Private Health Insurance (Prostheses) Rules 2011 (No. 2)
As amended
Made under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007.
This compilation was prepared on 5 November 2011 taking into account amendments up to the Private Health Insurance (Prostheses) Amendment Rules 2011 (No.3).
Prepared by the Department of Health and Ageing, Canberra.
Part 1 Preliminary
1. Name of Rules
2. Commencement
3. Revocation
4. Definitions
Part 2 Benefit requirements
5. Listing of, and benefits for, prostheses
5A. Circumstances in which a prosthesis is provided other than circumstances in which a medicare benefit is payable
5B. Conditions in relation to the provision of listed prostheses
6. Benefits for prostheses provided as part of hospital treatment
7. Benefits for prostheses provided as part of hospital-substitute treatment
Part 3 Other
8. Timing of applications to have a prosthesis listed
9. Minister may have regard to recommendations and advice
10. Listing criteria for prostheses to be listed in Part C of the Schedule
Notes
These Rules are the Private Health Insurance (Prostheses) Rules 2011 (No. 2).
These Rules commence on 22 August 2011.
These Rules revoke the Private Health Insurance (Prostheses) Rules 2011 (No. 1) as amended by the Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 1).
Note: Terms used in these Rules have the same meaning as in the Act―see section 13 of the Legislative Instruments Act 2003. These terms include:
complying health insurance policy
hospital-substitute treatment
hospital treatment
medicare benefit
In these Rules:
accredited podiatrist 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 purpose of these Rules is the same registration requirements for podiatric surgeons as set out in rule 8 of the current Private Health Insurance (Accreditation) Rules as made from time to time under section 333-20 of the Act.
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.
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.
(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
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.
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.
(1) For a no gap prosthesis provided as part of an episode of hospital treatment by a private hospital, the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’.
(2) For a gap permitted prosthesis provided as part of an episode of hospital treatment by a private hospital:
(a) the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and
(b) the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’.
(3) For a no gap prosthesis provided as part of an episode of hospital treatment by a public hospital:
(a) the minimum benefit is the lesser of the following amounts:
(i) the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or
(ii) the amount of the insured person’s liability to the public hospital for that prosthesis; and
(b) the maximum benefit is the amount for that prosthesis listed in the column under the heading 'Minimum Benefit'.
(4) For a gap permitted prosthesis provided as part of an episode of hospital treatment by a public hospital:
(a) the minimum benefit is the lesser of the following amounts:
(i) the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or
(ii) the amount of the insured person’s liability to the public hospital for that prosthesis; and
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.
(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.
As a matter of normal administrative practice, applications made under subsection 72-10 (2) of the Act will be considered after they have been received and, if the Minister decides to grant the application, the kind of prosthesis will be listed in the Schedule the next time the Minister makes or varies the Rules.
Note 1: Under subsection 72-10 (5) of the Act the Minister must list the kind of prosthesis, set out the minimum benefit and, if the Minister considers it appropriate, the maximum benefit for the prosthesis in these Rules on the next occasion that the Minister makes or varies the Rules after he or she grants an application and the applicant has paid to the Commonwealth any initial listing fee within 14 days of being informed of the Minister's decision to grant the application.
Note 2: Under subsection 72-15 (3) of the Act, the Minister may remove a kind of prosthesis from the list in the Rules if the applicant fails to pay an ongoing listing fee.
(1) In making the decision under subsection 72-10 of the Act, the Minister may have regard to a recommendation from the Prostheses List Advisory Committee.
(2) In setting the minimum and the maximum (if any) benefits for a kind of prosthesis, the Minister may have regard to the benefits as negotiated between the Negotiating Oversight Committee and the applicant.
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.
The Private Health Insurance (Prostheses) Rules 2011 (No.2) as shown in this compilation are
amended as indicated in the tables below.
Table of Instruments
Instrument | Date of FRLI registration | Date of commencement | Application, saving or transitional provision |
Private Health Insurance (Prostheses) Rules 2011 (No.2)
|
10 August 2011 (see F2011L01617 |
22 August 2011 |
|
Private Health Insurance (Prostheses) Amendment Rules 2011 (No.2)
|
2 September 2011 (see F2011L01802)
|
5 September 2011
|
|
Private Health Insurance (Prostheses) Amendment Rules 2011 (No.3)
|
4 November 2011 (see F2011L02240) |
5 November 2011 |
|
Table of Amendments
ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted | |
Provision affected | How affected |
Schedule |
am. 2011 No. F2011L01802
|
Part 1 Preliminary | am. 2011 No. F2011L02240 |
Note
Part A - Prostheses List August 2011
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
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 lens 13.75mm length. 6.0mm optic $156.00
121UV; L122UV PMMA Anterior 1 piece size, diopter range 3-30d.
Chamber Lens L122UV: 6.0mm optic,
13.75mm length, power range;
5.0 to 30.0 Diopters
Emagin Pty Ltd
EG009 Artisan Anterior Chamber Intraocular Aphakia ModelComposition: PMMA 5.00mm Optic Diameter x 8.5 $156.00
Lens 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 IOL 6.00 mm Optic Diameter x $198.00
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 Myopia. 5mm Optic Diameter x 8.5 $680.00
Composition: PMMA overall length; 6mm Optic
Diameter x 8.5 overall length
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 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Emagin Pty Ltd
EG012 Artisan Anterior Chamber IOL Phakic Intraocular Lens Myopic / 5.00mm Optic Diameter x 8.5 $680.00
Hyperopic in overall length;
t1
AMO Australia Pty Ltd
AO030 Verisyse Toric (Custom) Phakic intraocular lens: Model toric 5mm Optic Diameter x 7.5mm $1,056.00
overall length
Emagin Pty Ltd
EG008 Artisan Anterior Chamber Intraocular Phakic Intraocular Lens: Model Toric 5.00mm Optic Diameter x 7.5 $1,056.00
Lens Composition: PMMA in overall length
t2
AMO Australia Pty Ltd
AO029 Verisyse Toric (Custom) Phakic intraocular lens: Model toric 5mm Optic Diameter x 7.5mm $1,358.00
overall length
1.1.2.2 Foldable
Alcon Laboratories (Aust.) Pty Ltd
AL034 AcrySof Cachet Phakic Lens Anterior chamber foldable, acrylic, single -6.0 to -16.5 diopters, in 0.5 $723.00
piece phakic lens diopter increments
AMO Australia Pty Ltd
AO025 VeriFlex Foldable Phakic IOL Anterior chamber foldable phakic silicone -2 to -14.5d in 0.5d $723.00
intraocular lens increments. Overall diameter
8.5mm. Optic 6.0mm
Emagin Pty Ltd
EG010 Artiflex Anterior Chamber Intraocular Optic: Hydrophobic Polysiloxane. Haptic: 6mm optic diameter x 8.5 in $723.00
Lens 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 D $156.00
Prostheses List by Category, Groups and Sponsor Page 2 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Bausch & Lomb (Australia) Pty Ltd
BL006 Posterior chamber IOLS model P359 PMMA Posterior Chamber lens 1 piece; 12.25mm to 13.75mm length. $156.00
UV, P399 UV, 68 UV, 95 BUV, or 5.5mm to 7mm optic size,
lolab PC One Piece, model 6741B, diopter range -4.5 - 45d to 10
8591B, 8191B; Model EZE-Fit 65 - 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 Aberration corrected, optimized aspheric Overall length 11.0mm Optic $364.00
foldable square-edged single-piece size 6.0mm
intraocular lens for capsular bag fixation
CZ017 CT ASPHINA 509M CT ASPHINA 509M (MICS Aspheric Overall length 11.00mm Optic $364.00
Foldable IOL) size 6.0mm
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, preloaded, (15.50-22D), 10.5mm (22.50-
with aberration contro, intraocular lens 30D)
Carl Zeiss Pty Ltd
CZ028 CT ASPHINA 409MP Preloaded, micro incision, aspheric Diopter range: 0.0 to 32.0D; $374.00
(aberration neutral), foldable square-edged Optic size: 6.0mm; Overall
single piece inraocular lens for capsular length: 11.0mm
bag fixation.
at, pl, t1
Carl Zeiss Pty Ltd
CZ031 AT TORBI 709MP (Standard Range) Bitoric, preloaded, micro incision, aspheric Diopter range: Sph -10.0 to $760.00
(aberration neutral), foldable, square- 32.0, Cyl +1.0 to 6.5
edged, single-piece IOL for capsular bag Optic size: 6.0mm, Overall
fixation length: 11.0mm
Prostheses List by Category, Groups and Sponsor Page 3 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
at, pl, t2
Carl Zeiss Pty Ltd
CZ032 AT TORBI 709MP (high cyl) Bitoric, preloaded, micro incision, aspheric Diopter range: Sph -10.0 to $1,061.00
(aberration neutral), foldable, square- 32.0, Cyl +7.0 to 12.0, Optic
edged, single-piece IOL for capsular bag size: 6.0mm. Overall Length
fixation 11.0mm
t1
Carl Zeiss Pty Ltd
CZ020 AT TORBI 709M AT TORBI 709M (MICS Bitoric Overall length 11.00mm Optic $740.00
Aspheric Foldable IOL) Foldable IOL size 6.00mm
+6.0D +32.0D inclusive in
0.5D increments Cylinder +1.0
to 6.5D inclusive
CZ026 AT TORBI™709M AT TORBI™709M (MICS Bitoric Overall length 11.00mm Optic $740.00
Aspheric Foldable IOL) size 6.0mm -10.00 to +5.50D
inclusive in 0.5D increments
Cylinder +1.0D to 6.5D
inclusive in 0.5D increments
t2, at
Carl Zeiss Pty Ltd
CZ027 AT TORBI 709M AT TORBI 709M (MICS Bitoric Overall length 11.00mm Optic $1,041.00
Aspheric Foldable IOL) size 6.0mm -10.00 to +32.0D
inclusive in 0.5D increments
Cylinder +7.0D to 12.0D
inclusive in 0.5D increments
1.2.2.2 No edge modification
ConceptVision Australia Pty Ltd
CS003 Staar foldable silicone intraocular lens: Polyimide haptics 6.3mm optic - low 14.0mm length $281.00
Model AQ 5010V diopters
Prostheses List by Category, Groups and Sponsor Page 4 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
t1
ConceptVision Australia Pty Ltd
CS002 Staar Toric foldable silicone intraocular Plate haptics 6.0mm optic 10.8mm - 11.2mm length $579.00
lens: Model AA4203TF; Model
AA4203TL
1.2.2.3 Edge modification
Alcon Laboratories (Aust.) Pty Ltd
AL004 Acrysof Multipiece Models MA50BM, Foldable Acrylic Multi-piece Lens -5 D to +30 D $322.00
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 IOL, Soft Acrylic, Foldable, UV Absorbing, 6 mm Optic Diameter x 13mm $322.00
Sensar OptiEdge AR40e Foldable Posterior in overall length.
Acrylic IOL
AO006 Clariflex, Model CLRFLXB Posterior Foldable Silicone IOL with OptiEdge One size only $322.00
Chamber Intraocular Lens design
Bausch & Lomb (Australia) Pty Ltd
BL020 Akreos Adapt acrylic foldable posterior Composition: Hydrophilic acrylic polymer. 10.0 to 15.0 Diopter in 1.0 $322.00
chamber intraocular lens Packaged in lens folding device in a sterile Diopter increments15.0 to
vial. Four haptic design 25.0 Diopter in 0.5 Diopter
increments25.0 to 30.0
Diopter in 1.0 Diopter
increments
BL021 SoflexSE, Intraocular lenses, Posterior Composition: silicone, Lenses - foldable, Range of powers: 5.0 to 30.0 $322.00
Chamber posterior chamber intraocular lenses Diopter - Optic diameter
6.0mm; 13.0mm length
Carl Zeiss Pty Ltd
CZ003 Intraocular Lens: Model Bigbag Hydrophilic acrylic, foldable, PC, single 6.5mm optic diameter x 10.35 $322.00
piece, Tri-haptic, square edge design, UV overall diameter
blocker
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.
Prostheses List by Category, Groups and Sponsor Page 5 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ConceptVision Australia Pty Ltd
CS007 Staar foldable silicone IOLs: Models Plate haptics 6.0mm; Polymide haptics 5.5 10.8mm 0 13.5mm length $322.00
AQ2010V, AQ2017V and AO2003V or 6.3mm optic;
Kevin Grundy (IBD) Pty Ltd
KG001 Rayner C-Flex Hydrophilic HEMA-MMA copolymer, 5.75mm dia optic, 12.00mm $322.00
foldable with injector dia overall
KG002 Superflex Hydrophilic HEMA-MMA copolymer, 6.25mm dia optic, 12.5mm dia $322.00
foldable with injector overall
at
AMO Australia Pty Ltd
AO014 TECNIS™ Intraocular Lens (Z9002 & Foldable Intraocular Lenses - Ultraviolet 5-10 dioptre in 1.0 dioptre $364.00
ZA9003) light absorbing posterior chamber increments; 10.5 - 30 dioptre in
intraocular lenses, Silicone/Acrylic 0.5 increments
AO024 Tecnis™ One Piece (ZCB00) One piece intraocular lens with edge +6 diopters to +30 diopters in $364.00
modification and 360 degree square edge 0.5d increments
Bausch & Lomb (Australia) Pty Ltd
BL022 SofPort Advanced Optic (AO) Posterior chamber, foldable silicone IOL 0 D to 30.0 D $364.00
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 IOL, 0 D to 30.0 D $364.00
with anterior optic-haptic square edge,
posterior optic-haptic square edge, 360
degree optic square edge and aspheric
optic for aberration control
BL030 enVista The enVista, Model MX60, is an ultra- Overall diameter 12.5mm, optic $364.00
violet-absorbing, posterior chamber, body diameter 6.0mm in
hydrophobic acrylic one-piece intraocular dioptric powers ranging from
lens (IOL) Has an aspheric lens optic, +0.0 to +34D
square posterior edge, modified C haptics 0.0D to 10.0D in 1 Diopter
and available in dioptric powers ranging increments
from +0.0 to +34.0D. 11.0D to 30.0D in 0.5 Diopter
increments
31.0D to 34.0D in 1 Diopter
increments
Prostheses List by Category, Groups and Sponsor Page 6 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Carl Zeiss Pty Ltd
CZ030 CT ASPHINA 404 Small incision, foldable, single piece, Diopter range: -10.0 to 42.0, $364.00
monofocal, aspheric (aberration neutral), Optic size: 6.0mm, Overall
square-edged, hydrophilic acrylic (with length: 11.0mm
hydrophobic surface properties)
intraocular lens for capsular bag fixation.
(Monofocal lens for powers outside
standard 409MP MICS range).
IQ Medical
IQ004 Softec Acrylic, single piece, foldable intraocular Available in dioptric powers $364.00
lens with anterior and posterior optic- from -5.0 to +36.0, 1D steps: -
haptic square edge, 360 degree optic 5.0 to +10.0 and +31.0 to
square edge design, precision power +36.0; 0.5D steps: +10.5 to
calculation and aberration technology +18.0 and +25.0 to +29.5;
0.25D steps: +18.0 to +25.0
Kevin Grundy (IBD) Pty Ltd
KG012 Rayner "C-Flex" and Superflex" Aspheric Intra Ocular Lenses with Amon- C-Flex -970C + 22.5D to $364.00
Aspheric IOL Apple enhanced 360 Degree square edge, +34D Superflex-920H - 10D
Anti-vaulting Haptics to +22D
at, pl
Carl Zeiss Pty Ltd
CZ011 CT ASPHINA 603P Hydrophilic Acrylic, Foldable, PC, Single 6.0mm Optic x 10.5mm Overall $374.00
Piece, Square Edge Design, UV Blocker, Diameter
Trihaptic, Quad Haptic, Aspheric Optic,
Pre-Loaded
ConceptVision Australia Pty Ltd
CS008 Preloaded Aspheric Intraocular Lens Silicone intraocular lens 6.0mm $374.00
at, pl, t1, vblf
Design for Vision Pty Ltd
DV253 HOYA AF-1 351 Toric T3/T4/T5 Preloaded injector system, correct corneal IOL Power: + 6.0D to 30.0D $800.00
astigmatism micro-incision, ashperic, blue- (0.5 steps), IOL Cylinder
blocker, single piece hydophobic. power: 1.50D (T3), 2.25D
(T4), 3.00D (T5).
Prostheses List by Category, Groups and Sponsor Page 7 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
at, pl, vblf
Alcon Laboratories (Aust.) Pty Ltd
AL024 AcrySert model SN60WS Foldable Acrylic Single-piece Lens with +6 to +30 D $405.00
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 steps) $405.00
blocker, Foldable, Single-Piece,
Hydrophobic Acrylic
DV252 HOYA iSert® 251 Preloaded injector system, Micro-incision, +6.0D to 30.0D (5 steps) $405.00
Aspheric, Blue-Blocker, Single Piece,
Hydrophobic
at, t1
AMO Australia Pty Ltd
AO031 TECNIS® Toric 1-Piece IOL 1-piece IOL Posterior chamber +5.0 to +34.0 diopter powers $740.00
Intraocular lens, incorporates a proprietary in 0.5 diopter increments.
wavefront designed toric aspheric optic Cylinder power: 1.00 diopter,
with a squared posterior optic edge 1.50 diopter, 2.25 diopter,
designed to provide a 360 degree barrier. 3.00 diopter and 4.00 diopter
The edge of the optic has a frosted design (as measured at the IOL plane).
to reduce potential edge glare effects. Overall diameter 13mm, Optic
size 6mm.
at, vblf
Alcon Laboratories (Aust.) Pty Ltd
AL021 Alcon AcrySof SN60WF Foldable Acrylic Single-piece Lens with + 6.0 D to +30.0 D $385.00
Blue Light Protection and Aspheric
Correction
Bausch & Lomb (Australia) Pty Ltd
BL025 SofPort Advanced Optic (AO) Violet Posterior chamber, aphakic, foldable 6mm optic 13mm overall length $385.00
Shield silicone, anterior & posterior edge Modified C 5 degree
modification intraocular lens with angulation 0-30D, 0.5D steps
aberration technology, a violet light
Prostheses List by Category, Groups and Sponsor Page 8 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Design for Vision Pty Ltd
DV247 HOYA AF-1 iMics1 NY-60 Mini Incision, Aspheric, Blue-blocker, +6.0D to 30.0D (0.5 steps) $385.00
Single-piece, Hydrophobic
IQ Medical
IQ009 Softec HDY Acrylic, single piece, foldable intraocular Available in dioptric powers $385.00
lens with anterior and posterior optic- from -5.0 to + 36.0, 1D steps:
haptic square edge, 360 degree optic -5.0 to +10.0 and +31.0 to
square edge design, precision power +36.0; 0.5D steps: +10.5 to
calculation, aberration technology and blue +18.0 and +25.0 to 29.5;
light filter 0.25D steps: + 18.0 to +25.0
pl
ConceptVision Australia Pty Ltd
CS009 Staar KS-Xs Preloaded Acrylic Preloaded acrylic lens with anterior and Optic diameter 6.0mm, overall $332.00
Intraocular Lens posterior edge modification length 12.5mm, diopter range
+10 to +28.0
t1
Bausch & Lomb (Australia) Pty Ltd
BL028 Akreos Toric Astigmatism- Correcting Single piece, foldable, acrylic intraocular The overall diameter is 11 $698.00
Lens lens with a toric optic on the posterior millimetres for the entire lens
surface and axis marks on the posterior power range (spherical
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 copolymer, 5.00mm dia optic, 12.00mm $698.00
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 to $780.00
foldable, acrylic, toric, single piece lens 6.00 D cylinder.
with blue light protection and aspheric
correction
Prostheses List by Category, Groups and Sponsor Page 9 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
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, Single (0.5 steps)lOL Cylinder
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 to $740.00
foldable, acrylic, toric, single piece lens 6.00 D cylinder
with blue light protection
t2
Kevin Grundy (IBD) Pty Ltd
KG004 Rayner Premium Toric C-Flex HEMA-MMA copolymer, foldable with 5.75mm dia optic, 12.00mm $1,000.00
injector dia overall, cyls 1.5D to 11.0D
in 0.5D increments
KG013 Rayner Super Premium Toric I.O.L. Acrylic foldable toric single piece I.O.L -10.0D to 0.00D Sphere: 1D to $1,000.00
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 SN60AT Foldable Acrylic Single-piece Lens, +6 to +40D $364.00
asymmetric optic/consistent edge, with
blue light protection
AL025 AcrySof Multipiece Models MN60MA, Foldable Acrylic multi-piece Lens with - 5 D to + 30 D $364.00
MN60AC Blue light Protection
1.2.2.4 Multifocal or bifocal
AMO Australia Pty Ltd
AO020 ReZoom Acrylic Multifocal Intraocular Acrylic, foldable, posterior chamber, 6.0mm Optic Diameter x $780.00
Lens intraocular lens 13.0mm overall length
Prostheses List by Category, Groups and Sponsor Page 10 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AO023 TECNIS™ Multifocal Intraocular Lens Tecnis Multifocal foldable Posterior +5.0 Diopter to 34.0 Diopter in $780.00
(ZM900) Chamber Diffractive Intraocular Lens 0.5 diopter increments
Model ZM900. Posterior Chamber lens
with UV light-absorbing, foldable, silicone,
3 piece with a diffractive posterior optic
and a Modified Prolate Anterior Surface
Technology
at
AMO Australia Pty Ltd
AO026 TECNIS™ Multifocal Intraocular Lens Posterior chamber lens with UV light- +5 diopters to +34 diopters in $822.00
(ZMA00) absorbing, foldable acrylic, 3-piece with a 0.5d increments
diffractive posterior optic and a modified
anterior surface technology with edge
modification and 360 degree square edge.
AO027 Tecnis Multifocal 1-Piece Lens, Model A multifocal posterior chamber lens with 6.0mm Optic Diameter x $822.00
ZMB00 UV-blocking, foldable acrylic, 1-piece 13.0mm in overall length. +5.0
with a diffractive posterior optic and a Diopter to +34.0 Diopter in 0.5
modified anterior surface technology with Diopter increments.
edge modification and a 360 degree
square edge.
Carl Zeiss Pty Ltd
CZ015 AT LISA 809M Foldable aspheric single-piece intraocular Overall length 11.0mm Optic $822.00
lens with an aspheric front and an aspheric size 6.0mm
bifocal back surface, asymmetric light
distribution 65 percent distance and 35
percent near, with 3.75D addition in the
near foucs.
Kevin Grundy (IBD) Pty Ltd
KG009 Rayner "M-Flex" Mulitfocal Foldable IOL Acrylic, Foldable, Single piece multi-zoned 6.5mm Optic-Overall diameter $822.00
refractive aspheric multifocal with Amon- 12.5mm: +3D or + 4D
Apple 360 Degree Square edge, Anti Addition: +14D to +25D in
Vaulting Haptics 1.0D increments: +8.5D to
+23.5D in 0.5D increments
Prostheses List by Category, Groups and Sponsor Page 11 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
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 IOL for Optic size: 6.0mm. Overall
capsular bag fixation. The anterior length: 11.0mm
aspheric bifocal surface has an asymmetric
light distribution 65/35 for distance/near
vision, and 3.75D add for the near focus.
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 and Posterior Chamber, UV absorbing, +6 D to + 34 D $864.00
MN6AD1 foldable, acrylic, single and multiple lenses
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 Foldable aspheric single-piece intraocular Overall length 11.00mm Optic $1,198.00
lens with an aspheric toric front and an size 6.0mm -10.00 to +32.0D
aspheric bifocal back surface, asymmetric inclusive in 0.5D increments
light distribution 65 percent distance and Cylinder +1.0D to 6.5D
35 percent near, with 3.75D addition in inclusive in 0.5D increments
the near focus.
Prostheses List by Category, Groups and Sponsor Page 12 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Kevin Grundy (IBD) Pty Ltd
KG010 Rayner M-Flex Toric (Standard) Acrylic, Foldable, Single Piece, Multi- 5.75mm / 12.0mm: 6.25mm / $1,198.00
zoned Refractive Aspheric Toric Mulitfocal 12.5mm +3.00D or +4.00D
with Amon-Apple enhanced 360 degree Addition FAR: +14.0D to
Square edge, Anti Vaulting Haptics +32.00D in 0.5 STEPS:
+2.00D +3.00D +4.00D
Cylinder. NEAR: +14.0D to
27.0D in 0.5 STEPS: +2.00D
+3.00D +4.00D Cylinder
KG011 Rayner "M-Flex" Toric (Non Standard) Acrylic, Foldable, Single Piece, Muli- 5.75/12.0mm: 6.25/12.5mm $1,198.00
Zoned Refractive, Toric Multifocal with +3.00D to +4.00D Addition
Amon-Apple enhanced 360 Degree FAR: +14.0D to +32.0D in
square edge, Anti-vaulting Haptics, Patient 0.5D Increments: NEAR:
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 IOL Posterior chamber UV absorbing foldable, +6 to +34 D spherical; 1.00 to $1,240.00
acrylic, aspheric, toric single piece lense 3.00 D cylinder
with apodised diffractive optic and blue
light protection.
t2, at
Carl Zeiss Pty Ltd
CZ024 AT LISA toric 909M Foldable aspheric single-piece intraocular Overall length 11.00mm Optic $1,500.00
lens with an aspheric toric front and an size 6.0mm -10.00 to +32.0D
aspheric bifocal back surface, asymmetric inclusive in 0.5D increments
light distribution 65 percent distance and Cylinder +7.0D to 12.0D
35 percent near, with 3.75D addition in the inclusive in 0.5D increments
near focus.
Prostheses List by Category, Groups and Sponsor Page 13 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
1.2.2.5 Accommodative
pa
Bausch & Lomb (Australia) Pty Ltd
BL027 Crystalens HD Accommodating lens with > 3 Dioptres of 10.0 to 33.0 Dioptres in .05 $780.00
accommodation with dual mechanism of Dioptre steps
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 powers $780.00
accommodating intraocular lens with sqare from +5.0 to +36.0, 1D steps:
edge design, custom control precision and +31.0 to +36.0; 0.5D steps:
closed loop haptic design +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 provide 10.0 to 33.0 D in 0.50 Diopter $822.00
> 3 Diopters of accommodation with dual steps. 10.0 - 16.5 Diopters
mechanism of action: (1) forward axial (12mm length) and 17.0 - 33.0
movement of lens and (2) accommodative Diopters (11.5mm length).
arching 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 Accommodating 5.50mm Anterior Optic, $800.00
Posterior Chamber IOL 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 14 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
1.2.3 Pseudo-phakic, piggy-back
1.2.3.1 Monofocal
Design for Vision Pty Ltd
DV246 Rayner Sulcoflex Ashperic (Premium) Pseudophakic Supplementary I.O.L.O.L. -10.0D to -5.50D in 0.5D $323.00
I.O.L. increments. +5.50D
to 10.00D in 0.5D increments
at
Kevin Grundy (IBD) Pty Ltd
KG008 Rayner "Sulcoflex" Pseudophakic I.O.L. Sulcoflex Aspheric Pseudophakic I.O.L -5D to +5D $365.00
t1, at
Kevin Grundy (IBD) Pty Ltd
KG005 Rayner Sulcoflex Aspheric Toric Acrylic, Aspheric, Toric Pseudophakic SE -3 to +3 in 0.5 D steps $698.00
Pseudophakic Secondary I.O.L - Secondary IOL : Sulcus fixated with Cyl +1 to +3 in 1D steps
Standard undulating Haptics and Posterior Haptic
Angulation (Standard)
KG007 Rayner Sulcoflex Aspheric Toric Acrylic, Aspheric, Toric Pseudophakic SE -6.00 to +6.00 in 0.5 D $698.00
Pseudophakic Secondary IOL (Premium) Secondary IOL: Sulcus fixated with steps Syl +1.00 to +6.00 in
undulating Haptics and Posterior Haptic 0.5D steps
Angulation (Premium)
1.2.3.2 Multi-focal
at
Kevin Grundy (IBD) Pty Ltd
KG006 Rayner "Sulcoflex" Aspheric Multi-focal Acrylic, Aspheric Multi-focal 6.5mm / 13.5mm - $822.00
Pseudophakic Secondary IOL Pseudophakic Secondary IOL: Sulcus- 5.00D+5.00D sphere with +
Fixated with Undulating Haptics and 3.00 Addition
Posterior Haptic Angulation
1.3.1 Viscoelastic
Alcon Laboratories (Aust.) Pty Ltd
AL006 PROVISC VISCOELASTIC PROVISC contains sodium hyaluronate 0.85mL pack $80.00
SOLUTION
Prostheses List by Category, Groups and Sponsor Page 15 of 911
1 - OPHTHALMIC
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Billing Code Product Name Description Size Benefit Benefit Notations
AL007 VISCOAT Viscoelastic Fluid Chondroitin sulfate and sodium hyaluronate 0.75mL $80.00
AL015 Cellugel viscoelastic fluid Hypromellose 2% . $80.00
AL029 DisCoVisc Ophthalmic Viscosurgical Sodium hyaluronate 17 mg/mL and 0.5 mL and 1.0 mL $80.00
Device chondroitin sulfate 40mg/mL
AMO Australia Pty Ltd
AO008 Healon, Intraocular Viscoelastic Fluid Sodium Hyaluronate 10mg/ml Healon 0.4ml, 0.55ml & 0.85ml $80.00
Bausch & Lomb (Australia) Pty Ltd
BL008 Ocucoat Intraocular Fluid 20mg/mL hydroxypropylmethyl cellulose 1mL sterile $80.00
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 Ophthalin Viscoelastic Ophthalin; Viscoelastic Solution - sodium Volume 1.0ml $80.00
hyaluronate 10mg/ml. Preloaded in sterile
syringe with a 27G cannula for injection
CZ013 Ophthalin Plus Viscoelastic Ophthalin Plus; Viscoelastic Solution - Volume 1.0ml $80.00
sodium hyaluronate 15mg/ml. Preloaded
in sterile syringe with a 27G cannula for
injection
CZ022 VISTHESIA 1.5% VISTHESIA viscoelastic solution contains Total volume 0.8ml $80.00
1.5% hyaluronate (NaHA) and 1% of non
preserved lidocaine hydrochloride. Plus
two ampoules containing 0.3ml sodium
hyaluronate and lidocaine hydrochloride
20ml
IQ Medical
IQ002 Ocuvis and Ocumax 2% 20mg/mL hydroxypropylmethyl cellulose 2mL sterile $80.00
Hydroxypropylmethylcellulose 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 Fluid HEALON5- Sodium hyaluronate 23mg/ml 0.6ml $80.00
.
Prostheses List by Category, Groups and Sponsor Page 16 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AO010 Healon GV Intraocular Viscoelastic Fluid Sodium Hyaluronate 14mg/mL 0.5mm and 0.85ml $80.00
1.3.1.1 Dual Fluids
Alcon Laboratories (Aust.) Pty Ltd
AL005 DUOVISC VISCOELASTIC PROVISC contains sodium hyaluronate, Small & large packs $110.00
SYSTEM VISCOAT contains chondroitin sulfate
and sodium hyaluronate
Carl Zeiss Pty Ltd
CZ019 TwinVisc Viscoelastic Twinvisc Viscoelastic Solution - Ophthalin Total volume 1.4 ml $110.00
contains sodium Hyaluronate 1%/ Endogel
contains sodum Hyaluronate 2.2%
Preloaded in sterile syringe with a 25G
cannula for injection
1.3.2 Non Viscous
Design for Vision Pty Ltd
DV231 Vision Blue Trypan blue dye for ophthalmic applications 0.5ml syringe $48.00
1.4.1 Simple
Alcon Laboratories (Aust.) Pty Ltd
AL001 Capsular Tension Rings - 10.0 - 12.0 compressed, 12.3 $159.00
- 14.5 uncompressed
AMO Australia Pty Ltd
AO021 Stabileyes Capsular Tension Ring Polymethylmethacrylate (PMMA) Implant 12mm ring, and 13mm ring $159.00
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
Prostheses List by Category, Groups and Sponsor Page 17 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
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), 14A $243.00
per-load on disposable injector (12mm)
Insight Surgical Pty Ltd
IS001 Preloaded Capsulan Tension Ring Capsular tension ring preloaded (acrylic) 13/11mm $243.00
1.4.2 Complex
Design for Vision Pty Ltd
DV010 Morcher Coloboma Diaphram PMMA Implant 96G, 96L $334.00
1.5.1 Long Tube
AMO Australia Pty Ltd
AO012 Baerveldt Glaucoma Implant BG 101- Non-valved artificial drainage device, Surface area 250, 350, 425mm2 $425.00
350, Baerveldt Glaucoma Implant BG composition silicone - smooth, tumble-
103-425, Baerveldt Glaucoma Implant polished finish
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 of 2 Sizes: *230 mm square $625.00
silicon *175mm square
Prostheses List by Category, Groups and Sponsor Page 18 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
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 x $348.00
0.35mm thick
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
Prostheses List by Category, Groups and Sponsor Page 19 of 911
1 - OPHTHALMIC
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Billing Code Product Name Description Size Benefit Benefit Notations
1.7.1 Intracanilicular
Design for Vision Pty Ltd
DV022 Eyetec DCR Tubes Stainless steel, silicone tubing, Bodkin 30cm $135.00
lacrimal intubation set
DV241 Eyetec DCR Tubes Crawford and Cannaliculus Intubation Sets N/A $135.00
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 silicone 1. Probes 0.90mm x 4.5cm, $135.00
rods or silicone tubing - packaged sterile rod 40cm x 0.80mm. 2. Probes
0.40mm x 11cm, tubing 35cm
x 0.64mm. Probes 0.60mm x
11mm, tubing 35cm x 0.30mm.
Spectrum Surgical
SO021 FCI Lacrimal Intubation Set PVP Coated Silicone Tubing/PVP Coated PVP Bika: 0.64mm O.D. $135.00
Silicone Plug/Metal Probes/Polypropylene Tube/80 x 0.8mm probes, PVP
Thread 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 Intubation Silicone tubing swaged, imbedded into or Probes: 40mm to 120mm x $135.00
Set around malleable and flexible stainless steel 0.7mm to 1.2mm. Tube:
probes. PEEK thread. 0.64mm to 1.18mm x 25mm to
400mm. PEEK Thread: 0.2mm
to 0.4mm x 500mm.
Prostheses List by Category, Groups and Sponsor Page 20 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
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 guides. 0.64mm to 1.18mm x 30mm to
PEEK thread. Introducer. 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
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 (Aluminium Bioceramic diameter, 12, 14, $1,200.00
Oxide)/Hydroxyapatite (Synthetic) 16, 18, 20, 21, 22mm;
Synthetic Diameter, 10, 12, 14,
16, 18, 20, 22mm
Prostheses List by Category, Groups and Sponsor Page 21 of 911
1 - OPHTHALMIC
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Billing Code Product Name Description Size Benefit Benefit Notations
1.8.2 Extrascleral
1.8.2.1 Complex and permeable
Stryker Australia Pty Ltd
SK521 Sphere Orbital Sphere Models 6316, 6326, 6327, Orbital Sphere Models 6316: $785.00
6317 and 6322 8702-8704. COI implant, 14mm, 6326: 16mm, 6327:
models 7222, 7223 & 80026. MCOI 18mm, 6317: 20mm, 6322:
implant, models 7207 - 7209 Quad 22mm, 8702: 19mm, 8703:
Motility Implants 9866 - 9868 & 80022 21mm, 8704: 23mm, 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 oxide), 20, 22mm; Synthetic
mesh wrapped hydroxyapatite (synthetic), Hydroxyapatite diameter: 16,
mesh wrap (polyglycolic acid) 18, 20, 22mm
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 silicone needles 0.90mm x 6.5cm, rod $315.00
rods and silicone tubing - packaged sterile 40cm - 0.80mm, sleeve 10 x
2mm
Prostheses List by Category, Groups and Sponsor Page 22 of 911
1 - OPHTHALMIC
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Billing Code Product Name Description Size Benefit Benefit Notations
Spectrum Surgical
SO045 FCI Ptosis Probes Stainless steel needle probes swaged with 80mm x 0.8mm needle probes, $315.00
silicone tubing. 280mm 0.64mm tubing.
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 Copolymer) 7mm, Mira 287WG Murray
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 used Sleeves-Mira 70 Sleeve 1mm $45.00
in Scleral Buckling (Dimethylmethylvinyl I.D., Mira 71 Sleeve 1mm I.D.,
Siloxane Copolymer) Mira 72 McNutt Sleeve
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 Band $45.00
Retinal Implant used in Scleral Buckling 2mm, Mira 240 Circling Band
(Dimethylmethylvinyl Siloxane Copolymer) 2.5mm. 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
Prostheses List by Category, Groups and Sponsor Page 23 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
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
Spectrum Surgical
SO009 FCI Scleral Buckling Devices Band/strip: solid silicone Band - 2.0 x 0.75mm Type 40, $45.00
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 0.6mm
Strip - 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 Groove, $45.00
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 Used in Sponge- Mira 502 Cylinder $90.00
Scleral Buckling (Silicone Elastomer 2mm, Mira 5025 Cylinder
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 24 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
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, Length $25.00
30mm
Prostheses List by Category, Groups and Sponsor Page 25 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
1.9.4 Intraocular Gases
Alcon Laboratories (Aust.) Pty Ltd
AL035 ISPAN Retinal Gases for Constellation® Tamponade gases for retinal surgery C3F8 125g cylinder, dispensed in $75.00
Vision System and SF6 single dose syringe
AL036 ISPAN retinal gases Tamponade gases for retinal surgery C3F8 125 g cylinder, dispensed in $75.00
and SF6 single dose syringe
Device Technologies Australia Pty Ltd
DE284 Single Dose Ophthalmic Gases Single dose tamponading gas for retinal 30ml $75.00
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-Line Perfluorocarbon Liquid for use as a retinal 5mL $240.00
surgery additive
BL018 DK Line 100% purified perfluorodecalin Perfluorodecalin 7ml $240.00
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 26 of 911
1 - OPHTHALMIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DE205 Arcotane (Perfloro-N-Octane) Liquid perfluoro-N-Octane aid for retinal 5ml, 7ml $240.00
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 perfluorodecalin, 5ml $240.00
FCI - OCTA: Purified perfluoro-N-octane
SO024 FCI - DECA, FCI - OCTA FCI - DECA: Purified perfluorodecalin, 7ml $240.00
FCI - OCTA: Purified perfluoro-N-
Octane
1.9.6 Intraocular Silicone Oils
Bausch & Lomb (Australia) Pty Ltd
BL016 Oxane LMWC Fractioned Silicone Oil Purified fractioned silicone oil 10mL $195.00
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 Free) Viscosity: 1000 cst/5000 cst: solvent free 10ml $195.00
purified silicone oil
Prostheses List by Category, Groups and Sponsor Page 27 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.1.1 - Cemented
11.1.1.1 - Unpolished
B Braun Australia Pty Ltd
BB275 Excia Hip System Cemented stem cobalt chromium 9mm-18mm $1,850.00
Biomet Australia Pty Ltd
BI039 Integral Hip System Femoral Stem, Chrome Cobalt, 9-17mm $1,850.00
Cemented unpolished
BI047 Echo FX Stem Femoral Stem, Chrome Cobalt, 7-17mm $1,850.00
Cemented unpolished
BI050 Bi-Metric Hip System Titanium unpolished cemented 7-17mm $1,850.00
BI063 Bimetric Hip System Chrome Cobalt Cemented, unpolished 7-17mm $1,850.00
BI069 Biomet Taperloc Hip System Titanium unpolished 7.5mm to 20mm diameter $1,850.00
BI132 Mallory Head Hip System Cobalt Chrome, Unpolished 7-19mm $1,850.00
DJO Australasia Pty Ltd
DD006 Foundation Hip System 450, 460 Foundation Non-porous, cemented Stem 8, 9, 10.5, 12, 13.5, 15, and $1,850.00
16.5
ESKA Australia
EK080 Adapter GHE Femoral Stem Cemented CoCr, non polished 160mm & 180mm $1,850.00
Exactech Australia
EX012 Exotech Novation C femoral stem Femoral stem cemented unpolished 1-8 $1,850.00
EX053 Novation Cemented Plus Femoral Stem The Exatech Novation Cemented Femoral Size 10, 11, 12, 13, 14, 15, 17 $1,850.00
Stems are a line addition to the AcuMatch
C-Series Cemented femoral stems, as
follows: The trapezoidal cross-sectional
area was modified to a circulo-trapezoidal
geometry. A change to the sizing range and
neck length.
Johnson & Johnson Medical Pty Ltd
DP180 Charnley Standard Femoral Stem Stainless steel, (Ortron 90) fixed & Sizes less than 200mm $1,850.00
attachable femoral heads
DP203 Elite Plus Femoral Stem Stainless steel, Ortron 90, cemented CDH, Size 1-7 and all offsets $1,850.00
femoral stem, unpolished
Prostheses List by Category, Groups and Sponsor Page 28 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ573 Summit Cemented Femoral Stem CoCr, tapered, unpolished Sizes 0-10, with various offsets $1,850.00
Link Orthopaedics Australia
LO015 LINK Lubinus SPII Hip Prosthesis Stem Left & right 01-5 $1,850.00
Mathys Orthopaedics Pty Ltd
MA016 CCA Cemented Femoral Stem CoCr, straight, not polished 7.50mm -17.5mm $1,850.00
Orthotech Pty Ltd
OH226 Exotech Novation C femoral stem Femoral stem cemented unpolished 1-8 $1,850.00
Smith & Nephew Surgical Pty Ltd
SN010 Basis Femoral Component Hip stem, Cobalt Chromium Grit Blast Length 115 - 135mm $1,850.00
SN301 Spectron and Synergy Femoral Stem Non Porous Offset 1- 20 $1,850.00
Stryker Australia Pty Ltd
SR017 Omnifit hip system OMNIFIT cemented femoral component - Stem sizes 4-11 $1,850.00
cobalt chrome
SR018 Omnifit hip system OMNIFIT 'C' stem - cemented cobalt Stem sizes 4-11 $1,850.00
chrome, collared and collarless, 132
degree offset
ST576 Stryker Omnifit Cemented Stem Cemented femoral component Cobal Stem sizes 4-11 $1,850.00
Chrome
Zimmer Pty Ltd
ZI015 Zimmer 'VerSys Hip Systems Femoral Cemented - Cobalt Chrome unpolished 11 - 17 $1,850.00
Stem
ZI337 Natural Hip System Unpolished, straight, Femoral Stem, CoCr 140 - 160mm $1,850.00
Removable Neck
DJO Australasia Pty Ltd
DD026 R120 Cemented Femoral Stem CoCr, unpolished, tapered, collared, Size 1 to 6 $1,850.00
separate neck
ESKA Australia
EK031 Adapter Cemented Femoral Stem CoCr, unpolished, tapered, fixed proximal Femoral stem 1-7 $1,850.00
cement centralisers and distal centraliser
included
Prostheses List by Category, Groups and Sponsor Page 29 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Global Orthopaedic Technology
GO134 R120 Cemented Femoral Stem CoCr, unpolished, tapered, collared, Size 1 to 6 $1,850.00
separate neck
11.1.1.2 - Unpolished - precoat
Orthotech Pty Ltd
OH397 Furlong Hemi Range Cemented femoral stem XXS, XS, S, M & L $2,100.00
Stryker Australia Pty Ltd
HW031 Definition PM Femoral Component Femoral Stem - Vitallium Stem sizes 1 - 7 $2,100.00
11.1.1.3 - Polished
Austofix
AX068 Experion Hip System Polished, stainless steel, tapered stem Sizers 1-4, Offsets 35.5 - 44mm $2,100.00
B Braun Australia Pty Ltd
BB240 BiContact cemented Cemented stem cobal chrome 8-18 $2,100.00
Biomet Australia Pty Ltd
BI066 Stanmore Total Hip System Polished Femoral Stem - Standard and Size 1-5 $2,100.00
Straight, Chrome Cobalt
BI925 Mallory Head Hip System Femoral Stem, Cobalt Chrome, Polished 7-19mm $2,100.00
Corin Australia Pty Ltd
CR024 Taper Fit Femoral Stem Double taper stainless steel femoral stem sizes 0-4 with 4 different offsets $2,100.00
Global Orthopaedic Technology
GO164 Global Cemented Femoral Stem CoCr, polished, double taper, Sizes 0-4, various offsets $2,100.00
Johnson & Johnson Medical Pty Ltd
DP546 C- Stem & C- Stem AMT Femoral Stainless steel Ortron 90, highly polished, Size 1-8 standard, Size 1-8 $2,100.00
Stems triple taper High Offset, CDH and 0A to
3A sizes
JJ786 Corail Hip System Cemented Femoral Stainless steel cemented, polished femoral Size 8 - 20 $2,100.00
Stem stem, standard and high offsets
Prostheses List by Category, Groups and Sponsor Page 30 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Lima Orthopaedics Australia Pty Ltd
LC005 Lima Friendly Stem Femoral Stem Cemented, tapered, 0, 1, 2, 3 $2,100.00
polished
LC026 Lima Accent Hip System Femoral Stem Cemented, tapered, 1 -6 $2,100.00
polished
Mathys Orthopaedics Pty Ltd
MA463 twinSys Cemented Femoral Stem stainless steel, highly polished, triple tapered 8 sizes in standard and lateral $2,100.00
version (Size 9, 10, 11, 12, 13,
14, 15, 16)
Medacta Australia Pty Ltd
MU001 CONE Cemented Femoral Stem CoCr, highly polished, triple taper Standard sizes 1 to 8, $2,100.00
Lateralized sizes 2 to 7
MU004 Quadra Hip Cemented Femoral Stem High nitrogen stainless steel alloy, highly Std 0 to 7 $2,100.00
polished, double taper Lat 1 to 7
Smith & Nephew Surgical Pty Ltd
SN268 CPCS Femoral Stem Polished Non Porous, Std 1 - 5 $2,100.00
and High Offset
Zimmer Pty Ltd
ZI023 Zimmer Heritage Hip Systems Femoral Cobalt Chrome, polished, straight 11 - 17 $2,100.00
Stem
ZI373 MS-30 Hip prosthesis Stainless steel, polished tapered 6 to 16 $2,100.00
Removable Neck
Global Manufacturing Technology Pty Ltd
GM149 Absolut Cemented Femoral Stem CoCr, highly polished, tapered, with neck 0 to 14 $2,100.00
Lifehealthcare Pty Ltd
LH067 Groupe Lepine Total Hip Replacement Cemented Stainless steel polished Size 6, 7, 9, 9, 10, 11 $2,100.00
Wright Medical Australia
WR085 Profemur Xm Femoral Stem Femoral Stem, CoCr, Cemented, Polished 0, 1, 2, 3, 4 $2,100.00
Prostheses List by Category, Groups and Sponsor Page 31 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SCP
Stryker Australia Pty Ltd
HW041 Exeter Hip System Stainless Steel (Orthinox) Stem Sizes 0-6, Offsets 30, 33, $2,500.00
35.5, 37.5, 44, 50 & 56mm
Zimmer Pty Ltd
ZI009 Zimmer CPT Hip Systems Femoral Stem Co Cr (Zimaloy), polished and tapered Sizes 1 - 5 $2,500.00
11.1.10 - Uncemented, Modular, HA Coated, Long Lengths (Stem
11.1.10.1 - Grit Blast
Spacer
Wright Medical Australia
WR107 Profemur R Hip System Revision Hip Proximal Body Extension L52 x D21mm; $2,615.00
Piece, Titanium
Stem
Corin Australia Pty Ltd
CR113 Extreme Hip System Femoral Stem Stem component of modular femoral stem, 4 lengths - 250 to 400mm, 6 $5,020.00
titanium, HA, with distal screw holes diameters
Johnson & Johnson Medical Pty Ltd
DP009 Reef Hip Femoral Stem Titanium modular femoral stem with Length 225 - 375mm $5,020.00
optional distal locking, grit blast and full
HA coating
Link Orthopaedics Australia
LO138 Link MP Reconstruction Hip Prosthesis Stem, titanium, grit blast, HA 14 - 25mm x 210, 250, 290 & $5,020.00
330mm; 12 x 160, 180, 210,
250 - MP; 14 x 160, 180 -MP;
16 x 160, 180 - MP; 18 x
160, 180 - MP; 20 x 160, 180
- MP; 22.5 x 160, 180 -MP;
25 x 160, 180 - MP
Orthotech Pty Ltd
OH378 Securus Modular Revision Hip System Curved Femoral Stem 250 - 300mm $5,020.00
Prostheses List by Category, Groups and Sponsor Page 32 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.1.10.4 - Plasma
Body
Corin Australia Pty Ltd
CR156 Extreme Revision Hip Monobloc Combined metaphyseal and epiphyseal 4 sizes $4,520.00
Epiphysis Metaphyseal Section sections, adjustable rotation, anodized
titanium with HA coating
Stryker Australia Pty Ltd
SK056 Stryker Modular Revision Hip System Milled Proximal Body Titanium Plasma Dia 19-25mm with 2 mill $4,520.00
Spray, HA Depths; 27-29mm with 3 Mill
Depths
SK060 Stryker Modular Revision Hip System Broached Proximal Body Titanium Plasma 1-8 $4,520.00
Spray, HA
SK061 Stryker Modular Hip System Cone Proximal Body Titanium Plasma Dia 19-31mm, Heights $4,520.00
Spray, HA +0,+10,+20,+30
SK062 Stryker Modular Revision Hip System Calcar Proximal Body Titanium Plasma Diameter 19-29mm, 3 Heights $4,520.00
Spray each
Stem
Biomet Australia Pty Ltd
BI120 Mallory Head Hip System Femoral Stem, titanium plasma HA 220mm, Size 9-19mm $5,920.00
BI121 Mallory Head Hip System Femoral Stem, Calcar, HAP Coated, 250 - 260mm, Size 9-19mm $5,920.00
Titanium
BI138 Mallory Head Hip System Femoral Stem, Revision, HAP Coated, 300mm, size 7 to 19mm $5,920.00
Titanium
Stryker Australia Pty Ltd
SR045 Stryker Modular Revision Hip System Modular Long Bowed Titanium Plasma Length 217mm, 267mm and $5,920.00
HA Stem 317mm. Diameter 11mm - 26mm
11.1.11 - Calcar Replacement
11.1.11.1 - Short and Standard Length
Biomet Australia Pty Ltd
BI051 Bi-Metric Hip System Head Neck calcar Femoral Stem, Chrome 9-15mm $3,700.00
Cobalt, Cemented, unpolished 200 and
250 lengths
Prostheses List by Category, Groups and Sponsor Page 33 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SN273 Echelon/Spectron Revision Hip Stem - Non-porous 135-200mm $3,700.00
Stryker Australia Pty Ltd
ST586 Osteonics omnifit head/neck hip stem Cobal Chrome, Unpolished, standard and Stem sizes 5, 7 & 9 $3,700.00
long with calcar
11.1.11.2 - Long Length (≥200mm)
Johnson & Johnson Medical Pty Ltd
DP121 Solution Calcar Replacement Femoral CoCr calcar replacement stem, Size 7-10 inch (175 - 250mm) $6,900.00
Stem uncemented, beaded (Porocoat)
Smith & Nephew Surgical Pty Ltd
SN271 Echelon Revision Hip Stem – Non-porous 225mm-300mm $6,900.00
Stryker Australia Pty Ltd
ST589 Osteonics hip prostheses Restoration cacar replacement stem 15mm 205mm length - stem sizes 8-14 $6,900.00
titanium - HA coated
11.1.12 - Thrust Plates
11.1.12.1 - Thrust Plate
Zimmer Pty Ltd
ZI349 Thrust Plate Prosthesis Allopro Thrust Plate - Ti alloy 38 to 44mm $1,773.00
11.1.12.2 - Lateral Plate
Zimmer Pty Ltd
ZI350 Thrust Plate Prosthesis Allopro Lateral Plate - Ti alloy Std & Long (15 & 25 deg) $1,450.00
11.1.12.3 - Thrust Plate Bolt
Zimmer Pty Ltd
ZI351 Thrust Plate Prosthesis Allopro Threaded bolt - CoCr alloy 70 to 89mm $1,177.00
Prostheses List by Category, Groups and Sponsor Page 34 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.1.13 - Monoblock Hemis
Biomet Australia Pty Ltd
BI060 Austin Moore Self Locking Hip Straight Standard Femoral Prostheses, 38-55mm $615.00
Prosthesis System Titanium
BI062 FR Thompson Hip Prosthesis System Modular Curved Femoral Stem, Titanium. 38mm - 55mm $615.00
Johnson & Johnson Medical Pty Ltd
DP167 Thompson Hip Stainless steel (Ortron 90), Thompson head size 40-54 $615.00
unipolar monoblock femoral component
DP168 Austin Moore Hip Prosthesis Stainless steel (Ortron 90), AMP unipolar Head size 38-60mm $615.00
monoblock femoral component
Orthotech Pty Ltd
OH285 JRI Austin Moore Total Hip System Cementless femoral stem Head sizes range from 39mm - $615.00
56mm
OH299 JRI Total Hip System JRI Austin Moore Standard Stems Head Sizes range from 39mm - $615.00
Hemiarthroplasty. These prusct has an all- 56mm
in-one head and stem
Smith & Nephew Surgical Pty Ltd
SM037 Fracture Head Unipolar Femoral Head Stainless Steel or CoCr 38-60 S/M $615.00
SN277 Endoprosthesis CoCr 38 - 54mm $615.00
Stryker Australia Pty Ltd
HW025 Austin Moore Endoprosthesis Long Stem - Vitallium cobalt chrome Head size 38 to 63 $615.00
HW026 Austin Moore Endoprosthesis Standard Stem - Vitallium 105-165mm length, Head size: $615.00
38 to 57
SK196 Exeter Hip System - ETS Orthinox Stainless Steel Endoprosthesis 40mm Offset body with $615.00
(endoprosthesis trauma stem) unipolar monoblock monoblock head sizes 38mm,
40mm, 41mm, 42mm, 43mm,
44mm, 45mm, 46mm, 47mm,
48mm, 49mm, 50mm, 52mm,
54mm, 56mm
Zimmer Pty Ltd
ZI008 Zimmer Austin Moore Stainless Steel Sizes 38 - 60 $615.00
Prostheses List by Category, Groups and Sponsor Page 35 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.1.14 - Femoral Neck
B Braun Australia Pty Ltd
BB296 Metha - Modular neck adaptors Modular neck adaptors made from CoCr CCD - 130°, 135 °, 140°; $1,227.00
Offset - 0mm, -5mm ,+5mm;
Version - 7.5° left ante/right
retro, 0 °, 7.5 ° left retro/right
ante
Corin Australia Pty Ltd
CR101 Modular Neck for Acor & Integrale Titanium neck, with varying alignments & 4 sizes $1,227.00
Femoral Stems tapers
DJO Australasia Pty Ltd
DD028 R120 Femoral Neck CoCr, varying offsets & versions 32-38mm length, varying $1,227.00
degrees
Electus Ortho Pty Ltd
EZ007 Modula SC Neck The complete series of MODULA SC OX, OY, OZ, OA, OB, OC, $1,227.00
necks, all patented, consists of 15 sizes 9X, 9Y, 9Z, 9A, 9B, 9C, 9AA,
and makes it possible to optimise the 9BB, 9CC
reciprocal position of the stem and neck
cup on the basis of the articular needs of
the patient, by restoring the physiological
off-set and le
ESKA Australia
EK034 Adapter Femoral Neck CoCr, varying versions & offsets One Size $1,227.00
FOL Technology PTY Ltd
FO021 Multifit Modular Neck Modular Neck S, M, L $1,227.00
Global Orthopaedic Technology
GO139 R120 Femoral Neck CoCr, varying offsets & versions 32-38mm length, varying $1,227.00
degrees
Lifehealthcare Pty Ltd
LH184 Modular U Necks Cobalt chrome Standard, varus, valgus, $1,227.00
antiverted right, antiverted left
Prostheses List by Category, Groups and Sponsor Page 36 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Lima Orthopaedics Australia Pty Ltd
LC004 Lima F2L modular neck Titanium Short & Long (Straight & $1,227.00
Angled)
LC014 Sam-Fit modular neck Modular neck S1-S6, L1-L6 $1,227.00
LC029 H-Max Femoral neck Modular neck 1-6 $1,227.00
Smith & Nephew Surgical Pty Ltd
SN898 MDF Revision System Modular Neck - CoCr highly polished 24mm - 36.5mm $1,227.00
trapezoidal for MDF stem/MIS stem
multiple options of version height and neck
length
Stryker Australia Pty Ltd
SK444 ABG II Modular Hip System Neck for the ABGII stem Long & Short $1,227.00
SK446 Rejuvinate SPT Femoral Hip System Neck for Rejuvinate SPT Stem 30-38mm $1,227.00
Wright Medical Australia
WR139 Profemur Modular Neck Titanium and CoCr Femoral Necks Length 27 - 38.5mm; Neutral $1,227.00
to Ante/Retro - Varus Valgus 2
Zimmer Pty Ltd
ZI553 M/L Taper Kinectiv Neck Neck component for M/L taper stem size K, S, A, E, P, X, B, G, R, $1,227.00
C, J, D, K1, S1, AA, E1, P1,
X1, K2, E2, BB, G1, R1 ,S2,
P2, G2, CC, J1, X2, R2, J2, DD
Complex
Corin Australia Pty Ltd
CR114 Extreme Hip System Extended Neck Femoral neck with extension for locking 4 sizes $1,727.00
screw for stem
Exactech Australia
EX024 Exactech M Series body Titanium, complex neck segment 32 - 49mm, -5 - +30mm $1,727.00
Global Manufacturing Technology Pty Ltd
GM091 Apex Global & K2 & MSA Femoral Titanium and CoCr with lateral extension 25mm - 35mm to 35mm - 50mm $1,727.00
Neck for stem connection
Prostheses List by Category, Groups and Sponsor Page 37 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Global Orthopaedic Technology
GO014 UniSyn Hip Complex Neck Titanium, with lateral extension for stem 30-36mm non calcar, 45- $1,727.00
connection, includes calcar & non calcar 55mm for calcar
replacement necks, separate locking bolt
Orthotech Pty Ltd
OH061 Exactech M Series body Titanium, complex neck segment 32 - 49mm, -5 - +30mm $1,727.00
Wright Medical Australia
WR165 Guardian Limb Salvage System Guardian Femoral Neck One Size Only $1,727.00
11.1.2 - Cemented, Long Lengths (≥200mm)
11.1.2.1 - Polished and Unpolished, Conventional
ESKA Australia
EK081 Adapter GHE Femoral Long Stem CoCr, non polished, long stem 200mm - 350mm $3,550.00
Cemented
Johnson & Johnson Medical Pty Ltd
DP013 Wroblewski Resection femoral Stem Stainless steel, polished, includes 200mm-250mm $3,550.00
segmental support rings x 3
DP175 Charnley Hip Long Femoral Stem Stainless steel Ortron 90 stem 10"- 15" (250-375mm) $3,550.00
DP212 Elite Plus Long Femoral Stem Stainless steel, Ortron 90, cemented Sizes 3-5 (200-250mm) $3,550.00
femoral stem, unpolished
DP550 C- Stem & C- Stem AMT Femoral Stainless steel Ortron 90, highly polished, Size 3-8 x 200-240mm length $3,550.00
Stem triple taper, long stem
Link Orthopaedics Australia
LO012 LINK Endo - Model Saddle Prosthesis Cobal Chrome, unpolished and long 170mm / Sizes 01-5 $3,550.00
Stryker Australia Pty Ltd
HW040 Exeter Hip System Stainless Steel (Orthinox) polished long 37.5 and 44mm offsets $3,550.00
ST584 Osteonics omnifit cemented long stem cobalt chrome unpolished long Stem sizes 5-11, stem length $3,550.00
200, 250 AND 300mm
Zimmer Pty Ltd
ZI025 Zimmer VerSys CRC Hip Systems Cobalt Chrome, unpolished long stem 13 - 19 $3,550.00
Femoral Stem with calcar attachment option
ZI301 CPT Hip System Cobalt Chrome, polished, tapered, long Sizes 1 - 4 $3,550.00
stems
Prostheses List by Category, Groups and Sponsor Page 38 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Tumour
Lima Orthopaedics Australia Pty Ltd
LC001 Lima RPS Femoral System Cemented tumor Stem 130, 165, 200mm $7,176.00
11.1.3 - Uncemented
11.1.3.1 - Grit Blast
Biomet Australia Pty Ltd
BI932 PPF Hip System grit blast non HA 00 thru 12 $3,870.00
BI980 Echo Hip System Press Fit Femoral Component, titanium 7 - 17mm $3,870.00
DJO Australasia Pty Ltd
DD007 Foundation Hip System, 440, 470, 480 Foundation Porous, Press Fit, fracture 8, 9, 10.5, 12, 13.5, 15, 16.5, $3,870.00
Stem with or without collar 18.0
DD048 CLP Hip System - Femoral Component, Non modular femoral hip stem, designed 14 x standard offset $3,870.00
Ti, Grit Blast, non HA, standard and for uncemented use, and to be used with components and 12 lateral
lateral offset CoCro or Ceramic heads in total hip offset components
arthroplasty, or Bipolar heads in hemi-
arthroplasty
ESKA Australia
EK092 SCR Revision Stem Femoral Stem for Revision of THR 1 size (195mm) $3,870.00
(Double-tapered straight Stem with
rectangular profile)
Finsbury Orthopeadics Australia Pty Ltd
FI021 Adept Hip System Femoral Hip Stem, cementless, titanium, 12 standard sizes and 7 $3,870.00
long stem, grit blast lateralised sizes
FI044 Finsbury Type S Stem Tapered, Titanium, Uncemented Femoral Sizes 5 through 20. Standard & $3,870.00
Stem Lateralised
Lima Orthopaedics Australia Pty Ltd
LC011 Lima C2 Femoral Stem Femoral Stem, titanium, grit blast, non HA 1-8 $3,870.00
Link Orthopaedics Australia
LO107 Beta-Cone Cementless Hip Prosthesis Titanium, grit blast, non HA 9 Stem sizes 1-9 plus additional $3,870.00
9 stems with XL neck length.
Total 18 sizes
Prostheses List by Category, Groups and Sponsor Page 39 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Mathys Orthopaedics Pty Ltd
MA019 CBC Non Cemented Femoral Stem Titanium, grit blast, non HA, 5-20mm $3,870.00
MA427 CBH Non Cemented Femoral Stem Titanium, grit blast, non HA, 00-12 $3,870.00
Medacta Australia Pty Ltd
MU025 Quadra S Femoral Stem Titanium, grit blast, non HA, Standard #0 to #10 and #0 to $3,870.00
#3 with a shorter neck.
Lateralized #1 to #7 and #1 to
#3 with a shorter neck.
Smith & Nephew Surgical Pty Ltd
SM012 SL & SLR Plus Femoral Stem Titanium, grit blast, non HA, Sizes 01-12 for SL & 1-6 for $3,870.00
SLR
SM126 SL Plus MIA Femoral Stem Titanium, grit Blasted, double tapered 01-12 various offsets $3,870.00
SN842 Platform Hip Stem Titanium grit blasted stem 0-12 $3,870.00
Stryker Australia Pty Ltd
SR056 Hipstar™ TMZF® Hip Stem Titanium, grit blast and HA Size 0 through to 12 $3,870.00
Zimmer Pty Ltd
ZI338 Natural Hip System Femoral Stem Porous, Titanium 140 - 160mm $3,870.00
ZI376 Cone Hip prosthesis Titanium, grit blast, non HA 13 to 24mm $3,870.00
ZI397 Variall Hip System Titanium, grit blast, non HA sizes 0 to 11, $3,870.00
Removable Neck
DJO Australasia Pty Ltd
DD027 R120 Uncemented Femoral Stem Femoral Stem porous/HA coated, Size 1 to 6 $3,870.00
Modular, CrCo, standard lengths
Global Orthopaedic Technology
GO135 R120 Uncemented Femoral Stem Femoral Stem porous/HA coated, Size 1 to 6 $3,870.00
Modular, CrCo, standard lengths
Wright Medical Australia
WR136 Profemur Z Hip System Profemur Z, Titanium Tapered Femoral Standard Length Sizes 1 - 9 $3,870.00
Stem
WR142 Profemur E Hip System Profemur E Stem - without HA grit blasted 1 Standard - 9 Standard $3,870.00
'Titanium
Prostheses List by Category, Groups and Sponsor Page 40 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SCP
Zimmer Pty Ltd
ZI462 Alloclassic Hip Stem Titanium, grit blast, non HA, standard and 1 - 14 $4,270.00
high offset
ZI463 Alloclassic Hip Stem Zweymuller, Ti alloy, Short Cone, Slender 01, 0, 1, 10-13 $4,270.00
Neck
ZI468 CLS Cementless Hip Titanium, grit blast, non HA 5 - 20 $4,270.00
11.1.3.2 - Beaded
DJO Australasia Pty Ltd
DD001 Linear Hip Stem Linear Hip Stem Standard or Lateral Sizes 5, 6, 7, 8, 9, 10, 11, 12, $4,350.00
Offset (reduced neck) 13, 14, 15, 17 and 19
(standard and lateral offsets)
DD047 Revelation Hip System - Femoral Non modular femoral hip stem, designed 16 stems: 8 sizes Left & 8 sizes $4,350.00
Component, Ti, Grit Blast, non HA, for uncemented use, left & right specific Right - 8.0, 9.0, 10.5, 12.0,
standard & lateral offset with 130 degree neck angle & 12 degrees 13.5, 15.0 & 16.5
of built-in anteversion. Proximal
circumferential "3D" beading, a highly
polished neck & highly polished distal stem
Johnson & Johnson Medical Pty Ltd
DY516 Solution Implantable Hip System Revision Standard & MMA 8 straight or 6 inch (150mm) size 10.5 - 22.5 $4,350.00
bowed porous coated collarless, coxa vara
or high offset uncemented stem
JJ604 Tri-lock Femoral Stem Titanium, proximally beaded, (porocoat) Sizes 0-10 with various offsets $4,350.00
not HA,
JJ813 Summit Femoral Hip Titanium, beaded proximally, distal grit 0-12 $4,350.00
blast
Smith & Nephew Surgical Pty Ltd
SM171 MIS Stem Short, tapered, uncemented "press fit" Size 1-9 (73mm -101mm) $4,350.00
femoral stem with modular neck
functionality
SN270 Echelon Femoral Stem Porous Co Cr, Std and 9 - 19 $4,350.00
High Offset
SN305 Synergy Femoral stem Beaded Titanium Alloy, Std 9-20 $4,350.00
and High Offset
Prostheses List by Category, Groups and Sponsor Page 41 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI022 Zimmer Hip Systems Femoral Stem VerSys Beaded Fullcoat - Cobalt 11 - 20 $4,350.00
Chrome, Short & Standard
11.1.3.3 - Mesh
ESKA Australia
EK086 Adapter Uncemented Femoral Stem Co Cr, Titanium Spray, 3 Dimensional Femoral Stem 1 - 7 $4,450.00
Metal,
Johnson & Johnson Medical Pty Ltd
JJ777 Tri-Lock Gription Femoral Stem Titanium, Femoral stem, GRIPTION coated Size 0-12 standard and high $4,450.00
offset
Zimmer Pty Ltd
ZI006 Mayo Hip Titanium, mesh (fibre metal), non HA Small, medium, large and extra $4,450.00
large.
ZI016 Zimmer 'VerSys Hip Systems Femoral Titanium, mesh (fibre metal), non HA 9 - 18 $4,450.00
Stem
ZI492 Trabecular Metal Femoral Stem Titanium, porous tantalum Sizes 9 to 18 with standard and $4,450.00
extended offsets
11.1.3.4 - Plasma
Biomet Australia Pty Ltd
BI040 Integral Hip System Titanium Alloy, Plasma, non HA Length from 125mm to 175mm, $4,500.00
9-19mm
BI049 Bi-Metric Hip System Titanium, plasma non HA 7-17mm $4,500.00
BI074 Biomet Taperloc Hip System Titanium unpolished 7.5mm - 20mm diameter $4,500.00
BI139 Mallory Head Hip System Titanium, plasma 7-19mm x 135 -180mm $4,500.00
BI981 Echo Hip System Bi Metric Femoral Stem Echo Bi Metric Cementless Titanium 7 - 17mm $4,500.00
Femoral Component
FOL Technology PTY Ltd
FO020 Multifit Modular stem 125-165mm $4,500.00
Global Orthopaedic Technology
GO176 APEX K1tm Hip System K1 Femoral Stem - titanium plasma Stem std and lat sizes 1 to 12 $4,500.00
uncemented non-HA
Prostheses List by Category, Groups and Sponsor Page 42 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
SR027 Accolade HFx CoCr,plasma not HA Stem sizes 1-8, 127 degree neck $4,500.00
Zimmer Pty Ltd
ZI296 Anatomic II Hip System Femoral Stems Titanium, plasma Spray, no HA Sizes 9 - 19 $4,500.00
ZI327 M/L Taper Femoral Stem Titanium, plasma spray, non HA 9mm - 18mm in 1mm $4,500.00
increments, 10 sizes in all
ZI557 Porolock MIS Hip Stem Curved uncemented MIS Stem with A 140° size 1-14 ; B137° size $4,500.00
TiVPS coating 1-14 ; B extended offset 129°
size 1-14 ; C127° size 1-14
Removable Neck
Global Manufacturing Technology Pty Ltd
GM151 Paragon Femoral Stem, Non HA Titanium, proximal plasma, non HA 1-14 $4,500.00
Wright Medical Australia
WR102 Profemur TL Primary stem, tapered wedge, plasma 1-12 $4,500.00
coated
Zimmer Pty Ltd
ZI554 M/L Taper Hip Stem with Kinectiv Titanium, plasma, non HA size 5, 6, 7.5, 9, 10, 11, 12.5, $4,500.00
Technology 13.5, 15,16.25,17.5
11.1.4 - Uncemented, HA Coated
11.1.4.1 - Grit Blast
Austofix
AX044 Hyperion Uncemented Stem Titanium, gritblast, HA coated, collared, Sizes 9 to 20 $4,300.00
collarless and high offset
B Braun Australia Pty Ltd
BB239 BiContact Cementless Femoral stem, grit blast and HA 8-21 $4,300.00
Biomet Australia Pty Ltd
BH043 Exception Femoral Stem Standard or Varised, Left or Right Sizes 1-9 $4,300.00
Titanium Alloy, HA coated
Prostheses List by Category, Groups and Sponsor Page 43 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Corin Australia Pty Ltd
CR117 Metafix Femoral Stem Titanium femoral stem striated and fully standard, lateralised and 125 $4,300.00
coated with HA degree
Electus Ortho Pty Ltd
EZ001 APTA Hip Stem Anatomic, Titanium, HA Coated, Modular Sizes 1-8 in Left & Right, $4,300.00
Uncemented Femoral Stem Collarless & Collared
EZ004 Hydra Hip Stem Tapered, Titanium, HA Coated, Modular Sizes 9 through 16 $4,300.00
Uncemented Femoral Stem
Exactech Australia
EX002 Novation Element HA Novation Press-Fit Element Stems are collarless: standard offset, $4,300.00
intended for press-fix fixation and 12/14, sizes 8-18 Extended
manufactured from Titanium 6A1-4V and offset 12/14, sizes 8-18,
have rectangular cross-sectional geometry collared: standard offset 12/14,
with transverse proximal grooves and distal sizes 8-18
parallell grooves.
Finsbury Orthopeadics Australia Pty Ltd
FI043 Finsbury Type C Stem Tapered, Titanium, HA Coated, Sizes 7 through 20. Standard & $4,300.00
Uncemented Femoral Stem Lateralised
Johnson & Johnson Medical Pty Ltd
DY514 Kar (Corail Revision) Femoral Stem Titanium, grit blast, full HA coating, fluted Size ≤13, (length less than $4,300.00
distally 200mm)
Lifehealthcare Pty Ltd
LH366 Pavi / Targos Femoral Stem Titanium, grit blast with HA One piece varus neck in sizes $4,300.00
10-16 in lengths 140 - 170mm.
One piece standard neck in
sizes 9 -16 , lengths 140 -
170mm.
Lima Orthopaedics Australia Pty Ltd
LC003 Lima Total Hip Replacement System F2L Multineck Femoral Stem 1 - 6 $4,300.00
Uncemented, beaded, with HA
LC013 FIT stem FIT anatomical Femoral Stem 1-7 $4,300.00
LC028 H-Max Femoral stem Modular stem 9-18 $4,300.00
Link Orthopaedics Australia
LO034 CFP Hip Stem Titanium, grit blast, HA Extra small to Extra Large $4,300.00
Prostheses List by Category, Groups and Sponsor Page 44 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LO111 Beta-Cone Cementless Hip Prosthesis Titanium, grit blast, with HA 9 Stem sizes 1-9 plus additional $4,300.00
9 stems with XL neck length.
