      82mm; 93mm; 124mm

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 50 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

MC995          Endurant II AAA Iliac Extension                 Endurant II AAA Iliac Extension                    Proximal diameter: 10 to   $3,308.00

                                                                                                                                      28mm; Distal diameter: 10

                                                                                                                                      to 28mm; Covered length:

                                                                                                                                      82mm

                 Terumo Corporation Australia

TU004           Anaconda Endovascular Graft System           Iliac Extension Cuff. Ultrathin woven               8 - 18mm  $3,308.00

                                                                            polyester, nitinol ring stents,

                                                                            tantalum markers

TU005           Anaconda Endovascular Graft System           Iliac Leg, Ultrathin woven polyester,                8 - 23mm  $3,308.00

                                                                            nitinol ring stents, tantalum markers

TU041           Anaconda Endovascular Graft System           Flared iliac limb, Ultrathin woven                   Diameter: Proximal end 10-  $3,308.00

                                                                            polyester, nitinol ring stents,                          17mm, distal end 12-23mm:

                                                                            tantalum markers                                       Length 80-130mm

                 W L Gore & Associates

GT188           Excluder AAA Endovascular                      AAA Stent Graft Nitinol & ePTFE                  Diameter 12 - 14.5mm x 10 x   $3,308.00

                   Prostheses                                            Two piece system (2/2) Contralateral                14cm Length

                                                                            Limb

GT190           Excluder Endovascular Prostheses                Abdominal Stent Graft Nitinol &                    Diameter 10 - 14.5mm,   $3,308.00

                                                                            ePTFE - Iliac Extender                                Length 7cm

            L (long length)

                 Medtronic Australasia Pty Ltd

MC996          Endurant II AAA Contralateral Iliac              Endurant II Endoluminal Stent Graft                Proximal diameter: 16mm;   $4,350.00

                    Limb                                                  System - Contralateral Iliac Limb                    Distal diameter: 10 to

                                                                                                                                      28mm; Covered length:

                                                                                                                                      156mm, 199mm

10.2.9 - Iliac Graft Plug

                 Cook Medical Australia Pty Ltd

WC103          Zenith Iliac Plug                                     Zenith AAA Endovascular Graft                    Diameter 14, 16, 18, 20, 22,   $2,555.00

                                                                                                                                      24mm

                 Medtronic Australasia Pty Ltd

MC203          Talent Occluder System                            Nitinol stents attached to polyester                   Standard Sizes, 8 - 24mm x   $2,555.00

                                                                            graft sealed both ends                                 31 - 35mm

Prostheses List by Category, Groups and Sponsor                                                                                                              Page 51 of 975


10 - VASCULAR

                                                                                                                                                                                     Minimum                                                                                                                                                                                      Maximum

Billing Code   Product                                               Description                                            Size  Benefit         Benefit                                                Condition

10.3.1 - Tube

     10.3.1.1 - ≤10cm length

                 B Braun Australia Pty Ltd

BB025           Vascular Uni - Graft                                Vascular graft                                          10cm  $245.00

                 W L Gore & Associates

GT132           Gore-Tex Vascular Grafts                          Standard Wall Grafts (ePTFE)                       Diameter 4 - 8mm, Length   $245.00

                                                                                                                                      10cm

GT138           Gore-Tex Vascular Grafts                          Standard Wall Grafts Stretch (ePTFE)              Diameter 4 - 8mm, Length   $245.00

                                                                                                                                      10cm

GT149           Gore-Tex Vascular Grafts                          Thin Wall Grafts (ePTFE)                            Diameter 4 - 10mm, Length   $245.00

                                                                                                                                      10cm

GT158           Gore-Tex Vascular Grafts                          Thin Wall Grafts Stretch (ePTFE)                   Diameter 4 - 10mm, Length   $245.00

                                                                                                                                      10cm

GT167           Gore-Tex Vascular Grafts                          Vascular Grafts - Aorto-Pulmonary &              Diameter 3.5 - 5mm, Length   $245.00