Private Health Insurance (Prostheses) Amendment Rules 2010 (No. 1)

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

Dated  20  September 2010

________________________

Penny Shakespeare

Assistant Secretary

Private Health Insurance Branch

Medical Benefits Division

Department of Health and Ageing

1 Name of Rules

These Rules are the Private Health Insurance (Prostheses) Amendment Rules 2010 (No. 1).

2 Commencement

These Rules commence on 5 October 2010.

3  Amendment of the Schedule to the Private Health Insurance (Prostheses) Rules 2010 (No. 2)

These Rules amend the Schedule to the Private Health Insurance (Prostheses) Rules 2010 (No. 2), as set out below:

3.1               Part A – Prostheses, at page 64 of 866, delete Billing Code GL007 and the contents of all fields associated with it, including the subheading “Global Medical Solutions Australia Pty Ltd”.

3.2               Part A – Prostheses, at page 75 of 866, delete Billing Code SK125 and the contents of all fields associated with it, including the subheading “Stryker Australia Pty Ltd”.

3.3               Part A – Prostheses, at page 76 of 866, delete Billing Code SK120 and the contents of all fields associated with it, including the subheading “Stryker Australia Pty Ltd”.

3.4               Part A – Prostheses, at page 76 of 866, delete Billing Code SK121 and the contents of all fields associated with it.

3.5               Part A – Prostheses, at page 76 of 866, delete Billing Code SK122 and the contents of all fields associated with it.

3.6               Part A – Prostheses, at page 76 of 866, delete Billing Code SK123 and the contents of all fields associated with it.

3.7               Part A – Prostheses, at page 76 of 866, delete Billing Code SK124 and the contents of all fields associated with it.

3.8               Part A – Prostheses, at page 90 of 866, under the heading “Billing Code” delete “PU057” and insert “PU059”.

3.9               Part A – Prostheses, at page 91 of 866, under the heading “Billing Code” delete “PU058” and insert “PU060”.

3.10           Part A – Prostheses, at page 194 of 866, after the Billing Code AJ031 insert the subheading “Biomet Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “BH101”; under the heading “Product Name” insert “Interpore Bone Plate System”; under the heading “Description” insert “TPS Screw”; under the heading “Size” insert “14mm – 22mm”; under the heading “Minimum Benefit” insert “$250.00”; and under the heading “Maximum Benefit” insert “$850.00”.

3.11           Part A – Prostheses, at page 194 of 866, after the Billing Code BH101, under the heading “Billing Code” insert “BH104”; under the heading “Product Name” insert “Vuelock (Anterior Cervical Plate)”; under the heading “Description” insert “Vuelock Bone Screws”; under the heading “Size” insert “12mm – 16mm”; under the heading “Minimum Benefit” insert “$200.00”; and under the heading “Maximum Benefit” insert “$350.00”.

3.12           Part A – Prostheses, at page 194 of 866, after the Billing Code BH104, under the heading “Billing Code” insert “BH108”; under the heading “Product Name” insert “Anterior Cervical Plate System”; under the heading “Description” insert “Titanium Cancellous Bone Screw”; under the heading “Size” insert “4mm – 20mm”; under the heading “Minimum Benefit” insert “$200.00”; and under the heading “Maximum Benefit” insert “$260.00”.

3.13           Part A – Prostheses, at page 199 of 866, delete Billing Code OH241 and the contents of all fields associated with it.

3.14           Part A – Prostheses, at page 207 of 866, after the Billing Code BB278 insert  the subheading “Biomet Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “BH105”; under the heading “Product Name” insert “GEO Structure Vertebral Cage - PLIF”; under the heading “Description” insert “3 dimensional titanium intervertebral cage”; under the heading “Size” insert “One size only”; under the heading “Minimum Benefit” insert “$3,000.00”; and under the heading “Maximum Benefit” insert “$4,100.00”.

3.15           Part A – Prostheses, at page 210 of 866, delete Billing Code OH123 and the contents of all fields associated with it.

3.16           Part A – Prostheses, at page 212 of 866, after the Billing Code BB216 insert the  subheading “Biomet Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “BH106”; under the heading “Product Name” insert “Ibex Interbody Cage”; under the heading “Description” insert “Lumbar Cage”; under the heading “Size” insert “7mm-17mm”; under the heading “Minimum Benefit” insert “$2,503.00”; and under the heading “Maximum Benefit” insert “$3,500.00”.

3.17           Part A – Prostheses, at page 213 of 866, delete Billing Code OH347 and the contents of all fields associated with it.