Total 18 Sizes
Mathys Orthopaedics Pty Ltd
MA462 twinSys Non Cemented Femoral Stem Titanium, grit blast, fully HA Various offsets and sizes under $4,300.00
200mm length
Medacta Australia Pty Ltd
MU003 Quadra Hip Femoral Stem Titanium, grit blast, fully HA, Std 0 to 10 $4,300.00
Std (shortneck) 00 to 3
Lat 1 to 7
Lat (shortneck) 1 to 3
Smith & Nephew Surgical Pty Ltd
SM106 SBG Femoral Stem Titanium, grit blasted, proximal HA 05 - 7 $4,300.00
SN306 Synergy Femoral stem: HA coated Titanium Alloy, 9-20 $4,300.00
Std and High Offset
SN894 Anthology HAC Femoral Stem - Titanium grit blasted HA 01-18 90mm-122mm $4,300.00
coated
Stryker Australia Pty Ltd
ST573 Omnifit hip stem Titanium, grit blast and HA Stem sizes 4-14 $4,300.00
Wright Medical Australia
WR147 Profemur Anca-fit Hip System Anca-fit Femoral Stem with 1/3 proximal 9.5, 11, 12, 13, 14, 15, 16, $4,300.00
HA, grit blast 17.5, left and right
WR222 Profemur L Profemur L Hip Stem Size 1 - 11 $4,300.00
Zimmer Pty Ltd
ZI556 Avenir- Muller Stem Titanium, grit blast, with HA Standard sizes 1-8; Lateral $4,300.00
sizes 1-8
Removable Neck
Corin Australia Pty Ltd
CR099 Acor Anatomic Femoral Stem for Anodised titanium, fully HA Coated, 7 Sizes $4,300.00
Modular Neck curved stem and used with separate neck
CR100 Integrale Femoral Stem Anodised titanium, fully HA 7 Sizes $4,300.00
Coated,straight stem and used with
separate neck
Prostheses List by Category, Groups and Sponsor Page 45 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SCP
Johnson & Johnson Medical Pty Ltd
DP943 Corail Femoral Stem Titanium, grit blast, full HA coating, Size K6 to K20 or in lengths $4,700.00
110 -190mm
Orthotech Pty Ltd
OH279 JRI Furlong Total Hip System Uncemented Femoral Stem, titanium, grit 12 /14 Taper, and 5mm offset, $4,700.00
blast, with HA, short and standard spigot
Zimmer Pty Ltd
ZI520 Alloclassic Zweymuller Hip Stem HA Titanium, grit blast, with HA 1 - 12 $4,700.00
Coated
11.1.4.2 - Beaded
Johnson & Johnson Medical Pty Ltd
DY134 Summit Femoral Stem Titanium, beaded proximally with HA, Size 1-10 $4,850.00
duofix distal grit blast
DY424 Proxima Femoral Stem Titanium, beaded with HA (duofix), Size 1 to 9 $4,850.00
metaphyseal stem
JJ814 Silent Hip System-Femoral Component Neck preserving femoral stem, titanium, Sizes 18-28 x 45-70 $4,850.00
beaded with HA (Duofix)
Smith & Nephew Surgical Pty Ltd
SN003 Image Hip Stem Titanium, beaded, HA Sizes 9 - 18 $4,850.00
SN303 Synergy Femoral Stem HA Coated beaded 9 - 18 $4,850.00
Titanium Alloy, Std and High offset
SN678 Echelon with HA Cobalt Chromium with Hyrdoxyapetite 11-20 $4,850.00
Coating, beaded
SN751 Synergy Shortened Synergy Stem, Titanium, 1-18 $4,850.00
beaded, HA
SN825 Birmingham Mid Head Resection Stem Titanium, Beaded and HA 1-19 $4,850.00
SN843 Anthology Hip System Titanium, Beaded and HA 0-20 $4,850.00
Prostheses List by Category, Groups and Sponsor Page 46 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.1.4.3 - Mesh
ESKA Australia
EK087 Adapter Uncemented Femoral Stem CoCr, Titanium Spray, 3 Dimensional Femoral Stem 1 - 7 $4,950.00
Metal, HA
Zimmer Pty Ltd
ZI014 Zimmer Epoch Hip Systems Femoral Stem Cobalt Chrome, Core, PAEK outer 14 - 18 mm $4,950.00
matrix, Titanium mesh with HA
ZI017 Zimmer 'VerSys Hip Systems Femoral Titanium, mesh (fibre metal), with HA 9 - 18 $4,950.00
Stem
ZI365 Natural Hip System Titanium stem with cancellous spray 00 to 7 $4,950.00
titanium coating with HA, standard and
high offset
11.1.4.4 - Plasma
B Braun Australia Pty Ltd
BB274 Excia Hip System plasma titanium, HA 8mm-18mm $5,000.00
Biomet Australia Pty Ltd
BH038 Bi Metric Hip Femoral Stem, HA coated, porous plasma (7 to 21) mm diameter, $5,000.00
spray, titanium Standard or lateralised
BI075 Biomet Taperloc Hip System titanium, plasma, HA 7.5mm - 22.5mm $5,000.00
BI141 Mallory Head Hip System Titanium, plasma and HA 7-19mm $5,000.00
BI779 CDH Hip System Titanium, plasma and HA 8-12 mm Diameter $5,000.00
Corin Australia Pty Ltd
CR086 Tri-Fit Femoral Stem Titanium stem proximally coated with 5-20mm $5,000.00
plasma spray and HA
CR157 MiniHip Stem Short stem, Titanium, Plasma Spray with HA 9 sizes $5,000.00
Prostheses List by Category, Groups and Sponsor Page 47 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Exactech Australia
EX009 Novation Tapered and Splinned Femoral Novation Press-Fit femoral components tapered: Standard Offset, size $5,000.00
Stem are manufactured from titanium alloy. The 9-18, Extended Offset, Size 9-
stem has a circulo-trapezoidal cross- 18; HA, Standard Offset, Size
sectional geometry and distal taper. 9-18; HA, Extended Offset,
Size 9-18, splinned: Standard
Offset, Size 9-18; Extended
Offset, Size 9-18, RDD
Standard Offset size 11-18,
RDD Extended Offset size 11-
EX013 Exactech Femoral Stem Novation Hip System 9-18 $5,000.00
Global Manufacturing Technology Pty Ltd
GM133 K2 Global Modular Femoral Stem K2 Mid Stem Size 2 to 12 $5,000.00
Lima Orthopaedics Australia Pty Ltd
LC015 Sam-Fit modular stem Modular stem 1 - 7 $5,000.00
Orthotech Pty Ltd
OH232 Exactech Femoral Stem Novation Hip System 9-18 $5,000.00
OH280 JRI Furlonjg active stem JRI Furlong Active Stem, Titanium Aloy 12 / 14 Taper, 9-16mm $5,000.00
with Supravit Coating, 12/14 Taper
Smith & Nephew Surgical Pty Ltd
SM013 SL & SLR PLUS Femoral Stem Titanium, Plasma spray, proximal HA 01 to 12 for SL & 1-6 for $5,000.00
coating SLR, various offsets
SM122 Polarstem Titanium Stem, Plasma Spray & Full HA 01-10, various offsets $5,000.00
coating
SM127 SL Plus MIA Femoral Stem Titanium, Plasma spray, proximal HA 01-12, various offsets $5,000.00
coating
SN900 NANOS Neck Preserving Stem .Neck preserving femoral stem with Size 0 to Size 9 $5,000.00
vacuum plasma spray titanium porous
coating and Calcium Phosphate electro
chemical deposition process coating (Bonit
Coating) for use without modular femoral
neck choices
Stryker Australia Pty Ltd
HW024 ABG11 Hip Stem Prosthesis(Various) Titanium, Plasma coated with HA Stem sizes 1 - 8 Left, 1 - 8 $5,000.00
Right
Prostheses List by Category, Groups and Sponsor Page 48 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
HW055 Citation Hip TMZF - HA Stem - Titanium/HA coated Stem sizes 0 - 8 Left & Right $5,000.00
SK447 Rejuvinate SPT (Monolithic Stems, Titanium (TMZF), plasma coated, HA 4-12 $5,000.00
TMZF) Hip System
ST541 Secur-Fit Plus max hip system Titanium, plasma, HA Stem sizes 7-14 $5,000.00
ST574 secur-fit HA Max hip stem Titanium, plasma coated, HA Stem sizes 4-14 in 127 and 132 $5,000.00
degree neck angles
ST575 ACCOLADE hip prostheses Titanium, plasma coated, HA Stems sizes 0, 1, 2, 2.5,3, 3.5, $5,000.00
4, 4.5, 5, 5.5, 6, 7, 8
ST587 Osteonics hip prostheses Restoration stem - 155mm titanium - HA 155mm length - stem sizes 7-12 $5,000.00
coated
Zimmer Pty Ltd
ZI493 M/L Taper Stem Plasma sprayed titanium with HA Sizes 5 to 22 with standard and $5,000.00
extended offsets
ZI495 Zimmer Anatomic II Titanium, plasma spray with HA Sizes 1 - 12, left and right $5,000.00
Removable Neck
B Braun Australia Pty Ltd
BB295 Metha - modular short stem Short stem, plasma, HA 1 -6 $5,000.00
Global Manufacturing Technology Pty Ltd
GM090 APEX Global Femoral Stem Titanium, plasma coated, proximal HA , Sizes 2-8 $5,000.00
standard and short lengths
GM117 MSA Global Femoral Stem Titanium, plasma spray, with HA, distal 0 - 6 $5,000.00
flute & polished
GM120 K2 Global Femoral Stem Titanium, plasma spray, proximal HA Size 0to size 12 $5,000.00
GM150 Paragon Femoral Stem Titanium, proximal plasma & HA 1 to 14 $5,000.00
Global Orthopaedic Technology
GO034 UniSyn Non Modular Femoral Stem Titanium, proximal plasma spray with HA, 0 to 6 $5,000.00
distal flutes
Lifehealthcare Pty Ltd
LH069 MBA stem Titanium, grit blast with HA 1 - 8 $5,000.00
LH183 Lyderic II HA Modular Stem Titanium, plasma with HA Size 6-11 $5,000.00
Stryker Australia Pty Ltd
SK445 Rejuvinate SPT Femoral Hip System Titanium (TMZF), plasma, HA with 7-12 $5,000.00
removable neck
Prostheses List by Category, Groups and Sponsor Page 49 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SR062 ABGll Modular Stem Titanium (TMZF), plasma, HA with 1-8 (left and right) $5,000.00
removable neck
Wright Medical Australia
WR098 Profemur Renaissance Hip System Titanium Stem with HA Plasma Spray, Size 10 -18 $5,000.00
standard & reduced flare
WR123 Profemur R Hip System Titanium Tapered Stem - HA Plasma Spray Sizes 9 to 18 in 1 mm increments $5,000.00
Zimmer Pty Ltd
ZI555 M / L Taper Hip Stem with Kinectiv Titanium, plasma spray with HA size 5, 6 , 7.5, 9, 10, 11, 12.5, $5,000.00
Technology 13.5, 15, 16.25, 17.5
11.1.5 - Uncemented, Long Lengths (≥200mm)
11.1.5.1 - Grit Blast
Biomet Australia Pty Ltd
BI097 Kent Hip System Titanium, grit blast, non HA, distal screw Narrow, Std. Size 6 - 16 hole $5,410.00
holes
BI778 PLR Splined Revision Stem Splined Straight Stem, Ti, grit blast, non HA 14-24mm x 270mm $5,410.00
ESKA Australia
EK095 SCR Revision Stem Femoral Stem for Revision of THR 8 sizes (4 - 11) $5,410.00
(Double - tapered straight Stem with 200mm-243mm
rectangular profile)
Smith & Nephew Surgical Pty Ltd
SM014 SLR Plus Long Femoral Stem Titanium, grit blast, non HA, long stem Sizes 7-12 $5,410.00
Zimmer Pty Ltd
ZI377 Wagner Revision Hip Prosthesis Uncemented Stem Titanium, grit blast, non 190/14 to 385/25 $5,410.00
HA
11.1.5.2 - Beaded
Johnson & Johnson Medical Pty Ltd
DY517 Solution Implantable Hip System Revision Standard & MMA 8 straight or 8 inch (200mm) size 10.5 - 22.5 $5,750.00
bowed porous coated collarless, coxa vara
or high offset uncemented stem
Prostheses List by Category, Groups and Sponsor Page 50 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.1.5.4 - Plasma
Biomet Australia Pty Ltd
BI041 Integral Hip System Titanium Alloy, plasma, not HA, long Length from 180mm to 225mm, $5,900.00
9-20mm
BI052 Bi-Metric Hip System Revision 200 Stem, Titanium, plasma non 9-17mm $5,900.00
HA
BI053 Bi-Metric Hip System Revision 250 Stem, Titanium, plasma, non 9-17mm $5,900.00
HA
BI054 Bi-Metric Hip System Revision 300mm Femoral Stem, Titanium, 9-17mm $5,900.00
plasma non HA
BI135 Mallory Head Hip System Femoral Stem, Revision, Titanium 250mm, size 7 to 19mm $5,900.00
BI137 Mallory Head Hip System Femoral Stem, Revision, Titanium 300mm, size 7 to 19mm $5,900.00
BI692 Reach Revision Hip System Titanium plasma no HA Sizes 13 - 19 (L&R) by 200 - $5,900.00
250mm)
11.1.6 - Uncemented, Long Lengths, HA Coated (≤200mm)
11.1.6.1 - Grit Blast
Johnson & Johnson Medical Pty Ltd
DY515 Kar (Corail Revision) Femoral Stem Titanium, grit blast, full HA coating, fluted Sizes 14 - 20, (length 200mm $5,750.00
distally & greater)
Mathys Orthopaedics Pty Ltd
MA475 twinSys Non Cemented Long Femoral Titanium, grit blast, fully HA, long Various offsets and sizes > $5,750.00
Stem 200mm length (14 & 15)
Medacta Australia Pty Ltd
MU058 Quadra-R Hip Revision Stem Uncemented revision stem, HA Coated From size 0 to size 9` $5,750.00
Orthotech Pty Ltd
OH281 JRI Furlong revision Total Hip System Modular femoral stem, Grit blast, HA 12 / 14 Taper, 200mm long, $5,750.00
200ml long 5mm offset
Prostheses List by Category, Groups and Sponsor Page 51 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.1.6.4 - Plasma
Global Manufacturing Technology Pty Ltd
GM134 K2 Global Modular Femoral Stem K2 Stem K2 Stem Size 2, K2 Stem $6,400.00
Size3, K2 Stem Size 4, K2
Stem Size 5, K2 Stem Size 6 ,
K2 Stem Size 7, K2 Stem Size
8, K2 Stem Size 10, K2 Stem
Size 11,
Orthotech Pty Ltd
OH282 JRI Total Hip System JRI Furlong Revision Stems, Titanium 12 / 14 taper, 250mm long, $6,400.00
Alloy with Supravit Coating, 12 / 14 Taper 250ml long 5mm offset
OH283 JRI Total Hip System JRI Furlong Revision Plus Stem, Titanium 12 / 14 Taper, 200mm long and $6,400.00
Alloy with Supravit Zoned Coating, 12 / 200ml long with 5mm offset
14 Taper
OH284 JRI Total Hip System JRI Furlong Revision Plus Stem, Titanium 12 / 14 Taper, 250mm long, $6,400.00
Alloy with Supravit Zoned Coating, 12 / and 250ml long with 5ml offset
14 Taper
Smith & Nephew Surgical Pty Ltd
SM015 SLR Plus Long Femoral Stem Titanium, Plasma spray, proximal HA 7-11, various offsets $6,400.00
coating, long stem
Stryker Australia Pty Ltd
ST588 Osteonics hip prostheses Restoration stem - 205mm titanium - HA 205mm length - stem sizes 8-12 $6,400.00
coated
ST591 Osteonics hip prostheses Restoration HA long stem titanium - HA 255mm length - stem sizes 8 - $6,400.00
coated anatomic (left & right) 14, left & right
11.1.7 - Uncemented, Modular
11.1.7.1 - Grit Blast
Body
Biomet Australia Pty Ltd
BI086 Impact Modular Total Hip System Femoral body, Titanium, grit blast, non HA Size 3-6 Small/Medium $2,860.00
FOL Technology PTY Ltd
FO001 MGS Revision Modular stem neck Modular Neck 65 - 95 mm $2,860.00
Prostheses List by Category, Groups and Sponsor Page 52 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Global Manufacturing Technology Pty Ltd
GM052 SMR Modular Femoral Stem Proximal Titanium, grit blast, non HA, 40 to 70mm $2,860.00
Body
GM055 SMR Modular Hip System Calcar Component 40 to 70mm $2,860.00
Lima Orthopaedics Australia Pty Ltd
LC009 Lima Modulus Hip System Femoral Body, grit blast, non HA body w/screw, small and large $2,860.00
LC027 Lima Revision Total Hip System Femoral body, Titanium, non HA 50 - 110mm $2,860.00
Link Orthopaedics Australia
LO020 Link MP Recontruction Hip Prosthesis Titanium, Grit blast, femoral Body 35-65mm / 126 & 135 CCD $2,860.00
Mathys Orthopaedics Pty Ltd
MA524 Modular Revision Stem Proximal body, grit Blasted Titanium 50-70mm $2,860.00
Medartis
EO044 MRP-TITAN Neck Segment Body without fin with locking screw Cone K, M, L $2,860.00
12/14, body with fin with locking screw
Cone 12/14, body with trocanter with
locking screw Cone 12/14, special implant
for trocanter
Smith & Nephew Surgical Pty Ltd
SM016 Modular Plus Femoral System Proximal Titanium, grit blasted, with stem locking sizes AS/AL/BS/BL/CS/AX $2,860.00
Femoral Body bolt less than 75mm, various offsets
Stryker Australia Pty Ltd
ST001 Restoration T3 Revision Hip System - Titanium femoral body, grit blast, non HA S,M,L $2,860.00
Proximal body
Zimmer Pty Ltd
ZI378 PFM Hip series Titanium, grit blast, non HA, femoral body 55 to 85 $2,860.00
Cone
Exactech Australia
EX018 Exactech M Series Total Hip System Femoral Cone with calcar 21-31mm $3,120.00
Orthotech Pty Ltd
OH219 Exactech M Series Total Hip System Femoral Cone with calcar 21-31mm $3,120.00
Prostheses List by Category, Groups and Sponsor Page 53 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Spacer
Link Orthopaedics Australia
LO026 Link spacer Titanium, grit blast, non HA 10mm - 40mm $1,215.00
Medartis
EO004 MRP-TITAN Stem Short diopyseal stem 30mm length - diameter 16mm, $1,215.00
18mm, 20mm, 22mm
Wright Medical Australia
WR093 Profemur R Hip System Extension Piece for the profemur R, L26 x D19mm, D21mm & $1,215.00
Titanium, grit blast D23mm;
Stem
Biomet Australia Pty Ltd
BI081 ARCOS Modular Revision Hip System Grit Blast Distal Stems, non HA 150mm - 200mm $3,120.00
FOL Technology PTY Ltd
FO002 MGS Revision Modular stem Modular stem 130-210mm $3,120.00
Global Manufacturing Technology Pty Ltd
GM144 SMR Femoral Stem SMR Distal Component <200mm SMR Distal Component 14 x $3,120.00
160mm, SMR Distal
Component 16 x 160mm, SMR
Distal Component 17 x
160mm, SMR Distal
Component 18 x 160mm, SMR
Distal Component 19 x
160mm, SMR Distal
Component 20 x 160mm, SMR
Distal Component 22 x
160mm, SMR Distal
Component 14
Lima Orthopaedics Australia Pty Ltd
LC010 Lima Modulus Hip System Femoral Stem, titanium, grit blast, non HA Femoral Stem 16mm - 26mm $3,120.00
LC030 Lima Revision Total Hip System Titanium, grit blast, non HA 14, 16, 18 $3,120.00
Link Orthopaedics Australia
LO021 Link MP Reconstruction Hip Prosthesis Stem, grit blast, titanium non HA 12 - 25mm x 160mm $3,120.00
Prostheses List by Category, Groups and Sponsor Page 54 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Mathys Orthopaedics Pty Ltd
MA500 Lima Revision Total Hip System Titanium, grit blast, non HA 14, 16, 18 $3,120.00
Medartis
EO001 MRP- TITAN Stem Modular Revision Titanium stem, straight 140mm diameter 13-30 $3,120.00
and curved
Smith & Nephew Surgical Pty Ltd
SN899 MDF Revision System Femoral Stem - Titanium grit blasted for 10-25 - 150mm - 190 mm $3,120.00
use with moduylar femoral neck choices
anteverted, retroverted, standard and
multiple height. Allows fixation of proximal
sleeve in various shapes (suffix - N, SV &
MOD3)
Stryker Australia Pty Ltd
SK059 Stryker Modular Revision Hip System Titanium Alloy Bowed Conical Distal Stems Restoration Modular bowed $3,120.00
conical distal stem 195mm,
235mm
Zimmer Pty Ltd
ZI379 PFM Hip series Uncemented Stems, titaniuam, grit blast 140 to 260 x 14 to 24 $3,120.00
and non HA
ZI611 Revitan Modular Straight Stem Titanium, grit blast, non HA, cobalt 14 x 175, 140mm; 18 x $3,120.00
chrome junction 140mm; 20, 22, 24 x 195mm
ZI613 ZMR Modular Revision Hip System - Titanium, grit blast, non HA 150 to 17mm $3,120.00
Stem
11.1.7.2 - Beaded
Cone
Johnson & Johnson Medical Pty Ltd
DP982 SROM ZTT Femoral Sleeve Titanium, beaded without HA, proximal 12A-24F $3,120.00
femoral cone
Smith & Nephew Surgical Pty Ltd
SN895 MDF Revision System Modular sleeve with Stiktite titanium Small, Medium, Large and X- $3,120.00
porous coating Large - sizes 10-25
Prostheses List by Category, Groups and Sponsor Page 55 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stem, Tumour
ESKA Australia
EK107 MML Tumor Revision System Adapter Stem with Taper for Tibia and 13 to 16mm Diameters, each $4,778.00
Femur - Cementless, 3 Dimensional Metal 120 & 160mm in Length
11.1.7.3 - Mesh
Body, Tumour
ESKA Australia
EK101 MML Tumor Revision System Trochanteric Module - Adapter Version, Left or Right with Taper $3,860.00
Smooth or Structured, CoCr, 3 Locking 12/14
Dimensional Metal
11.1.7.4 - Plasma
Body
Biomet Australia Pty Ltd
BH032 ARCOS Revision Hip System - Broached proximal body porous plasma Standard or High Offset A B C $3,120.00
Broached proximal body spray D E and F
BH034 ARCOS Calcar Proximal Body Calcar Proximal Body porous plasma spray Calcar body 50mm Std +10 $3,120.00
+20 bodies, Std or high offset
Body A To E
BH130 ARCOS Revision Hip System Cone Cone Proximal Body Porous plasma 50mm body $3,120.00
Proximal Body sprayed coated
BI015 Reach Revision Hip System Titanium, Cobal Chrome, non HA Proximal Body #1-6 $3,120.00
BI126 Modular Calcar Mallory Head Revision Femoral body, Titanium, plasma, non HA 34, 45, 55 resection levels x $3,120.00
Hip System size a,b,c,d,e
Global Orthopaedic Technology
GO016 UniSyn Proximal Femoral Body non HA Titanium, plasma spray, non HA single height, variable diameter $3,120.00
and variable medial projections
Cone
Exactech Australia
EX014 Exactech M series modular Hip System Modular Titanium Revision Hip - 25-27mm, S, M, L, XL $3,120.00
Metaphyseal Segment
EX015 Exactech M series modular Hip System Femoral cone, titanium, plasma, not HA 21 - 23mm, S, M, L, XL $3,120.00
Prostheses List by Category, Groups and Sponsor Page 56 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
EX016 Exactech Total Hip System Modular Titanium Revision Hip - 29-31mm, S, M, L, XL $3,120.00
Metaphyseal Segment
Orthotech Pty Ltd
OH060 Exactech M series modular Hip System Femoral cone, titanium, plasma, not HA 21 - 23mm, S, M, L, XL $3,120.00
OH119 Exactech M series modular Hip System Modular Titanium Revision Hip - 25-27mm, S, M, L, XL $3,120.00
Metaphyseal Segment
OH120 Exactech Total Hip System Modular Titanium Revision Hip - 29-31mm, S, M, L, XL $3,120.00
Metaphyseal Segment
Stem
Biomet Australia Pty Ltd
BH132 ARCOS Modular Revision Hip System Distal Stem bullet or slottedtip, porous 115mmE $3,520.00
Short Distal Stems plasma spray
BI127 Modular Calcar Mallory Head Revision Femoral Component, Distal. Titanium 170-300mm $3,520.00
Hip System
Global Orthopaedic Technology
GO013 UniSyn Hip Plasma Femoral Stem Titanium, plasma spray, non HA <200mm $3,520.00
Wright Medical Australia
WR132 Profemur R Hip System Titanium tapered, Straight or bowed Stem, Length 95 - 215mm, Diameter $3,520.00
plasma coated 10 - 22.5mm
11.1.7.5 - Unpolished and Polished
Body, Tumour
Biomet Australia Pty Ltd
BI889 Orthopaedic Salvage System Proximal Femoral Component, Letson or 7cm Left or Right $5,150.00
Finn, Anatomic, Ti
Corin Australia Pty Ltd
CR123 METS Smooth Trochanter Titanium, uncoated small and standard $5,150.00
ESKA Australia
EK100 MML Tumor Revision System Trochanteric Module - Cemented Adapter Left or Right with Taper $5,150.00
Version, CoCr, Smooth Locking 12/14
Stryker Australia Pty Ltd
SK158 Howmedica Modular Resection System GMRS Proximal Femoral Component, Standard, Trochanteric, $5,150.00
Cast Chrome Cobalt Smooth
Prostheses List by Category, Groups and Sponsor Page 57 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Spacer, Tumour
Corin Australia Pty Ltd
CR129 METS Principal Shaft Titanium shaft 45mm-150mm $4,279.00
ESKA Australia
EK103 MML Tumor Revision System Extension Module with Taper Locking 7 Sizes in 10mm increments; $4,279.00
16/18 30mm - 160mm Length
Stem
Exactech Australia
EX017 Exactech M series modular Hip System Modular femoral stem, titanium, polished, 11 - 21mm x 135-165mm $3,520.00
non HA
Global Orthopaedic Technology
GO011 UniSyn Hip Fluted Femoral Stem Titanium, highly polished, fluted <200mm $3,520.00
Medartis
EO027 ESOP HA ESOP Femoral Stem Diaphyseal Ti Size 9-15 $3,520.00
polished
Orthotech Pty Ltd
OH059 Exactech M series modular Hip System Modular femoral stem, titanium, polished, 11 - 21mm x 135-165mm $3,520.00
non HA
Smith & Nephew Surgical Pty Ltd
SN817 Emperion Revision Hip Polished modular stem with option of calcar +10, +20mm $3,520.00
Stryker Australia Pty Ltd
SK022 Modular Revision System Fluted Distal Titanium, polished, fluted, no HA Stem Lengths 127 & 167mm $3,520.00
Stems straight & bowed. Diameter
11-26mm
Stem, SCP
Johnson & Johnson Medical Pty Ltd
JJ749 SROM Femoral Stem Titanium, fluted, distal polished femoral Sizes 6-21 $4,120.00
stem & neck
JJ750 SROM Calcar Replacement Femoral Titanium, fluted, distal polished femoral Sizes 6-21 $4,120.00
Stem stem & neck, with calcar replacement
Smith & Nephew Surgical Pty Ltd
SN749 Emperion Revision Hip Polished non HA Short & Long $4,120.00
Prostheses List by Category, Groups and Sponsor Page 58 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stem, Tumour
Corin Australia Pty Ltd
CR128 METS Total Femoral Link Component Curved titanium link shaft 165mm, 225mm $4,279.00
CR147 METS Smooth Integral Shaft & Stem Titanium, uncoated, shaft and stem with L=15,30mm D=27,,30mm $4,279.00
round or oval collar (round) D=30x38, 36x44
(oval)
ESKA Australia
EK106 MML Tumor Revision System Adapter Stem with Taper for Tibia and 10 to 16mm Diameters, each $4,279.00
Femur - Cemented 120 & 160mm in Length
11.1.8 - Uncemented, Modular, HA Coated
11.1.8.1 - Grit Blast
Body
Johnson & Johnson Medical Pty Ltd
DP005 Reef Hip Proximal Body & Neck Titanium neck combined with small 25-35mm $3,120.00
proximal body of varying size, grit blast,
HA. With locking screw
Link Orthopaedics Australia
LO133 Link MP Reconstruction Hip Prosthesis Link body, Titanium, grit blast, HA 35-65mm IN 126 & 135 $3,120.00
degrees
Medartis
EO026 ESOP HA Esop Femoral body Metaphyseal grit blast Left and Right Size 5-20 $3,120.00
Ti/HA,
Orthotech Pty Ltd
OH379 Securus Modular Revision Hip System Modular Proximal Body Std & 5mm offset $3,120.00
Cone
Corin Australia Pty Ltd
CR155 Extreme Revision Hip Metaphyseal Metaphyseal segment, adjustable rotation, 4 sizes $2,930.00
Section anodized titanium with HA coating
Prostheses List by Category, Groups and Sponsor Page 59 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stem
Link Orthopaedics Australia
LO136 Link MP Reconstruction Hip Prosthesis Stem 12 x 160, 180, 210, 250 - MP; $3,520.00
14 x 160, 180 -MP; 16 x 160,
180 - MP; 18 x 160, 180 -
MP; 20 x 160, 180 - MP; 22.5
x 160, 180 -MP; 25 x 160,
180 - MP
11.1.8.2 - Beaded
Cone
Johnson & Johnson Medical Pty Ltd
DP981 SROM ZTHA Femoral Sleeve Titanium, grit blasted with HA, (proximal Small / Large /XX Large size $2,930.00
femoral cone) 14B-24F
Smith & Nephew Surgical Pty Ltd
SN819 Emperion Revision Hip Proximal Modular Cone Standard, beaded 0, 1, 2, 3, 4, standard and long $2,930.00
HA coated
SN820 Emperion Revision Hip Proximal Modular Cone Long 0, 1, 2, 3, 4 $2,930.00
Spacer
Smith & Nephew Surgical Pty Ltd
SN896 MDF Revision System Modular Sleeve with Stiktite titanium Small, Medium, Large, and X- $3,120.00
porous coating and HA coating Large - sizes 10-25
11.1.8.4 - Plasma
Body
Biomet Australia Pty Ltd
BI128 Modular Calcar Mallory Head Revision Femoral body, Titanium, plasma, HA, 34, 45, 55 resection levels x $4,020.00
Hip System Calcar size a,b,c,d,e
BI837 Reach Revision Hip System Modular Reach Proximal Body - Proximal Body #1 - 6 $4,020.00
Collared/Collarless, Ti, HA Coated
Wright Medical Australia
WR141 Profemur Total Hip System Titanium uncemented proximal body - HA X-Small, Small, Standard 1, $4,020.00
Plasma sprayed Standard 2, Standard 3,
Standard 4, Large
Prostheses List by Category, Groups and Sponsor Page 60 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Cone
Global Orthopaedic Technology
GO017 UniSyn Proximal Femoral Body with HA Titanium, plasma spray, with HA single height, variable diameter $3,520.00
and variable medial projections
Stem
Stryker Australia Pty Ltd
SK058 Stryker Modular Revision Hip System Porous Distal Stems Titanium Plasma Spray Stem Lengths 127 & 167mm $3,920.00
straight & bowed. Diameter
11-26mm
11.1.8.5 - Unpolished and Polished
Body, Tumour
Corin Australia Pty Ltd
CR124 METS Spiked Trochanter Titanium, HA coated Small and Standard $4,520.00
Stem, Tumour
Corin Australia Pty Ltd
CR139 METS stippled Integral Shaft and Stem Titanium, HA coated, shaft and stem with L=15,30mm; D=27,30mm $4,920.00
round or oval collar (round); D=30x38,36x44mm
(oval)
11.1.9 - Uncemented, Modular, Long Lengths (Stem ≥200mm; Body
11.1.9.1 - Grit Blast
Body
Mathys Orthopaedics Pty Ltd
MA525 Modular Revision Stem Proximal Body, Long, Grit Blasted Titanium 80mm-110mm $3,860.00
Smith & Nephew Surgical Pty Ltd
SM145 PLUS Hip Joint Prostheses System Titanium, grit blasted, with stem locking Sizes CL/BX/CX >=75mm $3,860.00
bolt various offsets
Wright Medical Australia
WR144 Profemur R Hip System Titanium uncemented proximal body, grit X-small, Small, Standard 1, $3,860.00
blast Standard 2, Standard 3,
Standard 4, Large
Prostheses List by Category, Groups and Sponsor Page 61 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI490 Revitan Modular Proximal Body Titanium, grit blast, non HA, femoral body 55, 65, 75, 85, 95 and 105mm $3,860.00
heights
Body, Tumour
Zimmer Pty Ltd
ZI728 MOST Proximal Femur with Tissue MOST Proximal Femur with Tissue 80mm in length $7,400.00
Attachment Attachment
ZI729 MOST Basic Proximal Femur MOST Basic Proximal Femur 80mm in length $7,400.00
Stem
Biomet Australia Pty Ltd
BI072 Modular Calcar Mallory Head Revision Femoral stem, titanium, grit blast, non HA 12mm to 30mm x 250mm $4,620.00
Hip System
Global Manufacturing Technology Pty Ltd
GM143 SMR Femoral Stem SMR Distal Component 240mm SMR distal component 14x $4,620.00
240mm, SMR distal component
16 x 240mm, SMR distal
component 17x240mm, SMR
distal component 18 x 240mm,
SMR distal component 19 x
240mm, SMR distal component
20 x 240mm, SMR distal
component 22 x 240mm
Lima Orthopaedics Australia Pty Ltd
LC031 Lima Revision Total Hip System Titanium, grit blast, non HA 20, 22, 24 $4,620.00
Link Orthopaedics Australia
LO137 Link MP Reconstruction Hip Prosthesis Stem 14 - 25mm x 210, 250, 290 & $4,620.00
330mm;
Mathys Orthopaedics Pty Ltd
MA501 Lima Revision Total Hip System Titanium, grit blast, non HA 20, 22, 24 $4,620.00
Medartis
EO010 MRP- Titan Stem Modular Revision Titanium Stem, straight 200mm length diameter 13-30, $4,620.00
and curved, long and grit blast 260mm length diameter 11-21,
320mm length diameter 11-
21mm
Prostheses List by Category, Groups and Sponsor Page 62 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SM017 Modular 'PLUS Femoral Stem Titanium, grit blast, straight & curved, long 1 to 12 (all over 200mm) $4,620.00
SN897 MDF Revision System Femoral stem - Titanium grit blasted for 10-25 - 200mm - 360mm $4,620.00
use with modular femoral neck - choices
anteverted, retroverted, standard &
multiple height. Allows fixation of proximal
sleeve in various shapes (suffix-N,SV &
MOD3)
Stryker Australia Pty Ltd
ST011 Stryker Modular Hip System Conical distal stems titanium, grit blasted Length 155mm, Diameter 14 - $4,620.00
28mm
Wright Medical Australia
WR143 Profemur R Hip System Titanium tapered Splined, Straight or Length 95 - 215mm, Diameter $4,620.00
bowed Stem, grit blasted 10 - 22.5mm
Zimmer Pty Ltd
ZI612 Revitan Modular Straight Stem Titanium, grit blast, non HA, cobalt 14, 16, 18, 20, 22, 24, 26, 28 $4,620.00
chrome junction x 255mm; 16, 18, 20, 22, 24,
26 x 315mm
ZI614 ZMR Modular Revision Hip System - Titanium, grit blast, non HA 205, 220, 255, 270mm Straight $4,620.00
Stem & Bowed
11.1.9.4 - Plasma
Body
Biomet Australia Pty Ltd
BH131 ARCOS Revision Hip System Cone Cone Proximal Body Porous plasma 60-80mm body $4,520.00
Proximal Body sprayed coated
Zimmer Pty Ltd
ZI049 'ZMR Taper System Modular Revision Titanium body, plasma coating, non HA A - F $4,520.00
Hip
Stem
Biomet Australia Pty Ltd
BH133 ARCOS Modular Revision Hip System Distal Stem bullet or slotted tip, porous 150 to 250mm length. $5,520.00
Distal Stems plasma spray
BI118 Modular Calcar Mallory Head Hip System Femoral Stem, Titanium, plasma, no HA, 220 - 300mm long, 12mm to $5,520.00
long 26mm diameter
Prostheses List by Category, Groups and Sponsor Page 63 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BI119 Mallory Head Hip System Femoral Stem, Calcar, Titanium 260mm, Size 9-19mm $5,520.00
Global Orthopaedic Technology
GO020 UniSyn Hip Plasma Long Femoral Stem Titanium, plasma spray, non HA, long, >200mm $5,520.00
straight & bowed
11.1.9.5 - Unpolished and Polished
Spacer, Tumour
Lima Orthopaedics Australia Pty Ltd
LC002 Lima RPS Femoral System Modular Spacer 60 - 120mm $3,640.00
Stem
Exactech Australia
EX019 Exactech Total Hip System Modular stem Titanium polished, non HA 11-21mm x 200mm $5,520.00
EX020 Exactech Total Hip System Modular stem Titanium polished, non HA 11-21mm x 250mm $5,520.00
EX021 Exactech Total Hip System Modular Titanium Revision Hip - Stem 11-21mm x 300mm $5,520.00
Global Orthopaedic Technology
GO012 UniSyn Hip Fluted Long Femoral Stem Titanium, highly polished, fluted, long, >200mm $5,520.00
straight & bowed
Orthotech Pty Ltd
OH116 Exactech Total Hip System Modular stem Titanium polished, non HA 11-21mm x 200mm $5,520.00
OH117 Exactech Total Hip System Modular stem Titanium polished, non HA 11-21mm x 250mm $5,520.00
OH118 Exactech Total Hip System Modular Titanium Revision Hip - Stem 11-21mm x 300mm $5,520.00
Smith & Nephew Surgical Pty Ltd
SN818 Emperion Revision Hip Long Stem polished Modular Titanium +10, +20mm $5,520.00
Calcar Build-up,
Stryker Australia Pty Ltd
SR046 Stryker Modular Revision Hip System Modular Long Bowed Titanium Polished Length 217mm, 267mm and $5,520.00
Fluted Stem 317mm. Diamter 11mm-26mm
Prostheses List by Category, Groups and Sponsor Page 64 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stem, SCP
Johnson & Johnson Medical Pty Ltd
DY510 SROM Femoral Calcar Replacement Titanium, fluted, distal polished femoral 9 -21mm diameter, greater than $5,720.00
Stem, long long stem & neck, bowed and straight with 200mm length
Calcar Replacement
DY511 SROM Femoral Stem Long Titanium, fluted, distal polished femoral 9 -21mm diameter, greater than $5,720.00
long stem & neck, bowed and straight 200mm length
11.2.1 - Conventional Femoral Heads, ≤32mm
11.2.1.1 - Stainless Steel
Austofix
AX074 Experion Head Stainless Steel 28mm and 32mm, various sizes $800.00
Corin Australia Pty Ltd
CR045 Femoral Head Stainless Steel Femoral Head Dia 22, 26, 28 & 32mm, Short, $800.00
Std, Long & Extra Long Neck
Length
CR143 metallic femoral head M30NW femoral head with 10/12 taper 28mm-32mm with short, $800.00
medium or long neck
Lifehealthcare Pty Ltd
LH065 Groupe Lepine Total Hip Replacement Stainless Steel Head .-5mm/0mm/+5mm/ +10mm $800.00
Mathys Orthopaedics Pty Ltd
MA028 Mathys Stainless Steel Femoral Heads Stainless Steel, 22-32mm $800.00
Smith & Nephew Surgical Pty Ltd
SN697 Femoral Head Stainless steel 22-32mm,+0-+16mm $800.00
Stryker Australia Pty Ltd
HW038 V40 Orthinox Head Stainless Steel 22 - 28mm dia $800.00
Zimmer Pty Ltd
ZI052 Femoral Head Zimaloy - Stainless Steel 22mm, 28mm, 32mm $800.00
Prostheses List by Category, Groups and Sponsor Page 65 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.2.1.2 - Cobalt Chrome
Austofix
AX047 Hyperion Cobalt Chrome Femoral Head Cobalt Chrome, 12/14 Taper Sizes 22, 28 and 32 mm $800.00
B Braun Australia Pty Ltd
BB246 Metal Head Isodur CoCr Femoral Head 22.5mm, 26mm, 28mm, 32mm $800.00
Biomet Australia Pty Ltd
BI094 Mallory Head Hip System Femoral Head, Offset, Chrome Cobalt 28,32mm $800.00
BI973 Modular Head Implants Femoral Modular Head 22 - 32mm diameter, - 6 to $800.00
=12mm neck, collared, no collar
Corin Australia Pty Ltd
CR029 CoCr Femoral Head CoCr femoral head 22,26,28,32mm with 3 choices $800.00
of taper
CR135 METS CoCr Femoral Head CoCr 28mm-32mm $800.00
DJO Australasia Pty Ltd
DD039 R120 Metal Femoral Head R120 Metal Femoral Head <32mm 28mm, 32mm $800.00
DD050 FMP Acetabular System - CoCro CoCro femoral heads in 22mm and 32mm 22mm in +0,+4,+8mm and $800.00
Femoral Heads diameters to fit with FMP acetabular liners 32mm in -4.0, +4, +8, +12mm,
and FMP acetabular shells diameters
Electus Ortho Pty Ltd
EZ005 Adler CoCr Head Cobolt Chrome Femoral Heads for Adler Short, Medium, Long in 22 and $800.00
Stems 22,28mm OD 28 mm
ESKA Australia
EK060 ESKA Metal Femoral Head CoCr 28mm - 32mm $800.00
Exactech Australia
EX022 Exactech Femoral Head Cobalt Chrome Head -2 to -5mm, +0 to 10mm $800.00
FOL Technology PTY Ltd
FO006 Samo acetabular cup femoral head CoCr femoral head S, M, L and XL $800.00
Global Manufacturing Technology Pty Ltd
GM056 SMR Femoral Head CoCr 22 to 40mm $800.00
Prostheses List by Category, Groups and Sponsor Page 66 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
GM092 Apex Global Femoral Head CoCr 28mm to 40mm $800.00
GM146 BioBall Femoral Head Femoral Head Vivium < 32mm 28mm, 32mm $800.00
Global Orthopaedic Technology
GO009 Consensus Femoral Head CoCr 22-32mm $800.00
GO174 APEX K1 Hip System APEX/K1 femoral heads, Cobalt Chrome 28mm, 32mm Diameters size $800.00
range -3.5mm to +7.0mm
inclusive
GO186 R120 Metal Femoral Head R120 Metal Femoral Head <32mm 28mm, 32mm $800.00
Johnson & Johnson Medical Pty Ltd
DP124 DePuy Femoral Head CoCr Femoral Head Various Tapers & 22-32 mm $800.00
Neck Lengths
Lima Orthopaedics Australia Pty Ltd
LC032 Lima Total Hip replacement CoCr Femoral Head S, M, L, XL, XXL $800.00
Link Orthopaedics Australia
LO022 Link Prosthesis Femoral Head Prosthesis Head "B" CoCrMo Short/medium- $800.00
short/medium/Long
Mathys Orthopaedics Pty Ltd
MA469 Mathys CoCr Femoral Head Hip Prosthesis Femoral Head CoCrMo 28 mm & 32mm, $800.00
≤32mm (S,M,L,XL,XXL)
Medacta Australia Pty Ltd
MU005 Quadra Hip Femoral Head CoCr Dia 22mm (S to M) $800.00
Dia 28mm (S to XXL)
Dia 32mm (S to XXL)
Medartis
EO028 ESOP HA Femoral Head CoCr 22.2 -32mm $800.00
EO050 Peter Brehm CoCr femoral heads CoCr femoral Ball Diameter 28 & 32, small, $800.00
medium and large
Oceania Orthopaedics
OO034 IC-Head CoCrMo IC Head, CoCrMo 22,28,32mm - S-M-L-XL $800.00
Orthotech Pty Ltd
OH062 Exactech Femoral Head Cobalt Chrome Head -2 to -5mm, +0 to 10mm $800.00
OH293 JRI Femoral Head Cobalt Chrome Femoral; Heads 28mm, and 32mm head sizes $800.00
Prostheses List by Category, Groups and Sponsor Page 67 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SM055 Universal Femoral Head Chrome Cobalt =< 32mm $800.00
SN280 Femoral Head CoCr <=32mm $800.00
Stryker Australia Pty Ltd
HW032 Stryker CoCr Femoral Head Hip - Femoral Head 22, 26, 28, 30, 32mm $800.00
Wright Medical Australia
WR084 Femoral Head Femoral Head Cast Cobalt Chrome Alloy 22.5mm - 32mm Femoral Head $800.00
and neck ranging from -3.5mm
to +7mm
WR130 Gladiator Bipolar Hip System Gladiator bipolar hip system, bipolar CoCr 22mm short, 28mm short, $800.00
head 22mm to 32mm medium, long 32mm short
medium long
Zimmer Pty Ltd
ZI051 Femoral Head Zimaloy - Co Cr 22mm, 28mm, 32mm $800.00
ZI358 Durasul Ballhead for Inserts CoCr femoral head 22, 28, 32 $800.00
ZI364 Natural Hip System CoCr femoral head 22 to 32mm $800.00
ZI380 Femoral Head Head - Metal (Zweymuller Allopro) - 22mm, 28mm, 32mm $800.00
CoCr
Low Frequency Ion Treatment
Stryker Australia Pty Ltd
SR026 Stryker CoCr Femoral Head Cobal Chrome with LFIT Treatment 22-32mm $2,100.00
11.2.1.3 - Alumina
Austofix
AX065 Austofix Ceramic System Biolox Ceramic Femoral Head 28 and 32 mm $2,000.00
B Braun Australia Pty Ltd
BB250 Ceramic Head Biolox Ceramic Head Size 26 - 32mm diameters, $2,000.00
short, standard and long
Biomet Australia Pty Ltd
BI058 Modular Ceramic System Ceramic Head, Aluminium Alloy, biolox 28-32mm -6mm to +12mm $2,000.00
Delta
Corin Australia Pty Ltd
CR065 Ball Heads 12 - 14 Taper (Alumina) Ceramic femoral head, bilox forte ≤32mm $2,000.00
Prostheses List by Category, Groups and Sponsor Page 68 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
DJO Australasia Pty Ltd
DD041 R120 Ceramic Femoral Head R120 Ceramic, Biolox Femoral Head 28mm - 3.5mm to +3.5mm $2,000.00
<32mm 32mm
- 4.0mm to +4.0mm
Electus Ortho Pty Ltd
EZ002 Adler Ceramic Head <32 Ceramic Femoral Heads for Adler Stems. Short, Medium, Long in 28 and $2,000.00
Biolox Forte and Delta. 28,32mmOD 32mm
ESKA Australia
EK009 Eska Ceramic Femoral Head Ceramic, biolox forte 28-32mm $2,000.00
Exactech Australia
EX023 Exactech Femoral Head Ceramic/Femoral Head, Biolox Forte -2 to -5mm, +0 to +10mm $2,000.00
Finsbury Orthopeadics Australia Pty Ltd
FI017 Finsbury Modular Heads Ceramic Diameter 22-26-28-32mm $2,000.00
FOL Technology PTY Ltd
FO005 Samo acetabular cup ceramic head Ceramic femoral head S, M, L, and XL $2,000.00
Global Manufacturing Technology Pty Ltd
GM057 SMR Ceramic Femoral Head Ceramic, Biolox Forte 28 to 36mm $2,000.00
GM093 Apex Global Ceramic Femoral Head Ceramic, Biolox Forte 28mm to 36mm $2,000.00
GM140 Bio Ball Femoral Head Biolox Forte Bio Ball Femoral Head Biolox Forte 28mm, 32mm $2,000.00
Global Orthopaedic Technology
GO173 APEX K1 Hip system APEX/K1 Femoral heads, Alumina 28mm, 32mm and 36mm $2,000.00
Ceramic diameter size range -3.mm to
+4.0mm inclusive
GO188 R120 Ceramic Femoral Head R120 Ceramic, Biolox Femoral Head 28mm - 3.5mm to +3.5mm $2,000.00
<32mm 32mm
- 4.0mm to +4.0mm
Johnson & Johnson Medical Pty Ltd
JJ751 DePuy Ceramic Heads Ceramic (Biolox Forte) Femoral head ≤32mm $2,000.00
various tapers & neck lengths
Lifehealthcare Pty Ltd
LH462 10/12/14 Alumina Head Alumina Head Biolox Forte 28mm - 32mm $2,000.00
Prostheses List by Category, Groups and Sponsor Page 69 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Link Orthopaedics Australia
LO023 Link Prosthesis Femoral Head Prosthesis Head "A" Biolox forte Ceramic Short/medium - short /medium $2,000.00
Mathys Orthopaedics Pty Ltd
MA020 Mathys Ceramic Femoral Head Ceramic, Bionit (alumina) diameter 28-32mm $2,000.00
Medacta Australia Pty Ltd
MU006 Quadra Hip Ceramic Femoral Head Ceramic, Biolox Forte Dia 28mm (S,M,L) 32mm $2,000.00
(S,M,L)
Medartis
EO003 Biolox - Forte Ceramic Head Biolox Ceramic Head Diameter 28-32, S,M,L neck $2,000.00
length
EO029 ESOP HA Femoral Head Alumina Ceramic 28 and 32mm Diameter $2,000.00
Orthotech Pty Ltd
OH137 Exactech Femoral Head Ceramic/Femoral Head, Biolox Forte -2 to -5mm, +0 to +10mm $2,000.00
OH292 JRI Ceramic femoral Head Total Hip Replacement (THR) Ceramic 12 / 14 Taper, Biolox Delta $2,000.00
Femoral Heads, Biolox Delta Ceramic, Ceramic head sizes 28mm,
and Alumina Oxide 32mm. Alumina Oxide head
sizes 28mm
Smith & Nephew Surgical Pty Ltd
SM035 Universal Ceramic Femoral Head Ceramic, Biolox Forte S,M,L - 28mm/32mm $2,000.00
SN299 Femoral Head Ceramic, AlO3 <=32mm $2,000.00
Stryker Australia Pty Ltd
HW017 Stryker Biolox Forte Alumina Femoral Hip - Femoral Head 28, 32mm $2,000.00
Head
Wright Medical Australia
WR124 Transcend/Lineage Articulation System Head ceramic 28mm, 32mm, 3 lengths $2,000.00
Zimmer Pty Ltd
ZI055 Ceramic Femoral Head Ceramic Head 12/14 Taper, Biolox Forte 28 - 36mm $2,000.00
ZI346 Ceramic Femoral head for hip prosthesis Femoral Head - Biolox Ceramic 28 to 32mm $2,000.00
ZI355 Cerasul - Ceramic Ceramic Femoral Head 28mm $2,000.00
ZI381 Ceramic Head - Sulox Head - Ceramic 22 to 32mm $2,000.00
Prostheses List by Category, Groups and Sponsor Page 70 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Sleeve
Orthotech Pty Ltd
OH294 JRI Total Hip System Ceramic femoral head with sleeve 28, 32, 36mm $2,200.00
Stryker Australia Pty Ltd
SR023 Stryker Revision Femoral Head, Biolox With pre assembled titanium sleeve 28, 32mm $2,200.00
Forte Alumina
11.2.1.4 - Zirconium
Biomet Australia Pty Ltd
BI927 Modular Ceramic System Ceramic Head, Zirconium 28-32mm -6mm to +12mm $1,900.00
11.2.1.5 - Ceramic Mix
Corin Australia Pty Ltd
CR180 Ceramic modular head Biolox Delta Ceramic heads 32mm or less 28 and 32mm $2,100.00
Global Manufacturing Technology Pty Ltd
GM131 Biolox Delta Ceramic Femoral Heads Biolox Delta Ceramic Femoral Heads Biolox Delta Femoral Head $2,100.00
28mm 32mm 28mm - -3.5mm to +3.5mm
and Biolox Delta Femoral Head
32mm - 3.5mm to +7mm
Johnson & Johnson Medical Pty Ltd
DY551 Delta modular head Delta ceramic modular head 32mm $2,100.00
JJ752 DePuy Delta Heads Delta femoral head various tapers & neck ≤32mm $2,100.00
lengths
Lima Orthopaedics Australia Pty Ltd
LC034 Lima Total Hip replacement Ceramic Femoral Head (Biolox Delta) S, M, L, XL $2,100.00
Mathys Orthopaedics Pty Ltd
MA482 Ceramys Ceramic Femoral Head Ceramic, zirconia alumina combination 28 L, 28 M, 28 S, 32 L, 32 $2,100.00
M, 32 S
Prostheses List by Category, Groups and Sponsor Page 71 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Medacta Australia Pty Ltd
MU096 Biolox Delta Ceramic Ball Heads Ceramic femoral heads, BIOLOX® Delta Ball Head 12/14 Ø 28 Sizes: S, $2,100.00
AI2 O3 -ZrO2 M and L
Ball Head 12/14 Ø 32 sizes: S,
M, L and XL
Smith & Nephew Surgical Pty Ltd
SM144 Universal Delta Ceramic Femoral Head Delta Ceramic <=32 - S, M, L, XL,XXL $2,100.00
SM165 Revision Delta Ceramic Femoral Head Biolox Option Head ≤32mm $2,100.00
Stryker Australia Pty Ltd
SR028 Stryker Delta Ceramic Heads Femoral Head - Delta Ceramic <32mm $2,100.00
Wright Medical Australia
WR101 Delta Modular Heads Biolox Delta Heads 28mm, 32mm in -3.5mm, 0mm, $2,100.00
+ 3.5 neck lengths
Zimmer Pty Ltd
ZI538 Ceramic primary & revision femoral head Biolox Delta Ceramic 28 & 32mm $2,100.00
Sleeve
Johnson & Johnson Medical Pty Ltd
JJ818 DePuy Delta TS Heads Delta ceramic femoral head with titanium ≤32mm, +1 to +12 $2,300.00
sleeve
Mathys Orthopaedics Pty Ltd
MA484 Ceramys Ceramic Revision Femoral Head Ceramic, zirconia alumina combination, 28 L, 28 M, 28 S, 28 XL, 32 $2,300.00
supplied with titanium taper sleeve L, 32 M, 32 S, 32 XL, 28, 32
Medacta Australia Pty Ltd
MU079 BIOLOX OPTION Ceramic Biolox Delta with Titanium sleeve Diameter 28 S.M.L.XL, $2,300.00
diameter 32 S,M,L,XL
11.2.1.6 - Ceramicised Metal
Oceania Orthopaedics
OO032 IC- Head Biolux delta Biolux delta ceramic head 28 and 32mm. Small, medium $2,100.00
and large.
Smith & Nephew Surgical Pty Ltd
SN687 Femoral Head 12/14, 14/16 Taper, Oxinium 22 - 32mm, -3 - +16mm $2,100.00
Prostheses List by Category, Groups and Sponsor Page 72 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
11.2.2 - Conventional Femoral Heads, >32mm
11.2.2.1 - Stainless Steel
Austofix
AX075 Experion Head Stainless Steel 36mm, various sizes $811.00
Global Manufacturing Technology Pty Ltd
GM145 BioBall Femoral Head Femoral Head Vivium > 32mm 36mm to 58mm $811.00
Mathys Orthopaedics Pty Ltd
MA467 Mathys Unipolar Femoral Head Stainless steel, unipolar head 42 mm - 58mm $811.00
Medacta Australia Pty Ltd
MU018 Medacta Unipolar Head Stainless steel, solid head Size 40-56mm with variable $811.00
offsets
Smith & Nephew Surgical Pty Ltd
SN813 Femoral Head Stainless steel >32mm,+0-+16mm $811.00
Stryker Australia Pty Ltd
HW395 V40 Orthinox Head Stainless Steel >32mm $811.00
11.2.2.2 - Cobalt Chrome
Biomet Australia Pty Ltd
BI875 Endo II Head Modular Head - CoCr 41 mm through 61mm $950.00
BI877 Freedom 36 mm Modular Head Modular Head 36mm, -6mm to +9mm $950.00
BI974 Modular Head Implants Femoral Modular Head 36mm diameter , - 6 to + $950.00
12mm neck, collared, no collar
Corin Australia Pty Ltd
CR084 Unipolar Modular Head, CoCr CoCr Modular Head 38 - 60mm, short, standard and $950.00
long necks
DJO Australasia Pty Ltd
DD038 R120 Metal Femoral Head R120 Metal Femoral Head >32mm 36mm $950.00
DD049 Foundation Unipolar System - CoCr CoCr unipolar femoral heads, 40mm to 40mm to 64mm in 2mm $950.00
Unipolar Femoral Heads 64mm. Unipolar Femoral Heads increments
Prostheses List by Category, Groups and Sponsor Page 73 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Exactech Australia
EX003 L-Series Unipolar Head L-Series unipolar is a modular unipolar head: 42mm, 43mm, $950.00
endoprosthesis consisting of a truncated 44mm, 45mm, 46mm, 47mm,
spherical head and interchangeable neck 48mm, 49mm, 50mm, 51mm,
sleeves. The device is fully machined from 52mm, 53mm, 54mm, 55mm
cobalt chrome conforming to ASTMF taper sleeve: 12/14-3.5mm,
1537-94 12/14 +0mm, 12/14 +3.5mm,
12/14 +7mm, 12/14 +10mm
Global Manufacturing Technology Pty Ltd
GM066 BioBall Femoral Head Femoral Head Vivium > 32mm 36mm to 58mm $950.00
Global Orthopaedic Technology
GO178 APEX K1 Hip System APEX/K1 Femoral heads, Cobalt Chrome 36mm Diameter size range - $950.00
3.5mm to +7.0mm inclusive
GO185 R120 Metal Femoral Head R120 Metal Femoral Head >32mm 36mm $950.00
Johnson & Johnson Medical Pty Ltd
DY026 Elite Unipolar Femoral Head CoCr unipolar head 42 - 60 mm $950.00
DY402 Cathcart Unipolar Head CoCr Unipolar Femoral head. Needs to 41 to 60mm $950.00
be used with DY403 Head Taper insert
Lima Orthopaedics Australia Pty Ltd
LC033 Lima Total Hip replacement CoCr Femoral Head S, M, L, XL $950.00
Medacta Australia Pty Ltd
MU097 Femoral Head CoCr Femoral Ball Head 12/14 Ø 36mm & Ø 40mm: both of $950.00
sizes S-M-L-XL-XXL
Smith & Nephew Surgical Pty Ltd
SN308 Unipolar Head Co Cr 12/14 42 - 61mm $950.00
SN809 Femoral head CoCr >32mm $950.00
Stryker Australia Pty Ltd
ST570 UNITRAX Vitallium alloy /CoCr 38-64mm OD 2mm increments $950.00
Wright Medical Australia
WR129 Gladiator Bipolar Hip System Bipolar Gladiator Bipolar Hip System Bipolar 36mm Short Medium Long $950.00
CoCR Head CoCR Head 36mm
Zimmer Pty Ltd
ZI054 Femoral Head Cobal Chrome femoral Head 38 - 63mm $950.00
Prostheses List by Category, Groups and Sponsor Page 74 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
ZI347 Femoral Head CoCr femoral head 42 to 60 $950.00
ZI359 Large Zimmer Femoral Heads CoCr femoral head 34 - 38mm $950.00
ZI500 Femoral Head Head - Metal (Zweymuller Allopro) - 36mm, 38mm $950.00
CoCr
Low Frequency Ion Treatment
Stryker Australia Pty Ltd
SK405 LFIT Femoral Heads Femoral head with low friction ion 36mm-72mm $2,300.00
treatment
11.2.2.3 - Alumina
Austofix
AX064 Austofix Ceramic System Biolox ceramic femoral head 36mm $2,055.00
B Braun Australia Pty Ltd
BB302 Ceramic Head Biolox Ceramic Head 36mm $2,055.00
Corin Australia Pty Ltd
CR097 Alumina Head Ceramic femoral head, biolox forte >32mm $2,055.00
DJO Australasia Pty Ltd
DD040 R120 Ceramic Femoral Head R120 Ceramic, Biolox Femoral Head > 36mm $2,055.00
32mm
Electus Ortho Pty Ltd
EZ006 Adler Ceramic Head >32 Ceramic Femoral Heads for Adler Stems. Short, Medium, Long in 36 and $2,055.00
Biolox Forte and Delta. 36,40mm OD 40mm
Global Manufacturing Technology Pty Ltd
GM139 Bio Ball Femoral Head Biolox Forte BioBall Femoral Head Biolox Forte 36mm $2,055.00
Global Orthopaedic Technology
GO179 APEX K1 Hip System APEX/K1 Femoral heads, Alumina 36mm Diameter size range - $2,055.00
Ceramic 3.mm to +4.0mm inclusive
GO187 R120 Ceramic Femoral Head R120 Ceramic, Biolox Femoral Head > 36mm $2,055.00
32mm
Lifehealthcare Pty Ltd
LH463 10/12/14 Alumina Head Alumina Head Biolox forte 36mm $2,055.00
Prostheses List by Category, Groups and Sponsor Page 75 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Mathys Orthopaedics Pty Ltd
MA517 Bionit Ceramic Femoral Head Femoral Head, Ceramic 36 to 54mm $2,055.00
Medacta Australia Pty Ltd
MU007 Quadra Hip Large Ceramic Femoral Ceramic, Biolox Forte, larger 36mm (S,M,L) $2,055.00
Head
Smith & Nephew Surgical Pty Ltd
SM094 Universal Ceramic Femoral Head Ceramic Biolox Forte >32mm $2,055.00
SM167 Revision Delta Ceramic Femoral Head Biolox Option Head >32mm $2,055.00
SN811 Reflection Head Ceramic, AlO3, Biolox Forte >32mm $2,055.00
Stryker Australia Pty Ltd
HW394 Stryker large ceramic femoral head Biolox Forte 36mm - 60mm $2,055.00
SK404 Stryker large ceramic femoral head Alumina Femoral Head 38mm-60mm $2,055.00
Wright Medical Australia
WR089 Transcend/Lineage Articulation System Head ceramic 36mm, 3 lengths $2,055.00
11.2.2.5 - Ceramic Mix
Biomet Australia Pty Ltd
BH036 Biolox Delta Option Ceramic Femoral ceramic modular head, biolox delta 36mm to 60mm $2,300.00
Heads
Corin Australia Pty Ltd
CR179 Ceramic Modular head Biolox Delta Ceramic heads > 32mm 36, 40 and 44mm $2,300.00
ESKA Australia
EK036 ESKA Cera Metal Femoral Head CoCr, with bonded ceramic (alumina) 36-48mm $2,300.00
bearing surface, large diameter
EK091 Ceramic Femoral Head Ceramic Femoral Head - Delta 36 to 44mm $2,300.00
Global Manufacturing Technology Pty Ltd
GM108 BioBall Delta Femoral Head Femoral Head Biolox Delta 36mm, 38mm, 40mm, 44mm, $2,300.00
48mm
GM132 Biolox Delta Ceramic Femoral Heads Biolox Delta Femoral Head 36mm Biolox Delta Femoral Head $2,300.00
36mm -4.0mm to +8.0mm,
40mm -4.0mm to +8.0mm
Prostheses List by Category, Groups and Sponsor Page 76 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DY464 DePuy Delta Ceramic Femoral Head Ceramic delta >32mm >32mm $2,300.00
DY552 Delta modular head Delta ceramic modular head 36-58mm $2,300.00
Lifehealthcare Pty Ltd
LH399 Delta Modular head Biolox Delta ceramic femoral ball head >36mm $2,300.00
Lima Orthopaedics Australia Pty Ltd
LC035 Lima Total Hip replacement Ceramic Femoral Head (Biolox Delta) S, M, L, XL $2,300.00
Mathys Orthopaedics Pty Ltd
MA483 Ceramys Large Ceramic Femoral Head Ceramic, zirconia alumina combination, 36 L, 36 M, 36 S $2,300.00
large diameters
Medacta Australia Pty Ltd
MU095 Biolox Delta Ceramic Ball heads Ceramic femoral heads, BIOLOX® Delta Ball Head 12/14 Ø 36 Sizes: S, $2,300.00
Ai2 O3 -ZrO2 M, L and XL
Ball Head 12/14 Ø 40 Sizes: S,
M, L and XL
Ball Head 12/14 Ø 44 Sizes: S,
M, L and XL
Orthotech Pty Ltd
OH300 JRI Total Hip System Total Hip Replacement (THR) Ceramic 12 / 14 Taper, Biolox Delta $2,300.00
Femoral Heads, Biolox Delta Ceramic, Ceramic head sizes 36mm.
and Alumina Oxide Alumina Oxide head sizes
28mm
Smith & Nephew Surgical Pty Ltd
SM095 Universal Delta Ceramic Femoral Head Delta Ceramic >32mm $2,300.00
Stryker Australia Pty Ltd
SR029 Stryker Large Femoral Head - Delta Delta Ceramic 36mm - 50mm $2,300.00
Ceramic
Wright Medical Australia
WR100 Delta Modular Heads Biolox Delta Heads 36mm - 44mm in -3.5mm, $2,300.00
0mm, +3.5 neck lengths
Zimmer Pty Ltd
ZI539 Ceramic primary & revision femoral head Biolox Delta Ceramic 36 - 40mm $2,300.00
Prostheses List by Category, Groups and Sponsor Page 77 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Sleeve
Johnson & Johnson Medical Pty Ltd
JJ819 DePuy Delta TS Heads Delta ceramic femoral head with titanium >32mm, +1 to +12 $2,500.00
sleeve
Mathys Orthopaedics Pty Ltd
MA485 Ceramys Large Ceramic Revision Ceramic, zirconia alumina combination, 36 L, 36 M, 36 S, 36 XL, 36 $2,500.00
Femoral Head large diameters, supplied with titanium
taper sleeve
Medacta Australia Pty Ltd
MU080 BIOLOX OPTION Ceramic Biolox Delta with Titanium Sleeve Diameter 36 S.M.L.XL $2,500.00
11.2.2.6 - Ceramicised Metal
Oceania Orthopaedics
OO033 IC-Head Biolux delta Biolux delta ceramic head 36mm. Small, medium and large. $2,300.00
Smith & Nephew Surgical Pty Ltd
SN812 Femoral Head 12/14, 14/16 Taper, Oxinium >32mm, -3 - +16mm $2,300.00
11.2.3 - Metal on Metal Heads
Biomet Australia Pty Ltd
BI045 Scientific Hip Prostheses System Head, Chrome Cobalt, Metal on metal 28mm, -6mm to +12mm neck $2,400.00
BI056 Exceed M2A Femoral Head Head, Chrome Cobalt, Metal on metal 28mm, -6mm to +12mm neck $2,400.00
BI068 Stanmore Hip System Head, Chrome Cobalt, metal on metal 28mm, -6mm to +12mm neck $2,400.00
BI070 Biomet Taperloc Hip System Head, Chrome Cobalt, metal on metal 28mm or 32mm, -6mm to $2,400.00
+12mm neck
BI896 M2A Magnum System Femoral Head, Cobalt Chrome, metal on 38-60mm $2,400.00
metal
BI944 M2a 38 Femoral Head Metal on Metal Femoral Head, Cobalt 38mm $2,400.00
Chrome
Corin Australia Pty Ltd
CR016 Optimom Modular Head Metal on metal, CoCr >32mm $2,400.00
Prostheses List by Category, Groups and Sponsor Page 78 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
CR020 Metalok Femoral Head Metal on metal, CoCr Head 28mm (short/med/long $2,400.00
neck)
DJO Australasia Pty Ltd
DD051 FMP Femoral Head CoCr Femoral Head 22-32mm $2,400.00
DD052 FMP Femoral Head CoCr Femoral Head 34-38mm $2,400.00
Electus Ortho Pty Ltd
EZ003 Adler Metal on Metal Head Metal on Metal Articulating Femoral Short, Medium, Long in 32,36 $2,400.00
Heads for Adler Stems 32,36,40mm OD and 40 mm
ESKA Australia
EK064 Silver Surf Large Metal Head CoCr, metal on metal, dimpled, large 36mm - 48mm $2,400.00
Global Orthopaedic Technology
GO047 ICON Femoral Head CoCr, metal on metal, large diameter 38-58mm $2,400.00
GO132 FMP Femoral Head CoCr, metal on metal 28 to 38mm $2,400.00
Johnson & Johnson Medical Pty Ltd
DY530 Pinnacle Femoral Head CoCr metal on metal 33-48mm $2,400.00
DY531 Pinnacle Femoral Head CoCr metal on metal 28-32mm $2,400.00
DY550 Adept MoM Modular Head Metal on Metal modular head, CoChr, 38 - 58mm going up in 2mm $2,400.00
12/14 Eurocone increments. 4 different neck
lengths
Mathys Orthopaedics Pty Ltd
MA519 Metamys Metal on Metal Femoral Head CoCr metal on metal 28mm, 32mm, 36mm $2,400.00
Medacta Australia Pty Ltd
MU057 ROMAX Resurfacing System - Large Large femoral head for metal-metal From diameter 38mm to $2,400.00
Femoral Head articulation diameter 60mm, every 2mm
Smith & Nephew Surgical Pty Ltd
SN741 Birmingham Modular Femoral Head Cobalt Chrome 38 - 58mm $2,400.00
Stryker Australia Pty Ltd
SR051 Mitch Hip System Femoral Head Metal on Metal 38mm - 60mm $2,400.00
Wright Medical Australia
WR088 Transcend/Lineage Articulation System Metal femoral head CoCr 32mm, 4 lengths $2,400.00
Prostheses List by Category, Groups and Sponsor Page 79 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
WR091 Transcend/Lineage Articulation System Metal femoral head CoCr 36mm, 4 lengths $2,400.00
WR092 BFH Total, A-class Cobalt Chrome super finished femoral 36mm to 56mm in 2mm $2,400.00
head. Size range from 36mm to 56mm in increments each with - 3.5mm,
2mm increments with 3 head lengths per 0mm, + 3.5mm head lengths
size
WR116 CONSERVE Total hip head CoCr SLT Taper Femoral Head Sizes 38mm-54mm in 2mm $2,400.00
increments, -3.5 to +3.5 Neck
WR126 Transcend/Lineage Articulation System Metal femoral head CoCr 28 and 32mm, 4 lengths $2,400.00
Zimmer Pty Ltd
ZI472 Durom (Metasul) Resurfacing System - Forged CoCr femoral head A1 to L1 $2,400.00
Ballhead
ZI734 Metasul Femoral Head Wrought forged High Carbon Cobalt 36 - 60mm $2,400.00
Chrome metal on metal
ZI735 Metasul Femoral Head Wrought Forged High carbon Cobalt 28mm - 32mm $2,400.00
Chrome metal on metal
11.2.4 - Resurfacing, Cemented
11.2.4.1 - Metal
Biomet Australia Pty Ltd
BI839 Resurfacing Hip System Femoral Head CoCr, Cemented 38 - 60mm $3,350.00
Corin Australia Pty Ltd
CR047 Cormet Resurfacing Head Cemented CoCr Resurfacing Head Dia 40 -56mm $3,350.00
ESKA Australia
EK079 Silver Surf Cemented Resurfacing CoCr, metal on metal, cemented with 38mm - 58mm $3,350.00
Femoral Head dimpled articular surface
Global Orthopaedic Technology
GO049 ICON Resurfacing Head CoCr, cemented, resurfacing, metal on 38-58mm head $3,350.00
metal
Johnson & Johnson Medical Pty Ltd
DY546 ADEPT MoM Resurfacing Head Resurfacing Head MoM, Cast CoChr 38-58 going up in 2mm $3,350.00
increments
Prostheses List by Category, Groups and Sponsor Page 80 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medacta Australia Pty Ltd
MU054 ROMAX Resurfacing Femoral Head Cemented resurfacing femoral head From diameter 38-60mm, $3,350.00
every 2mm
Smith & Nephew Surgical Pty Ltd
SN743 Birmingham Hip Resurfacing Prostheses Cobal Chrome 38 - 58 mm heads $3,350.00
- Femoral Component
Stryker Australia Pty Ltd
SR043 Mitch Hip System Resurfacing Head 38mm - 60mm $3,350.00
Wright Medical Australia
WR111 Conserve Plus A-CLASS Resurfacing CoCr A-CLASS super finished 36mm to 56mm in 2mm $3,350.00
Head resurfacing femoral head increments each with - 3.5mm,
0mm, + 3.5mm head lengths
WR138 CONSERVE PLUS Total Hip CoCr Femoral Head - Super Polished Sizes 36mm - 54mm in 2mm $3,350.00
Resurfacing System increments
Zimmer Pty Ltd
ZI466 Durom (Metasul) Resurfacing femoral component A - V $3,350.00
11.2.4.2 - Ceramic
ESKA Australia
EK078 Hip Surf Cemented Resurfacing Ceramic CoCr,ceramic articular surface, cemented 38mm - 58mm $4,600.00
Femoral Head
11.2.5 - Resurfacing, Uncemented
11.2.5.1 - Metal
Biomet Australia Pty Ltd
BI838 Resurfacing Hip System Femoral Head CoCr, Ti, HA Coated 38 - 60mm $3,850.00
BI840 Resurfacing Hip System Femoral Head CoCr, Ti, no HA 38 - 60mm $3,850.00
Corin Australia Pty Ltd
CR090 Cormet Resurfacing Head Bi Coated CoCr with titanium plasma spray and HA 40mm-56mm $3,850.00
CR122 Cormet Resurfacing Head Fully Bi Coated CoCr with Titanium plasma spray and HA 44 to 56mm $3,850.00
Prostheses List by Category, Groups and Sponsor Page 81 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ESKA Australia
EK049 Silver Surf Resurfacing Femoral Head CoCr, metal on metal, cementless with 38mm-58mm $3,850.00
titanium spray, 3 dimensional metal with &
without HA and dimpled articular surface
Stryker Australia Pty Ltd
SR059 Mitch PER Hip System Proximal Epihyseal Replacement 38 - 60mm $3,850.00
11.2.5.2 - Ceramic
ESKA Australia
EK066 Hip Surf Resurfacing Ceramic Femoral CoCr, Titanium spray, 3 dimensional 38-58mm $4,600.00
Head metal, ceramic articular surface, without HA
11.2.6 - Bipolar/Multipolar
11.2.6.1 - Bipolar
Austofix
AX045 Hyperion Moonstone Bipolar Cup Stainless Steel Shell, UHMWPE liner with Sizes 39 - 59 $857.00
locking ring
B Braun Australia Pty Ltd
BB249 Bipolar Head Bipolar shell plus liner 38 - 60mm $857.00
Exactech Australia
EX008 L-Series Bipolar Head The L-Series Bipolar Head is a modular 28mm 40mm OD, 28mm $857.00
two piece device consisting of a spherical 41mm OD, 28mm 42mm OD,
cobalt chrome shell and interchangeable 28mm 43mm OD, 28mm
polyethylene liner inserts 44mm OD, 28mm 45mm OD,
28mm 46mm OD, 28mm
47mm OD, 28mm 48mm OD,
28mm 49mm OD, 28mm
50mm OD, 28mm 51mm OD,
28mm 52mm OD, 28mm
53mm OD, 28mm 54mm OD,
28mm 55mm OD, 28mm
57mm OD, 28mm 59 mm OD,
28
Prostheses List by Category, Groups and Sponsor Page 82 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP171 Hastings Bipolar Prosthesis Bipolar femoral head, CoCr with fixed Size 36 - 56 $857.00
UHMWPE insert
DP188 Self Centering Bipolar Head Bipolar femoral head, CoCr with 28mm inner diameter, 39- $857.00
UHMWPE insert 65mm outer diameter
Lifehealthcare Pty Ltd
LH064 Groupe Lepine Bipolar shell and UHMPE liner 42 - 60mm in 1mm increments $857.00
Link Orthopaedics Australia
LO036 LINK Vario bipolar Cup Shell with unmodified polyethylene plus 44-65mm $857.00
locking ring
Mathys Orthopaedics Pty Ltd
MA025 Mathys Bipolar Femoral Head Stainless steel with fixed UHMWPE insert 28mm Inner diameter, 42- $857.00
58mm outer diameter
Medacta Australia Pty Ltd
MU021 Medacta Bipolar Head Stainless Steel, with UHMWPE insert For ballhead diameter 28mm- $857.00
42,44,46,48,50,52,54,56,58,6
0mm. For ballhead diameter
22.2mm -
39,40,41,42,43,44,45,46,47,4
8,49,50,51,52mm
Oceania Orthopaedics
OO035 Bi-polar head Bipolar head 44, 46, 48, 50, 52, 54, 56, 58, 60mm $857.00
Orthotech Pty Ltd
OH398 Furlong Hemi Range Bipolar head 40-58mm $857.00
Smith & Nephew Surgical Pty Ltd
SN267 Tandem/Convene Shell/Liner 22 - 64mm $857.00
Stryker Australia Pty Ltd
ST566 Osteonics hip prostheses Bipolar shell and polyethylene insert ID 22, 26, 28, 32mm dia $857.00
(factory Assembled)
Wright Medical Australia
WR110 SLR Biploar Acetabular Shell Cast Cobalt Chrome Alloy 38mm - 65mm in millimetre $857.00
increments
Prostheses List by Category, Groups and Sponsor Page 83 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
WR128 Gladiator Bipolar Hip System Gladiator Bipolar 36mm x 22mm, $857.00
37mmx22mmx38mmx22mm,
39mmx22mm, 40mmx22mm,
41mmx22mm, 42mmx28mm,
43mmx28mm, 44mmx28mm,
45mmx28mm, 46mmx32mm,
47mmx32mm, 48mmx32mm,
49mmx32mm, 50mmx36mm,
51mmx36mm, 52mmx36mm,
53mmx36mm, 54mmx36mm,
55mmx36mm, 56mmx36mm,
57mmx36mm, 58mmx36mm, 5
Zimmer Pty Ltd
ZI286 Zimmer Acetabular Cup Multipolar (Bipolar) Cup-Co Chr Outer Diameter 38 - 72mm, $857.00
W/WHMWPE Inner Diameter 22,28, or 32mm
11.2.6.2 - Tripolar/Multipolar
Biomet Australia Pty Ltd
BI096 Tripolar Acetabular Cup Series Ringloc Series shell, UHMWPE liner and 24-28mm $1,248.00
Chrome Cobalt head
ESKA Australia
EK015 ESKA Bipolar Femoral Head CoCr, UHMWPE with inner femoral head various diameters $1,248.00
included
Lima Orthopaedics Australia Pty Ltd
LC019 Lima bipolar Total Hip Replacement Bipolar shell, inset and head 41, 42, 43, 44, 45, 46, 47, 48, $1,248.00
System 49, 50, 51, 52, 53, 54, 55, 56,
57mm
Prostheses List by Category, Groups and Sponsor Page 84 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.3.1 - Cups, Cemented
11.3.1.1 - Unmodified polyethylene
Austofix
AX046 Hyperion Emergence Cemented Cup Acetabular Cup, UHMWPE Sizes 42 - 54 $750.00
B Braun Australia Pty Ltd
BB236 Polyethylene Acetabular Cup Unmodified Polyethylene 22.2mm-32mm articulations; $750.00
40mm-64mm diameters
Biomet Australia Pty Ltd
BI067 Stanmore Total Hip System Acetabular Cup, unmodified UHMWPE 25-32mm x size 40-53mm $750.00
BI129 Mallory Head Hip System Acetabular cup, UHMWPE 40-80mm $750.00
Corin Australia Pty Ltd
CR042 Cenator Acetabular Cup Flanged Cemented UHMWPE Dia 40 - 62mm, 22, 26, 28 $750.00
heads
Exactech Australia
EX052 All Polyethylene cemented acetabular The All Polyethylene cemented acetabular 22mm ID: 44mm OD, 46mm $750.00
component components are indicated for use in OD, 48mm OD, 50mm OD,
skeletally mature individuals undergoing 52mm OD, 54mm OD
primary surgery for total hip replacement 28mmID: 48mmOD,
due to osteoarthritis, rheumatoid arthritis, 50mmOD, 52mmOD, 54mm
osteonecrosis, ankylosing spondylitis, OD, 56mm OD, 58mm OD,
congential 60mm OD 32mm
ID: 52mm OD, 54mmOD,
56mm OD, 58mm OD, 60mm
OD
Global Manufacturing Technology Pty Ltd
GM022 Edinburgh Cemented Cup UHMWPE 44mm to 56mm outer, 28-32 $750.00
inner diameter
GM128 Contile Fin II Acetabular, Mueller Cup Mueller Cup 28mm Neutral and 10 Degree, $750.00
28mm and 32mm 32mm Neutral and 10 Degree
Prostheses List by Category, Groups and Sponsor Page 85 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP182 Charnely Hip System Bore, LPW and UHMWPE cup, cemented 28mm inner diameter, 38 - $750.00
Flanged Cups 53mm outer diameter
JJ755 OGEE Cemented Cup UHMWPE cup, cemented 22 - 32mm inner diameter, 40- $750.00
53mm outer diamter
JJ756 Wroblewski Cemented Cup UHMWPE cup, cemented 22mm inner diamter, 40 - $750.00
53mm outer diameter and
angled bored
JJ757 LPW Cemented Cup UHMWPE cup, cemented 28mm inner diameter, 40 - $750.00
53mm outer diameter
Lima Orthopaedics Australia Pty Ltd
LC007 Lima Total Hip Replacement System Mueller Ceramic and UHMWPE Cup 44 - 62mm $750.00
(Cemented)
LC020 Lima Mueller Cup UHMWPE Cup unmodified Cemented 44 - 62mm $750.00
Link Orthopaedics Australia
LO018 LINK IP Acetabular Cup UHMWPE unmodified 40 - 58mm $750.00
Mathys Orthopaedics Pty Ltd
MA027 CCB Cemented UHMWPE Cup UHMWPE, low & full profile 28/32 ID - 42/64 OD $750.00
Orthotech Pty Ltd
OH105 Lima Mueller Cup UHMWPE Cup unmodified Cemented 44 - 62mm $750.00
OH290 JRI Cemented Cup UHMWPE Cup unmodified Cemented 28mm and 32mm $750.00
Smith & Nephew Surgical Pty Ltd
SN282 Opera Acetabular Cup Flanged unmodified 22 - 28mm; 40 - 53mm $750.00
UHMWPE
SN288 Reflection Acetabular Cup Unmodified UHMWPE 22 - 36mm, 42 - 76mm $750.00
Stryker Australia Pty Ltd
ST552 Osteonics hip prostheses All poly cup polyethylene unmodified OD: 46-61mm. ID: 22, 26, 28, $750.00
32mm
Wright Medical Australia
WR120 WMT Acetabular Cups All Poly UHMWPE unmodified 42 - 68mm in 2mm increments $750.00
Zimmer Pty Ltd
ZI027 ZCA Acetabular Cup UHMPE unmodified 47 - 61 $750.00
Prostheses List by Category, Groups and Sponsor Page 86 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI368 Apollo Hooded acetabular cup UHMPE unmodified 28/46mm to 28/62mm $750.00
ZI384 MS30 Hip - Cups Cemented UHMPE unmodified 22/36 to 32/64 $750.00
Metal Insert, Sandwich
Zimmer Pty Ltd
ZI383 MS30 Hip - Cups Cemented Low Profile with Metasul - PE with special 38 to 58mm $2,354.00
metal alloy
11.3.1.2 - Modified polyethylene
Johnson & Johnson Medical Pty Ltd
JJ689 Marathon Cup System Cemented Cemented modified UHMWPE acetabular Inner diameter 22-36mm, outer $936.00
Acetabular Cup cup with flange diameter 38-53mm
Smith & Nephew Surgical Pty Ltd
SN695 Opera Acetabular Cup Flanged - XLPE modified 22-36mm, 42-76mm $936.00
polyethylene
SN696 Reflection Acetabular Cup - XLPE 22-36mm,40-61mm $936.00
Stryker Australia Pty Ltd
HW029 Duration Polyethelene cemented Duration Poly Cup - Enhanced 22 - 36 mm ID $936.00
acetabular component Polyethylene
HW403 Exeter Hip System Exeter Duration Cup - Enhanced OD: 40-60mm, ID: 22, 26, 28, $936.00
Polyethylene - Low and High Profile 30
SK460 Exeter Rim Fit Flanged X3 Cup X3 Highly crosslinked Cup 40 - 60 OD, 22 - 44 ID $936.00
ST013 Trident Crossfire All Polyethelene Cup UHMPE modified 40-64mm(Outer Diameter) $936.00
Zimmer Pty Ltd
ZI314 ZCA All Poly Acetabular Cup - XLPE UHMPE modified 22, 26, 28 & 32 mm heads; $936.00
47-61mm diameter; flanged and
non-flanged
Flange
Stryker Australia Pty Ltd
HW030 Contemporary Hip System Range Exeter Contemporary Flanged modified ID: 26, 28, 32. OD 46, 48, $961.00
Enhanced Polyethylene 50, 52, 54, 56, 58, 60
Prostheses List by Category, Groups and Sponsor Page 87 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.3.1.3 - Constrained, modified and unmodified polythylene
ESKA Australia
EK020 ESKA Cemented UHMWPE Cup UHMWPE, neutral & hooded . $832.00
Link Orthopaedics Australia
LO019 Lubinus eccentric Acetabular Cup UHMWPE constrained 44 - 58mm $832.00
Stryker Australia Pty Ltd
HW043 Brunswick Cup Polyethylene 44, 48, 50, 52, 54, 56mm OD $832.00
SK430 Trident Constrained All Poly Acetabular UHMWPE constrained cemented cup 40-70mm $832.00
Cup
11.3.1.4 - Metal Shell
Biomet Australia Pty Ltd
BH040 Avantage Dual Mobility Cemented Acetabular shell, polished inner surface, 44mm - 50mm $1,800.00
Acetabular Cup Stainless Steel
Corin Australia Pty Ltd
CR159 Saturne Cemented Tripolar Cup Stainless steel cemented acetabular cup Sizes 44 - 60 in 2mm increments $1,800.00
with an anatomical anti-disloction profile
Smith & Nephew Surgical Pty Ltd
SM133 Polar Cup Cemented Acetabular Shell Stainless steel, cemented shell that has 43-63MM $1,800.00
polished inner surface for dual mobility
with constrained UHMWPE liner/head
11.3.2 - Shells, Uncemented
11.3.2.1 - Grit Blast
Mathys Orthopaedics Pty Ltd
MA498 SeleXys Acetabular TH+ Shell Uncemented Ti acetabular shell, grit blast, 42mm - 72mm in 2mm $2,300.00
non HA increments
Stryker Australia Pty Ltd
SK128 Trident Acetabular Component System Titanium, arc deposited, non HA Shell sizes 42mm - 74mm OD $2,300.00
Zimmer Pty Ltd
ZI353 Allofit Cup Titanium, macro texture, non HA 46 - 68mm $2,300.00
Prostheses List by Category, Groups and Sponsor Page 88 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI385 CLS Cups Titanium, macro texture, non HA 46 to 62mm $2,300.00
ZI395 Variall Screw Cup System Metasul Insert - special metal alloy II28 to NN28mm $2,300.00
ZI396 Variall Screw Cup System Titanium, macro texture, non HA 46 to 62mm $2,300.00
11.3.2.2 - Beaded
DJO Australasia Pty Ltd
DD023 FMP Acetabular Shell Titanium, non HA, beaded, variable screw 42-70mm $2,508.00
holes
Global Orthopaedic Technology
GO040 Consensus Acetabular Shell Titanium, beaded, porous coating, non 42mm to 68mm $2,508.00
HA, variable holes
Johnson & Johnson Medical Pty Ltd
DP360 Duraloc Acetabular Shells Titanium, beaded, (Porocoat) non HA, Size 36-76 $2,508.00
with or without holes &/or spikes
DY521 Pinnacle Acetabular Shell Titanium, beaded (Porocoat), not HA, 38 - 80mm $2,508.00
multiple holes, variable spike
arrangements, can be used with ceramic,
metal and UHMWPE liners
Mathys Orthopaedics Pty Ltd
MA496 SeleXys Acetabular PC Shell Uncemented Ti acetabular shell, beaded, 42mm - 72mm in 2mm $2,508.00
non HA increments
Smith & Nephew Surgical Pty Ltd
SN285 Reflection Acetabular Cup, Beaded Titanium Alloy 42 - 80mm $2,508.00
SN290 Reflection Acetabular Shell Ceramic, Porous 46-66mm OD $2,508.00
Titanium Alloy
Wright Medical Australia
WR109 Procotyl L Acetabular System / Beaded Acetabular shell non HA 42 - 68mm in 2mm increments $2,508.00
Acetabular shell non HA
WR114 Dynasty Acetabular System/ Actebular Beaded Acetabular shell non HA 42 - 68mm in 2mm increments $2,508.00
Shell
WR127 Lineage and Transcend Acetabular Titanium, beaded, non HA Shells 40 - 80mm in 2mm $2,508.00
Systems increments
WR146 Lineage Acetabular System Titanium Deep Profile Multi Hole 46 - 74mm in 2mm increments $2,508.00
Acetabular Shell
Prostheses List by Category, Groups and Sponsor Page 89 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.3.2.3 - Mesh
Electus Ortho Pty Ltd
EZ008 Fixa Ti-Por Cup Porous Matrix Titanium, Screw Holes with Size 44-66mm $2,500.00
Plugs, Hemispherical Acetabular Cup
ESKA Australia
EK041 BS Acetabular Shell non HA CoCr, Titanium spray, 3 dimensional 46-68mm $2,500.00
metal, variable screw holes, without HA
EK088 2000 Plus Acetabular Metal Shell CoCr, Titanium Spray, 3 Dimensional 44-68mm $2,500.00
Metal, Variable Screw Holes,
Zimmer Pty Ltd
ZI034 Trilogy Acetabular Cup Titanium mesh (fibre metal) non HA for 38 - 80 $2,500.00
UHMPE insert
ZI042 Trilogy Acetabular Cup Titanium mesh (fibre metal) non HA for 48 - 70 $2,500.00
ceramic insert
ZI386 Fitmore Cup Titanium mesh non HA 42 to 68mm $2,500.00
Flange
ESKA Australia
EK070 BS Dysplasia Acetabular Shell CoCr, Titanium spray, 3 dimensional 46-66mm $3,500.00
metal, variable screw holes and proximal
flange, without HA
11.3.2.4 - Plasma
Biomet Australia Pty Ltd
BI111 Mallory Head Hip System Acetabular shell, Titanium Alloy, plasma, 40-80mm $2,300.00
non HA
ESKA Australia
EK093 BSC Cup Spherical The spherical cup made from pure titanium 46mm, 48mm, 50mm, 52mm, $2,300.00
for the restoration of the Acetabulum 54mm, 56mm, 58mm, 60mm,
62mm, 64mm, 66mm
Prostheses List by Category, Groups and Sponsor Page 90 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
EK094 ISC Interlock Cup The ISC Interlock Cup is made from pure 46mm, 48mm, 50mm, 52mm, $2,300.00
titanium for the restoration of the 54mm, 56mm, 58mm, 60mm,
Acetabulum 62mm, 64mm, 66mm
Exactech Australia
EX011 Novation Crown Cup Shell - plasma Novation Crown Cup and Liners: No- Shell: No-Hole shell size 48-68, $2,300.00
coated Hole and Cluster Hole design options, 2mm increments; Cluster Hole
shells manufactured from titanium (Ti) alloy Size 48-68, 2mm increments;
with plasma coating, sphere and taper Multi-Hole Size 48-56, Multi-
inner diameter geometry. Hole with Rim Fixation, Size
56-68
Mathys Orthopaedics Pty Ltd
MA497 SeleXys Acetabular TPS Shell Uncemented Ti acetabular shell, Ti plasma 42mm - 72mm in 2mm $2,300.00
spray, non HA increments
Smith & Nephew Surgical Pty Ltd
SM025 EP Fit Acetabular Shell Titanium, plasma spray, non HA, with 40 - 68mm Dia $2,300.00
variable number of holes for
UHMWPE,ceramic & metal inserts
SM128 POLAR CUP ACETABULAR Stainless steel with titanium plasma spray 43-67MM $2,300.00
Cementless Shell coating that has polished inner surface for
dual mobility with constrained UHMWPE
liner/head
Flange
Smith & Nephew Surgical Pty Ltd
SM129 POLAR CUP ACETABULAR Stainless steel with titanium plasma spray 43-67MM $3,300.00
Cementless Shell coating and pegs & flanges, that has
polished inner surface for dual mobility
with constrained UHMWPE liner/head
11.3.2.5 - Porous Metal
Biomet Australia Pty Ltd
BI971 Regenerex Ringloc+ Acetabular shell, solid, limited hole or multi 48 to 72mm OD $3,350.00
hole, Porous Ti Alloy
Johnson & Johnson Medical Pty Ltd
JJ653 Pinnacle Hip System - Gription Cup Acetabular implant for use with the 38 - 80mm in outer diameter $3,350.00
pinnacle hip system
Prostheses List by Category, Groups and Sponsor Page 91 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
SK428 Trident Tritanium Acetabular Shells Acetabular Shell, tritanium 40mm - 80mm $3,350.00
Zimmer Pty Ltd
ZI325 Trabecular Metal Modular Acetabular Titanium, porous tantalum 38-80mm diameter; Cluster, $3,350.00
System Multiholed, No Holes
ZI617 Continuum Acetabular Shell Trabecular Metal Acetabular Shell 40CC, 42DD, 44EE, 46FF, $3,350.00
48GG, 50HH, 5II, 54JJ,
56KK, 58LL, 60MM, 62NN,
64OO, 66PP, 68QU, 70RR,
72SS, 74TT, 76UU, 78VV, 80W
11.3.3 - Shells, Uncemented, HA
11.3.3.1 - Grit Blast
Corin Australia Pty Ltd
CR119 Horizon Acetabular Shell Anodised titanium, HA encoated with 42 - 70 mm $2,700.00
screw holes for ceramic inserts
Johnson & Johnson Medical Pty Ltd
JJ702 Gyros Hip System Dual mobility acetabular cup, stainless 44-68mm $2,700.00
steel, grit blasted with HA
Lifehealthcare Pty Ltd
LH068 Pavi Titanium, grit blast with HA 46 - 64mm in 2 mm increments $2,700.00
& 0 or 10 Degrees
Link Orthopaedics Australia
LO032 Link acetabular cup system Titanium, grit blast, HA 40 - 68mm $2,700.00
LO150 BetaCup Cementless Acetabular Cup Acetabular Cup system comprising of 16 Ø $2,700.00
System metal casings, TiCaP coating, 3 Ceramic
or 4 UHMWPE Inserts, head diameters
from Ø 26mm and Ø 36mm
Medartis
EO011 Atlas Acetabular Cup System Titanium, grit blast & HA Atlas Cup 40-74mm $2,700.00
Orthotech Pty Ltd
OH286 JRI CSF Cup Grit blast with HA, titanium 44mm - 70mm $2,700.00
Prostheses List by Category, Groups and Sponsor Page 92 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW014 ABG 11Cup with Hydroxyapatite Titanium, grit blast and HA for UHMPE Sizes 42mm to 74mm OD in $2,700.00
insert 2mm increments
HW015 ABG 11Cup with Hydroxyapatite Titanium, grit blast and HA for ceramic Sizes 44mm to 66mm OD in $2,700.00
insert 2mm increments
ST548 Trident acetabular component system Titanium, arc deposited, with HA 40-74mm OD in 2mm $2,700.00
increments
ST554 Stryker Securfit HA Coated Shell Titanium, arc deposited, with HA 40 - 80mm $2,700.00
Shell and Insert
Stryker Australia Pty Ltd
SK092 Stryker Hydroxyapatite coated cup with Shell with Biolox forte ceramic liner 44 - 80mm OD $3,400.00
ceramic liner
11.3.3.2 - Beaded
Johnson & Johnson Medical Pty Ltd
DP557 Duraloc Acetabular Shell with HA Titanium, beaded, Duofix,HA, with or Inner 36-70 $2,908.00
without holes
DY031 Duraloc Option Acetabular Shell Titanium, beaded with HA (duofix) 46-66 mm $2,908.00
DY520 Pinnacle Acetabular Shell Titanium, beaded (Duofix), multiple holes, 38 - 80mm $2,908.00
variable spike arrangements, can be used
with ceramic, metal and UHMWPE liners
Smith & Nephew Surgical Pty Ltd
SN286 Reflection Acetabular Cup HA Coated Titanium 42 - 80mm $2,908.00
Alloy, beaded
Wright Medical Australia
WR095 Procotyl L Acetabular Cup Beaded, Titanium HA coated cup 42 - 68mm $2,908.00
WR135 Transcend/Lineage Articulation System Beaded, Titanium HA coated cup 42 - 74mm in 2mm increments $2,908.00
Flange
Johnson & Johnson Medical Pty Ltd
JJ701 Gyros Hip System Dual mobility acetabular cup, stainless 44-68mm $3,100.00
steel, grit blasted with HA and flanges for
screw fixation
Prostheses List by Category, Groups and Sponsor Page 93 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.3.3.3 - Mesh
ESKA Australia
EK040 BS Acetabular Shell with HA CoCr, Titanium spray, 3 dimensional 46-68mm $2,900.00
metal, variable screw holes, HA
EK089 2000 Plus Acetabular Metal Shell CoCr, Titanium Spray, 3 Dimensional 44-68mm $2,900.00
Metal, Variable Screw Holes, HA
Zimmer Pty Ltd
ZI035 Trilogy Acetabular Cup Titanium mesh (fibre metal) with HA for 38 - 80 $2,900.00
UHMPE insert
ZI041 Trilogy Acetabular Cup Titanium mesh (fibre metal) with HA for 38 - 80 $2,900.00
ceramic insert
ZI618 Trilogy IT HA/TCP Acetabular System Titanium mesh (fibre metal) with HA 40CC; 42DD; 44EE; 46FF,; $2,900.00
48GG; 50HH; 52II; 54JJ;
56KK' 58LL' 60MM' 62NN;
64OO; 66PP; 68QU; 70RR;
72SS; 74TT
11.3.3.4 - Plasma
Austofix
AX082 Plasmaloc Acetabular Cup Titanium, plasma spray, HA 46-66mm $2,700.00
B Braun Australia Pty Ltd
BB243 Plasmacup Titanium, plasma, HA 44mm-68mm $2,700.00
Biomet Australia Pty Ltd
BH039 Avantage Reload Dual Mobility Revision Acetabular Cup polished inner 44mm - 64mm $2,700.00
Cementless Acetabular Cup surface, with flanges, Porous HA Coating,
Stainless Steel
BI110 Mallory Head Hip System Acetabular Shell 40-80mm $2,700.00
BI112 Mallory Head Hip System Acetabular shell, solid, plasma, HA 40-80mm $2,700.00
BI770 Exceed Acetabular System Acetabular shell, solid, plasma, HA Shell sizes 40-70mm $2,700.00
Corin Australia Pty Ltd
CR074 Alpha Lock Plus Titanium Acetabular Titanium hip cup with plasma spray & HA 42 - 70mm Diameter $2,700.00
Shell and special pre-closed screw holes
Prostheses List by Category, Groups and Sponsor Page 94 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
CR085 Cera Fit Acetabular Shell Titanium plasma spray & HA for 42, 44, 46, 48, 50, 52, 54, 56, $2,700.00
UHMWPE Ceramic and Metal Inserts 58, 60, 62, 64, 66, 68, 70, &
74mm
CR161 Saturne Press Fit Dual Mobility A cementless, stippled and peripherally Sizes: 44 - 64 in 2mm $2,700.00
Acetabular Cup expanded, acetabular cup. Flattened pole increments
and an elevated rim to help prevent
dislocation.
CR165 Trinity Acetabular Cup Tri-liner hemispherical shell. Titanium 44 - 68 mm in 2mm increments $2,700.00
(Ti6A14V) material with Titanium and HA
coated plasma spray
Electus Ortho Pty Ltd
EZ010 Fixa Cup Solid Titanium, Porous & HA Coated, 44-66mm $2,700.00
Screw Holes with Plugs, Hemispherical
Acetabular Cup
Exactech Australia
EX007 Novation Crown Cup Shell - plasma and Novation Crown cup and liners - no-hole Shell: No-Hole Shell size 48- $2,700.00
HA coated and cluster hole design options. Shells 68, 2mm increments; Cluster
manufactured from titanium (Ti) alloy with Hole Size 48-68, 2mm
plasma coating and an additional increments; Multi-Hole Size 48-
hydroxylapitite (HA) coating option. 56, Multi-Hole with Rim
Sphere and taper inner diameter geometry. Fixation, Size 56-68
FOL Technology PTY Ltd
FO008 Samo Acetabular Cup Acetabular cup 40 - 70 $2,700.00
Global Manufacturing Technology Pty Ltd
GM047 Fin II Acetabular Shell titanium, Plasma sprayed, HA, with 44 to 72mm $2,700.00
variable screw options
GM113 Global Acetabular Shell Titanium, plasma spray, HA with variable 42-72mm $2,700.00
number of holes
Lima Orthopaedics Australia Pty Ltd
LC016 Lima Total Hip Replacement System Titanium, plasma, HA 44 - 66mm $2,700.00
Medacta Australia Pty Ltd
MU008 Versafitcup Acetabular Shell Titanium, plasma spray, with HA, variable 46 to 64 $2,700.00
holes
MU022 Versafitcup Dual Mobility Acetabular Stainless steel, with titanium plasma coating from diameter 46mm to 64mm $2,700.00
Shell and HA, and polished inner surface for in 2mm increments
dual articulation
Prostheses List by Category, Groups and Sponsor Page 95 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Orthotech Pty Ltd
OH295 JRI CSF Plus Cup Titanium, plasma, HA for ceramic insert 44mm - 70mm O/D $2,700.00
OH296 JRI CSF Plus Cup Titanium, plasma, HA for modified poly 44mm - 70mm O/D $2,700.00
insert
Smith & Nephew Surgical Pty Ltd
SM024 EP Fit Acetabular Shell Titanium, plasma spray, and HA, with 40 - 72mm Dia $2,700.00
variable number of holes for
UHMWPE,ceramic & metal inserts
Stryker Australia Pty Ltd
SK500 Restoration ADM Cup (Anatomic Dual Chobalt-Chome; HA Coated; Anatomic Left and Right; 48-46mm $2,700.00
Mobility) Cup Dual Mobility Cup
Flange
Smith & Nephew Surgical Pty Ltd
SM131 POLAR CUP ACETABULAR Stainless steel with titanium plasma spray 43-67MM $3,700.00
Cementless Shell coating and HA and pegs & flanges, that
has polished inner surface for dual mobility
with constrained UHMWPE liner/head
11.3.3.5 - Porous Metal
Stryker Australia Pty Ltd
SK429 Trident Tritanium Acetabular Shells (PA Acetabular Shell, HA Coating, tritanium 40mm - 80mm $3,500.00
coated)
11.3.4 - Insert/Liner
11.3.4.1 - Unmodified polyethylene
Austofix
AX072 Plasmaloc Poly Liner UHMWPE 46mm to 66mm, Neutral & 10 $820.00
degree
B Braun Australia Pty Ltd
BB237 Plasmacup PE insert UMHPE unmodified liner 44mm-68mm diameters, $820.00
22.2mm-32mm articulations
Prostheses List by Category, Groups and Sponsor Page 96 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Corin Australia Pty Ltd
CR073 UHMWPE Insert for Alpha Lock Plus UHMWPE Insert 22-32mm $820.00
shell
ESKA Australia
EK001 2000 Plus Acetabular UHMWPE Liner UHMWPE, titanium or CoCr locking lug, 28-32mm inner diameter $820.00
neutral & hooded
EK082 BS Acetabular UHMWPE Liner UHMWPE, for all head sizes 28mm-48mm inner diameter $820.00
FOL Technology PTY Ltd
FO007 Samo acetabular cup poly insert X linked poly insert 22 - 36 $820.00
Global Manufacturing Technology Pty Ltd
GM048 Fin II UHMWPE Insert UHMWPE 44 to 72mm, 0 & 5 degree hood $820.00
GM115 Global Acetabular UHMWPE Insert UHMWPE 44-72mm $820.00
Global Orthopaedic Technology
GO038 Consensus Hip System Acetabular Cup Inserts UHMWPE 22mm 42mm to 68mm $820.00
to 32mm
Johnson & Johnson Medical Pty Ltd
DP112 Duraloc Enduron Liner UHMWPE liner Inner diameter 22-32mm, 36- $820.00
76mm outer diameter
DP222 DePuy Custom Made Acetabular Liners UHMWPE custom liner for obsolete Made to order $820.00
DePuy shells
DP946 Octopus UHMWPE Liner UHMWPE liner used with Octopus 22.2, 28 and 32mm Size 55, 50 $820.00
Acetabular Reconstruction Shell (DP945)
DP968 SROM Acetabular UHMWPE Liner UHMWPE 22-32mm $820.00
Lima Orthopaedics Australia Pty Ltd
LC018 Lima Delta Cup Insert Protruded UHMWPE Unmodified Liner A, B, C, D, E $820.00
Link Orthopaedics Australia
LO033 Link aceta bular Insert UHMWPE acetabular Insert unmodified 40 - 68mm $820.00
LO152 BetaCup Cementless Acetabular Cup UHMWPE Insert 26mm> $820.00
System
Mathys Orthopaedics Pty Ltd
MA419 SeleXys Acetabular UHMWPE Liner UHMWPE 44mm-72mm $820.00
Prostheses List by Category, Groups and Sponsor Page 97 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Medacta Australia Pty Ltd
MU010 Versafitcup UHMWPE Liner UHMWPE Head dia 28mm (48 to 64) or $820.00
32mm (54 to 64), hooded &
neutral
MU023 Versafitcup UHMWPE Liner Fixed UHMWPE Liner for Versafitcup For head diameter 22.2mm $820.00
Dual Mobility Acetabular Shell sizes 46 - 48mm ; for head
diameter 28mm sizes 48 -
64mm
Medartis
EO012 Atlas Acetabular Cup System liner polyethylene liner, Titanium & HA Atlas Poly Insert Std. Dia 28 $820.00
and 32mm
Orthotech Pty Ltd
OH287 JRI CSF Cup insert UHMWPE unmodified 28mm, 32mm, 36mm $820.00
Smith & Nephew Surgical Pty Ltd
SM020 BICON UHMWPE Insert UHMWPE 1 to 9 $820.00
SM026 EP Fit & MPF UHMWPE Insert UHMWPE 40 - 68mm Dia $820.00
SN289 Reflection Acetabular Liner, unmodified UHMPE 22 - 36mm, 42 - 76mm $820.00
Stryker Australia Pty Ltd
ST561 Strker Omnifit/SecurFit Acetabular Insert Series I and II inserts, UHMPE 22 - 36mm ID for cups 40 - $820.00
80mm OD
Wright Medical Australia
WR094 SLR Bipolar Acetabular Liners UHMWPE 22mm - 32mm ID, ranging from $820.00
38mm to 65mm
WR119 WMT Acetabular Liners Duramer UHMWPE unmodified Liner Grp 0, Grp 1, Grp 2, Grp 3, $820.00
Grp 4, Grp 5, and Grp 6
WR140 Procotyl-E cup unmodified polyethylene liner Group 1 - 3 sizes 22 - 32 $820.00
Zimmer Pty Ltd
ZI033 Trilogy Oblique liner UHMPE unmodified 38 - 62 $820.00
ZI037 Trilogy liner UHMPE unmodified 38 - 80 in 22, 28, 32 $820.00
ZI367 Armour Cup Armor Cup P/E Insert 22 to 32mm, FF to 66QU $820.00
ZI372 Lor Acetabular Cup P/E Insert 28, 32 $820.00
ZI388 Liner for CLS, Fitmore and Allofit UHMPE unmodified 22, 28, 32mm Size 46 to 62 $820.00
Prostheses List by Category, Groups and Sponsor Page 98 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Sandwich
Smith & Nephew Surgical Pty Ltd
SM043 Bofor Acetabular Insert UHMWPE with titanium surround 48 -70mm $1,600.00
11.3.4.2 - Modified polyethylene
Biomet Australia Pty Ltd
BI106 Mallory Head Hip System Acetabular Liner, UHMWPE, modified 36mm $1,160.00
BI972 E-Poly HXLPE Liner Highly cross linked PE liner, stabilised with Liner size 22 to size 28 head $1,160.00
Vit E sizes 28mm, 32mm,
36mm,38mm,40mm
Corin Australia Pty Ltd
CR163 Trinity polyethylene liner Highly cross linked Polyethylene liner in 28mm, 32mm, 36mm, 40mm $1,160.00
neutral +4mm offset +4mm oblique and
4mm elevated wall variants for use with the
Trinity acetabular multi-bearing shell
DJO Australasia Pty Ltd
DD044 FMP Acetabular System - Acetabular Acetabular cup inserts, UHMWPE ID of 22mm, 28mm, 32mm to $1,160.00
Cup Insert UHMWPE compression moulded and cross-linked. suit Acetabular shells of OD
22mm, 28mm and 32mm Internal 40mm-70mm, available in
Diameters available in 0-degree (neutral), 0,10,20-degree hooded options
10-degree hooded and 20-degree hooded
options.
Electus Ortho Pty Ltd
EZ012 Adler PE Acetabular Liners XLPE Liners - for Fixa Cups Neutral, 15 degree, in $1,160.00
22,28,32,36mm ID
Prostheses List by Category, Groups and Sponsor Page 99 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Exactech Australia
EX004 Novation GXL Liner The GXL Liner are indicated for use in Liner Neutral: Group 1: 28mm $1,160.00
skeletally mature individuals undergoing ID, Group 2: 28mm IS, 32mm
primary surgery for total hip replacement ID, Group 3: 32mm ID, 36mm
ID; Group 4: 32mm, 36mm,
Group 5: 32mm, 36mm, Liner
"Lipped": Group 1: 28mm,
Group2: 28mm, 32mm, Group
3: 36mm, Group 4: 32mm,
36mm, Group 5: 36mm, Liner
"+5 Lateralised" G
Global Manufacturing Technology Pty Ltd
GM125 Global Acetabular System HCLA (highly HCLA (highly Cross-Linked and 68-76mm/36 $1,160.00
Cross-Linked and Annealed) Annealed) Acetabular Insert 68-76mm/32
Acetabular Liner 68-76mm/28
60-66mm/36
60-66mm/32
60-66mm/28
56-58mm/36
56-58mm/32
56-58mm/28
52-54/32
52-54mm/28
50mm/28
46-48mm/28
10 Degree
68-76mm/36
68-76mm/32
68-76mm/28
60-66mm/36
60-66mm/32
60-66mm/28
56-58mm/36
56-58
Prostheses List by Category, Groups and Sponsor Page 100 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
GM129 Contile Fin II Acetabular Insert Highly Acetabular Insert Highly Cross Linked Diameter 28mm 44mm to $1,160.00
Cross Linked Polyethylene Polyethylene 72mm Neutral to 10 Degree,
Diameter 32mm 44mm to
72mm Neutral to 10 Degree,
Diameter 36mm 44mm to
72mm Neutral to 10 Degree,
Diameter 40mm 44mm to
72mm Neutral to 10 Degree
Johnson & Johnson Medical Pty Ltd
DY036 Duraloc Marathon Acetabular UHMWPE, highly cross linked, Sizes 36-76mm $1,160.00
UHMWPE Cross Linked Liner
DY210 Pinnacle Acetabular Cross Linked UHMWPE, highly cross linked 22-48mm ID $1,160.00
UHMWPE Insert (Marathon)
Lifehealthcare Pty Ltd
LH174 GL - U Hooded Liner Hooded/Flat Insert 46, 48, 50, 52, 54, 56, 58, 60, $1,160.00
62, 64mm
Mathys Orthopaedics Pty Ltd
MA503 Selexys Acetabular Cup Liner Insert / Liner, modified polyethylene. Articulation 28, 32, 36mm; Cup $1,160.00
Highly crossed link polyethylene, stabilised size AA to LL (42 to 70mm)
with Vit E.
Medacta Australia Pty Ltd
MU019 Versafitcup Acetabular Highly Highly Crosslinked UHMWPE Internal diameter 28,32 & 36, $1,160.00
Crosslinked UHMWPE Liner neutral & hooded
Orthotech Pty Ltd
OH298 JRI CSF Plus Cup Insert UHMWPE modified 10 degree liners 28mm, 32mm, $1,160.00
36mm
Smith & Nephew Surgical Pty Ltd
SM029 EP Fit & MPF Highly cross linked Modified UHMWPE 42 -76mm Dia, all head sizes $1,160.00
UHMWPE Insert
SM053 Bicon highly cross linked UHMWPE Modified UHMWPE 42 -76mm Dia, all head sizes $1,160.00
Insert
SN291 Reflection Acetabular Liner XLPE modified UHMPE 22 - 44mm inner diameter, 42 - $1,160.00
80mm outer diameter
Stryker Australia Pty Ltd
HW072 Vitalock Acetabular system 12 UHMPE 22mm,26mm,28mm, 32mm ID $1,160.00
Crossfire liner
Prostheses List by Category, Groups and Sponsor Page 101 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
SK318 X3 Trident Acetabular Inserts Modified UHMPE Inner diameters: 22mm, 26mm, $1,160.00
28mm 32mm, 36mm, 38 -
64mm. For outer diameter
shells 40mm - 80mm.
ST546 Stryker Acetabular Crossfire Insert Modified UHMPE 22 -36mm ID $1,160.00
ST549 Trident acetabular component system Trident polyethlene liner, enhanced 22, 26, 28, 32mm dia $1,160.00
polyethlene
ST931 Stryker Acetabular Insert Enhanced Polyethylene insert 22 - 36mm ID $1,160.00
Wright Medical Australia
WR087 Lineage A-Class Crosslinked Standard and lateralized, 0deg and 15deg 28, 32, 36ID $1,160.00
Polyethylene Liner lipped crosslinked
WR103 Dynasty Acetabular System /poly liner A-class Crosslinked polyethylene liner, ID 22,28,32,36, 38,40,42,46 $1,160.00
standard and lipped, large head options
WR106 Procotyl L A-class Crosslinked A-class crosslinked poly liners, standard 28, 32, 36, 40 ID $1,160.00
polyethylene liner,standard & lipped, and lipped liners
large head options
Zimmer Pty Ltd
ZI045 'Longevity XLPE Acetabular liner UHMPE modified 46 - 70 $1,160.00
ZI046 Acetabular Cup Longevity XLPE Polyethylene Liner 20 38 - 80 $1,160.00
Degree
ZI047 Acetabular Cup Longevity XLPE Polyethylene Liner 10 38 - 80 $1,160.00
Degree
ZI048 Acetabular Cup Longevity XLPE Polyethylene Liner 0 38 - 80 $1,160.00
Degree
ZI357 Alpha Durasul Insert UHMPE modified 22mm x 42 to 28mm x 68 $1,160.00
ZI360 Converge Durasul Insert - Special UHMWPE 22/39 to 38/81mm $1,160.00
ZI393 Variall Screw Cup System Durasul Insert - special UHMWPE II28 to NN28mm $1,160.00
ZI491 Trabecular Metal Acetabular Revision UHMPE modified 28mm x 48mm-80mm - 0deg $1,160.00
System Longevity Liner & 10deg; 32mm x 54-80mm -
0deg & 10 deg; 36mm x
58mm-80mm - 0deg & 10deg;
40mm x 62-80mm - 0deg & 10
deg
Prostheses List by Category, Groups and Sponsor Page 102 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
ZI620 Continuum Acetabular System HXPE Liner (Highly Cross Linked) - 28mm Neutral - EE to QU; $1,160.00
Neutral, Elevated, Offset and Oblique 32mm Neutral GG to VV;
36mm Neutral II to W; 40mm
Neutral KK to VV; 22mm
Elevated - CC to FF; 28mm
Elevated EE to QU; 32mm
Elevated GG to VV; 36mm
Elevated II to VV; 28mm 7 mm
Offset CC28 to QU28; 32mm
7mm Offset EE32 to QU32; 36m
11.3.4.3 - Ceramic
Austofix
AX063 Austofix Ceramic System Captiv ceramic liner - Biolox 48-69mm $2,560.00
AX070 Plasmaloc Ceramic Liner Biolox Forte 46mm to 66mm $2,560.00
B Braun Australia Pty Ltd
BB235 Plasmacup Ceramic Insert Biolox liner 26mm, 28mm, 32mm, 36mm $2,560.00
Biomet Australia Pty Ltd
BI073 Modular Ceramic System Acetabular Ceramic/ Polyethylene Liner, 28mm, 32mm, -6 to +12mm $2,560.00
UHMWPE
Corin Australia Pty Ltd
CR063 Ceramic Insert for Cera Fit Acetabular Ceramic insert, Biolox Forte For 28-36mm heads $2,560.00
Shell
CR120 Horizon Ceramic Liner Ceramic insert, Biolox Forte 9 sizes for 28, 32 and 36mm $2,560.00
heads
Electus Ortho Pty Ltd
EZ013 Adler Ceramic Acetabular Liners Ceramic Liners - for Fixa Cups Biolox Forte & Delta, 28,32,36 $2,560.00
& 40 mm ID
ESKA Australia
EK006 2000 Plus Acetabular Ceramic Liner Ceramic, (Alumina & Polyurethane), 28-32mm inner diameter $2,560.00
hooded & neutral
EK065 BS Acetabular Ceramic Insert Ceramic, (Alumina & Polyurethane), for 36 - 48mm inner diameter, 46 - $2,560.00
larger diameter heads 66mm outer diameter
Prostheses List by Category, Groups and Sponsor Page 103 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Exactech Australia
EX001 Novation Ceramic AHS Liner Novation Ceramic AHS is indicated for Group 1 brown 28mm ID, $2,560.00
use in primary total hip arthroplasty in Group 2 Blue 32mm ID, Group
skeletally mature patients with non- 3 gray 36mm, Group 4 purple
inflmmatory degenerative joint disease. 36mm ID, Group 5 green
36mm ID
FOL Technology PTY Ltd
FO009 Samo acetabular cup ceramic insert Ceramic insert 28 - 40 $2,560.00
Global Manufacturing Technology Pty Ltd
GM049 Fin II Ceramic Insert Ceramic, Biolox Forte 44 to 72mm $2,560.00
GM114 Global Acetabular Ceramic Insert Ceramic, Biolox Forte 44-72mm $2,560.00
Global Orthopaedic Technology
GO039 Consensus Acetabular Ceramic Liner Ceramic, biolox forte 42mm to 68mm $2,560.00
Johnson & Johnson Medical Pty Ltd
DY034 Duraloc Option Acetabular Shell Ceramic, Biolox Forte 46-66 mm $2,560.00
Ceramic Insert
DY512 Pinnacle Acetabular Cup System Pinnacle ceramic liner 44 - 66mm $2,560.00
Lifehealthcare Pty Ltd
LH177 GL - Alumina U Liner Ceramic Insert Biolox 46-64mm (increment by 2mm) $2,560.00
Lima Orthopaedics Australia Pty Ltd
LC017 Lima Delta Ceramic Liner Ceramic Liner, biolox forte and delta A, B, C, D, E $2,560.00
Link Orthopaedics Australia
LO151 BetaCup Cementless Acetabular Cup Ceramic Insert 28mm> $2,560.00
System
Mathys Orthopaedics Pty Ltd
MA421 SeleXys Acetabular Bionit Ceramic Liner Bionit ceramic (alumina) 44-72mm $2,560.00
Medacta Australia Pty Ltd
MU012 Versafitcup Ceramic Insert Ceramic, Biolox Forte Head dia 28mm (48 to 64) or $2,560.00
32mm (52 to 64) or 36mm (54
to 64)
Prostheses List by Category, Groups and Sponsor Page 104 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Orthotech Pty Ltd
OH288 JRI CSF Cup Ceramic Insert Ceramic Inserts, Alumina oxide, Biolox 28mm $2,560.00
Forte
OH297 JRI CSF Plus Cup ceramic Insert CSF Plus Cup Liner, Delta Liner 28mm, 32mm, 36mm $2,560.00
Smith & Nephew Surgical Pty Ltd
SM021 Bicon Ceramic Insert Ceramic, Biolox Forte For shells 1-9, all head sizes $2,560.00
SM027 EP Fit & MPF Ceramic Insert Ceramic, Biolox Forte For 42 -76mm shells, all head $2,560.00
sizes
SN297 Reflection Acetabular Liner Ceramic, AlO3 biolox 28 - 36mm, 46 - 66mm OD $2,560.00
forte
Stryker Australia Pty Ltd
ST565 Alumina acetabular inserts Ceramic insert, alumina 28, 32 & 36mm dia $2,560.00
Wright Medical Australia
WR125 Transcend/ Lineage Articulation System Ceramic Liner, biolox forte 28mm & 32mm Group 1,2,3 & $2,560.00
4
WR134 Procotyl-E cup ceramic inserts Ceramic insert, biolox forte Group 1 - 3, Size 28 and 32 $2,560.00
Zimmer Pty Ltd
ZI044 Trilogy AB Ceramic Liner Biolox forte 48 - 70 $2,560.00
ZI394 Variall Screw Cup System Cerasul Insert - Ceramic II28 to NN28mm $2,560.00
Sandwich
Medartis
EO038 Atlas Acetabular Cup System liner - ceramic and poly 'Titanium & HA Atlas Alumina Insert Dia $2,560.00
28mmort
Zimmer Pty Ltd
ZI354 Alpha Cerasul Insert UHMPE unmodified with ceramic insert 52 to 70mm $2,560.00
11.3.4.4 - Metal
Biomet Australia Pty Ltd
BI057 M2A taper Metal Acetabular Insert, Chrome Cobalt Standard $2,100.00
Corin Australia Pty Ltd
CR164 Trinity Metal Liner Metal liner for use with the Trinity 28mm, 32mm, 36mm, 40mm $2,100.00
acetabular shell
Prostheses List by Category, Groups and Sponsor Page 105 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Electus Ortho Pty Ltd
EZ011 Adler Metal Acetabular Liners Metal Liners - for Fixa Cups Metal Liner 32.36, 40mm ID $2,100.00
ESKA Australia
EK037 BS Acetabular Shell Metal Liner CoCr, large diameter, metal on metal, 36 -48mm 'inner diameter, 46- $2,100.00
insert varying thickness, can be used with 66mm outer diameter
conventional & resurfacing heads
Global Manufacturing Technology Pty Ltd
GM119 Global Metal Acetabular Inserts CoCr, metal on metal, varying diameter Multiple sizes $2,100.00
GM127 Contile Finn II, Acetabular system, insert Acetabular Insert Metal metal on metal 28mm 44mm to $2,100.00
metal 50mm
metal on metal 32mm 48mm to
62mm
metal on metal 36mm 52mm to
72mm
Johnson & Johnson Medical Pty Ltd
DY021 Ultima & Ultamet Acetabular Metal Liner CoCr, Metal on metal liners used with 28-44mm inner diameter,44- $2,100.00
SROM & Pinnacle Acetabular shells 66mm outer diameter
DY513 Pinnacle Acetabular Cup System Pinnacle Ultamet metal liner 44 - 66mm $2,100.00
Lima Orthopaedics Australia Pty Ltd
LC012 Lima Cup Metal Liner 28mm, 32mm and 36mm $2,100.00
Mathys Orthopaedics Pty Ltd
MA495 SeleXys Acetabular metal (metamys) metal on metal acetabular liner 42mm, 44mm, 50mm, 54mm $2,100.00
inlays and 56mm
Smith & Nephew Surgical Pty Ltd
SN845 Reflection CoCr Acetabular Insert 52 - 60mm $2,100.00
Wright Medical Australia
WR090 Transcend/Lineage Articulation System Metal CoCr Liner Grp 1, Grp 2, Grp 3, Grp 4 $2,100.00
28, 32 & 36mm
WR104 Dynasty Acetabular System / metal liner, Dynasty Metal liner ID 28,32,36,38,40,42,44,48 $2,100.00
large head options
WR108 Procotyl L metal liner, large head options CoCr superfinished Metal liners 28,32,36ID $2,100.00
Prostheses List by Category, Groups and Sponsor Page 106 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI619 Continuum Acetabular System Metasul Taper Liners 28mm DD28 to GG28; 32mm $2,100.00
FF32 to II32; 36mm HH36 to
TT36; 40mm JJ40 to W40
Sandwich
DJO Australasia Pty Ltd
DD043 FMP Acetabular System - Acetabular Modular metal on metal liner, available in 28mm ID, 34mm ID, 38mm $2,300.00
cup insert, metal on metal 28mm ID, 34mm ID, 38mm ID, to fit ID, to fit FMP Acetabular Cups
FMP Acetabular Cup system from 48 mm to 70mm OD
Mathys Orthopaedics Pty Ltd
MA494 SeleXys Acetabular metal (metamys) metal on metal acetabular liner with 42mm - 72mm in 2mm $2,300.00
inlays UHWPE- metal sandwich for larger sizes increments
Zimmer Pty Ltd
ZI389 Metasul Liner for CLS, Fitmore and UHMPE unmodified with metal insert 28mm $2,300.00
Allofit
11.3.4.5 - Constrained
Biomet Australia Pty Ltd
BH041 Avantage Dual Mobility Acetabular Cup UHMWPE Dual Mobility Liner 44-66mm diameter shells $1,836.00
Inlay
BI092 Mallory Head Hip System Acetabular Liner, Constrained, Ringloc, 28-38mm $1,836.00
UHMWPE
BI878 Freedom Constrained Liner Constrained Acetabular Liner - 23 to 62 $1,836.00
UHMWPE, Ti
BI928 Tripolar Acetabular Cup Series Ringloc Series, UHMWPE, Chrome 24-28mm $1,836.00
Cobalt
Corin Australia Pty Ltd
CR162 Saturne acetabular liner Polyethylene liner for double mobility cup Sizes 44/22; 46/22; 48/28; $1,836.00
50/28; 54/28; 56/28; 60/28;
64/28; 66/28
Prostheses List by Category, Groups and Sponsor Page 107 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
DJO Australasia Pty Ltd
DD046 FMP Acetabular System - Constrainer 28mm constrained liner and titanium 28mm ID, from MP5 to MP12 $1,836.00
Liner locking ring is used with the FMP (40mm through to 70mmOD)
acetabular system to treat recurrent
dislocation.
ESKA Australia
EK096 PE Liner 2000 Plus S-Snap Lock Constrained Acetabular Liner - 32mm inner diameter, 52- $1,836.00
UHMWPE, neutral 68mm outer diameter
Exactech Australia
EX005 Novation Crown Cup Constrained Liner Sphere and taper liner diameter geometry Locking Ring is one size and $1,836.00
and Ring for compatability with the Novation Crown Constrained Liner: Group 1:
Cup 48/50mm, shells, 38mm ID;
Group 2: 53/54mm, shells,
32mm ID; Group 3: 56/58mm
shells, 36mm ID; Group 4:
60/62mm shells, 36mm ID;
Group 5: 64/66/68mm shells,
36mm ID
Global Manufacturing Technology Pty Ltd
GM124 Global Acetabular System- Highly cross- highly cross linked and annealed 28mm, 32mm 36mm Diameter $1,836.00
linked and Annealed constrained liner constrained liner Neutral, 10 degree and 20
degree size range 44mm to 72mm
GM126 Global acetabular system - constrained constrained polyethylene liner Diameter 28mm, 32mm and $1,836.00
liner 36mm 44mm to 72mm Neutral,
10 degree and 20 degree
Johnson & Johnson Medical Pty Ltd
DP969 SROM Acetabular Constrained UHMWPE Constrained liner includes 0Deg, 10 Deg, 28mm, 32mm, $1,836.00
UHMWPE Liner locking ring
JJ703 Gyros Hip System Dual mobility constrained liners, 44-68mm $1,836.00
unmodified UHMWPE for Gyros Cup.
Medacta Australia Pty Ltd
MU024 Versafitcup UHMWPE Constrained UHMWPE Constrained Liner for For head diameter 22mm sizes $1,836.00
Liner Versafitcup Dual Mobility Acetabular Shell 46 - 64mm. For had diameter
28mm sizes 48 - 64mm.
Prostheses List by Category, Groups and Sponsor Page 108 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
MU098 Versafitcup HX UHMWPE Constrained HighCross UHMWPE Constrained Liner From Ø 46 to Ø 64mm for $1,836.00
Liner for Versafitcup Dual Mobility Acetabular head Ø 22mm. From Ø 48 to
Shell Ø 64mm for head Ø 28mm.
Oceania Orthopaedics
OO036 IC Polaric head IC Polaric head 38, 40, 42, 44, 46, 48, 50, 52, $1,836.00
54, 56, 58
Smith & Nephew Surgical Pty Ltd
SM042 Bicon Constrained Liner UHMWPE 1 - 9, 28mm, 32mm $1,836.00
SM134 POLAR Dual Mobility Constrained UHMWPE FOR '22.2-28MM Head sizes $1,836.00
Liner and 43-72MM diameter shells
SM135 POLAR Dual Mobility Constrained Modified UHMWPE FOR '22.2-28MM Head sizes $1,836.00
Highly Cross Linked Liner and 43-72MM diameter shells
SN689 Reflection Constrained Acetabular Liner unmodified 22 - 32mm, 42 - 76mm $1,836.00
UHMWPE
SN856 R3 Acetabular System XLPE Constrained Acetabular liner 40-78mm $1,836.00
Stryker Australia Pty Ltd
SK501 Restoration Anatomic Dual Mobility The polyethylene insert for the Restoration 42mm - 58mm Inserts are 0 $1,836.00
Polyethylene Insert ADM component articulates with the degrees with an inner diameter
highly polished inner surface of the of 28mm
Restoration ADM cup and is articul;ated
with a standard cobalt-chrome or ceramic
28mm diameter femoral head
SR067 Anatomic X3 Liners Anatomic X3 Liner with constraint 36mm, 40mm, 44mm, 48mm $1,836.00
and 52mm
ST539 Constrained acetabular insert UHMPE & cobalt chrome bipolar 22, 26, 28, 32mm dia $1,836.00
constrained insert
Zimmer Pty Ltd
ZI030 Trilogy Constrained Liner - Polyethylene UHMPE unmodified 50 - 80 $1,836.00
ZI561 Trabecular Metal Acetabular Revision Cemented Constrained Liner 50x28mm; 52x28mm; $1,836.00
System 54x32mm; 56x32mm;
58x36mm; 60x36mm;
66/68/70x36mm;
72/74x36mm; 76/78/80x36mm
Prostheses List by Category, Groups and Sponsor Page 109 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI568 Trilogy Acetabular System Longevity Constrained Liner 50/52/54mmODx28mmID; $1,836.00
56mmODx32mmID;
58mmODx32mmID;
60mmODx36mmID;
62mmODx36mmID;
64mmODx36mmID;
66mmODx36ID;
68mmODx36mmID;
70mmODx36mmID;
72mmODx36mmID;
74mmODx36mmID;
76mmODx36mmID;
78mmODx36mmID;
80mmODx36mmID
Cup and Ring
Johnson & Johnson Medical Pty Ltd
DP014 Duraloc & Pinnacle Constrained Inserts UHMWPE, constrained liner with titanium Inner diameter 28-44mm, 36- $1,836.00
alloy locking ring 76mm outer diameter
Stryker Australia Pty Ltd
ST932 Stryker Trident Constrained Acetabular Two pre assembled components: Outer Sizing 22 - 32mm in 0 degrees $1,836.00
Insert insert component and a captured UHR & 10 degrees
(Universal Head) component.
Composition - Cobalt chrome alloy and
UHMWPE (ultra high molecular weight
polyethylene) with a Titanium 6A1-4V ELI
alloy retaining ring
Zimmer Pty Ltd
ZI737 LONGEVITY CONSTRAINED Longevity HXPE constrained Liner with Inner Diameter: 28mm, 32mm $1,836.00
LINER Titanium Alloy Locking Ring and 36mm head size. Outer
Diameter 50mm to 80mm shell
size in 2mm increments.
11.3.4.6 - Ceramic Mix
Corin Australia Pty Ltd
CR158 Biolox Delta Acetabular Liner Biolox Delta ceramic acetabular liner 28mm, 32mm, 36mm, 40mm $2,620.00
ESKA Australia
EK090 Biolox Delta Acetabular Liner Biolox Delta ceramic acetabular liner 28mm, 32mm, 36mm $2,620.00
Prostheses List by Category, Groups and Sponsor Page 110 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Global Manufacturing Technology Pty Ltd
GM130 Contile Fin II Acetabular Biolox Delta Contile Fin II Acetabular Biolox Delta Inserts 28mm 44mm to 46mm, $2,620.00
Ceramic Liners Ceramic Liner inserts 28mm,32mm, 36mm Inserts 32mm 48mm to 66mm,
& 46mm Inserts 36mm 52mm to 66mm,
Inserts 40mm 56mm to 66mm
Mathys Orthopaedics Pty Ltd
MA486 SeleXys Acetabular Ceramys Ceramic Ceramys ceramic (zirconia & alumina 28/AA, 28/BB, 28/CC, $2,620.00
Liner combination) 28/DD, 32/CC, 32DD, 32/EE,
32/FF,36/EE, 36/FF, 36/GG,
386HH,36/II, 36/JJ, 36/KK,
/36/LL
Medacta Australia Pty Ltd
MU013 Versafitcup Delta Ceramic Insert Ceramic, Delta 28mm (A to G), 32mm (C to $2,620.00
G), 36mm (E to G), 40mm (F
to G)
Smith & Nephew Surgical Pty Ltd
SM143 EP fit & MPF Delta Ceramic Insert Ceramic Delta Acetabular Liners 44mm-72mm *28mm - 44mm $2,620.00
Wright Medical Australia
WR099 Procotyl L Delta Ceramic Liner Delta ceramic liners 28, 32, 36, 40, 44 ID $2,620.00
Zimmer Pty Ltd
ZI621 Continuum Acetabular System Biolox Delta Taper Ceramic Liner 28mm: EE28 to HH28; 32mm: $2,620.00
GG32 to JJ32; 36mm: II36 to
TT36; 40mm: KK40 to VV40
Ring
Smith & Nephew Surgical Pty Ltd
SN855 R3 Acetabular system Delta Ceramic Liner 40-78mm $2,620.00
11.3.5 - Bonded Shell/Liner
11.3.5.1 - Unmodified polyethylene
Mathys Orthopaedics Pty Ltd
MA513 RM Acetabular Cup, Metal on Metal Titanium bonded UHMWPE Cup, with 46 to 68mm $3,000.00
and without lugs
Prostheses List by Category, Groups and Sponsor Page 111 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Shell and Insert
Finsbury Orthopeadics Australia Pty Ltd
FI002 ADEPT MoP Acetabular Component Titanium, plasma with HA cup with 44-66 outer diameter going up $3,400.00
presembleed with unmodified UHMPE in 2mm increments
11.3.5.2 - Modified polyethylene
Mathys Orthopaedics Pty Ltd
MA502 RM Pressfit Acetabular Cup Acetabular component - Bonded Shell / 28, 32, 36mm (Articulation); 44 $3,340.00
Liner - polyethylene modified. Ti coated to 70mm (Cup size)
monoblock, bearing surface is Vit E
stabilised highly cross linked polyethylene
11.3.5.4 - Metal
Flange
Finsbury Orthopeadics Australia Pty Ltd
FI003 ADEPT MoP Acetabular Component Titanium, plasma with HA cup with 44-66 Outer diameter going up $4,000.00
presembleed with unmodified UHMPE in 4mm increments
with dysplasia flange
Sandwich
Mathys Orthopaedics Pty Ltd
MA512 RM Classic Acetabular Cup, Metal on Titanium bonded UHMWPE Cup, with 46 - 68mm $4,200.00
Metal metal inlay bearing surface, with and
without lugs
11.3.5.5 - Ceramic Mix
B Braun Australia Pty Ltd
BB318 Plasmacup Delta 36mm combination plasmacup HA coated 36mm x 48mm - 54mm $5,220.00
shell & Biolox Delta liner diameter
Johnson & Johnson Medical Pty Ltd
DY547 Delta motion acetabular cup Titanium, plasma with HA cup with 42 - 68mm OD $5,220.00
preassembled delta ceramic liner
Prostheses List by Category, Groups and Sponsor Page 112 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Flange
Finsbury Orthopeadics Australia Pty Ltd
FI005 ADEPT CoC Acetabular component Titanium, plasma with HA cup with 44-66 Outer diameter going up $6,220.00
presembleed delta ceramic liner with in 4mm increments
dysplasia flange
11.3.6 - Solid Metal, Not Resurfacing
Biomet Australia Pty Ltd
BI055 M2A taper Metal on Metal Acetabular Shell, Titanium 46 - 70mm $2,300.00
BI783 M2a Modular Head Component & Metal on Metal Acetabular, Chrome 48-70 mm $2,300.00
Special Acetabular Cup Cobalt, Ti, no HA
11.3.7 - Resurfacing Cup
11.3.7.1 - Metal
Biomet Australia Pty Ltd
BI841 Resurfacing Hip System Acetabular Shell CoCr, Ti 44 - 66mm $4,650.00
Wright Medical Australia
WR086 Conserve Total SUPERFIX Shell Porous coated, super finished, revision 50mm - 72mm OD $4,650.00
resurfacing cup with fins and screws
Zimmer Pty Ltd
ZI467 Durom resurfacing cup CoCr and Titanium, plasma spray, non HA A - V $4,650.00
11.3.7.2 - Metal, HA Coated
Biomet Australia Pty Ltd
BI842 Resurfacing Hip System Acetabular Shell CoCr, Ti, HA Coated 44 - 66mm $5,150.00
Corin Australia Pty Ltd
CR048 Cormet Resurfacing Cup Metal on Metal bearing surface, Titanium, Dia 40 -56mm $5,150.00
Plasma spray with HA Coating (Bicoat)
Prostheses List by Category, Groups and Sponsor Page 113 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Global Orthopaedic Technology
GO048 ICON Acetabular Cup CoCr, beaded, HA coating, with fins, 44-66mm cups $5,150.00
resurfacing, metal on metal
Johnson & Johnson Medical Pty Ltd
DY548 Adept MoM Acetabular Component Porocast beaded Shell , Co Cr, HA 44-66mm Outer diameter going $5,150.00
coated size 44-66mm up in 2mm increments
Medacta Australia Pty Ltd
MU055 ROMAX Acetabular Cup Cementless Acetabular Cup, HA coated From diameter 44-66mm, $5,150.00
every 2mm
Smith & Nephew Surgical Pty Ltd
SN742 Birmingham Hip Resurfacing Prostheses Cobal Chrome, beaded, HA 44 - 66 mm cups $5,150.00
- Acetabular Cup
Stryker Australia Pty Ltd
SR044 Mitch Hip System Titanium, plasma spray, HA 44mm - 66mm $5,150.00
Wright Medical Australia
WR122 CONSERVE PLUS Total Hip Titanium Acetabular Shell - Super Polished ID 36 - 54mm, OD 46 - 64mm $5,150.00
Resurfacing System
WR145 Conserve Plus Total Hip Resurfacing Titanium Thin Acetabular Shell - Super 36 - 54mm ID in 2mm $5,150.00
System Polished Increments
Flange
Corin Australia Pty Ltd
CR087 Cormet Dysplasia Cup Dysplasia cup with three-holed proximal 48, 52, 56, 60, 64mm $7,000.00
flange, Metal on Metal bearing surface,
Titanium, Plasma spray with HA Coating
(Bicoat)
Global Orthopaedic Technology
GO050 ICON Dysplasia Resurfacing Acetabular CoCr, beaded, HA coating, with fins, 46-66mm $7,000.00
Cup resurfacing, metal on metal, with flange
Johnson & Johnson Medical Pty Ltd
DY549 Adept MoM Acetabular Component - Porocast beaded Shell , Co Cr, HA 46-66mm Outer diameter going $7,000.00
Extra Fixation Cup coated, dysplasia flange up in 4mm increments
Smith & Nephew Surgical Pty Ltd
SN744 Birmingham Hip Resurfacing Dysplasia Cobal Chrome, beaded, HA with screw Dysplasia Cups: 46 - 66 mm $7,000.00
Cup fixation cups
Prostheses List by Category, Groups and Sponsor Page 114 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
SR070 Mitch Hip System - Dysplasia Cup Dysplasia Cup 44mm-68mm $7,000.00
Wright Medical Australia
WR113 Quadra-Fix Acetabular Shell Dysplasia Cup, Porous Coated, HA O.D. 44mm - 66mm $7,000.00
11.3.7.3 - Ceramic
ESKA Australia
EK056 BS Acetabular Resurfacing Ceramic Ceramic, (Alumina & Polyurethane), for 38-58mm $2,600.00
Insert resurfacing heads
11.3.8 - Acetabular Reconstruction Devices
11.3.8.1 - Shell
B Braun Australia Pty Ltd
BB247 Reconstruction Shell Isotan 52-64mm, left and right $3,166.00
Biomet Australia Pty Ltd
BI704 Par 5 Protrusio Acetabular System Acetabular reconstruction Shells - Titanium 56 - 72mm $3,166.00
Metal, no HA
BI836 Par 5 Protrusio Acetabular System Acetabular reconstruction Shell CrCo, Ti, 56 - 72mm $3,166.00
HA Coated
BI914 Batcup Revision Acetabular Cup including locking 21 to 24mm $3,166.00
ring and lugs
BI970 Regenerex Revision Shell Acetabular support component Porous Ti 54 to 76mm OD, 44 to 66 ID $3,166.00
Alloy
Corin Australia Pty Ltd
CR160 Saturne reconstruction cup Dual coated, mobile, cementless Sizes: 50 - 66mm $3,166.00
reconstruction cup
ESKA Australia
EK027 Cranial Acetabular Reconstruction Shells CoCr, Titanium, 3 dimensional, non HA, 52mm - 72mm Left and Right $3,166.00
various locking & flanges from eccentric to
small & large proximal flanges
Prostheses List by Category, Groups and Sponsor Page 115 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP945 Octopus Acetabular Reconstruction Shell Titanium, grit blast, HA coating, rimmed, Size 50, 55mm $3,166.00
used in conjunction with Octopus Outer
Reconstruction Ring (DP948)
Lima Orthopaedics Australia Pty Ltd
LC022 Lima reconstruction shell Acetabular reconstruction shell 50 - 66mm $3,166.00
LC025 Lima Bilobo Hemisphere bone revision Acetabular reconstruction shell 50 - 58mm $3,166.00
shell
Link Orthopaedics Australia
LO013 Link Acetabular Reconstruction Cup Acetabular reconstruction shell 45 - 55 mm $3,166.00
System
Wright Medical Australia
WR133 Procotyl-E cup acetabular reconstruction shell titanium alloy 52mm - 76mm, in 2mm $3,166.00
increments
Zimmer Pty Ltd
ZI249 Trabecular Metal Reconstruction Shell Porous tantalum, reconstruction shell 22 and 28mm diameter $3,166.00
ZI371 Lor Acetabular Cup Oblong Revision Shell, cementless - Ti alloy 52/58 to 72/84 $3,166.00
Eccentric
Johnson & Johnson Medical Pty Ltd
DP975 SROM Oblong Acetabular Shell Titanium, beaded, non HA, double bubble 51-66mm - L, R or neutral $4,295.00
Smith & Nephew Surgical Pty Ltd
SM039 BOFOR Acetabular Reconstruction Shell Titanium, plasma spray, eccentric design 48mm X + 5mm - 70mm X $4,295.00
with multiple fixation holes +12mm
11.3.8.2 - Cage
Biomet Australia Pty Ltd
BI982 Mainstream Burch/Schneider Burch/Schneider Reinforcement Ring 44/50 Left and Right, 50-56 $1,426.00
Reinforcement Ring Cemented Left and Right
BI983 Max-Ti Modular Protrusio Cage Acetabular Support Component, Porous 52, 56, 60, 64, 68 and 72mm $1,426.00
Ti Alloy Left and 52, 56, 60, 64, 68 and
72 mm Right
Prostheses List by Category, Groups and Sponsor Page 116 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
FOL Technology PTY Ltd
FO003 Samo Revision Hip System acetabular Acetabular reinforcement ring with hook 44 - 64 mm $1,426.00
FO004 Samo Revision Hip System acetabular Acetabular reinforcement ring 44 - 64 mm $1,426.00
Global Manufacturing Technology Pty Ltd
GM051 Fin II Revision Ring Titanium with hook & flanges 52 to 72mm $1,426.00
Johnson & Johnson Medical Pty Ltd
DP948 Octopus Reconstruction Ring Titanium ring with proximal flanges & distal Size 50-55mm $1,426.00
hook, used in conjunction with Acetabular
Reconstruction shell (DP945)
DY064 Protrusio Acetabular Reconstruction Cage Titanium, grit blast, proximal distal flange, 49-69ID $1,426.00
left & right sided
DY169 Ultima Acetabular Reconstruction Ring Titanium, acetabular reconstruction cage 40 - 70mm $1,426.00
with proximal rim
Lifehealthcare Pty Ltd
LH175 B2C Espace Acetabular Cup Acetabular cage Espace Shell 0 degrees peak - $1,426.00
diam 50mm, 54mm, 58mm,
62mm with plastic insert,
Espace Shell 20 degrees peak -
diam 50mm, 54mm, 58mm,
62mm with plastic insert,
Espace Shell 8mm extension -
diam 50mm, 54mm, 58mm,
62mm with plastic insert,
Espace Shell 14mm
Lima Orthopaedics Australia Pty Ltd
LC021 Lima acetabular plate Acetabular reconstruction cage 50, 54, 58, 62, 64mm $1,426.00
Link Orthopaedics Australia
LO028 LINK Partial Pelvis Replacement Acetabular reconstruction cage 48-67mm $1,426.00
LO029 LINK Partial Pelvis Replacement Acetabular reconstruction cage with 48-67mm $1,426.00
inferior flange
Mathys Orthopaedics Pty Ltd
MA024 CCE Acetabular Reinforcing Ring Titanium, grit blast, acetabular Dia 42 - 58mm $1,426.00
reconstruction cage with proximal rim
Prostheses List by Category, Groups and Sponsor Page 117 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Oceania Orthopaedics
OO037 IC Reinforcement cage Acetabular Reinforcement cage Left and Right. 44mm, 46mm, $1,426.00
48mm, 50mm, 52mm, 54mm,
56mm, 58mm
OO038 IC titanium ring Acetabular recontrusction ring 42mm, 44mm, 46mm, 48mm, $1,426.00
50mm, 52mm, 54mm, 56mm,
58mm
Orthotech Pty Ltd
OH291 JRI Reconstruction Ring Acetabular reconstruction cage 44mm, 47mm, 50mm, 54mm $1,426.00
Smith & Nephew Surgical Pty Ltd
SN265 Contour Acetabular Reinforcement cage 44 - 74mm OD $1,426.00
Stryker Australia Pty Ltd
HW064 Kerboull - Vitallium Petrusio cage 44, 48, 52, 56, 60mm OD $1,426.00
ST547 Restoration acetabular gap ring Acetabular reconstruction cage 48-72mm OD in 2mm $1,426.00
increments
ST557 Restoration gap cup II acetabular cage Acetabular reconstruction cage with 48-72mm OD in 2mm $1,426.00
extended plates increments
Wright Medical Australia
WR096 Procotyl-E L Plates titanium alloy One size only for left and right $1,426.00
WR112 Procotyl-E double plate titanium alloy 4, 5 and 6 holes left and right $1,426.00
sides
WR137 Procotyl-E T Plate titanium alloy plates One size only for left and right $1,426.00
Zimmer Pty Ltd
ZI001 Zimmer Acetabular roof ring Acetabular reconstruction cage 46 - 60mm $1,426.00
ZI002 Zimmer Acetabular Reconstruction Cage Acetabular Reconstruction Cage - Left, 52, 58, 64mm OD $1,426.00
right
ZI390 Acetabular Reinforcement Roof Ring - Ti alloy 44 to 58mm $1,426.00
ZI391 Acetabular Reinforcement Roof Ring with Hook - Ti alloy 36/23 to 64/23mm $1,426.00
ZI392 Acetabular Reinforcement Protrusio Cage - Ti alloy 44 to 50mm (left and right) $1,426.00
ZI540 Trabecular metal acetabular revision Modular cup-cage titanium alloy 56-80 Long & short flanged left $1,426.00
system modular cup-cage & right
Prostheses List by Category, Groups and Sponsor Page 118 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.3.8.3 - Saddle
Link Orthopaedics Australia
LO009 LINK Endo - model Saddle Prosthesis Saddle Component One size only $4,976.00
11.3.8.4 - Saddle Base
Link Orthopaedics Australia
LO010 LINK Endo - Model Saddle Prosthesis Saddle Base Component Sizes 1-7 $3,909.00
11.3.8.5 - Hooks, Flanges, Blades
Biomet Australia Pty Ltd
BI700 Par 5 Protrusio Acetabular System Obturator Hook or Blade or Flange, Ti Short, Medium or Long $500.00
Link Orthopaedics Australia
LO030 LINK Partial Pelvis Replacement Hook for Obturator Foramen Width 6-12mm $500.00
Medacta Australia Pty Ltd
MU015 Versafitcup Attachable Proximal Flange Stainless Steel attachable flange/lug with 4.5 L 35-40-45-50-55mm $500.00
screw
MU016 Versafitcup Attachable Obturator Hook Stainless Steel Obturator Hook . $500.00
Wright Medical Australia
WR097 Procotyl-E hooks titanium alloy hook 18mm, 23mm, 28mm $500.00
11.4.1 - Augment
Biomet Australia Pty Ltd
BI984 Max-Ti Modular Protrusio Cage Acetabular Augment, Porous Ti Alloy Dome Augment (1 Hole Large, $1,400.00
2 Hole Large, 1 Hole Small),
iliac flange Augment (6 mm)
Johnson & Johnson Medical Pty Ltd
DP173 PLAD Acetabular Rim Augment Metal & polyethylene curved plate for 22- 28mm $1,400.00
screw attachment to UHMWPE cemented
cups. Includes 4 screws.
Prostheses List by Category, Groups and Sponsor Page 119 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI271 Trabecular Metal acetabular Medial wall Tantalum disc 26mm, 32mm and 38mm $1,400.00
augment
Bone Reconstruction
Biomet Australia Pty Ltd
BI960 Regenerex revision cup acetabular augment, Porous Ti Alloy 48 to 58mm, small medium or $3,300.00
large version
Zimmer Pty Ltd
ZI276 Trabecular Metal Acetabular Augment Tantalum acetabular augment 40 - 70mm x 10, 15, 20 &30mm $3,300.00
11.4.10 - Head Taper Insert
Biomet Australia Pty Ltd
BH037 Biolox Delta Option Taper Taper Sleeve, Titanium -6mm, -3mm, Std, +3mm and $520.00
+6mm
BI876 Endo II Head Modular Head Taper Insert - CoCr -6mm to +6mm $520.00
BI895 M2A Magnum Prosthesis Taper Insert, Cobalt chrome 42 - 50mm, -6, -3, STD, +3, $520.00
+6, +9; 52 - 60mm, -6, -3,
STD,
3, +6, +9
Johnson & Johnson Medical Pty Ltd
DY403 Cathcart Taper Insert CoCr head taper insert for use with -3 to +10mm $520.00
Unipolar Head (DY402)
Smith & Nephew Surgical Pty Ltd
SN307 Unipolar Taper Sleeve Co Cr 12/14 and 14/16 tapers, +0,- $520.00
3,+4,+8,+12mm.
Stryker Australia Pty Ltd
ST569 Head Taper Insert Neck extention, vitallium alloy -4 TO +12mm $520.00
Prostheses List by Category, Groups and Sponsor Page 120 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.4.11 - Neck Adapter
Corin Australia Pty Ltd
CR098 Taper Adaptor Sleeve Adaptor sleeve to adjust taper from 10-12 2 Sizes $520.00
to 12-14,Titanium, for Ceramic Heads
Global Manufacturing Technology Pty Ltd
GM042 BioBall - Revision Neck Adaptor Titanium, varying tapers & lengths, for 12/14 standard, 12/14 offset, $520.00
ceramic & metal heads 14/16 standard.small to 5 XL ,
M to 5 XL, M to 5 XL for each
GM107 APEX Global Neck Adaptor Titanium neck adaptor for variable tapers, variable tapers $520.00
used in revision with ceramic head
Medacta Australia Pty Ltd
MU056 Romax Neck Adaptor Adaptor for Large Heads Adaptor 12/14: size S, size M, $520.00
size L and size XL
Stryker Australia Pty Ltd
SK482 Stryker Neck Taper Adaptor Adaptor Sleeve for Stryker stems -5, -4, 0, +4, +5, +8 +10, +12, $520.00
+15, +16mm offset
Zimmer Pty Ltd
ZI567 Zimmer Hip System VerSys Endo Adaptors +7.0mm; +10.5mm; +14.0mm $520.00
11.4.12 – Nut
Global Orthopaedic Technology
GO019 UniSyn Hip Connecting Nut Titanium, locking nut, supplied separately short & long $204.00
11.4.13 - Pin
Johnson & Johnson Medical Pty Ltd
DP976 SROM Acetabular Insert Locking Pin Titanium pin provided seperately from 3.5mm - 5.0mm $181.00
insert
Smith & Nephew Surgical Pty Ltd
SN292 Reflection Fixation peg Titanium Alloy One size only $181.00
Prostheses List by Category, Groups and Sponsor Page 121 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.4.14 - Plug - Including Dome Plug
B Braun Australia Pty Ltd
BB277 Excia Hip System Cement plug 8mm-18mm $160.00
Biomet Australia Pty Ltd
BI130 Bio-Plug Cement Restrictor Canal Plug, UHMWPE 7-20mm $160.00
Corin Australia Pty Ltd
CR041 Hardinge Canal Occluder Cement plug, UHMWPE One size only $160.00
Johnson & Johnson Medical Pty Ltd
DP998 DePuy Acetabular Apical Plugs Titanium, apical hole plug for Duraloc, One size only $160.00
Pinnacle & SROM Acetabular shells
Medacta Australia Pty Ltd
MU017 Medacta Acetabular Plug Titanium Plug . $160.00
Wright Medical Australia
WR118 WMT Perfecta Hip System PMMA cement Plug 9 - 21mm in 1mm increments $160.00
Zimmer Pty Ltd
ZI451 Allofit screw hole plugs Sterile, 7 per set One size only $160.00
11.4.15 - Plug and Hood
Lima Orthopaedics Australia Pty Ltd
LC006 Lima Plug and hood UHMWPE Cement Plug with distal 8mm - 16mm $290.00
femoral stem hood
11.4.16 - Resurfacing Peg/Nail
ESKA Australia
EK054 Nail TiNb Nail TiNb 3 x 30, 40, 50mm length $600.00
Prostheses List by Category, Groups and Sponsor Page 122 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
11.4.17 - Ring
Biomet Australia Pty Ltd
BI140 Mallory Head Hip System Acetabular Shell, Ringloc. Replacement Size 1 $171.00
Ring, Titanium alloy
DJO Australasia Pty Ltd
DD045 FMP Acetabular System - Constrained 28mm constrained liner locking ring, one size, to fit all 28mm ID $171.00
Liner Locking Ring manufactured from titanium, is used with constrained liners
the FMP constrained acetabular liners.
Johnson & Johnson Medical Pty Ltd
DP250 Duraloc Cup Locking System Titanium locking Ring for Duraloc insert, Size 36-76mm $171.00
seperately listed, only for revision
Smith & Nephew Surgical Pty Ltd
SN701 Reflection Constrained acetabular liner - adaptor ring 42 - 76mm $171.00
Zimmer Pty Ltd
ZI473 APR Conversion Ring Titanium ring 39 to 71 $171.00
ZI738 Titanium Alloy Locking Ring for Titanium Alloy Locking Ring Outer diameter 50mm to 80mm $171.00
Longevity Constrained Liner Shell size in 2mm increments
11.4.18 - Screw
Biomet Australia Pty Ltd
BI098 Kent Hip System Transverse Screws, Titanium 4.5mm x (26-55mm) $200.00
Corin Australia Pty Ltd
CR033 Cormet Dysplasia Cup Screw Dual threaded locking screw Lengths 25 - 70mm $200.00
ESKA Australia
EK099 MML Tumor Revision System Screw for Trochanter Module 20 to 50mm in Length, in 10mm $200.00
increments
Prostheses List by Category, Groups and Sponsor Page 123 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
EK102 MML Tumor Revision System Locking Screw One size $200.00
Global Manufacturing Technology Pty Ltd
GM053 SMR Locking Screw Locking Screw for Proximal Body to Stem 40 to 70mm $200.00
Global Orthopaedic Technology
GO175 interface acetabular system 6.5mm cancellous bone screws 15mm to 70mm $200.00
Johnson & Johnson Medical Pty Ltd
DY020 SROM Trochanteric Washer Screw Titanium, attaches washer to calcar 42mm, 52mm, 62mm $200.00
replacement stem
Link Orthopaedics Australia
LO011 LINK Endo - Model Saddle Prosthesis Saddle Set Screw for Base Component One size only $200.00
LO031 LINK Endo-Model Partial Pelvis Fixation Screws, for Obturator Foramen, 20mm - 35mm; four (4) sizes $200.00
Replacement including screw lock
Medartis
EO005 MRP-TITAN Screws Locking screw Short and long $200.00
Orthotech Pty Ltd
OH382 Securus Modular Revision Hip System Distal locking screws 30-70mm $200.00
Zimmer Pty Ltd
ZI352 Thrust Plate Prosthesis Allopro Cortical Screw - SS 36, 60mm $200.00
11.4.19 - Sleeve
DJO Australasia Pty Ltd
DD042 Foundation Unipolar System - CoCr Unipolar sleeves are used in conjunction -3.5mm,+0mm (neutral), $260.00
Unipolar Sleeves with Unipolar CoCr Femoral Heads to +3.5mm, +7mm & +10mm
provide -3.5mm, +0mm, +3.5mm,
+7.0mm & +10mm neck length options
when used in conjunction with a femoral
hip component in hemi-arthroplasty
operations.
Prostheses List by Category, Groups and Sponsor Page 124 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Exactech Australia
EX010 L-Series Taper Sleeve for Unipolar Head The L-series unipolar is a modular taper sleeve: 12/14 -3.5mm, $260.00
endoprosthesis consisting of a truncated 12/14 +0mm, 12/14 +3.5mm,
spherical head and interchangeable neck 12/14 +7mm, 12/14 +10mm
sleeves. The device is fully machined from
cobalt chrome conforming to ASTM
F1537-94.
Johnson & Johnson Medical Pty Ltd
DY553 Delta Modular Head - sleeve sleeve for use with Delta Modular Head S - XL, -3.5 to +7 $260.00
Medartis
EO048 Pharo Intermediate Sleeve -5 to +10 (six sizes) $260.00
Smith & Nephew Surgical Pty Ltd
SM166 Revision Delta Ceramic Femoral Head Biolox Option Sleeve ≤32mm $260.00
Sleeve
SM168 Revision Delta Ceramic Femoral Head Biolox Option Sleeve >32mm $260.00
Sleeve
SN365 Matrix: Modular Hip System Sleeve -Trunnion One size only $260.00
SN850 Birmingham Hip Modular Resurfacing Head Sleeve -8mm to +16mm $260.00
Stryker Australia Pty Ltd
ST821 Titanium Adapter Sleeve For use with new ceramic heads One size only $260.00
Zimmer Pty Ltd
ZI474 Durom Hip Resurfacing System - Forged CoCr allo A1 to L1 $260.00
Adaptor Sleeves
11.4.2 - Bolt
Biomet Australia Pty Ltd
BI122 Mallory Head Hip System Trochanter Bolt, Titanium Round/Oblong $400.00
Global Orthopaedic Technology
GO168 Iso-Elastic™ Cerclage System Iso-Elastic™ Cerclage Cable Assembly One Size Only $400.00
Link Orthopaedics Australia
LO024 Link MP Reconstruction Hip Prosthesis Locking bolt 38 & 58 mm $400.00
Prostheses List by Category, Groups and Sponsor Page 125 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Oceania Orthopaedics
OO030 Mutars RS revision system - bolt RS bolt 40,50,65,75,90,100,115,125mm $400.00
Orthotech Pty Ltd
OH381 Securus Modular Revision Hip System Modular Locking Bolt One Size $400.00
Zimmer Pty Ltd
ZI726 MOST Tissue Attachment Bold - Short MOST Tissue Attachment Bold - Short 13.5mm $400.00
ZI733 MOST Tissue Attachment Bolt - Long MOST Tissue Attachment Bolt - Long 20mm $400.00
11.4.20 - Spacer- Unique
Biomet Australia Pty Ltd
BI953 Stage One Hip Mold Spacer mold, stainless steel, silicon. 9 - 17mm x 43 - 64 Head $1,560.00
Lima Orthopaedics Australia Pty Ltd
LC023 Lima Total Hip Replacement System Spacer S-M-L $1,560.00
Zimmer Pty Ltd
ZI311 Spacer-G Temporary implantable device for the Short Stems, Head size 46mm, $1,560.00
treatment of infected total hip replacement, 54mm, 60mm
Composition - stainless steel core
surrounded by PMMA impregnated with
Gentamicin
ZI312 Spacer-G Temporary implantable device for the Long Stems, Head size 46mm, $1,560.00
treatment of infected total hip replacement, 54mm, 60mm
Composition - stainless steel core
surrounded by PMMA impregnated with
Gentamicin
11.4.21 - Spike - Acetabular
Smith & Nephew Surgical Pty Ltd
SM136 Polar Cup Acetabular Pegs Stainless steel, morse tapered anchorage 15mm $87.00
pegs
Prostheses List by Category, Groups and Sponsor Page 126 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW012 ABG Hip System Spikes - Titanium, used with ABG11 Cups 7mm, 8mm, 9mm lengths $87.00
11.4.22 - Trochanter Plate
Biomet Australia Pty Ltd
BI123 Mallory Head Hip System Trochanter Plate, Titanium Sizes 40-70 $460.00
Corin Australia Pty Ltd
CR125 METS Trochanter plate Titanium with plasma spray of titanium and One size $460.00
HA
ESKA Australia
EK097 MML Tumor Revision System Plate for Trochanter Module, 3 Straight $460.00
Dimensional Metal
11.4.23 - Trochanteric Replacement
Johnson & Johnson Medical Pty Ltd
DP001 Reef Femoral Wing Titanium grit blasted with HA trochanteric Sizes 1-3 $1,000.00
replacement/augment
Medartis
EO045 MRP-TITAN Stem Trochanteric replacement Small and Large $1,000.00
11.4.24 - Washer
ESKA Australia
EK098 MML Tumor Revision System Washer for Trochanter Module, 3 one size: ID=6.3mm, OD=15mm $577.00
Dimensional Metal
Johnson & Johnson Medical Pty Ltd
DP986 SROM Trochanteric Washer Titanium, fixation with separate screw 40 x 31, 60 x 45, 70 x 54 $577.00
(DY020) to calcar replacing SROM
Femoral Stem
Prostheses List by Category, Groups and Sponsor Page 127 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI724 MOST Tissue Attachment Washer - Long MOST Tissue Attachment Washer - Long 9mm $577.00
ZI727 MOST Tissue Attachment Washer - MOST Tissue Attachment Washer - Short 5mm $577.00
Short
11.4.25 - Wire - Cobalt Chrome
Corin Australia Pty Ltd
CR127 METS Trochanter Reattachment Wire CoCr 0.6m $80.00
11.4.26 - Wire - Stainless Steel
Johnson & Johnson Medical Pty Ltd
DP224 Charnley & Wroblewski Trochanteric Stainless steel wire for trochanteric 0.5-3.00mm, 18 to 20g $250.00
Spring Wire attachment
11.4.3 - Bone Screw
Austofix
AX050 Hyperion Captiv Bone Screw Titanium, cancellous self tapping bone screw 6mm, 20 to 45 mm lengths $137.00
AX081 Plasmaloc Acetabular Screws 6.5mm Cancellous Bone Screws 25-60mm $137.00
B Braun Australia Pty Ltd
BB238 Acetabular Fixation Screws Isotan 16mm-68mm $137.00
Biomet Australia Pty Ltd
BI109 Mallory Head Hip System Screw, Acetabular (6.5 - 5.5)mm dia x (15 - $137.00
70)mm length
BI702 Par 5 Protrusio Acetabular System Screws - Titanium Metal 6.5mm $137.00
Corin Australia Pty Ltd
CR070 Titanium Counter Sunk Screw Titanium Counter Sunk Screw Lengths 15-70mm $137.00
Prostheses List by Category, Groups and Sponsor Page 128 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
CR116 Extreme Hip System Femoral Shaft Titanium distal femoral locking screw 6.2mm diameter, 13 lengths in $137.00
Locking Screw 5mm increments
CR121 Horizon Acetabular Fixation Screw Titanium countersunk cancellous screw Diam 6.5mm, lenghts 16 - 55 mm $137.00
CR126 METS Trochanter Screw Titanium Short, Medium, Long $137.00
DJO Australasia Pty Ltd
DD025 FMP Acetabular Screws Titanium, cancellous screws 25mm to 50mm $137.00
Electus Ortho Pty Ltd
EZ009 Adler Bone Screw Bone Screw for Acetabular Cup 6.5mm Diameter. 20-50mm $137.00
ESKA Australia
EK052 ESKA Acetabular Screw Titanium, cancellous screw 15mm - 90mm $137.00
Exactech Australia
EX006 Novation Crown Cup Screws Titanium cortical bone screws Full radius tip: 6.5mm x 15mm, $137.00
6.5mm x 20mm, 6.5mm x
25mm, 6.5mm x 30mm, 6.5mm
x 35mm, 6.5mm x 40mm,
6.5mm x 45mm, 6.5mm x
50mm, 6.5mm x 55mm, 6.5mm
x 60mm, 6.5mm x 70mm;
Peripheral Rim screw: 4.5mm x
25mm, 4.5mm x 30mm, 4.5mm
x 35mm, 4.5mm x 40mm,
4.5mm
FOL Technology PTY Ltd
FO010 Samo Acetabular Cup bone screw Bone screw 20 - 40 mm $137.00
Global Manufacturing Technology Pty Ltd
GM058 Fin II Acetabular Screw Titanium, '6.5mm Cancellous Bone Screws 15 - 80mm $137.00
GM059 SMR Distal Locking Screw Titanium, '4.5mm Cortical Bone Screws 20 to 80mm $137.00
GM116 Global Acetabular Cancellous Screw Titanium 6.5mm cancellous bone screw 15mm to 50mm $137.00
Global Orthopaedic Technology
GO133 FMP Acetabular Screws Titanium, cancellous screws 25mm to 50mm $137.00
GO147 Keramos Acetabular Screws Titanium, cancellous screws 25mm to 50mm $137.00
Prostheses List by Category, Groups and Sponsor Page 129 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP944 DePuy Hip Bone Screws Titanium, cancellous screws Size 3.5-6.5 diameter 5- $137.00
120mm length
JJ704 Gyros Hip System Stainless steel screws for Gyros acetabular 20 - 65mm $137.00
cup with flanges
Lifehealthcare Pty Ltd
LH062 Groupe Lepine Acetabular Screws 5.5mm dia in 15mm-60mm $137.00
length 5mm increments
Lima Orthopaedics Australia Pty Ltd
LC024 Lima Bone Screw Titanium Bone Screw 20 - 60mm $137.00
Mathys Orthopaedics Pty Ltd
MA514 Acetabular Screws Titanium cancellous bone screws varying lengths and sizes $137.00
Medacta Australia Pty Ltd
MU014 Medacta Acetabular Screws Titanium, cancellous screws 6.5 L 15-45mm $137.00
Medartis
EO013 Atlas Acetabular Cup System Screw Atlas Screw Dia 6.5mm 15- $137.00
50mm L
Oceania Orthopaedics
OO031 Mutars RS revision system - bone screws RS bone screw 25mm, 30mm, 40mm, 42mm, $137.00
45mm, 50mm, 55mm, 60mm
Orthotech Pty Ltd
OH289 JRI CSF Hip System CSF Bone Screws, Titanium Alloy 15mm - 50mm $137.00
Smith & Nephew Surgical Pty Ltd
SM041 Universal Cancellous Bone Screws Cancellous bone screw titanium 15-60mm long 6.4mm dia $137.00
SM137 Polar Cup Acetabular Screws Stainless Steel Cortical Screws 4.5mm by 40-60mm $137.00
Stryker Australia Pty Ltd
HW011 ABG Hip System Bone screw - Titanium, used with ABG11 12,15,20,25,30,35,40,45 and $137.00
Cups 50mm lengths
HW047 Exeter Hip System X-Change Bone Screws - Stainless Steel 3.5mm X 10, 15, 20, 25, 30, $137.00
35mm
ST545 Osteonics hip prostheses Cancellous bone screw, Titanium 6.5mm & 5.5mm dia $137.00
Prostheses List by Category, Groups and Sponsor Page 130 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Wright Medical Australia
WR105 Quadra-Fix Acetabular Shell Quadra-Fix Double threaded, 6.5mm 35mm - 80mm in 5mm $137.00
Cancellous bone Screw increments
WR121 Procotyl-E screws titanium alloy Diameter 5.5mm, Length 15 - $137.00
60mm
WR131 Transcend/Lineage Articulation System Bone screw titanium 6.5mm x 1.5 - 6cm in 0.5cm $137.00
increments long
Zimmer Pty Ltd
ZI036 Acetabular Cup Trilogy Bone Screw - Titanium 15 - 60 $137.00
11.4.4 - Calcar Block
Zimmer Pty Ltd
ZI024 Zimmer 'VerSys CRC Hip Systems Modular Calcar Block One size only $572.00
11.4.5 - Cement Restrictor
Austofix
AX076 Experion Cement Restrictor UHMWPE Universal, one size $120.00
Global Orthopaedic Technology
GO165 Global Cement Restrictor PMMA, Various $120.00
Johnson & Johnson Medical Pty Ltd
DP233 Hardinge Cement Restrictor Hardinge cement Restrictor (ea) One size only $120.00
DP448 BIO Stop G Biostop Restrictor (Gelatin, Glkycerol, size 8-20 $120.00
PHBM, Water)
DP575 C-Stem End Cap End Cap Biostop Restrictor (Gelatin, Size 8- 20 $120.00
Glycerol, PHBM, water)
JJ753 Hardinge Cement Restrictor UHMWPE cement restrictor One size only $120.00
JJ754 DePuy Femoral Cement Restrictor UHMWPE cement restrictor Size 0 to 10 $120.00
Link Orthopaedics Australia
LO106 LINK Intramedullary Plug P/E Intramedullary Plug 12 to 20 mm $120.00
Prostheses List by Category, Groups and Sponsor Page 131 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Mathys Orthopaedics Pty Ltd
MA018 Intramedullary Plug Cement Restricter Small to Extra Large $120.00
Smith & Nephew Surgical Pty Ltd
SN263 Buck Cement Restrictor 18.5 - 35mm $120.00
Stryker Australia Pty Ltd
HW001 Hardinge Cement Restrictor PMMA 6,9 and 12 Leaf $120.00
SK505 BioPrep Bone Preparation System Femoral Preparation Kit with cement 18.5 - 25mm O.D. $120.00
restrictor
ST582 Osteonics hip prostheses Cement restrictor Polyethylene Universal and sizes 1-8 $120.00
Zimmer Pty Ltd
ZI226 Zimmer Bone Plug Allen Medullary Plug 8 - 23mm $120.00
ZI356 Medullary Plug, MS 30 Centring Plug, cement restrictor, hip - PE 1 to 7 $120.00
11.4.6 - Centraliser
Austofix
AX077 Experion Distal Centraliser PMMA Universal $158.00
B Braun Australia Pty Ltd
BB245 Distal centraliser PMMA 7mm - 18mm $158.00
BB276 Excia Hip System Distal Centraliser, PMMA 8mm-18mm $158.00
Biomet Australia Pty Ltd
BI131 Mallory Head Hip System Femoral Centraliser, UHMWPE 9-17mm $158.00
Exactech Australia
EX054 Novation Distal Centralizer, PMMA The Exatech distal centralizer is used for Size 10mm, 11mm, 12mm, $158.00
cemented only hip arthroplasty, it 13mm, 14mm, 15mm, 17mm
centralises the stem position in the femur.
Global Orthopaedic Technology
GO166 Global Distal Centraliser PMMA, Various $158.00
GO167 R120 Distal Centraliser PMMA, Various $158.00
Prostheses List by Category, Groups and Sponsor Page 132 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP297 Universal Femoral Stem Distal Centraliser PMMA Distal Centralisers includes 10-20mm $158.00
Charnley, Elite Plus, C-Stem and Summit
centralisers
DP584 PLA Centraliser Poly Lactic Acid+D108 Centraliser 9-20mm $158.00
JJ584 Femoral Prep Kit Femoral Preparation Kit One size only $158.00
Medacta Australia Pty Ltd
MU002 CONE Femoral Stem Distal centraliser PMMA 10mm to 18mm $158.00
Smith & Nephew Surgical Pty Ltd
SN269 CPCS Polished Cemented Stem Distal Centraliser 8 - 18 $158.00
SN359 Invis Distal Centraliser PMMA 7 - 21mm $158.00
Stryker Australia Pty Ltd
HW034 Definition PM Femoral Component Distal Centraliser - PMMA - Ring 11-22mm $158.00
Centraliser
HW057 RELIANCE HIP Distal Centraliser - PMMA 10-18mm $158.00
SK315 Exeter Hip System Exeter Distal Centraliser -PMMA One Size Only $158.00
ST581 Osteonics hip prostheses Distal spacer PMMA 8-15mm $158.00
Zimmer Pty Ltd
ZI013 Zimmer distal centralisers CPT, VerSys, PMMA Centraliser Size 1 $158.00
Natural and MS30
ZI020 Zimmer VerSys Proximal Centraliser - PMMA 11 - 17 $158.00
ZI021 Zimmer Hip Systems Femoral Stem VerSys Distal Centraliser - PMMA 10 - 18 $158.00
ZI366 Natural Hip System Distal Centraliser - PE 10 to 19 $158.00
ZI374 MS-30 Hip prosthesis Centralizer for Cemented Stems (Protek) - 8 to 18 $158.00
metal alloys
11.4.7 - Claw
Biomet Australia Pty Ltd
BI124 Modular Calcar Mallory Head Revision Trochanteric Claw, Titanium Medium, Large $460.00
Hip System
Prostheses List by Category, Groups and Sponsor Page 133 of 911
11 - HIP
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ESKA Australia
EK108 MML Tumor Revision System Claw for Trochanter Module, 3 Straight, Angled $460.00
Dimensional Metal
11.4.8 - Connector
Biomet Australia Pty Ltd
BI125 Modular Calcar Mallory Head Revision Trochanteric Connector Sizes 40-70mm $570.00
Hip System
ESKA Australia
EK104 MML Tumor Revision System Connection Module - Connects the 3mm, straight (0°) or bowed $570.00
Extension modules with the dual taper (5°) with taper locking 16 / 18
EK105 MML Tumor Revision System Connection Module for Intramed, T10/12 - 16/18, IK16/18 - $570.00
Prosthesis and Arthodesis-Connection 16/18 with 70mm in Length
11.4.9 - Dome Plug
Johnson & Johnson Medical Pty Ltd
DY077 Apex Hole eliminator Hole eliminator screw Titanium One size only $160.00
Orthotech Pty Ltd
OH380 Securus Modular Revision Hip System Modular Body Cap One size $160.00
Smith & Nephew Surgical Pty Ltd
SN294 Reflection Tapered hole cover (Reflection Interfit) One size only $160.00
SN295 Reflection Threaded hole cover (Reflection) One size only $160.00
Stryker Australia Pty Ltd
ST551 Osteonics Hip Prostheses Dome hole plug titanium One size only $160.00
Wright Medical Australia
WR115 Transcend/Lineage Articulation System Apical dome plug titanium One size only $160.00
Zimmer Pty Ltd
ZI622 Continuum Acetabular System Screw Hole Plugs Screw Hole Pack - Three Pack $160.00
Prostheses List by Category, Groups and Sponsor Page 134 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
12.1.1 - Cemented, Alloy
12.1.1.1 - Minimally Stabilised
Advanced Surgical Design & Manufacture Ltd
AE039 Active Knee Femoral Component Femoral Component, Cemented, CoCr Sizes 00 - 5 Left & Right $3,300.00
B Braun Australia Pty Ltd
BB205 Columbus Total Knee System (TKS) Femoral component, cemented, CoCr F1 - F7, Left and Right $3,300.00
Femoral Component
Biomet Australia Pty Ltd
BI147 AGC System femoral component Femoral Component, cemented, CoCr, 55-80mm $3,300.00
left and right sided (anatomic)
BI168 Maxim Complete Knee System Femoral Femoral Component, Cemented, CoCr 55-80mm $3,300.00
Component
BI898 Vanguard Total Knee System Femoral Component, CR, Cemented, 55, 57.5, 60, 62.5, 65, 67.5, $3,300.00
anatomic, CoCr. 70, 75, 80 Left and Right
BI902 ROCC Femoral Compoent Femoral Component, cemented, posterior 1-8 $3,300.00
stabilised, CoCr
Corin Australia Pty Ltd
CR105 Score Knee System Femoral Femoral component, Cemented, CoCr, 7 sizes $3,300.00
Component with extended patellar groove
DJO Australasia Pty Ltd
DD017 3D Knee System Femoral Component Femoral Component, cemented, CoCr Size 2 to 12 $3,300.00
Exactech Australia
EX031 Optetrak Total Knee System Femoral Femoral Component, cemented, CoCr Size 1 - 6 $3,300.00
Component
Finsbury Orthopeadics Australia Pty Ltd
FI028 MRK (Medial Rotation Knee) Total Femoral Component, Cemented, CoCr 0-5 Left and Right $3,300.00
Knee System Femoral Component
FI052 Saiph Knee System Femoral Component CoCr Polished Cemented Femoral 1 - 8 Left & Right $3,300.00
Cemented Component
FOL Technology PTY Ltd
FO018 Trekking Knee System - Femoral Femoral component cemented 1 - 5 $3,300.00
Component
Prostheses List by Category, Groups and Sponsor Page 135 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Global Orthopaedic Technology
GO006 RBK Total Knee System Femoral Femoral Component, CoCr, cemented 0 - 5 $3,300.00
Component
GO196 Absolut Knee - Cemented Femoral CR Cemented Femoral Component, Non- Size 1 Left & Right, size2 Left $3,300.00
Component Porous, Size 1 to 6 & Right, size 3 Left & Right,
size 4 left & Right, size 5 Left &
Right, size 6 Left & Right
Johnson & Johnson Medical Pty Ltd
DY471 PFC Sigma Knee System femoral Femoral component, cemented, CoCr Size 1-6 including narrow sizes $3,300.00
component
Link Orthopaedics Australia
LO154 Link Gemini Femoral Component Femoral component, cemented, CoCR, Extra small - Extra large $3,300.00
microporous
Mathys Orthopaedics Pty Ltd
MA108 Balansys Femoral Component Femoral component, cemented, CoCr A, B, C, D, E Left & Right $3,300.00
MA490 Balansys Knee System / Femoral Balansys Femoral Component/ CR 60 - 76, left and right $3,300.00
Component, CR, cemented, TiNbN cemented, TiNbN coated
coated
Medacta Australia Pty Ltd
MU026 Evolis Knee System Femoral Femoral component, cemented, CoCr 1- 6, left and right $3,300.00
Component
MU043 Cinétique Knee System Femoral Femoral component, cemented, CoCr Sizes 1 to 6, Left and Right $3,300.00
Component
MU063 GMK cemented standard femur cemented standard femoral component sizes 1to 6, left to right $3,300.00
Oceania Orthopaedics
OO001 ACS Knee System - Femoral Cemented resurfacing femoral component Left/Right 1-6 $3,300.00
component cemented for use in knee athroplasty
Orthotech Pty Ltd
OH020 Optetrak Total Knee System Femoral Femoral Component, cemented, CoCr Size 1 - 6 $3,300.00
Component
Smith & Nephew Surgical Pty Ltd
SM064 VKS (Vario) Knee System Femoral Femoral Component, CoCr, cemented 1-12 $3,300.00
Component
Prostheses List by Category, Groups and Sponsor Page 136 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SN321 Genesis II Knee System Femoral Femoral Component, cemented, CoCr Left/Right Size 1-8 $3,300.00
Component
Stryker Australia Pty Ltd
HW076 Duracon Knee System Femoral Minimally stabilised, cemented, CoCr Small, Medium, Medium- $3,300.00
Component (Vitallium) Large, Large, Extra-Large
HW147 Kinemax Knee System Femoral Minimally stabilised, cemented, CoCr XS, S, M, L, XL, XXL $3,300.00
Component (Vitallium)
HW396 Duracon Knee System Femoral Minimally stabilised, cemented, CoCr Small, Medium, Medium- $3,300.00
Component (Vitallium), with removable lugs, and Large, Large, Extra-Large
capacity to attach femoral box
SK324 Triathlon Knee System Femoral Minimally stabilised, cemented, CoCr Sizes 1 to 8 $3,300.00
Component
SK332 Scorpio NRG Knee System Femoral Minimally stabilised, cemented, CoCr Sizes 3,4,5,6,7,9,11,13 $3,300.00
Component
SR063 Scorpio Knee System Femoral Minimally stabilised, cemented, CoCr with 3 Left, 3 Right, 5 Left, 5 Right, $3,300.00
Component TiNi surface treatment (LFIT - Low 7 Left, 7 Right, 9 Left, 9 Right,
friction ion treatment) 11 Left, 11 Right, 13 Left, 13
Right
ST634 Scorpio Knee System Femoral Minimally stabilised, cemented, CoCr 3, 5, 7, 9, 11, 13 $3,300.00
Component
Wright Medical Australia
WR192 Advance Total Knee System Cemented, grit blasted, minimally 0, 1, 2, 3, 4, 5, 6 $3,300.00
stabilised, femoral component
WR202 Advantim Total Knee System Cemented femoral component, CoCr Small, Medium, Large, Xlarge $3,300.00
Zimmer Pty Ltd
ZI420 Natural Knee Femoral Component Femoral Component, Cemented, CoCr Size 00 to 5 $3,300.00
ZI559 Natural Knee II Flex Femur Femoral Component, cemented, CoCr, Sizes 1 to 5 GSM Left and $3,300.00
High Flex Right and Sizes 0 to 4 GSF Left
and Right
Ceramic Surface
Johnson & Johnson Medical Pty Ltd
DY374 LCS Complete Knee System femoral Femoral component, cemented, Titanium Sizes small to large+ $3,450.00
component with TiN surface treatment
Prostheses List by Category, Groups and Sponsor Page 137 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medacta Australia Pty Ltd
MU027 Evolis Knee System Femoral Femoral Component, cemented, CoCr, 1 - 6, left and right $3,450.00
Component with TiNi (TiNibN) surface coating
MU044 Cinétique Knee System Femoral Femoral Component, cemented, CoCr, Sizes 1 to 6, Left and Right $3,450.00
Component with TiNi (TiNibN) surface coating
Revision
Johnson & Johnson Medical Pty Ltd
DY368 LCS Complete Knee System femoral Femoral component, cemented, CoCr Sizes small to large+ $6,050.00
component
Medacta Australia Pty Ltd
MU081 GMK Revision cemented standard femur Cemented minimally stabilised femoral Sizes 1 to 6, Left and Right $6,050.00
component
Oceania Orthopaedics
OO017 ACS Knee System - ACS LS Revision Cemented femoral component, revision, Left/Right Sizes 2/3/4/5/6 $6,050.00
Femoral component, Cemented for use with stems
Smith & Nephew Surgical Pty Ltd
SM085 TC (Tri Compartment) PLUS Knee Femoral Component, CoCr, cemented 2 - 10 $6,050.00
System Femoral Component
Wright Medical Australia
WR180 Advance Total Knee System Stemmed condular medial pivot 1, 2, 3, 4, 5 All in Left & Right $6,050.00
component, cemented, grit blasted,
minimally stabilised, femoral component,
CoCr, usually used with a anterior lipped
insert
SCP
Johnson & Johnson Medical Pty Ltd
DP004 LCS Complete Knee System femoral Femoral cemented, CoCr Sizes small to large+ $3,800.00
component
12.1.1.2 - Posterior Stabilised
B Braun Australia Pty Ltd
BB196 Emotion Total Knee System (TKS) Femoral Component, cemented, CoCr, F1 - F8, Left and Right $3,400.00
Femoral Component Posterior stabilised
Prostheses List by Category, Groups and Sponsor Page 138 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BB206 Columbus Total Knee System (TKS) Femoral component, cemented, CoCr, F1 - F7, Left and Right $3,400.00
Femoral Component posterior stabilised
Biomet Australia Pty Ltd
BI150 AGC System femoral component Femoral Component, cemented, CoCr, 55 to 80mm $3,400.00
left and right sided (anatomic), posterior
stabilised
BI158 AGC System femoral component Femoral Component, cemented, CoCr, 55-80mm $3,400.00
unsided (universal), posterior stabilised
BI178 Maxim Complete Knee System Femoral Femoral Component, Cemented, CoCr, 55-80mm $3,400.00
Component Posterior Stabilised
BI195 Vanguard Rotating Platform Femoral Femoral Component, Cemented, CoCr, 60-75mm $3,400.00
Component Posterior Stabilised
BI897 Vanguard Total Knee System Femoral Component, Posterior Stabilised, 55, 57.5, 60, 62.5, 65, 67.5, $3,400.00
Cemented, anatomic, CoCr. 70, 75, 80 Left and Right
Exactech Australia
EX033 Optetrak Total Knee System Femoral Femoral Component, cemented, CoCr, Size 1 - 6 $3,400.00
Component posterior stabilised
EX034 Optetrak Hi Flex Femoral Component Femoral Component, Cemented, CoCr, 1-6 $3,400.00
High Flex (Hi Flex), posterior stabilised
Johnson & Johnson Medical Pty Ltd
DP149 PFC Sigma Knee System femoral Femoral component, cemented, CoCr, Size 1-6 including narrow sizes $3,400.00
component posterior stabilised
DY371 LCS Complete System femoral Femoral Component, cemented, CoCr, Sizes small to large+ $3,400.00
component posterior stabilised
DY404 PFC Sigma Knee System RPF/PS150 Femoral component, cemented, CoCr, Size 1-6 including narrow sizes $3,400.00
femoral component high flex, posterior stabilised
Mathys Orthopaedics Pty Ltd
MA487 BalanSys Femoral Component Femoral component, cemented, CoCr, A, B, C, D, E Left & Right $3,400.00
posterior stabilised
MA493 Balansys Knee System / Femoral Balansys Femoral Component/PS 60-76, left and right $3,400.00
Component, PS, cemented, TiNbN cemented, TiNbN coated, CoCrMo,
coated TiNbN
Medacta Australia Pty Ltd
MU028 Evolis Knee System Femoral Femoral Component, cemented, CoCr, 1 - 6, left and right $3,400.00
Component posterior stabilised
Prostheses List by Category, Groups and Sponsor Page 139 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
MU029 Evolis Knee System Femoral Femoral Component, cemented, CoCr, 1 - 6, left and right $3,400.00
Component posterior stabilised with TiNi (TiNibN)
surface coating
MU064 GMK posterior stabilised cemented cemented posterior stabilised femoral sizes 1 to 6, left to right $3,400.00
femur component
Oceania Orthopaedics
OO018 ACS Knee System - PS Femoral ACS posterior stabilised femoral size 2,3,4,5,6 left/right $3,400.00
component, cemented component, cemented
Orthotech Pty Ltd
OH212 Optetrak Total Knee System Femoral Femoral Component, cemented, CoCr, Size 1 - 6 $3,400.00
Component posterior stabilised
OH233 Optetrak Hi Flex Femoral Component Femoral Component, Cemented, CoCr, 1-6 $3,400.00
High Flex (Hi Flex), posterior stabilised
Smith & Nephew Surgical Pty Ltd
SN847 Journey Knee System Femoral Femoral Component, Cemented, CoCr, Sizes 1-10, Left and Right $3,400.00
Component posterior stabilised
SN871 Genesis II Knee System Femoral Femoral component, cemented posterior Left / Right 1-8 $3,400.00
Component stabilised, CoCr
SN872 Profix Knee System Femoral Femoral component, cemented posterior Left / Right 1-8 $3,400.00
Component stabilised, CoCr
Stryker Australia Pty Ltd
HW080 Duracon Knee System Femoral Posterior stabilised, cemented, CoCr Small, Medium, Medium- $3,400.00
Component (Vitallium) Large, Large, Extra-Large
SR003 Scorpio NRG Knee System Femoral Posterior stabilised, cemented, CoCr Sizes 3,4,5,6,7,9,11,13 $3,400.00
Component
SR009 Triathlon Knee System Femoral Posterior stabilised, cemented, CoCr, with Sizes 1 to 8 $3,400.00
Component ability to add lugs or augments
SR019 Scorpio Knee System Femoral Posterior stabilised, cemented, CoCr 3, 5, 7, 9, 11, 13 $3,400.00
Component
ST984 Scorpio Knee System Femoral Posterior stabilised, cemented, CoCr with 3 Left, 3 Right, 5 Left, 5 Right, $3,400.00
Component TiNi surface treatment (LFIT - Low 7 Left, 7 Right, 9 Left, 9 Right,
Friction Ion Treatment) 11 Left, 11 Right, 13 Left, 13
Right
Prostheses List by Category, Groups and Sponsor Page 140 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Tornier Pty Ltd
TO008 HLS Noetos Femoral Component Femoral Component, cemented, CoCr, 1 - 6 CoCr $3,400.00
posterior stabilised using midline condyle
TO060 HLS Kneetec - Femoral Implant Femoral implant of the HLS Kneetec Left and Right, 10 sizes each: 7 $3,400.00
System, cemented, CoCr, Posterior standard (1 to 7) and 3
Stabilised "narrow" (3 to 5)
Zimmer Pty Ltd
ZI589 NexGen LPS Flex GSF Femoral Cobalt Chrome, High Flex, cemented, Sizes GSF C to G, Left to Right $3,400.00
Components - Option posterior stabilised
ZI736 NexGen LPS-Flex Tivanium Femoral LPS-Flex Tivanium Femoral Component, 00-5968-013-51 LPS-Flex $3,400.00
Component Size C Left Tivanium Femoral Component,
LPS-Flex Tivanium Femoral Component, Size C Left
Size C Right 00-5968-013-52 LPS-Flex
LPS-Flex Tivanium Femoral Component, Tivanium Femoral Component,
Size D Left Size C Right
LPS-Flex Tivanium Femoral Component, 00-5968-014-51 LPS-Flex
Size D Right Tivanium Femoral Component,
LPS-Flex Tivanium Femoral Component, Size D Left
Size E Left 00-5968-014-52 LPS-Flex
LPS Tivanium Femoral Component,
Size D
Revision
Corin Australia Pty Ltd
CR109 Score Knee System Femoral Femoral Component, CoCr, cemented, 4 sizes in left and right $6,150.00
Component Posterior Stabilised
Global Orthopaedic Technology
GO113 RBK Total Knee System Femoral Femoral Component, cemented, CoCr, Size 0 to 5 $6,150.00
Component posterior stabilised
Johnson & Johnson Medical Pty Ltd
DP268 SROM Noiles Posterior Stabilised Posterior stabilised, CoCr, cemented, Sizes xxsmall-large $6,150.00
Revision femoral component femoral component
Mathys Orthopaedics Pty Ltd
MA506 Balansys Revision Knee Femoral component, contrained A to E, right to left $6,150.00
Medacta Australia Pty Ltd
MU089 GMK Revision cemented posterior- Cemented posterior stabilised femoral Sizes 1 to 6, Left and Right $6,150.00
stabilised femur component
Prostheses List by Category, Groups and Sponsor Page 141 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SM141 TC (Tri Compartment) PLUS Knee Femoral Component, CoCr, Cemented 2-10mm $6,150.00
System Femoral Component posterior stabilised
Tornier Pty Ltd
TO021 HLS Noetos Revision Femoral Femoral Component, cemented, CoCr, 1 to 6 right and left $6,150.00
Component posterior stabilised using midline condyle
Zimmer Pty Ltd
ZI119 NexGen LCCK (Legacy Constrained Femoral component, posterior stabilised, A - H (L&R) $6,150.00
Condylar Knee) Femoral Component CoCr
ZI423 Natural Knee Femoral Component Femoral component, cemented, CoCr, Size 00 to 4 (left & right), $6,150.00
possterior stabilised
12.1.1.3 - Totally Constrained
Biomet Australia Pty Ltd
BI180 Maxim Complete Knee System Femoral Femoral Component, Cemented, CoCr, 60-75mm $3,500.00
Component totally constrained
Exactech Australia
EX035 Optetrak Total Knee System CCK and Femoral Component, cemented, CoCr, Size 1 - 6(CCK), Size 1- $3,500.00
NMC (constrained Condylar and Non- totally stabilised 5(NMC)
Modular Constrained Knee) Femoral
component
Link Orthopaedics Australia
LO170 LINK Endo Model Rotational and Hinge Femoral Components Extra Small - Extra Large $3,500.00
Knee Prostheses
Smith & Nephew Surgical Pty Ltd
SN660 Profix Knee System Femoral Femoral Component, CoCr, Cemented, Left & Right, 2-7 $3,500.00
Component totally constrained
SN866 Profix Knee System Femoral Femoral component, cemented, totally Left / Right 1 - 8 $3,500.00
Component stabilised, CoCr
Stryker Australia Pty Ltd
HW149 Kinemax Knee System Stabilizer Totally constrained, cemented, CoCr XS, S, M, L, XL, XXL $3,500.00
Femoral Component (Vitallium)
Prostheses List by Category, Groups and Sponsor Page 142 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Hinged
Johnson & Johnson Medical Pty Ltd
DP254 SROM Noiles Knee System femoral Rotating Hinge, cemented, CoCr, SROM Sizes xxsmall-large $6,750.00
component & LPS knee systems, with Hinge Pin
Smith & Nephew Surgical Pty Ltd
SM082 'RT (Rotating Hinge) PLUS Knee Femoral Component, CoCr, Cemented, 0-10 $6,750.00
System Femoral Component hinged
Zimmer Pty Ltd
ZI305 Nexgen Rotating Hinged Knee Femoral Femoral Component, with a fixed rotating B-F $6,750.00
Component hinge on UHMWPE bearings, cemented,
CoCr
Revision
Biomet Australia Pty Ltd
BI933 Vanguard SSK Knee System Femoral Component, CoCr, Ti 55 to 80mm $6,250.00
Johnson & Johnson Medical Pty Ltd
DP150 PFC Sigma Knee System TC3 femoral Femoral component, cemented, CoCr, Size 1-6 $6,250.00
component totally constrained
DY148 LCS Complete Knee System femoral Femoral component, cemented, CoCr, Sizes small to large+ $6,250.00
component totally constrained
Orthotech Pty Ltd
OH024 Optetrak Total Knee System CCK Femoral Component, cemented, CoCr, Size 1 - 6 $6,250.00
(Constrained Condylar Knee) Femoral totally stabilised
Component
Smith & Nephew Surgical Pty Ltd
SN851 Legion Knee System Femoral Femoral Component, CoCr, Cemented, Sizes 1-10, Left and Right $6,250.00
Component totally constrained
SN865 Genesis II Knee System Femoral Femoral component, cemented, totally Left / Right 1 - 8 $6,250.00
Component stabilised, CoCr
Stryker Australia Pty Ltd
SK440 Triathlon TS Knee System Femoral Totally constrained, cemented, CoCr Left & Right Size 1-8 $6,250.00
Component
Prostheses List by Category, Groups and Sponsor Page 143 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SR060 Scorpio Knee System Femoral Totally constrained, CoCr with TiNi 3 Left, 3 Right, 5 Left, 5 Right, $6,250.00
Component surface treatment (LFIT - Low Friction 7 Left, 7 Right, 9 Left, 9 Right,
Ion Treatment) 11 Left, 11 Right, 13 Left, 13
Right
ST602 Duracon TS Knee System Femoral Totally constrained, cemented, CoCr Extra Small, Small, Medium, $6,250.00
Component (Vitallium) Medium Large, Large, Extra
Large
Wright Medical Australia
WR185 Advance Revision Knee System Cemented, grit blasted, totally constrained, 1, 2, 3, 4, 5 $6,250.00
femoral component, CoCr
Revision, Hinged
Biomet Australia Pty Ltd
BH120 RHK Knee - Femoral Component Rotating hinge, cemented, CoCr with hinge Small right, Standard right, $6,750.00
assembly. Small left, Standard left.