3.18           Part A – Prostheses, at page 215 of 866, after the heading “Group 16a – Vertebral Body, Telescoping Cage – Integral Fixation” insert the subheading “Biomet Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “BH100”; under the heading “Product Name” insert “Interpore Bone Plate System”; under the heading “Description” insert “TPS Bone Plate”; under the heading “Size” insert “20cm – 56cm”; under the heading “Minimum Benefit” insert “$2,300.00”; and under the heading “Maximum Benefit” insert “$3,500.00”.

3.19           Part A – Prostheses, at page 221 of 866, after the Billing Code BH081, under the heading “Billing Code” insert “BH102”; under the heading “Product Name” insert “Interpore Bone Plate System”; under the heading “Description” insert “TPS Locked Nut”; under the heading “Size” insert “3mm”; under the heading “Minimum Benefit” insert “$177.00”; and under the heading “Maximum Benefit” insert “$650.00”.

3.20           Part A – Prostheses, at page 243 of 866, after the Billing Code AJ032 insert the  subheading “Biomet Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “BH103”; under the heading “Product Name” insert “Vuelock (Anterior Cervical Plate)”; under the heading “Description” insert “Vuelock (Anterior Cervical Plate)”; under the heading “Size” insert “Level 1-4, 12mm – 92mm”; under the heading “Minimum Benefit” insert “$1,400.00”; and under the heading “Maximum Benefit” insert “$2,600.00”.

3.21           Part A – Prostheses, at page 243 of 866, after the Billing Code BH103, under the heading “Billing Code” insert “BH107”; under the heading “Product Name” insert “Anterior Cervical Plate System”; under the heading “Description” insert “Titanium Locking Plate”; under the heading “Size” insert “20mm – 140mm”; under the heading “Minimum Benefit” insert “$1,400.00”; and under the heading “Maximum Benefit” insert “$2,600.00”.

3.22           Part A – Prostheses, at page 245 of 866, delete Billing Code OH240 and the contents of all fields associated with it.

3.23           Part A – Prostheses, at page 279 of 866, for the Billing Code CZ020, under the heading “Size” delete the reference to “6.0D” that appears prior to the word “inclusive” and insert “6.5D”.

3.24           Part A – Prostheses, at page 308 of 866, delete Billing Code SR047 and the contents of all fields associated with it, including the subheading “Stryker Australia Pty Ltd” and heading “carboxymethylcellulose putty additive”.

3.25           Part A – Prostheses, at page 311 of 866, delete Billing Code SR048 and the contents of all fields associated with it, including the subheading “Stryker Australia Pty Ltd”.

3.26           Part A – Prostheses, at page 312 of 866, delete Billing Code SR049 and the contents of all fields associated with it, including the subheading “Stryker Australia Pty Ltd” and heading “carboxymethylcellulose putty additive”.

3.27           Part A – Prostheses, at page 312 of 866, after the Billing Code WR020 delete the heading “needs to split Billing code”.

3.28           Part A – Prostheses, at page 312 of 886, after the Billing Code WR020 delete the subheading “Wright Medical Australia”.

3.29           Part A – Prostheses, at page 313 of 866, delete Billing Code SK186 and the contents of all fields associated with it.

3.30           Part A – Prostheses, at page 654 of 866, under the heading “Billing Code” delete “ST988” and insert “SK510”.

3.31           Part A – Prostheses, at page 686 of 866, after the Billing Code SK246 insert the subheading “Synthes Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “SY270”; under the heading “Product Name” insert “AO/ASIF Intramedullary Nails”; under the heading “Description” insert “Antegrade/Retrograde Femoral Nail”;  under the heading “Size” insert “Diameter 6.5mm-18mm, Length 30mm-500mm”; and under the heading “Minimum Benefit” insert “$1,030.00”.

3.32           Part A – Prostheses, at page 687 of 866, after the subheading “Synthes Australia Pty Ltd”, under the heading “Billing Code” insert “SY060”; under the heading “Product Name” insert “AO/ASIF Intermedullary Nails”; under the heading “Description” insert “Cannulated and Solid Tibial Nail”;  under the heading “Size” insert “7.0mm-19mm diameter 200mm-600mm length”; and under the heading “Minimum Benefit” insert “$910.00”.

3.33           Part A – Prostheses, at page 730 of 866, after the Billing Code SY049, under the heading “Billing Code” insert “SY071”; under the heading “Product Name” insert “AO/ASIF Screws Steel”; under the heading “Description” insert “Cannulated screws”; under the heading “Size” insert “2.7mm-4.49mm”; and under the heading “Minimum Benefit” insert “$175.00”.

3.34           Part A – Prostheses, at page 756 of 866, delete Billing Code SK046 and the contents of all fields associated with it.

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