Global Orthopaedic Technology
GO169 RBK Total Knee System Femoral Femoral Component, cemented, CoCr, Size 0 to 5 $6,750.00
Component totally constrained
Link Orthopaedics Australia
LO157 LINK Endo Model M Modular Knee Femoral Components Extra Small - Extra Large $6,750.00
Prostheses System
Smith & Nephew Surgical Pty Ltd
SM158 Legion Hinge Femur CoCr The femoral component of the Legion Size 2 to 7 $6,750.00
Hinge system.
Stryker Australia Pty Ltd
HW143 MRH (Modular Rotating Hinge) MRH Rotating Hinge Femoral component, Left, Right $6,750.00
(Modular Rotating Hinge) Femoral CoCr (Vitallium), cemented, w/attachable
Component stem, Fixed
12.1.2 - Cemented, Alloy, PMMA Coating
12.1.2.1 - Minimally Stabilised
Zimmer Pty Ltd
ZI590 NexGen CR Flex Femoral Components Cobalt Chrome, High Flex, Precoat Sizes A to G, Left to Right, $3,400.00
- Precoat cemented, Cruciate retaining GSF C to G Left to Right
Prostheses List by Category, Groups and Sponsor Page 144 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Revision
Zimmer Pty Ltd
ZI113 NexGen Knee Femoral Component Femoral Component, cemented with A - H (L&R) $6,150.00
PMMA, CoCr
SCP
Zimmer Pty Ltd
ZI111 NexGen Knee Femoral Component Femoral Component, cemented with A - H (L&R) $3,900.00
PMMA, CoCr
12.1.2.2 - Posterior Stabilised
Link Orthopaedics Australia
LO153 LINK Gemini Femoral Component PS Femoral component PS, cemented, CoCr, Extra small - Extra Large $3,500.00
microporus
Zimmer Pty Ltd
ZI588 NexGen LPS Flex Femoral Component Cobalt Chrome, High Flex, cemented, Sizes A to G, Left to Right $3,500.00
- PreCoat PMMA coating, posterior stabilised
SCP
Zimmer Pty Ltd
ZI117 NexGen Femoral Component Femoral Component, posterior stabilised, A - H (L&R) $4,000.00
PMMA coating, cemented, CoCr
12.1.3 - Cemented, Non-Alloy
12.1.3.1 - Minimally Stabilised
Ceramic Surface
Smith & Nephew Surgical Pty Ltd
SN879 Genesis II Knee System Femoral Femoral component, Oxinium, cemented Left / Right 1-9 $4,200.00
Component
SN880 Profix Knee System Femoral Femoral component, Oxinium, cemented Left / Right 1-9 $4,200.00
Component
Prostheses List by Category, Groups and Sponsor Page 145 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
12.1.3.2 - Posterior Stabilised
Ceramic Surface
Smith & Nephew Surgical Pty Ltd
SN779 Journey Knee System Femoral Femoral Component, cemented, Oxinium, 1-10 $4,300.00
Component posterior stabilised (bicruciate substitute)
SN883 Genesis II Knee System Femoral Femoral Component, cemented, posterior 1-9 $4,300.00
Component stabilised, Oxinium
SN884 Profix Knee System Femoral Femoral Component, cemented, posterior 1-8 $4,300.00
Component stabilised, Oxinium
12.1.3.3 - Totally Constrained
Revision
Oceania Orthopaedics
OO016 ACS Knee System - ACS SC Revision Cemented femoral component, Cemented Left/Right Sizes 2/3/4/5/6 $7,500.00
Femoral component, Cemented
Smith & Nephew Surgical Pty Ltd
SN736 Legion Knee System Femoral Femoral Component, Oxinium, Cemented, Size 1 - 9 $7,500.00
Component totally constrained
Revision, Hinged
Wright Medical Australia
WR151 Guardian Limb Salvage System Resurfacing Femur with extensive distal 2, 3, 4, Left & Right $7,540.00
femoral buildup
12.1.4 - Uncemented, Alloy
12.1.4.1 - Minimally Stabilised
B Braun Australia Pty Ltd
BB234 Columbus Total Knee System (TKS) Femoral Component, uncemented, CoCr, F1 - F7, Left and Right $3,700.00
Femoral Component Titanium plasma spray (Plasmapore)
Prostheses List by Category, Groups and Sponsor Page 146 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Biomet Australia Pty Ltd
BI159 AGC System femoral component Femoral Component, uncemented, CoCr 55-80mm $3,700.00
with titanium plasma sprayed surface
(Porous plasma spray PPS) left and right
sided (anatomic),
BI167 Maxim Complete Knee System Femoral Femoral Component, uncemented, CoCr 55-80mm $3,700.00
Component with titanium plasma sprayed surface
(Porous plasma spray PPS)
BI886 Vanguard Total Knee System Femoral Component, CR, uncemented, 55, 57.5, 60, 62.5, 65, 67.5, $3,700.00
anatomic, CoCr, Ti 70, 75, 80 Left and Right
DJO Australasia Pty Ltd
DD018 3D Knee System Femoral Component Femoral Component, uncemented, Size 2 to 12 $3,700.00
beaded, CoCr
Global Orthopaedic Technology
GO195 Absolut Knee, CR Femoral Component CR Femoral Component Porous Coated Size 1 Left & Right, size 2 left $3,700.00
Porous Coated Size 1 to 6 left & Right. & Right, size 3 Left & Right,
size 4 Left & Right, size 5 left &
Right, size 6 Left & Right
Johnson & Johnson Medical Pty Ltd
DP148 PFC Sigma Knee System femoral Femoral component, uncemented, CoCr, Size 1-6 $3,700.00
component Beaded
JJ606 PFC Sigma Knee System femoral Femoral component, uncemented, CoCr, Size 1-6 $3,700.00
component beaded (Porocoat)
Mathys Orthopaedics Pty Ltd
MA457 Balansys Femoral Component Femur, CoCr with Ti vacuum plasma A to E, left & right $3,700.00
spray coating or beaded coating
Medacta Australia Pty Ltd
MU038 Evolis Knee System Femoral Femoral component, uncemented, CoCr, 1 - 6, left to right $3,700.00
Component titanium plasma spray
Oceania Orthopaedics
OO002 ACS Knee System - Femoral Porous coated resurfacing femoral Left/Right 1-6 $3,700.00
component porous coated component for use in knee arthroplasty
Prostheses List by Category, Groups and Sponsor Page 147 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SM052 VKS (Vario) Knee System Femoral Femoral Component, CoCr, uncemented, 1-6 $3,700.00
Component Titanium Plasma Spray (Vacuum spray
and triple layer)
SN326 'Genesis II Knee System Femoral Femoral Component, CoCr, uncemented, Left/Right Size 1-8 $3,700.00
Component beaded
SN375 Profix Knee System Femoral Femoral Component, CoCr, uncemented, Left/Right Size 1-8 $3,700.00
Component beaded
Stryker Australia Pty Ltd
HW075 Duracon Knee System Femoral Minimally stabilised, uncemented, beaded, Small, Medium, Medium- $3,700.00
Component CoCr (Vitallium) Large, Large, Extra-Large
HW397 Duracon Knee System Femoral Minimally stabilised, uncemented, beaded, Small, Medium, Medium- $3,700.00
Component with removable lugs and capacity to attach Large, Large, Extra-Large
box , CoCr (Vitallium),
HW401 Kinemax Knee System Femoral Minimally stabilised, uncemented, beaded, XS, S, M, L, XL, XXL $3,700.00
Component CoCr, (Vitallium)
SK387 Triathlon Knee System Femoral Minimally stabilised, uncemented, beaded, 1 to 8 $3,700.00
Component CoCr
ST033 Scorpio Knee System Femoral Minimally stabilised, uncemented, beaded, 3,5,7,9,11,13 $3,700.00
Component (microstructure), CoCr
Wright Medical Australia
WR184 Advance Total Knee System Uncemented, beaded, non HA, CoCr, 1, 2, 3, 4, 5, 6 $3,700.00
usually used with a anterior lipped insert
WR201 Advantim Total Knee System Beaded Femoral Component, CoCr Small, Medium, Large, Xlarge $3,700.00
Zimmer Pty Ltd
ZI418 Natural Knee Femoral Component CSTi Femoral Component, uncemented, CoCr, Size 00 to 5 $3,700.00
with Cancellous Structured Titanium
ingrowth surface
ZI558 Natural Knee II Flex Femur CSTi Femoral Component, uncemented, CoCr, Sizes 1 to 5 GSM Left & Right $3,700.00
with cancellous structure titanium ingrowth and Sizes 0 to 4 GSF Left and
CSTi High Flex Right
ZI591 NexGen CR Flex Femoral Components Cobalt Chrome, High Flex, Uncemented, Sizes A to G, Left to Right, $3,700.00
- Uncemented Cruciate retaining GSF C to G Left to Right
Prostheses List by Category, Groups and Sponsor Page 148 of 911
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Ceramic Surface
Endotec Australia Pty Ltd
EA006 Buechel-Pappas Ultracoat Total Knee Ceramic Coated, Titanium Femoral and BP TKR Ultracoat Primary $3,850.00
Replacement System (Primary and Tibial components with mobile Femoral sizes 1-6(inc) Left &
Revision) Polyethylene inserts, all polyethylene Right
patella ceramic coated, titanium backed
polyethylene mobile patella
EA013 Buechel-Pappas Ultracoat Total Knee Femoral Component, Titanium, uncemented, 1-6(inc) Left & Right $3,850.00
Replacement System Femoral Component beaded, TiNi articular and bone surface
treatment
12 - KNEE
Ceramic Surface, SCP
Johnson & Johnson Medical Pty Ltd
DY373 LCS Complete Knee System femoral Femoral component, uncemented, Sizes small to large+ $4,350.00
component Porocoat, beaded Titanium with TiN
surface treatment
Revision
Wright Medical Australia
WR161 Advance Total Knee System Stemmed Condylar medial pivot 1, 2, 3, 4, 5, All in left & right $6,650.00
component, uncemented, beaded, non
HA, CoCr used with anterior lipped insert,
minimally constrained
SCP
Johnson & Johnson Medical Pty Ltd
DP003 LCS Complete Knee System femoral Femoral component, uncemented, CoCr, Sizes small to large+ $4,200.00
component beaded (Porocoat)
Zimmer Pty Ltd
ZI109 NexGen Knee Femoral Component Femoral Component, uncemented, CoCr A - H (L&R) $4,200.00
plus titanium fibre metal mesh ingrowth
12.1.4.2 - Posterior Stabilised
Biomet Australia Pty Ltd
BI165 AGC System femoral component Femoral Component, uncemented, CoCr 55-80mm $3,800.00
with titanium plasma sprayed surface
(Porous plasma spray PPS) left and right
sided (anatomic), posterior stabilised
BI174 Maxim Complete Knee System Femoral Femoral Component, uncemented, CoCr 55-80mm $3,800.00
Component with titanium plasma sprayed surface
(Porous plasma spray PPS), posterior
stabilised
Prostheses List by Category, Groups and Sponsor Page 149 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BI910 Vanguard Rotating Platform Femoral Femoral Component, uncemented, CoCr, 60 - 75mm $3,800.00
Component Titanium plasma sprayed surface (Porous
plasma spray PPS), Posterior Stabilised
BI951 Vanguard Total Knee System Femoral Component, Posterior Stabilised, 55-80 $3,800.00
anatomic, Plasma Porous Coated, CoCr
& Ti alloy
Exactech Australia
EX037 Optetrak Hi Flex Femoral Component Femoral Component, uncemented, CoCr 1-6 $3,800.00
beaded, high flex (Hi Flex), posterior
stabilised
Medacta Australia Pty Ltd
MU039 Evolis Knee System Femoral Femoral component, uncemented, CoCr, 1 - 6, left to right $3,800.00
Component titanium plasma spray, posterior stabilised
Oceania Orthopaedics
OO004 ACS Knee System - Posterior stabilised Posterior stabilised, porous coated, Left/Right 1-6 $3,800.00
femoral component porous coated femoral component for use in knee
arthroplasty
Orthotech Pty Ltd
OH234 Optetrak Hi Flex Femoral Component Femoral Component, uncemented, CoCr 1-6 $3,800.00
beaded, high flex (Hi Flex), posterior
stabilised
Smith & Nephew Surgical Pty Ltd
SM071 TC (Tri Compartment) PLUS Knee Femoral Component, CoCr, 2-12 $3,800.00
System Femoral Component uncemented,Titanium Plasma Spray
(Vacuum spray and triple layer), posterior
stabilised
SN873 Genesis II Knee System Femoral Femoral component, CoCr, cementless, Left / Right 1-8 $3,800.00
Component beaded, posterior stabilised
SN874 Profix Knee System Femoral Femoral component, CoCr, cementless, Left / Right 1-8 $3,800.00
Component beaded, posterior stabilised
Stryker Australia Pty Ltd
SK386 Triathlon Knee System Femoral Posterior stabilised, uncemented, beaded, Sizes 1 to 8 $3,800.00
Component CoCr
SR007 Scorpio Knee System Femoral Posterior stabilised, CoCr, uncemented, 3,5,7,9,11,13 $3,800.00
Component beaded, (microstructured), with TiNi
surface treatment (LFIT - Low friction ion
treatment)
Prostheses List by Category, Groups and Sponsor Page 150 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI592 NexGen LPS Flex Femoral Components Cobalt Chrome, High Flex, Uncemented, Sizes A to G, Left to Right, $3,800.00
- Uncemented Posterior stabilised GSF C to G Left to Right
Revision
Wright Medical Australia
WR170 Advantim / Ortholoc Revision Knee Femoral component CoCr Posterior Small, Medium, Large, Xlarge $6,550.00
Stabilised, beaded, without buildup
WR194 Advantim / Ortholoc Revision Knee Femoral component CoCr Revision Small, Medium, Large, Xlarge $6,550.00
beaded varying distal and posterior
buildups
SCP
Zimmer Pty Ltd
ZI115 NexGen Knee Femoral Component Femoral Component, uncemented, CoCr A - H (L&R) $4,300.00
plus titanium fibre metal mesh ingrowth,
posterior stabilised
12.1.4.3 - Totally Constrained
Revision
Johnson & Johnson Medical Pty Ltd
DY149 LCS Complete Knee System femoral Femoral component, uncemented, CoCr, Size 1 - 6 including narrow $6,850.00
component beaded (Porocoat), totally constrained sizesss small to large
Smith & Nephew Surgical Pty Ltd
SN383 Profix Knee System Femoral Femoral Component, CoCr, uncemented, Right/Left Size 1-7 $6,850.00
Component beaded, totally constrained
12.1.5 - Uncemented, Alloy, HA Coating
12.1.5.1 - Minimally Stabilised
Advanced Surgical Design & Manufacture Ltd
AE041 Active Knee Femoral Component Femoral Component, uncemented, distally Sizes 00 -- 5 Left & Right $4,100.00
beaded with HA
B Braun Australia Pty Ltd
BB232 Emotion Total Knee System (TKS) Femoral Component, uncemented, CoCr F1 - F8, Left and Right $4,100.00
Femoral Component Titanium plasma spray (Plasmapore), HA
coated
Prostheses List by Category, Groups and Sponsor Page 151 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Biomet Australia Pty Ltd
BI962 Vanguard Total Knee System Femoral Component, Cruciate Retaining, 55 - 80 $4,100.00
Anatomic, HA, Plasma Porous Coated,
CoCr & Ti alloy
Corin Australia Pty Ltd
CR107 Score Knee System Femoral Femoral Component, CoCr, uncemented, 7 Sizes $4,100.00
Component stippled surface, titanium plasma spray
with HA, pegged
Finsbury Orthopeadics Australia Pty Ltd
FI029 MRK (Medial Rotation Knee) Total Femoral Component, uncemented, CoCr 0-5 Left and Right $4,100.00
Knee System Femoral Component with stippled surface titanium plasma spray
HA coated
FI053 Saiph Knee System Femoral Component CoCr Polished Cementless Femoral 1 - 8 Left & Right $4,100.00
Cementless Component, Porous Titanium and HA
Global Orthopaedic Technology
GO007 RBK Total Knee System Femoral Femoral Component, uncemented, 1-5 $4,100.00
Component beaded, CoCr with HA
Link Orthopaedics Australia
LO169 Link Gemini Femoral Component Femoral Component, uncemented, CoCr, Extra small - Extra large $4,100.00
microporous, HX coating (TiCap)/Calcium
Phosphate.
Medacta Australia Pty Ltd
MU066 GMK Uncemented Standard Femur Uncemented standard femoral component 1 to 6, left and right $4,100.00
with titanium porous covered by an
hydroxyapatite coating
Oceania Orthopaedics
OO003 ACS Knee System - Femoral Tricalcium phosphate coated resurfacing Left/Right 1-6 $4,100.00
component Ti/TCP coated femoral component for use in knee
arthroplasty
Smith & Nephew Surgical Pty Ltd
SN878 Profix Knee System Femoral Femoral component, CoCr, cementless, Left / Right 1-8 $4,100.00
Component beaded, HA
SN910 Genesis II CR HA Porous 1-8 $4,100.00
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Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW077 Duracon Knee System Femoral Minimally stabilised, uncemented, beaded Small, Medium, Medium- $4,100.00
Component with PA (Hydroxyapatite), CoCr Large, Large, Extra-Large
SK325 Triathlon Knee System Femoral Minimally stabilised, CoCr, uncemented, Sizes 1 to 8 $4,100.00
Component beaded with PA (Hydroxyapatite)
SK334 Scorpio NRG Knee System Femoral Minimally stabilised, uncemented, with Sizes 3,4,5,6,7,9,11,13 $4,100.00
Component Hydroxyapatite, CoCr
ST030 Scorpio Knee System Femoral Minimally stabilised, uncemented, beaded 3,5,7,9,11,13 $4,100.00
Component (microstructure) with PA,
(Hydroxyapatite), CoCr,
Wright Medical Australia
WR183 Advance HA Coated Femoral Uncemented, beaded, HA, CoCr, usually 1 - 6 Left and Right $4,100.00
Component used with a anterior lipped insert
SCP
Zimmer Pty Ltd
ZI110 NexGen Knee Femoral Component Femoral Component, uncemented, CoCr A - H (L&R) $4,600.00
plus titanium fibre metal mesh ingrowth and
HA/TCP, cruciate retaining
12.1.5.2 - Posterior Stabilised
Biomet Australia Pty Ltd
BI887 ROCC Femoral Component Femoral Component, uncemented, 1-8 $4,200.00
Titanium plasma sprayed surface (Porous
plasma spray PPS) with HA
BI911 Vanguard Rotating Platform Femoral Femoral Component, uncemented, CoCr, 60 -75mm $4,200.00
Component Titanium plasma sprayed surface (Porous
plasma spray PPS) with HA, Posterior
Stabilised
BI958 Vanguard Total Knee System Femoral Component, Posterior Stabilised, 55-80 $4,200.00
Anatomic, HA, Plasma Porous Coated,
CoCr & Ti Alloy
Prostheses List by Category, Groups and Sponsor Page 153 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
FOL Technology PTY Ltd
FO019 Trekking Knee System - Femoral Femoral component uncemented 1 - 5 $4,200.00
Component
Link Orthopaedics Australia
LO168 LINK Gemini Femoral Component PS Femoral component PS Uncemented, Extra Small - Extra Large $4,200.00
CoCr, microporus, HX Coating
(TiCap)/Calcium phosphate
Medacta Australia Pty Ltd
MU051 Cinétique Knee System Femoral Femoral component, uncemented, CoCr, Sizes 1 to 6, Left and Right $4,200.00
Component with titanium micro beads, with HA,
posterior stabilised
MU078 GMK Uncemented Posterior stabilised uncemented posterior stabilised femoral 1 to 6, left to right $4,200.00
femur component with titanium porus coating
covered by an hydroxyapatite coating
Smith & Nephew Surgical Pty Ltd
SN911 Genesis II PS HA Porous 1-8 $4,200.00
Stryker Australia Pty Ltd
HW398 Duracon Knee System Femoral Posterior stabilised, uncemented, beaded Small, Medium, Medium- $4,200.00
Component with PA (Hydroxyapatite), CoCr, Large, Large, Extra-Large
SR004 Scorpio NRG Knee System Femoral Posterior stabilised, uncemented with Sizes 3,4,5,6,7,9,11,13 $4,200.00
Component Hydroxyapatite, CoCr,
SR006 Scorpio Knee System Femoral Posterior stabilised, uncemented, beaded 3,5,7,9,11,13 $4,200.00
Component (microstructure) with PA
(Hydroxyapatite), CoCr
SR024 Triathlon Knee System Femoral Posterior stabilised, uncemented, beaded Size 1 - 8 $4,200.00
Component with PA (Hydroxyapatite), CoCr
Tornier Pty Ltd
TO018 HLS Noetos Femoral Component Femoral Component, uncemented, HA 1 - 6 CoCr $4,200.00
coated, CoCr, posterior stabilised using
midline condyle
Zimmer Pty Ltd
ZI062 NexGen Knee Femoral Component Femoral Component, uncemented, high Sizes A-G Left & Right $4,200.00
flex, CoCr plus titanium fibre metal mesh
ingrowth and HA/TCP, posterior stabilised
Prostheses List by Category, Groups and Sponsor Page 154 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
12.10.1 - Cemented
Smith & Nephew Surgical Pty Ltd
SN835 Journey Deuce Bicompartment Femoral Bicompartment Femoral Component, 1-8 $4,300.00
Component cemented, Oxinium
12.11.1 - Augments
Advanced Surgical Design & Manufacture Ltd
AE071 Active Knee Posterior Block Posterior Femoral Block 1 - 5, 4 - 8mm $1,283.00
AE072 Active Knee Femoral Distal Spacer Femoral Distal Block 1 - 5, 4 - 8mm $1,283.00
AE073 Active Knee Femoral Augments Combined Distal and Posterior Block, 1-5, 4 - 8mm $1,283.00
CoCr
AE074 Active Knee Revision System - Tibial Half Block Wedge 1-5, 5 - 10 Deg $1,283.00
Half Block Spacer
AE076 Active Knee Tibial Full Block Wedge Tibial full block of full wedge, CoCr 1-5, 5 - 10 Deg $1,283.00
AE077 Active Knee Half Block Wedge Half Block or Half Wedge, CoCr 1-5, 5 - 10 Deg $1,283.00
B Braun Australia Pty Ltd
BB320 Emotion Total Knee System Tibial and Medial/Lateral Tibial, Distal Femoral and 4mm to 12mm $1,283.00
Femoral Augments Postero-Distal Augments
Biomet Australia Pty Ltd
BH125 RHK Knee - Augments Augment, Femoral or Coned Tibial (63-79)mm x 20mm, small or $1,283.00
Augments std x (10-30)mm
BI183 Maxim Complete Knee System Femoral Tibial and femoral half wedges and half 55-80mm $1,283.00
and Tibial Augments blocks, Titanium
BI952 Vanguard Total Knee System Femoral Augments, anatomic, distal or 5-15mm x 55-80mm $1,283.00
posterior, Ti alloy
Corin Australia Pty Ltd
CR004 Rotaglide + Total Knee System Tibial Tibial augments, half blocks, CoCr, Small 4mm - Large12mm $1,283.00
Augments cement fixation
Prostheses List by Category, Groups and Sponsor Page 155 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
CR112 Score Knee System Tibial and Femoral Tibial and Femoral half blocks, CoCr, 31 sizes $1,283.00
Augments screw fixation used for femoral blocks,
tibial blocks cemented
Exactech Australia
EX025 Optetrak Total Knee System Tibial Tibial Augments for CCK femoral Size 1 - 6 $1,283.00
Augments component, half and third blocks, titanium,
screw fixation
EX026 Optetrak Total Knee System Femoral Femoral Augments for CCK femoral Size 1-6 $1,283.00
Augments component, distal and posterior blocks,
titanium, screw fixation
Global Orthopaedic Technology
GO116 RBK Total Knee System Tibial Tibial hemi blocks and wedges, CoCr, 4mm and 10mm thick $1,283.00
Augments Titanium
GO118 RBK Total Knee System Femoral Distal and posterior femoral blocks, titanium 4mm and 10mm thick $1,283.00
Augments
Johnson & Johnson Medical Pty Ltd
DP158 PFC Sigma Knee System femoral Distal and posterior femoral augments, Sizes 1 - 6. 4-16mm $1,283.00
augments CoCr , with screws
DP161 PFC Sigma Knee System tibial augments Tibial wedges (full and hemi) and hemi Size 1-6 $1,283.00
blocks, CoCr, with screw
DP269 SROM Noiles Knee System femoral Distal or posterior and combined distal and Sizes xxsmall - xlarge. 5-10mm $1,283.00
augments posterior femoral augments
DY153 LCS Complete Knee System Augments Femoral distal and posterior augments, Sizes small to large+. 5-15mm $1,283.00
CoCr, with screws
DY159 MBT Knee System tibial augments Tibial blocks, with screws, CoCr Sizes 1-7. 5-15mm $1,283.00
Mathys Orthopaedics Pty Ltd
MA508 Balansys Revision Knee, Augments Revision Femoral/Tibial Augments, 5 and 10mm $1,283.00
complete with screws
Medacta Australia Pty Ltd
MU085 GMK Revision femoral distal wedge Screwed femoral distal augmentation Size 1 to 6, each one available $1,283.00
in 3 thicknesses: 4mm, 8mm,
12mm
MU087 GMK Revision femoral posterior wedge Screwed femoral posterior augmentation Size 1 to 6, each one available $1,283.00
in 2 thicknesses: 5mm, 10mm
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Billing Code Product Name Description Size Benefit Benefit Notations
MU094 GMK Revision tibial wedge Cemented tibial baseplate augmentation Size 0 to 6, each one available $1,283.00
in 2 thicknesses: 5, 10mm
Oceania Orthopaedics
OO026 ACS Knee System-ACS spacer (tibial ACS tibial and femoral augments for use Left and Right, medial, lateral, $1,283.00
and femoral) with mobile bearing and Revision FB tibial posterior and distal.
base plates
Orthotech Pty Ltd
OH026 Optetrak Total Knee System Tibial Tibial Augments for CCK femoral Size 1 - 6 $1,283.00
Augments component, half and third blocks, titanium,
screw fixation
OH029 Optetrak Total Knee System Femoral Femoral Augments for CCK femoral Size 1-6 $1,283.00
Augments component, distal and posterior blocks,
titanium, screw fixation
Smith & Nephew Surgical Pty Ltd
SM078 TC (Tri Compartment) PLUS Knee Tibial Augment Half blocks, CoCr, 5mm, 10mm, 15mm $1,283.00
System Tibial Augment includes screws for fixation
SM088 RT (Rotating Hinge) PLUS Knee Femoral Augment Distal and posterior 5-15mm $1,283.00
System Femoral Augment blocks, CoCr, includes screws for fixation
SM089 RT (Rotating Hinge) PLUS Knee Tibial Augment Half blocks, CoCr, 5-10mm $1,283.00
System Tibial Augment includes screws for fixation
SM098 TC (Tri Compartment) PLUS Knee Femoral Augment Distal and posterior 5mm, 10mm, 15mm $1,283.00
System Femoral Augment blocks, CoCr, includes screws for fixation
SM153 Legion Hinge Femoral Wedge A distal femoral Wedge for use with the Size 2 to 7 5,10,15,20mm $1,283.00
Legion Hinge system.
SN330 Genesis II Knee System Tibial and Tibial Augments, half blocks and half 1-8 $1,283.00
Femoral Augments wedges, (CoCr) and Femoral Augments,
distal and posterior or distal and posterior
combined
SN381 Profix Knee System Tibial and Femoral Tibial Augments, Half wedges and half 1-7. Small - Large $1,283.00
Augment blocks, uncemented beaded includes
screws for fixation, Titanium. Femoral
Augments, Posterior, Distal and Posterior
and distal combined, uncemented beaded,
includes screws for fixation, Titanium
Prostheses List by Category, Groups and Sponsor Page 157 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
SN384 Profix Knee System Tibial and Femoral Tibial Augments, Half wedges and half 1-7 $1,283.00
Augment blocks, cement fixation, Titanium. Femoral
Augments, Posterior, Distal and Posterior
and distal combined, includes screws for
fixation, Titanium
SN821 Legion Knee System Femoral Augement Femoral Augment, posterior, distal and 5-15mm $1,283.00
combined posterior and distal, Titanium,
includes screws for fixation
SN822 Legion Knee System Tibial Augement Tibial Augments, half blocks and half 5-15mm $1,283.00
wedges, full blocks and full wedges,
Titanium includes screws for fixation
Stryker Australia Pty Ltd
HW099 Duracon Knee System Tibial Augments Tibial Augments Full wedge (angled) & Left & right, full & angled, 5mm $1,283.00
Full block (flat), CoCr (Vitallium), cemented & 10mm
HW153 Kinemax Knee System & Modular Distal & posterior femoral blocks & Kinemax: Full, Distal & $1,283.00
Rotating Hinge Distal & Posterior spacers, CoCr (Vitallium), cemented Posterior Augments: xs-xl; 5mm
Femoral Augments & Spacers /10mm MRH Distal
Femoral Augments xs-xl; 5mm /
10mm
HW168 Kinemax Knee System Full Tibial Full Tibial Block, CoCr (Vitallium), xs-xl, 10mm thickness $1,283.00
Augment cemented
HW169 Kinemax Knee System Hemi Tibial Half block, CoCr (Vitallium), cemented LM/RL & LL/RM xs-xl in 5 & $1,283.00
Augment 10mm thickness
SK441 Triathlon Knee System Femoral Femoral blocks distal & posterior, CoCr, Left & Right 5mm size 1-8 $1,283.00
Augments mechanical attachment 10mm size 1-815mm size 1-8
SR036 Triathlon Knee System Hemi Augments Half (hemi) tibial blocks, CoCr, LM/RL & LL/RM, 1 to 8, $1,283.00
mechanical attachment 5mm and 10mm
ST018 Scorpio Knee System Femoral & Tibial Femoral & tibial blocks distal, posterior 5mm & 10mm for all sizes of $1,283.00
Augment and full, CoCr, cemented femur and tibia. 5 degrees for
all tibia sizes
ST604 Duracon Knee System Tibial Augments Tibial Augments Half (hemi) wedge LM/RL & LL/RM in 5mm, $1,283.00
(angled) & Half (hemi) block (flat), CoCr 10mm thicknesses
(Vitallium), cemented
ST658 Series 7000 Knee System Femoral & Series 7000, femoral & tibial blocks, 3, 5, 7, 9, 11, 13 in 4mm, $1,283.00
Tibial Augments CoCr, cemented 8mm, 10 degree and 20 degree
Prostheses List by Category, Groups and Sponsor Page 158 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Tornier Pty Ltd
TO022 HLS Noetos Revision Knee augments Distal and Posterior Femoral and tibial 1 to 6 Thickness 4, 8 and 12 $1,283.00
Wedges and blocks, CoCr
TO027 HLS Noetos Revision Tibial Spacers Tibial Spacer (including 2 screws) CoCr 1 to 6 thickness 4, 8 and 12mm $1,283.00
Wright Medical Australia
WR178 Advance Total Knee System Augments Offset tibial block augments, screw fixation 1, 2/1, 3/2, 4/3, 5/4, 6/5, All in $1,283.00
for use with offset stemmed tibial 5mm, 10mm, 15mm
component
WR193 Advance Revision Knee System augments Femoral Augments titanium, separate distal 1 - 5, 5mm thick, 10mm thick, $1,283.00
and posterior with screw attachment posterior and distal
WR197 Advance Revision Knee System tibial Tibial augments, wedges and blocks, 15 degree, sizes 1, 2/1+, 3/2+, $1,283.00
augments screw attachment 4/3+, 5/4+, 6/5+, Blocks 5mm,
10mm, 15mm
Zimmer Pty Ltd
ZI067 Insall-Burstein II Femoral and Tibial Femoral posterior, distal and combined 5, 10mm $1,283.00
augments blocks, tibial hemi blocks and wedges
ZI075 Insall-Burstein II Wedge Full - Ti 7 - 20mm $1,283.00
ZI140 NexGen Tibial Augments Tibial Augments, wedges, hemi and one 1 - 10 $1,283.00
third and tibial blocks hemi, titanium
ZI141 NexGen Tibial Augment Tibial Augment, Full Wedge, Titanium 1 - 10 $1,283.00
ZI142 NexGen Knee Tibial Augments One Third Wedge - Ti 1 - 10 $1,283.00
ZI143 NexGen Knee Tibial Augments NexGen Tibial Blocks - half and full, 1 - 10 $1,283.00
Titanium
ZI144 NexGen Femoral Augments Femoral blocks, posterior, distal and A - H $1,283.00
anterior, titanium
ZI145 NexGen Femoral Augments Femoral blocks, combined posterior distal A - H $1,283.00
block
ZI404 Natural Knee Tibial Augments Tibial hemi blocks, titanium, lug fixation 4 to 8mm Size 00 to 5 $1,283.00
ZI425 Natural Knee Femoral Augments Femoral blocks combined distal and Size 0 to 4 $1,283.00
posterior, titanium
Prostheses List by Category, Groups and Sponsor Page 159 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
ZI607 Natural Knee II Modular Cemented Modular Cemented Tibial Augments - Sizes 00.0, 1,2,3,4 x 4mm; $1,283.00
Tibial Baseplate Augments Medial & Lateral 00,0,1,2,3,4 x 8mm - Medial &
Lateral
12.11.10 - Stems - straight or offset
B Braun Australia Pty Ltd
BB200 Emotion Total Knee System (TKS) Tibial and femoral stems, CoCr, cemented Short, D: 10mm to 16mm , $1,258.00
Tibial and Femoral Stems or uncemented Medium, D: 10mm to 16mm,
Long, D: 10mm to 16mm
BB242 Columbus Total Knee System (TKS) Tibial Stem, cemented or uncemented, 12mm & 14mm, in $1,258.00
Tibial Stem CoCr uncemented, 12mm & 14mm in
cemented.
Biomet Australia Pty Ltd
BI171 Maxim Complete Knee System Femoral Femoral and Tibial Stems, Titanium, 40mm 80mm $1,258.00
and Tibial Stems curved and straight, cemented
BI184 Biomet Universal Tibial and femoral Tibial and Femoral Stems, Titanium, 55-80mm $1,258.00
stems curved and straight, cemented
BI978 Regenerex Tibial Tray Stem, PressFit, Ti Alloy 40, 80mm $1,258.00
Corin Australia Pty Ltd
CR003 Rotaglide + Total Knee System Femoral Femoral and Tibial Stems, CoCr, 30mm - 70mm $1,258.00
and Tibial Stems cemented
CR104 Score Knee System Femoral and Tibial Femoral and Tibial Stems, Titanium, 4 diameters, 3 lengths $1,258.00
Stems cemented
Endotec Australia Pty Ltd
EA023 Buechel-Pappas Ultracoat Total Knee Femoral and Tibial stems, titanium, BP TKR Revision stems $1,258.00
Replacement System Femoral and TiNi surface treatment, uncemented 9mm - 20mm (inc)
Tibial Stems
Exactech Australia
EX027 Optetrak Total Knee System Femoral Femoral and Tibial Stems for Optetrak Size 1 - 6 $1,258.00
and Tibial Stems Knee System, titanium, cemented or
uncemented, femoral stem requires stem
extension adapter on every occasion, tibial
stem requires screw fixation
Global Orthopaedic Technology
GO114 RBK Total Knee System Stems Tibial and Femoral Stems, cemented, 10mm to 24mm thick x 80mm $1,258.00
Titanium including locking bolt to 170mm long
Prostheses List by Category, Groups and Sponsor Page 160 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP143 PFC Sigma Knee System tibial stems Tibial stems cemented and fluted Sizes 30-150mm $1,258.00
uncemented, titanium
DP153 PFC Sigma Knee System femoral stems Femoral stems cemented and fluted 5-7degree, 125-175mm $1,258.00
uncemented, titanium with variable
angulation
DP272 SROM Noiles Knee System stems Femoral and tibial stems, uncemented, Sizes 100-150mm $1,258.00
fluted and slotted including attachment bolt
JJ655 PFC Knee System - Universal Slotted Tibial/Femoral Stem-Titanium Lengths 75, 115, 150mm; $1,258.00
Stem widths 10 to 24mm
Link Orthopaedics Australia
LO173 Link Endo Model Rotational and Hinge Stems Extra small - Extra large $1,258.00
Knee Prostheses
Mathys Orthopaedics Pty Ltd
MA507 Balansys Revision Knee, Stems Ti uncemented Stem, straight and offset, 80 to 200mm, straight and $1,258.00
complete with locking screw offset 4mm
Medacta Australia Pty Ltd
MU035 Evolis Knee System Tibial Stem Tibial stems, titanium, cemented 30/60mm length (12mm $1,258.00
diameter)
MU069 GMK Tibial Extension Stem Tibial Baseplate extension stem diameter 11mm, length 65mm $1,258.00
MU082 GMK Revision cemented extension stem Cemented tibia and femur extension stem Diameter 11mm, available in 3 $1,258.00
lengths (65, 105, 150mm)
MU086 GMK Revision uncemented extension Uncemented tibia and femur extension stem 5 diameters (11,13,16,19,22 $1,258.00
stem mm) each one available in 3
lengths (65, 105, 150mm)
Oceania Orthopaedics
OO015 ACS Knee System - Tibial extension stem Tibial extension stem 14/25mm, 14/50mm, 14/75mm $1,258.00
OO028 ACS Knee System - ACS revision ACS revision tibial and femoral stems, 12/14/16/18mm wide stems $1,258.00
stems, straight and offset straight and offset
Prostheses List by Category, Groups and Sponsor Page 161 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Orthotech Pty Ltd
OH027 Optetrak Total Knee System Femoral Femoral and Tibial Stems for Optetrak Size 1 - 6 $1,258.00
and Tibial Stems Knee System, titanium, cemented or
uncemented, femoral stem requires stem
extension adapter on every occasion, tibial
stem requires screw fixation
Smith & Nephew Surgical Pty Ltd
SM077 RT (Rotating Hinge) PLUS Knee Femoral and Tibial Stems, Titanium, 95 -120 $1,258.00
System Femoral and Tibial Stems uncemented
SM079 TC (Tri Compartment) PLUS Knee System Femoral and Tibial Stems, Cemented, CoCr 80-150 $1,258.00
Femoral and Tibial Stems
SM080 TC (Tri Compartment) PLUS Knee Femoral and Tibial Stems, uncemented, 10/80 - 20/150 $1,258.00
System Femoral and Tibial Stems Titanium
SM081 TC (Tri Compartment) PLUS Knee Femoral and Tibial Stems, uncemented, 10/80 - 20/150 $1,258.00
System Femoral and Tibial Stems Titanium, Varus or Valgus angulation
correction
SM084 RT (Rotating Hinge) PLUS Knee Femoral and Tibial Stems, CoCr, Cemented 95-160 $1,258.00
System Femoral and Tibial Stems
SM086 RT (Rotating Hinge) PLUS Knee Femoral and Tibial Stems, Titanium, 95 - 160 $1,258.00
System Femoral and Tibial Stems uncemented
SM087 RT (Rotating Hinge) PLUS Knee Femoral and Tibial Stems, Titanium, 200 $1,258.00
System Femoral and Tibial Stems uncemented (longer stems)
SN316 Genesis II Knee System Tibial and Tibial and Femoral Stems, titanium, 10-24x100mm, 10-20 x $1,258.00
Femoral Stems cemented or press fit 150mm 10-16x 200mm
SN319 Genesis II Metaphyseal Stem 1-8 $1,258.00
SN347 Genesis I/M Peg: Femoral and Tibial: Titanium 10-16mm Diameter x 40- $1,258.00
200mm Length
SN376 Profix Knee System Femoral and Tibial Femoral and Tibial stems, Titanium, 10-20mm x 100mm. 10- $1,258.00
Stems Cemented or press fit, 20x150mm 10-20 x 200mm
SN377 Profix Metaphyseal Tibial Stem 14-20mm $1,258.00
SN715 Genesis II Knee System Femoral and Tibial and Femoral Stems, Titanium, 18 - 24mm x 200mm $1,258.00
Tibial Stems cemented or press fit (larger diameter
range for 200mm length)
SN823 Legion Knee System Femoral and Tibial Femoral and Tibial stems, Titanium, 120-220mm $1,258.00
Stems Cemented or press fit
Prostheses List by Category, Groups and Sponsor Page 162 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW098 Duracon Knee System Stems TS (Total Stabilizer) Stems, CoCr 40mm, 80mm, 155mm lengths $1,258.00
(Vitallium), uncemented
HW171 Duracon Knee System / Kinemax Knee Stem, femoral & tbial, CoCr, (Vitallium), 40mm, 80mm, 155mm for each $1,258.00
System stem cemented size
SK434 Triathlon Knee System TS Titanium stem Stem, Titanium, uncemented 10-25 (100mm) 10-25 $1,258.00
(150mm)
SR035 Triathlon Knee System TS stem Tibial stem, Titanium, cemented 9x50mm, 9x100mm, $1,258.00
9x150mm, 12x50mm,
12x100mm, 12x150mm,
15x50mm, 15x100mm,
15x150mm
SR037 Triathlon Knee System Femoral Distal Modular Femoral Distal Fixation Peg CoCr one size $1,258.00
Fixation Peg
ST606 Duracon Knee System Tibial & Femoral Stem, femoral & tibial, titanium, cemented 10mm-19mm, 21mm, 23mm in $1,258.00
stem 80mm and 155mm lengths
Tornier Pty Ltd
TO028 HLS Noetos Revision Stems Femoral and Tibial extension stems CoCr 1 to 6 Length 75 and 150mm $1,258.00
Wright Medical Australia
WR148 Advantim Total Knee System Tibial Primary Smooth/Finned Titanium 3" Length in Small-Xlarge $1,258.00
CoCr short stem. This stem is required for
primary prosthesis.
WR171 Advantim / Ortholoc Revision Knee Tibial Revision Smooth/Finned Titanium 6" Length in varying diameters $1,258.00
WR186 Advantim / Ortholoc Revision Knee Femoral stems titanium 5 Degree Size 4 10mm5 $1,258.00
Degree Size 6 10mm7
Degree Size 4 10mm7
Degree Size 6 10mm
WR195 Advance Revision Knee System stems Uncemented stems, femoral and tibial 11 - 22mm in 1mm increments, $1,258.00
100 & 140mm lengths
WR196 Advantim Total Knee System Tibial Primary Smooth/Finned Titanium 6" Length in Small-Xlarge $1,258.00
CoCr long stem. This stem is required for
primary prosthesis.
WR199 Advance Revision Knee System stems Cemented stems, femoral and tibial 10, 12,14, 16, 18 x 65mm, 15 $1,258.00
x 30mm
Prostheses List by Category, Groups and Sponsor Page 163 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI072 Insall-Burstein II Femoral and Tibial Tibial and Femoral Stems, cemented, 10 - 24mm $1,258.00
Stems titanium
ZI095 Miller Galante II long femoral and tibial Femoral and Tibial straight and offset, 12 - 18mm $1,258.00
stems titanium, cemented, long
ZI096 Miller Galante II standard femoral and Femoral and Tibial straight and offset, 12 - 18mm $1,258.00
tibial stems titanium, cemented, standard
ZI146 NexGen Femoral and Tibial Stems Femoral and Tibial Stems, straight and Length - 35 - 155mm, $1,258.00
offset, cemented Diameters - 10 - 24 mm
ZI417 Natural Knee Tibial Stem Tibial Stem, Titanium, cemented including 60 to 215mm $1,258.00
locking bolt
ZI424 Natural Knee Femoral Stems Femoral Stem, Titanium, cemented 10.5mm/125mm to $1,258.00
including locking bolt 18.5mm/250mm
12.11.11 - Stem Extenders, Sleeves and other couplings
B Braun Australia Pty Ltd
BB319 Emotion Total Knee System Femoral Revision nut for Femur Extension Stem One size only $780.00
Stem Extension
Exactech Australia
EX029 Opetrak Total Knee System Femoral Femoral Stem Extension Adapter that One size only $780.00
Stem Extension Adpater provides for set changes in angulation of
stem needs to be used on every occasion
Orthotech Pty Ltd
OH057 Opetrak Total Knee System Femoral Femoral Stem Extension Adapter that One size only $780.00
Stem Extension Adpater provides for set changes in angulation of
stem needs to be used on every occasion
Stryker Australia Pty Ltd
HW233 KRH (Kinemax Knee System Rotating KRH & MRH Rotating Hinge Tibial One size only $780.00
Hinge) & MRH (Modular Rotating Sleeve, UHMWPE, (Duration) houses
Hinge) Rotating Hinge Sleeve Rotating Hinge Tibial Rotating component
sHydroxyapatiteft
SK442 Triathlon Knee System Stem Extender Stem extender, cemented, CoCr 25mm & 50mm $780.00
Prostheses List by Category, Groups and Sponsor Page 164 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Tornier Pty Ltd
TO024 HLS Noetos Revision Stem Extender, Stem Adaptor (Femoral Sledge) CoCr 5, 7 and 9 degrees $780.00
Sleeve and other Couplings
TO025 HLS Hoetos Revision Knee Sleeve stem adaptor (flange piece) CoCr 5, 7 and 9 degrees, right and left $780.00
Metaphyseal
Biomet Australia Pty Ltd
BH063 Regenerex Sleeve Augment Augment, cone porous SSK/OSS 25mm to 40mm x Extra $2,700.00
Systems, Ti small/Large
Johnson & Johnson Medical Pty Ltd
DP261 SROM Noiles Knee System tibial sleeves Tibial metaphyseal sleeve, porous coated, 37-61mm $2,700.00
for proximal bone replacement
DP271 SROM Noiles Knee System femoral Femoral metaphyseal sleeve, porous Size 31-46mm $2,700.00
sleeves coated, for distal bone replacement
DY156 LCS, PFC and SROM Knee Systems, Universal femoral metaphyseal sleeve, 20 - 46mm $2,700.00
femoral metaphyseal sleeve Porocoat, smaller size cemented, larger
sizes uncemented, titanium
DY157 MBT Knee Systems tibial metaphyseal Universal tibial metaphyseal sleeve, 29 - 61mm $2,700.00
sleeve Porocoat, smaller size cemented or
uncemented, larger sizes uncemented,
titanium
JJ706 LCS, PFC & SROM Knee System - Universal Fully Beaded (Porocoat) 31-46mm $2,700.00
Universal Fully Porous Femoral Femoral Metaphyseal Titanium Sleeve
Metaphyseal Sleeve
Zimmer Pty Ltd
ZI485 Trabecular Metal Tibial Cone Trabecular Metal Tibial void filling cone for N/A $2,700.00
proximal metaphyseal bone surrounding
stem, full or stepped
ZI516 Trabecular Metal Femoral Cone Trabecular Metal femoral void filling cone Small, Medium, Large $2,700.00
for distal metaphyseal bone surrounding stem
Prostheses List by Category, Groups and Sponsor Page 165 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
12.11.12 - Temporary Spacers
Zimmer Pty Ltd
ZI313 Spacer-K Temporary implantable device for the Small, Medium, Large $2,079.00
treatment of infected total knee
replacement, Composition - stainless steel
core surrounded by PMMA impregnated
with Gentamicin
12.11.2 - Axles for hinged prostheses
Johnson & Johnson Medical Pty Ltd
JJ705 LPS & SROM Systems - Hinge Pin Rotating Hinge Axle - uncemented, CoCr xxsmall - medium $728.00
Smith & Nephew Surgical Pty Ltd
SN901 Legion Hinge Axle Is used to secure the Legion Hinge femoral Sizes 2-7 $728.00
component to baseplate.
Stryker Australia Pty Ltd
HW201 HMRS (Howmedica Modular HMRS Fixed Hinged Knee Axle Pin, One size only $728.00
Replacement System) Fixed Hinged CrCo, (Vitallium), uncemented, Fixed
Knee Axle Pin
12.11.3 - Bolts
Global Orthopaedic Technology
GO158 RBK Universal Knee System Insert Bolt Insert bolt for RBK universal pegged and 10mm - 20mm $305.00
non pegged inserts
GO190 APEX Knee Reconstruction System, Tibial Insert Locking Bolt One size $305.00
Locking Bolt.
Johnson & Johnson Medical Pty Ltd
DP155 PFC Sigma Knee System femoral stem Bolts to connect femoral stem, straight and Neutral +/- 2mm $305.00
bolts offset
Prostheses List by Category, Groups and Sponsor Page 166 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW208 HMRS (Howmedica Modular HMRS Hexagonal Socket Bolt - CoCr One size only $305.00
Replacement System) Hexagonal Socket (Vitallium) for HMRS Connecting piece
Bolt assembly (2)
Zimmer Pty Ltd
ZI426 Natural Knee Stem Locking Bolt Femoral Stem Locking Bolt (additional One size only $305.00
separate listing)
12.11.4 - Connectors for hinged prostheses
Global Orthopaedic Technology
GO119 RBK Total Knee System Rotating hinge Rotating Hinge Bushing Mechansim Complete mechanism $3,453.00
bushing mechanism
Link Orthopaedics Australia
LO163 LINK Endo Model M Modular Knee Hinge components Extra Small - Extra Large $3,453.00
Prostheses System
LO174 Link Endo Rotational and Hinge Knee Hinge Component Extra small - Extra large $3,453.00
Prostheses
Smith & Nephew Surgical Pty Ltd
SM154 Legion Hinge Sleeve and Bolt Is used to secure the Legion Hinge femoral Sizes 2-7 $3,453.00
component to the hinge mechanism
attached to the baseplate.
Stryker Australia Pty Ltd
HW231 GMRS (Global Modular Replacement GMRS & MRH Tibial Rotating Hinge GMRS-small MRH/crossover $3,453.00
System) & MRH (Modular Rotating component (not baseplate) separated from MRH - xs-xl &
Hinge) Tibial Rotating Component femoral component by bumper and l-xl
rotates on top of tibial insert , Fixed
Wright Medical Australia
WR149 Guardian Limb Salvage System Tibial Hinge Assembly with polyethylene One Size only $3,453.00
bearing, with/ without rotational stop pin -
CoCR
WR157 Guardian Limb Salvage System Quick Snap Axial Pin, CoCr, Titanium 1, 2, 3, 4 $3,453.00
Prostheses List by Category, Groups and Sponsor Page 167 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI309 Nexgen Rotating Hinge Replacement Rotating hinge replacement which includes B-F $3,453.00
metal rotating hinge plus Polyethylene
bushing and fixation pin
12.11.5 - Conversion modules
Smith & Nephew Surgical Pty Ltd
SN314 Genesis II Knee System Femoral Femoral Conversion Module, for Genesis Left/Right size 1-8 $1,185.00
Conversion Module II CR or PS femoral component, includes
screws for fixation
Stryker Australia Pty Ltd
HW085 Duracon Knee System Modular Modular Stabilizer Box, CoCr (Vitallium) Small, Medium, Medium- $1,185.00
Stabilizer Box Large, Large, Extra-Large
12.11.6 - End caps
B Braun Australia Pty Ltd
BB210 Columbus Total Knee System (TKS) Tibial Stem (cap), cemented or Small & Large D: 12mm & D: $725.00
Tibial Stems uncemented, short (mini) (obturator stem) 14mm
CoCr, usually required when stem not used
BB241 Emotion Total Knee System (TKS) Tibial Stem (cap), cemented or 12mm, 14mm & 16mm in $725.00
Tibial Stem uncemented, short (mini) (obturator stem) cemented and uncemented
CoCr, usually required when stem not used
12.11.7 - Offset couplers/adaptors
Biomet Australia Pty Ltd
BI956 Offset Tibial Tray System Offset Adapter for connection to tibial 0mm, 2.5mm, 5mm Offset $1,350.00
stems and baseplate, titanium
Prostheses List by Category, Groups and Sponsor Page 168 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Corin Australia Pty Ltd
CR111 Score Knee System Offset Connector Connector for stems to alter stem offset 2mm, 4mm, 6mm $1,350.00
morse taper but also including screw for
additional fixation, titanium
Johnson & Johnson Medical Pty Ltd
JJ654 PFC Sigma - Femoral Adaptor Offset Adaptor 5 and 7 degree $1,350.00
Medacta Australia Pty Ltd
MU088 GMK Revision offset adaptor Offset adaptor for tibial and femoral 3mm and 5mm offset $1,350.00
revision extension stem
Oceania Orthopaedics
OO027 ACS Knee System - ACS double taper ACS double taper adapter for use with 0, +2mm, +4mm, +6mm. $1,350.00
adapter ACS femoral and tibial components and
stems.
Smith & Nephew Surgical Pty Ltd
SN885 Genesis II Knee System Offset Couplers Offset Coupler, titanium 2-4 $1,350.00
SN886 Profix Knee System Offset Couplers Offset Coupler, titanium 2-4 $1,350.00
Stryker Australia Pty Ltd
SK435 Triathlon Knee System Tibial / Femoral Tibial & femral offset adaptor, CoCr 2,4,6,8mm $1,350.00
Offset Adaptor
ST603 Duracon Knee System Tibial / Femoral Tibial / Femoral Offset Adaptor, CoCr, 2mm, 4mm, 6mm, 8mm $1,350.00
Offset Adaptor (Vitallium)
12.11.8 - Pegs, lugs, etc
Biomet Australia Pty Ltd
BI173 Maxim Complete Knee System Tibial Insert locking pin, Titanium One size only $140.00
Locking Bar
Johnson & Johnson Medical Pty Ltd
DP255 SROM Noiles Knee System bumper Replacements for UHMWPE axis bearings Sizes xxsmall - medium. $140.00
and hinge bearing replacements and bumpers, for hinged prosthesis
DP267 SROM Noiles Knee System femoral Cap and bolt for end of femoral One size only $140.00
metaphyseal sleeve cap metaphyseal sleeve if stem not used
Prostheses List by Category, Groups and Sponsor Page 169 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DP384 AMK primary locking pin and clip Normally supplied with insert, this covers One size only $140.00
separate provision
DY460 SROM Noiles Knee System tibial Cap and bolt for end of tibial metaphyseal One size only $140.00
metaphyseal sleeve cap sleeve if stem not used
JJ659 LCS Complete Knee System APG arm APG arm for use with APG mobile tibial Sizes small to large+ $140.00
insert only
Link Orthopaedics Australia
LO043 LINK Endo Model Rotational and Hinge Full tibial blocks made of UHMWPE Small, Medium, Large $140.00
Knee Prosthesis System
LO159 LINK Endo Model M Modular Knee Centering Stars Small, medium, large $140.00
Prostheses System
Mathys Orthopaedics Pty Ltd
MA511 Balansys Revision Knee, Sealing Cap Sealing cap 61 $140.00
Smith & Nephew Surgical Pty Ltd
SN318 Genesis II Lug One size only $140.00
SN342 Genesis Custom Flex Lock Peg Left & right $140.00
Stryker Australia Pty Ltd
HW167 Kinemax Knee System Tibial Fixation Peg Tibial Fixation Peg, CoCr (Vitallium), 20mm $140.00
Zimmer Pty Ltd
ZI406 Natural Knee Tibial Augment Fixation Tibial Augment Fixation peg and screws One size only $140.00
ZI422 Natural Knee Femoral Spacer Lug - Ti alloy 4 to 12mm $140.00
ZI427 Natural Knee Posterior Stabiliser Bar Posterior Stabiliser Bar including fixation One size only $140.00
screws
12.11.9 - Screws
Advanced Surgical Design & Manufacture Ltd
AE042 Active Knee - Tibial bone screws Bone Screw Titanium TiN coated - 20mm - 50mm $140.00
Optional
Endotec Australia Pty Ltd
EA024 Buechel-Pappas Ultracoat Total Knee Screws used for augmentation of bone BP Rebar screws 15mm-50mm (inc) $140.00
Replacement System Rebar Screws defects and reinforcement of PMMA,
TiNi surface treatment
ESKA Australia
EK112 ESKA Tumor Revision System MML Total remoral implant various sizes $140.00
Prostheses List by Category, Groups and Sponsor Page 170 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Exactech Australia
EX030 Optetrak Total Knee System Tibial Stem Tibial Stem Screw for Tibial stem fixation One size only $140.00
Extension Screw
Global Orthopaedic Technology
GO120 RBK Total Knee System Screw, Ti 5mm to 5.7mm x 5mm to $140.00
17.5mm long
GO192 APEX Knee Reconstruction System, 6.5mm Bone Screw 20mm, 25mm, 30mm, 35mm, $140.00
Bone Screw 40mm, 45mm, 50mm, 55mm,
60mm, 65mm & 70mm.
Medacta Australia Pty Ltd
MU036 Evolis Knee System Fixation Screw Tibial screw for baseplate fixation to bone, 20/25/30/35/40/45mm (6.5mm $140.00
titanium, optional diameter)
Oceania Orthopaedics
OO029 ACS Knee System - ACS Screws Screw for spacers and augments 2 sizes $140.00
Orthotech Pty Ltd
OH056 Optetrak Total Knee System Tibial Stem Tibial Stem Screw for Tibial stem fixation One size only $140.00
Extension Screw
Smith & Nephew Surgical Pty Ltd
SM091 RT (Rotating Hinge) PLUS Knee Insert clip and screws for stem fixation, 0-10 $140.00
System Clip and Screw packed together as emergency kit
SN329 Genesis II Tibial screws 15-50mm $140.00
SN367 Mobile Bearing Knee System Insert Insert Locking Screw, used to lock AP One size only $140.00
Locking Screw translation of Mobile insert
SN393 Profix Knee System Tibial Screws Tibial Screws, Titanium for fixation of 15-50mm $140.00
baseplate to bone (optional)
Stryker Australia Pty Ltd
HW084 Duracon Knee System Augment Locking Augment Locking Screw, CoCr (Vitallium) 5mm, 10mm $140.00
Screw
HW097 Duracon Knee System Tibial Baseplate Tibial baseplate screw, CoCr (Vitallium) 6.2mm diameter in 15mm, $140.00
Screw 20mm, 25mm, 30mm, 35mm,
40mm, 50mm, 55mm, 60mm
lengths
HW192 HMRS (Howmedica Modular HMRS Hex Head Cortical Bone Screw, 16-30mm in 2mm increments $140.00
Replacement System) Hex Head Self Tapping, CoCr (Vitallium) for and 35-70mm in 5m increments
Cortical Bone Screw, Self Tapping prosthesis fixation
Prostheses List by Category, Groups and Sponsor Page 171 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
HW195 HMRS (Howmedica Modular HMRS Plug Screw Axis, UHMWPE, One size only $140.00
Replacement System) Plug screw Axis (Duration) for fixation of HMRS Axis
within HMRS bearing component of
HMRS Distal Femur / Proximal Tibia and
HMRS Femoral / Tibial Joint.
HW209 HMRS (Howmedica Modular HMRS Screw Jack UHMWPE (Duration) One size only $140.00
Replacement System) Screw Jack - use with Self Tapping Hex Head
Cortical Bone Screws for Proximal Femur
and Tibia soft tissue fixation
Wright Medical Australia
WR179 Advantim Total Knee System Cortical Bone Screws, to fix femoral 4.5mm x 2.0 - 7.5cm in 0.5cm $140.00
component to bone, Titanium optional increments long
WR200 Advance Revision Knee System Optional bone screw for tibial component 6.5mm x 1.5 - 6cm in 0.5cm $140.00
increments long
Zimmer Pty Ltd
ZI089 Miller Galante II Bone Screw - Ti 20 - 80mm $140.00
12.12.1 - Articulating Component
Advanced Surgical Design & Manufacture Ltd
AE133 HemiCAP Contoured Articular Knee Articular resurfacing component - CoCr Articular Component 15mm - $2,300.00
System Resurfacing Component with titanium plasma spray 0.5mm x 0.5mm to 2.0mm x
2.0mm offset; Articular
Component 20mm - 1.0mm x
1.0mm to 4.0mm x 4.0mm
offset; 6 x 2mm to 10 x 3mm
Offset
AE137 HemiCAP Patello-Femoral Resurfacing A distal femoral trochlear surface articular 20mm, 35mm $2,300.00
System - Femoral Trochlear Component component comprised of cobalt-chromium
Articular alloy which mates to a fixation stud
Prostheses List by Category, Groups and Sponsor Page 172 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
12.12.2 - Fixation Component
Advanced Surgical Design & Manufacture Ltd
AE134 HemiCAP Contoured Articular Knee Proximal Morse taper, fully cannulated, Component for 15mm & 20mm $700.00
System Fixation component tapered, threaded fixation component - Articular Components Screw
Titanium with titanium plasma spray 9.5mm Dia x 20mm; 11mm x
22mm
AE135 HemiCAP Patello-Femoral Resurfacing A titanium-alloy fixation stud 8.5mm x 17.0mm $700.00
System - Fixation Stud
12.2.1 - Cemented, Alloy
Biomet Australia Pty Ltd
BI031 Oxford Meniscal Knee System Uni Uni Femoral Component, CoCr, Small, Medium, Large, Extra $2,300.00
Femoral Component Cemented (Phase III) Large.
BI203 Repicci II Unicondylar Knee System Uni Uni Femoral Component, Cemented, 45-60mm $2,300.00
femoral component CoCr
Exactech Australia
EX044 Optetrak Uni Condylar Knee System Uni Femoral Component, cemented, CoCr 1-6 $2,300.00
Femoral Component
Global Orthopaedic Technology
GO032 Global re-surfacing uni-compartmental Uni Femoral component, CoCr, cemented Size 1-5 Right medial/left $2,300.00
knee femoral component lateral; Size 1-5 Left
medial/right lateral
Johnson & Johnson Medical Pty Ltd
DY112 Preservation Knee System uni femoral Uni femoral component, cemented, CoCr Size 1-5 $2,300.00
component
JJ781 Sigma HP Unicompartmental Knee - Unicompartmental femoral component, Size 1-6, LM/RL & RM/LL $2,300.00
Unicondylar femoral component cemented, CoCr
Link Orthopaedics Australia
LO059 LINK Endo-Model SLED Uni femoral Uni Femoral Component, cemented, CoCr Short, medium-short, medium $2,300.00
componet & large
Prostheses List by Category, Groups and Sponsor Page 173 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Mathys Orthopaedics Pty Ltd
MA451 BalanSys UNI femoral component Uni Femoral component, cemented CoCr A, B,C,D,E $2,300.00
Medacta Australia Pty Ltd
MU060 Unicompartmental femoral component cemented unicompartmental femoral 1 to 4 $2,300.00
component
Orthotech Pty Ltd
OH230 Optetrak Uni Condylar Knee System Uni Femoral Component, cemented, CoCr 1-6 $2,300.00
Femoral Component
OH395 Freedom PKR / Active Uni Femoral component, cemented with All sizes for Femoral $2,300.00
Unicompartmental Knee System hydroglaze (Electro-polished surface), Component
Femoral Component CoCr
Smith & Nephew Surgical Pty Ltd
SM049 UC (Unicompartment) PLUS Solution Uni Femoral Component, CoCr, cemented Femoral - 4, 6, 8, 10. $2,300.00
Knee System Uni Femoral Component
SM157 Journey Uni Femur- Cocr Uni Femur - CoCr - It is UniCondylar Size 1 to Size 7 $2,300.00
Femur
SN338 Genesis II Uni Femoral Component Uni Femoral component, CoCr, cemented X-Small - Magnum Plus $2,300.00
Stryker Australia Pty Ltd
SR083 Triathlon PKR - Cemented Femoral Triathlon PKR - Uni Femoral Component, 12 -Femurs in total: 1 through $2,300.00
Component CoCR, Cemented to 6, Left Media/Right lateral +
1 through to 6, Right
Media/Left Lateral
ST055 EIUS Unicompartmental Knee System Uni Femoral component, cemented, CoCr XS, S, M, L, XL $2,300.00
Femoral Component
Tornier Pty Ltd
TO007 HLS Uni Femoral Component Femoral Component - Cemented, CoCr 1 - 4 CoCr $2,300.00
Wright Medical Australia
WR156 Advance-Unicondylar Knee System Uni Femoral component, cemented, Sizes 1, 2, 3, 4 $2,300.00
CoCR
Zimmer Pty Ltd
ZI401 Allegretto Unicompartmental Knee Uni Femoral component, cemented, CoCr Size 1 to 3, Size 1+ to 3+ $2,300.00
Femoral Componen
Prostheses List by Category, Groups and Sponsor Page 174 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Ceramic Surface
Corin Australia Pty Ltd
CR059 Uniglide Uni Knee System Uni Femoral Uni Femoral Component, CoCr, 1-4 $2,450.00
Component cemented, with TiNi surface coating
12.2.1.1 - PMMA Coating
B Braun Australia Pty Ltd
BB197 Emotion Unicondylar Knee System Uni Uni Femoral Component, cemented, F1 - F8, Left and Right $2,300.00
Femoral Component CoCr, with PMMA
Zimmer Pty Ltd
ZI106 Miller Galante Unicompartmental Femoral Component, Co Cr, Cemented Small to extra large $2,300.00
Femoral Compoment for fixed insert
ZI494 ZUK (Zimmer Uni-Compartmental High Femoral Component, cemented, CoCr, Sizes A to G $2,300.00
Flex Knee) Femoral Component high flex
12.2.2 - Cemented, Non-Alloy
Ceramic Surface
Smith & Nephew Surgical Pty Ltd
SM156 Journey Uni Femur-Oxinium Uni Femur - Oxinium - It is UniCondylar Size 1 to Size 7 Please refer to $2,825.00
Femur the pocket guide
SN710 Genesis Uni Femoral Component Uni Femoral component, Oxinium, X-Small - Magnum $2,825.00
cemented
12.2.3 - Uncemented, Alloy
Biomet Australia Pty Ltd
BI967 Oxford Meniscal Knee System Femoral Component, Porous Coated, Small - Extra Large $2,300.00
CoCr Ti
12.2.3.1 - HA Coating
Biomet Australia Pty Ltd
BI966 Oxford Meniscal Knee System Femoral Component, Porous HA Coated Small - Extra Large $2,500.00
CoCr, Ti, HA
Prostheses List by Category, Groups and Sponsor Page 175 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
ST655 UNIX Unicompartmental Knee System Uni Femoral component, uncemented with 1, 2, 3, 4 $2,500.00
Femoral Component Hydroxyapatite, CoCr
Ceramic Surface
Corin Australia Pty Ltd
CR058 Uniglide Uni Knee System Uni Femoral Uni femoral component, CoCr, 1-4 $2,650.00
Component uncemented, Titanium plasma spray, with
calcium phosphate (HA) ingrowth surface
with TiNi articular surface coating
12.3.1 - Cemented, All polyethylene
Exactech Australia
EX056 Optetrak Net Compression Molded The Exatctech Optetrak Comprehensive Size 1 - 9mm, 11mm, 13mm $1,250.00
Cruciate Retaining All Polyethylene Tibial Knee System is a knee joint prosthesis Size 2 - 9mm, 11mm, 13mm
Component intended for use in treating human knee Size 3 - 9mm, 11mm, 13mm
joint diseases. It consists of femoral Size 4 - 9mm, 11mm, 13mm
components, tibial components, patella Size 5 - 9mm, 11mm, 13mm
components and a variety of optional Size 6 - 11mm, 13mm
augmentation blocks and
EX057 Optetrak Net Compression Molded The Exactech Optetrak Comprehensive Size 1 - 9mm, 11mm, 13mm $1,250.00
Posterior Stabilised All Polyethylene Knee System is a knee joint prosthesis Size 2 - 9mm, 11mm, 13mm
Tibial Component intended for use in treating human knee Size 3 - 9mm, 11mm, 13mm
joint diseases. It consists of femoral Size 4 - 9mm, 11mm, 13mm
components, tibial components, patella Size 5 - 9mm, 11mm, 13mm
components and a variety of optional Size 6 - 11mm, 13mm
augmentation blocks and
Johnson & Johnson Medical Pty Ltd
JJ589 PFC Sigma Knee System tibial baseplate All poly UHMWPE, Cemented, pegged Sizes 1 - 6. 8-30mm $1,250.00
JJ590 PFC Sigma Knee System Tibial Baseplate All poly UHMWPE, cemented, non Sizes 1 - 6. 8-30mm $1,250.00
pegged
Smith & Nephew Surgical Pty Ltd
SN869 Genesis II Knee System Tibial Baseplate Tibial Baseplate, all poly, cemented Left / Right 1 - 8 $1,250.00
SN870 Profix Knee System Tibial Baseplate Tibial Baseplate, all poly, cemented Left / Right 1 - 8 $1,250.00
Prostheses List by Category, Groups and Sponsor Page 176 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW095 Duracon Knee System Tibial Baseplate Tibial baseplate, All UHMWPE, cemented Small, Medium, Large, Extra- $1,250.00
Large
ST647 Scorpio Knee System Tibial Baseplate Tibial baseplate, All UHMWPE, cemented 3, 5, 7, 9, 11, 13 $1,250.00
Wright Medical Australia
WR203 Advantim Total Knee System All Poly Tibial UHMWPE Small, Medium, Large, Xlarge $1,250.00
Zimmer Pty Ltd
ZI127 NexGen Knee Tibial Baseplate Baseplate All Poly, cemented, UHMWPE 1 - 10 $1,250.00
12.3.2 - Cemented, Alloy
Advanced Surgical Design & Manufacture Ltd
AE040 Active Knee Tibial Baseplate Tibial baseplate, Cemented, CoCr Sizes 1-5 $2,150.00
Biomet Australia Pty Ltd
BI182 Biomet Universal Tibial Baseplate Tibial baseplate, Cemented, one piece, Ti 59-91mm $2,150.00
or CoCr
DJO Australasia Pty Ltd
DD019 3D Knee System Tibial Baseplate Tibial Baseplate, cemented, CoCr Size 1 to 12 $2,150.00
Exactech Australia
EX032 Optetrak Total Knee System, Tibial Tibial Baseplate, titanium, fixed insert, Size 1-6 $2,150.00
Baseplate cemented
EX036 Optetrak Total Knee System, Tibial Tibial Baseplate, titanium, fixed insert Size 1-6 $2,150.00
Baseplate (finned, trapezoid, offset with locking
screw), cemented
Finsbury Orthopeadics Australia Pty Ltd
FI010 MRK (Medial Rotation Knee) Total Tibial Baseplate, cemented, Titanium for 1-5 $2,150.00
Knee System Tibial Baseplate fixed insert
FI054 Saiph Knee System Tibial Component CoCr Tibial Component, Cemented A - F, Standard and Long Stem $2,150.00
Cemented
Prostheses List by Category, Groups and Sponsor Page 177 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
FOL Technology PTY Ltd
FO016 Trekking Knee System, Tibial Tibial component cemented 1 - 5 $2,150.00
Component
Global Orthopaedic Technology
GO194 Absolut Knee, Tibial Baseplate - Tibial Baseplate, Cemented, Non-Porous, Size 1 Left & Right, size 2 Left $2,150.00
Cemented Size 1 - 7 Left & Right & Right, size 3 Left & Right,
size 4 Left & Right, size 5 Left
& Right, size 6 Left & Right,
size 7 Left & Right.
Johnson & Johnson Medical Pty Ltd
JJ662 PFC Sigma Knee System Tibial Baseplate Tibial baseplate, cemented, keeled, Size 1-6 $2,150.00
titanium, with capacity for stem attachment
JJ663 PFC Sigma Knee System Tibial Baseplate Tibial baseplate, cemented, cruciform Size 1-6 $2,150.00
keeled, titanium
Mathys Orthopaedics Pty Ltd
MA515 Balansys Tibial Baseplate Tibial Baseplate cemented, CoCr 64 to 85mm $2,150.00
MA518 Balansys Tibial Baseplate Tibial Baseplate cemented, CoCr, TiNbN 64 - 85mm $2,150.00
coated for patients with hypersensitivity to
other materials
Medacta Australia Pty Ltd
MU075 GMK Cemented fixed Tibia Tray Asymmetric polished cemented fixed tibial 1 to 6, left to right $2,150.00
component
Orthotech Pty Ltd
OH329 Optetrak Total Knee System, Tibial Tibial Baseplate, titanium, fixed insert, Size 1-6 $2,150.00
Baseplate cemented
OH330 Optetrak Total Knee System, Tibial Tibial Baseplate, titanium, fixed insert Size 1-6 $2,150.00
Baseplate (finned), cemented
Smith & Nephew Surgical Pty Ltd
SM065 VKS (Vario) Knee System Tibial Tibial Baseplate, CoCr, Cemented, for 1-12 $2,150.00
Baseplate fixed insert
SN354 Genesis Knee System Tibial Baseplate Tibial Baseplate, cemented, titanium Left/Right Small- Magnum $2,150.00
8mm-15mm
SN848 Journey Knee System Tibial Baseplate Tibial baseplate, cemented, Titanium, for Sizes 1-8, Left and Right $2,150.00
fixed insert
Prostheses List by Category, Groups and Sponsor Page 178 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SN857 Genesis II Knee System Tibial Baseplate Tibial Baseplate, cemented, Titanium, grit 1 - 9 $2,150.00
blasted
SN858 Profix Knee System Tibial Baseplate Tibial Baseplate, cemented, Titanium, grit 1 - 8 $2,150.00
blasted
Stryker Australia Pty Ltd
HW087 Duracon Knee System Tibial Baseplate Tibial baseplate, cemented, cruciform Small, Medium, Large, Extra- $2,150.00
stem, CoCr (Vitallium) Large
HW154 Kinemax Knee System Tibial Baseplate Tibial baseplate, cemented, CoCr XS, S, M, L, XL $2,150.00
(Vitallium)
SK327 Triathlon Knee System Tibial Baseplate Tibial baseplate, cemented, CoCr Sizes 1 to 8 $2,150.00
ST066 Scorpio Knee System Tibial Baseplate Tibial baseplate, cemented, CoCr 3, 5, 7, 9, 11, 13 $2,150.00
Tornier Pty Ltd
TO034 HLS Noetos Tibial Baseplate, Fixed Tibial Baseplate/Tray, Cemented, Fixed Size 1 to 6 $2,150.00
Bearing, CoCr
TO062 HLS Kneetec - Fixed Tibial Tray Fixed Tibial Tray for HLS Kneetec Sizes 1 to 8 $2,150.00
System, CoCr, Cemented
Wright Medical Australia
WR175 Advantim / Ortholoc Knee Tibial Components Modular Stem Base, Small, Small Plus, Medium, $2,150.00
cemented, non beaded CoCr Medium Plus, Large, Large
Plus, Xlarge
WR188 Advance Total Knee System Tibial component, CoCr, cemented 1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, $2,150.00
5+, 6
Zimmer Pty Ltd
ZI413 Natural Knee Tibial Baseplate Tibial Baseplate, Cemented - Titanium for Size 00 to 5 $2,150.00
fixed inserts
ZI435 SAL Knee Tibial Baseplate - CoCr alloy 60/AOA to 92/E $2,150.00
ZI595 NexGen Knee Tibial Components Option - Titanium 1 to 10 $2,150.00
Stemmed - Option
ZI608 Natural Knee II Modular Cemented Modular Cemented Baseplate Sizes 00, 0, 1,2,3,4, 5 - Left $2,150.00
Tibial Baseplate and Right
Prostheses List by Category, Groups and Sponsor Page 179 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Hinged
Link Orthopaedics Australia
LO158 LINK Endo Model M Modular Knee Tibial Components Extra Small - Extra Large $4,150.00
Prostheses System
Revision
B Braun Australia Pty Ltd
BB204 Columbus Total Knee System (TKS) Tibial baseplate, cemented, CoCr for fixed T1 to T5 $3,650.00
Tibial Baseplate insert
Biomet Australia Pty Ltd
BI169 Biomet Universal Tibial Baseplate Tibial baseplate, Cemented, Titanium, 59-91mm $3,650.00
which allows for attachmnet of a variety of
different stems and for fixed inserts
BI177 Biomet Universal Stemmed Tibial Tibial Baseplate, titanium, cemented 59-91mm $3,650.00
Component
BI811 Offset Tibial Tray System Tibial baseplate, Cemented, Titanium, 59-91mm $3,650.00
which allows for attachment of the offset
adaptor
Johnson & Johnson Medical Pty Ltd
DY467 PFC Sigma Knee System tibial baseplate Tibial baseplate, cemented, keeled, Size 1-6 $3,650.00
Titanium, standard and offset keels with
capacity for augment and stem attachment
JJ510 PFC Sigma Knee System tibial baseplate Tibial baseplate, cemented, keeled, forged Size 1-6 $3,650.00
CoCr, polished tibial insert surface
Mathys Orthopaedics Pty Ltd
MA509 Balansys Revision Knee, Tibial Plateau Revision Tibial Baseplate, modular 64 to 85 $3,650.00
Medacta Australia Pty Ltd
MU030 Evolis Knee System Tibial baseplate Tibial baseplate, cemented, titanium for 1 - 6 $3,650.00
fixed insert
Smith & Nephew Surgical Pty Ltd
SM100 TC (Tri Compartment) PLUS Knee Tibial Baseplate, CoCr, Cemented, for 2 - 10 $3,650.00
System Tibial Baseplate fixed insert
Prostheses List by Category, Groups and Sponsor Page 180 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
SN824 Legion Knee System Tibial Baseplate Tibial baseplate, cemented, Titanium, for 1-8 $3,650.00
fixed insert,
Stryker Australia Pty Ltd
SR034 Triathlon TS Knee System Tibial Tibial baseplate, stemmed revision, 1 to 8 $3,650.00
Baseplate cemented, CoCr
SR080 Duracon Knee System Stemmed Stemmed revision baseplate, CoCr, XS1, XS2, S1, S2, M1, M2, $3,650.00
Revision Baseplate (Vitallium). Cemented, Fixed L1, L2, Xl1, Xl2
ST034 Scorpio Knee System Tibial Baseplate Tibial baseplate, cemented, ability to attach 3,5,7,9,11,13 $3,650.00
stems, CoCr
Tornier Pty Ltd
TO026 HLS Noetos Revision Tibial Baseplate Tibial Tray, CoCr, cemented, 1 to 6 $3,650.00
Wright Medical Australia
WR168 Advance Total Knee System Revision tibial component, titanium, 1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, $3,650.00
cemented with offset stem 5+ in Left & Right
WR198 Advance Revision Knee System Revision tibial component, titanium, 0+, 1, 1+, 2, 2+, 3, 3+, 4, 4+, $3,650.00
cemented 5, 5+, 6
Revision, Hinged
Smith & Nephew Surgical Pty Ltd
SM092 RT (Rotating Hinge) PLUS Knee Tibial Baseplate, CoCr, cemented, for 0-10 $4,150.00
System Tibial Baseplate fixed insert
Stryker Australia Pty Ltd
HW141 MRH (Modular Rotating Hinge) Tibial MRH Tibial baseplate, CoCr (Vitallium), Small, Medium, Large $4,150.00
Baseplate fixed insert with central hole for hinged
insertion, w/attachable stem
Revision
Oceania Orthopaedics
OO020 ACS Knee System-ACS Revision tibial Revision base plate, cemented, for use Left and Right, Sizes 2,3,4,5,6 $3,650.00
component, cemented with augments and straight or offset stems
Prostheses List by Category, Groups and Sponsor Page 181 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
12.3.2.1 - PMMA Coating
Zimmer Pty Ltd
ZI073 Insall-Burstein II Tibial Baseplate Tibial baseplate cemented, titanium, 54 - 74mm $2,250.00
PMMA coating, for fixed insert
ZI102 Miller Galante II Tibial Baseplate Tibial Baseplate, PMMA, Titanium, A - K $2,250.00
cemented, for fixed insert
ZI122 NexGen Tibial Baseplate Pegged Tibial Baseplate, cemented, for 1 - 10 $2,250.00
fixed insert, titanium, PMMA coated
ZI126 NexGen Knee Tibial Baseplate Stemmed AP wedged tibial baseplate, 1 - 10 $2,250.00
cemented, for fixed insert, titanium,
PMMA coated
ZI594 NexGen Knee Tibial Components Precoat - Titanium 1 to 10 $2,250.00
Stemmed - Precoat
12.3.3 - Cemented, Alloy, Moulded Polyethylene
Biomet Australia Pty Ltd
BI153 AGC Knee System Tibial Baseplate Tibial baseplate, CoCr, Moulded, V2 63-91mm $3,150.00
(version 2), UHMWPE, cemented
BI810 Vanguard Complete Knee System Tibial bearing & tray, ' Mono Lok' 59 -91mm $3,150.00
Cruciate Retaining or Posterior Stabilised,
CoCr UHMWPE
12.3.4 - Cemented, Alloy, for Mobile Insert
B Braun Australia Pty Ltd
BB201 Emotion Total Knee System (TKS) Tibial baseplate, cemented, CoCr, with T1 to T8, left and right $2,400.00
Tibial Baseplate polished insert surface for mobile insert
Biomet Australia Pty Ltd
BI196 Vanguard Rotating Platform Tibial Tibial Baseplate Chrome Cobalt 63-87mm $2,400.00
Baseplate
BI894 ROCC Tibial Baseplate Tibial Baseplate, cemented, CoCr for 1-8 $2,400.00
mobile insert
Prostheses List by Category, Groups and Sponsor Page 182 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Exactech Australia
EX040 Optetrak RBK (Rotating Bearing Knee) Tibial Baseplate, titanium with polished 1-6 $2,400.00
Tibial Baseplate insert surface, cemented, for a mobile
insert
FOL Technology PTY Ltd
FO013 Trekking Knee System, Tibial Mobile tibial tray, cemented 1 - 5 $2,400.00
Global Orthopaedic Technology
GO003 RBK Total Knee System Tibial Tibial baseplate, grit blast, CoCr, 0 - 5 $2,400.00
Baseplate cemented, for mobile bearing insert
GO155 RBK Universal Knee System Tibial Tibial Baseplate, short keel, cemented, 1 - 5 $2,400.00
Baseplate CoCr, for mobile insert
Johnson & Johnson Medical Pty Ltd
DP032 MBT Knee System tibial baseplate Tibial baseplate, cemented, CoCr, for Sizes 1 - 7 $2,400.00
rotating platform, (keeled and non keeled)
DP235 LCS Classic and Universal Knee System Tibial baseplate, CoCr, cemented for Sizes small to large+ $2,400.00
tibial baseplate rotating platform
Link Orthopaedics Australia
LO171 Link Endo Model Rotational and Hinge Tibial Components Extra small - extra large $2,400.00
Knee Prostheses
LO176 Link Gemini Tibial Baseplate Tibial baseplate, cemented Extra small - extra large $2,400.00
Mathys Orthopaedics Pty Ltd
MA312 Balansys Tibial Baseplate Tibial baseplate for Mobile Bearing insert, ML/AP Dimensions: $2,400.00
cemented, CoCr 64/70/75/80/86
Medacta Australia Pty Ltd
MU047 Cinétique Knee System Tibial Baseplate Tibial Baseplate, cemented, with polished Sizes 1 to 7, Left and Right $2,400.00
insert surface for mobile insert
MU048 Cinétique Knee System Tibial Baseplate Tibial Baseplate, cemented, titanium, with Sizes 1 to 7, Left and Right $2,400.00
TiNi (TiNibN) surface coating of insert
surface for mobile insert
MU077 GMK Mobile Cemented Tibia Tray Asymmetric mobile cemented tibial 1 to 6, left to right $2,400.00
component
Oceania Orthopaedics
OO006 ACS Knee System - ACS tibial Tibial base plate, cemented, for use with 2-7 $2,400.00
component cemented mobile bearing insert, TiN coated
Prostheses List by Category, Groups and Sponsor Page 183 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
OO008 Implant ACS Knee System - cemented Tibial base plate, cemented, for use with Sizes 2-7 $2,400.00
tibial component mobile bearing insert, TiN coated
Orthotech Pty Ltd
OH236 Optetrak RBK (Rotating Bearing Knee) Tibial Baseplate, titanium with polished 1-6 $2,400.00
Tibial Baseplate insert surface, cemented, for a mobile
insert
Smith & Nephew Surgical Pty Ltd
SM030 TC (Tri Compartment) PLUS Knee Tibial Baseplate, CoCr, Cemented for 2 to 12 $2,400.00
System Tibial Baseplate mobile insert, polished insert surface
SN369 Mobile Bearing Knee System Tibial Tibial baseplate, cemented, CoCr, Left & Right, Size 1-8 $2,400.00
Baseplate polished insert surface, for mobile insert,
Stryker Australia Pty Ltd
SR030 Triathlon Knee System Tibial Baseplate Mobile bearing, tibial baseplate, cemented, 1 to 8 $2,400.00
CoCr
ST069 Scorpio Knee System Tibial Baseplate Mobile bearing tibial baseplate, cemented, 3, 5, 7, 9, 11, 13 $2,400.00
CoCr
ST913 Duracon ISA Knee System Tibial Mobile bearing tibial baseplate, cemented, Small, medium, large, X-large $2,400.00
Baseplate CoCr (Vitallium)
Tornier Pty Ltd
TO033 HLS Noetos Tibial Baseplate, mobile Tibial Baseplate/Tray, Cemented, Mobile Size 1 to 6 $2,400.00
Bearing, CoCr
TO061 HLS Kneetec - Mobile Tibial Tray Mobile Tibial Tray for HLS Kneetec Sizes 1 to 8 $2,400.00
System, CoCr, Cemented
Revision
B Braun Australia Pty Ltd
BB253 Columbus Total Knee System (TKS) Tibial Baseplate, Cemented, CoCr for T1- T5 $3,900.00
Tibial Baseplate mobile insert, polished insert surface
Corin Australia Pty Ltd
CR106 Score Knee System Tibial Baseplate Tibial Baseplate, Cemented, CoCr, 7 Sizes $3,900.00
polished insert surface for mobile insert
Global Orthopaedic Technology
GO115 RBK Total Knee System Tibial Tibial Baseplate, for mobile insert, CrCo, Size 00 to 5 $3,900.00
Baseplate cemented
Prostheses List by Category, Groups and Sponsor Page 184 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
JJ634 LCS Complete Knee System - MBT Thick Tibial Tray 1 to 6 $3,900.00
Revision Thick Tray
JJ804 MBT Revision Thick Tibial Tray Tibial Tray Size range 2 to 5. Tray $3,900.00
Thickness of 25mm
Oceania Orthopaedics
OO019 ACS Knee System - ACS SC Revision Revision MB base plate for use with Sizes 2,3,4,5,6 $3,900.00
Tibial component, Cemented augments and straight or offset stems
Revision, Hinged
Biomet Australia Pty Ltd
BH122 RHK Knee - Stemmed Tibial Tray Tibial Component, stemmed tray 63-71mm $4,400.00
BH123 RHK Knee - Modular Tibial Tray Tibial Component, modular tray 63 to 71mm $4,400.00
Johnson & Johnson Medical Pty Ltd
DP259 SROM Noiles Knee System tibial Tibial baseplate, CoCr, cemented, for Sizes xxsmall-large $4,400.00
component rotating platform insert
DY151 MBT Knee System Revision Tibial base Tibial baseplate, cemented, CoCr, for Sizes 1-7 $4,400.00
Plate rotating platform, also usable with specific
hinged insert
Smith & Nephew Surgical Pty Ltd
SM160 Legion Hinge Tibial Baseplate A tibial baseplate used for the Legion Size 2 to 7 Left, Right $4,400.00
Hinge system.
Zimmer Pty Ltd
ZI308 Nexgen Rotating Hinge Tibial Baseplate Stemmed Tibial Baseplate with polished 1-6 $4,400.00
tibial insert surface, cemented, PMMA
coated for Nexgen rotating hinged femoral
component
12.3.4.1 - PMMA Coating
Zimmer Pty Ltd
ZI061 NexGen Tibial Baseplate Tibial baseplate, cemented, CoCr, with Sizes 1 - 10 $2,500.00
PMMA coating for mobile insert
ZI129 NexGen Legacy Knee Tibial Baseplate Tibial baseplate, cemented, CoCr, with 1 - 10 $2,500.00
PMMA coating for legacy posterior
stabilised mobile insert
Prostheses List by Category, Groups and Sponsor Page 185 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI415 Natural Knee Primary Tibial Baseplate - Mobile Bearing Size 00 to 5 $2,500.00
Non Porous - CoCr alloy
12.3.5 - Uncemented, Alloy
Biomet Australia Pty Ltd
BI170 Maxim Complete Knee System Tibial Tibial baseplate, uncemented, Titanium 59-91mm $2,300.00
Baseplate plasma sprayed surface (Porous plasma
spray PPS)
BI977 Regenerex Tibial Tray Tibial Baseplate, modular. Regenerex 59, 63, 67, 71, 75, 79, 83 mm $2,300.00
porous coat, Ti Alloy
DJO Australasia Pty Ltd
DD020 3D Knee System Tibial Baseplate Tibial Baseplate, uncemented, beaded, Size 1 to 12 $2,300.00
CoCr and Titanium
Smith & Nephew Surgical Pty Ltd
SM066 VKS (Vario) Knee System Tibial Tibial Baseplate, CoCr, uncemented, 1-12 $2,300.00
Baseplate Titanium Plasma Spray (Vacuum spray
and triple layer), for fixed insert
SN859 Genesis II Knee System Tibial Baseplate Tibial Baseplate, cementless, titanium, Left / Right 1-8 $2,300.00
beaded, for fixed insert
SN860 Profix Knee System Tibial Baseplate Tibial Baseplate, cementless, titanium, Left / Right 1-8 $2,300.00
beaded, for fixed insert
Stryker Australia Pty Ltd
HW086 Duracon Knee System Tibial Baseplate Tibial baseplate, uncemented, beaded, Small, Medium, Large, Extra- $2,300.00
CoCr (Vitallium) Large
SK388 Triathlon Knee System Tibial Baseplate Tibial baseplate, uncemented, beaded, Sizes 1 to 8 $2,300.00
CoCr
ST029 Scorpio Knee System Tibial Baseplate Tibial baseplate, uncemented, beaded 3,5,7,9,11,13 $2,300.00
(microstructure), CoCr
Wright Medical Australia
WR176 Advantim / Ortholoc Knee Tibial Components Modular Stem Base, Small, Small Plus, Medium, $2,300.00
uncemented and beaded CoCr Medium Plus, Large, Large
Plus, Xlarge
Prostheses List by Category, Groups and Sponsor Page 186 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI086 Stemmed Tibial Tray:Porous Ti A - K $2,300.00
ZI103 Miller Galante II Tibial Baseplate Tibial Baseplate, titanium, fibre metal mesh A - K $2,300.00
ingrowth, uncemented for fixed insert
ZI104 Miller Galante II Tibial Baseplate Tibial Baseplate, titanium, uncemented, A - K $2,300.00
fibre metal mesh ingrowth, for fixed insert
ZI120 NexGen Tibial Baseplate Pegged tibial baseplate, uncemented, 1 - 10 $2,300.00
titanium fibre metal mesh for fixed insert
ZI412 Natural Knee Tibial Baseplate CSTi Tibial Baseplate, uncemented, Cancellous Size 00 to 5 $2,300.00
structure Titanium ingrowth surface for
fixed inserts
ZI569 Nexgen Trabecular Metal Tibial Tray Nexgen Trabecular Metal Tibial Tray sizes 2, 3, 4, 5, 6, 7 & 8 $2,300.00
Revision
B Braun Australia Pty Ltd
BB231 Columbus Total Knee System (TKS) Tibial Baseplate, uncemented, CoCr for T1 - T5 $3,800.00
Tibial Baseplate fixed insert
Medacta Australia Pty Ltd
MU040 Evolis Knee System Tibial baseplate Tibial baseplate, uncemented, titanium with 1 -6 $3,800.00
titanium plasma spray, for fixed insert
Stryker Australia Pty Ltd
SR081 Duracon Knee System Stemmed Stemmed revision baseplate, CoCr, S1, S2, M1, M2, L1, L2 XL1, $3,800.00
Revision Baseplate (Vitallium), uncemented, beaded, with XL2
screw holes for screw fixation, fixed
Wright Medical Australia
WR169 Advance Total Knee System Tibial component, beaded, titanium 1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, $3,800.00
5+, 6
WR173 Advantim / Ortholoc Revision Knee Tibial Components Modular Stem Small, Small Plus, Medium, $3,800.00
Thickened Base (beaded) Medium Plus, Large, Large
Plus, Xlarge
WR174 Advantim / Ortholoc Revision Knee Tibial Components Modular Stem, medial Small, Small Plus, Medium, $3,800.00
or lateral wedged base (beaded) Titanium Medium Plus, Large, Large
Plus, Xlarge
Prostheses List by Category, Groups and Sponsor Page 187 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI123 NexGen Tibial Baseplate Stemmed tibial baseplate, uncemented, 1 - 10 $3,800.00
titanium fibre metal mesh for fixed insert
ZI416 Natural Knee Tibial Baseplate CSTi Tibial Baseplate, uncemented, with fixed 0 to 5 $3,800.00
long stems and capacity to attach
augments, Cancellous structure Titanium
ingrowth surface for fixed inserts
Revision
Oceania Orthopaedics
OO021 ACS Knee System-ACS Revision tibial Revision tibial component, cementless Left and Right, Sizes 2,3,4,5,6 $3,800.00
component, cementless porous coated porous coated, for use with augments and
straight or offset stems.
12.3.5.1 - HA Coating
Advanced Surgical Design & Manufacture Ltd
AE043 Active Knee Tibial Baseplate Tibial baseplate, uncemented, beaded with Sizes 1-5 $2,700.00
HA, Titanium
AE099 Active Knee Tibial Baseplate Tibial Baseplate, HA, uncemented, Sizes 1 to 5 (A-Narrow & B- $2,700.00
beaded, stemmed , CoCr Wide)
Biomet Australia Pty Ltd
BI186 Maxim Complete Knee System Tibial Tibial baseplate, uncemented, Titanium 59 - 91mm $2,700.00
Baseplate plasma sprayed surface (Porous plasma
spray PPS) with HA
BI961 Tibial Tray System Tibial Tray System - Primary, one piece, 59-91 $2,700.00
highly polished, uncemented, HA, plasma
porous coated
Finsbury Orthopeadics Australia Pty Ltd
FI011 MRK (Medial Rotation Knee) Total Tibial Baseplate, uncemented, Titanium 1-5 $2,700.00
Knee System Tibial Baseplate with stippled surface titanium plasma spray
HA coated
FI055 Saiph Knee System Tibial Component CoCr Tibial Component, Porous Titanium A - F, Standard an Long Stem $2,700.00
Cementless and HA
Prostheses List by Category, Groups and Sponsor Page 188 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
FOL Technology PTY Ltd
FO017 Trekking Knee System, tibial component Tibial component uncemented 1 - 5 $2,700.00
Global Orthopaedic Technology
GO193 Absolut Knee, Tibial Base Plate - Porous Tibial Baseplate, Cementless, Porous Size 1 Left & Right, size 2 Left $2,700.00
Coated HA, With & Without Holes, Size & Right, size 3 Left & Right,
1 to 6, Left & Right. size 4 Left & Right, size 5 Left
& Right, size 6 Left & Right.
Johnson & Johnson Medical Pty Ltd
DP891 AMK Tibial Baseplate Tibial Baseplate, uncemented, CoCr, Size 1-5 $2,700.00
beaded, HA (Duofix), for fixed insert
Medacta Australia Pty Ltd
MU067 GMK Uncemented Fixed Tibia Tray Asymmetric uncemented fixed tibial 1 to 6, left and right $2,700.00
component
Smith & Nephew Surgical Pty Ltd
SN861 Genesis II Knee System Tibial Baseplate Tibial baseplate, cementless, titanium, Left / Right 1 - 8 $2,700.00
beaded, HA for fixed insert
SN862 Profix Knee System Tibial Baseplate Tibial baseplate, cementless, titanium, Left / Right 1 - 8 $2,700.00
beaded, HA for fixed insert
Stryker Australia Pty Ltd
HW088 Duracon Knee System Tibial Baseplate Tibial baseplate, uncemented, beaded, Small, Medium, Large, Extra- $2,700.00
cruciform stem, with PA (Hydroxyapatite), Large
CoCr (Vitallium)
SK326 Triathlon Knee System Tibial Baseplate Tibial baseplate, uncemented, beaded with Sizes 1 to 8 $2,700.00
PA (Hydroxyapatite), without screw
holes, CoCr
SK433 Triathlon Knee System Tibial Baseplate Tibial baseplate, uncemented, beaded with 1-8 $2,700.00
PA (Hydroxyapatite), with screw holes,
CoCr
ST031 Scorpio Knee System Tibial Baseplate Tibial baseplate, uncemented, beaded 3,5,7,9,11,13 $2,700.00
(microstructure) with PA
(Hydroxyapatite), ability to add screws,
CoCr
ST648 Scorpio Knee System & S7000 Tibial Tibial baseplate, uncemented, with 3, 5, 7, 9, 11, 13 $2,700.00
Baseplate Hydroxyapatite, CoCr
Prostheses List by Category, Groups and Sponsor Page 189 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI121 NexGen Tibial Baseplate Pegged tibial baseplate, uncemented, 1 - 10 $2,700.00
titanium fibre metal mesh, with HA/TCP
for fixed insert
ZI124 NexGen Tibial Baseplate Stemmed tibial baseplate, uncemented, 1 - 10 $2,700.00
titanium fibre metal mesh, with HA/TCP
for fixed insert
Revision
Wright Medical Australia
WR181 Advance HA Coated Tibial Base Tibial component, beaded, titanium, HA 1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, $2,700.00
5+, 6
12.3.6 - Uncemented, Alloy, Moulded Polyethylene
Biomet Australia Pty Ltd
BI863 AGC Knee System Tibial Baseplate Tibial baseplate, titanium, Moulded, V2 (63-91) x (8-22)mm $3,300.00
(version 2), uncemented with titanium
plasma sprayed surface (Porous plasma
spray PPS)
Zimmer Pty Ltd
ZI295 NexGen Porous Tantalum Tibial One piece Trabecular Metal (Tantalum) Sizes 3 - 8, Height 10mm - $3,300.00
Baseplate and Insert Tibial Baseplate and Insert UHMWPE 17mm
(minimal and posterior constrained)
12.3.7 - Uncemented, Alloy, for Mobile Insert
Endotec Australia Pty Ltd
EA008 Buechel-Pappas Ultracoat Total Knee Tibial Baseplate, uncemented, beaded, 1-6(inc) $2,950.00
Replacement System Tibial Baseplate Titanium, TiNi Insert and bone ingrowth
surface treated, for a mobile insert
Global Orthopaedic Technology
GO004 RBK Total Knee System Tibial Tibial baseplate, CoCr, beaded, 1-5 $2,950.00
Baseplate uncemented, for mobile bearing insert
GO156 RBK Universal Knee System Tibial Tibial Baseplate, short keel, uncemented, 1 - 5 $2,950.00
Baseplate CoCr, beaded, for mobile insert
Prostheses List by Category, Groups and Sponsor Page 190 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP031 MBT Knee System tibial baseplate Tibial baseplate, uncemented, CoCr, Sizes 1 - 7 $2,950.00
beaded (Porocoat) for rotating platform,
(keeled and non keeled)
DY377 MBT knee system tibial baseplate Tibial baseplate, uncemented, Titanium, Sizes 1 - 7 $2,950.00
TiN, beaded (Porocoat) for rotating
platform, (non keeled only)
Mathys Orthopaedics Pty Ltd
MA460 Balansys Tibial Baseplate Tibial Baseplate for Mobile Bearing insert, 64/8mm - 85/15.5mm $2,950.00
Uncemented, CoCr
Oceania Orthopaedics
OO005 ACS Knee System - ACS tibial Tibial base plate, porous coated, for use 2-7 $2,950.00
component cementless with mobile bearing insert, TiN coated
OO009 ACS Knee System - porous coated Tibial base plate, porous coated, for use Sizes 2-7 $2,950.00
tibial component with mobile bearing insert, TiN coated
Smith & Nephew Surgical Pty Ltd
SM068 VKS (Vario) Knee System Tibial Tibial Baseplate, CoCr, uncemented, 1-12 $2,950.00
Baseplate Titanium Plasma Spray (Vacuum spray
and triple layer), for mobile insert (SB (Self
aligning bearing))
SN370 Mobile Bearing Knee System Tibial Tibial baseplate, uncemented, beaded, Left & Right, Size 1-8 $2,950.00
Baseplate HA, CoCr, polished insert surface, for
mobile insert,
Zimmer Pty Ltd
ZI414 Natural Knee Tibial Baseplate CSTi Tibial Baseplate, uncemented, with fixed Size 00 to 5 $2,950.00
long stems and capacity to attach
augments, Cancellous structure Titanium
ingrowth surface for mobile inserts
Revision
B Braun Australia Pty Ltd
BB254 Columbus Total Knee System (TKS) Tibial Baseplate, uncemented,CoCr, T1- T5 $4,300.00
Tibial Baseplate Titanium plasma spray (Plasmapore),
polished insert surface for mobile insert
Endotec Australia Pty Ltd
EA015 Buechel-Pappas Ultracoat Total Knee Tibial Baseplate, uncemented, beaded, 1-6(inc) $4,300.00
Replacement System Tibial Baseplate Titanium, TiNi Insert and bone ingrowth
surface treated, for a mobile insert
Prostheses List by Category, Groups and Sponsor Page 191 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
12.3.7.1 - HA Coating
Advanced Surgical Design & Manufacture Ltd
AE045 Active Knee Mobile Tibial Tray Tibial Tray, mobile, uncemented, beaded, Sizes 1-5 $3,350.00
with HA, CoCr
B Braun Australia Pty Ltd
BB233 Emotion Total Knee System (TKS) Tibial baseplate, uncemented, CoCr, T1 - T8 $3,350.00
Tibial Baseplate Titanium plasma spray (Plasmapore) with
polished insert surface, HA coated for
mobile insert
Biomet Australia Pty Ltd
BI900 ROCC Tibial Baseplate Tibial Baseplate, uncemented, Titanium 1-8 $3,350.00
plasma sprayed surface (Porous plasma
spray PPS) with HA for mobile insert
FOL Technology PTY Ltd
FO012 Trekking Knee System, Tibial Mobile tibial tray, uncemented 1 - 5 $3,350.00
Global Orthopaedic Technology
GO005 RBK Total Knee System Tibial Tibial baseplate, CoCr, uncemented, 1-5 $3,350.00
Baseplate beaded, with Titanium plasma spray and
HA for mobile bearing insert
GO157 RBK Universal Knee System Tibial Tibial Baseplate, short keel, uncemented, 1 -5 $3,350.00
Baseplate CoCr, beaded, with titanium plasma spray
and HA, for mobile insert
Johnson & Johnson Medical Pty Ltd
DP035 MBT Knee System tibial baseplate Tibial baseplate, uncemented, CoCr, HA Size 1-7 $3,350.00
(Duofix), beaded (Porocoat) for rotating
platform, ( non keeled only)
Link Orthopaedics Australia
LO175 Link Gemini Tibial Baseplate Tibial Baseplate, uncemented, Extra small - Extra large $3,350.00
Microporous, HX coating (hydroxy apatite)
Prostheses List by Category, Groups and Sponsor Page 192 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Medacta Australia Pty Ltd
MU053 Cinétique Knee System Tibial Baseplate Tibial Baseplate, uncemented, CoCr, with Sizes 1 to 7, left and right $3,350.00
titanium micro beads, with HA, with
polished insert surface for mobile insert
MU076 GMK Uncemented mobile Tibia Tray Asymmetric uncemented mobile tibia with 1 to 6, left and right $3,350.00
titanium porous coating by an
hydroxyapatite coating
Oceania Orthopaedics
OO007 ACS Knee System - TCP coated tibial Tibial base plate, TCP coated for use with Sizes 2-7 $3,350.00
component mobile bearing insert, TiN coated
Stryker Australia Pty Ltd
ST067 Scorpio Knee System Tibial Baseplate Mobile bearing tibial baseplate, 3, 5, 7, 9, 11, 13 $3,350.00
uncemented, beaded (microstructure) with
PA (Hydroxyapatite), CoCr
Revision
Corin Australia Pty Ltd
CR102 Score Knee System Tibial Baseplate Tibial baseplate, CoCr, uncemented, 7 Sizes $4,850.00
stippled surface, titanium plasma spray
with HA
Smith & Nephew Surgical Pty Ltd
SN368 'Mobile Bearing Knee System Tibial Tibial baseplate, uncemented, beaded, Left & Right Size 1-8 $4,850.00
Baseplate CoCr, polished insert surface, for mobile
insert,
12.4.1 - Cemented, Alloy Polyethylene
Biomet Australia Pty Ltd
BI202 Repicci II Unicondylar Knee System Uni Uni tibial Component, all poly Cemented, 32-42mm $1,250.00
Tibial component UHMWPE
Corin Australia Pty Ltd
CR091 Uniglide Uni Knee System Uni Tibial All poly uni tibial component, cemented Sizes 3, 5 & 7, thicknesses $1,250.00
Component 7mm to 13mm
Prostheses List by Category, Groups and Sponsor Page 193 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Exactech Australia
EX045 Optetrak Uni Condylar Knee System Uni Tibial, all poly, Cemented 1-6 $1,250.00
Tibial Component
Global Orthopaedic Technology
GO031 Global re-surfacing uni-compartmental All poly, uni compartment, tibial 0-5 6.5mm - 9.5mm regular $1,250.00
knee tibial component component, UHMWPE
Johnson & Johnson Medical Pty Ltd
DY114 Preservation Knee System uni tibial Uni all poly, cemented, tibial baseplate, Sizes 1 - 5. 7-13.5mm $1,250.00
baseplate UHMWPE
JJ778 Sigma HP Unicompartmental Knee - All Unicompartmental all poly tibial Size 1-6, 8-12mm LM/RL & $1,250.00
poly tibial component component UHMWPE cemented RM/LL
Medacta Australia Pty Ltd
MU070 GMK Unicompartmental Full - PE Tibia cemented unicompartmental all 1 to 5, left and right, $1,250.00
Component polyethylene fixed component 8/9/10/11/12/14mm thicknesses
Orthotech Pty Ltd
OH231 Optetrak Uni Condylar Knee System Uni Tibial, all poly, Cemented 1-6 $1,250.00
Tibial Component
OH396 Freedom PKR / Active Uni tibial baseplate, cemented, all Sizes A to J $1,250.00
Unicompartmental Knee System Tibial UHMWPE
Baseplate
Smith & Nephew Surgical Pty Ltd
SN337 Genesis Uni Tibial Baseplate Uni Tibial baseplate, all poly, cemented Left & Right, X Small- $1,250.00
Magnum Plus, 8mm-15mm
Stryker Australia Pty Ltd
ST054 EIUS Unicompartmental Knee System Uni tibial baseplate, cemented, all XS, S, M, L, XL $1,250.00
Tibial Baseplate UHMWPE, (N2VAC)
Prostheses List by Category, Groups and Sponsor Page 194 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Tornier Pty Ltd
TO016 HLS Evolution Uni Tibial insert Uni Tibial Insert All Polyethylene, Cemented 1 - 6 UHMWPE $1,250.00
Wright Medical Australia
WR162 Advance-Unicondylar Knee System Uni all poly tibial insert Sizes 1, 2, 3, 4 in 7mm, 8mm, $1,250.00
9mm, 10mm
Zimmer Pty Ltd
ZI108 Miller Galante Unicompartmental tibial All Poly Uni Tibial Baseplate, UHMWPE 1 to 6 $1,250.00
baseplate
ZI402 Allegretto Unicompartmental Knee Tibial All poly uni tibial component, cemented, 9/38 to 15/48mm $1,250.00
Component UHMWPE
12.4.2 - Cemented, Alloy
Biomet Australia Pty Ltd
BI204 Repicci II Unicondylar Knee System Uni Uni Tibial baseplate, Cemented, Titanium, Std, Large, Xlarge $1,550.00
Tibial baseplate for fixed insert
Johnson & Johnson Medical Pty Ltd
DY118 Preservation Knee System uni tibial Uni tibial baseplate, cemented, CoCr, for Size 1-5 $1,550.00
baseplate fixed insert
JJ780 Sigma HP Unicompartmental Knee - Unicompartmental tibial base plate, Size 1-6, LM/RL & RM/LL $1,550.00
Fixed bearing tibial tray cemented, CoCr for fixed bearing insert
Mathys Orthopaedics Pty Ltd
MA452 BalanSys UNI tibial baseplate Uni tibial baseplate for fixed bearing insert, 1,2,3,4,5 $1,550.00
cemented, CoCr
Medacta Australia Pty Ltd
MU065 GMK Unicompartmental fixed tibial cemented unicompartmental fixed tibial 1 to 5, left and right $1,550.00
baseplate component with peg and fixation keel
Smith & Nephew Surgical Pty Ltd
SM120 UC (Unicompartment) PLUS Solution Uni Tibial Baseplate, CoCr, cemented for Tibial - 40 - 56 x (8, 10, 12, $1,550.00
Knee System Uni Tibial Baseplate fixed insert 14mm)
SN336 Genesis Uni Tibial Baseplate Uni Tibial baseplate, cemented, CoCr for XSmall-Magnum $1,550.00
fixed insert
Prostheses List by Category, Groups and Sponsor Page 195 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
SN836 Journey Knee System Tibial Uni Uni Tibial Baseplate,Titanium, cemented, 1-8 $1,550.00
Baseplate for fixed insert
Stryker Australia Pty Ltd
SK497 Triathlon PKR - Cemented Tibial Uni tibial baseplate, cemented, CoCR Size 1 to 6 $1,550.00
component
Tornier Pty Ltd
TO017 HLS Evolution Uni Tibial insert Uni Tibial Insert, Cemented, alloy, 1 - 6 UHMWPE, CoCr $1,550.00
modular, CoCr
Zimmer Pty Ltd
ZI107 Miller Galante Unicompartmental tibial Uni 'Tibial baseplate, cemented, Titanium 1 to 6 $1,550.00
baseplate
12.4.3 - Cemented, Alloy, Moulded Polyethylene
Biomet Australia Pty Ltd
BI871 Vanguard unicondylar Knee System Tibial Component, CoCr UHMWPE (A-E) x (5-8) $2,000.00
Link Orthopaedics Australia
LO060 LINK Endo-Model SLED Uni Tibial Uni tibial tray including UHMWPE insert, 7mm-13mm in 45, 50, 55 $2,000.00
Tray cemented, CoCr tray diameter
Zimmer Pty Ltd
ZI403 Allegretto Unicompartmental Knee Tibial Baseplate Monoblock - Ti alloy / PE 7.5/38 to 15/48mm $2,000.00
12.4.4 - Cemented, Alloy, for Mobile Insert
Biomet Australia Pty Ltd
BI033 Oxford Meniscal Knee System Uni Uni Tibial Baseplate, cemented, polished (38-53mm) x sizes 26-34 $1,750.00
Tibial Baseplate insert surface, for mobile insert (Phase III)
Corin Australia Pty Ltd
CR061 Uniglide Uni Knee System Uni Tibial Uni tibial component, CoCr, with TiNi Sizes 1 - 8 inclusive $1,750.00
Component insert surface coating for mobile insert
Prostheses List by Category, Groups and Sponsor Page 196 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DY117 Preservation Knee System uni tibial Uni tibial baseplate, cemented, CoCr, for Size 1-5 $1,750.00
baseplate mobile insert
Mathys Orthopaedics Pty Ltd
MA453 BalanSys UNI tibial baseplate Uni Tibial component for mobile insert, 1,2,3,4,5 $1,750.00
cemented, CoCr
MA477 BalanSys UNI tibial baseplate Uni Tibial baseplate for mobile insert, 1, 2, 3, 4, 5 $1,750.00
cemented, CoCr with convex surface
Zimmer Pty Ltd
ZI502 Natural Knee Primary Tibial Baseplate - Mobile Bearing Size 00 to 5 $1,750.00
Non Porous - CoCr alloy
12.4.5 - Uncemented, Alloy
12.4.5.1 - HA Coating
Stryker Australia Pty Ltd
SK329 UNIX Unicompartmental Knee System Uni tibial baseplate, uncemented with Sizes 1 to 4 $1,800.00
Tibial Baseplate Hydroxyapatite, CoCr
12.4.6 - Uncemented, Alloy, for Mobile Insert
Zimmer Pty Ltd
ZI430 Natural Knee Unicompartmental -Tibia Baseplate - Ti Por 1 to Por 6 $1,800.00
alloy
12.4.6.1 - HA Coating
Biomet Australia Pty Ltd
BI860 Oxford Meniscal Knee System Uni Uni Tibial Baseplate, uncemented Titanium (38-53) x (26-34)mm $2,000.00
Tibial Baseplate plasma sprayed surface (Porous plasma
spray PPS) with HA (Phase III)
Prostheses List by Category, Groups and Sponsor Page 197 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Corin Australia Pty Ltd
CR057 Uniglide Uni Knee System Uni Tibial Uni tibial component, CoCr, uncemented, 1-8 $2,000.00
Component Titanium plasma spray, with calcium
phosphate (HA) ingrowth surface with
TiNi insert surface coating for mobile insert
12.5.1 - Minimally Stabilised
Advanced Surgical Design & Manufacture Ltd
AE046 Active knee Tibial Insert Mobile insert, dished, UHMWPE Sizes 1 - 5 Thickness 6 - 9.5mm $1,140.00
AE047 Active Knee Tibial Insert Tibial Insert, UHMWPE, ultra congruent Sizes 1 - 5 Thickness 6 - $1,140.00
17.5mm
AE049 Active Knee Tibial Insert Tibial Insert, minimally stabilised, Sizes 1 - 5 Thickness 6 - $1,140.00
UHWMPE 15.5mm
AE079 Active Knee Ultra Plus Tibial Insert Tibial Insert, UHMWPE, anterior lipped 1 - 5, 6 - 17.5mm Thickness $1,140.00
B Braun Australia Pty Ltd
BB198 Emotion Total Knee System (TKS) Tibial Insert, UHMWPE, mobile T1 to T8 Size: 10 to 24mm $1,140.00
Tibial Insert
BB207 Columbus Total Knee System (TKS) Tibial Insert, UHMWPE, fixed T1 - T5 $1,140.00
Tibial Insert
BB255 Columbus Total Knee System (TKS) Tibial Insert, UHMWPE, Mobile T1- T5 $1,140.00
Tibial Insert
Biomet Australia Pty Ltd
BH124 RHK Knee - Tibial Bearing Tibial Insert, ArCom Bi-Helical Rotating (63-71)mm x (12-20)mm $1,140.00
Bearing
BI149 AGC Total Knee System Tibial Insert Tibial Insert 'Tradition' fixed, UHMWPE 59-91mm $1,140.00
with locking pin
BI172 Maxim Complete Knee System Tibial Tibial Insert, UHMWPE, fixed with 59-91mm $1,140.00
Insert locking pin
BI197 Rotating Platform Knee System Tibial Bearing, UHMWPE 60-75mm $1,140.00
Prostheses List by Category, Groups and Sponsor Page 198 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
BI798 Ascent Total Knee System Tibial Insert Tibial Insert, UHMWPE, curved (dished) 59, 63/67, 71/75, 79/83, $1,140.00
or lipped, fixed with locking pin 87/91mm widths, 10-20mm
thicknesses
BI888 Vanguard Total Knee System Tibial Bearing, CR, curved or lipped, 59, 63/67, 71/75, 79/83, 87/91 $1,140.00
UHMWPE widths, 10, 12, 14, 16, 18,
20mm thicknesses
BI976 Vanguard E-Poly CR Tibial bearing Vitamin E infused Highly Cross linked 59 to 91 x (10 -18mm) $1,140.00
Polyethylene /cruciate Retaining Tibial
bearing.
Corin Australia Pty Ltd
CR007 Rotaglide + Total Knee System, Tibial Tibial Insert, Mobile bearing, UHMWPE 7mm - 17mm $1,140.00
Insert
CR008 Rotaglide + Total Knee System, Tibial Tibial Insert, fixed, UHMWPE 9.5mm - 17mm $1,140.00
Insert
CR108 Score Knee System Tibial Insert Tibial Insert, mobile bearing, UHMWPE 7 sizes, 5 thicknesses $1,140.00
DJO Australasia Pty Ltd
DD021 3D Knee System Tibial Insert Tibial insert, UHMWPE, fixed with lateral Size 1 to 12, 9mm to 19mm $1,140.00
pivot with locking screw
Endotec Australia Pty Ltd
EA010 Buechel-Pappas Ultracoat Total Knee Tibial Insert, UHMWPE, mobile bearing 1-6(inc) $1,140.00
Replacement System Tibial Insert
ESKA Australia
EK044 RP (Rotating Platform)Tibial Insert B Tibial insert, UHMWPE, mobile, deep 8-10-12-14mm $1,140.00
dish
Exactech Australia
EX039 Optetrak Total Knee System, Tibial Tibial Insert, UHMWPE, Fixed (Cruciate Size 1-6 $1,140.00
Insert retained)
Finsbury Orthopeadics Australia Pty Ltd
FI027 MRK (Medial Rotation Knee) Total Tibial Insert, UHMWPE, Fixed 1/2/3, 8-18mm thickness $1,140.00
Knee System Tibial Insert
Global Orthopaedic Technology
GO002 RBK Total Knee System Tibial Insert Tibial Insert, UHMWPE, mobile bearing 1-5, 10-20mm $1,140.00
GO159 RBK Universal Tibial Insert Tibial Insert, UHMWPE, fixed, requiring Size 1- 5, 10mm - 20mm $1,140.00
fixation with separate bolt
GO160 RBK Universal Tibial Insert Tibial Insert, UHMWPE, mobile bearing, 1-5, 10mm - 20mm $1,140.00
requiring fixation with separate bolt
Prostheses List by Category, Groups and Sponsor Page 199 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
GO191 APEX Knee Reconstruction System, Tibial Insert, Standard, Ultra & Congruent, Size 1, 10mm to 20mm, size 2, $1,140.00
Tibial Insert, Standard, Ultra & Size 1-7, 10mm to 20mm. 10mm to 20mm, size 3, 10mm
Congruent to 20mm, size 4, 10mm to
20mm, size 5, 10mm to 20mm,
size 6, 10mm to 20mm, size 7,
10mm to 20mm.
Johnson & Johnson Medical Pty Ltd
DP026 LCS Complete Knee System rotating Tibial insert, for rotating platform, Sizes small to large+ $1,140.00
platform tibial Insert UHMWPE
DP162 PFC Sigma Knee System tibial insert Tibial insert for AMK Duofix tibial Sizes 1 - 6. 8-30mm $1,140.00
baseplate with locking post and clip,
UHMWPE
DP166 PFC Sigma Knee System tibial insert Tibial Insert, rotating platform UHMWPE Sizes 1 - 6. 8-30mm $1,140.00
DP238 LCS Classic and Universal Knee System Tibial inserts, meniscal bearing medial and Sizes small to large+. 10-20mm $1,140.00
meniscal bearing tibial Insert lateral (by 2 per procedure)
DY465 LCS Classic and Universal Knee System Tibial insert, UHMWPE, rotating platform, Sizes small to large+. 10-30mm $1,140.00
rotating platform tibial insert standard and deep dish, used for revising
LCS classic and universal TKA
DY481 PFC Sigma Knee System tibial insert Tibial insert, UHMWPE, standard and Sizes 1 - 6. 8-30mm $1,140.00
posterior lipped
JJ509 PFC Sigma Knee System tibial insert Tibial insert, UHMWPE, moderately cross Sizes 1 - 6. 8-30mm $1,140.00
linked
JJ658 LCS Complete Knee System APG Tibial Insert, Mobile, UHMWPE, used Sizes small to large+ $1,140.00
Tibial Insert with APG guide arm only
JJ667 AMK Tibial Insert Tibial insert UHMWPE, minimally stabilised Size 1-5 $1,140.00
Link Orthopaedics Australia
LO155 LINK Endo Model M Modular knee Insert Extra Small - Extra Large $1,140.00
Prosthesis System
LO172 Link Endo Model Rotational and Hinge Plastic insert Extra small - Extra large $1,140.00
Knee Prostheses
LO177 Link Gemini Tibial Insert Tibial Insert, UHMWPE, mobile/fixed Extra small - Extra large $1,140.00
insert
Prostheses List by Category, Groups and Sponsor Page 200 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Mathys Orthopaedics Pty Ltd
MA311 Balansys Tibial Mobile Insert Tibial Insert, mobile bearing, UHMWPE, 64/8mm -85/20.5mm $1,140.00
MA516 Balansys Tibial Insert Tibial Insert, ultra congruent and minimally 64/8 to 85/20.5mm $1,140.00
stabilised, UHMWPE
Medacta Australia Pty Ltd
MU034 Evolis Knee System Tibial Insert Tibial Insert, UHMWPE, fixed 1 - 6, 9/11/13/16/19mm $1,140.00
thickness
MU049 Cinétique Knee System Tibial Insert Tibial Insert, UHMWPE, mobile bearing, Size 1 to 6, 7/9/11/13/15mm $1,140.00
standard, thicknesses
MU068 GMK Standard mobile tibial insert posterior cruciate retaining mobile size 1 to 6, 10/12/14/17/20mm $1,140.00
polyethylene insert thickness
MU071 GMK Standard Fixed Tibial Insert Posterior cruciate retaining fixed size 1 to 6, 10/12/14/17/20mm $1,140.00
polyethylene insert thickness
MU074 GMK ultracongruent Fixed tibial Insert Ultracongruent fixed polyethylene insert 1 to 6, 10/12/14/17/20mm $1,140.00
thickness
MU083 UC mobile insert for Cinetique femoral Polyethylene ultra-congruent insert for Size 1 to 6 each one available in $1,140.00
revision Cinetique femoral revision (using a GMK 3 thicknesses (14, 17, 20mm)
revision femur)
MU084 GMK Revision System Polyethylene minimally stabilised fixed Size 1 to 6, each one available $1,140.00
insert for evolis tibial revision (using a on 5 thicknesses: 10, 12, 14,
GMK tibia) 17, 20 mm
MU092 UC fixed insert for Evolis tibial revision Polyethylene ultra-congruent fixed insert Size 1 to 6, each one available $1,140.00
for Evolis tibial revision (using a GMK tibia) in 5 thicknesses: 10, 12, 14, 17
20mm
MU093 UC mobile insert for Cinetique tibial Polyethylene ultra-congruent insert for Size 1 to 6 each one available in $1,140.00
revision GMK and Cinetique tibial revision (using a 3 thicknesses (14, 17, 20mm)
GMK tibia)
Oceania Orthopaedics
OO010 ACS Knee System - PE tibial inserts, ACS PE tibial insert, mobile bearing 10mm, 12.5mm, 15mmm, $1,140.00
mobile bearing 17.5mm, 20mm, sizes 1 through
6
OO022 ACS Knee System-ACS FB Tibial PE- ACS fixed bearing tibial inserts for use Sizes, 2,3,4,5,6. 10mm, $1,140.00
Inserts with ACS Revision fixed bearing base plate 12.5mm, 15mm, 17.5mm,
20mm.
Prostheses List by Category, Groups and Sponsor Page 201 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
OO023 ACS Knee System-ACS MB Tibial PE- ACS mobile bearing tibial inserts for use Sizes 2,3,4,5. 10mm, 12.5mm, $1,140.00
Inserts with ACS SC mobile bearing base plate. 15mm, 17.5mm
Orthotech Pty Ltd
OH331 Optetrak Total Knee System, Tibial Tibial Insert, UHMWPE, Fixed (Cruciate Size 1-6 $1,140.00
Insert retained)
Smith & Nephew Surgical Pty Limited
SL002 Genesis II Knee System Tibial Insert Tibial Insert, UHMWPE, fixed, without peg 1-8; 9-25mm $1,140.00
SL003 Profix Knee System Tibial Insert Tibial Insert, UHMWPE, Fixed Left / Right 1 - 8 $1,140.00
SL004 VKS (Vario) Knee System Tibial Insert Tibial insert, UHMWPE, Fixed SZ 1-12 $1,140.00
Smith & Nephew Surgical Pty Ltd
SM031 TC (Tri Compartment) PLUS Knee Tibial Insert, UHMWPE, mobile, deep 1-12 : 9-19mm $1,140.00
System Tibial Insert dished
SM063 Tibial Insert Mobile Bearing Tibial Insert 1-12 $1,140.00
SM090 RT (Rotating Hinge) PLUS Knee Tibial Insert, UHMWPE, fixed, for hinged 0-10 $1,140.00
System Tibial Insert femoral and tibial components, reinforced
fixation clip and centeral hole for femoral
component hinge post
SM174 Verilast CR Insert Cruciate Retaining Tibial Insert Sizes 1-8, 9-25mm $1,140.00
SN320 Genesis II Knee System Tibial Insert Tibial Insert for mobile insert, UHMWPE Left & Right, Size 1-8, 9- $1,140.00
15mm
SN348 Genesis Knee System Tibial Insert Tibial Insert, UHMWPE, fixed Left & Right XS-Magnum $1,140.00
8MM-15MM
SN378 Profix Knee System Tibial Insert Tibial Insert, UHMWPE, Mobile, anterior Size 1-8 10-16mm $1,140.00
lip (Conforming Plus)
SN379 Profix Knee System Tibial Insert Tibial Insert, UHMWPE, Mobile Size 1-8 10-16mm $1,140.00
SN699 Profix Knee System Tibial Insert Tibial Insert, UHMWPE, Mobile, anterior 1-8, 18-20mm $1,140.00
lip (Conforming Plus) Larger sized inserts
Stryker Australia Pty Ltd
HW091 Duracon Knee System Tibial Insert Minimally stabilised, AP Lipped tibial Small, Medium, Large, Extra- $1,140.00
insert, UHMWPE, (Duration) Large in each thickness 9mm,
11mm, 13mm, 16mm, 19mm,
22mm, 25mm
Prostheses List by Category, Groups and Sponsor Page 202 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
HW102 Duracon Knee System Tibial Insert Minimally stabilised, tibial insert to match Small, Medium, Large, Extra- $1,140.00
PCA femur with Duracon baseplate, Large in each thickness 9mm,
UHMWPE (Duration) 11mm, 13mm, 16mm, 19mm,
22mm, 25mm, 28mm, 31mm
HW160 Kinemax Knee System Tibial Insert Minimally stabilised, tibial insert, Low 8, 10, 12, 15, 18, 21, 25mm $1,140.00
Stress, UHMWPE (Duration) per size
HW162 Interax Knee System Patella Patella, resurfacing, all UHMWPE 8, 10, 12, 15, 18, 21mm per size $1,140.00
(Duration)
HW174 Kinemax Knee System Tibial Insert Minimally stabilised tibial insert, 8, 10, 12, 15, 18, 21, 25mm $1,140.00
UHMWPE, (Duration) per size
HW232 HMRS (Howmedica Modular HMRS Rotating Hinge Tibial insert, 6, 10, 14mm $1,140.00
Replacement System) Rotating Hinge UHMWPE (Duration), Fixed
Tibial Insert
HW248 MRH (Modular Rotating Hinge) & MRH & GMRS Tibial insert, (Duration) xsmall - xlarge $1,140.00
GMRS (Global Modular Replacement UHMWPE, for MRH and GMRS Tibial
System) Tibial Inserts baseplate, CoCr (Vitallium), Fixed with
central hole for Hinge
SK091 Duracon Knee System CS Lipped Tibial Minimally stabilised, CS Lipped tibial XS,S,M,L,XL Thickness $1,140.00
Insert insert, deep dish, UHMWPE, (Duration) 9,11,13,16,19,22,25mm
SK328 Triathlon Knee System Tibial Insert Minimally stabilised, tibial insert, Sizes 1 to 8 $1,140.00
UHMWPE, (N2VAC) (9/11/13/16/19/22/25mm
thickness)
SK333 Scorpio NRG Knee System Tibial Insert Minimally stabilised tibial insert, Sizes 3,4,5,6,7,9,11,13, x $1,140.00
UHMPWE (N2VAC) (8/10/12/15/18/21/24mm
thickness)
SK431 Triathlon Knee System CS Lipped Insert Minimally stabilised, CS Lipped tibial Sizes 1-8 _small - large) size $1,140.00
insert deep dish, UHMWPE (N2VAC) increments, 9mm, 11mm,
13mm, 16mm, 19mm, 22mm,
25mm
SK432 Triathlon Knee System CS Lipped Tibial Minimally stabilised, CS Lipped tibial Sizes 1-8 _small - large) size $1,140.00
Insert insert deep dish, UHMWPE, (X3) increments, 9mm, 11mm,
13mm, 16mm, 19mm, 22mm,
25mm
SR031 Triathlon Knee System Tibial Insert Minimally stabilised, mobile bearing tibial 1 to 8, 9mm to 19mm $1,140.00
insert, UHMWPE (N2VAC)
Prostheses List by Category, Groups and Sponsor Page 203 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SR033 Triathlon Knee System Tibial Insert Minimally constrained, CS Lipped Tibial 1 to 8, 9mm to 22mm $1,140.00
insert, deep dished (CS) UHMWPE,
N2VAC, mobile bearing
SR076 Triathlon X3 CR Tibial Insert Intended use as part of a total knee system Sizes 1-8 available in $1,140.00
in primary cemented and primary 9,11,13,16,19mm thicknesses
uncemented total knee arthroplasty.
SR077 Scorpio NRG X3 CR Tibial Insert Intended use as part of a total knee system Sizes 3,5,7,9,11 in thicknesses: $1,140.00
in primary cemented and primary 8,10,12,15,18,21,24mm
uncemented total knee arthroplasty.
SR079 Triathlon X3 CS Lipped Tibial Insert Intended use as part of a total knee system Sizes 1-8 available in $1,140.00
in primary cemented and primary 9,11,13,16,19,22 and 25mm
uncemented total knee arthroplasty. thicknesses
ST032 Scorpio Knee System Tibial Insert Minimally stabilised, mobile bearing tibial 8-24mm for all tibia sizes $1,140.00
insert, UHMWPE (N2VAC)
ST608 Scorpio Knee System Tibial Insert Minimally stabilised tibial insert, 8-18mm in 2mm increments $1,140.00
UHMWPE (N2VAC)
ST643 S7000 Knee System Tibial Insert Minimally stabilised tibial insert, 3, 5, 7, 9, 11, 13 in 8, 10, 12, $1,140.00
UHMWPE (N2VAC), used for Series 15, 18, 21,24mm
7000 Minimally stabilised tibial insert
revisions
ST912 Duracon ISA Knee System Tibial Insert Minimally stabilised, mobile bearing tibial Small, medium, large, X-large - $1,140.00
insert, UHMWPE (Duration) left, right
Wright Medical Australia
WR204 Advantim Total Knee System Tibial Inserts Total Condylar UHMWPE, 10-36mm in 2mm increments $1,140.00
includes unconstrained insert and minimally
stabilised (LSI)
WR223 Advanced Knee Tibial Insert Minimally stabilised, fixed, tibial insert, 0, 1, 2, 3, 4, 5, 6 in 10 - mm $1,140.00
UHMWPE thicknesses
Zimmer Pty Ltd
ZI077 Miller Galante I Tibial Insert Tibial Insert, UHMWPE, fixed 8 - 22mm $1,140.00
ZI088 Miller Galante II Tibial Insert Tibial Insert, UHMWPE, fixed 9 - 23mm $1,140.00
ZI134 NexGen Tibial Insert Tibial Insert, fixed, standard and anterior 9 - 23 mm $1,140.00
lipped, UHMWPE
ZI135 NexGen Tibial Insert Ant. Constr. - UHMWPE 9 - 23mm $1,140.00
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Billing Code Product Name Description Size Benefit Benefit Notations
ZI138 NexGen MBK Tibial Insert Tibial Insert, UHMWPE, mobile 9 - 23mm $1,140.00
ZI139 NexGen Tibial Insert Tibial Insert, UHMWPE, 'anatomically 9 - 23mm $1,140.00
rotated'
ZI408 Natural Knee Tibial Insert Tibial Insert, UHMWPE, mobile insert 00 to 5, 9 to 22mm $1,140.00
ZI410 Natural Knee Tibial Insert Tibial Insert, UHMWPE, fixed 00 to 5, 9 to 22mm $1,140.00
ZI411 Natural Knee Tibial Insert Tibial Insert, UHMWPE, fixed, 00 to 5, 9 to 22mm $1,140.00
ultracongruent dished
ZI434 SAL Knee Tibial Insert Tibial Insert, UHMWPE, mobile bearing Mobile Bearing - 0/1 to E/16 $1,140.00
ZI450 Natural Knee Tibial Insert Tibial Insert, UHMWPE, Highly crossed 00 to 5, 9 to 22mm $1,140.00
linked (Durasul PE), congruent and ultra
congruent
ZI515 NexGen Prolong Tibial Insert Tibial Insert, Highly Crosslinked - Sizes A - G 9mm to 20mm $1,140.00
UHMWPE (prolong), mobile bearing
ZI584 NexGen Prolong Flex Articulating Surface Highly Crosslinked - Ultra High Molecular Sizes 1 to 10, 9mm to 23mm $1,140.00
Weight Polyethylene - Fixed Bearing - CR
ZI585 NexGen Prolong Flex Articulating Surface Highly Crosslinked - Ultra High Molecular Sizes 1 to 10, 9mm to 23mm $1,140.00
Weight Polyethylene - Mobile Bearing - CR
12.5.2 - Posterior Stabilised
B Braun Australia Pty Ltd
BB199 Emotion Total Knee System (TKS) Tibial Insert, UHMWPE, mobile, posterior T1 to T8 Sizes: 10 to 24mm $1,200.00
Tibial Insert stabilised with peg
BB209 Columbus Total Knee System (TKS) Tibial Insert, UHMWPE, fixed, posterior T1 - T5 $1,200.00
Tibial Insert stabilised with included screw for fixation
to baseplate
Biomet Australia Pty Ltd
BI179 Maxim Complete Knee System Tibial Tibial Insert, UHMWPE, fixed with 59-91mm $1,200.00
Insert locking pin, posterior stabilised with peg
Prostheses List by Category, Groups and Sponsor Page 205 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
BI885 ROCC Tibial Insert Tibial Insert, mobile bearing, rotating 1-6 (tray size), 10-20mm $1,200.00
platform, UHMWPE (bearing size)
BI905 AGC Total Knee System Tibial Insert Tibial Insert 'Tradition', Posterior 59-91mm $1,200.00
Stabilised with peg, UHMWPE with
locking pin
BI907 TRAC Knee System Bearing Posterior Stabilised UHMWPE 59 - 91mm $1,200.00
BI975 Vanguard E-Poly PS bearing Vitamin E infusion Highly Cross linked 59 - 91 x (10 - 18mm) $1,200.00
Polythylene Posterior Stabilised Tibial
Bearing
Corin Australia Pty Ltd
CR110 Score Knee System Tibial Insert Tibial Insert, mobile bearing, posterior 20 sizes $1,200.00
stabilised with reinforcement post
Exactech Australia
EX041 Optetrak Total Knee System, Tibial Tibial Insert, UHMWPE, Fixed (Posterior Size 1-6 $1,200.00
Insert Stabilised)
EX042 Optetrak Total Knee System, Tibial Tibial Insert, UHMWPE, Fixed (Hi Flex) Size 1-6 $1,200.00
Insert
EX043 Optetrak RBK (Rotating Bearing Knee) Tibial Insert, UHMWPE, mobile, posterior 1-6 $1,200.00
Total Knee System Tibial Insert stabilised
Finsbury Orthopeadics Australia Pty Ltd
FI056 Saiph Knee System APS Tibial Insert Compression Moulded Anterior Posterior A - F, Left & Right 10 - 20mm $1,200.00
Stablilised Tibial Bearing
FOL Technology PTY Ltd
FO011 Trekking Knee System, Tibial Mobile tibial insert 1 - 5 (+0/+7) $1,200.00
FO015 Trekking Knee System, Tibial Insert Tibial Insert 1 - 5 (+0/+13) $1,200.00
Global Orthopaedic Technology
GO117 RBK Total Knee System Tibial Insert Tibial Insert, UHMWPE, mobile bearing, Size 0 to 5, 10mm to 20mm $1,200.00
posterior stabilised with peg, separate bolt thick
fixation that passes down the peg
Johnson & Johnson Medical Pty Ltd
DP270 SROM Noiles Knee System tibial insert Tibial insert, UHMWPE, posterior Xsm-lrg. 10-30mm $1,200.00
stabilised, rotating platform
DY372 LCS Complete Knee System rotating Tibial insert, rotating platform with post, Sizes small to large+. 10-30mm $1,200.00
platform tibial insert UHMWPE
Prostheses List by Category, Groups and Sponsor Page 206 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
DY405 PFC Sigma Knee System RPF tibial Tibial insert, UHMWPE, rotating platform Size 1 - 6. 10-30mm $1,200.00
insert for high flex with post
DY457 PFC Sigma Knee System tibial insert Tibial insert, posterior stabilised, rotating Sizes 1 - 6. 8-30mm $1,200.00
platform UHMWPE
JJ508 PFC Sigma Knee System tibial insert Tibial insert, UHMWPE, moderately cross Sizes 1 - 6. 8-30mm $1,200.00
linked, with peg
JJ665 PFC Sigma Knee System Tibial Insert Tibial insert, posterior stabilised, Sizes 1-6. 8-30mm $1,200.00
UHMWPE, with post
JJ666 AMK Tibial Insert Tibial insert UHMWPE, minimally Size 1-5 $1,200.00
stabilised (with separate locking post)
Link Orthopaedics Australia
LO178 Link Gemini Tibial Insert Tibial Insert, UHMWPE, Fixed PS insert Extra small - Extra large $1,200.00
Mathys Orthopaedics Pty Ltd
MA489 Balansys Tibial Insert Tibial insert, posterior stabilised UHMWPE Height: $1,200.00
8/10.5/13/15.5/18/20.5/23 -
ML/AP Dimensions:
64/70/75/80/85 - fixed bearing
MA510 Balansys Revision Knee, Tibial Insert Tibial insert, contrained, with stabilising 64/10.5 to 85/23 $1,200.00
screw for reinforcement
Medacta Australia Pty Ltd
MU032 Evolis Knee System Tibial Insert Tibial Insert, UHMWPE, fixed, posterior 1 - 6, 9/11/13/16/19mm $1,200.00
stabilised thickness
MU059 GMK Posterior Stabilised fixed tibial Posterior Stabilised fixed polyethylene size 1 to 6, 10/12/14/17/20mm $1,200.00
insert insert thickness
MU073 GMK Ultracongruent Mobile Tibial Insert Ultracongruent Mobile Polyethylene Insert size 1 to 6, 10/12/14/17/20mm $1,200.00
thickness
MU090 PS fixed insert for Evolis tibial revision Polyethylene posterior-stabilised fixed Size 1 to 6, each one available $1,200.00
insert for Evolis tibial revision (using a in 5 thicknesses: 10, 12, 14, 17
GMK tibia) 20mm
MU091 GMK Revision semi-constrained fixed Semi-constrained Posterior Stabilised fixed Size 1 to 6, each one available $1,200.00
tibial insert Tibial Insert in 8 thicknesses: 10, 12, 14, 17,
20, 23, 26, 29mm
Prostheses List by Category, Groups and Sponsor Page 207 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Oceania Orthopaedics
OO011 ACS Knee System - Posterior stabilised ACS Posterior stabilised PE tibial inserts, Sizes 1-6, 10, 12.5, 15, 17.5, $1,200.00
PE tibial inserts, mobile bearing mobile bearing 20mm
OO024 ACS Knee System-ACS FB PS Tibial ACS posterior stabilised tibial inserts for Sizes 2,3,4,5,6. 10mm, $1,200.00
PE-Inserts use with ACS FB revision bearing base 12.5mm, 15mm, 17.5mm, 20mm
plate.
OO025 ACS Knee System-ACS MB PS Tibial ACS Mobile bearing posterior stabilised Sizes 2,3,4,5,6. 10mm, $1,200.00
PE-Inserts tibial inserts for use with ACS SC revision 12.5mm, 15mm, 17.5mm, 20mm
tibial base plate.
Orthotech Pty Ltd
OH235 Optetrak RBK (Rotating Bearing Knee) Tibial Insert, UHMWPE, mobile, posterior 1-6 $1,200.00
Total Knee System Tibial Insert stabilised
OH332 Optetrak Total Knee System, Tibial Tibial Insert, UHMWPE, Fixed (Posterior Size 1-6 $1,200.00
Insert Stabilised)
OH333 Optetrak Total Knee System, Tibial Tibial Insert, UHMWPE, Fixed (Hi Flex) Size 1-6 $1,200.00
Insert
Smith & Nephew Surgical Pty Limited
SL005 Genesis II Knee System Tibial Insert Tibial Insert, UHMWPE, Posterior SZ 1-8; 9-25mm $1,200.00
Stabalised with peg, Fixed
Smith & Nephew Surgical Pty Ltd
SM072 TC (Tri Compartment) PLUS Knee Tibial Insert, UHMWPE, fixed, posterior 2-12 $1,200.00
System Tibial Insert stabilised with peg
SM175 Verilast PS Insert Posterior Stabilized Tibial Insert Sizes 1-8; 9-25mm $1,200.00
SN349 Genesis Knee System Tibial Insert Tibial Insert, UHMWPE, fixed, posterior Right/Left S-XL 8mm-25mm $1,200.00
stabilised with peg
SN780 Journey Knee System Tibial Insert Tibial Insert, UHMWPE, Fixed posterior 8-30mm, 1-10 $1,200.00
stabilised with peg
SN876 Profix Knee System Tibial Insert Tibial Insert, UHMWPE, posterior 1-8 $1,200.00
stabilised with peg, fixed
Prostheses List by Category, Groups and Sponsor Page 208 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW092 Duracon Knee System Tibial Insert Posterior stabilised tibial insert, with Small, Medium, Large, Extra- $1,200.00
reinforcing pin, UHMWPE, (Duration) Large in each thickness 9mm,
11mm, 13mm, 16mm, 19mm,
22mm, 25mm
SR002 Triathlon Knee System Tibial Insert Posterior stabilised insert, Sizes 1 to 8 $1,200.00
UHMWPE,(N2VAC) (9/11/13/16/19/22/25mm
thickness)
SR008 Scorpio Knee System Tibial Insert Posterior stabilised tibial insert, UHMWPE 8-18mm in 2mm increments $1,200.00
(N2VAC)
SR012 Scorpio NRG Knee System Tibial Insert Posterior stabilised tibial insert, Sizes 3,4,5,6,7,9,11,13, x $1,200.00
UHMWPE, (N2VAC) (8/10/12/15/18/21/24mm
thickness)
SR013 Scorpio Knee System Tibial Insert Posterior stabilised mobile bearing insert, 10,12,15,18, 21mm thickness; $1,200.00
UHMWPE (N2VAC) sizews 3,5,7,9,11,13
SR020 S7000 Tibial Insert Posterior stabilised tibial insert, 3, 5, 7, 9, 11, 13 in 8, 10, 12, $1,200.00
UHMWPE, (N2VAC), used for series 15, 18, 21,24mm
7000 revisions
SR032 Triathlon Knee System Tibial Insert Posterior stabilised mobile bearing insert, 1 to 8, 9mm to 22mm $1,200.00
UHMWPE (N2VAC)
SR074 Triathlon X3 PS Tibial Insert Intended use as part of a total knee system Sizes 1-8 available in $1,200.00
in primary cemented and primary 9,11,13,16,19,22 and 25mm
uncemented total knee arthroplasty. thicknesses
Intended to be used in situation where the
posterior cruciate ligament is absent, or
cannot be preserved.
SR078 Scorpio NRG X3 PS tibial Insert intended to be used in situations where the 3,5,7,9,11 in thickness: $1,200.00
posterior cruciate ligament is absent, or 8,10,12,15,18,21,24mm
cannot be preserved.
ST644 S7000 Tibial Insert series I Posterior stabilised tibial insert, Series II, 3, 5, 7, 9, 11, 13 in 8, 10, 12, $1,200.00
UHMWPE (N2VAC) 15, 18, 21,24mm
ST646 S7000 Tibial Insert, series II Tibial Insert posterior stabilised - PSII 3, 5, 7, 9, 11, 13 in 8, 10, 12, $1,200.00
UHMWPE 15, 18, 21,24mm
ST925 Scorpio Knee System SuperFlex Tibial Posterior stabilised tibial insert, SuperFlex, 3, 5, 7, 9 , 11, 13 in thickness $1,200.00
Insert UHMWPE (N2VAC) 8, 10, 12, 15, 18, 21, 24mm
Prostheses List by Category, Groups and Sponsor Page 209 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Tornier Pty Ltd
TO035 HLS Noetos Tibial insert, mobile Tibial Insert, Mobile, UHMWPE, 1 to 6, 9, 11 & 13mm $1,200.00
Posterior Stabilised
TO036 HLS Noetos Tibial insert, fixed Tibial Insert, fixed, UHMWPE, posterior 1 to 6, 9, 11 & 13mm $1,200.00
stabilised
TO063 HLS Kneetec - Mobile Tibial Insert Mobile Tibial Insert for HLS Kneetec 4 thicknesses: 9, 11, 13 and 15 $1,200.00
System, UHMWPE, posterior stabilised mm. 7 sizes for each thickness:
from 1 to 7/8
TO064 HLS Kneetec - Fixed Tibial Insert Fixed Tibial part of the HLS Kneetec 6 thicknesses: 9, 11, 13, 15, 18 $1,200.00
system, UHMWPE, posterior stabilised and 21 mm. 7 sizes for each
thickness: from 1 to 7/8
Wright Medical Australia
WR172 Advantim / Ortholoc Revision Knee Tibial inserts posterior stabilised Small, Medium, Large, X- $1,200.00
UHMWPE (LSI and "unconstrained" Large - 10 to 35mm in 2mm
insert ranges) increments
WR189 Advance Total Knee System Posterior stabilised, fixed tibial insert, 1, 2, 3, 4, 5, 6 $1,200.00
UHMWPE
Zimmer Pty Ltd
ZI057 NexGen Flex Tibial Insert Tibial Insert, fixed, posterior stabilised, Sizes 9 - 23mm $1,200.00
high flex, UHMWPE
ZI058 NexGen LPS Tibial Insert Tibial Insert, posterior stabilised, Sizes 9 - 23mm $1,200.00
UHMWPE, mobile
ZI066 Insall-Burstein II Tibial Insert Tibial Insert which is fixed and posterior 8 - 25mm $1,200.00
stabilised, UHMWPE,
ZI136 NexGen Tibial Insert Tibial Insert, fixed, posterior stabilised, 9 - 23mm $1,200.00
UHMWPE
ZI137 NexGen LCCK Tibial Insert Tibial Insert, posterior stabilised, 10 - 35mm $1,200.00
UHMWPE, fixed, with post
ZI521 NexGen LPS Prolong Tibial Insert Tibial Insert, Highly Crosslinked - Sizes A - G, 9mm to 20mm $1,200.00
UHMWPE (prolong), fixed posterior
stabilised
ZI586 NexGen Prolong Flex Articulating Surface Highly Crosslinked - Ultra high Molecular Sizes 1 to 10, 9mm to 23mm $1,200.00
Weight Polyethylene - Fixed Bearing - LPS
ZI587 NexGen Prolong Flex Articulating Surface Highly Crosslinked - Ultra high Molecular Sizes 1 to 10, 9mm to 23mm $1,200.00
Weight Polyethylene - Mobile Bearing -
LPS
Prostheses List by Category, Groups and Sponsor Page 210 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
12.5.3 - Totally Constrained
Biomet Australia Pty Ltd
BI181 Maxim Complete Knee System Tibial Tibial Insert, UHMWPE, fixed with 59-91mm $1,250.00
Insert locking pin, Totally constrained with peg
BI802 Ascent Total Knee System Tibial Insert Tibial Insert, totally constrained, fixed with 59, 63/67, 71/75, 79/83, $1,250.00
locking pin, UHMWPE 87/91mm widths, 10-20mm
thicknesses
BI904 Vanguard Total Knee System Tibial Bearing, PS, PS+. UHMWPE 59, 63/67, 71/75, 79/83, $1,250.00
87/91, widths, 10. 12, 14, 16,
18, 20, 22, 24mm thicknesses
BI939 Vanguard SSK Knee System Tibial Bearing Insert, PSC, UHMWPE 59-75mm x (10-24mm) $1,250.00
BI954 AGC Dual Articular Knee System Tibial Tibial Insert, UHMWPE, totally 59 - 83mm, 8 - 20mm Depth $1,250.00
Insert constrained, Rotating, reinforcement post
on baseplate
Exactech Australia
EX028 Optetrak Total Knee System Tibial Tibial Insert, UHMWPE, fixed and totally Size 1 - 6 $1,250.00
Insert stabilised with peg and reinforced with
screw/post fixation (Spine stiffening screw)
Johnson & Johnson Medical Pty Ltd
DP257 SROM Noiles Knee System tibial insert Tibial insert, rotating platform, hinged, with XXSml - Large $1,250.00
metal axis ring incorporated and
polyethylene axis bearings
DP570 AMK Ultra coordinate revision tibial Tibial Insert UHMWPE, totally Sizes 1-5, 10-30mm $1,250.00
insert constrained, with separate locking post
DY367 PFC Sigma TC3 Knee System Tibial Tibial Insert, totally constrained, mobile Size 1.5 to 5 thickness of $1,250.00
Insert bearing, UHMWPE, with post 10mm to 30mm
JJ532 LCS Complete Knee System tibial insert Tibial insert, UHMWPE, rotating platform, Sizes small to large+. 10-30mm $1,250.00
totally constrained, with reinforcing post
JJ664 PFC Sigma Knee System TC3 Tibial Tibial insert, totally constrained, Sizes 1-6. 8-30mm $1,250.00
Insert UHMWPE, with post
Prostheses List by Category, Groups and Sponsor Page 211 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Orthotech Pty Ltd
OH025 Optetrak Total Knee System Tibial Tibial Insert, UHMWPE, fixed and totally Size 1 - 6 $1,250.00
Insert stabilised with peg and reinforced with
screw/post fixation (Spine stiffening screw)
Smith & Nephew Surgical Pty Ltd
SM159 Legion Hinge Rotating Platform Insert This tibial insert is used for the construction Sizes 2-7 11,13,15,18,21mm $1,250.00
of the Legion hinge.
SM161 Legion Hinge Guided Motion Tibial Insert This tibial insert is used for the construction Sizes 2-7 11,13,15,18,21mm $1,250.00
of the Legion hinge.
SN340 Genesis Knee System Tibial Insert Tibial Insert, UHMWPE, fixed, totally Left/Right Small- XLarge $1,250.00
stabilised with peg 10mm - 25mm
SN353 Genesis Knee System Tibial Insert Tibial Insert, UHMWPE, fixed, totally Left/Right Constrained Small - $1,250.00
stabilised with peg, to be used with Xlarge, Crutiate retaining Size
Genesis I baseplate and Tricon Femoral 1-8, Post Stabilising Size 1-8,
Component Tricon/Genisis Small-Xlarge
SN863 Genesis II Knee System Tibial Insert Tibial insert, UHMWPE, fixed, totally Left / Right 1 - 8 $1,250.00
constrained
SN864 Profix Knee System Tibial Insert Tibial insert, UHMWPE, fixed, totally Left / Right 1 - 8 $1,250.00
constrained
Stryker Australia Pty Ltd
HW161 Kinemax Knee System Tibial Insert Totally constrained tibial insert, with metal 8, 10, 12, 15, 18, 21, 25mm $1,250.00
post, UHMWPE (Duration) per size
SK410 Scorpio Knee System Tibial Insert Totally constrained tibial insert, with metal 3 - 11 mm 7F/5T, 5F/7T, $1,250.00
post, UHMWPE (N2VAC) 11F/9T, 9F/11T10mm-
24mm
SK438 Triathlon TS Knee System Tibial Insert Totally constrained, TS (Total Stabilizer) Tibial Insert Sizes: Left & right $1,250.00
Insert, with metal post, UHMWPE (X3) 9-31mm sizes 1-8Reinforced
Post Sizes 9-31mm
SK439 Triathlon Knee System Tibial Insert Totally constrained tibial insert, with metal Tibial Insert Sizes: Left & right $1,250.00
post, +/- 2° int/ext rotation, UHMWPE 9-31mm sizes 1-8
(X3) Reinforced Post Sizes 9-31mm
ST024 Scorpio Knee System Tibial Insert Totally constrained tibial insert, with metal 8-24mm for all tibia sizes $1,250.00
post, UHMWPE (X3)
Prostheses List by Category, Groups and Sponsor Page 212 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
ST601 Duracon TS Knee System Tibial Insert Totally constrained tibial insert, with metal Extra Small, Small, Medium, $1,250.00
post, UHMWPE (Duration) Medium Large, Large, Extra
Large
Wright Medical Australia
WR187 Advance Revision Knee System insert totally constrained, UHMWPE, fixed tibial 1, 2, 3, 4, 5, 6 in 10 - 30mm in $1,250.00
insert with reinforcing peg 2mm increments
Zimmer Pty Ltd
ZI307 Nexgen Rotating Hinge Tibial Insert Tibial insert for NexGen Rotating Hinge 12-26mm, sizes B-F $1,250.00
prosthesis, UHMWPE, mobile. Includes
hinge locking post.
12.6.1 - Tibial Insert: Uni-Compartmental Arthroplasty
B Braun Australia Pty Ltd
BB203 Emotion Unicondylar Knee System Uni Uni tibial insert, UHMWPE, fixed F1 and F5, 7mm-11mm $790.00
Tibial Insert
Biomet Australia Pty Ltd
BI032 Oxford Meniscal Knee System Uni Uni Tibial Insert, mobile bearing, Small Standard, Large, Xlarge, $790.00
Tibial Insert UHMWPE sizes 3-9
BI205 Repicci II Unicondylar Knee System Uni Uni Tibial insert, fixed , UHMWPE Std, Large, Xlarge $790.00
tibial insert
BI861 Oxford Meniscal Knee System Uni Uni Tibial Insert conforming surface, (Small - Extra Large) x (3-9) $790.00
Tibial Insert mobile bearing, UHMWPE (Phase III)
Corin Australia Pty Ltd
CR060 Uniglide Uni Knee System Uni Tibial Uni tibial insert, mobile bearing, UHMWPE Height 4, 5, 6, 7, 8, 9, 10, 11, $790.00
Insert 12mm; Size 1-4
Johnson & Johnson Medical Pty Ltd
JJ660 Preservation Knee System Uni Tibial Uni Tibial Insert, Fixed Bearing, UHMWPE Sizes 1-5. 7-15mm $790.00
Insert
JJ661 Preservation Knee System Uni Tibial Uni Tibial Insert, Mobile Bearing, Sizes 1-5. 7-15mm $790.00
Insert UHMWPE
JJ779 Sigma HP Unicompartmental Knee - Unicompartmental tibial insert, fixed Size 1-6, 7-12mm LM/RL & $790.00
Fixed bearing insert bearing UHMWPE RM/LL
Mathys Orthopaedics Pty Ltd
MA454 BalanSys UNI tibial Insert Uni tibial insert, UHMWPE, fixed 5,6,7,9 $790.00
Prostheses List by Category, Groups and Sponsor Page 213 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MA455 BalanSys UNI tibial Insert Uni tibial insert, UHMWPE, mobile 5,6,7,9 $790.00
MA478 BalanSys UNI tibial Insert Uni tibial insert, UHMWPE, mobile 5, 6, 7, 9 $790.00
convex for the uni convex tibial baseplate
Medacta Australia Pty Ltd
MU062 GMK Unicompartmental fixed tibia insert cemented unicompartmental polyethylene 1 to 5, left and right, $790.00
fixed tibial insert 8/9/10/11/12/14mm thiknesses
Smith & Nephew Surgical Pty Ltd
SM121 UC (Unicompartment) PLUS Solution Uni Tibial Insert, UHMWPE, fixed 40 (8mm, 10mm, 12mm, $790.00
Knee System Uni Tibial Insert 14mm), 44 (8mm, 10mm, 12,,
14mm), 48 (8mm, 10mm,
12mm, 14mm), 52 (8mm,
10mm, 12mm, 14mm), 56
(8mm, 10mm, 12mm, 14mm)
SN334 Genesis Uni Tibial Insert Uni Tibial Insert, UHMWPE, fixed x-Small-Magnum 8mm-12mm $790.00
SN837 Journey Knee System Uni Tibial Insert Uni Tibial Insert, for fixed bearing, 10-18mm $790.00
UHMWPE
Stryker Australia Pty Ltd
SK498 Triathlon PKR - X3 Polyethylene Tibial Uni tibial insert, X3 polyethylene, fixed Size 1 to 6, thicknesses from $790.00
insert 8mm to 12mm
ST656 UNIX Unicompartmental Knee System Uni tibial insert, UHMWPE, Fixed 1, 2, 3, 4 in 8, 10, 12, 15mm $790.00
Tibial Insert
Zimmer Pty Ltd
ZI105 Miller Galante Unicompartmental Insert Uni Tibial Insert, UHMWPE, fixed 8 - 14 mm $790.00
ZI429 Natural Knee Unicompartmental - Tibia PE Insert 1,2 x 9mm to 5,6 x 13mm $790.00
12.7.1 - Alloy
Biomet Australia Pty Ltd
BI945 Vanguard PFR Femoral Component, Ti XS to Xlarge $2,750.00
Prostheses List by Category, Groups and Sponsor Page 214 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Global Orthopaedic Technology
GO035 RBK Total Knee System Patello Trochlear Component, cemented, CoCr Size 00 to 5 $2,750.00
Femoral (trochlear component)
Johnson & Johnson Medical Pty Ltd
DY111 LCS Patellofemoral Joint Prosthesis Femoral trochlear component, cemented, Sizes small to large+ $2,750.00
(femoral component) CoCr
JJ776 Sigma HP Trochlear Component Femoral trochlear component, cemented, Sizes 1-5, left and right $2,750.00
CoCr
Link Orthopaedics Australia
LO058 LINK Lubinus Total Patella Glide Femoral trochlear Component, cemented, Small, medium, large, extra large $2,750.00
Replacement (femoral trochlear CoCr
component)
Stryker Australia Pty Ltd
ST600 Avon Patello Femoral System Femoral Trochlear component, CoCr (Vitallium), Extra Small, Small, Medium, $2,750.00
Component cemented Large
Zimmer Pty Ltd
ZI563 Zimmer Gender Solutions Patellofemoral Patellofemoral joint fem implant PMMA Sizes 1 - 5 - Left & Right $2,750.00
Joint System precoat
12.7.2 - Non-Alloy
Ceramic Surface
Smith & Nephew Surgical Pty Ltd
SN834 Journey Knee System Patella Femoral Trochlear Component,cemented, Oxinium Sm, Med Lg, XLg $3,000.00
Replacement Trochlear Component
12.8.1 - Cemented, All Polyethylene
Advanced Surgical Design & Manufacture Ltd
AE050 Active Knee Patella Patella, cemented, UHMWPE Sizes 1 - 5 $600.00
Prostheses List by Category, Groups and Sponsor Page 215 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
AE136 HemiCAP Patello-Femoral Resurfacing An all-polyethylene patella resurfacing 20mm,25mm,30mm $600.00
System - Patella Component device used alone or in conjunction with a
femoral trochlear component Available in
2 configurations Button and Anatomic
B Braun Australia Pty Ltd
BB202 Emotion Total Knee System (TKS) All poly patellar, UHMWPE cemented, 3 P1 to P6, 26 - 41 x 7 - 12mm $600.00
Patellar Component pegs, onlay
BB208 Columbus Total Knee System (TKS) All poly patellar, UHMWPE cemented, 3 P1 - P4 $600.00
Patellar Component pegs, onlay
Biomet Australia Pty Ltd
BH121 RHK Knee - Patella Patella Small (31mm), Medium $600.00
(34mm), Large (37mm)
BI176 Biomet Universal Patellar component All poly Patella, cemented, UHMWPE, size 25 to 37mm $600.00
domed
BI899 ROCC Patellar Component All poly Patella, cemented, UHMWPE, 1-8 $600.00
anatomically shaped
Corin Australia Pty Ltd
CR103 Score Knee System Patellar Component All poly patella UHMWPE, cemented 6 Diameters $600.00
DJO Australasia Pty Ltd
DD022 3D Knee System Patellar component All poly, cemented patella, 3 pegs Size 26 to 38mm $600.00
Endotec Australia Pty Ltd
EA012 Buechel-Pappas Ultracoat Total Knee All poly patella, cemented, 3 pegs 1-6(inc) $600.00
Replacement System Patellar Component
ESKA Australia
EK024 RP (Rotating Platform) patella component Patella, all polyethylene (UHMWPE), can small, medium, large $600.00
be used either cemented or uncemented
Exactech Australia
EX038 Optetrak Total Knee System Patellar 26-41mm $600.00
Finsbury Orthopeadics Australia Pty Ltd
FI012 MRK (Medial Rotation Knee) Total All Poly Patellar, UHMWPE, 1 central 20-30mm $600.00
Knee System Patellar Component peg, This is a uncemented poly button
FI057 Saiph Knee System Patella Component Inset or Onset Polyethylene Patella Small & Large, 16mm - 28mm $600.00
Component
FOL Technology PTY Ltd
FO014 Trekking Knee System, Patellar Patellar 30 - 40 $600.00
Prostheses List by Category, Groups and Sponsor Page 216 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Global Orthopaedic Technology
GO001 RBK Total Knee System Patella Patella component All poly, UHMWPE, 24mm - 40mm $600.00
component cemented, 3 pegs
GO189 APEX Knee Reconstruction System, All-Poly Dome 3 Peg Patella 29mm x 10mm & 8mm, 32mm $600.00
All-Poly 3 Peg Dome Patella, Size x 10mm & 8mm, 35mm x
29mm to 41mm x 8mm to 10mm 10mm & 8mm, 38mm x 10mm
& 8mm, 41mm x 10mm
Johnson & Johnson Medical Pty Ltd
DP152 PFC Sigma Knee System patella Cemented, all poly, oval dome, round 25-50mm $600.00
component dome and inset patella
DP264 SROM Noiles Knee System patella All poly, cemented patella Sizes 25 - 38mm $600.00
DP377 AMK Patella All poly, cemented Size 30 - 38mm $600.00
DP524 LCS Complete Knee System patella All Poly patella, UHMWPE, cemented Sizes small to large+ $600.00
component
Link Orthopaedics Australia
LO042 LINK Endo Model Knee Patella Patella Component, UHMWPE, cemented Small, medium & large $600.00
Component
LO057 LINK Lubinus Total Patella Glide Patella Component, UHMWPE, cemented Small, medium & large $600.00
Replacement (patella component)
Mathys Orthopaedics Pty Ltd
MA111 Balansys Patella Component All Polyethylene, UHMWPE, cemented Dia 25, 28, 31, 34, 37mm $600.00
Medacta Australia Pty Ltd
MU031 Evolis Knee System Patella Component All poly patella, cemented, UHMWPE 20, 24,28, 30, 33, 36, 39mm $600.00
diam
MU041 Cinétique Knee System Patella All Poly Patella, UHMWPE, cemented, 3 sizes: Size#1-2; #3-4; #5-6 $600.00
Component dome with 3 pegs
MU061 GMK Inset Patella Inset cemented polyethylene patella sizes 1-2; 3-4; 5-6 $600.00
(20/24/28/32mm diameter)
MU072 GMK Resurfacing Patella resurfacing three pegged cemented size 1- 2, 3-4, 5-6 $600.00
polyethylene patella
Oceania Orthopaedics
OO012 ACS Knee System - PE patella implant ACS PE patella 26mm, 29mm, 32mm, 35mm $600.00
Prostheses List by Category, Groups and Sponsor Page 217 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Orthotech Pty Ltd
OH023 Optetrak Total Knee System Patellar 26-41mm $600.00
Smith & Nephew Surgical Pty Ltd
SN323 Genesis II Patella Component Patella Component, Inlay, cemented, 23-35mm $600.00
UHMWPE, can be used for multiple
systems (Genesis II, Journey PFJ, Journey
Deuce, Legion)
SN350 Genesis Knee System Patella Component Patella Component, cemented, all poly, X-Small - Large $600.00
UHMWPE
SN382 Profix Knee System Patella Component Patella Component, UHMWPE, Inset and 23-35mm $600.00
Onlay, cemented
SN394 Mod III Patella Femoral Component Patella Component, UHMWPE, Onlay, Mini-Large $600.00
cemented, for Mod III
Stryker Australia Pty Ltd
HW105 Duracon Knee System Patella Patella component, UHMWPE (Duration), Small, Medium, Large, Xlarge $600.00
Component cemented
HW140 Kinemax Knee System Patella Patella component Symmetric & Small, Medium, Large $600.00
Component Asymmetric, UHMWPE (Duration),
cemented
HW182 PCA Modular Knee System Patella Patella component, UHMWPE, Small, Medium, Large, Extra $600.00
Component (Duration), cemented Large
SK314 Avon Patello Femoral System Patella Patella component, UHMWPE (Duration), Small, Medium, Large $600.00
Component Fixed, cemented
SK323 Triathlon Knee System Patella Patella Component, Cemented, Symmetric: 27mm x 8mm, $600.00
Component Asymmetric & Symmetric, (X3) UHMWPE 29mm x 8mm, 31mm x 9mm,
33mm x 9mm, 36mm x 10mm,
39mm x 11mm; Assymetric:
29mm x 9mm, 32mm x 10mm,
35mm x 10mm, 38mm x
11mm, 40mm x 11mm
SK415 Scorpio Knee System Patella Component Patella Component, Inset, Recessed, Concentric & Medialized Dome $600.00
Medialized dome, Universal Dome, patella sizes: 5, 7, 9 & 11;
Concentric Dome, UHMWPE (X3), Universal Dome patella sizes: 3,
Fixed, Cemented 5, 7, 9 & 11; Inset &
Recessed patella sizes: 26, 28,
30 and 32mm
Prostheses List by Category, Groups and Sponsor Page 218 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
SK419 Triathlon Knee System Patella Patella Component, Cemented, 29 (X3)3 x 9mm, 32 x 36 x $600.00
Component Asymmetric, (X3) UHMWPE 10mm, 35 x 39 x 10mm, 38 x
42x 11mm, 40 x 44 x 11mm
ST636 Scorpio Knee System & S7000 Knee Patella component, Inlay, UHMWPE 3, 5, 7, 9, 11, 13 $600.00
System Patella Component (N2VAC), cemented
Tornier Pty Ltd
TO009 HLS Noetos System patella Patella, cemented, UHMWPE small, medium, large $600.00
TO065 HLS Kneetec - Patella Patellar implant of the HLS Kneetec Extra-small, Small, Medium, $600.00
system, UHMWPE, Cemented dome Long
design and anchoring pegs
Wright Medical Australia
WR177 Advantim Total Knee System Patella All Poly UHMWPE 25,28,32mm, 35mm, 38mm, $600.00
41mm
WR190 Advance Total Knee System patella All poly patella, recessed and onlay 25, 28, 32, 35, 38, 41mm $600.00
components
Zimmer Pty Ltd
ZI071 Insall-Burstein II Patella Component All poly, cemented, patella, UHMWPE 32 - 41mm $600.00
ZI093 Miller Galante II Patella All poly Patella, cemented, UHMWPE 32 - 41mm $600.00
ZI148 NexGen Patella Component Ally poly, cemented, patella, UHMWPE 26 - 41 $600.00
ZI432 Natural Knee Patella All poly patella, cemented, UHMWPE Size 0/7mm to 3/10 mm $600.00
12.8.2 - Cemented, Polyethylene, Metal Backed
12.8.2.1 - Mobile
Biomet Australia Pty Ltd
BI903 ROCC Patellar Component Patella Component, cemented, metal 1-8 $1,352.00
backed, CoCr, with mobile poly
Johnson & Johnson Medical Pty Ltd
DP523 LCS Complete Knee System patella Metal backed, CoCr, rotating, cemented Sizes small to large+ $1,352.00
component
JJ669 LCS Patellofemoral Joint Prosthesis Metal backed, CoCr, rotating, cemented, Sizes small to large+ $1,352.00
(patellar component patella
Medacta Australia Pty Ltd
MU045 Cinétique Knee System Patella Patella component, metal backed, CoCr 3 Sizes: Size #1-2; #3-4; #5-6 $1,352.00
Component cemented, with mobile poly
Prostheses List by Category, Groups and Sponsor Page 219 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
MU046 Cinétique Knee System Patella Patella component, metal backed, CoCr 3 sizes: Size #1-2; #3-4; #5-6 $1,352.00
Component cemented, with mobile poly and TiNi
(TiNbN) insert surface treatment
Oceania Orthopaedics
OO014 ACS Knee System - Cemented mobile ACS cemented mobile bearing patella 2, 3, 4, 5, 6 $1,352.00
bearing patella
12.8.3 - Uncemented, Polyethylene, Metal Backed
12.8.3.1 - Mobile
Biomet Australia Pty Ltd
BI901 ROCC Patellar Component Patella Component, uncemented, metal 1-8 $1,352.00
backed, Titanium plasma sprayed surface
(Porous plasma spray PPS) with HA
Endotec Australia Pty Ltd
EA011 Buechel-Pappas Ultracoat Total Knee Patellar component, metal backed, 1-6(inc) $1,352.00
Replacement System Patellar Component uncemented, beaded, Titanium, TiNi surface
treatment for bone and mobile patella poly
Global Orthopaedic Technology
GO008 RBK Total Knee System Patella Patella component, metal back, CoCr, sizes 1 - 5 $1,352.00
component mobile, titanium plasma sprayed with HA,
uncemented
Johnson & Johnson Medical Pty Ltd
DY502 LCS Complete Knee System patella Metal backed, CoCr, rotating, Sizes small to large+ $1,352.00
component uncemented
JJ668 LCS Patellofemoral Joint Prosthesis Metal backed, CoCr, rotating, Sizes small to large+ $1,352.00
(patellar component uncemented, patella
Medacta Australia Pty Ltd
MU052 Cinétique Knee System Patella Patella component, metal backed, CoCr Size #1-2; #3-4; #5-6 $1,352.00
Component uncemented, with titanium micro beads
Oceania Orthopaedics
OO013 ACS Knee System - TCP cementless ACS TCP cementless mobile bearing 2, 3, 4, 5, 6 $1,352.00
mobile bearing patella patella
Prostheses List by Category, Groups and Sponsor Page 220 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
12.8.3.2 - Moulded
Smith & Nephew Surgical Pty Ltd
SM142 TC (Tri Compartment) PLUS Knee Patella Component, metal backed, 8-26mm - 12/35mm $800.00
System and VKS Patella Component uncemented,Titanium Plasma Spray
(Vacuum spray and triple layer), moulded
Stryker Australia Pty Ltd
HW108 Scorpio Knee System Patella Component Patella component, Metal backed, CoCr, Small, Medium, Large, Xlarge $800.00
uncemented, beaded, PA
(Hydroxyapatite), Moulded UHMWPE
(N2VAC), Fixed
ST609 Scorpio Knee System Patella Component Patella component, Metal backed, CoCr, 26-32mm in 2mm increments $800.00
uncemented, beaded, moulded 10mm thick
polyethylene (N2VAC)
Zimmer Pty Ltd
ZI147 NexGen Patella Component Metal backed, trabecular metal 26 - 41 $800.00
(Tantalum), patella component, with
moulded UHMWPE, uncemented
ZI431 Natural Knee Patella CSTi Patella metal backed, with cancellous Size 0 to 3 $800.00
structure Titanium ingrowth
ZI454 Natural Knee Patella CSTi Patella metal backed, with cancellous 0-3 $800.00
structure Titanium ingrowth with highly
crosslinked poly (durasul)
Revision
Zimmer Pty Ltd
ZI266 NexGen Trabecular Metal Augmented Augmented trabecular metal combined Small, medium, large and x-large $1,200.00
Patella with NexGen all poly patella component (2
piece)
12.8.4 - Polyethylene Insert for Mobile Patella
Johnson & Johnson Medical Pty Ltd
JJ697 LCS Total Knee System - Replacement Replacement UHMWPE insert for LCS Small+ to Large+ $600.00
Patella Polyethylene mobile bearing patella
Prostheses List by Category, Groups and Sponsor Page 221 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
12.9.1 - Distal Femur
12.9.1.1 - Condylar only (only when combined with a proximal tibial replacement)
Corin Australia Pty Ltd
CR181 METS Femoral Knee CoCr-Molybedenum with Titanium stem Small and standard $4,481.00
component
CR189 METS Femoral Knee and Stem CoCr-Molybedenum with titanium stem small and standard $4,481.00
12.9.1.2 - Condylar, including metaphyseal and/or diaphyseal
Biomet Australia Pty Ltd
BI865 Orthopaedic Salvage System Femoral Component, Resurfacing or 30 - 70mm $8,008.00
Segmental, CoCr,Ti
Corin Australia Pty Ltd
CR183 METS Tibial Rotating Hinge Polyethylene CoCr-Molybedenum tibial component Stem length 105mm and $8,008.00
114mm
CR185 METS Tibial Rotating Hinge Metal Casing Ti casing and CoCr-Mo tibial component Stem lengths 140mm and 180mm $8,008.00
CR191 METS Proximal Tibial Rotating Hinge CoCr-Mo tibial component and titanium small and standard $8,008.00
Coated casing with hA coated patella tendon
reattachment mechansim
ESKA Australia
EK114 ESKA Tumor Revision System MML Total femoral implant various sizes $8,008.00
Johnson & Johnson Medical Pty Ltd
DY188 Limb Preservation System Distal Femoral Replacement Component XX Small and X Small $8,008.00
Left/Right
Link Orthopaedics Australia
LO156 LINK Endo Model M Modular Knee Femoral Component Extra Small - Extra Large $8,008.00
Prostheses System
Stryker Australia Pty Ltd
HW227 HMRS (Howmedica Modular HMRS Rotating Hinge Distal Femur, 120, 140, 160mm $8,008.00
Replacement System) Rotating Hinge CoCr (Vitallium) uncemented, porous
Distal Femur Component coated, Fixed
Prostheses List by Category, Groups and Sponsor Page 222 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
SK157 GMRS (Global Modular Replacement GMRS Distal Femoral component, CoCr, Small Left 65mm, Small Left $8,008.00
System) Distal Femoral Component uncemented, Fixed 75mm, Small Left 85mm, Small
Left 95mm, Small Right 65mm,
Small Right 75mm, Small Right
85mm, Small Right 95mm,
Standard Left, Standard Right
Wright Medical Australia
WR158 Guardian Limb Salvage System Special indication distal femur Left & Right $8,008.00
Zimmer Pty Ltd
ZI570 Zimmer segmental system - distal femoral Distal femoral component B & C, left and right $8,008.00
component
Complex
Wright Medical Australia
WR160 Limb Salvage System for the skeletally Repiphysis non invasive expandable Custom Made $67,600.00
immature - Repiphysis custom designed prosthesis for proximal
tibia, distal or total femur (all components
delivered as one unit)
12.9.2 - Proximal Tibia
12.9.2.1 - Condylar only (only when combined with a proximal tibial replacement)
Biomet Australia Pty Ltd
BH134 Orthopaedic Salvage System Tibial Component, Resurfacing or 63-83mm $8,102.00
Segmental, Non-Modular tray, CoCr, Ti
Corin Australia Pty Ltd
CR152 METS Tibial Component Rotating Hinge Small and standard $8,102.00
CoCr-Molybdenum with UHMWPE
bumper pad
ESKA Australia
EK110 ESKA Tumor Revisiion System MML Distal femoral implant various sizes $8,102.00
EK113 ESKA Tumor Revision System MML Total femoral implant various sizes $8,102.00
Prostheses List by Category, Groups and Sponsor Page 223 of 911
12 - KNEE
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Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW234 HMRS (Howmedica Modular HMRS stemmed tibial baseplate, CoCr One size only $8,102.00
Replacement System) Stemmed Tibial (Vitallium), uncemented, porous coated,
Baseplate w/large connecting stem attached for
diaphyseal fixation, Fixed
Fixed Stem
Biomet Australia Pty Ltd
BH135 Orthopaedic Salvage System Tibial Component, Resurfacing or 63-83mm $4,982.00
Segmental, Non-Modular tray, CoCr, Ti
Stryker Australia Pty Ltd
HW196 HMRS (Howmedica Modular HMRS Tibial Joint (baseplate) - 5553 $4,982.00
Replacement System) Tibial Joint uncemented, CoCr (Vitallium), porous
(Baseplate) coated, w/medial & lateral flanges moulde
agaibnst tibia w/bar bolt fixation, and metal
cHydroxyapatitember for axis of hinge
HW197 HMRS (Howmedica Modular HMRS Proximal Tibia, uncemented, CoCr 6346 $4,982.00
Replacement System) Proximal Tibial (Vitallium), porous coated, and metal
Component cHydroxyapatitember for axis of hinge,
connects to anchorage piece for bone
attachement, Fixed
Wright Medical Australia
WR164 Guardian Limb Salvage System Stemmed tibial tray 1 - 5 $4,982.00
12.9.2.2 - Condylar, including metaphyseal and/or diaphyseal
Corin Australia Pty Ltd
CR133 METS Tibial Fixed Hinge CoCr-Molybdenum Stem lengths 140mm and 180mm $8,034.00
CR137 METS Proximal Tibia Fixed Hinge CoCr-Molybdenum proximal tibial Small and standard $8,034.00
component including bumper
CR138 METS Proximal Tibia Fixed Hinge CoCr-Molybdenum with HA coated Small and standard $8,034.00
Coated patella tendon reattachment mechanism
and bumper
CR151 METS Proximal Tibia Rotating Hinge Titanium with UHMWPE bearing Small and standard $8,034.00
CR192 METS Proximal Tibial Rotating Hinge UHMWPE bearing component N/A $8,034.00
Coated
Prostheses List by Category, Groups and Sponsor Page 224 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
ESKA Australia
EK109 ESKA Tumor Revision System MML Distal femoral implant various sizes $8,034.00
Johnson & Johnson Medical Pty Ltd
DY195 Limb Preservation System Tibial Replacement Component XX Small - Med $8,034.00
Stryker Australia Pty Ltd
SK156 GMRS (Global Modular Replacement GMRS Proximal Tibial component, CoCr, Small, Standard $8,034.00
System) Proximal Tibial Component uncemented, porous coated, 7 x
tendon/suture holes for soft tissue re-
attachment, Fixed
Wright Medical Australia
WR152 Guardian Limb Salvage System Proximal Tibial replacement One Size Only $8,034.00
Fixed Stem
Link Orthopaedics Australia
LO160 LINK Endo Model M Modular Knee Tibial Components Extra Small - Extra Large $5,482.00
Prostheses System
12.9.3 - Diaphyseal Extension Piece (Femoral or Tibial)
Biomet Australia Pty Ltd
BI868 Orthopaedic Salvage System Diaphyseal Segment or Diaphyseal Diaphyseal Segment 3-23cm, $4,410.00
Coupler, Stacking Adapter and Locking Diaphyseal coupler 10-30cm
Screws, Ti
Corin Australia Pty Ltd
CR150 METS Tibial Shaft Titanium shaft 45-115mm $4,410.00
CR187 METS Integral shaft and stem Titamium shaft with HA coated collar Shft length 30-70mm, stem $4,410.00
component length 120mm
Link Orthopaedics Australia
LO161 LINK Endo Model M Modular Knee Coupling One Size only $4,410.00
Prostheses System
Stryker Australia Pty Ltd
HW204 HMRS Extension Piece Extension Piece, Uncemented CoCr, 60mm, 80mm, 100mm $4,410.00
connects to anchorage piece (optional)
Prostheses List by Category, Groups and Sponsor Page 225 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
HW207 HMRS (Howmedica Modular HMRS Connecting Piece, uncemented, One size only $4,410.00
Replacement System) Connecting Piece CoCr (Vitallium) 2 parts, bolted together
with 2 screws, connecting Distal &
Proximal Femur +/- extension piece for
total femur replacement.
HW246 MRS (Modular Replacement System) MRS Femoral Body uncemented, Standard Diametre 40-220mm $4,410.00
Femoral Body male/female connections, Titanium in 20mm increments and small
diameter 40-160mm in 20mm
increments
SK162 GMRS (Global Modular Replacement GMRS Connection Piece, uncemented Left 80, 90mm; Right 80, $4,410.00
System) Connection Piece Titanium, to replace varying lengths of 90mm
diaphyseal bone loss
Wright Medical Australia
WR166 Guardian Limb Salvage System Guardian mid section male/female taper 40, 50, 60, 70, 90, 110, $4,410.00
140mm
Zimmer Pty Ltd
ZI576 Zimmer segmental system - segments - fem/tib segment male-female Male/female x 30, 40, 60, 80, $4,410.00
femoral/ tibial 100, 120, 140, 160, 180,200,
220mm. Male/Male x 80, 90,
200mm.
12.9.3.1 - Incorporating Bone Fixation
Johnson & Johnson Medical Pty Ltd
DY189 Limb Preservation System LPS Diaphyseal Stem, Cemented, Bowed, 11mm - 17mm diameter x 150 $4,576.00
with 2cm Beaded Collar - 200mm length
DY193 Limb Preservation System LPS Diaphyseal Stem, Cemented, 9mm - 17mm diameter, 100 - $4,576.00
Straight, with 2cm Beaded Collar 125mm length
Stryker Australia Pty Ltd
SK161 GMRS (Global Modular Replacement GMRS Extension Piece, uncemented 30, 40, 50, 60, 70, 80, 100, $4,576.00
System) Extension Piece Titanium, connects to anchorage piece 120, 140, 160, 180, 200,
(optional) for increases diaphyseal 220mm
replacement
Wright Medical Australia
WR150 Guardian Limb Salvage System Guardian beaded extended collar Femoral 11, 13, 15, 17mm x 152mm $4,576.00
Stem Straight/Tapered - Titanium
Prostheses List by Category, Groups and Sponsor Page 226 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
12.9.4 - Bone Anchorage Piece
Stryker Australia Pty Ltd
HW205 HMRS (Howmedica Modular HMRS Straight Anchorage Piece (Stem) 11, 12, 13, 14, 15mm $4,451.00
Replacement System) Straight w/ small diaphyseal replacement,
Anchorage Piece uncemented, porous coated, CoCr
(Vitallium), porous coated with lateral
flange w/ 3 holes for fixation
HW206 HMRS (Howmedica Modular HMRS Curved Anchorage Piece 12, 13, 14, 15, 16, 17, 19mm $4,451.00
Replacement System) (Howmedica w/diaphyseal replacement, uncemented,
Modular Replacement System) Curved CoCr (Vitallium), porous coated with
Anchorage Piece lateral flange w/ 3 holes for fixation
SK159 HMRS (Howmedica Modular HMRS Plus Curved Anchorage Piece with 12, 13, 14, 15, 16, 17, 19mm $4,451.00
Replacement System) Plus Curved GMRS locking taper for crossover w/
Anchorage Stem GMRS system. Offers small diaphyseal
replacement, uncemented, CoCr
(Vitallium), porous coated with lateral
flange w/ 3 holes for fixation, Fixed
SK160 HMRS (Howmedica Modular HMRS Plus Straight Anchorage Piece with 11, 12, 13, 14, 15mm $4,451.00
Replacement System) Plus Straight GMRS locking taper for crossover w/
Anchorage Stem GMRS system. Offers small diaphyseal
replacement, uncemented, CoCr
(Vitallium), porous coated with lateral
flange w/ 3 holes for fixation
12.9.4.1 - With Compression
Biomet Australia Pty Ltd
BI963 Compress Compliant Prestress System Anchor Assembly: Plug, Transverse pin, 10-24mm femoral canal $10,360.00
spindle, nut, cap. diameter,
Prostheses List by Category, Groups and Sponsor Page 227 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
12.9.5 - Tibial Inserts
Biomet Australia Pty Ltd
BH137 Orthopaedic Salvage System Tibial bearing Insert UHMWPE 12-22mm Thick $2,300.00
Corin Australia Pty Ltd
CR184 METS Tibial Rotating Hinge Polyethylene UHMWPE tibial bearing component N/A $2,300.00
CR186 METS Tibial Rotating Hinge Metal Casing UHMWPE tibial bering component N/A $2,300.00
ESKA Australia
EK111 ESKA Tumor Revision System MML Distal femoral implant various sizes $2,300.00
Johnson & Johnson Medical Pty Ltd
DY196 Limb Preservation System Tibial Hinge Insert XX Small - Large, 12 - 31mm $2,300.00
Stryker Australia Pty Ltd
HW251 MRS (Modular Replacement System) Tibial insert UHMWPE (Duration) for Small and Medium in 11, 13, $2,300.00
Tibial Insert MRS Metal Encapsulated Rotating Hinge 16, 21mm
Tibial component, Mobile.
Wright Medical Australia
WR155 Guardian Limb Salvage System Duramer specialised Tibial insert, 8, 10, 12, 16, 20mm $2,300.00
UHMWPE
Zimmer Pty Ltd
ZI566 Zimmer segmental system - articulating Segmental articulating surface B, C, D, E & F - 12, 14, 17, $2,300.00
surfaces 20, 23 & 26mm
12.9.6 - Augments
Biomet Australia Pty Ltd
BI866 Orthopaedic Salvage System Femoral or Tibial Augment, Ti 'Femoral Sleeve - One Size; $2,137.00
OR Femoral Flange - One Size;
OR Tibial Block Augment 10-
20mm; OR Tibial Augment
Sleeve - Small/Large
Prostheses List by Category, Groups and Sponsor Page 228 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Corin Australia Pty Ltd
CR134 METS Tibial Plateau Plate CoCr Small and standard in 4 $2,137.00
thicknesses
CR153 METS Femoral Plateau Plate Titanium Small & Standard, 4 thicknesses $2,137.00
Link Orthopaedics Australia
LO166 LINK Endo Model M Modular Knee Augments Small, Medium, Large $2,137.00
Prostheses System
12.9.7 - Stems
Biomet Australia Pty Ltd
BI864 Orthopaedic Salvage System Stem, Cemented or Porous, Ti (9-19)mm diameter x (90- $3,037.00
300)mm length
Corin Australia Pty Ltd
CR142 METS Stem Titanium, curved and straight 6 diameters, 10-15mm $3,037.00
CR145 METS Tibial Stem Titanium 5 diameters 9-13mm $3,037.00
CR149 METS Integral Shaft & Stem Coated HA coated titanium collar, shaft and stem Shaft Length 15-55mm, stem $3,037.00
length 120mm
Johnson & Johnson Medical Pty Ltd
DY190 Limb Preservation System LPS Diaphyseal Stem Fully Beaded, Porocoat 12.5mm - 18.5mm $3,037.00
Bowed, with 2cm Beaded Collar diameter x 150mm - 200mm
length
DY194 Limb Preservation System LPS Diaphyseal Stem Fully Beaded, Porocoat 10.5mm - 18.5mm $3,037.00
Straight, with 2cm Beaded Collar diameter x 100mm - 125mm
length
Link Orthopaedics Australia
LO167 LINK Endo Model M Modular Knee Stems Exrta Small - Extra Large $3,037.00
Prostheses System
Stryker Australia Pty Ltd
HW247 Howmedica Modular Resection System Oncology Femoral Stem - Vitallium 127mm and 203mm length 11, $3,037.00
13, 15, 17mm diameter
HW250 MRS (Modular Replacement System) MRS Tibial Stem - cemented, CoCr 127mm in 9, 11, 13mm diameter $3,037.00
Tibial Stem (Vitallium), Fixed
Prostheses List by Category, Groups and Sponsor Page 229 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK166 GMRS (Global Modular Replacement GMRS Long Bowed Stem,Titanium, with 200mm stem length in 11, 12, $3,037.00
System) Long Bowed Stem Ti plasma coating, uncemented, proximal 13, 14, 15, 16, 17, 18, 19mm
3cm Hydroxyapatite coated (Purefix)
SK167 GMRS (Global Modular Replacement GMRS Short Bowed Stem,Titanium, with 150mm in: 11, 12, 13, 14, 15, $3,037.00
System) Short Bowed Pressfit Stem Ti plasma coating, uncemented, proximal 16, 17, 18, 19mm
3cm Hydroxyapatite coated (Purefix)
SK168 GMRS (Global Modular Replacement GMRS Straight Fluted Stem,Titanium, with 125mm length in 8, 9, 10, 11, $3,037.00
System) Straight Fluted Stem Ti plasma coating, uncemented, proximal 12, 13, 14, 15, 16, 17, 18,
3cm Hydroxyapatite coated (Purefix) 19mm
SK330 MRS (Modular Replacement System) MRS Femoral stems with female taper, 11 x 127mm, 13 x 127mm, $3,037.00
Femoral Stems Titanium, uncemented, 15 x 127mm, 17 x 127mm
Wright Medical Australia
WR153 Guardian Limb Slavage System Guardian Femoral Stem Straight/Tapered 11, 13, 15, 17mm x 152mm $3,037.00
- Titanium
WR163 Guardian Limb Salvage System Guardian Femoral Stem Straight - without 9, 11, 13 x 120mm $3,037.00
plasma collar Titanium
WR167 Guardian Limb Salvage System Guardian femoral Stem Straight With 9, 11, 13 x 120mm $3,037.00
Plasma Collar - Titanium
Zimmer Pty Ltd
ZI574 Zimmer segmental system - cemented stem Segmental cemented stem 9-19mm x 130mm; 190mm, $3,037.00
250mm
12.9.8 - Couplers or adaptors, incorporating stem extenders, sleeves and
12.9.8.1 - Collar
Biomet Australia Pty Ltd
BI964 Compress Compliant Prestress System Medullary Centering Sleeve 13-25mm $4,498.00
Corin Australia Pty Ltd
CR140 METS Stippled Collar Titanium, HA coated, round or oval 4 sizes round, 4 sizes oval $4,498.00
CR141 METS Smooth Collar Titanium, uncoated, round or oval 4 sizes round, 4 sizes oval $4,498.00
CR146 METS Tibial Collar Coated Titanium collar with HA coating 5 diameters 20-32mm $4,498.00
Prostheses List by Category, Groups and Sponsor Page 230 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Link Orthopaedics Australia
LO164 LINK Endo Model M Modular Knee Collar Couplings 10mm $4,498.00
Prostheses System
Zimmer Pty Ltd
ZI572 Zimmer segmental system - smooth stem Segmental smooth stem collar 12-16mm & 17-19mm $4,498.00
collar
ZI583 Zimmer segmental system - TM stem Segmental TM stem collar 12-16mm, 25mm: 12-16mm, $4,498.00
collar 30mm: 12-16mm, 35mm; 17-
19mm, 30mm; 17-19mm,
35mm
12.9.8.2 - Adaptor
Biomet Australia Pty Ltd
BI965 Compress Compliant Prestress System Femoral Adapter OSS or Finn Adapter $1,700.00
Johnson & Johnson Medical Pty Ltd
JJ825 Limb Preservation System - Diaphyseal Diaphyseal Sleeve 18 - 28mm $1,700.00
Sleeve
JJ826 Limb Preservation System - Sleeve Base Modular revison diaphyseal sleeve base Extra small - large $1,700.00
JJ827 Limb Preservation System - Sleeve Diaphyseal sleeve adapter +0 to +10mm $1,700.00
Adapter
Link Orthopaedics Australia
LO165 LINK Endo Model M Modular Knee Adaptor Coupling Short, Long $1,700.00
Prostheses System
Stryker Australia Pty Ltd
SK172 Howmedica Modular Resection System GMRS Adaptors Male/Female Taper, Male Taper; Female Taper $1,700.00
Titanium/Forged Cobalt Chrome
Complex
Johnson & Johnson Medical Pty Ltd
DY217 Limb Preservation System Intercalary Segment Component 55mm $7,288.00
(Male/Female)
Prostheses List by Category, Groups and Sponsor Page 231 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
12.9.8.3 - Stem extender
Johnson & Johnson Medical Pty Ltd
DY191 Limb Preservation System Total Femoral Segment Component 55 mm Length $4,400.00
(Male/Male)
DY192 Limb Preservation System Segmental Component (Male/Male) 25 to 125mm Length $4,400.00
Link Orthopaedics Australia
LO162 LINK Endo Model M Modular Knee Stem extender, segment 30mm - 250mm $4,400.00
Prostheses System
Wright Medical Australia
WR154 Guardian Limb Salvage System Male-Male Mid-Section extender 40, 50, 60, 70, 90, 110, $4,400.00
140mm
Zimmer Pty Ltd
ZI730 Zimmer Segmental System, Variable Variable Stiffness Stem Extensions - 9 to 19mm diameter, 130mm $4,400.00
Stiffness Stems Straight/Bowed and Precoat for Segmental and 190mm length
System in various sizes.
ZI732 Zimmer Segmental System, Intercalary Trabecular Metal Intercalary Segments for 45mm, 55mm, 65 mm length $4,400.00
Segments various lengths
12.9.9 - Connectors and assembly for hinged prostheses
Biomet Australia Pty Ltd
BH136 Orthopaedic Salvage System Femoral/Tibial Interlocking devices:locking One size only except srew - $726.00
pin, femoral and tibial bushings, tibial small or large, Tibial bearing
bearing. Axle, reinforced Yoke, locking 12-22mm
screws CoCr, Ti
Corin Australia Pty Ltd
CR182 METS Femoral Knee Axle, airclip and brushes component N/A $726.00
CR188 METS Integral shaft and stem Titanium stem insert / component Shaft length 30-70mm, stem $726.00
length 120mm
CR190 METS Femoral Knee with stem Axle, circlip and brushes component N/A $726.00
Prostheses List by Category, Groups and Sponsor Page 232 of 911
12 - KNEE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW144 KRH (Kinematic Rotating Hinge) Tibial KRH Rotating Hinge Tibial bearing Small and Medium $726.00
Bearing Component component, CoCr, Mobile 11mm/15mm by 110mm/180mm
HW145 GMRS (Global Modular Replacement GMRS, MRH, KRH Rotating Hinge Small & standard $726.00
System) MRH (Modular Rotating Hinge) Femoral Bushings & Bumpers UHMWPE,
Kinematic Rotating Hinge (KRH) (Duration)
Femoral Bushings & Bumpers
HW228 HMRS (Howmedica Modular HMRS Rotating Hinge Axle - uncemented, One size only $726.00
Replacement System) Rotating Hinge CoCr (Vitallium)
Axle
HW229 HMRS (Howmedica Modular HMRS Rotating Hinge Femoral Bushing - One size only $726.00
Replacement System) Rotating Hinge UHMWPE, (Duration)
Femoral Bushing
HW230 HMRS (Howmedica Modular HMRS & MRH Rotating Hinge Bumper - HMRS: 0°, 3°, 5° MRH: $726.00
Replacement System) & MRH (Modular (Duration) UHMWPE 0°, 3°
Rotating Hinge) Rotating Hinge Bumper
SK331 MRH (Modular Rotating Hinge) Rotating MRH Assembly pack consists of: Tibial 1 Tibial Sleeve, 1 Bumper $726.00
Hinge Assembly Pack sleeve, Bumper insert & Femoral Bushing Insert, 2 Femoral Bushing
components UHMWPE (Duration) Components
Zimmer Pty Ltd
ZI560 Nexgen complete knee solution Rotating hinge knee cement shield servicing B, C, D, E & F $726.00
kit
ZI571 Zimmer segmental system - segmental Segmental poly insert B & C $726.00
poly insert
ZI573 Zimmer segmental system - hinge Segmental femoral hinge servicing kit B & C $726.00
servicing kit
Prostheses List by Category, Groups and Sponsor Page 233 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.1.1 - Ankle joint component
6.1.1.1 - Liner - fixed bearing
Johnson & Johnson Medical Pty Ltd
DY083 Agility LP Ankle System Agility Ankle Tibial Insert Size 1-6 $660.00
6.1.1.2 - Liner - mobile bearing
Finsbury Orthopeadics Australia Pty Ltd
FI032 Box Ankle Meniscal Insert, UHMWPE Small 5-8mm, Medium 5-8mm $622.00
and Large 5-8mm
Integra Neurosciences Pty Ltd
IG079 Hintegra Total Ankle Prosthesis - PE Sliding insert Size 0 - 6, thickness 5 - 9mm $622.00
Inlay
Johnson & Johnson Medical Pty Ltd
DY408 Mobility Ankle Mobile Bearing 1-6 from 3-11mm $622.00
Lifehealthcare Pty Ltd
LH435 LINK STAR Ankle Prosthesis UHMWPE Sliding Core 6- 14mm $622.00
LMT Surgical Pty Ltd
LM107 CCI Evolution CCI Evolution Bearing Component Std/Std+/Large, 4-10mm $622.00
Tornier Pty Ltd
TO073 Cheville Salto Ankle Prostheses Mobile insert UHMWPE Sizes 0,1,2,3. Each size has $622.00
thickness 4,5,6 & 7mm
6.1.2 - Sinus Tarsi Implant
6.1.2.1 - Metal
Device Technologies Australia Pty Ltd
DE293 Prostop Arthroereisis Subtalar implant 7x12mm 8x12mm 9x14mm $1,390.00
10x14mm 11x16mm 12x16mm
Integra Neurosciences Pty Ltd
IG053 MBA Titanium Subtalar Implant Implant for subtalar joint arthroereisis 6, 8, 9, 10, 12mm and guide $1,390.00
pin 2mm
Prostheses List by Category, Groups and Sponsor Page 234 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Lifehealthcare Pty Ltd
LH454 Horizon Subtalar Implant Subtalar Screw 6mm, 8mm, 10mm, 11mm, $1,390.00
12mm
Lima Orthopaedics Australia Pty Ltd
LC063 Calcaneo stop screw Cannulated self-drilling & self threading Diameter 7mm Length 28mm $1,390.00
eccentric screw for calcaneous stop
LMT Surgical Pty Ltd
LM100 Hyprocure Sinus Tarsi Implant 5-9mm $1,390.00
LM101 Instratek Sub-Talar Lok Arthroereisis Implant System 7-11mm $1,390.00
Orthopaedic Solutions Pty Ltd
OE005 Futura Conical Subtalar Implant The Conical Subtalar Implant (CSI) is 7 - 12 $1,390.00
designed to treat hyperpronated foot and
to stabilize the subtalar joint. It is intended
to block forward, downward and medial
displacement of the talus, allowing for
normal subtalar joint motion while
simultaneously
Wright Medical Australia
WR001 BioArch Subtalar Arthroereisis Implant Conical, tapered, titanium implant with 8, 9, 10, 11, 12mm $1,390.00
blunt thread design.
6.1.2.2 - Metal Poly
Integra Neurosciences Pty Ltd
IG072 Kalix Flat foot implant titanium/UHMWP 9 - 17mm diameter $1,165.00
6.1.3 - Ankle joint
6.1.3.1 - Talar component
Finsbury Orthopeadics Australia Pty Ltd
FI031 Box Ankle Talar Component CoChr. Cementless Small, Medium and Large $2,300.00
Integra Neurosciences Pty Ltd
IG094 Hintegra Total Ankle Prosthesis Talar Implant - Flat talar resection Left - Size 1-5, Right - Size 1-5 $2,300.00
Prostheses List by Category, Groups and Sponsor Page 235 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP871 Agility Ankle System Agility Ankle Talar Size 1 - 6 $2,300.00
DY409 Agility LP Ankle System Wide Ankle Talus Size 1-6 $2,300.00
DY419 Mobile Ankle Uncemented Porocoat Talar component Size 1-6 $2,300.00
Lifehealthcare Pty Ltd
LH433 LINK STAR Ankle Prosthesis Talar Component, cemented xx-Small - x- large $2,300.00
LH436 LINK STAR Ankle Prosthesis Talar Component, cementless xx- small - x-large $2,300.00
LMT Surgical Pty Ltd
LM106 CCI Evolution CCI Evolution Talar Component Std/Std+/Large $2,300.00
Tornier Pty Ltd
TO072 Salto Ankle Prostheses Talar component mobile bearing CoCr, Ti, Sizes 0,1,2,3 left and right $2,300.00
HA
CS
Integra Neurosciences Pty Ltd
IG078 Hintegra Total Ankle Prosthesis - Talar Talar implant for primary surgery Right and left, sizes 0 to 6 $3,100.00
component with Pegs
6.1.3.2 - Tibial component
Finsbury Orthopeadics Australia Pty Ltd
FI030 Box Ankle Tibial Component CoChr. Cementless Small, Medium and Large $2,000.00
Integra Neurosciences Pty Ltd
IG077 Hintegra Total Ankle Prosthesis Tibial implant Right and left, sizes 1 - 6 $2,000.00
IG095 Hintegra Total Ankle Prosthesis Flat Cut Tibial Implant Right & Left, Sizes 1 - 6, $2,000.00
Thickness 8mm or 12mm
Johnson & Johnson Medical Pty Ltd
DY418 Mobile Ankle Uncemented Porocoat Tibial component Size 1-6 $2,000.00
Lifehealthcare Pty Ltd
LH434 LINK STAR Ankle Prosthesis Tibial Component, cemented xx-small - x-large $2,000.00
LH437 LINK STAR Ankle Prosthesis Tibial Component, cementless xx-small - x-large $2,000.00
LH438 LINK STAR Ankle Prosthesis Revision Tibial Component, Cemented Extra small - Extra large $2,000.00
Prostheses List by Category, Groups and Sponsor Page 236 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LMT Surgical Pty Ltd
LM108 CCI Evolution CCI Evolution Tibial Component Std/Std+/Lge/Lge+ $2,000.00
Tornier Pty Ltd
TO071 Cheville Salto Ankle Prostheses Tibial component mobile bearing CoCr, Ti, Sizes 0,1,2,3 left and right $2,000.00
HA
6.1.3.3 - Tibial component, cemented/uncemented, fixed bearing
Johnson & Johnson Medical Pty Ltd
DY082 Agility LP Ankle System Agility Ankle Tibial Shell Right and Left Size 1-6 $1,724.00
6.1.4 - Replacement of other joints of the foot including articulations
6.1.4.1 - Great toe, MTP, total, metatarsal component
Integra Neurosciences Pty Ltd
IG056 Kinetik Great Toe Implant Metatarsal Component made of chrome 1, 2, 3 Right & Left $800.00
cobalt 01-2002, 01-2004, 01-2006, 01-
2003, 01-2005, 01-2007
Smith & Nephew Surgical Pty Ltd
SM008 Toefit - Plus Titanium alloy Metatarsal Component XS-L $800.00
SM047 Toefit - Plus Modular cobalt chrome meta-tarsal head Proximal Insert 6, 7, 8 $800.00
insert for proximal component of total
Metatarsophalangeal arthroplasty
Surgiplas Medical
SP057 Bio-Action Great Toe System Bio-Action Metatarsal Implant Cobalt Small neutral / small left/ small $800.00
Chrome right/ large neutral
SP061 Reflexion 1st MPJ Implant System Reflexion metatarsal stems, 3 part 1st MPJ Small, medium, large $800.00
reconstruction system, 2 part composition
- titanium/cobalt chrome, 1 part
composition - titanium/UHMWPE,
Prostheses List by Category, Groups and Sponsor Page 237 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.1.4.2 - Great toe, MTP, total, phalangeal component
Integra Neurosciences Pty Ltd
IG055 Kinetik Great Toe Implant Phalangeal Component made of titanium 0,1,2,3 $790.00
alloy 01-2010, 01-2012, 01-2014, 01-
2016
Smith & Nephew Surgical Pty Ltd
SM009 Toefit - Plus Titanium Alloy Phalangeal Component XS-L $790.00
Surgiplas Medical
SP056 Bio-Action Great Toe Implant Bio-Action Phalangeal Implant, Titanium Small neutral/ small modified/ $790.00
Alloy and UHMWPE. large modified.
SP063 Reflexion 1st MPJ Implant System ReflexionPhalangeal Bases, 3 part 1st MPJ Small, medium, large $790.00
reconstruction system, 2 part composition
- titanium/cobalt chrome, 1 part
composition - titanium/UHMWPE,
6.1.4.3 - Great toe, MTP, total, articular insert or liner
Smith & Nephew Surgical Pty Ltd
SM046 Toefit - Plus Polyethylene Polyethylene Distal Insert 11 - $530.00
15mm
Surgiplas Medical
SP062 Reflexion 1st MPJ Implant System Reflexion metatarsal heads, 3 part 1st MPJ Standard, long, extra-long $530.00
reconstruction system, 2 part composition
- titanium/cobalt chrome, 1 part
composition - titanium/UHMWPE,
6.1.4.4 - Great toe, resurfacing hemi articulation, metatarsal
Advanced Surgical Design & Manufacture Ltd
AE138 Hemi CAP Articular Resurfacing Great Articular Component 12mm (1-2mm x 1.5-3mm $740.00
Toe System offset), 15mm (1.5-2.5mm x
2.5-4.5mm offset)
AE139 Hemi CAP Articular Resurfacing Great Fixation Component 8mm x 16mm, 9.5mm x 18mm $740.00
Toe System
Prostheses List by Category, Groups and Sponsor Page 238 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SM045 Toefit - Plus Chromium Cobalt Distal Insert 13 - 17mm $740.00
6.1.4.5 - Great toe, resurfacing hemi articulation, phalangeal
Device Technologies Australia Pty Ltd
DE289 AnaToemic AnaToemic Phalangial Prosthesis 17mm, 20mm, 21.5mm, 23mm $1,205.00
Integra Neurosciences Pty Ltd
IG058 K2 Hemi Toe Implant System Surface replacement for base of hallux with 1-4 $1,205.00
titanium plasma coated stem for fixation
and suture hole for FHL tendon transfer
Lifehealthcare Pty Ltd
LH232 Toe Joint Metallic Hemiarthroplasty resurfacing 8mm - 23 mm $1,205.00
prosthesis for the Metatarsophalangeal
Joint
Surgiplas Medical
SP055 Hemi-Great Toe Implant Great Toe implant, Cobalt Chromium XS, S, M, L $1,205.00
Wright Medical Australia
WR045 Wright Titanium Great Toe Great toe titanium 0,1, 2, 3, 4 $1,205.00
WR047 LPT Great Toe Implant Titanium LPT Metatarsal Component Sizes 1, 2 & 3 Regular Great $1,205.00
available in Regular and Angled Toe Toe Implants. Sizes 1 & 2
Angled Great Toe Implants
Prostheses List by Category, Groups and Sponsor Page 239 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.1.4.6 - Great toe, non articulating articulation (for silastic implant replacement)
Orthopaedic Solutions Pty Ltd
OE006 Stayfuse Titanium inter-digital fusion device Prox 2.8mm Blue; Mid 3.8mm $577.00
x 6mm Blue; Mid 4.3mm x
6mm Blue; Prox 3.3mm Grey;
Prox 3.8mm Grey; Mid 3.8 x
6mm Grey; Mid 4.3 x 6mm
Grey; Mid 5.0 x 5mm Grey;
Mid 5.0 x 6mm Grey; Prox
6.5mm Gold; Distal 5.5 x
10mm Gold; Distal 6.5 x 10mm
Gold
Wright Medical Australia
WR044 WMT Orthopaedics Implants Hinge Toe Silastic flexible hinge toe with/without 0, 1, 2, 3, 4, 5, 6, 7 $577.00
and Hammertoe Implant grommets
6.2.1 - Wrist
6.2.1.1 - Carpal component
Integra Neurosciences Pty Ltd
IG110 Universal2 Carpal Component Carpal plate (titanium) with fixed central xs, small, med, large $1,800.00
peg and porous coating
Lifehealthcare Pty Ltd
LH256 Total Wrist Implant System Carpal Component Small, Medium, Large $1,800.00
LH390 Artelon Co-polymer biomaterial built on well Standard & Large $1,800.00
known chemical components (PUUR) -
Polycaprolactone & Urethrane Urea
6.2.1.2 - Radial component
Integra Neurosciences Pty Ltd
IG112 Universal2 Radial Component Radial Implant (cobalt chrome) with x-small - left & right, small - left $3,275.00
integral stem and porous coating & right, medium - left & right,
large - left & right
Prostheses List by Category, Groups and Sponsor Page 240 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Lifehealthcare Pty Ltd
LH253 Total Wrist Implant System Left and Right Radial Components Small, Medium, Large $3,275.00
LH470 Stability Sigmoid Notch Total DRUJ Radial stem is made of Cobalt chromium Small & Large $3,275.00
system / Stability Sigmoid Notch Radial with a CPTi plasma spray on the back for
Stem and Insert. Total Wrist Implant bone ongrowth. Radial Insert is made of
System UHMWP Polyethyelene
6.2.1.3 - Carpal spacer
Integra Neurosciences Pty Ltd
IG111 Universal2 Carpal Poly Component Polyethylene carpal component to restore xs-standard, xs +1, xs+2, small $2,150.00
proper carpal height in Universal2 total - standard, small +1, small +2,
wrist implant Med-standard, med+1, med+2;
large-standard, large+1, large+2
Lifehealthcare Pty Ltd
LH255 Total Wrist Implant System Carpal Ball Small, Medium, Large $2,150.00
Orthopaedic Solutions Pty Ltd
OE027 BioProfile Pyrocarbon Total Wrist Low Temperature Isotropic Pyrolytic Medium, Large $2,150.00
Replacement (Capitate Resurfacing) Carbon Implants for capitate resurfacing
(reverse total wrist arthroplasty)
OE028 BioProfile Pyrocarbon Carpal Implants Low temperature Isotropic Pyrolytic Small, Medium, Large & Extra $2,150.00
Carbon Implants for carpal Large
replacement/interposition, includes
Proximal Scaphoid,
Scapho/Trapezio/Trapezoid & Trapezium
Wright Medical Australia
WR041 Orthosphere The Orthosphere is a spherical 9mm - 14mm $2,150.00
interpositional implant that may be used in
both the carpometacarpal joint and
tarsometatarsal joint as a spherical
interpositional device. It is used to replace
the sympotmatic joint - either between the
trapezium and firs
Prostheses List by Category, Groups and Sponsor Page 241 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI597 NCB Plating System NCB Spacers & Screw Caps 1, 2 and 3 $2,150.00
6.2.1.4 - Distal ulnar stem
Lifehealthcare Pty Ltd
LH400 Ulnar Head Implants UlnarHead CoCr 1,2,3,4 $1,120.00
Medical & Optical Instruments Australia Pty Ltd
MO145 Martin Ulna Head prosthesis Ulnar Stem Titanium Small, medium and $1,120.00
large,2mm,4mm and 17mm
collar
Orthopaedic Solutions Pty Ltd
OE031 Eclypse Modular Pyrocarbon Ulnar A modular titanium stem for ulnar head 6, 7.5, 9mm $1,120.00
Head prostheses
Wright Medical Australia
WR027 E-Centrix Ulnar Head Replacement Ulnar Stem 5.5 STD, 6.5 STD, 7.5 STD, $1,120.00
8.5 STD
WR028 E-Centrix Ulnar Head Replacement Ulnar Stem Extender 20mm $1,120.00
6.2.1.5 - Distal ulnar head
Lifehealthcare Pty Ltd
LH401 Ulnar Head Implants Ulnar Stem CoCr 1,2,3,4 $1,120.00
Medical & Optical Instruments Australia Pty Ltd
MO324 Martin Ulna Head prosthesis UHP Ceramic Head Small, medium and large $1,120.00
MO325 Martin Ulna Head prosthesis UHP Cobalt Chrome Head Small, medium and large $1,120.00
Orthopaedic Solutions Pty Ltd
OE030 Eclypse Modular Pyrocarbon Ulnar A modular pyrocarbon ulnar head 14, 16, 18mm $1,120.00
Head prosthesis
Wright Medical Australia
WR026 E-Centrix Ulnar Head Replacement Ulnar Head 16 x 1.5mm Offset, 16 x $1,120.00
3.0mm Offset, 18 x 1.5mm
Offset, 20 x 1.5Offset, 20 x
3.0mm Offset
Prostheses List by Category, Groups and Sponsor Page 242 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.2.1.6 - Tendon Spacer
Wright Medical Australia
WR053 WMT Orthopaedic Implants Hand Silastic tendon spacer 24in long, 3, 4, 5, 6mm wide $310.00
6.2.2 - Finger Joint Articulations
6.2.2.1 - Thumb, carpometacarpal
Lifehealthcare Pty Ltd
LH333 Trapezio Metacarpal Prosthesis DLC Stem - Cobalt Chrome 1 or 2 $884.00
LH335 Elektra Stem Cobalt Chromium/Hydroxyapatite coated 6-8mm $884.00
LH336 Elektra Neck Cobalt Chromium Extra Short, Short, Medium, $884.00
Long
LH338 Trapezio Metacarpal Prosthesis DLC Cup, Polyethylene One size only $884.00
LH339 Trapezio Metacarpal Prosthesis DLC Neck Cobalt Chrome Short, Medium or long $884.00
LH346 Elektra Cup Cobalt Chromium and Hydroxyapatite One size only $884.00
coating
LH472 SR Hand Implant System SR Hand MCP/TMC (Basal Thumb) XS/S/M/L/XL, 1,2,3,4,5 $884.00
Implants - CoCr- Titanium Alloy,
UHMWPE
LMT Surgical Pty Ltd
LM028 Ascension pyrocarbon carpal implant Pyrocarbon carpal prostheses Multiple sizes $884.00
Orthopaedic Solutions Pty Ltd
OE029 BIOProfile Pyrocarbon Low Temperature Isotropic Pyrolytic Small, Medium, Large & Extra $884.00
Carpometacarpal Implants Carbon Implants for carpometacarpal Large
resurfacing (arthroplasty)
Wright Medical Australia
WR042 WMT Orthopaedic Implants Hand The Swanson Trapezium Implant is a 1, 2, 3, 4, 5 $884.00
flexible, one-piece intramedullary-stemmed
implant developed to restore function to
thumbs disabled by degenerative arthritis
or post-traumatic arthritis.
Prostheses List by Category, Groups and Sponsor Page 243 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
WR043 Wright Swanson Titanium Carpal The Swanson Basal Thumb implant is a 1 to 5 - length 19.3 to 26.3mm, $884.00
Scaphoid, Carpal Lunate, Basal Thumb one-piece intramedullary-stemmed implant width 9.5 to 13.6mm
Implant designed to be used as an adjunct to
resection arthroplasty of the
trapeziometacarpal joint. It acts as a
spacer to preserve joint relationship and
allow appropriate capsulolig
6.2.2.2 - Thumb, interphalangeal
Lifehealthcare Pty Ltd
LH257 Preflex MCP Finger Joint Implant 00/10/20/30/40/50/60mm $585.00
LH328 MCP Finger Prosthesis "Ariadna" Distal part, Stainless Steel 1,2 or3 $585.00
LH330 MCP Finger Prosthesis "Ariadna" Proximal part, Stainless Steel 1,2,or 3 $585.00
LMT Surgical Pty Ltd
LM083 Memometal Ivory Trapezo - metacarpal A cement less Trapezo- Metacarpal Cup sizes 9-11 mm, Head $585.00
cement less prosthesis prosthesis. Short medium and long, Stem
size 1,2,3,4.
Orthotech Pty Ltd
OH202 Daphne Metacarpophalangeal Joint Prosthesis 3, 4, 5, 6 $585.00
Wright Medical Australia
WR046 WMT Orthopaedic Implants Silastic finger joint with/without Ti 00, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 $585.00
Finger/Thumb grommets 470 series
6.2.2.3 - Other fingers, metacarpophalangeal
Finsbury Orthopeadics Australia Pty Ltd
FI045 PIPR Finger Joint Proximal Interphalangeal Replacement Joint Sizes 7 through to 11 $1,400.00
Johnson & Johnson Medical Pty Ltd
DP573 Neuflex Finger Neuflex MCP implant - Anasil Silicone Size 0-60 $1,400.00
DY400 Neuflex Finger Neuflex PIP 1 to 20 $1,400.00
Lifehealthcare Pty Ltd
LH329 PIP Finger Prosthesis 'DGT" Proximal part Stainless Steel textured in 1,2 or3 $1,400.00
Cobalt Chrome
Prostheses List by Category, Groups and Sponsor Page 244 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LH344 PIP Finger Prosthesis "DGT" Distal part, Stainless Steel texture with 1,2 or3 $1,400.00
Cobalt Chrome
LH471 SR Hand Implant System SR Hand PIP (Basal Thumb) Implants - XS/S/M/L/XL, 1,2,3,4,5 $1,400.00
CoCr- Titanium Alloy, UHMWPE
LMT Surgical Pty Ltd
LM011 Ascension Finger Joint Replacement Pyrocarbon, distal or proximal 05D/05P/10D/10P 20D/20P, $1,400.00
30D/30P, 40D/40P/50D/50P
LM053 Osteotec Silicone PIP Joint Replacement 2 component hinged joint replacement for 5 - 50 $1,400.00
the proximal interphalangeal joint
LM095 Hinged finger joint Hinged finger joint replacement 5 sizes screw component - 4 x $1,400.00
18mm, 5 x 18mm, 6 x 20mm, 7
x 22mm, 8 x 25mm; 1 size
pivot component
LM102 Ascension Silicone Finger joint MCP moulded silicone finger joint Various $1,400.00
replacement
6.2.2.4 - Other fingers, interphalangeal
LMT Surgical Pty Ltd
LM103 Ascension Silicone Finger joint PIP moulded silicone finger joint 00-05 $1,600.00
replacement
Mathys Orthopaedics Pty Ltd
MA520 RM Finger Interphalangeal thumb, titanium coated L24.5, diam 6-7 $1,600.00
PEEK Optima, includes expansion screw
MA521 RM Finger Interphalangeal-distal proximal, small, L18 D4.0 - L26 D6.0 $1,600.00
standard, large titanium coated PEEK,
Optima, Semi-constrained
6.2.3 - Elbow
6.2.3.1 - Distal humeral component/s
Biomet Australia Pty Ltd
BH060 Discovery Elbow System Humeral Component, Hydroxy Apatite + (305)mm diam x (75-150)mm $4,618.00
porous coated or cemented length
Prostheses List by Category, Groups and Sponsor Page 245 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DY137 Acclaim Elbow Humeral Stem, Std/Lge 100-200mm $4,618.00
Stryker Australia Pty Ltd
HW377 Souter Strathclyde Elbow Humeral - Long stem, left and right Medium, Large $4,618.00
HW379 Souter Strathclyde Elbow Revision Humeral - Custom, Long Stem A, B, C, D $4,618.00
ST818 Osteonics Solar Elbow System - humeral Titanium alloy with polyethylene bushing Standard, large $4,618.00
assembly
ST819 Osteonics Solar Elbow System - long Titanium alloy with polyethylene bushing Standard, large $4,618.00
humeral assembly
Tornier Pty Ltd
TO068 Latitude Elbow Prosthesis Latitude Humeral Stem component, CoCr Small, Medium, Large for both $4,618.00
left and right
TO070 Latitude Elbow Prosthesis Latitude Ulnar Stem CoCr + UMHWPE Small , Medium, Large $4,618.00
Left and Right specific for both
long and short stem option
Zimmer Pty Ltd
ZI004 Coonrad-Morrey Elbow Humerus - Titanium 4, 6, 8 inch, Left & Right $4,618.00
ZI342 GSB Cemented Elbow GSB Humerus - CoCr alloy/PE 76,86,86L $4,618.00
6.2.3.10 - Accessories - cement restrictor
Stryker Australia Pty Ltd
HW223 Howmedica Modular Resection System Ulna Joint - Vitallium One size only $3,783.00
6.2.3.2 - Proximal radial stem
Biomet Australia Pty Ltd
BH059 Explor Radial Head Stem (5-10)mm x (22-32)mm $1,325.00
Lifehealthcare Pty Ltd
LH403 Radial Head Implants Radial Stem 2,3,4,4N $1,325.00
LMT Surgical Pty Ltd
LM104 Ascension Radial Head Proximal Radial Stem 01/02/03/04, standard & long $1,325.00
Prostheses List by Category, Groups and Sponsor Page 246 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medical & Optical Instruments Australia Pty Ltd
MO271 Acumed Total Radial Head Stem 6-10mm diameter, 0-8mm neck $1,325.00
height
Orthopaedic Solutions Pty Ltd
OE033 MoPyC-Modular Pyrocarbon Radial A modular titanium stem for radial head 7mm, 8mm, 9mm, 10mm $1,325.00
head Prosthesis prosthesis
Tornier Pty Ltd
TO074 RHS Radial Head System, Radial Stem RHS Elbow prosthesis, Proximal Radial Press-Fit Short Stems: 6 to $1,325.00
Stem, Press-fit Short Stems or Long 10mm , neck 13mm or 16mm.
Cemented Stems, Ti Co Cementeed Long Stems: 6.5 or
8mm, neck 19 or 22mm
TO077 Latitude Elbow Prosthesis Latitude Radial Stem component Diam 6.5mm or 5mm $1,325.00
Wright Medical Australia
WR022 Evolve Modular Radial Head Cobalt chromium alloy, standard and plus Stem 4.5 - 9.5mm Standard, $1,325.00
stems +2 & +4mm
6.2.3.3 - Proximal radial head/neck
Biomet Australia Pty Ltd
BH058 Explor Radial Head Head (10-20)mm x (20-24)mm $1,334.00
Lifehealthcare Pty Ltd
LH402 Radial Head Implants Radial Head 2,3,4,4N $1,334.00
LMT Surgical Pty Ltd
LM105 Ascension Radial head Proximal Radial Head 20/22/24mm $1,334.00
Medical & Optical Instruments Australia Pty Ltd
MO270 Acumed Total Radial Head Head 20-28mm $1,334.00
Orthopaedic Solutions Pty Ltd
OE032 MoPyC-Modular Pyrocarbon Radial A modular pyrocarbon radial head / neck 18mm, 20mm, 22mm $1,334.00
head Prosthesis prosthesis
Stryker Australia Pty Ltd
HW381 Radial Head Prostheses Radial Head - Small, Medium, Large 8 - 15mm $1,334.00
Tornier Pty Ltd
TO075 RHS Radial Head System, Radial Head RHS Elbow prosthesis, Radial Head, Ti 18mm to 24mm $1,334.00
Co
Prostheses List by Category, Groups and Sponsor Page 247 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
TO076 Latitude Elbow Prosthesis Latitude Radial Head component Small, Medium, Large, Large + $1,334.00
Wright Medical Australia
WR023 WMT Orthopaedic Implants Radial/Ulna Radial head implant HP silastic 1, 1.5, 2, 2.5, 3 $1,334.00
Head
WR024 WMT Orthopaedic Implants Radial/Ulna Radial head titanium 1, 1.5, 2, 2.5, 3 $1,334.00
Head
WR025 Evolve Modular Radial Head Cobalt chromium alloy head Head 18-28mm Std, +2 and $1,334.00
+4mm
6.2.3.4 - Proximal ulnar component
Biomet Australia Pty Ltd
BH061 Discovery Elbow System Ulnar Component; Hydroxy apatite + (3-5)mm dia x (75-115)mm $3,577.00
porous coated or cemented length
Johnson & Johnson Medical Pty Ltd
DY138 Acclaim Elbow Ulnar Stem, Std/Lge-Left/Right 60-85mm $3,577.00
Stryker Australia Pty Ltd
HW378 Souter Strathclyde Elbow Ulnar - Retentive, non retentive 50 - 90mm (Non), 70 - 90mm $3,577.00
(Retentive)
HW380 Souter Strathclyde Elbow Revision Ulnar - Custom, Long stem Small, Medium $3,577.00
Tornier Pty Ltd
TO013 Tornier Latitude Total Elbow Prosthesis Ulnar component, CoCr + UHMWPE Small, Medium, Large $3,577.00
Zimmer Pty Ltd
ZI003 Coonrad-Morrey Elbow Ulna - Titanium Petite, Left, Right $3,577.00
ZI344 GSB Cemented Elbow GSB Ulna Component - CoCr alloy 12/71,12/61,16/71,16/61 $3,577.00
6.2.3.5 - Proximal ulnar spacer
Zimmer Pty Ltd
ZI464 GSB Elbow Ulna Extension One size only $1,339.00
Prostheses List by Category, Groups and Sponsor Page 248 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.2.3.6 - Elbow pin
Stryker Australia Pty Ltd
HW224 Howmedica Modular Resection System Humeral Axis - Vitallium One size only $829.00
6.2.3.7 - Accessories - bushing / insert / spool
Biomet Australia Pty Ltd
BH062 Discovery Elbow System 2 x Condyle Bearings, 2 x screws, Poly Std, Revision $1,440.00
articulation bearings
Johnson & Johnson Medical Pty Ltd
DY140 Acclaim Elbow Linked Ulnar Metal Bearing or One size only $1,440.00
Polyethylene Yoke
Tornier Pty Ltd
TO069 Latitude Elbow Prosthesis Latitude Humeral Spool component, Standard spool: Small, $1,440.00
standard or anatomic, CoCr + PEEK Medium, Large, Large +,
anterior, posterior or centered,
Anatomic Spool: Small,
Medium, Large, Large +, Left
and Right, Anterior Centred
and Posterior Offset
Zimmer Pty Ltd
ZI005 Coonrad-Morrey Elbow Bushing - Polyethylene, Titanium 1 & 2 $1,440.00
ZI465 GSB Elbow Special Bushing for Humerous Length 76 - 86mm $1,440.00
6.2.3.8 - Accessories - circlips
Stryker Australia Pty Ltd
HW199 Howmedica Modular Resection System Circlip - Vitallium One size only $74.00
Prostheses List by Category, Groups and Sponsor Page 249 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.2.3.9 - Accessories - washers
Zimmer Pty Ltd
ZI345 GSB Cemented Elbow GSB Washer - PE 2/12,4/12,6/12,2/16,4/16,6/16 $138.00
6.2.4 - Shoulder - Humeral
6.2.4.1 - Humeral component and head – monoblock, cemented
Smith & Nephew Surgical Pty Ltd
SN138 Neer 3 Total Shoulder System Humeral stems Head size 15 - 26, stem diam 8 $2,740.00
- 12mm
6.2.4.10 - Bipolar humeral head
Biomet Australia Pty Ltd
BI209 Bi-Angular Shoulder System Bi Polar Head, Chrome Cobalt Std to +4mm $1,400.00
Stryker Australia Pty Ltd
ST676 Osteonics Solar Shoulder Prostheses Solar bipolar humeral inner head, cobalt 22mm with 0, +2 and +4mm $1,400.00
chromium neck lengths
Zimmer Pty Ltd
ZI444 BiPolar Head Humeral Head used with Select Shoulder 26/42 to 26/60 $1,400.00
Humeral Stem - CoCr alloy/ PE
6.2.4.11 - Bipolar humeral shell
Biomet Australia Pty Ltd
BI208 Bi-Angular Shoulder System Bi Polar Shell, Titanium/ Size 40-60mm $1,660.00
UHMWPE/Chrome Cobalt
BI214 Bio-Modular Shoulder System Bi-Polar shell/ Titanium, chrome Cobalt 40-60mm $1,660.00
Stryker Australia Pty Ltd
ST877 Osteonics Solar Shoulder Prostheses Solar bipolar humeral outer head, cobalt 22mm with 0, +2 and +4mm $1,660.00
chromium neck lengths
Prostheses List by Category, Groups and Sponsor Page 250 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.2.4.12 - Standard humeral head
Biomet Australia Pty Ltd
BH126 Versadial Humeral Head Humeral Head (38 -58)mm x (19 -37)mm x $1,327.00
(39-61)mm
BI215 Bio-Modular Shoulder System Humeral Head, Chrome Cobalt 40-54mm $1,327.00
BI218 Bio-Modular Shoulder System Modular Head, Chrome Cobalt Std, +2, +4mm $1,327.00
BI222 Bio-Modular Shoulder System Shoulder Offset Head, Chrome Cobalt 40-54mm $1,327.00
BI835 Bio-Modular Shoulder System Extended Articular Surface Humeral Head, 40 - 54mm $1,327.00
CrCo
Device Technologies Australia Pty Ltd
DE171 Univers 3D Shoulder Prostheses Metal Head 40/14 - 54/23 $1,327.00
DE174 Univers Fracture Prostheses Metal head 43/15 - 51/22 $1,327.00
DE257 Eclipse Humeral Head Prosthesis Eclipse Humeral Head Prosthesis Head 41/16 - 53/20 $1,327.00
DJO Australasia Pty Ltd
DD003 Turon Shoulder System - Humeral Head Turon Standard Humeral Head, Standard 38-54mm x 14-26mm $1,327.00
and Offset
DD030 Foundation Shoulder System Humeral Head, CrCo 38mm to 54mm $1,327.00
Exactech Australia
EX058 Equinoxe Humeral Head The humeral head is used in hemi-shoulder 38mm - 53mm $1,327.00
and total-shoulder joint replacement
procedures and for use in fractures of the
proximal humerus and for use in total-
shoulder joint replacement procedures in
conjunction with an irreparable or
nonfunctional rotat
Global Orthopaedic Technology
GO142 Foundation Shoulder System Humeral Head, CrCo 38mm to 54mm $1,327.00
Johnson & Johnson Medical Pty Ltd
DP020 Global Advantage Shoulder Eccentric Head, Cobalt chrome alloy 44- 56mm x 18, 21mm $1,327.00
DP962 Delta Shoulder system DELTA Humeral Head INOX / ST.Steel / 36 - 42 mm in +0-+4 $1,327.00
Nichtrostender St.
Prostheses List by Category, Groups and Sponsor Page 251 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DY129 Global Advantage CTA Head Extended Lip Rotator Cuff Humeral Head 44 x 18 - 56 x 23 $1,327.00
component
JJ554 DELTA Xtend Delta Xtend CTA Head Extended Lip 48 + 52; 21, 26mm $1,327.00
JJ614 Global AP Shoulder Humeral Head-Eccentric 40 – 56mm $1,327.00
JJ788 Global AP CTA Humeral Head CTA Humeral Head Sizes 44-56mm $1,327.00
JJ828 Global Shoulder System Standard humeral head 40-56mm $1,327.00
Lima Orthopaedics Australia Pty Ltd
LC045 Randelli/SMR Total Shoulder Randelli/SMR Humeral Head 42, 44, 46, 48, 50, 52, 54mm $1,327.00
Mathys Orthopaedics Pty Ltd
MA448 Affinis Total Shoulder Humeral Head - CoCr Diameter 39, 41, 43, 45, 47, $1,327.00
49, 51, 53mm
Orthotech Pty Ltd
OH386 VAIOS Humeral Head Humeral Head 42-54mm $1,327.00
Smith & Nephew Surgical Pty Ltd
SM113 Promos Shoulder Replacement Ball head anatomic R19/H14-R26/H21 $1,327.00
SN403 Modular Cofield Humeral Head 14x36mm - 36x58mm $1,327.00
Stryker Australia Pty Ltd
HW214 Howmedica Modular Resection System Humeral Head Fixed - Vitallium One size only $1,327.00
ST027 Solar Total Shoulder System Dual Offset Humeral Heads 40-50mm diameter, 15-21mm $1,327.00
thickness
ST672 Osteonics Solar Shoulder Prostheses Humeral head polyethylene 40-55mm by 12-34mm $1,327.00
ST673 Osteonics Solar Shoulder Prostheses Dual offset humeral head polyethylene 40,45,50mm Diameter by 15, $1,327.00
18, 21mm Thickness
Synthes Australia Pty Ltd
SY432 Epoca Custom Offset Shoulder Prosthesis Epoca Head 40 - 54mm, Height: 15 - $1,327.00
20.25mm
Tornier Pty Ltd
TO003 Aequalis Primary Shoulder Prostheses Aequalis Primary Eccentric Humeral Head, Diameter: $1,327.00
CoCr 37,39,41,43,46,48,50,52mm
Prostheses List by Category, Groups and Sponsor Page 252 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
TO055 Affinity Shoulder - Standard Humeral High integrity Morse taper and highly 40 x 15, 40 x 18, 40 x 21, 44 x $1,327.00
Head. polished CoCr 15, 44 x 18, 44 x 21, 48 x 15,
48 x 18, 48 x 1, 52 x 15, 52 x
18, 52 x 21, 56 x 15, 56 x 18,
56 x 21.
TO058 Affinity Shoulder - Eccentric Humeral Infinitely dialable eccentric heads, multiple 40 x 18, 40 x 21, 44 x 18, 44 x $1,327.00
Head. head hight per diam, high integrity morse 21, 48 x 18, 48 x 21, 52 x 18,
taper, highly polished CoCr. 52 x 21, 56 x 18, 56 x 21.
Zimmer Pty Ltd
ZI300 Bigliani Shoulder System Bigliani-Flatow Shoulder - Heads (Cobalt 40, 46, 52, 52mm diameters $1,327.00
chrome)
ZI441 Select Shoulder Humeral Head Eccentric - CoCr alloy 44/19 to 56/32 $1,327.00
ZI445 Intermedics Select Shoulder UniPolar Head -metal alloy 40 x 16mm to 56 x 32mm $1,327.00
ZI562 Anatomical Shoulder Anatomical removable head D40 H14; D42 H15; D44 $1,327.00
H16; D46 H16; D48 H17;
D50 H18; D52 H19; D48
H20; D50 H21; D52 H23.
ZI565 Anatomical Shoulder Anatomical Fracture Humeral Head 40mm Left & Right; 44mm Left $1,327.00
& Right; 48mm Left and Right.
Cer
Mathys Orthopaedics Pty Ltd
MA480 Affinis Fracture - Head Affinis Humeral Head - Ceramic 39 to 53 $1,525.00
6.2.4.13 - Resurfacing humeral head
Biomet Australia Pty Ltd
BI343 Copeland Shoulder System Humeral Resurfacing head, macrobond small, med large, xlarge 1-8 $3,200.00
coated
BI345 Copeland Shoulder System Humeral Component, Chrome Cobalt Small, Std, Large (no specific $3,200.00
size)
Johnson & Johnson Medical Pty Ltd
JJ787 Global CAP Resurfacing Humeral Head Global CAP Conservative Anatomical 40-56mm Diameter $3,200.00
Implant Prosthesis (Shoulder Humeral Head
Surface Replacement)
JJ805 Global CAP CTA Global CAP CTA Head 40 - 56 x 15 - 21mm $3,200.00
Prostheses List by Category, Groups and Sponsor Page 253 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LMT Surgical Pty Ltd
LM078 Ascension HRA - Humeral Resurfacing A anatomic semi constrained, monobody 40mm x 16mm to 56mm $3,200.00
Arthroplasty device intended for resurfacing of the x21mm
humeral head.
Smith & Nephew Surgical Pty Ltd
SM170 PROMOS Modular Shoulder System PROMOS Modular Shoulder System 38-54mm $3,200.00
Resurfacing Humeral Head
Synthes Australia Pty Ltd
SY438 Epoca Resurfacing Head The humeral head surface replacement is Diameter 40 - 54mm $3,200.00
designed to replace the humeral articulating
surface and is chrome cobalt with
hydroxyapatite coating underneath
Tornier Pty Ltd
TO031 Aequalis Resurfacing Shoulder Resurfacing humeral head 12 head sizes from 37mm x $3,200.00
13.5mm to 54mm x 27mm, 3
stem lengths: 30, 35 and 40mm
6.2.4.14 - Humeral cup
Biomet Australia Pty Ltd
BH055 Comprehensive shoulder - reverse Reverse shoulder humeral bearing, highly (Standard or Retentive) x (std, $815.00
humeral cup cross linked UHMWPE +3) x (31 to 41)mm
Exactech Australia
EX048 Equinoxe Humeral Liner including The Equinoxe Reverse Shoulder System Liner: 38mm+0, 38mm+2.5, $815.00
Humeral Adapter Tray includes a reverse semi-constrained 42mm+0, 42mm+2.5
prosthesis for use in total-shoulder joint Constrained Humeral Liner:
replacement procedures in cases with an 38mm+0, 38mm+2.5,
irreparable or nonfunctional rotator cuff. 42mm+0, 42mm+2.5 Tray: +0,
+5, +10
Johnson & Johnson Medical Pty Ltd
DP958 Delta Shoulder system Humeral Cup Laterilised Polyethylene 36 - 42mm in +0 to $815.00
+9/STD/LAT/STD Retentive
JJ553 DELTA Xtend High Mobility Humeral PE Cup 38 + 42; 3, 6, 9mm $815.00
JJ559 DELTA Xtend Standard Humeral PE Cup 38 + 42; 3, 6, 9mm $815.00
JJ560 DELTA Xtend Retentive Humeral PE Cup 38 + 42; 6mm $815.00
Prostheses List by Category, Groups and Sponsor Page 254 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Orthotech Pty Ltd
OH390 VAIOS Reverse Humeral Insert Reverse Humeral Insert +0/+6mm $815.00
Smith & Nephew Surgical Pty Ltd
SN888 PROMOS Reverse Modular Shoulder Polyethylene insert for reverse total 36/6mm, 36/9mm, 36/12mm, $815.00
System shoulder joint arthroplasty 42/6mm, 42/9mm, 42/12mm
Tornier Pty Ltd
TO040 Aequalis Reversed Shoulder Eccentric Eccentric Humeral Insert (High Mobility 36mm and 42mm, 2mm $815.00
humeral Insert (High Mobility Cup) Cup) for Aequalis Reversed Shoulder eccentric +6mm and +9mm,
4mm eccentric +9mm and
+12mm
Zimmer Pty Ltd
ZI580 Anatomical shoulder Anatomical Inverse/Reverse Humeral Cup Zero degree Retro; Zero $815.00
degree Retro +6; +10 degree
Retro; –10 degree Retro; +20
degree Retro; -20 degree
Retro;9mm 0 degree Retro;
9mm 0 degree Retro +6.
Reverse
Johnson & Johnson Medical Pty Ltd
JJ552 DELTA Xtend Modular Eccentric Epiphysis HA Coated 1 + 2 Left + Right $2,482.00
6.2.4.15 - Focal defect resurfacing - cap
Advanced Surgical Design & Manufacture Ltd
AE131 HemiCAP Contoured Articular Articular Component - Chrome Cobalt Articular Component 25mm - $4,035.00
Resurfacing Shoulder System 2.5mm x 2.5mm to 5.0mm x
5.0mm offset; Articular
Component 30mm - 4.5mm x
4.5mm to 7.0mm x 7.0mm
offset; Articular Component
35mm - 6.0mm x 6.0mm to
9.5mm x 9.5mm; Articular
Component 40mm - 8.0mm x
8.0mm to 12.0mm x 12.0mm
Prostheses List by Category, Groups and Sponsor Page 255 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.2.4.16 - Focal defect resurfacing - screw
Advanced Surgical Design & Manufacture Ltd
AE132 HemiCAP Contoured Articular Fixation Screw - Titanium Fixation component for 25mm, $1,545.00
Resurfacing Shoulder System 30mm, 35mm, 40mm Artuclar
Components Screw 10.5mm
Dia & 12.5mm Dia & 13.7mm
Dia
6.2.4.19 - Special purpose/tumour prosthesis
Corin Australia Pty Ltd
CR166 METS Humeral Collar Round Smooth Titanium, smooth uncoated collar for a 20mm, 22mm, 24mm $2,316.00
secure fit in the humeral canal
CR167 METS Humeral Component for use with Titanium humeral component Small and standard $7,042.00
Hemi Head
CR168 METS Humeral Head Fixation Screw Titanium screw which fixes the humeral Small and standard $565.00
component and the humeral head together
CR169 METS Humeral Component with Liner Titanium component with HA coated rails Mono-size, left and right $8,990.00
and re-attachment for tissue reattachment, HYMWPE liner
with encased metal ring for use with
contrained glenoid
CR170 METS Humeral Collar Round Coated Titanium colar with HAP coated stipples 20mm, 22mm, 24mm $4,122.00
CR171 METS Humeal Stem Straight titanium stems, 7-11mm diameters Diameters 7-11mm, Lengths $2,723.00
70-90mm
CR172 METS Humeral Shaft Titanium shafts in 15mm increments, Lengths 38-143mm $3,243.00
reconstructs the humeral shaft where there
is diseased or deficient bone
CR173 METS Humeral Integral Shaft & Stem Titanium, combined shaft, stem & collar 20mm shaft plateau with 8mm $7,945.00
Coated with HA coated stipples diameter stem, 24mm shaft
plateau with 10mm diameter
stem
7945
Prostheses List by Category, Groups and Sponsor Page 256 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
CR174 METS Humeral Integral Shaft & Stem Titanium, combined shaft, stem & collar 20mm shaft plateau with 8mm $4,480.00
Uncoated diameter stem, 24mm shaft
plateau with 10mm diameter stem
CR175 METS Humeral Component with Liner Titanium component, UHMWPE liner with Mono-size, left and right $7,083.00
encased metal ring for use with
constrained glenoid
CR176 METS Humeral Component with Titanium humeral component with HA Small and standard $9,342.00
Reattachment for use with Hemi Head coated rails for tissue reattachment
CR177 METS Bayley Walker Glenoid Titanium HAP coated tapered screw with Extra small, small and standard $7,485.00
Component 22.2mm CoCr-Molybdenum head, for
Glenoid fixation
CR178 METS Humeral Hemi-head Titanium humeral hemi-head forming part Diameters 43mm, 46mm, $3,388.00
of a modular system to replace diseased or 52mm, 55mm, 58mm
damaged bone
6.2.4.19 - Special purpose/tumour prosthesis - limb salvage system
Wright Medical Australia
WR159 Limb Salvage System for the Skeletally Repiphysis non invasive expandable Custom Made $67,600.00
Immature - Repiphysis custom designed prosthesis for the upper
limb (all components delivered as one unit)
6.2.4.2 - Humeral component - cemented
Biomet Australia Pty Ltd
BI884 Comprehensive Fracture Stem Fracture Stem Cobalt Chrome, Titanium 4,6,8,10,12,14mm $3,969.00
DJO Australasia Pty Ltd
DD005 Turon Shoulder System - Humeral Stems Turon Humeral Stem, Primary and 6-16mm x 115mm and 6- $3,969.00
Revision 16mm x 200mm
Johnson & Johnson Medical Pty Ltd
DP966 Global FX Shoulder Global FX Stem Chrome 6-12mm and STD and revision $3,969.00
160-220mm length
DY273 Global FX Porocoat FX PC Stem Standard / Long 6-12mm $3,969.00
Mathys Orthopaedics Pty Ltd
MA523 Affinis Shoulder System Stem Cemented - adjustable cone 6, 9, 12 and 15mm $3,969.00
Prostheses List by Category, Groups and Sponsor Page 257 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SM169 PROMOS Modular Shoulder System PROMOS Modular Shoulder System 8x80mm, 8x120mm, $3,969.00
Cemented Humeral Stem 10x80mm, 10x120mm,
12x80mm, 12x120mm,
14x80mm, 8x160mm,
10x160mm, 12x160mm
SN395 Modular Neer 3 Humeral stem component Stem diameter 8-14mm, stem $3,969.00
length 125-175mm
SN404 Modular Cofield Humeral Stem 6mmx115mm - 16mmx245mm $3,969.00
Tornier Pty Ltd
TO056 Affinity Shoulder - Revision Humeral Stem Fixed angle humeral stem with low-profile Long Humeral Stems: 4 $3,969.00
lateral borders, Ti alloy, cemented or diameters - 8, 10, 12, 14mm.
uncemented. Long stem.
Zimmer Pty Ltd
ZI579 Anatomical shoulder Anatomical cemented Humeral Stem 7 x 100mm; 9 x 110mm; 12 x $3,969.00
110mm; 7 x 200mm; 9 x
210mm; 14 x 210mm
Reverse
Johnson & Johnson Medical Pty Ltd
JJ548 DELTA Xtend Monobloc Humeral Cemented Epiphysis 8 to 14 mm $6,800.00
Standard
JJ549 DELTA Xtend Monobloc Humeral Cemented Epiphysis 8 to 14mm $6,800.00
Revision
6.2.4.21 - Necks/collar (modular)
DJO Australasia Pty Ltd
DD002 Turon Shoulder System - Humeral Neck Turon - Humeral Neck Neutral and 7.5 Degree $1,050.00
Johnson & Johnson Medical Pty Ltd
JJ616 Global AP Shoulder Ball Taper Adjustable Neck Assembly N/A $1,050.00
Prostheses List by Category, Groups and Sponsor Page 258 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.2.4.3 - Humeral component - uncemented
Biomet Australia Pty Ltd
BH047 Comprehensive Shoulder System Humeral Stems, standard, mini, micro and 4mm to 20mm Diameter $3,500.00
revision, porous coated, Ti
Device Technologies Australia Pty Ltd
DE168 Univers 3D Shoulder Prostheses Stem 6-12mm $3,500.00
DE173 Univers Fracture Prostheses Shaft 8-13mm $3,500.00
DJO Australasia Pty Ltd
DD029 Foundation Shoulder System Humeral Stem, Ti 6mm to 16mm $3,500.00
DD032 Reverse Shoulder System Humeral Stem, Ti 6mm to 12mm $3,500.00
Global Orthopaedic Technology
GO141 Foundation Shoulder System Humeral Stem, Ti 6mm to 16mm $3,500.00
GO148 Reverse Shoulder System Humeral Stem, Ti 6mm to 12mm $3,500.00
Johnson & Johnson Medical Pty Ltd
DP029 Global Advantage Shoulder Revision Stem Titanium alloy 8mm x 200mm - 14mm x 220mm $3,500.00
DP030 Global Advantage Shoulder Stem Standard, Titanium alloy 6mm - 16mm $3,500.00
DP077 Global Advantage Shoulder Global Advantage Stem Size 8 to 14 or Length 6-16mm $3,500.00
JJ610 Global AP Shoulder Humeral Stem Humeral Stem 6mm, 8mm, $3,500.00
10mm, 12mm, 14mm, 16mm
JJ611 Global AP Shoulder Humeral Stem Long Humeral Stem Long - 8mm, $3,500.00
10mm, 12mm, 14mm
JJ612 Global Shoulder System Porocoat Humeral Stem 6-16mm $3,500.00
Mathys Orthopaedics Pty Ltd
MA522 Affinis Shoulder System Stem Cementless - Titanium, adjustable 6, 7.5, 9, 10.5, 12, 13.5 and $3,500.00
cone 15mm
Smith & Nephew Surgical Pty Ltd
SM110 Promos Shoulder Replacement Humeral Stem 01 - 4 $3,500.00
Stryker Australia Pty Ltd
ST674 Osteonics Solar Shoulder Prostheses Humeral stem polyethylene 3,5,7,9,11 $3,500.00
Prostheses List by Category, Groups and Sponsor Page 259 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Synthes Australia Pty Ltd
SY431 Epoca Custom Offset Shoulder Prosthesis Epoca ZF Cementless Stem 6 - 14mm, Length: 115 - 135mm $3,500.00
Tornier Pty Ltd
TO002 Aequalis Primary Shoulder Prostheses Aequalis Primary stem, Ti Ta 6.5-15mm - 1mm increm wide, $3,500.00
66-167mm long
TO029 Aequalis Fracture Shoulder HA Coated Fracture shoulder humeral stem Cobalt Diam 6.5mm - 130mm and $3,500.00
Chrome, HA coated 170mm lengths, Diam 9mm -
130mm, 180mm and 210mm
lengths. Diam 12mm - 130mm,
180mm and 210mm lengths
TO048 Aequalis Reversed fracture-standard Monobloc Humeral Stem CoCr and HA Length 130mm Dia 7 9 11 13 15 $3,500.00
Coated proximally
TO049 Aequalis Reversed Fracture Shoulder - Monobloc Humeral Stem CoCr and HA Length 170, 180 or 210mm Dia $3,500.00
Revision coated proximally 7 9 11 13mm
TO057 Affinity Shoulder - Standard Humeral Fixed angle humeral stem with low-profile Standard Humeral Stems: 7 $3,500.00
Stem lateral borders, Ti alloy, cemented or diameters - 6, 8, 10, 12, 14,
uncemented. 16, 18mm.
Zimmer Pty Ltd
ZI289 Bigliani Shoulder System Cobalt Chrome Lengths 130 - 200mm, $3,500.00
Thickness 6 - 16mm
ZI326 Bigliani/Flatow Trabecular Metal Porous Tantulum Humeral Stem 6mm-19mm diameter $3,500.00
Humeral Shoulder
ZI443 Select Shoulder Stem - Ti alloy 7mm Short to 14.5mm $3,500.00
ZI446 Intermedics Select Shoulder Long Stem - Ti alloy 7 to 14.5mm $3,500.00
ZI528 Zimmer Trabecular Metal Reverse Trabecular Metal Humeral Stem Titanium 12mm x 130mm; 12mm x $3,500.00
Shoulder System Alloy and Tantalum 170mm; 14mm x 130mm
ZI582 Anatomical Shoulder Anatomical Press-fit Humeral Stem 7 x 100mm, 9 x 110mm, 10.5 x $3,500.00
110mm, 12 x 110mm, 14 x
110mm
6.2.4.4 - Modular humeral component - metaphyseal, cemented
DJO Australasia Pty Ltd
DD036 Reverse Shoulder System Humeral Socket Shell - Ti Neutral, +4mm, +8mm offset $2,436.00
Prostheses List by Category, Groups and Sponsor Page 260 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Exactech Australia
EX051 Equinoxe Humeral Long Stem The long/revision stem is intended for 8x175mm, 8x215mm, $2,436.00
cemented fixation only. The long/revision 10x200mm, 12x200mm
stem is advised when the distal bone
quality is insufficient to adequately anchor
the primary stems (typically as a result of
mid-humeral fractures)
EX055 Equinoxe Humeral Stem, Fracture The fracture stem is intended for cemented Fracture: left: 7mm - 12mm, $2,436.00
fixation only and is advised for 3 & 4 part right 7mm- 12mm Long stem
fractures of the proximal humerus fracture: left 7mm, 200mm right
7mm,200mm
EX059 Equinoxe Humeral Stem, primary The cemented primary humeral stem is 1.5mm o/s, 4.5mm o/s & 6mm $2,436.00
including replicator plate intended for cemented fixation only. The - 17mm
press-fit are intended for press-fit
applications but may be used with bone
cement if deemed appropriate by the
surgeon
EX064 Equinoxe Reverse Shoulder, Fracture Reverse, fracture humeral adapter tray. +0mm. $2,436.00
Humeral Adapter Tray.
Global Orthopaedic Technology
GO152 Reverse Shoulder System Humeral Socket Shell - Ti Neutral, +4mm, +8mm offset $2,436.00
Johnson & Johnson Medical Pty Ltd
JJ833 Delta Shoulder System Modular metaphyseal cemented component 1-4 in 26-42mm $2,436.00
6.2.4.5 - Modular humeral component - metaphyseal, uncemented
Biomet Australia Pty Ltd
BI880 Mosaic Humeral Replacement System Mosaic System - CoCr, Ti Proximal Body - Std to +20 $2,580.00
Device Technologies Australia Pty Ltd
DE256 Eclipse Humeral Head Prosthesis Eclipse Humeral Head Prosthesis Trunnion 41 - 53mm $2,580.00
DJO Australasia Pty Ltd
DD035 Reverse Shoulder System Humeral Socket Insert - UHMWPE 32mm to 40mm $2,580.00
Global Orthopaedic Technology
GO151 Reverse Shoulder System Humeral Socket Insert - UHMWPE 32mm to 40mm $2,580.00
Prostheses List by Category, Groups and Sponsor Page 261 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
JJ551 DELTA Xtend Modular Centered Epiphysis HA coated 1 + 2 $2,580.00
JJ834 Delta Shoulder System Modular metaphyseal component HA coated 1-4 in 26-42mm $2,580.00
Lima Orthopaedics Australia Pty Ltd
LC041 Randelli/SMR Total Shoulder Randelli/SMR Humeral Body with Locking One size only $2,580.00
Screw
Mathys Orthopaedics Pty Ltd
MA481 Affinis Shoulder System Affinis Fracture Stem - metaphyseal, 15.5, Part 2- 18 $2,580.00
uncemented
Orthotech Pty Ltd
OH387 VAIOS humeral neck Humeral Neck one size $2,580.00
Smith & Nephew Surgical Pty Ltd
SM111 Promos Shoulder Replacement Body 30 - 35 - 40mm $2,580.00
SN893 Promos Reverse Modular Shoulder Body 36/mm, 36/10mm, 36/15mm, $2,580.00
System 42/5, 42/10mm, 42/15mm
Tornier Pty Ltd
TO043 Aequalis Reversed Shoulder - Cemented: CoCr and UMWHPE, D.36mm & 42mm $2,580.00
Metaphysis (Cemented or Cementless) Cementless: CoCr, HA Coated and
UMWHPE
6.2.4.6 - Modular humeral component - diaphyseal, cemented, Long (>220mm)
Lima Orthopaedics Australia Pty Ltd
LC048 Randelli/SMR Total Shoulder Randelli/SMR shoulder revision cemented 200, 240, 280mm $3,000.00
stem
6.2.4.7 - Modular humeral component - diaphyseal, uncemented, long (>220mm)
Johnson & Johnson Medical Pty Ltd
DP965 Delta Shoulder system Revision Cementless Diaphysis INOX / Size 1-4 $3,818.00
ST. Steel + Aluminia+HAC
Stryker Australia Pty Ltd
SK427 Solar Reunion Humeral Fracture System Solar Reunion Humeral Fracture System Short & Long $3,818.00
Prostheses List by Category, Groups and Sponsor Page 262 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.2.4.8 - Modular Humeral component - diaphyseal, cemented, short (≤220mm)
Biomet Australia Pty Ltd
BI882 Mosaic Humeral Replacement System Mosaic Distal Stem (6.5 to 14.5) mm dia x (50 to $4,000.00
200)mm length
Johnson & Johnson Medical Pty Ltd
JJ550 DELTA Xtend Modular Humeral Diaphysis 10, 12, 14, 16mm $4,000.00
Lima Orthopaedics Australia Pty Ltd
LC042 Randelli/SMR Total Shoulder Randelli SMR shoulder cemented stem 8, 10, 12, 14, 16mm $4,000.00
Mathys Orthopaedics Pty Ltd
MA479 Affinis Shoulder System Affinis Fracture Stem - diaphyseal, 6/125, 9/125, 12/125, 12/125, $4,000.00
cemented, short 9/200, 12/200
Synthes Australia Pty Ltd
SY571 Epoca Custom Offset Shoulder Prosthesis Epoca Stem - Cemented 6-14mm, Length: 115-215mm $4,000.00
Tornier Pty Ltd
TO078 Aequalis Reversed Shoulder, Cemented Aequalis Reversed Shoulder prosthesis, Diam 6.5mm to 15mm, Length $4,000.00
Stem Cemented Stem, CoCr 100 to 210mm
6.2.4.9 - Modular Humeral component - diaphyseal, uncemented, short (≤220mm)
Biomet Australia Pty Ltd
BI216 Bio-Modular Shoulder System Humeral Stem, titanium 6-15mm $2,800.00
Device Technologies Australia Pty Ltd
DE258 Eclipse Humeral Head Prosthesis Eclipse Humeral Head Prosthesis Cage Small - X-Large $2,800.00
Screw
Johnson & Johnson Medical Pty Ltd
DP956 Delta Shoulder system Modular diaphyseal stem HA coated Size 1-4 $2,800.00
Lima Orthopaedics Australia Pty Ltd
LC043 Randelli/SMR Total Shoulder Randelli/SMR Shoulder Uncemented Stem 11-24mm $2,800.00
Orthotech Pty Ltd
OH388 VAIOS Humeral Stem Humeral Stem 8-16mm $2,800.00
Prostheses List by Category, Groups and Sponsor Page 263 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Synthes Australia Pty Ltd
SY572 Epoca Custom Offset Shoulder Prosthesis Epoca Stem - Uncemented 6-14mm, Length: 115-215mm $2,800.00
Tornier Pty Ltd
TO079 Aequalis Reversed Shoulder, Cementless Aequalis Reversed Shoulder prosthetis, Diam 6.5mm to 154mm, Length $2,800.00
Stem Cementless stem Ti, HA Coated 100mm to 210mm
Zimmer Pty Ltd
ZI575 Anatomical Shoulder Anatomical Fracture Stem 7-14mm x 130mm; 7mm x $2,800.00
170mm; 9, 11, 13mm x 200mm.
6.2.5 - Shoulder - Glenoid
6.2.5.1 - Glenoid component, All poly
Biomet Australia Pty Ltd
BH050 Comprehensive Shoulder - Glenoid Stem Glenoid Post, Ti Regenerx or Polyethylene 1 size $1,995.00
BI342 Copeland Shoulder System Glenoid, UHMWPE One size only $1,995.00
Device Technologies Australia Pty Ltd
DE172 Univers 3D Shoulder Prostheses Cemented glenoid Small, Medium, Large $1,995.00
DJO Australasia Pty Ltd
DD004 Turon Shoulder System - All-Poly Turon - All-Poly Glenoid, Keeled and 38mm, 42mm, 46mm, 50mm, $1,995.00
Glenoid Pegged 54mm
DD031 Foundation Shoulder System Pegged & Keeled Glenoid, compression 38mm to 54mm $1,995.00
moulded UHMWPE
Exactech Australia
EX060 Equinoxe Glenoid, keeled UHMWPE component used to replace the small, medium, large $1,995.00
Glenoid during total shoulder arthroplasty.
This component is to be used with the
Equinoxe total shoulder replacement
EX061 Equinoxe Glenoid, pegged UHMWPE component used to replace the small, medium, large $1,995.00
Glenoid during total shoulder arthroplasty.
This component is to be used with the
Equinoxe total shoulder replacement
Prostheses List by Category, Groups and Sponsor Page 264 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Global Orthopaedic Technology
GO143 Foundation Shoulder System Pegged & Keeled Glenoid, compression 38mm to 54mm $1,995.00
moulded UHMWPE
Johnson & Johnson Medical Pty Ltd
DP086 Global Shoulder Global FIN/ Peg Glenoid Size 40-56 $1,995.00
DY360 Global Advantage Shoulder Anchor Peg Glenoid 40 to 56 mm $1,995.00
JJ637 Global Advantage Shoulder – Cross Cross Linked Polyethylene Glenoid Implant 40 to 56mm including XL $1,995.00
Linked Anchor Peg Glenoid
Lima Orthopaedics Australia Pty Ltd
LC008 Randelli/SMR Shoulder System Cemented Glenoid Mini, Small, Standard $1,995.00
Mathys Orthopaedics Pty Ltd
MA450 Affinis Total Shoulder Glenoid - UHMWPE Size 1 to 4 $1,995.00
Orthotech Pty Ltd
OH385 VAIOS Cemented Glenoid Cemented Glenoid Sm & Lg $1,995.00
Smith & Nephew Surgical Pty Ltd
SM114 Promos Shoulder Replacement Glenoid 1-23: - 4-29 $1,995.00
SN397 Cofield Glenoid All Polyethylene component Small, Standard $1,995.00
Stryker Australia Pty Ltd
ST675 Osteonics Solar Shoulder Prostheses Glenoid component polyethylene 5,7,9,11 $1,995.00
Synthes Australia Pty Ltd
SY434 Epoca Custom Offset Shoulder Prosthesis Epoca Glenoid 40mm - 54mm $1,995.00
Tornier Pty Ltd
TO004 Aequalis Primary Shoulder Prostheses UHMWPE Keeled Glenoid Component 31mm,35mm,39mm dia (small, $1,995.00
medium & large)
TO015 Aequalis Pegged Glenoid USA Pegged Glenoid Polyethylene (UHMWPE) Small, Medium, Large, Extra $1,995.00
Large
TO059 Affinity Shoulder - Pegged Glenoid. Minimally cemented Pegged Glenoid 5 diameters: 44, 44, 48, 52, 56. $1,995.00
UHMWP with finned press-fit central peg.
Zimmer Pty Ltd
ZI304 Bigliani Shoulder System Bigliani-Flatow shoulder - Glenoid 40, 46 and 52mm diameters $1,995.00
(UHMWPE)
Prostheses List by Category, Groups and Sponsor Page 265 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI440 Anatomical Glenoid - PE S, M, L $1,995.00
ZI442 Select Shoulder Glenoid - PE S, M, L, XL $1,995.00
ZI581 Anatomical Shoulder Anatomical Pegged Glenoid Small, Medium and Large $1,995.00
6.2.5.2 - Glenoid component, Metal backed
Biomet Australia Pty Ltd
BH049 Comprehensive shoulder - glenoid Modular hybrid glenoid base UHMWPE; small, medium, large $2,220.00
Titanium
BI217 Bio-Modular Shoulder System Glenoid Component, Cemented, Small, Medium, Large x 4 or $2,220.00
Titanium/UHMWPE 7mm
BI344 Copeland Shoulder System Glenoid Component, HA Coated, Chrome Small, Std, Extra Deep (no $2,220.00
Cobalt, UHMWPE specific size)
Device Technologies Australia Pty Ltd
DE169 Univers 3D Shoulder Prostheses Glenoid Metal Back Small, Medium, Large $2,220.00
Johnson & Johnson Medical Pty Ltd
DP899 S-Fit Metal Glenoid S-FIT M/B Glenoid Size 40-52 $2,220.00
Lima Orthopaedics Australia Pty Ltd
LC038 Randelli/SMR Shoulder System Uncemented Glenoid Mini, Small, Standard $2,220.00
Orthotech Pty Ltd
OH383 VAIOS Glenoid Metal Back Glenoid Metal Back Sm & Lg $2,220.00
OH389 VAIOS Humeral Metal Back Reverse Humeral Metal Back one size $2,220.00
Smith & Nephew Surgical Pty Ltd
SN398 Cofield Glenoid Component Metal backed Standard Base. Base Insert. $2,220.00
Glenoid Comp Sm, Stan, St
W/off
Synthes Australia Pty Ltd
SY436 Epoca Custom Offset Shoulder Prosthesis Epoca Reco Glenoid 42 - 52mm $2,220.00
6.2.5.3 - Glenoid component & insert
Biomet Australia Pty Ltd
BI221 Bio-Modular Shoulder System Glenoid Shell, Titanium Low Profile $4,088.00
Prostheses List by Category, Groups and Sponsor Page 266 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI319 Bigliani Flatow Total Shoulder System - Trabecular Metal Backed Glenoid Diameter 40 - 52mm $4,088.00
Glenoids (uncemented)
6.2.5.4 - Glenoid insert
Biomet Australia Pty Ltd
BI219 Bio-Modular Shoulder System Glenoid Liner Noncemented, UHMWPE Low Profile $1,960.00
Device Technologies Australia Pty Ltd
DE170 Univers 3D Shoulder Prostheses Glenoid PE-Inlay Small, Medium, Large $1,960.00
Johnson & Johnson Medical Pty Ltd
DP898 S-Fit Metal Glenoid S-FIT Glenoid Bearing Size 40-52 $1,960.00
Lima Orthopaedics Australia Pty Ltd
LC039 Randelli/SMR Shoulder System Uncemented Glenoid Liner Mini, Small, Standard $1,960.00
Orthotech Pty Ltd
OH384 VAIOS Glenoid Insert Glenoid insert Sm & Lg $1,960.00
Synthes Australia Pty Ltd
SY437 Epoca Custom Offset Shoulder Prosthesis Epoca Glenoid Insert 42 - 54mm $1,960.00
Zimmer Pty Ltd
ZI529 Zimmer Trabecular Metal Reverse Polyethylene Liner Standard 7 Deg. & Retentive $1,960.00
Shoulder System 65 Deg; 36mm - Neutral, Plus
3mm, Plus 6mm; 40mm -
Neutral, Plus 3mm, Plus 6mm
ZI577 Anatomical Shoulder Anatomical Inverse/Reverse Humeral Poly 36mm x 0, 3 & 6mm; 40mm x $1,960.00
inlay 0, 3 & 6mm.
6.2.5.5 - Reverse glenoid component, Base plate, uncemented
Biomet Australia Pty Ltd
BH052 Comprehensive Shoulder - Reverse Reverse glenoid baseplate, Ti, Porous one size $2,096.00
Glenoid Baseplate coating
Prostheses List by Category, Groups and Sponsor Page 267 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DJO Australasia Pty Ltd
DD053 Reverse Shoulder - Glenoid Baseplate & Reverse Glenoid Component, Baseplate & Baseplate - Small to Large, $2,096.00
Head Head Head - 32mm to 40mm
Exactech Australia
EX049 Equinoxe Glenoid Plate The glenoid plate provides multiple options one size $2,096.00
for screw insertion
Johnson & Johnson Medical Pty Ltd
DP950 Delta Shoulder system Standard Metaglene INOX/ ST. Steel + One size only $2,096.00
Aluminia+HAC
DP951 Delta Shoulder system Revision Metaglene INOX/ ST. Steel + One size only $2,096.00
Aluminia+HAC
JJ562 DELTA Xtend Metaglene . $2,096.00
JJ563 DELTA Xtend Revision Metaglene . $2,096.00
Smith & Nephew Surgical Pty Ltd
SN892 Promos Reverse Modular Shoulder Glenoid Base Plate 5-20mm 1-5 Small Medium $2,096.00
System Large
Tornier Pty Ltd
TO066 Aequalis Reversed Shoulder, Glenoid Glenoid Base Plate (Metaglene) with Long Standard or Revision (Long $2,096.00
Base Plate Post option for revision Post)
dia 25mm and dia 29mm
Zimmer Pty Ltd
ZI533 Zimmer Trabecular Metal Reverse Trabecular Metal Reverse Base Plate - Ti One Size Only $2,096.00
Shoulder System Alloy & Tantalum
ZI578 Anatomical Shoulder Anatomical Inverse/Reverse Glenoid One size only. $2,096.00
Fixation
6.2.5.6 - Glenosphere
Biomet Australia Pty Ltd
BH051 Comprehensive Shoulder - Reverse Reverse glenosphere (31mm to 41)mm x (standard, $2,290.00
Glenosphere +3, +6)
Exactech Australia
EX050 Equinoxe Glenosphere The glenosphere aids in glenosphere 38mm, 42mm $2,290.00
insertion and protects any remaining intact
soft tissues.
Prostheses List by Category, Groups and Sponsor Page 268 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP952 Delta Shoulder system Centror Glenoid INOX / ST.Steel / Size 36-40 /42 $2,290.00
Nichtrostender St.
JJ555 DELTA Xtend Eccentric Glenosphere 38 + 42 $2,290.00
JJ556 DELTA Xtend Standard Glenosphere 38 + 42 $2,290.00
Orthotech Pty Ltd
OH391 VAIOS Glenoid Dome Glenoid Dome 0,1.5mm $2,290.00
Smith & Nephew Surgical Pty Ltd
SN891 Promos Reverse Modular Shoulder Glenosphere centric 36mm, centric 42mm, $2,290.00
System eccentric 36/+5mm, eccentric
42/+5mm
Tornier Pty Ltd
TO067 Aequalis Reversed Shoulder, Glenoid Glenoid Sphere, standard, eccentric or Diam 36 and 42mm $2,290.00
Sphere wear compensation Centre, or Eccentricity +2mm,
or Wear Compensations 10deg
Zimmer Pty Ltd
ZI532 Zimmer Trabecular Metal Reverse Glenosphere - CoCr - Mo Alloy 36mm, 40mm $2,290.00
Shoulder System
ZI564 Anatomical Shoulder Anatomical Inverse/Reverse Glenoid Head 36mm; 40mm $2,290.00
6.2.6 - Shoulder - Accessories
6.2.6.1 - Humeral sleeve
Biomet Australia Pty Ltd
BH129 Mosaic Humeral Replacement System Soft Tissue Attachment Segment short, long $950.00
Overlseeve
Lima Orthopaedics Australia Pty Ltd
LC040 Randelli/SMR Total Shoulder Randelli/SMR Neutral Taper 0 - 6mm $950.00
6.2.6.2 - Humeral spacer
Biomet Australia Pty Ltd
BH128 Mosaic Humeral Replacement System Humeral Stem Extension Segment 80, 110, 140mm $1,000.00
Prostheses List by Category, Groups and Sponsor Page 269 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP964 Delta Shoulder system Humeral Spacer INOX / ST.Steel / Dia 36/42 + 9 $1,000.00
Nichtrostender St.
JJ561 DELTA Xtend Humeral Spacer 9mm $1,000.00
Tornier Pty Ltd
TO011 Aequalis Shoulder Prostheses Reverse CoCr Reverse Humeral Neck diameter 36 & 42mm wide x $1,000.00
9mm high
Zimmer Pty Ltd
ZI530 Zimmer Trabecular Metal Reverse Spacer 9mm, 12mm Taper Insert $1,000.00
Shoulder System
ZI531 Zimmer Trabecular Metal Reverse Dual Taper Insert One Size Only $1,000.00
Shoulder System
6.2.6.3 - Articular insert
Smith & Nephew Surgical Pty Ltd
SN409 Modular Cofield Standard Articular Insert Small, Standard $470.00
6.2.6.4 - Taper assembly
Johnson & Johnson Medical Pty Ltd
JJ615 Global AP Shoulder Fixed 135 Degree Taper Assembly 135 Degree Angle $1,118.00
6.2.6.5 - Eccentrical adaptor
Biomet Australia Pty Ltd
BH127 Versadial Humeral Head Eccentric adaptor, taper insert Std, reverse $1,220.00
Lima Orthopaedics Australia Pty Ltd
LC037 Randelli/SMR Total Shoulder Randelli/SMR Eccentrical Adapter 0 - 6mm $1,220.00
Smith & Nephew Surgical Pty Ltd
SM112 Promos Shoulder Replacement Inclination set allowing 12 degrees of 20 - 22 - 24 - 26mm $1,220.00
inclination in any direction, allowing
surgeon to match the optimal position of
the head with the anatomy of the patient
for anatomic shoulder joint arthroplasty
Prostheses List by Category, Groups and Sponsor Page 270 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Synthes Australia Pty Ltd
SY433 Epoca Custom Offset Shoulder Prosthesis Modular press-fit component for One size only $1,220.00
independent adjustments of the head or
shaft; both medial and posterior offset
6.2.6.6 - Definition screw
Exactech Australia
EX062 Equinoxe Reverse Torque Definition Reverse Torque Definition Screw with One size only $1,220.00
Screw Kit Drive
EX065 Equinoxe Torque Definition Screw Kit. Torque Definition Screw with Drive. One size only. $1,220.00
6.2.6.7 - Reverse humeral tray
Biomet Australia Pty Ltd
BH054 Comprehensive Shoulder - reverse Modular Reverse Humeral tray, to mount Std, +5, +10 $873.00
humeral tray onto Comprehensive stem Ti
Tornier Pty Ltd
TO045 Aequalis Reversed Shoulder - The humeral cup is made of UHMWPE. It D. 36mm +6mm, D.36mm $873.00
Lateralized Insert comes in two diameters (36 + 42mm) to +9mm, D.36mm +12mm,
correspond with the humeral metaphyseal D.42mm +6mm, D. 42mm
components & three heights 6, 9 & 12mm. +9mm, D.42mm +12mm
6.3.1 - Intramedullary Nails
6.3.1.1 - Femoral, Proximal short (<220mm)
Ti
Johnson & Johnson Medical Pty Ltd
MN034 Affixus Hip Fracture Nail System Short Hip fracture nails 9-13mm diameter, 180mm $995.00 $1,200.00
length
6.3.1.13 - Dynamic distraction nail - electronic
Orthotech Pty Ltd
OH393 Wittenstein FITBONE - Active limb Active intramedullary nail one size $16,500.00 $22,500.00
lengthening nail
Prostheses List by Category, Groups and Sponsor Page 271 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
TI
Biomet Australia Pty Ltd
BI248 SST Small Bone Locking Nail Forearm Nail, Titanium 3.5mm x (180-260mm) $1,617.00
6.3.1.2 - Femoral, Proximal long (≥220mm)
Zimmer Pty Ltd
ZI523 SIRUS Nail Sirus Femoral Nail 9, 10, 11, 12, 13mm diam x $1,050.00
300 to 480mm in 20mm
increments
Ti
Johnson & Johnson Medical Pty Ltd
MN035 Affixus Hip Fracture Nail System Long Hip fracture nails 9-15mm diameter, 260-460mm $1,200.00 $1,700.00
length
6.3.1.3 - Femoral, Distal
Austofix
AX020 S2 Nail System Cannulated supracondylar nail, stainless 11/13mm x 160-380mm $1,050.00 $1,085.00
steel
CN
Surgiplas Medical
SP029 OsteoMed Plating & Fixation System Plates - Fracture; Screws - Cannulated Lag 6 Hole Fracture Plate 47 - $330.00
52mm; 2 x 2 Hole Angled
Fracture Plate; 3 x 3 Hole
Angled Fracture Plate; 6.5mm x
(30 -150)mm; 7.3mm x (30 -
150)mm
6.3.1.8 - Arthrodesis ankle
TI
Wright Medical Australia
WR208 Valor Hindfoot Fusion System Valor Hindfoot Fusion Nail, Titanium Alloy 10 & 11.5mm diameter, 150, $1,195.00 $1,700.00
200 & 250mm length, left and
right
Prostheses List by Category, Groups and Sponsor Page 272 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.1.9 - Flexible/paediatric
Ti
Stryker Australia Pty Ltd
SK506 T2 Kids Paediatric Nail Paediatric Flexible Nail 1.5-4mm, 300-450mm $475.00 $950.00
6.3.11 - External Fixateur Standard - any long bone and pelvis
6.3.11.2 - Frame - Full
Smith & Nephew Surgical Pty Ltd
SN031 Original Ilazarov System External circular fixation system, stainless Adult and Paediatric $10,165.00
steel and composite carbon fibre
6.3.11.5 - Rods
Biomet Australia Pty Ltd
BI830 EBI XFIX Vision System Ring Connector Assembly, stainless 1 or 2 bolt model $1,450.00
steel/aluminium
6.3.11.6 - Coupling devices
Com
Biomet Australia Pty Ltd
BI851 EBI XFIX Dynafix System Clamp (Straight, Transport, Rotational T- Ex Small, Small, Adult, 4-6mm $1,662.00
clamp, Adaptor, Lenghtener, Shim, Single)
BI852 EBI XFIX Dynafix System Clamp (Rotational Serrated T-clamp, Ex Small, Small, Adult, 4-6mm $3,348.00
Swivel, Translational, Uniplaner, CD)
6.3.11.7 - Compression/distraction device
Com
Biomet Australia Pty Ltd
BI850 EBI XFIX DynaFix System Hip Distractor Aluminium, Stainless Steel, One Size Only $5,989.00
Titanium
Prostheses List by Category, Groups and Sponsor Page 273 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.12 - External Fixateur Small - upper limb
6.3.12.3 - Monoplanar device
RL
Lima Orthopaedics Australia Pty Ltd
LC055 S.E.M. II 300 External Radiolucent External Radiolucent Fixator with Forearm 25cm to 30cm $2,080.00 $2,500.00
Fixator and collies fracture
6.3.12.5 - Coupling devices
RL
Lima Orthopaedics Australia Pty Ltd
LC059 S.E.M. II 400 External fixator - Connection arch 140° and 180° $45.00
Connector
6.3.12.6 - Compression/distraction device
Biomet Australia Pty Ltd
BI849 EBI XFIX DynaFix System OptiROM Passive Distractor Module One Size Only $2,600.00
6.3.13 - External Fixateur Mini - hand and foot
6.3.13.1 - Frame - Full
Lima Orthopaedics Australia Pty Ltd
LC057 S.E.M. II 400 External Fixator External fixator with 2 hole clamps or 30mm $1,500.00
hinged rod
Wright Medical Australia
WR205 Sidekick Rearfoot Fixator Pre-assembled external fixator for specific n/a $2,480.00 $5,500.00
indications of triple arthrodesis, subtalar
arthrodesis and ankle arthrodesis
6.3.13.4 - Rods
Lima Orthopaedics Australia Pty Ltd
LC060 S.E.M. II 400 External fixator - Threaded Rod Rod length 40 to 100mm $250.00
Threaded Rod
Prostheses List by Category, Groups and Sponsor Page 274 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.13.5 - Coupling devices
RL
Lima Orthopaedics Australia Pty Ltd
LC058 S.E.M. II 400 External Fixator -Clamp Clamp - Left / Right / Threaded / Non One size $100.00
Threaded
LC061 S.E.M. II 400 External fixator -Bolt Bolt One size $35.00
6.3.13.7 - Articulating hinge
RL
Wright Medical Australia
WR206 Sidekick Coretrak Articulating Fixator Sterile kit, includes tube fixator, articulating Standard, long, articulating $2,460.00 $4,700.00
fixator, half pin and pin covers, for
external fixation of the foot or hand
6.3.14 - Bone Cement
6.3.14.1 - Cement only
CareFusion 316 Pty Ltd
ZQ001 Ava-Tex Radiopaque Bone Cement Kit 13.8g Barium-Polymer Powder & 6ml 12mL $174.00
Liquid Monomer (part No. BCPM003
Cook Medical Australia Pty Ltd
WC145 Osteo-Firm Osteo Bone cement - Osteo Firm One size only $174.00
Global Manufacturing Technology Pty Ltd
GM009 C-ment1, C-ment 3, Genta C-ment , Acrylic Bone Cement 40 grams $174.00
Genta C-ment 3
GM018 C-ment 1, C-ment 3, Genta C-ment, Acrylic Bone Cement with Gentamicin 40 grams $174.00
Genta C-ment 3
GM148 BonOs Inject Injectable acrylic vertebroplasty cement 40gm $174.00
Heraeus Kulzer Australia Pty Ltd
HK003 Palamed Single mix PMMA 40 grams $174.00
HK005 Palacos or Palamed bone cement Single mix PMMA 40g $174.00
Johnson & Johnson Medical Pty Ltd
DP107 CMW Bone Cement CMW Bone Cement Various without 20, 40 grams $174.00
Antibiotic
Prostheses List by Category, Groups and Sponsor Page 275 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DY097 Vetebrplastic Cement Vetebrplastic cement One size only $174.00
JJ580 SmartSet HV High Viscosity Bone Methyl Methacrylate, Methly Acrylate 40 Gram $174.00
Cement Copolymer Bone Cement
JJ581 SmartSet MV Endurance Medium PMMA, Styrene Copolymer Bone 40 Gram $174.00
Viscosity Bone Cement Cement
JJ609 Vertebroplasty System Vertobroplasty System 11cc $174.00
Medtronic Australasia Pty Ltd
MC984 CD HORIZON Fenestrated Screw Fenestrated screw cement - High viscosity, 20g powder, 9g vial $174.00
Cement radiopaque, PMMA bone cement
Orthotech Pty Ltd
OH126 Cemex bone cement 1 mix 1 mix 40g powder and 13.3g $174.00
Methylmethacrylate/Polymethylmethacrylate liquid
OH166 Mendec Spine Bone Cement 20g sterile powder / 9.4g sterile $174.00
liquid
OH171 Mendec Spine Bone Cement 20g powder / 9.4g sterile liquid $174.00
Scient'x Australia
SX051 OsseoFix+ System Radiopaque bone cement vertebroplasty 10gm, 11gm, 13gm $174.00
system, including mixing chamber, cement
delivery gun, extension tube, cement
delivery cannula and targeting needle.
Smith & Nephew Surgical Pty Ltd
SN667 Versabond Bone Cement Methyl Methacrylate Methyl Acrylate 40g $174.00
Copolymer, Methylmethacrylate
Homopolymer, Supplied as Powder
(copolymer) and liquid (monomer) in an
ampule
Stryker Australia Pty Ltd
HW322 Surgical Simplex P Radiopaque Bone Polymethyl Methacrylate, Styrene 40 grams $174.00
Cement Copolymer, Barium Sulfate
SK458 Simplex P Speed Set Bone Cement PMMA Bone Cement 40g pack $174.00
Prostheses List by Category, Groups and Sponsor Page 276 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI731 Hi-Fatigue Bone Cement Hi Fatigue Bone Cement 1 x 40 grams $174.00
6.3.14.2 - Antibiotic
CDS
Biomet Australia Pty Ltd
BH112 Optipac Refobacin Plus, Prefilled Vaccum Mixing 40gm $500.00
System, Gentamicin Sulphate, PMMA
Cement
BH113 Optipac Refobacin Plus, Prefilled Vacuum mixing 60-80gm $500.00
system, Gentamicin Sulphate, PMMA
Cement
6.3.14.2 - Cement with Antibiotic
Biomet Australia Pty Ltd
BI243 Refobacin Plus Bone Cement Bone Cement, Gentamicin, PMMA 40gm $184.00
BI844 Refobacin Plus Bone Cement Bone Cement, Methyl methacrylate, 40 gm (2 x 20 gm) $184.00
Gentamicin
BI845 Refobacin Plus Bone Cement Bone Cement, Methyl methacrylate, 80 gm (2 x 40 gm) $184.00
Gentamicin
Heraeus Kulzer Australia Pty Ltd
HK004 Palamed G Single Mix PMMA with with gentamicin 40 grams $184.00
HK006 Palacos or Palamed Bone Cement with Single Mix PMMA with Gentamicin 40 grams $184.00
Gentamicin
HK007 Palacos or Palamed Bone Cement with Single Mix PMMA with Gentamicin 20 grams $184.00
Gentamicin
HK008 Copal G+C High-viscosity, radiopaque bone cement 40g $184.00
with gentamicin and clindamycin
Johnson & Johnson Medical Pty Ltd
DP108 CMW Antibiotic Bone Cement CMW Bone Cement Various with 20, 40 grams $184.00
Antibiotic
JJ577 SmartSet GMV Endurance Medium PMMA, Styrene Copolymer Bone 20-40 gram $184.00
Viscosity Antibiotic Bone Cement Cement With Gentamicin
Prostheses List by Category, Groups and Sponsor Page 277 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ578 SmartSet GHV High Viscosity Antibiotic Methyl Methacrylate, Methyl Acrylate 40 Gram $184.00
Bone Cement Copolymer Bone Cement With Gentamicin
Orthotech Pty Ltd
OH127 Cemex-genta bone cement 1 mix Methylmethacrylate/ 1 mix 40g powder and 13.3g $184.00
Polymethylmethacrylate with gentamiacin liquid
Stryker Australia Pty Ltd
HW320 Antibiotic Simplex Bone Cement with Polymethyl Methacrylate, Styrene 40 grams $184.00
Tobramycin Copolymer, Barium Sulfate
6.3.14.3 - Cement with Complex Delivery System
CareFusion 316 Pty Ltd
ZQ002 AVAmax Plus Radiopaque bone cement system 11G & 13G $500.00
ZQ003 AVAmax Radiopaque bone cement system 11G & 13G $500.00
Johnson & Johnson Medical Pty Ltd
DP446 VacuMix Pre Loaded CMW Cement Vaccum Mixing System Pre Loaded with 50, 80 grams $500.00
Non - Antibiotic Bone Cement
JJ582 SmartMix Cemvac Prefilled Syringe & SmartMix Vacuum Mixing System 60g to 100g $500.00
SmartMix Prefilled Bowl Preloaded With Non Antibiotic Bone
Cement
JJ583 SmartMix Cemvac Perfilled Syringe & SmartMix Vacuum Mixing System 60g to 100g $500.00
SmartMix Prefilled Bowl With Antibiotic Preloaded With Antibiotic Bone Cement
Cement
JJ736 Confidence Spinal cement system Spinal Bone Cement PMMA and 11cc $500.00
Percutaneous Administration Kit
Stryker Australia Pty Ltd
SK426 Cortoss Vertebral Augmentation Kit Cortoss Cement 10cc, Delivery Gun, Mix 10cc $500.00
Tips, Percutaneous Administration Kit
Synthes Australia Pty Ltd
SY429 Vertecem Vertebral Augmentation Vertecem Cement, and Viscosafe Mixing 21gm $500.00
System
Prostheses List by Category, Groups and Sponsor Page 278 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.14.4 - Cement with Antibiotic and Complex Delivery System
Johnson & Johnson Medical Pty Ltd
DP445 VacuMix Pre Loaded CMW Cement Vaccum Mixing System Pre Loaded with 50, 80 grams $500.00
Antibiotic Bone Cement
6.3.14.5 - Accessories - Restrictors
Stryker Australia Pty Ltd
HW006 Stryker Cement Security System PMMA Bone Plug 6 - 24mm $268.00
Tornier Pty Ltd
TO006 Bone Plug UHMWPE - Cement Plug 24mm $268.00
Wright Medical Australia
WR117 Bone Plug PMMA Cement 8, 10, 12, 14, 16mm $268.00
Zimmer Pty Ltd
ZI188 Zimmer Bone Cement Systems Poly Medullary Plug - PMMA 8 - 23 mm $268.00
ZI328 Coonrad/Morrey Elbow Cement PMMA/Plastic Cement Restrictor Extra Small, Small, Regular $268.00
Restrictor
ZI343 GSB Cemented Elbow GSB Elbow Humeral Medullary Plug - PE One size only $268.00
6.3.15 - Bone Graft Substitute
6.3.15.1 - Ceramic, 0-5cc
Austofix
AX066 Graftys BCP - Preformed 5cc Biphasic Calcium Phosphate Granules 0-5cc $760.00
AX073 Graftys Bone Cement - HBS Bone Macroporous Calcium Phosphate Cement 5cc $760.00
Cement
AX078 Graftys Bone Cement - Quickset Bone Macroporous Calcium Phosphate Cement 5cc $760.00
Cement
AX080 Graftys BCP - Granules 5cc Biphasic Calcium Phosphate Granules 0.5-5cc $760.00
Austspine Pty Ltd
AJ005 Kasios TCP TCP Bone graft substitute Granules 5cc $760.00
AJ007 JectOS Injectable synthetic bone graft substitute 5cc $760.00
Prostheses List by Category, Groups and Sponsor Page 279 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AJ010 KGBone Synthetic bone substitute, custom-fit for 4mm-10mm $760.00
KAGE cervical interbody cage
Device Technologies Australia Pty Ltd
DE130 MBCP Micro & Macroporous Biphasic Calcium 0.5 - 3mm (1- 2cc) $760.00
Phosphate, composition - ceramic
consituting calcium phosphate
hydroxyapatic 60% and tricalcium
phosphate beta (TCP) 40%, granules
DE308 BonAlive Granules Bone Graft Substitute - Bioactive Glass 13130 - 0.5-0.8mm small $760.00
Granules granules, 5cc syringe
13330 -1.0-2.0mm medium
granules, 5cc syringe
13430 -2.0-3.15mm large
granules, 5cc syringe
DE310 SINTlife Nanostructured Paste/putty in syringe - 5 cc 5 cc $760.00
DE312 ENGlpore Granules (size 1,0-2, 5 mm) 5 cc Granules (size 1,0-2, 5 mm) 5 $760.00
Granules (size 2, 5-4, 0 mm) 5 cc cc
Granules (size 2, 5-4, 0 mm) 5
cc
Emergo Asia Pacific Pty Ltd
ER002 Kryptonite Radiopaque 5cc sterile kit with syringe with $760.00
barium
ER004 Kryptonite Osteoconductive Adhesive 5cc sterile kit with syringe $760.00
Global Orthopaedic Technology
GO055 ApaPore ApaPore 60. Sterile, hydroxyapatite- 4cc block $760.00
based bone matrix
GO060 ApaPore ApaPore 70. Sterile, hydroxyapatite- 4cc block $760.00
based bone matrix
GO064 ApaPore ApaPore 80. Sterile, hydroxyapatite- 4cc block $760.00
based bone matrix
Johnson & Johnson Medical Pty Ltd
DP447 Biosel 2 BIOSEL II Dose 5G (Calcium Phosphates) 5g $760.00
DY362 Conduit Conduit Cylinder H8 - 20 x D10 - 20mm $760.00
DY363 Conduit Conduit Wedge H6-18 x D15 x L15 $760.00
Prostheses List by Category, Groups and Sponsor Page 280 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DY427 Conduit TCP Bone matrix implant 5cc $760.00
Lifehealthcare Pty Ltd
LH349 Kainos Granules 1 x 2cm3 $760.00
LH350 Kainos Granules 1 x 3cm3 $760.00
LH351 Kainos Granules 1x5cm3 $760.00
LH357 Kainos Blocks 4-8x13x14 $760.00
LMT Surgical Pty Ltd
LM067 Crossbone Bone substitute wedges 6-15mm height $760.00
Medtronic Australasia Pty Ltd
MC415 BCP Biphasic Calcium Phosphate Reabsorbable 1-3cc $760.00
Graft Supplement
MC594 Mastergraft Calcium Phosphate Ceramic Granules 5cc Vial $760.00
MC669 BCP Biphasic Calcium Phosphate Reabsorbable 5cc $760.00
Graft Supplement
MC853 Nanostim Synthetic Bone Paste 1cc $760.00
MC854 Nanostim Synthetic Bone Paste 2cc $760.00
MC855 Nanostim Synthetic Bone Paste 5cc $760.00
Nuvasive Australia and NZ Pty Ltd
NV075 AttraX bone graft substitute 1cc Cylinder (Putty) 1cc, 2cc 2.5cc, 5cc $760.00
2cc Cylinder (Putty)
2.5cc Cylinder (Putty)
5cc (2x2.5cc) Strip (Putty)
Orthotech Pty Ltd
OH374 GeneX GeneX paste 5cc $760.00
OH376 GeneX GeneX putty 5cc $760.00
OH377 GeneX GeneX putty 2.5cc $760.00
Scient'x Australia
SX019 Bonex Granules 2cc $760.00
Stryker Australia Pty Ltd
SK184 VITOSS - Synthetic cancellous bone Beta-tricalcium phosphate 1.2cc dowel $760.00
void filler
SK191 VITOSS - Synthetic Cancellous bone Beta-tricalcium phosphate 5cc morsels $760.00
void filler
Prostheses List by Category, Groups and Sponsor Page 281 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK232 BoneSource Classic Bone Cement Calcium Phosphate Bone Matrix 2.5gm pack $760.00
Replacement. Sodium Phosphate Solution
and Mixing Bowl included
SK233 BoneSource Classic Bone Cement Calcium Phosphate Bone Matrix 5gm pack $760.00
Replacement. Sodium Phosphate Solution
and Mixing Bowl included
SK480 HydroSet Injectable Calcium Phosphate Injectable, rapid set, calcium phosphate 5cc $760.00
Cement bone substitute kit
SR061 HydroSet Injectable Calcium Phosphate Injectable, rapid set, calcium phosphate 3cc $760.00
Cement bone substitute kit
Synthes Australia Pty Ltd
SY003 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone 5g $760.00
Graft Substitute
SY004 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone 1g $760.00
Graft Substitute
SY005 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone 0.5g $760.00
Graft Substitute
SY331 Norian® Fast Set Putty 5cc $760.00
SY333 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone 2.5cc $760.00
Graft Substitute
SY358 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone F1, 2, 3, 4, 5 & C1, 2, 3, 4, 5 $760.00
Graft Substitute-Cervios Cylinder
Wright Medical Australia
WR005 ProDense / Osteoset Composite Bone Void Filler - Pellets 2cc, 5cc $760.00
WR008 ProDense / Osteoset XR Composite Bone Void Filler - Pellets, 3.0mm, 1.25cc $760.00
Injector
WR009 ProDense / Osteoset XR Composite Bone Void Filler - Pellets, 4.8mm, 5cc $760.00
Injector
WR014 OSTEOSET - BVT KIT (STANDARD Mini Bead Kit 5cc Standard/Fast Cure $760.00
CURE, FAST CURE)
WR016 Osteoset Bone Void Filler Calcium Sulphate 3mm & 4.8mm Pellets 5cc $760.00
WR018 Osteoset Bone Void Filler Calcium Sulphate 4.8mm Syringe 5cc $760.00
Zimmer Pty Ltd
ZI192 Bone Graft Substitute Triosite Granules (0.5 - 1.0 mm grain 1 g Tube $760.00
sizes)- HATCP
Prostheses List by Category, Groups and Sponsor Page 282 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI193 Bone Graft Substitute Triosite Granules (2 - 3mm grain size) - 5g Tube $760.00
HATCP
ZI194 Bone Graft Substitute Triosite Block 5 x 5 x 10mm Box of 4 - 10mm $760.00
HATCP
ZI195 Bone Graft Substitute Triosite Block 5 x 5 x 20mm Box of 4 - 20mm $760.00
HATCP
ZI196 Bone Graft Substitute Triosite Block 5 x 5 x 10mm Box of 2 - 10mm $760.00
HATCP
ZI197 Bone Graft Substitute Triosite Block 5 x 5 x 20mm Box of 2 - 20mm $760.00
HATCP
ZI198 Bone Graft Substitute Triosite Oesteotomy Wedges - HATCP 6 - 12mm $760.00
CDS
LMT Surgical Pty Ltd
LM091 FixEx Bone Cement Calcium Phosphate Bone Cement 5cc $1,250.00
Surgiplas Medical
SP064 Osteovation Calcium Phosphate Bone substitute kit, 2-3cc $1,250.00
quick set, EX/Impact/Inject
SP065 Osteovation Calcium Phosphate Bone sbustitute kit; 5cc $1,250.00
Quick Set; EX/Impact/Inject
Synthes Australia Pty Ltd
SY189 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone 8.5, 9.5, 10.5, 12.5 & 14cm $1,250.00
Graft Substitute-Cylinder
SY281 Norian® Injectable Bone Cement 5cc $1,250.00
SY450 chronOS ß-TCP Porous ß-Tricalcium Phosphate Bone 50 mm x25 mm x 3 mm $1,250.00
Graft Substitute & Resorbable Polymer -
Strip
SY573 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone Small Syringe, 5x5x10mm $1,250.00
Graft Substitute-Block
SY575 chronOS™ β-TCP Porous chron β-Tricalcium Phosphate 25x20x6-8mm $1,250.00
Bone Graft Substitute-Wedge
Wright Medical Australia
WR002 ProDense / Osteoset XR Composite Injectable Bone Void Filler 4cc $1,250.00
WR017 Osteoset Bone Void Filler Calcium Sulphate 3mm Syringe 1.25cc $1,250.00
Prostheses List by Category, Groups and Sponsor Page 283 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
WR019 Osteoset MIIG X3 Injectable Calcium Sulphate Bone Void 5cc $1,250.00
Filler, Includes Syringe
6.3.15.10 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), >5cc - 10cc
Medtronic Australasia Pty Ltd
MC663 Mastergraft Matrix 10cc $1,988.00
Stryker Australia Pty Ltd
SK467 VITOSS Foam - Compression Resistant Highly porous bone graft material made 10cc Foam strip (25x100x4) $1,988.00
Synthetic Cancellous Bone Void Filler from beta-tricalcium phosphate (β-TCP)
and Type I bovine collagen.
SK468 VITOSS Foam - Compression Resistant Highly porous bone graft material made 10cc Foam strip (25x50x8) $1,988.00
Synthetic Cancellous Bone Void Filler from beta-tricalcium phosphate (β-TCP)
and Type I bovine collagen.
SK470 VITOSS Foam - Compression Resistant Highly porous bone graft material made Small Cup 52mm Diameter $1,988.00
Synthetic Cancellous Bone Void Filler from beta-tricalcium phosphate (β-TCP)
and Type I bovine collagen.
SK471 VITOSS Foam - Compression Resistant Highly porous bone graft material made Large Cup 56mm Diameter $1,988.00
Synthetic Cancellous Bone Void Filler from beta-tricalcium phosphate (β-TCP)
and Type I bovine collagen.
SK479 VITOSS Foam - Compression Resistant Highly porous bone graft material made 10cc Foam Pack $1,988.00
Synthetic Cancellous Bone Void Filler. from beta-tricalcium phosphate (β-TCP)
and Type I bovine collagen
6.3.15.11 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), >10cc - 20cc
Medtronic Australasia Pty Ltd
MC662 Mastergraft Matrix 20cc $2,256.00
Stryker Australia Pty Ltd
SK469 VITOSS Foam - Compression Resistant Highly porous bone graft material made 20cc Foam strip (25x100x8) $2,256.00
Synthetic Cancellous Bone Void Filler from beta-tricalcium phosphate (β-TCP)
and Type I bovine collagen.
Prostheses List by Category, Groups and Sponsor Page 284 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.15.12 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), >20cc
Stryker Australia Pty Ltd
SK475 VITOSS Foam - Compression Resistant Highly porous bone graft material made Sheet (Wide Strip) 75x100x4mm $3,000.00
Synthetic Cancellous Bone Void Filler. from beta-tricalcium phosphate (β-TCP)
and Type I bovine collagen.
6.3.15.13 - Biologically Active Bone Inductor, 0 - 2.5mg
Medtronic Australasia Pty Ltd
MC806 Infuse Bone Graft Recombinant human bone morphogenetic Extra Small 2.1mg $1,500.00
protein rhBMP-2
MC807 Infuse Bone Graft Recombinant human bone morphogenetic Mini 1.05mg $1,500.00
protein rhBMP-2
6.3.15.14 - Biologically Active Bone Inductor, >2.5mg - 5mg
Medtronic Australasia Pty Ltd
MC808 Infuse Bone Graft Recombinant human bone morphogenetic Small 4.2mg $3,200.00
protein rhBMP-2
6.3.15.15 - Biologically Active Bone Inductor, >5mg - 10mg
Medtronic Australasia Pty Ltd
MC683 Infuse Bone Graft Recombinant human Bone Morphogenetic Medium 8.4mg $6,000.00
Protein rhBMP-2
6.3.15.16 - Biologically Active Bone Inductor, >10mg
Medtronic Australasia Pty Ltd
MC684 Infuse Bone Graft Recombinant human Bone Morphogenetic Large 12mg $6,400.00
Protein rhBMP-2
Stryker Australia Pty Ltd
ST865 OP-1 Implant - Osteogenic Protein 1, Osteoinductive and osteoconductive bone 1 vial $6,400.00
3.5mg graft substitute
Prostheses List by Category, Groups and Sponsor Page 285 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.15.17 - Metal Scaffold
Orthotech Pty Ltd
OH372 Otis Wedge Wedge for tibial osteotomy 6-15mm $1,283.00
Wright Medical Australia
WR071 BioFoam Bone Wedge Titanium metal foam bone wedge used for Depth 14, 18, 20 & 22mm, $1,283.00
angular correction in ankle and foot. Width 10, 18 & 22mm,
Thickness 5, 7.5, 8, 10 &
12mm.
6.3.15.2 - Ceramic, >5cc - 10cc
Austofix
AX069 Graftys Bone Cement - Quickset Bone Macroporous Calcium Phosphate Cement 8cc $1,200.00
Cement
AX071 Graftys Bone Cement - HBS Bone Macroporous Calcium Phosphate Cement 8cc $1,200.00
Cement
AX079 Graftys BCP - Granules 10cc Biphasic Calcium Phosphate Granules 10cc $1,200.00
Austspine Pty Ltd
AJ006 Kasios TCP TCP Bone graft substitute Granules 10cc $1,200.00
AJ008 JectOS 10cc Injectable synthetic bone graft substitute 10cc $1,200.00
Biomet Australia Pty Ltd
BI946 Calcibon Granules or paste, TCP 10cc $1,200.00
Device Technologies Australia Pty Ltd
DE135 MBCP Micro & Macroporous Biphasic Calcium 1- 3mm (10cc) $1,200.00
Phosphate, composition - ceramic
consituting calcium phosphate
hydroxyapatic 60% and tricalcium
phosphate beta (TCP) 40%, granules
DE307 BonAlive Granules Bone Graft Substitute - Bioactive Glass 13140 - 0.5-0.8mm small $1,200.00
Granules granules, 10cc syringe
13340 - 1.0-2.0mm medium
granules, 10cc syringe
13440 - 2.0-3.15mm large
granules, 10cc syringe
Prostheses List by Category, Groups and Sponsor Page 286 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DE311 SINTlife Nanostructured Paste/putty in syringe - 10 10 cc $1,200.00
cc
Emergo Asia Pacific Pty Ltd
ER001 Kryptonite Osteoconductive Adhesive 10cc sterile kit with syringe $1,200.00
ER003 Kryptonite Radiopaque 10cc sterile kit with syringe with $1,200.00
barium
Global Orthopaedic Technology
GO061 ApaPore ApaPore 70. Sterile, hydroxyapatite- 10cc block $1,200.00
based bone matrix
GO065 ApaPore ApaPore 80. Sterile, hydroxyapatite- 10cc block $1,200.00
based bone matrix
GO066 ApaPore Actifuse. Sterile, hydroxyapatite-based 1-2ml to 10cc $1,200.00
bone matrix
Integra Neurosciences Pty Ltd
IG082 MBCP Wedge Composition - 60% hydroxyapatite / 40% MBCP Wedge - 6 degrees to $1,200.00
Ca3(PO4)2 To be used in combination 14 degrees
with Surfix Opening Wedge HTO Plates
and screws/lock screws
Johnson & Johnson Medical Pty Ltd
DY353 Conduit TCP Bone matrix implant 10cc $1,200.00
Lifehealthcare Pty Ltd
LH352 Kainos Granules 1x6cm3 $1,200.00
LH353 Kainos Granules 1x10cm3 $1,200.00
Medtronic Australasia Pty Ltd
MC595 Mastergraft Calcium Phosphate Ceramic Granules 10cc Vial $1,200.00
MC670 BCP Biphasic Calcium Phosphate Reabsorbable 10cc $1,200.00
Graft Supplement
MC856 Nanostim Synthetic Bone Paste 10cc $1,200.00
Nuvasive Australia and NZ Pty Ltd
NV076 AttraX bone graft substitute 6cc (2x3cc) Blocks (Putty) 6cc, 10cc $1,200.00
(>5cc<=10cc) 10cc (2x5cc) Strip (Putty)
Orthotech Pty Ltd
OH373 GeneX GeneX paste 10cc $1,200.00
Prostheses List by Category, Groups and Sponsor Page 287 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
OH375 GeneX GeneX putty 10cc $1,200.00
Scient'x Australia
SX018 Bonex Granules 10cc $1,200.00
Stryker Australia Pty Ltd
SK188 VITOSS - Synthetic cancellous bone Beta-tricalcium phosphate 10cc morsels and 10cc dowels $1,200.00
void filler
SK234 BoneSource Classic Bone Cement Calcium Phosphate Bone Matrix 10gm pack $1,200.00
Replacement. Sodium Phosphate Solution
and Mixing Bowl included
SR054 HydroSet Injectable Calcium Phosphate Injectable, rapid set, calcium phosphate 10cc $1,200.00
bone substitute kit
Synthes Australia Pty Ltd
SY002 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone 10g $1,200.00
Graft Substitute
SY332 Norian® Fast Set Putty 10cc $1,200.00
Wright Medical Australia
WR006 ProDense / Osteroset XR Composite Bone Void Filler - Pellets 10cc $1,200.00
WR012 Osteoset Calcium Sulphate 4.8mm pellets 10cc $1,200.00
WR021 Osteoset T Pellets Calcium sulphate with tobramycin 10cc $1,200.00
CDS
Biomet Australia Pty Ltd
BI936 GPS Bone Biologics TCP Granules/GPS, TCP 10ml $1,525.00
Lifehealthcare Pty Ltd
LH449 Kainos+βTCP with SmartPReP 2 APC- Beta-tricalcium phosphate (βTCP) 10cc βTCP: 20ml blood $1,525.00
20 granules with autologous platelet process pack for 3ml APC
concentrate (APC+)
Stryker Australia Pty Ltd
SK189 CORTOSS - Synthetic cortical bone - 10cc CORTOSS kit $1,525.00
void filler
Surgiplas Medical
SP066 Osteovation Calcium Phosphate Bone substitute kit; 10cc $1,525.00
Quick Set; EX/Impact/Inject
Prostheses List by Category, Groups and Sponsor Page 288 of 911
6 - SPECIALIST ORTHOPAEDIC
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Billing Code Product Name Description Size Benefit Benefit Notations
Synthes Australia Pty Ltd
SY282 Norian® Injectable Bone Cement 10cc $1,525.00
SY451 chronOS ß-TCP Porous ß-Tricalcium Phosphate Bone 50-100 mm x25 mm x 3-6 mm $1,525.00
Graft Substitute & Resorbable Polymer -
Strip
SY574 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone Large Syringe, 12.5 x $1,525.00
Graft Substitute-Block 12.5x10mm
SY576 chronOS™ β-TCP Porous β - Tricalcium Phosphate Bone 20x25x10-14mm; 25x35x7- $1,525.00
Graft Substitute - Wedge 13mm
Wright Medical Australia
WR003 ProDense / Osteoset XR Composite Injectable Bone Void Filler 10cc $1,525.00
WR039 Cellplex TCP Synthetic Cancellous Bone Alpha & Beta Tricalcium Phosphate 7cc $1,525.00
6.3.15.3 - Calcium and/or hydroxyapatite, biologically active additive
1b, 0-5cc, SDS
Austspine Pty Ltd
AJ041 i-FACTOR Peptide Enhanced Bone P-15, ABM, Osteoinductive, 0 - 5.0mL $1,579.00 $6,400.00
Graft Osteoconductive bone graft substitute
2b, 5cc-10cc, SDS
Austspine Pty Ltd
AJ042 i-FACTOR Peptide Enhanced Bone P-15, ABM, Osteoinductive, 5.0ml - 10ml $1,988.00 $12,000.00
Graft Osteoconductive bone graft substitute
6.3.15.3 - Ceramic, >10cc - 20cc
Austspine Pty Ltd
AJ034 Jectos 20cc Injectible synthetic bone graft substitute 20cc $1,500.00
Biomet Australia Pty Ltd
BI947 Calcibon Granules or paste, TCP 20ml $1,500.00
Device Technologies Australia Pty Ltd
DE136 MBCP Micro & Macroporous Biphasic Calcium 2-3mm (16cc) $1,500.00
Phosphate, composition - ceramic
consituting calcium phosphate
hydroxyapatic 60% and tricalcium
phosphate beta (TCP) 40%, granules
Prostheses List by Category, Groups and Sponsor Page 289 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DE137 MBCP Micro & Macroporous Biphasic Calcium 5 x 5 x 10-20mm $1,500.00
Phosphate, composition - ceramic
consituting calcium phosphate
hydroxyapatic 60% and tricalcium
phosphate beta (TCP) 40%, sticks
DE309 ENGlpore Granules (size 1,0-2,5 mm) 15 cc Granules (size 1,0-2,5 mm) 15 $1,500.00
Granules (size 2,5-4,0 mm) 15 cc cc
Granules (size 2,5-4,0 mm) 15
cc
Global Orthopaedic Technology
GO067 ApaPore Actifuse. Sterile, hydroxyapatite-based 20cc $1,500.00
bone matrix
Johnson & Johnson Medical Pty Ltd
DY354 Conduit TCP Bone matrix implant 15cc $1,500.00
Lifehealthcare Pty Ltd
LH354 Kainos Granules 1x16cm3 $1,500.00
LH355 Kainos Granules 1x20cm3 $1,500.00
LMT Surgical Pty Ltd
LM092 FixEx Bone Cement Calcium Phosphate Bone Cement 20cc $1,500.00
Medtronic Australasia Pty Ltd
MC596 Mastergraft Calcium Phosphate Ceramic Granules 15cc Vial $1,500.00
MC671 BCP Biphasic Calcium Phosphate Reabsorbable 20cc $1,500.00
Graft Supplement
Orthotech Pty Ltd
OH019 Bone Plast Bone Void Filler Powder 20cc $1,500.00
Stryker Australia Pty Ltd
SK185 VITOSS - Synthetic cancellous bone Beta-tricalcium phosphate 15cc morsels $1,500.00
void filler
SK481 HydroSet injectable Calcium Phosphate Injectable, rapid set, calcium phosphate 15cc $1,500.00
Cement bone substitute kit
Synthes Australia Pty Ltd
SY001 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone 20g $1,500.00
Graft Substitute
Prostheses List by Category, Groups and Sponsor Page 290 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Wright Medical Australia
WR007 ProDense / Osteoset XR Composite Bone Void Filler - Pellets 20cc $1,500.00
WR015 Osteoset Pellets - Bone Graft Substitute Calcium Sulphate 4.8mm Pellets 20cc $1,500.00
CDS
Biomet Australia Pty Ltd
BI937 GPS Bone Biologics TCP Granules/GPS, TCP 20ml $2,150.00
Lifehealthcare Pty Ltd
LH455 Kainos+βTCP with SmartPReP 2 APC- beta-tricalcium phosphate (βTCP) granules 20cc βTCP; 60ml blood $2,150.00
60 with autologous platelet concentrate process pack for 5-10ml APC
(APC+)
Synthes Australia Pty Ltd
SY452 chronOS ß-TCP Porous ß-Tricalcium Phosphate Bone 100 mm x25 mm x 6mm $2,150.00
Graft Substitute & Resorbable Polymer -
Strip
Wright Medical Australia
WR004 ProDense/Osteoset XR Composite Injectable Bone Void Filler 20cc $2,150.00
WR020 Osteoset MIIG X3 Injectable Calcium Sulphate Bone Void 15cc $2,150.00
Filler, Includes Syringe
WR040 Cellplex TCP Synthetic Cancellous Bone Alpha & Beta Tricalcium Phosphate 15cc & 20cc $2,150.00
WR215 Pro-Dense core Decompression Kit Composite Injectable Bone Void Filler 15cc $2,150.00
plus instrumentation kit for core
decompression
6.3.15.4 - Ceramic, >20cc
Biomet Australia Pty Ltd
BI948 Calcibon Granules or paste, TCP 50ml $1,560.00
Device Technologies Australia Pty Ltd
DE082 Hatric Bone Substitute Ceramic 7mm - 15mm $1,560.00
DE138 MBCP Micro & Macroporous Biphasic Calcium 5-12mm to 15 - 13mm $1,560.00
Phosphate, composition - ceramic
consituting calcium phosphate
hydroxyapatic 60% and tricalcium
phosphate beta (TCP) 40%, granules
Prostheses List by Category, Groups and Sponsor Page 291 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Health Care Surgical Pty Ltd
HC011 Squale Bone Substitute Block H: 4 -20mm $1,560.00
Johnson & Johnson Medical Pty Ltd
DY355 Conduit TCP Bone matrix implant 30cc $1,560.00
DY361 Conduit Conduit Blocks 10 x 10 x 10mm to 25 x 25 x $1,560.00
30mm
Lifehealthcare Pty Ltd
LH356 Kainos Granules 1x30cm3 $1,560.00
Medtronic Australasia Pty Ltd
MC597 Mastergraft Calcium Phosphate Ceramic Granules 30cc Vial $1,560.00
Scient'x Australia
SX017 Bonex Block L:5.5 - 50mm $1,560.00
Stryker Australia Pty Ltd
SK187 VITOSS - Synthetic cancellous bone Beta-tricalcium phosphate 30cc morsels and 30cc dowels $1,560.00
void filler
SK235 BoneSource Classic Bone Cement Calcium Phosphate Bone Matrix 25gm pack $1,560.00
Replacement. Sodium Phosphate Solution
and Mixing Bowl included
ST021 Stryker Bone Substitute Bonesave, Calcium Phosphate 40gms, sizes 2 - 4 and 4-6mm $1,560.00
Wright Medical Australia
WR011 Osteoset BVF Kit Kit contains calcium sulfate, diluent, mould, 25cc only $1,560.00
spatula and mixing bowl
WR013 Osteoset T Pellets Calcium sulphate with tobramycin 20cc $1,560.00
CDS
Biomet Australia Pty Ltd
BI938 GPS Bone Biologics TCP Granules/GPS, TCP 50ml $3,980.00
6.3.15.4.1 Composite (Extracellular Collagen Matrix with DBM or Ceramic), 0 - 5cc
SDS
Austspine Pty Ltd
AJ043 i-FACTOR Flex Peptide Enhanced P-15, ABM, Osteoinductive, 25mm x 25mm x 4mm $850.00 $6,400.00
Bone Graft - 25mm Osteoconductive bone graft substitute
Prostheses List by Category, Groups and Sponsor Page 292 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.15.4.2 Composite (Extracellular Collagen Matrix with DBM or Ceramic), >5cc - 10cc
SDS
Austspine Pty Ltd
AJ044 i-FACTOR Flex Peptide Enhanced P-15, ABM, Osteoinductive, 50mm x 25mm x 4mm, 100mm $1,988.00 $12,000.00
Bone Graft - 50 & 100mm Osteoconductive bone graft substitute x 25mm x 4mm
6.3.15.5 - Demineralised Bone Matrix,< 2cc
Henry Schein-Halas Pty Ltd
HD001 Bio-Oss Bone Natural Bone Mineral Derived from bovine bone 0.25g, 0.5cc volume $99.00
HD002 Bio-Oss Bone Natural Bone Mineral Derived from bovine bone 0.5g, 1cc volume $99.00
6.3.15.6 - Demineralised Bone Matrix, 2 – 5cc
Henry Schein-Halas Pty Ltd
HD003 Bio-Oss Bone Natural Bone Mineral Derived from bovine bone 2.0gm $529.00
HD009 Bio-Oss This bone block consists of anorganic approx 1.4-1.6g, 2cc $529.00
bovine bone matrix sterilised by gamma-
irradiation. Bio-Oss is a natural bone
mineral for filling of bone defects in
maxillofacial surgery, implantology, and
periodontology.
Lifehealthcare Pty Ltd
LH476 Orthoss - Bone implant material Orthoss Spongiosa Block. Bone Implant 1 x 1x 2 approx. 1.6g $529.00
material, biological, animal source.
6.3.15.7 - Demineralised Bone Matrix, >5cc - 10cc
Lifehealthcare Pty Ltd
LH474 Orthoss - Bone implant material Orthoss Granules Spongiosa. Bone Granule Size 2-4mm, 3g $1,400.00
implant material, biological, animal source (approx. 8-10cc)
LH475 Orthoss - Bone implant material Orthoss Spongiosa Block. Bone Implant 2 x 2 x 1.3cm (approx. 3.6g) $1,400.00
material, biological, animal source.
Prostheses List by Category, Groups and Sponsor Page 293 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.15.8 - Demineralised Bone Matrix, >10cc
Lifehealthcare Pty Ltd
LH473 Orthoss - Bone implant material Orthoss Granules Spongiosa, Bone Granule size 1-2mm, 5g-7g; $2,100.00
implant material, biological, animal source (approx.. 13-20cc)
6.3.15.9 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), 0 - 5cc
Henry Schein-Halas Pty Ltd
HD007 Bio-Oss Collagen The product consists of Bio-Oss granules, 1 preformed block of $850.00
embedded in 10% porcine collagen. The cancellous-bone granulate and
collagen component is resorbed within a collagen, block sizes 500mg
few weeks. The properties of the Bio-Oss
granules remain unchanged. Facilitates
handling.
HD008 Bio-Oss Collagen The product consists of Bio-Oss granules, 1 preformed block of $850.00
embedded in 10% porcine collagen. The cancellous-bone granulate and
collagen component is resorbed within a collagen, block size 250mg
few weeks. The properties of the Bio-Oss
granules remain unchanged. Facilitates
handling.
HD014 Bio-Oss Collagen The product consists of Bio-Oss granules, 1 preformed block of $850.00
embedded in 10% porcine collagen. The cancellous-bone granulate and
collagen component is resorbed within a collagen, block size 100mg
few weeks. The properties of the Bio-Oss
granules remain unchanged. Facilitates
handling.
Medtronic Australasia Pty Ltd
MC660 Mastergraft Matrix 5cc $850.00
Stryker Australia Pty Ltd
SK466 VITOSS Foam - Compression Resistant Highly porous bone graft material made 5cc Foam strip (25x50x4) $850.00
Synthetic Cancellous Boane Void Filler from beta-tricalcium phosphate (β-TCP)
and Type I bovine collagen.
SK476 VITOSS Foam - Compression Resistant Highly porous bone graft material made 1.2cc Foam Pack $850.00
Synthetic Cancellous Bone Void Filler. from beta-tricalcium phosphate (β-TCP)
and Type I bovine collagen
Prostheses List by Category, Groups and Sponsor Page 294 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK477 VITOSS Foam - Compression Resistant Highly porous bone graft material made 2.5cc Foam Pack $850.00
Synthetic Cancellous Bone Void Filler. from beta-tricalcium phosphate (β-TCP)
and Type I bovine collagen
SK478 VITOSS Foam - Compression Resistant Highly porous bone graft material made 5cc Foam Pack $850.00
Synthetic Cancellous Bone Void Filler. from beta-tricalcium phosphate (β-TCP)
and Type I bovine collagen.
6.3.16 - Meshes - metallic
Lima Orthopaedics Australia Pty Ltd
LC066 TNP® Calcaneus Bone Plate Ti TNP® Calcaneus Bone Plate Ti Plate has holes to $950.00
accommodate screw sizes from
2 to 6mm
Ti
Lima Orthopaedics Australia Pty Ltd
LC069 TNP® SRT Net Plate Ti TNP® SRT Net Plate Ti One size $1,400.00
LC070 TNP® Net Plate Ti TNP net plate Ti 13x23mm $1,400.00 $1,500.00
6.3.2 - Intramedullary Nail Accessories
6.3.2.1 - Intramedullary nail lag screw
Smith & Nephew Surgical Pty Ltd
SN481 Compression Hip Screw System Lag Screw 55 - 140mm $196.00
SN761 IMHS CP Subtrochanteric lag screw 12.7mm x 70mm to 12.7mm x $205.00
140mm
Ti, CN
Johnson & Johnson Medical Pty Ltd
MN036 Affixus Hip Fracture Nail System Lag Screw 70-130mm $196.00 $300.00
6.3.2.4 - Locking bolt
Orthotech Pty Ltd
OH394 Wittenstein FITBONE - Internal limb Locking screw long/short thread 20-85mm $120.00 $975.00
lengthening locking screw
Prostheses List by Category, Groups and Sponsor Page 295 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SN902 FAST-FIX 360 This is a double anchor, self tying device One size $440.00 $460.00
for all-inside meniscal repair
6.3.2.5 - End caps and extension caps
Ti
Johnson & Johnson Medical Pty Ltd
MN037 Affixus Hip Fracture Nail System End Caps 5mm, flush or impinging $79.00 $96.00
Wright Medical Australia
WR207 Valor Hindfoot Fusion System - Endcap Valor Endcap n/a $79.00 $95.00
6.3.2.6 - Compression screw used with lag, long 4.5-7.5mm
Smith & Nephew Surgical Pty Ltd
SN467 Compressing Screw For Intramedullary and compression Hip 19mm & 28.5mm $32.00
Screw Systems
6.3.2.9 - Lag used with compression
Smith & Nephew Surgical Pty Ltd
SM155 InterTAN CHS-Integrated Interlocking Integrated Interlocking Screws 11mm x 7.0mm diameter, $410.00
Screws 65mm Lag Screw/60mm
Compression Screw (65/60),
70/65, 75/70, 80/75, 85/80,
90/85, 100/95, 105/100,
110/105, 115/110, 120/115,
125/120, 130/125, 135/130,
140/135.
SN489 Intermediate Osteotomy System Lag 35 mm - 85mm, 1 1/2" - 3-3/4" $472.00
SN839 Trigen InterTAN Nail Lag/Compression Screw, Titanium 30-120 $410.00
Prostheses List by Category, Groups and Sponsor Page 296 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.3 - Plates
6.3.3.1 Standard (screw size ≥4.5mm)
Johnson & Johnson Medical Pty Ltd
JJ711 ALPS - Anatomic Locked Plating 3.5MM Titanium 100° Tubular Plate 5-10 holes $400.00
System
Lifehealthcare Pty Ltd
LH248 SCS Distal Radius Plate System Left and Right, Tined Small, Large $1,140.00
Orthopaedic Solutions Pty Ltd
OE009 Nexfix MTP Fusion System A bendable stainless steel bone plate and Left: 2+3; Right: 2+3 $730.00
screw system with unique low profile
locking screw option. Indicated for use in
primary and revision MTP fusion
OE014 CoverLoc Volar Plate A stainless steel volar plate system '22mm x 3, 4 & 8 hole left & $2,350.00
intended for fixation of fractures and right 25mm x 3 & 4 hole left &
osteotomies involving the distal radius. The right
CoverLoc feature is unique and allows
both compression and lagging with fixed
angle screws.
Smith & Nephew Surgical Pty Ltd
SN062 TC 100 Narrow Compression Plate 4.5mm, 5 - 7 holes $95.00
SN730 Accord Orthopaedic Cable System, Titanium Plate 150-250mm $2,550.00
Synthes Australia Pty Ltd
SY097 AO/ASIF Plates - Steel broad straight plate DCP/LCDCP 4.5mm, 2 - 28 hole $644.00
SY350 AO/ASIF Plate Reconstruction Plate 2-24 holes $530.00
Com
Synthes Australia Pty Ltd
SY030 AO/ASIF Plates DHS plates 130-150 deg/ 2-16 hole / 43- $875.00
27mm length / barrel 25 -
38mm
Prostheses List by Category, Groups and Sponsor Page 297 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.3.13 - Periarticular anatomic - Fibula
COM, Titanium, Locking, VAL
Wright Medical Australia
WR079 Ortholoc Fracture System - Plates Lateral Fibula, Posterior Fibula or Right & Left: Small, Medium & $750.00
Syndesmosis Plates Large
Complex, Titanium, VAL, LK
Johnson & Johnson Medical Pty Ltd
JJ821 ALPS Fibula Plating System Anatomic Fibular Locking Plate 90mm-200mm $1,300.00 $1,814.00
Ti, Locking, VAL.
Stryker Australia Pty Ltd
SK510 Stryker Locked Plate System Periarticular variable angle locking plate - 1-16 holes. $1,300.00 $1,800.00
fibula.
6.3.3.14 - Periarticular anatomic - Tibia
Com, Ti, LK & VAL
Johnson & Johnson Medical Pty Ltd
DY532 ALPS Proximal Tibia Locking Plate Proximal Tibia Locking Plate 3 to 15 holes $1,212.00 $1,854.00
COM, TI, LK, VAL
Wright Medical Australia
WR083 Ortholoc Fracture System - Plates Medial Maleolar, Anterolateral Tibia or Right & Left: Small, Medium & $750.00
Medial Tibia Plates Large
6.3.3.14 Periarticular anatomic - Calcaneal
Com
Synthes Australia Pty Ltd
SY017 AO/ASIF Plates Calcaneal Length 60 - 70mm $752.00
SY188 AO/ASIF Plates Calcaneal, Locking 3.5mm, 30 - 100mm $1,209.00
6.3.3.15 - Periarticular anatomic - Calcaneal
Complex, Ti, LK & VAL
Johnson & Johnson Medical Pty Ltd
DY536 ALPS Foot System Calcaneal foot plate small to large $1,275.00 $1,500.00
Prostheses List by Category, Groups and Sponsor Page 298 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Locking.
Wright Medical Australia
WR077 Charlotte LisfrancReconstruction System Stainless steel plate for stabilisation of the 4, 6, 5 & 9 hole. $750.00
- Bridge Plate. tarsometatarsal joint.
6.3.3.16 - Periarticular anatomic - Foot
TI, LK, VAL
Wright Medical Australia
WR082 Orloloc Fracture System - Plates Akin, MTP Plates Akin - 3 Hole, 17mm; MTP - 4 $750.00
Hole, 23mm
6.3.3.16 Periarticular anatomic - Cable plate (hook/grip)
Biomet Australia Pty Ltd
BI258 BMP Cable System Dynamic Compression Plate, 3 hole, One size only $850.00
Stainless Steel
BI259 BMP Cable System Dynamic Compression Plate, 5 hole, One size only $1,200.00
Stainless Steel
BI260 BMP Cable System Dynamic Compression Plate, 7 hole, One size only $1,638.00
stainless steel
BI261 BMP Cable System Dynamic Compression Plate, 9 hole, One size only $1,800.00
Stainless Steel
Johnson & Johnson Medical Pty Ltd
DP854 Songer Cable System - Titanium Flex Bar - Large/Small or Flanged Crimp 35mm/30mm $159.00 $220.00
2 Hole Bar /Flat Bar (Pk 2)
DP858 Songer Cable System - Stainless Steel Flanged Crimp/Flat Bar (Pk2) or 2 Hole One size only $185.00
Bar (Pk 2)
Zimmer Pty Ltd
ZI163 Zimmer Internal Fixation Systems: Cable Cable-Ready Plate Cable Stainless Steel 610 mm long $367.00
System
ZI167 Zimmer Internal Fixation Systems: Cable Cable-Ready 6 Hole Plate - Stainless Steel 187mm long $660.00
System
ZI168 Zimmer Internal Fixation Systems: Cable Cable-Ready 8 Hole Plate - Stainless Steel 246mm long $710.00
System
ZI169 Zimmer Internal Fixation Systems: Cable Cable-Ready 10 Hole Plate - Stainless 305mm long $790.00
System Steel
Prostheses List by Category, Groups and Sponsor Page 299 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.3.18 Periarticular anatomic - Cable plate with integrated cables - >2
Zimmer Pty Ltd
ZI297 Cable Ready Cable Grip System Titanium 5 hole GTR with 4 cables $4,050.00
ZI298 Cable Ready Cable Grip System Titanium 2 hole GTR with 4 cables $2,600.00
ZI299 Cable Ready Cable Grip System Titanium 4 hole GTR with 4 cables $3,750.00
6.3.3.2 - Small (screw size 2.71mm – 4.49mm)
Com
Synthes Australia Pty Ltd
SY016 AO/ASIF Plates Cloverleaf 3-6 hole, length 104mm $674.00
COM, TI, LK, VAL
Wright Medical Australia
WR076 Orloloc Fracture System - Plates Universal 6 Hole & 8 Hole $674.00 $750.00
TI
Lifehealthcare Pty Ltd
LH419 SBi Precise SD Distal Volar Plate An anatomically contoured locking titanium Left Distal Volar Plate, 22 x $2,350.00
plate and titanium alloy screw/peg system 52mm (Narrow)
intended for fixation of distal radius Left Distal Volar Plate, 25 x
fractures via open reduction 52mm (Standard)
Left Distal Volar Plate, 22 x
75mm (Narrow-Long)
Left Distal Volar Plate, 25 x
75mm (Standard-Long)
Right Distal Volar Plate, 22 x
52mm (Narrow)
Right Distal Volar Plate, 25 x
52mm (Standard)
Right Distal Volar Plate, 22 x
75mm (Narrow-Long)
Right Distal Volar Plate, 25 x
75mm (Standard-Long)
Prostheses List by Category, Groups and Sponsor Page 300 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.3.2 - Small (screw size 2.71mm - 4.49mm)(including blade)
Medartis
EO009 Aptus Radius Locking plates Aptus Radius Locking plates (fracture 2.5mm locking plates, 1.6- $1,450.00
plate, correction plate volar, correction 2.00mm thickness
plate long volar, correction plate with flap
volar, correction plate long with flap volar,
frame plate volar, frame plate long volar, H
plate dorsal, Adaptive Plate; Radial Head
Plate; 4 Corner Plate; Y plate
Com, LK
Integra Neurosciences Pty Ltd
IG064 Integra Total Wrist Fusion System - Straight (bendable), Standard bend, Short 1 size only of each type of plate: $231.00 $1,450.00
Plates Bend
Straight: 105.5mm length
Standard and short bend:
110mm length
Com, TI, LK & VAL
Integra Neurosciences Pty Ltd
IG062 Tibiaxys Ankle Arthrodesis Plates Medial/lateral anterior plate 3mm thick; lateral plate: 92mm $700.00 $1,353.00
long; medial plate 77mm long
Complex
LMT Surgical Pty Ltd
LM099 TriMed Sidewinder Ankle Fixation Plate Left and Right, 6 & 7 Hole, $158.00 $1,200.00
Narrow and Wide
Complex, Ti, LK & VAL
Johnson & Johnson Medical Pty Ltd
DY535 ALPS Foot System Complex periarticular foot, metatarsal and small to large $700.00 $980.00
tarsal plates
Ti, LK & VAL
Johnson & Johnson Medical Pty Ltd
DY537 ALPS foot system periarticular foot, metatarsal and tarsal small to large $550.00 $750.00
plates
Prostheses List by Category, Groups and Sponsor Page 301 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.3.3 - Mini (screw size 2.01 – 2.7 mm)
Com
Zimmer Pty Ltd
ZI227 ZPS 3.5mm Straight Recon Plates 6 Hole $801.00
ZI228 ZPS 3.5mm Curved Recon Plates 6 Hole $857.00
COM, TI, LK, VAL
Wright Medical Australia
WR070 Orlolc Fracture System - Plates Straight, T, L Plates Straight - 3, 4 & 6 Hole, T - 6 $750.00
& 7 Hole, L - 6 Hole
Complex, Locking
Biomet Australia Pty Ltd
BH064 Sternalock Ladder Plate 12 Hole (2 x 6) $490.00 $1,480.00
Locking
Biomet Australia Pty Ltd
BH065 Sternalock Straight Locking Plate 8 Hole $490.00 $950.00
TI, VAL
Zimmer Pty Ltd
ZI471 NCB Plates Polyaxial locking plates, special titanium Plate size 60 to 324mm long $2,000.00
alloy
6.3.3.4 - Dynamic - hip
Smith & Nephew Surgical Pty Ltd
SN493 Paediatric Osteotomy System Plate (hip screw) With Prox slot 90D - 140D $937.00
6.3.3.5 - Dynamic - supracondylar
Austofix
AX056 Tectona Hip Plate Hip plate, locking with removable targeting 130, 135 and 140 degree, 2 to $800.00
jig, sterile packed 8 hole
Prostheses List by Category, Groups and Sponsor Page 302 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.3.7 - Periarticular anatomic - Humerus
Com, LK, VAL
Wright Medical Australia
WR220 Evolve Ortholco EPS System - Distal Stainless Steel, Polyaxial Locking Plate, Right & Left, 2.7 & 3.5mm, 8- $1,400.00 $1,500.00
Humerus Straight, Coronal, Medial, Lateral, 21 holes
Posterolateral
Com, Ti, LK, VAL
Austofix
AX088 Austofix Proximal Humeral Plating Anatomic Periarticular Humeral Variable 3-15 Hole $1,400.00 $2,000.00
System - Austofix Proximal Humeral Plate Angle Locking Plate, Titanium
LK
Lima Orthopaedics Australia Pty Ltd
LC050 DiPhos H Plate Proximal Humeral 3 hole plate 3 hole $1,376.00 $1,450.00
LC051 DiPhos H Plate Proximal Humeral 5 hole plate 5 hole $1,376.00 $1,500.00
6.3.3.8 - Periarticular anatomic - Radius
Lifehealthcare Pty Ltd
LH461 rHead Plating System Comprehensive plating system: four plate Neck Plate: neck width - 15 or $1,320.00
designs; locking & non-locking screw 18mm, plate width - 6mm,
options length - 23 or 29mm. Rim Plate:
neck width 13.6 or 16.8mm,
plate width 6mm, length 29.75
or 35.75mm. Bone Screws:
diameter - 2.4 or 2.7mm; length
- 8mm - 28mm.
Ti, LK
Austofix
AX040 VRP Distal Radius Fixation System, Volar Distal Radius Plate - Non-standard Wide, narrow, long, short sizes $1,300.00
Volar Distal Radius Plate - Non-standard
Prostheses List by Category, Groups and Sponsor Page 303 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.3.9 - Periarticular anatomic - Ulna
Com, VAL, LK
Wright Medical Australia
WR221 Evolve Ortholoc EPS System - Stainless Steel, Polyaxial Locking Plate, Right & Left, 2.7 & 3.5mm, 9- $1,500.00
Olecranon Plate Olecranon, Right & Left 16 holes
6.3.4 - Screws
6.3.4.1 - Standard ( ≥4.5mm)
Biomet Australia Pty Ltd
BI262 EBI XFIX Dynafix System Bone Screw, Cortical, tapered, 2.4mm to 6.00mm diameter $110.00
Cancellous, Stainless Steel
Exactech Australia
EX063 Equinoxe Reverse Shoulder, fracture Locking screw for tray adapter. One size. $230.00
humeral adapter tray locking screw.
LMA PacMed Pty Ltd
PM095 Orthopaedic External Fixation System Screw Shaft Dia 3.0 - 6.0mm, Thread $115.00
Dia 6.0 - 2.0mm, Total Length
40 - 260mm, Thread Length 15
- 100mm
LMT Surgical Pty Ltd
LM007 TriMed Fixation System Bone Screw Various $120.00
CN
Zimmer Pty Ltd
ZI600 NCB System NCB Cannulated Screws 14mm to 65mm $175.00
ZI601 NCBSystem NCB Cannulated Cancellous Screws 4.5mm x 30-90mm $175.00
LK
Wright Medical Australia
WR074 Charlotte Lisfranc Recontruction System Solid Core Stainless Steel Screw 4.5mm diameter, 8 - 100mm $235.00
- Screw. length
Prostheses List by Category, Groups and Sponsor Page 304 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LK, CN
Lifehealthcare Pty Ltd
LH439 Mondeal Locking Screws 2.0 to 6.5mm diameter Locking cancellous 2.0 - 2.3mm, 2.7 - 3.0mm, 4.0 $140.00
bone screws - 6.5 mm diameter, 6 - 40 mm
length; 3.5 - 6.5mm diameter,
10 - 100mm length.
Ti
Integra Neurosciences Pty Ltd
IG113 Bone Screws Titanium screws (2) for use with the 4.5mm x (15, 20, 25, 30, $19.00 $120.00
Universal2 Total Wrist System only 35mm)
Johnson & Johnson Medical Pty Ltd
MN038 Affixus Hip Fracture Nail System Anti rotational and distal bone screws 20-80mm $93.00 $155.00
Wright Medical Australia
WR209 Valor Hindfoot Fusion System Valor Screw 25-100mm, 5mm diameter $93.00 $260.00
Ti, CN
Lima Orthopaedics Australia Pty Ltd
LC071 TNP® Cannulated Self drilling Screw TNP® Cannulated Self drilling Screw with Diameter 4.5, 6mm x 20- $150.00
with Ultra Flathead Ultra Flathead 120mm Length
Ti, DT, CN
Lima Orthopaedics Australia Pty Ltd
LC068 DTS - DOUBLE THREADED DTS - DOUBLE THREADED Diameter 4.5 and 6.5mm x $400.00
CANNULATED SCREW CANNULATED SCREW Length 30 to 100mm
VAL
Johnson & Johnson Medical Pty Ltd
JJ731 ALPS Distal Tibia Polyaxial Titanium locking screws 20-100mm $170.00
6.3.4.2 - Small (2.71mm – 4.49mm)
Austofix
AX087 Austofix Proximal Humeral Plating Cortical Screw, Titanium 3.5mm, 20-40mm $15.00 $67.00
System - Austofix Cortical Screw
AX090 Austofix Proximal Humeral Plating Cancellous Screw, Titanium 4mm 20-40mm $15.00 $105.00
System - Austofix PHP Cancellous Screw
Prostheses List by Category, Groups and Sponsor Page 305 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Integra Neurosciences Pty Ltd
IG066 Cortical Screw Cortex Screw 3.5mm diameter: 10-32mm $93.00 $100.00
length
Johnson & Johnson Medical Pty Ltd
JJ713 ALPS SFS Cancellous Titanium Bone Screws 10-150MM $120.00
Lifehealthcare Pty Ltd
LH324 ITS Cortical Screws Cortical Screws D=3.5mm & 4.2, 4.5mm, $53.00
Length =14mm - 60 mm (with
incremental of 2)
LH440 Mondeal Screws Screws Diameter = 1.2, 1.7 2.0, 2.3, $67.00
2.7, 3.0, 3.5, 4.0, 4.5, and
5.0mm; Length. = 4mm -
24mm
Medical & Optical Instruments Australia Pty Ltd
MO321 Acumed Hexalobe Non Locking Screws Acumed Hexalobe Non Locking Screws Small (2.71mm-4.49mm) $15.00 $30.00
Orthotech Pty Ltd
OH392 VAIOS Locking screw Locking screw one size $93.00 $210.00
Wright Medical Australia
WR219 Evolve Ortholoc EPS System 3.5 NL Stainless Steel, Cortical & Cancellous 3.5mm diameter 10-60mm $15.00 $150.00
Screws Screws
Break Off
Medartis
EO032 Forefoot Snap off Screws Titanium Alloy Screws with Snap-off Grip Auto Compressive long L10 - $425.00
/ Cannulated L34
EO035 Forefoot Snap off Screws Titanium Alloy Screws with Snap-off Grip Arthrodesis large diameter L28 $425.00
/ Cannulated - L40
'DT, CN
K2 Surgical
KS001 Foot Motion - self-drilling cannulated Self-drilling auto-compressive cannulated 3.0mm diameter, length 8mm- $286.00 $550.00
compression screws screw 40mm
Prostheses List by Category, Groups and Sponsor Page 306 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LK
Austofix
AX086 Austofix Proximal Humeral Plating Locking Screw Titanium 3.5mm, 20-100mm $94.00 $170.00
System - Austofix PHP Locking Screw
AX089 Austofix Proximal Humeral Plating Variable Angle Locking Screw, Cobalt 3.5mm 20-100mm $94.00 $235.00
System - Austofix VA Locking Screw Chrome
Integra Neurosciences Pty Ltd
IG068 Surfix Screw plus Surfix Lock-Screw Locking screws with an independent lock- 3.5mm: 10-28mm $130.00 $180.00
screw head tht screw into fixation plates.
This combination effects dynamic
compression.
Johnson & Johnson Medical Pty Ltd
JJ714 ALPS SFS Cancellous Titanium Locking Bone Screws 10-100mm $180.00
Lifehealthcare Pty Ltd
LH323 ITS Cancellous Screws Cancellous Screws D=3.5mm & 4.2mm, Length = $157.00
14mm - 60mm (with
incremental of 2)
Medical & Optical Instruments Australia Pty Ltd
MO322 Acumed Hexalobe Locking Screws Acumed Hexalobe Locking Screws Small (2.71mm-4.49mm) $70.00
Wright Medical Australia
WR078 Charlotte Lisfranc Recontruction System Solid core stainless steel screw. 3.7mm diameter, 8-100mm $235.00
- Screw. length.
WR218 Evolve Ortholoc EPS System 3.5 Stainless Steel, Variable Angle Locking, 3.5mm Diameter, 10-60mm $94.00 $150.00
locking Cortical & Cancellous Screws
TI
Integra Neurosciences Pty Ltd
IG063 Cortical Screw Cortex Screw 4mm diameter with 6mm head; $93.00 $120.00
40mm - 100mm length
Lima Orthopaedics Australia Pty Ltd
LC052 Bone Screw Bone Screw self tapping cortical Diameter 3.5mm length 20- $15.00 $60.00
100mm
Prostheses List by Category, Groups and Sponsor Page 307 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Ti, CN & LK
Johnson & Johnson Medical Pty Ltd
MN040 Bristow-Latarjet Instability Shoulder Set Cannulated titanium locking screw 36mm to 48mm $180.00 $286.00
- Screw
Ti, DT
Lima Orthopaedics Australia Pty Ltd
LC062 HVS BONE SCREW Self drilling, self threading double threaded Length 10-34mm $275.00 $415.00
cannulated screw
Ti, DT, CN
Lima Orthopaedics Australia Pty Ltd
LC067 DTS - DOUBLE THREADED DTS - DOUBLE THREADED Diameter 3, 3.5, x Length 12 to $286.00 $450.00
CANNULATED SCREW WITH CANNULATED SCREWS 40mm
GUIDEWIRE PACKAGED WITH GUIDEWIRE
Ti, LK
Lima Orthopaedics Australia Pty Ltd
LC053 Threaded Head Bone Screw Threaded Head Bone Screw Cancellous Diameter 3.5, 4mm, length 10- $94.00 $120.00
60mm
Titanium, Locking
Wright Medical Australia
WR072 Ortholoc Fracture System Screws Titanium, variable angle locking screws 3.5 & 4.0mm diameter, 8- $235.00
100mm length
6.3.4.3 - Mini (2.01 – 2.7 mm)
Integra Neurosciences Pty Ltd
IG065 Cortical Screw Cortex Screw 2.7mm diameter: 10-32mm $93.00 $100.00
length
Medical & Optical Instruments Australia Pty Ltd
MO323 Acumed Hexalobe Non Locking Screws Acumed Hexalobe Non Locking Screws Mini (2.01mm-2.7mm) $30.00
Orthopaedic Solutions Pty Ltd
OE013 CoverLoc Screws CoverLoc Screws, stainless steel, (lag & 2.7mm & 3.3mm x 10mm- $150.00
cortical) & Pegs (threaded & unthreaded) 26mm in 2mm increments
Prostheses List by Category, Groups and Sponsor Page 308 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Wright Medical Australia
WR217 Evolve Ortholoc EPS System - 2.7 NL Stainless Steel, Cortical Screws 2.7mm Diameter, 10-50mm $67.00 $150.00
Screws
Break Off, TI
Medartis
EO033 Forefoot Snap off Screws Titanium Alloy Screws with Snap-off Grip FSA 2 part 9-21/14-26 $425.00
EO034 Forefoot Snap off Screws Titanium Alloy Screws with Snap-off Grip Weil self tapping L9 - L15 $425.00
Wright Medical Australia
WR035 Charlotte Foot & Ankle System Snap-off screws, titanium alloy 2.0 dia 11, 12, 14mm. 2.7 dia $315.00
13, 15, 17mm
WR061 Twist-off Screw Unique feature of two thread diameters to 2.0mm diameter x 11-15mm, $286.00
suit variable bone quality, specifically 2.5mm diameter x 11-15mm,
designed for Weil-osteotomy, titanium, self
drilling and self tapping, twist-off connector
LK
Austofix
AX083 VRP Distal Radius Fixation System - Variable Angle Locking Screw, Cobalt 2.5mm, 10-30mm $94.00 $170.00
VRP VA locking Screw Chrome
Integra Neurosciences Pty Ltd
IG067 Surfix screw plus Surfix Lock-Screw Locking screws with an independent lock- 2.7mm: 10-32mm $94.00 $180.00
screw head
Medical & Optical Instruments Australia Pty Ltd
MO320 Acumed Hexalobe Locking Screws Acumed Hexalobe Locking Screws Mini (2.01mm-2.7mm) $70.00
Wright Medical Australia
WR216 Evolve EPS System 2.7 Locking Stainless Steel, Variable Angle Locking 2.7mm Diameter, 10-50mm $94.00 $150.00
Cortical Screws
Ti, Break Off
Lima Orthopaedics Australia Pty Ltd
LC056 Self Breaking Screw - Mini Self Breaking Screw Mini Diameter 2.7 mm x length 11- $257.00
22 mm
Prostheses List by Category, Groups and Sponsor Page 309 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Titanium, Locking
Wright Medical Australia
WR081 Ortholoc Fracture System Titanium, variable angle locking screws 2.4, 2.7mm diameter, 8- $235.00
100mm length
VAL, TI
Smith & Nephew Surgical Pty Ltd
SN890 PROMOS Reverse Modular Shoulder Glenoid Bone Screw 6/20mm 6/25mm, 6/30mm, $250.00
System 6/35mm, 6/40mm
6.3.4.4 - Micro (≤ 2.0mm)
'DT, CN, TI
K2 Surgical
KS002 Foot Motion - weil screws Weil screw is a titanium self tapping, self- 2.0mm diameter, length 8mm - $196.00 $425.00
cutting screw 15mm
Ti, Break Off
Lima Orthopaedics Australia Pty Ltd
LC077 Self Breaking Screw - Micro Self Breaking Screw - Micro Dia 2.0 mm x Length 7-24 mm $230.00 $257.00
TI, VAL
Wright Medical Australia
WR073 Ortholoc Fracture System Titanium, variable angle locking screws 2.0mm diameter, 8 - 100mm $144.00 $235.00
length
6.3.4.5 - Dynamic
CN
Synthes Australia Pty Ltd
SY054 AO/ASIF Plates DHS/DCS lag screw 50-145mm L $247.00
6.3.4.6 - Screw washers
Lima Orthopaedics Australia Pty Ltd
LC075 F.T.S. Screw Washers F.T.S. Screw - Washer Diameter 13, 16, 19mm $85.00 $115.00
Prostheses List by Category, Groups and Sponsor Page 310 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Ti, CN
Johnson & Johnson Medical Pty Ltd
JJ824 Bristow-Latarjet Instability Shoulder Set Cannulated titanium top hat screw 36mm to 48mm $46.00 $235.00
- Top Hat Screw
6.3.4.7 - Interference screw (may include sleeve)
Johnson & Johnson Medical Pty Ltd
JJ124 Intrafix Tibial Sheath High density non absorbable tibial sheath 7 to 10mm x (15 to 30mm) $272.00
Signature Orthopaedics
SF001 Tissue Loc Tenodesis Screw Cannulated Interference Screw - PEEK 4x10mm, 5x10mm, 4x15mm, $178.00 $670.00
5x15mm, 6x15mm, 6x20mm,
7x25mm, 8x25mm, 8x30mm,
9x25mm, 9x30mm
CN
Advanced Surgical Design & Manufacture Ltd
AE127 Parcus PEEK CF Interface Screw PEEK CF Interface Screw 7,8,9mm x 20-35mm $340.00 $440.00
10,11,12mm x 25-35mm
6.3.4.7 Interference screw
Advanced Surgical Design & Manufacture Ltd
AE095 ASDM Standard ACL Fixation Screw Standard Flat Head Screw 7 - 11mm Diameter 20mm - $178.00
50mm Length
AE096 ACL Fixation Screws Round Head, Titanium 7-11mm Diameter 25 - 35mm $178.00
Length
Smith & Nephew Surgical Pty Ltd
SM164 BIOSURE A non-absorbable polymer (PEEK) 6-12mm in diameter $440.00
interference screw for use in
ligament/tendon reconstruction
Wright Medical Australia
WR080 G-Force Tenodesis System Cannulated Interference Screw - PEEK 4-8mm diameter, 10-25mm $570.00 $670.00
Optima width
Prostheses List by Category, Groups and Sponsor Page 311 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
TI
Advanced Surgical Design & Manufacture Ltd
AE098 Low Profile Tibial Screw Titanium 7 - 10mm Diameter 25 -40mm $240.00
Length
Arthrocare Australasia Pty Ltd
AF006 Atlantech graft fixation screw - titanium Titanium ACL Screw 7 x 20mm, 7 x 25mm, 7 x $161.00
30mm, 8 x 20mm, 8 x 25mm,
8 x 30mm, 9 x 20mm, 9 x 30mm
Corin Australia Pty Ltd
CR031 LARS Interference Screw Titanium Interference screw 5.2 - 10mm diameter, 15 - $340.00
30mm
6.3.4.9 - Screw post/peg
Smith & Nephew Surgical Pty Ltd
SN422 Fixation Post Tibial fixation Device 25 -55mm $241.00
6.3.5 - Pins and K-wires
6.3.5.3 Pins ( >2mm) Threaded
LMA PacMed Pty Ltd
PM097 Orthopaedic External Fixation System Osteotite Screw Shaft Dia 3.0 - 6.0mm, Thread $149.00
Dia 6.0 - 2.0mm, Total Length
40 - 260mm, Thread Length 15
- 90mm
6.3.5.4 Pins (>2mm) Non-threaded
Biomet Australia Pty Ltd
BI304 Rush Intramedullary Pins Stainless Steel 3.2mm x (100-250mm) $300.00
BI306 Rush Intramedullary Pins Stainless Steel (6 - 6.4mm) x (280 - 440mm) $175.00
Smith & Nephew Surgical Pty Ltd
SN445 Steinmann Pins Skeletal Traction Pin-Cove Point 150-200mm $73.00
Synthes Australia Pty Ltd
SY126 AO/ASIF Intramedullary Nails Spiral blade Length 20 - 150mm $655.00
Prostheses List by Category, Groups and Sponsor Page 312 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.5 - Pins and Rigid Wires
6.3.5.3 - Pins ( >2mm) Threaded
Lima Orthopaedics Australia Pty Ltd
LC054 S.E.M. II 300 External Radiolucent Self Threading Pins Diameter 2.5, 3mm 80-85mm $135.00 $250.00
Fixator Length
LC078 S.E.M. II 400 External Fixator - Self Self Threading Pin Pin Dia 2.5 mm with 10mm $135.00 $250.00
Threading Pins thread length
6.3.5.4 - Pins (>2mm) Non-threaded
Lima Orthopaedics Australia Pty Ltd
LC076 Steinmann Pin Steinmann Diameter 2 - 5mm x Length $25.00
150 - 250mm
6.3.6 - Wires/Cables
6.3.6.1 - Wires - Single
Johnson & Johnson Medical Pty Ltd
DP480 DePuy Spinal Wire Wire with Button or Beaded Wire 18 - 24 gauge wire $65.00
DY528 Expedium Spinal System - Cobalt CoCr wire single with/without button 1.0mm $150.00 $278.00
Chrome Single Wire
LMT Surgical Pty Ltd
LM005 TriMed Fixation Systems Multiple stainless steel wire forms various sizes $465.00
Orthotech Pty Ltd
OH260 Hartshill Wire (packet 10) stainless steel 1.2mm diam & 0.9mm diam $65.00
6.3.6.2 - Wires - Double-looped wire
Johnson & Johnson Medical Pty Ltd
DP045 Isola System (Stainless Steel) Double Wire One size only $65.00 $166.00
DY527 Expedium Spinal System - Cobalt CoCr wire double with/without button 1.0mm $166.00 $278.00
Chrome Double Wire
Medtronic Australasia Pty Ltd
MC506 Orfil Double Pearl-Tipped Wires 1 - 350mm $65.00 $166.00
Prostheses List by Category, Groups and Sponsor Page 313 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.6.3 - Cables - Mutli-filament
Synthes Australia Pty Ltd
SY276 Spine Cable System Single Lead One size only $412.00
SY277 Spine Cable System Double Lead One size only $470.00
6.3.6.4 - Cables - Mutli-filament with in-built locking device
Johnson & Johnson Medical Pty Ltd
DP859 Songer Cable System - Stainless Steel Isola Single Cable & Crimp (Pkt 6) One size only $412.00 $967.00
DP860 Songer Cable System - Stainless Steel Double Loop Cable with 2 Crimps One size only $470.00 $660.00
DP862 Songer Cable System - Titanium Double Loop Cable with 2 Crimps One size only $470.00 $682.00
DP864 Songer Cable System - Titanium Isola Single Cable & Crimp (Pkt 6) One size only $412.00 $1,925.00
Lifehealthcare Pty Ltd
LH273 Blackstone - Posterior Cervical System Double Loop Cable w/Four Crimps - One size only $470.00
Titanium
LH274 Blackstone - Posterior Cervical System Single Loop Cable w/Two Crimps - One size only $412.00
Titanium
Medtronic Australasia Pty Ltd
MC441 Atlas Cable System (SS) Single w/crimp and bar One size only $412.00
MC442 Atlas Cable System (SS) Double w/2 crimps One size only $470.00
MC444 Atlas Cable System (Ti) Single (loop end) w/crimp One size only $412.00
MC445 Atlas Cable System (Ti) Double w/2 crimps One size only $470.00
Smith & Nephew Surgical Pty Ltd
SN732 Accord Orthopaedic Cable System, SS Cable 2.0mm $621.00
w/clamp
Zimmer Pty Ltd
ZI164 Zimmer Internal Fixation Systems: Cable Cable-Ready GTR Distal end Cable - 635 mm long $450.00
System Cobalt Chrome
ZI173 Zimmer Internal Fixation Systems: Cable Cable-Ready GTR Cable - Proximal 635mm long $505.00
System
ZI174 Zimmer Internal Fixation Systems: Cable Cable-Ready Stainless Steel Cable 1.8mm $407.00
System
Prostheses List by Category, Groups and Sponsor Page 314 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
TI
Orthotech Pty Ltd
OH258 Songer cable system Double loop titanium spinal cable plus One size only $470.00 $520.00
crimps
6.3.6.5 - Cables, Multi-filament with >1 locking device
Lima Orthopaedics Australia Pty Ltd
LC049 DCD Cerclage Cable The DCD cerclage cable is used to treat Single size only. $350.00
femoral fractures, humeral and tibial
fractures, diaphyseal reconstruction in
revision hip arthroplasty and diaphyseal
reconstruction in revision shoulder
arthroplasty. The spacers minimise contact
with the periostium to reduce the potential
of interruption to the periosteal blood
supply to facilitate bone healing.
TI, VAL
Zimmer Pty Ltd
ZI290 Cable Ready Cable Grip System Titanium - comes with two cables (Co Cr), 23 x 53mm, 1.8 x 635mm $1,736.00
Integral Crimps
6.3.7 - Wire/Cable Accessories
6.3.7.1 - Locking device
Medtronic Australasia Pty Ltd
MC443 Atlas Cable System (SS) Crimp One size only $170.00
MC446 Atlas Cable System (Ti) Crimp One size only $170.00
TI
Lifehealthcare Pty Ltd
LH272 Blackstone - Posterior Cervical System Crimp Two Pack - Titanium One size only $170.00
Orthotech Pty Ltd
OH259 Songer Cable System - 2 Crimps Titanium One size only $170.00 $250.00
Prostheses List by Category, Groups and Sponsor Page 315 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.3.7.2 - Hook/Grip
Biomet Australia Pty Ltd
BI255 BMP Cable System Trochanteric Grip, Chrome Cobalt 1.6mm or 2.0mm $545.00
Smith & Nephew Surgical Pty Ltd
SN735 Accord Orthopaedic Cable System, Std Cable Grip 85-265mm $2,000.00
Zimmer Pty Ltd
ZI708 Universal Clamp Universal Clamp 5.5mm $760.00 $1,850.00
6.3.8 - Staples
6.3.8.1 - Small (≤11mm)
Lima Orthopaedics Australia Pty Ltd
LC072 Ligament Fixation Staple - Small Ligament Fixation Staple - Small 6 - 11 mm width $125.00 $160.00
LC073 Straight Staples - Small Straight Staples - Small 7.5 to 10 mm width $125.00 $160.00
MM
Lima Orthopaedics Australia Pty Ltd
LC065 ADS INTERPHALANX COLD INTERPHALANX Cold Memory Staple 0-35 Degree $700.00
MEMORY STAPLE
LC081 Mono-cortical Hot Memory Staple - 2 Mono-cortical Hot Memory Staple - 2 leg Width 8-11 mm $700.00
leg Small Small
Surgical Specialties
SQ044 OSSStaple Osteosynthesis Staple Dynamic Compression Implants OSS Large wire 2.0-3.0 - Sizes $500.00
Staple - Biocompatible Nitonol 20x20x20, 22x25x22,
30x30x30, 12x15x12
Ti
Lima Orthopaedics Australia Pty Ltd
LC074 Osteotomy Offset Staple - Small Osteotomy Offset Staple - Small 5 - 11 mm $125.00 $160.00
6.3.8.2 - Medium (11-20mm)
Corin Australia Pty Ltd
CR118 LARS Ligament Staple CoCr synthetic ligament anchor 6mm, 8mm or 10mm x 20mm $445.00
Prostheses List by Category, Groups and Sponsor Page 316 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Lima Orthopaedics Australia Pty Ltd
LC083 Ligament Fixation Staple - Medium Ligament Fixation Staple - Medium 11 - 16 mm width $160.00 $170.00
LC084 Straight Staples - Medium Straight Staples - Medium 12.5 mm $160.00 $170.00
LC085 Osteotomy Offset Staple - Medium Osteotomy Offset Staple - Medium 11 - 20 mm $160.00 $170.00
Com
Integra Neurosciences Pty Ltd
IG076 Uni-Clip Compression Staple Stainless steel Width 11mm - 20mm, Length $750.00
13mm - 32mm; Notched -
Width 11mm - 20mm, Length
13mm - 32mm;
MM
Lima Orthopaedics Australia Pty Ltd
LC064 Hot Memory Staple 4 leg - Medium Hot Memory Staple 4 leg - Medium Width 11-20 mm $710.00 $900.00
LC080 Mono-cortical Hot Memory Staple - 2 Mono-cortical Hot Memory Staple - 2 leg Width 11-20 mm $710.00 $750.00
leg Medium Medium
LC082 Asymmetric Hot Memory Staple - Asymmetric Hot Memory Staple - 2 leg - Width 11-12mm $710.00 $750.00
Medium Medium
6.3.8.3 - Large (≥21mm)
Lima Orthopaedics Australia Pty Ltd
LC086 Osteotomy Offset Staple - Large Osteotomy Offset Staple - Large 26 - 36 mm $160.00 $180.00
MM
Lima Orthopaedics Australia Pty Ltd
LC079 Mono-Cortical Hot Memory Staple - 2 Mono-Cortical Hot Memory Staple - 2 leg Width 20-30 mm $710.00 $800.00
leg large large
Surgical Specialties
SQ048 Calcaneal Step OSStaple Dynamic Compression Implant, Calcaneal 2mm, 4mm, 6mm 9mm & $710.00
Step OSStaple, Nitinol Memory Alloy 12mm offsets
Prostheses List by Category, Groups and Sponsor Page 317 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
6.3.8.4 - Plate staple
MM, Com
Surgical Specialties
SQ047 OSSStaple Osteosynthesis Staple Dynamic Compression Implants OSS Plate Staple - 15x6, 15x8, $540.00
Plate Staple - Biocompatible Nitonol 15x10
Construction
6.3.9 - Soft Tissue Fixation Devices
6.3.9.1 - No suture (including arrows)
Biomet Australia Pty Ltd
BH117 Allthread Knotless Suture Anchor Knotless peek suture anchor, polymer 5.5 &6.8mm $285.00 $600.00
6.3.9.1 No suture
AB
ConMed Linvatec Australia Pty Ltd
LV075 BioCuff C Screw Self-Reinforced 96L/4D PLA Screw 6.0mm O.D x 28, 32 & 36mm L $400.00 $480.00
6.3.9.2 - Suture, Large anchors (≥4mm)
Advanced Surgical Design & Manufacture Ltd
AE128 V-Lox PEEK CF Suture Anchors Titanium Fully Threaded Suture Anchor 4.5mm; 5.5mm; 6.5mm, double $255.00 $430.00
loaded and triple loaded suture
anchors
AE129 V-Lox PEEK CF Suture Anchors PEEK CF Fully Threaded Suture Anchor 4.5m; 5.5mm; 6.5mm, $255.00 $493.00
Biomet Australia Pty Ltd
BH119 Allthread Peek Suture Anchor Suture anchor, peek polymer, with 5.5 &6.8mm $435.00 $493.00
maxbraid suture and without needles
ConMed Linvatec Australia Pty Ltd
LV113 PopLok Suture Anchor PEEK Optima Suture Anchor with or 2.8mm, 3.3mm, 3.5mm & $690.00
without sutures 4.5mm diameters
Signature Orthopaedics
SF003 Signature ST Shoulder Anchor PEEK fully threaded suture anchor 4.5mm, 5.5mm &6.5mm $255.00 $493.00
Prostheses List by Category, Groups and Sponsor Page 318 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SM147 Twinfix PK PEEK Optima fully threaded suture anchor 4.5mm 5.5mm and 6.5mm $493.00
SM148 Footprint Non-knot tying suture anchor 4.5mm, 5.5mm, 6.5mm $600.00
Wright Medical Australia
WR211 G Force Ancholok Soft Tissue Anchors Peek suture anchor 5.0mm $435.00
TI
Arthrocare Australasia Pty Ltd
AF034 Titan Ti Suture Anchor System Tendon to bone Anchor 5.5mm and 6.55mm x 16.5mm $395.00
Biomet Australia Pty Ltd
BH118 Allthread Titanium Suture Anchor Suture anchor, titanium with Maxbraid 5.0 & 6.5mm $435.00
suture with and without needles.
Johnson & Johnson Medical Pty Ltd
DY538 Healix Anchor System Titanium anchor with suture 4.5 - 6.5mm $435.00 $493.00
Smith & Nephew Surgical Pty Ltd
SM179 TWINFIX Ti This is a titanium suture anchor for repair 4.5mm, 5.5mm, 6.5mm $430.00
and reattachment of ligaments to bone in
joint arthroscopy
Wright Medical Australia
WR213 G Force Anchorlok Soft Tissue Anchors Titanium suture anchor 5.0mm $370.00
6.3.9.3 - Suture, Medium anchors (2.4 – 3.9mm)
Smith & Nephew Surgical Pty Ltd
SN909 BIORAPTOR Knotless This is a knotless suture anchor for repair 2.9mm. $460.00 $600.00
and reattachment of the labrum in shoulder
and hip arthroscopy.
Wright Medical Australia
WR210 G Force Anchorlok Soft Tissue Anchors Peek suture anchor 3.5mm $400.00 $435.00
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Billing Code Product Name Description Size Benefit Benefit Notations
a, b
Johnson & Johnson Medical Pty Ltd
JJ810 GRYPHON BR Instability Anchor Instability Anchor with Orthocord 2.4-3.0mm $493.00
AB
Smith & Nephew Surgical Pty Ltd
SM178 RAPTORMITE 3.7 This is a absorbable suture anchor for 3.7mm $460.00
repair and reattachment of ligaments in
arthroscopic surgery
TI
Wright Medical Australia
WR214 G Force Anchorlok Soft Tissue Anchors Titanium Suture Anchor 2.5 & 3.5mm $370.00
6.3.9.3 Single suture, Medium anchors (2.4 – 3.9mm)
Smith & Nephew Surgical Pty Ltd
SN846 KINSA Suture Anchor, Polmer With Polyester 2.9mm $600.00
Suture Material
AB
Smith & Nephew Surgical Pty Ltd
SN908 OSTEORAPTOR This is an hydroxyapatite incorporated 2.9mm $460.00 $495.00
absorbable suture anchor for repair and
reattachment of the labrum in shoulder and
hip arthroscopy
TI
Smith & Nephew Surgical Pty Ltd
SN907 TWINFIX Ti This is a titanium suture anchor for repair 2.8mm $430.00
and reattachment of ligaments to bone in
joint arthroscopy
6.3.9.4 - Suture, Small anchors (≤2.3mm)
Johnson & Johnson Medical Pty Ltd
MN101 OmniSpan Meniscal Repair System Pre-loaded Peek backstops and 0 to 27 degrees $194.00 $440.00
ORTHOCORD suture
Prostheses List by Category, Groups and Sponsor Page 320 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SM146 Bioraptor 2.3 PK PEEK optima suture anchor 2.3mm $440.00
TI
Wright Medical Australia
WR212 G Force Anchorlok Soft Tissue Anchors Titanium suture anchor 1.9mm $345.00 $370.00
6.3.9.4 Single suture, Small anchors (≤2.3mm)
AB
Smith & Nephew Surgical Pty Ltd
SN906 OSTEORAPTOR This is an hydroxyapatite incorporated 2.3mm $495.00
absorbable suture anchor for repair and
reattachment of the labrum in shoulder and
hip arthroscopy
TI
Stryker Australia Pty Ltd
SK177 Stryker Cuff Anchor Glenoid Titanium anchor kit for soft tissue Dia 2 - 3mm $194.00
reattachment
Titanium
Smith & Nephew Surgical Pty Ltd
SN903 Minitac This is a titanium suture anchor with 2.0mm $430.00
needles for repair and reattachment of the
ligaments in small joint arthroscopy
6.3.9.5 - Button/thread/tape or Button/thread/button
Advanced Surgical Design & Manufacture Ltd
AE130 Parcus - GFS Parcus - GFS Fixation for knee ligament GFS Standard with 10mm, $369.00
reconstruction 15mm, 20mm & 25mm Suture
Loops; and
GFS Large with 15mm to
45mm Suture Loops (in 2mm
increments)
Biomet Australia Pty Ltd
BH111 Ziptight Fixation System Ankle syndesmosis device, stainless steel, One Size $369.00 $589.00
titanium, PE suture with or without
disposable instruments
Prostheses List by Category, Groups and Sponsor Page 321 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SN853 Endobutton Fixation for ACL/PCL reconstruction 5-9mm, 15-60mm $369.00
6.3.9.6 - Button
Arthrocare Australasia Pty Ltd
AF004 OPUS Knotless Anchor System Knotless anchor fixating soft tissue to bone 5.5mm & 6.5mm $730.00
6.3.9.7 Knotless Suture, Medium anchor (2.4 – 3.9mm)
Arthrocare Australasia Pty Ltd
AF005 OPUS Knotless Anchor System Knotless anchor fixating soft tissue to bone 2.8 - 3.4mm $690.00
6.3.9.8 Knotless Suture, Small anchor (≤2.3mm)
Arthrocare Australasia Pty Ltd
AF001 OPUS Knotless Anchor System All in one Dual Knotless anchor for fixating 1.8mm $920.00 $940.00
soft tissue to bone
Group 10: Shoulder - Humeral
Stryker Australia Pty Ltd
HW216 Howmedica Modular Resection System Distal Humerus Cone - Vitallium One size only $4,580.00
HW217 Howmedica Modular Resection System Distal Humerus Flange - Vitallium One size only $4,347.00
HW218 Howmedica Modular Resection System Humerus Connection Piece - Vitallium One size only $4,122.00
HW221 Howmedica Modular Resection System Humerus Extension Piece - Vitallium 5, 15, 30, 45, 60, 75, 90, 105, $5,243.00
120, 135, 150, 165mm
HW255 Howmedica Modular Resection System Oncology Humeral Body - Titanium 40 - 140mm in 20mm $2,827.00
increments
Prostheses List by Category, Groups and Sponsor Page 322 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Group 10b: Humeral Stem
Lima Orthopaedics Australia Pty Ltd
LC044 Lima RPS Tumor System RPS Total Shoulder Replacement Stem 200, 240, 280mm $6,900.00
Stryker Australia Pty Ltd
HW222 Howmedica Modular Resection System Humeral Anchorage Piece - Vitallium 9, 10, 11, 12mm $4,393.00
HW256 HMRS Oncology Humeral Stem Cobalt Chromium 7x75mm, 7x115mm, 9x75mm, $4,778.00
9x115mm, 11x115mm,
25mmx75mm, 25mmx100mm,
50mmx75mm,
50mmx100mm,75mmx100mm,
100mmx50mm
Group 10f: Standard Humeral Head
Lima Orthopaedics Australia Pty Ltd
LC046 Lima RPS Tumor System RPS Humeral Head 46, 52, 58mm $3,680.00
Stryker Australia Pty Ltd
HW254 HMRS Oncology Humeral Head/Cap Cobalt Chromium 40, 44mm, Cap $4,260.00
Group 11: Shoulder – Glenoid
Group 11a: Glenoid Component
Global Orthopaedic Technology
GO149 Reverse Shoulder System Glenoid Baseplate, Ti, Porous, HA Small to Large $2,875.00
GO150 Reverse Shoulder System Glenoid Head, CoCr 32mm to 40mm $2,875.00
Synthes Australia Pty Ltd
SY435 Epoca Custom Offset Shoulder Prosthesis Epoca Glenoid Screw 8-30mm $250.00
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Billing Code Product Name Description Size Benefit Benefit Notations
Group11e: Other
Stryker Australia Pty Ltd
HW200 Howmedica Modular Resection System Plug Screw Axis - Vitallium One size only $217.00
HW202 Howmedica Modular Resection System Wedge - Vitallium One size only $211.00
HW203 Howmedica Modular Resection System Bearing - Vitallium One size only $178.00
HW219 Howmedica Modular Resection System Humerus Connecting Screw - Vitallium One size only $653.00
HW220 Howmedica Modular Resection System Humerus Hex Socket Bolt - Vitallium One size only $565.00
Group 13: Shoulder Accessories
Group 13b: Shoulder Accessories - Humeral Spacer
Lima Orthopaedics Australia Pty Ltd
LC036 Lima RPS Tumor System RPS Additional Spacer 40, 60, 90, 120mm $1,900.00
Group 13c: Shoulder Accessories - Other
Biomet Australia Pty Ltd
BI220 Bio-Modular Shoulder System Glenoid Screw 5mm x (15-40mm) $145.00
Johnson & Johnson Medical Pty Ltd
DP954 Delta Shoulder system Metaglene Screw Stainless Steel 3.5mm and 4.5mm $213.00
JJ557 DELTA Xtend Non Locking Metaglene Screw Dia 4.5 4.5mm; 18, 24, 30, 36, 42 $215.00
JJ558 DELTA Xtend Locking Metaglene Screw Dia 4.5 4.5mm; 24, 30, 36, 42, 48 $276.00
Zimmer Pty Ltd
ZI534 Zimmer Trabecular Metal Reverse Inverse/Reverse Screw 4.5mm 18mm, 24mm, 27mm, 30mm, $145.00
Shoulder System 33mm, 36mm, 42mm, 48mm
Prostheses List by Category, Groups and Sponsor Page 324 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Group 14: Intramedullary Nails
Group 14a: Femoral
Biomet Australia Pty Ltd
BI921 EBI Paediatric Locking Nail System Femoral Locking Nail - titanium; 28 -42cm x 5.5 - 6.5mm $1,000.00
Johnson & Johnson Medical Pty Ltd
DP571 Art Retrograde Nail Femoral Nail Titanium Unsterile or Sterile 9 -12mm x 30 - 50cm $1,740.00
DP900 Albizza Nail Albizza Nail - Stainless Steel 240-320mm Length $10,692.00
DP929 Supacondylar Nail System Supracondylar Titanium Nail Sterile or 10 to 12 mm x 15-30cm $1,210.00
Unsterile
DY326 Ace Trochanteric Nail Trochanteric Nails Sterile in Standard or 125 - 130 deg, 9 - 11mm, 320 $1,735.00
Left or Right - 420mm, sterile and non-sterile
Smith & Nephew Surgical Pty Ltd
SN521 TriGen Nail: TAN & FAN, titanium 10, 11.5 &13mm diameter $750.00
Stryker Australia Pty Ltd
SK337 Stryker Trauma Locking Nail System Arthrodesis Nail - Knee Arthrodesis Nail Left/Right; $5,182.00
11.5mm and 13mm
Zimmer Pty Ltd
ZI715 Zimmer Natural Nail System Cephalomedullary, Femoral Long Nails, 10mm to 14.5mm (in 1.5mm $995.00 $1,425.00
Titanium increments) x 30 to 48cm (in
2cm increments) x 125 & 130
CCD Left and Right.
ZI721 Zimmer Natural Nail System Retrograde Femoral Nail - Titanium 10mm to 13mm (in 1.5mm $995.00 $1,595.00
increments) x 20, 24, 28, 30,
32, 34, 36, 38, 40, 42, 44cm
Universal.
ZI722 Zimmer Natural Nail System Antegrade Femoral Nails, Greater 8 to 14mm x 24 to 48cm (in $995.00 $1,095.00
Trochanter, Titanium 2cm increments) Left and Right
ZI723 Zimmer Natural Nail System Cephalomedullary, Short Nails, Titanium 10mm to 14.5mm (in 1.5mm $995.00
increments) x 21.5cm 125 to
135 CCD (in 5 CCD
increments) Left and Right.
Prostheses List by Category, Groups and Sponsor Page 325 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
D
Stryker Australia Pty Ltd
SK202 Stryker Trauma Locking Nail System SCN Diameter 11m - 14mm, Length $990.00
170mm - 240mm
E
LMA PacMed Pty Ltd
PM116 ISKD Internal Limb Lengthening System Titanium Alloy Diameter 12.5 - 14.5mm $16,500.00
Synthes Australia Pty Ltd
SY262 AO/ASIF Intramedullary Nails Femoral Nail 9-15mm dia / 120-150 deg / $2,060.00
170 - 500mm Length
SY264 AO/ASIF Intramedullary Nails Distal Femoral Nail - DFN 9-15mm / 160-420mm Length $1,082.00
P
B Braun Australia Pty Ltd
BB051 BRAUN AUST Intramedullary Nails Compression Nail 100mmx10.5mm- $1,600.00
610mmx12.5mm
Johnson & Johnson Medical Pty Ltd
DP343 Femoral Nail System Femoral Nail Titanium Sterile or Unsterile 8 -15mm x 30- 240mm $1,740.00
JJ672 VersaNail IM Nailing Platform Troch Entry and Universal Femoral Nails, 9-13mm x 28-48CM $2,060.00
Titanium, Locking, cannulated.
Smith & Nephew Surgical Pty Ltd
SN509 Russel Taylor Intramedullary Hip Screw Nail (IMHS) Standard 10-16mm 21 cm $650.00
Stainless Steel length, Long 10-12mm
Diameter Right& Left 34-42cm
Length
SN763 IMHS CP Intramedullary Hip Nail, stainless steel 10 - 16mm x 19.5cm left and $760.00
right
SN764 IMHS CP Intramedullary Hip Nail, stainless steel 10 - 14mm x 32 - 44cm left $830.00
and right
SN838 Trigen InterTAN Nail Nail, Titanium diameter 10-13mmlength 18- $1,350.00
46cmAngle 125°-135°
Stryker Australia Pty Ltd
SK214 Stryker Trauma Locking Nail System Reconstruction Nail Recon Nail Left/Right $1,200.00
Prostheses List by Category, Groups and Sponsor Page 326 of 911
6 - SPECIALIST ORTHOPAEDIC
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Billing Code Product Name Description Size Benefit Benefit Notations
SK244 Stryker Intramedullary Hip Screw Gamma3 Long 120, 125, 130 Deg; Diameter $1,350.00
10-13mm; Length 280-420mm
SK246 Gamma LN Standard - Titanium 120, 125, 130 Deg; Diameter $995.00
10-12mm; Length 170-200mm
Synthes Australia Pty Ltd
SY270 AO/ASIFIntramedullary Nails Antegrade/Retrograde Femoral Nail Diameter 6.5-18mm, Length $1,030.00
30-500mm
P, D
Austofix
AX024 Austofix Femoral & Tibial Nailing System F2 Femoral Nail 4.8/6.2; s-s Dia 9 - 12mm; Lengths 320 - $1,475.00
460mm
Group 14b: Tibial
Smith & Nephew Surgical Pty Ltd
SN522 TriGen Knee Nail 8.8, 10, 11.5 & 13mm $1,050.00
diameters, 26-50cm lengths
SN841 Trigen META Metaphyseal Nail, Titanium 8.5-13mm15x50cm $1,250.00
Zimmer Pty Ltd
ZI522 SIRUS Nail Sirus Tibial Nail 8, 9, 10mm diam x 240 to $1,050.00
420mm in 14mm increments
ZI719 Zimmer Natural Nail System Tibial Nails - Titanium 8.3mm; 9.3mm; 10mm; 11mm; $910.00 $1,295.00
12mm; 14mm x 24 to 44cm in
2cm increments
E
Synthes Australia Pty Ltd
SY060 AO/ASIF Intermedullary Nails Cannulated and Solid Tibial Nail 7.0mm-19mm dia 200-600mm $910.00
length
SY128 AO/ASIF Intramedullary Nails Tibial unreamed - steel 8 - 9 mm , length 255 - 420mm $1,009.00
P
Johnson & Johnson Medical Pty Ltd
DP330 Tibial Nail System Tibial Nail or Dynamic Tibial Nail Titanium 8-13mm x 25.5-42.5cm $1,405.00
Unsterile or Sterile
Prostheses List by Category, Groups and Sponsor Page 327 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
JJ674 VersaNail IM Nailing Platform Tibial Nails, Titanium, Locking, cannulated. 8-13mm x 25 - 50cm $1,350.00
P, D
Austofix
AX022 Austofix Femoral & Tibial Nailing System Tibial Nail 4.0/4.8; s-s Dia 8 - 11mm, Lengths 260 - $1,009.00
420mm
Group 14c: Humeral
Johnson & Johnson Medical Pty Ltd
DP367 Humeral Nail System Humeral Nail Titanium Sterile or Unsterile 20 – 30 cm $1,032.00
Smith & Nephew Surgical Pty Ltd
SN740 Trigen Humeral Nail 7-11cm x 16-30cm $660.00
Zimmer Pty Ltd
ZI716 Zimmer Natural Nail System Antegrade Humeral Nail - Titanium 7, 8, 9 & 10mm x 15, 18, 19.5, $660.00 $1,925.00
21, 22.5, 24, 25.5, 27, 28.5 &
30cm. Left & Right.
ZI717 Zimmer Natural Nail System Cancellous Screws Titanium - Partially 6.0mm x 50 to 145mm at 5mm $94.00
Threaded & Fixed Angle increments
E
Lima Orthopaedics Australia Pty Ltd
LC047 Lima Humeral Nail Stainless steel Dia 7 - 8mm, length 200 - $1,990.00
300mm
Synthes Australia Pty Ltd
SY129 AO/ASIF Intramedullary Nails Humeral Nail 6.0 - 12.0 mm length 100 - $865.00
400mm
P
B Braun Australia Pty Ltd
BB107 BRAUN AUST Intramedullary Nails Nail for small bones Dia 3mm-8mm $1,617.00 $3,200.00
Medical & Optical Instruments Australia Pty Ltd
MO154 Polarus Proximal Humeral Fixation System Polarus Proximal Humeral Rod 150 - 300mm length $1,925.00
Standard/Plus Titanium
Prostheses List by Category, Groups and Sponsor Page 328 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
SK006 Stryker Trauma Locking Nail System Titanium - Humeral Nail Dia 7,8,9mm length 140 - $2,195.00
320mm
SK199 Stryker Trauma Locking Nail System Proximal Humeral Nail Nail Left/Right $2,158.00
P, D
Austofix
AX013 Proximal Humeral Nail Stainless Steel Diameter 8 mm, Length 170 $1,075.00
mm
Device Technologies Australia Pty Ltd
DE096 Fixion IM nail - Humeral Stainless steel Dia 6.7 - 8.5mm (reduced), $1,990.00
length 180 - 280mm
Johnson & Johnson Medical Pty Ltd
JJ673 VersaNail IM Nailing Platform Humeral Nails, Universal and Proximal, 7-10 mm x 150-280mm $2,195.00
Titanium, Locking, cannulated
Proximal
Tornier Pty Ltd
TO050 Aequalis Humeral Nail Intermedullary Humeral Nail, straight, Right/Left $660.00 $2,195.00
cannulated, Ti
Group 14d: Other
Biomet Australia Pty Ltd
BH044 Biomet Phoenix Nail Arthrodesis Nailing Ankle Arthrodesis Locking Nail, Titanium 9 - 12mm diameter x 150 - $1,700.00 $2,000.00
System - Nail Alloy 420mm length
BI252 SST Small Bone Locking Nail Fibula Nail, titanium (3.5, 4.5mm) x 150mm $1,333.00
Integra Neurosciences Pty Ltd
IG100 Panta Arthrodesis Nail Ankle Nail, Titanium Diameter 10 -13 mm Length $1,000.00
- 150-240 mm
Johnson & Johnson Medical Pty Ltd
DP528 Nancy Nail System Pediatric Flexible Nail 2.5 or 3.0 mm x 190 -290mm $431.00
DP529 Nancy Nail System Pediatric Flexible Nail 3.5 mm x 270-350mm $475.00
DP531 Nancy Nail System Pediatric Flexible Nail 4.0 mm x 330-450mm $475.00
Prostheses List by Category, Groups and Sponsor Page 329 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
DP572 Nancy Nail System Pediatric Flexible Nail 2.0 mm x 130 - 190mm $414.00
DY380 Versa Nail TTC Fusion Nail Sterile 10mm x 15cm up to 12mm x $1,245.00
30cm
DY381 Versa Nail TTC Fusion Nail Unsterile 10mm x 15cm up to 12mm x $1,110.00
30cm
JJ639 Small Bone Fixation System - Small Intramedullary Nail 1.6mm and 1.1mm $700.00 $950.00
Bone Flexible Nail
JJ641 Small Bone Fixation System - Small Intramedullary Nail Fixation System Kit 1.6mm and 1.1mm $700.00 $1,250.00
Bone Fixation System Kit
Lifehealthcare Pty Ltd
LH326 Metaflex Low compression screw Diameter: 1.2, 1.4, 1.6, 2.0 - $390.00
2.5mm, Length: 10mm - 30mm
LH368 Fassier-Duval Telescopic IM System The Fassier-Duval Telescopic IM System The system is composed of a $3,300.00
Component: Female is an endomedular nail designed for total of 108 rods in 9 different
patients suffering from Osteogenesis diameters per type. The nail is
Imperfecta (OI), Skeletal Displasia, manufactured in both Ti alloy
Congenital Tibial Pseudoarthrosis, Limb (Ti6A14V ASTM-136) and
lengthening over nail, Segmental Tumor medical grade stainless steel
removal and other bone defo (316L, ASTM 138). It is
available in five diameters:
3.2,4.4,8,5.6 and 6.4mm;
Link Orthopaedics Australia
LO100 LINK Arthrodesis Pin Cobalt Chromium 90mm $6,300.00
Medical & Optical Instruments Australia Pty Ltd
MO159 Polarus Humeral Rod System Polarus Ulna Rod Titanium 210 to 270mm length $1,460.00
MO161 Polarus Humeral Rod System Polarus Radius Rod Titanium 190 to 230mm length $1,460.00
Smith & Nephew Surgical Pty Ltd
SN496 Intramedullary Nailing System Foresight Nail 4-5mm Diameter 20-26cm $660.00
Length
SN497 Intramedullary Nailing System Knee Fussion Nail, Stainless Steel 11x 65-75 & 12 x 65-85cm $4,400.00
SN772 Trigen Hindfoot Fusion Nail, Titanium 10 - 11.5mm Diameter $1,195.00
Stryker Australia Pty Ltd
HW257 Wichita Fusion Nail System Femoral Component - Vitallium 18mm $2,690.00
Prostheses List by Category, Groups and Sponsor Page 330 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
HW354 Metaizeau Nail Stainless Steel 2-4mm x 400-500mm $160.00
SK465 Stryker Intermedullay Nailing System T2 Retrograde/Antegrade/Compression 7-15mmDiameter, 140 to $1,625.00
Nails 480mm lengths
Synthes Australia Pty Ltd
SY263 AO/ASIF Intramedullary Nails Hip Pin 30-200mm Length $391.00
SY416 AO/ASIF Intramedullary Nails ASLS Intramedullary Angular Stable Locking 4-6mm, 26-125mm $655.00
System
Wright Medical Australia
WR029 Micronail intramedullary radial fixation Titanium, Distal radial nail 1, 2, 3, 4 and XL $1,620.00
D
Medical & Optical Instruments Australia Pty Ltd
MO280 Acumed Fibula Rod System Intramedullary Nail, fibula lower limb 3.00mm & 3.6mm diameter left $1,050.00 $1,575.00
specific and right specific rods with
lengths of 110mm, 145mm,
180mm
Stryker Australia Pty Ltd
SK450 T2 Ankle Arthrodesis Nail T2 Ankle Arthrodesis Type II Anodized 10, 11, 12mm Diameters & $1,700.00
Titanium Alloy (Ti6A14V) 150,200 & 300mm Lengths
E
Lifehealthcare Pty Ltd
LH367 Fassier-Duval Telescopic IM System The Fassier-Dual Telescopic IM System is The syste is composed fo a $3,300.00
Component: Male an endomedular nail designed for patients total of 108 rods in 9 different
suffering from Osteogenesis Impecfecta diameters per type. The nail is
(OI), Skeletal Displasia, Congenital Tibial manufactured in both Ti alloy
Pseudoarthosis, Limb lengthening over nail, (Ti6A14V ASTM-136) and
Segmental Tumor removal and other bone medical grade Stainless Steel
deform (315L, ASTM 138). It is
available in five diameters: 3.2,
4,4.8,5.6 and 6.4 mm
Synthes Australia Pty Ltd
SY064 Titanium Elastic Nail 1.5mm - 4.0mm $220.00
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Billing Code Product Name Description Size Benefit Benefit Notations
P
Austofix
AX026 Austofix Femoral & Tibial Nailing System F2 Hip Nail 4.8/6.5; high nitrogen s-s Dia 11mm, Length 170mm - $760.00
240mm
Synthes Australia Pty Ltd
SY124 AO/ASIF Intramedullary Nails Proximal sleeve Standard 130 deg antigrade, $361.00
spiral blade
TI
Link Orthopaedics Australia
LO101 LINK Arthrodesis Pin Tilastan 90mm $7,300.00
Group 15: Intramedullary Nail Accessories
Group 15a: Screws
Biomet Australia Pty Ltd
BH046 Biomet Phoenix Ankle Nailing System - Double lead screw - Ti-6Al-4V Standard 5mm Dia x (20 to 110)mm $184.00 $250.00
5mm Double-lead thread screw or osseotite finish length
BI249 SST Small Bone Locking Nail Screw, Distal Fixator, Titanium One size only $115.00
BI250 SST Small Bone Locking Nail Set Screw w/holder, Titanium One size only $115.00
BI287 Uniflex Tibial Nail Tibial Nail Transverse Screw, Titanium 4.0, 5.0mm x (20-70mm) $184.00
BI922 EBI Paediatric Locking Nail System Screw Pilot Double Thread - titanium; 20 - 68mm x 4.0mm $140.00
Integra Neurosciences Pty Ltd
IG101 Panta Arthrodesis Nail Locking Screw, Titanium Diameter 5 mmLength - 20 - $79.00
110 mm
Johnson & Johnson Medical Pty Ltd
DP901 Albizza Nail Albizza Nail Cotter Screw 3.5 or 4.5 0r 5.5 mm 25-75 $95.00
mm length
DY323 Ace Trochanteric Nail Trochanteric Lag Screw Sterile 60 to 120mm $256.00
DY324 Ace Trochanteric Nail Trochanteric Anti Rotation Screw Sterile 60 to 100mm $96.00
JJ707 ATN Trochanteric Nail System Titanium anti-rotational screw for 40 - 150mm $187.00
Trochanteric nail
JJ708 ATN Trochanteric Nail System Titanium lag screw for Trochanteric nail 40-150mm $465.00
Prostheses List by Category, Groups and Sponsor Page 332 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medical & Optical Instruments Australia Pty Ltd
MO156 Polarus Proximal Humeral Fixation System Polarus Screws Cancellous/Cortical 12.5 to 60mm length $220.00
Titanium
Smith & Nephew Surgical Pty Ltd
SN519 TriGen Capture Reconstruction Screws Titanium 6.4mm diameter 65-125mm $219.00
length
SN520 TriGen Captured Screws Titanium 4.5 & 5.0mm diameters, 20- $120.00
110mm lengths
SN739 Trigen Self Tapping Cortical Screw 20mm - 60mm $95.00
SN762 IMHS CP Captured locking screw 4.5mm x 22mm to 4.5mm x $95.00
64mm
SN774 IMHS CP Captured Compression Screw, Stainless 19mm $93.00
Steel
SN775 IMHS CP Set Screw, Stainless Steel Standard $65.00
Stryker Australia Pty Ltd
HW274 Alta Modular Trauma System - Cortical Screw/Screw Nut Assembly - 5mm $280.00
Components Titanium
SK203 Stryker Trauma Locking Nail System SCN Condyle Screws 5mm x $324.00
(40mm-120mm)
SK204 Stryker Trauma Locking Nail System SCN Nut for Condyle Screws 5mm $232.00
SK215 Stryker Trauma Locking Nail System Reconstruction Nail Recon Lag Screw $260.00
SK216 Stryker Trauma Locking Nail System Reconstruction Nail Blocking Screw $95.00
SK228 Omega Plus Compression Hip Screw Cephalic Implants Hansson Twin Hook 50- $195.00
System 140mm
SK230 Hansson Pin Cephalic Implants Hansson Pin 70-140mm $335.00
SK243 Gamma LN Lag Screw - Titanium 10.5mmx70mm - $465.00
10.5mmx130mm
SK245 Gamma LN Locking Screw - Titanium 5x25mm - 5x95mm $155.00
SK247 Gamma LN Set Screw - Titanium 8x17.5mm $95.00
SK490 U-Blade U-Blade Lag Screw Set All Gamma 3 U-Blade's are $655.00
10.5mm in diameter, ranging
from 70-130mm in 5mm
increments
Prostheses List by Category, Groups and Sponsor Page 333 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST043 Stryker Trauma Locking Nail System: Titanium 20-120mm $140.00
Locking Screw with & without shaft
Synthes Australia Pty Ltd
SY127 AO/ASIF Intramedullary Nails Shaft screw 5.0mm , length 70 - 125mm $157.00
SY131 AO/ASIF Intramedullary Nails Locking bolts - steel 3.9 - 4.9mm , length 18 - 100mm $87.00
SY132 AO/ASIF Intramedullary Nails Locking bolts 3.0mm-6.0mm Dia 10-150mm $121.00
Length
SY265 AO/ASIF Intramedullary Nails Locking Screws 15 -150mm $124.00
Wright Medical Australia
WR031 Micronail intramedullary radial fixation 2.7mm Titanium Screw 10mm - 20mm $220.00
WR032 Micronail Intramedullary Radial Fixation 2.5mm ti buttress screw 16 - 28mm $250.00
Zimmer Pty Ltd
ZI524 SIRUS Nail Sirus Locking Screws 3.9, 4.9mm x 24 to 100mm $138.00
ZI525 SIRUS Nail Sirus Cervical Screws 6.5mm diam x 60 to 140mm in $219.00
5mm increments
ZI713 Zimmer Natural Nail System Lag Screws, Titanium 10.5mm x 70 to 130mm in $196.00 $425.00
5mm increments
ZI714 Zimmer Natural Nail System Cortical Screws (Partially Threaded) 4.0mm & 530mm x 20mm to $94.00
Titanium 60mm (2.5mm increments);
4.0mm & 5.0mm x 65 to 100
mm (5mm increments)
ZI718 Zimmer Natural Nail System Cortical Screws - Fixed Angle (Fully 4.0mm & 5.0mm x 20 to 60mm $94.00
Threaded) Titanium (2.5mm increments); 4.0mm &
5.0mm x 65 to 100mm (5mm
increments)
Group 15b: Caps
Austofix
AX029 Austofix Femoral & Tibial Nailing System End Cap; I.M. Nails; s-s 8 - 13mm $123.00
Prostheses List by Category, Groups and Sponsor Page 334 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Biomet Australia Pty Ltd
BH045 Biomet Phoenix Arthrodesis Nailing Offset end cap, Titanium 0mm - 20mm $79.00 $225.00
System - End Cap
BI251 SST Small Bone Locking Nail Nail End Cap, titanium low profile, one size only $218.00
BI923 EBI Paediatric Locking Nail System Nail end cap, titanium 5.5mm - 6.5mm $150.00
Integra Neurosciences Pty Ltd
IG102 Panta Arthrodesis Nail End Cap, Titanium One Size $45.00
Johnson & Johnson Medical Pty Ltd
DP331 Tibial Nail System End Cap Titanium One size only $65.00
DP339 Femoral Nail End Cap Titanium One size only $45.00
DP371 Humeral Nail System End Cap Various Titanium Unsterile or One size only $65.00
Sterile
DY325 Ace Trochanteric Nail Trochanteric End Cap Sterile 5 to 25mm $161.00
DY382 Versa Nail TTC Nail Cap Unsterile Impinging and One Size $45.00 $99.00
Non Impinging
DY383 Versa Nail TTC Nail Cap Sterile Impinging and Non One Size $45.00 $150.00
Impinging
JJ675 VersaNail IM Nailing Platform End caps for VersaNail IM Nail Platform Flush, impinging & 5-15mm $150.00
Medical & Optical Instruments Australia Pty Ltd
MO200 Polarus Proximal Humeral Fixation System End cap, titanium Only size only $45.00 $180.00
Smith & Nephew Surgical Pty Ltd
SN498 Intramedullary Nailing System Nail Cap One size only $79.00
Stryker Australia Pty Ltd
SK201 Stryker Trauma Locking Nail System Proximal Humeral Nail Proximal Humerous Washer $52.00
round/square
SK229 Omega Plus Compression Hip Screw Cephalic Implants Hansson Twin Hook $63.00
System Compression Screw 25mm
SK248 Gamma LN Proximal/Extension Plug - Titanium 0mm, +5mm, +10mm $95.00
SK491 U-Blade End Cap U-Blade Lag Screw End Cap One size 9mm x 10.5mm $250.00
(diameter)
ST035 Stryker Trauma Locking Nail System: Titanium One size only $165.00
Compression Screw
Prostheses List by Category, Groups and Sponsor Page 335 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST045 Stryker Trauma Locking Nail System: Titanium Standard, +5, +10, +15 $95.00
End Cap
Synthes Australia Pty Ltd
SY125 AO/ASIF Intramedullary Nails End cap 0 - 40mm $207.00
Zimmer Pty Ltd
ZI526 SIRUS Nail Sirus End Cap 5-25mm length in 5mm $200.00
increments
ZI709 Zimmer Natural Nail System Cortical Nuts and Washers Cortical Nut for the 6mm $79.00 $94.00
Cancellous Screw
ZI710 Zimmer Natural Nail System Cephalomedullary Nail Caps - Titanium Height: 0mm, 5mm, 10mm & $79.00 $94.00
(Neutral, Sliding & Locking) 15mm
ZI711 Zimmer Natural Nail System Femoral Nail Caps (Titanium) Height: 0mm, 5mm, 10mm & $79.00 $94.00
15mm
ZI712 Zimmer Natural Nail System Humeral Nail Caps (Titanium) Antegrade Height: 0mm, 5mm, 10mm & $79.00 $94.00
& Retrograde 15mm (Antegrade), 0mm,
5mm, 10mm (Retrograde)
ZI720 Zimmer Natural Nail System Tibial Nail Caps (Titanium) Height: 0mm, 5mm, 10mm & $79.00 $94.00
15mm
Group 16: Plates
LMT Surgical Pty Ltd
LM002 TriMed Fixation System Plates, Stainless Steel Various sizes $915.00 $950.00
Group 16a: Standard ≥4.5mm
Device Technologies Australia Pty Ltd
DE055 Osteotomy Plates Osteotomy, Tibial - Stainless Steel 5mm - 17.5mm $820.00
DE078 Osteotomy Plates Osteotomy, Femoral - Stainless Steel 7.5mm - 17.5 mm $1,193.00
DE094 Osteotomy Plates Anterior/posterior sloped. Stainless steel 5 - 15mm length $1,098.00
DE216 Arthrex Osteotomy Plates Tibial, Composition Titanium 0-17.5mm $1,300.00
DE217 Arthrex Osteotomy Plates Femoral, Titanium 5mm - 17.5mm $1,480.00
Prostheses List by Category, Groups and Sponsor Page 336 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Integra Neurosciences Pty Ltd
IG084 Newdeal Bendable Osteosynthesis Composition - 316L Stainless Steel. To 2-4 hole plates $740.00
Plates be used only with Newdeal screws/lock
screws.
IG085 Newdeal Bendable Osteosynthesis Composition - 316L Stainless Steel. To 5 - 9 hole plates $975.00
Plates be used only with Newdeal screws/lock
screws
Johnson & Johnson Medical Pty Ltd
DP608 Small / Large Fragment Set Straight Plate Titanium 3-12 Hole $366.00
DP612 Small / Large Fragment Set Active Compression Plate Titanium 3.5mm 5 to 10 Hole $193.00
DP678 Small / Large Fragment Set S/S Small or Narrow DCP Plate 2.7mm or 3.5mm with 2 - 12 $98.00
Hole
JJ709 ALPS - Anatomic Locked Plating 3.5MM Titanium 100° Tubular Plate 1-4 holes $300.00
System
Orthotech Pty Ltd
OH370 Otis Plate Left & Right plate 1 size $550.00 $1,050.00
Smith & Nephew Surgical Pty Ltd
SN071 TC 100 4.5mm Narrow Compression Sterile, 2 - 4 holes 39 - 71mm $79.00
plates
SN078 TC 100 4.5mm Broad Compression Sterile, 20 - 26 holes 326 - 423mm $320.00
plates
SN108 TC 100 Plate: Broad Compression 4.5mm, 3 - 10 holes $165.00
SN119 TC 100 4.5mm T-plate Sterile, 3 - 4 holes 68 - 84mm $147.00
SN131 TC 100 4.5mm Narrow Compression Sterile, 14 - 24 holes 231 - 390mm $225.00
plates
SN132 TC 100 4.5mm Narrow Compression Sterile, 11 - 13 holes 183 - 215mm $180.00
plates
SN133 TC 100 4.5mm Narrow Compression Sterile, 8 - 10 holes 135 - 167mm $102.00
plates
SN135 TC 100 95 Degree Condylar Plates Small stature Shaft length 92 - 299 mm, $360.00
blade length 50 - 80mm
SN137 TC 100 Plate: Broad Compression 4.5mm, 6 - 8 holes $138.00
Prostheses List by Category, Groups and Sponsor Page 337 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SN543 TC 100 Plate Pelvic Fragment Plates 3-18 hole, 45-190mm $160.00
SN557 TC 100 Plate 4.5mm Broad Compression Plate 14-18 hole $270.00
Stryker Australia Pty Ltd
HW305 Dall Miles Cable Grip System - Stainless Stainless Steel Plate:5 hole - Stainless 6 inches $640.00
Steel Steel
HW306 Dall Miles Cable Grip System - Stainless Stainless Steel Plate:7 hole - Stainless 8 inches $804.00
Steel Steel
HW307 Dall Miles Cable Grip System - Stainless Stainless Steel Plate:9 hole - Stainless 10 inches $819.00
Steel Steel
HW308 Dall Miles Cable Grip System - Stainless Stainless Steel Plate:11 hole - Stainless 12 inches $866.00
Steel Steel
SK088 Stryker Plating System Basic Fragment Waisted Compression Plate Broad 15-26 Holes $325.00
Set
ST036 Stryker Plating System Small & Basic Oblique T Plate or T Plate, Stainless Steel 42-86mm Length $304.00
Fragment - T Plate or Titanium, Oblique
ST039 Stryker Plating System Small & Basic Stainless Steel or Titanium, Left or Right 3-20 Holes, 67-339mm Plate $231.00
Fragment - L Plate Length
ST041 Stryker Plating System Basic Fragment Waisted Compression Plate Broad 6-14 holes $316.00
Set
Synthes Australia Pty Ltd
SY033 AO/ASIF Plates Semi tubular 2 - 28 hole $165.00
SY117 AO/ASIF Plates T & L plate - left & right ≥4.5mm diameter $572.00
SY172 LCP Plate Straight Plate, Sterile/Non Sterile Dia 3.5 - 5.0mm, length 2-20 $229.00
hole
Zimmer Pty Ltd
ZI132 NexGen Knee High Tibial Osteotomy Plate - Ti 1 - 10 $632.00
System
ZI220 Zimmer Plates Cloverleaf plates 88 - 104mm $227.00
ZI222 Zimmer Plates Epiphysis plates 2 - 6 Hole $113.00
ZI223 Zimmer Plates 1/4 Tubular Plate 3 - 8 Hole $264.00
ZI224 Zimmer Plates Standard DC Plate 2 - 12 Hole $243.00
ZI225 Zimmer Plates Broad Plates 5 - 14 Hole $449.00
Prostheses List by Category, Groups and Sponsor Page 338 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AB
Danex Medical Pty Ltd
XD005 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5mm plates:- 20 holes, c- $310.00
Polylactic Acid Trimethylene Carbonate plate & x-plate 7 hole, L-plate
Copolymer 7 hole L & R. burrhole
XD007 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Plates 6 & 8 hole $433.00
copolymer
Surgical Specialties
SQ054 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5mm plates:- 20 holes, c- $310.00
Polylactic Acid Trimethylene Carbonate plate & x-plate 7 hole, L-plate
Copolymer 7 hole L & R. burrhole
SQ062 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Plates 6 & 8 hole $433.00
copolymer
Com
Integra Neurosciences Pty Ltd
IG083 Newdeal Reinforced Bendable Composition - 316L Stainless Steel. To 2 holes, 4 holes/77mm, 4 $810.00
Osteosynthesis Plates be used only with Newdeal Screws/lock holes/112mm
screws
IG086 Newdeal Distal Humeral Plates Composition - 316L Stainless Steel. To Left and right $890.00
be used only with Newdeal screws/lock
screws
IG087 Newdeal Femoral Osteosynthesis Plates Composition - 316L Stainless Steel. To 8/9/10 hole, left and right $1,400.00
be used only with Newdeal screws/lock
screws
IG088 Newdeal Distal Femoral Varus Composition - 316L Stainless Steel. To be One size only $1,150.00
Osteotomy Plate used only with Newdeal screws/lock
screws
IG090 Newdeal Proximal Humeral Plate Composition - 316L Stainless Steel. To be '6 - 8 holes' $948.00
used only with Newdeal screws/lock
screws
IG091 Newdeal HTO Plates Composition - 316L Stainless Steel. To be Opening wedge HTO plates, $900.00
used only with Newdeal screws/lock left and right. Closing wedge
screws. HTO plates, left and right.
Reinforced closing wedge HTO
plates, left and right
LMT Surgical Pty Ltd
LM064 TriMed Ulnar Osteotomy System Stainless Steel Ulnar Osteotomy Plate 5 - 9 holes $900.00
Prostheses List by Category, Groups and Sponsor Page 339 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LM072 Trimed Hook Plate stainless steel 4 and 6 hole plates 4 and 6 holes/right and left $740.00 $800.00
LM074 Elix (plate) Anatomically shaped plate with PEEK 4 Hole, right and left plate. $1,010.00 $1,500.00
inserts
LM088 NewClip Variable Angle Periarticular Stainless steel and titanium plates size 1 to 8 $1,500.00
Fixation Plates
Stryker Australia Pty Ltd
SK055 Matta Pelvic System Straight acetabular plate 10-14 Holes $368.00
SK057 Matta Pelvic System Straight acetabular plate 15-20 Holes $160.00
SK064 Skryker Plating System Matta Pelvic Plates Curved, Straight and Symphysis $800.00
Pubis 2 - 30 hole
SK067 Matta Pelvic System Curved Pelvic Plate Radius 108 4-9 Holes $53.00
SK069 Matta Pelvic System Curved Pelvic Plate Radius 108 10-14 Holes $32.00
SK070 Matta Pelvic System Curved Pelvic Plate Radius 108 15-20 Holes $800.00
SK071 Matta Pelvic System Curved Pelvic Plate Radius 88 4-9 Holes $61.00
SK073 Matta Pelvic System Curved Pelvic Plate Radius 88 10-14 Holes $800.00
SK074 Matta Pelvic System Curved Pelvic Plate Radius 88 15-20 Holes $800.00
SK075 Stryker Plating System Basic Fragment 4.5mm Reconstruction Plate 3-9 Holes $780.00
Set
SK077 Stryker Plating System Basic Fragment 4.5mm Reconstruction Plate 10-16 Holes $780.00
Set
SK094 Stryker Plating System Small Fragment Calcaneal Plate 70-80mm $605.00
Set
SK449 Stryker Plating System Locking Compression Anatomical Shape 2 Hole to 22 Hole $1,450.00
Synthes Australia Pty Ltd
SY020 AO/ASIF Plates Spoon plate 5-12 hole $415.00
SY024 AO/ASIF Plates Cobra head 8-11 hole $572.00
SY100 AO/ASIF Plates 4.5mm Hook Plate 3-12 hole $530.00
SY116 AO/ASIF Plates 4.5mm recon plate 2-28 hole $840.00
Zimmer Pty Ltd
ZI230 ZPS 4.5mm Straight Recon Plate 6 Hole $880.00
Prostheses List by Category, Groups and Sponsor Page 340 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 16b: Small – 2.71 – 4.49mm
Device Technologies Australia Pty Ltd
DE215 Arthrex Osteotomy Plates Metatarsal 2mm - 8mm $550.00
DE298 Tightrope Syndesmosis Buttress Plate For Syndesmosis and Fracture Repair Universal one size only $550.00 $1,200.00
LMT Surgical Pty Ltd
LM057 Ascension Radial Head Locking Plate Titanium pre-formed anatomical radial small and large $1,310.00
and Screws head plate
Smith & Nephew Surgical Pty Ltd
SN001 TC 100 Quarter Tubular plates (2.7mm Sterile 23 - 63mm $42.00
cortex screws)
SN011 TC 100 3.5mm Small Fragment Sterile, 14 - 26 hole 169 - 265mm $294.00
(Compression) plates
SN012 TC 100 3.5mm One Third Tubular Sterile, 2 - 8 holes 25 - 97mm $42.00
plates
SN104 TC 100 1/3 Tubular Plate with Collar 3 - 10 Hole $46.00
SN118 TC 100 3.5mm Small Fragment Sterile, 8 - 12 hole 97 - 145mm $123.00
(Compression) plates
SN130 TC 100 3.5mm One Third Tubular Sterile, 9 - 12 holes 109 - 145mm $58.00
plates
SN136 TC 100 Small T-Plates Sterile, right angled and oblique 3 - 4 holes in head, 3 - 6 holes $102.00
in shaft
SN731 Accord Orthopaedic Cable System, Sm Cable 75-255mm $1,400.00
Grip
Stryker Australia Pty Ltd
SK081 Stryker Plating System Small Fragment Waisted compression plate 2-10 Holes $220.00
Set
SK082 Stryker Plating System Small Fragment Waisted compression plate 11-20 Holes $220.00
Set
SK083 Stryker Plating System Small Fragment Standard compression plate 2-9 Holes $166.00
Set
SK084 Stryker Plating System Small Fragment Standard compression plate 10-20 Holes $220.00
Set
Prostheses List by Category, Groups and Sponsor Page 341 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK099 Stryker Plating System Small Fragment One Third Tubular Plate with Collar 9-14 Holes $175.00
Set
SK100 Stryker Plating System Small Fragment Plates T-Plates 2 - 10 hole $165.00
SK110 Stryker Plating System Compression Plates 2 - 22 Holes $152.00
ST008 Stryker Plating System Small & Basic Narrow or Broad 2-20 holes, 26-260mm plate $310.00
Fragment - Compression Plate length
ST017 Stryker Plating System Small & Basic Stainless Steel or Titanium 50-60mm $380.00
Fragment - Calcaneal Plate
ST025 Stryker Plating System Small Fragment Stainless Steel 4-9 Holes $497.00
Set
ST037 Stryker Plating System SmallFragment One Third Tubular Plate with Collar 2-8 Holes $113.00
Set
Synthes Australia Pty Ltd
SY018 AO/ASIF Plates Reconstruction Plate 2 - 24hole $740.00
SY114 AO/ASIF Plates 3.5mm - 5.0mm Straight DCP/LCDCP 2-28 hole $231.00
SY115 AO/ASIF Plates 3.5mm, T- PLATE - right & oblique angle 2-8 hole $294.00
SY161 LCP Plate 1/3 Tubular Plate Dia 3.5mm, length 2-16 hole $175.00
Zimmer Pty Ltd
ZI211 Zimmer Plates ZPS SC 1/3 Tubular Plate - Forearm 3 - 8 Hole $46.00
ZI212 Zimmer Plates ZPS Semi Tubular Small Narrow Plate 3 - 8 Hole $113.00
ZI216 Zimmer Plates SCP Forearm plate 4 - 12 Hole $113.00
ZI217 Zimmer Plates T Buttress Plates 4 - 6 Hole $355.00
ZI219 Zimmer Plates T-Plates 68 - 147mm $248.00
ZI541 Zimmer Universal Locking System 3.5mm Universal Locking System 3 hole 40mm; 4 hole 53mm; 5 $470.00
Reconstruction Plates, Straight-Sterile- hole 79mm; 7 hole 92mm; 8
Sterile & Non Sterile hole 105mm; 9 hole 118mm;
10 hole 131mm; 11 hole
144mm; 12 hole 157mm
ZI542 Zimmer Universal Locking System 3.5mm Locking Dual Compression Plate 4 hole 53mm; 5 hole 66; 6 hole $229.00 $240.00
Sterile and Non Sterile 79mm; 7 hole 92mm; 8 hole
105mm; 9 hole 118mm; 10
hole 131mm; 11 hole 144mm;
12 hole 157mm; 14 hole
183mm
Prostheses List by Category, Groups and Sponsor Page 342 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI543 Zimmer Universal Locking System 3.5mm Locking T Plate Sterile and Non- 3 hole head 5 hole shaft 73mm $260.00
Sterile length; 4 hole head 6 hole shaft
85mm length; 3 hole head 3
hole shaft left 51mm length; 3
hole head 4 hole shaft left
63mm length; 3 hole head 3
hole shaft right 51mm length; 3
hole head 4 hole shaft right
63mm length.
ZI544 Zimmer Universal Locking System 3.5mm Locking One-Third Tubular Plate - 5 hole 68mm; 6 hole 81mm; 7 $175.00 $190.00
Sterile and non-sterile hole 94mm; 8 hole 107mm; 10
hole 133mm
ZI545 Zimmer Universal Locking system 3.5 mm Optional Locking Reconstructive 13 hole; 14 hole; 15 hole; 16 $550.00
Plate- Sterile and Non-Sterile hole; 18 hole; 20 hole; 22 hole
ZI546 Zimmer Universal Locking System 3.5mm Optional Locking dual 16 hole; 20 hole $229.00 $350.00
Compression Plate - Sterile and Non-
Sterile
ZI547 Zimmer Universal Locking System 3.5mm Optical Locking-Third Tubular 3 hole; 4 hole; 12 hole; 14 hole $175.00 $210.00
Plate-Sterile & Non Sterile
Com
Integra Neurosciences Pty Ltd
IG081 Hallu-Fix Plates Composition - titanium, Hallu-C Plate: left Hallu-C Plate left and right $654.00
and right, Hallu-S Plate: left and right 40,45,50mm; Hallu-S Plate
right 50,55mm, left 60mm
IG089 Newdeal Femoral Varus and De- Composition - 316L Stainless Steel. To Newdeal Femoral Varus and $962.00
rotation Osteotomy Plates be used only with Newdeal screws/lock De-rotation Osteotomy Plates -
screws 3 holes, Newdeal Femoral
Varus and De-rotation
Osteotomy Plates - 4 holes,
Newdeal Reinforced Femoral
Newdeal and De-rotation
Osteotomy Plates - left and right
IG096 Basal Osteotomy Plate Titanium 5 Deg, Left and Right, 10Deg, $460.00
Left and Right
IG097 Calcanea, Calcaneal Fracture Plate Titanium Small, Medium, Large $1,275.00
Prostheses List by Category, Groups and Sponsor Page 343 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
IG106 B-BOP Plantar Basal Osteotomy Plate Titanium Moderate Correction(5°) Left, $460.00
(Sterile) Right. Severe Correction (10°)
Left, Right
Johnson & Johnson Medical Pty Ltd
JJ710 ALPS - Anatomic Locked Plating 3.5MM Titanium LOCKING 5-10 hole plates $500.00
System COMPRESSION PLATE
Orthotech Pty Ltd
OH339 Fyxis plate Foot plate 40-55mm $720.00
Smith & Nephew Surgical Pty Ltd
SN044 TC 100 3.5mm Small Fragment Sterile, 2 - 7 holes 25mm - 85mm $81.00
(Compression) Plates
Stryker Australia Pty Ltd
SK098 Stryker Plating System Small Fragment Stainless steel, reconstruction plate 10-22 Holes $551.00
Set
SK102 Stryker Plating System Small Fragment Cloverleaf Plate 6-10 Holes $330.00
Set
ST051 Stryker Plating System Small Fragment Cloverleaf Plate 3-5 Holes $340.00
Set
Synthes Australia Pty Ltd
SY106 AO/ASIF Plates - Steel Angled blade plate 3 - 26 hole, length 25 - $1,082.00
110mm, 90 - 130 degree
Group 16c: Mini - ≤2.7mm
Aus Systems Pty Ltd
AU001 Aus Systems Titanium Miniplates (Bone 2hole x 2hole Strip Plate Stiff 1.2mm profile, 4, 6, 8mm length $56.00
Plates) between inner holes
Medical & Optical Instruments Australia Pty Ltd
MO178 Acutrak Fusion Screws Fusion Screws Titanium 12-37mm 12-37mm $330.00
Smith & Nephew Surgical Pty Ltd
SN006 TC 100 1.5mm Mini Plates Stainless steel, Sterile Straight 3-6 holes, T-Plates 3-4 $155.00
holes
SN073 TC 100 L - Plates & T - Plates 2.0mm & 2.7mm $75.00
SN083 TC 100 2.0mm T-plates Sterile, 9 hole shaft 3 - 4 holes $155.00
SN087 TC 100 Semi Tubular plates 8 - 12 holes 135 - 199mm $70.00
Prostheses List by Category, Groups and Sponsor Page 344 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SN088 TC 100 Semi Tubular plates 2 - 7 holes $56.00
SN116 TC 100 2.7mm T-plates Sterile One size only $83.00
SN532 TC 100 Plate 2.0mm Straight Plate 3-20 hole $81.00
Stryker Australia Pty Ltd
SR055 Stryker Locking Plate System Plates including Locking, Standard & Straight, Curved, L, T, Y & 3-D $520.00
Compression
SR075 Stryker Locking Plate System Locking Plates Straight, Curved, H, T, L & 3-D $750.00
ST730 Leibinger Titanium Implant System Hand system, fixation plate, L-shape, 1.7mm, 6 holes $225.00
right/left
Synthes Australia Pty Ltd
SY029 AO/ASIF Plates straight & shaped plate 2.0mm - 2.7mm, 2 - 50 hole $369.00
SY112 AO/ASIF Plates Plate 1.0mm - 2.7mm $402.00
SY253 AO/ASIF Plates Foot & hand plates - steel - titanium 1 - 4mm $670.00
multiple hole
Zimmer Pty Ltd
ZI214 Zimmer Plates Mini Straight & Epiphysis Plates 3 - 8 Hole $153.00
ZI215 Zimmer Plates Mini SCP Plate 3 - 12 Hole $113.00
ZI549 Zimmer Universal Locking System 2.7mm Universal Locking System 6 hole 49mm; 8 hole 65mm $470.00
Reconstruction Plates, Straight - Sterile &
Non Sterile
ZI550 Zimmer Universal Locking System 2.7mm Locking Dual Compression Plate 2 hole 26mm; 4 hole 49mm; 6 $229.00 $240.00
Sterile and Non Sterile hole 72mm; 7 hole 84mm; 8
hole 95mm; 9 hole 107mm; 10
hole 118mm; 12 hole 141mm;
16 hole 187mm
ZI551 Zimmer Universal Locking System 2.7 mm Locking T & L Plate Sterile and 2 hole head 3 hole shaft 39mm $260.00
Non-Sterile length; 2 hole head 5 hole shaft
62mm length; 3 hole shaft left
39mm; 3 hole shaft right 39mm;
3 hole shaft oblique left 42mm;
3 hole shaft oblique right 42mm;
5 hole shaft left 62mm; 5 hole
shaft right 62mm; 5 hole shaft
obl
Prostheses List by Category, Groups and Sponsor Page 345 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI552 Zimmer Universal Locking System 2.7mm Locking One-Quarter Tubular 3 hole 36mm; 4 hole 47mm; 5 $175.00 $190.00
Plate-Sterile and Non-Sterile hole 59mm; 6 hole 70mm;l 7
hole 82mm; 8 hole 93mm
AB
Danex Medical Pty Ltd
XD002 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5-2.5 mesh plates, 14 x 14 $2,490.00
Polylactic Acid Trimethylene Carbonate holes; 1.5mm baby mesh plate
Copolymer 14 x 14 holes
XD003 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5-2.5 mesh plate, 7 x 7 holes; $1,200.00
Polylactic Acid Trimethylene Carbonate 1.5mm baby mesh plate 7 x 7
Copolymer holes
XD004 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5mm baby plates:- 20 hole, $350.00
Polylactic Acid Trimethylene Carbonate c-plate & x-plate 7 hole, 2 hole
Copolymer
XD006 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5-2.5mm plates:- 2-10 hole $240.00
Polylactic Acid Trimethylene Carbonate plates and extended, c-plate &
Copolymer x-plate 7 hole, H-plate 8 hole,
orthognathic hole and L-plate L
& R 7 hole
Surgical Specialties
SQ052 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5-2.5 mesh plate, 7 x 7 holes; $1,200.00
Polylactic Acid Trimethylene Carbonate 1.5mm baby mesh plate 7 x 7
Copolymer holes
SQ053 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5mm baby plates:- 20 hole, $350.00
Polylactic Acid Trimethylene Carbonate c-plate & x-plate 7 hole, 2 hole
Copolymer
SQ055 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5-2.5mm plates:- 2-10 hole $240.00
Polylactic Acid Trimethylene Carbonate plates and extended, c-plate &
Copolymer x-plate 7 hole, H-plate 8 hole,
orthognathic hole and L-plate L
& R 7 hole
SQ066 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5-2.5 mesh plates, 14 x 14 $2,490.00
Polylactic Acid Trimethylene Carbonate holes; 1.5mm baby mesh plate
Copolymer 14 x 14 holes
Prostheses List by Category, Groups and Sponsor Page 346 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Com
B Braun Australia Pty Ltd
BB311 Position HTO Implant System - HTO Titanium Osteotomy Plate, internal fixation One size $1,300.00 $1,600.00
Plate plate used in proximal tibial repositioning
osteotomy.
Medartis
EO008 Aptus Hand &Foot Plates Straight plate 4-16hole; curved 16 hole; T 1.2/1.5/2.0/2.3/2.5/2.8 $670.00
plate, Y plate, L plate 4-10 hole; T plate
offset 11-12 hole; grid-rectuangular,
trapezoid, angled, square 4 hole - 12 hole,
1 hole plate and Wing Plate, rotation plate,
double row T plate
Smith & Nephew Surgical Pty Ltd
SN081 TC 100 2.0mm H-plates Sterile One size only $108.00
SN129 TC 100 1.5mm Mini Plates Stainless steel, Sterile H-Plates 4 holes $100.00
SN542 TC 100 Plate Multifragment Plates One size only $113.00
Stryker Australia Pty Ltd
ST722 Leibinger Titanium Implant System Leibinger profyle hand & small fragment 1.2mm system, 4x2 holes $520.00
system, fixation plate, 3D plate, titanium
ST738 Leibinger Titanium Implant System Leibinger profyle hand & small fragment 1.7mm system, 2x2 holes $267.00
system, fixation, 3D plate, titanium
ST741 Leibinger Titanium Implant System Leibinger profyle hand & small fragment 1.7mm system, 4x2 holes $520.00
system, 3D plate, titanium
ST764 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 4x2 holes $505.00
System, fixation plate, 3D plate, Titanium
ST786 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction System, 4 holes $320.00
straight plate, Titanium
ST787 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction System, 6 holes $480.00
straight plate, Titanium
ST788 Leibinger Titanium Implant System Leibinger System, anatomical shap, Titanium 1 - 4 holes $330.00
Prostheses List by Category, Groups and Sponsor Page 347 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Surgiplas Medical
SP052 CONTOUR Hand Contour Hand - Plates XS / S / M / L; straight plate 4- $670.00
16 hole; Z plate, Y plate, T
plate, L plate 5-9 hole; Straight
plate, T plate with stabilizers 5-
6 hole; Square, Grid-
rectangular plate 4-8 hole;
Straight, T, Y Compression
Plate 4-7 hole; Condylar plate
w/out stabilizer 5-6 hole.
Synthes Australia Pty Ltd
SY113 AO/ASIF Plates 2.0mm condylar Left & right $420.00
Group 16d: Other
Biomet Australia Pty Ltd
BI843 EBI XFIX DynaFix System Plate, VS Osteotomy Ti 4 hole, 6 hole $975.00
BI930 Sternalock Plates - xyphoid, "L" & square 4 hole $195.00
BI931 Sternalock Plates - "X" & "T" 5-8 hole $300.00
Device Technologies Australia Pty Ltd
DE285 Lapidus Plate The Lapidus Plate is a fusion plate One size only $650.00
DE287 Low Profile MTP Plate Arthrodesis Plate Contoured Left Short, $600.00
Contoured Right Short,
Contoured Left Long,
Contoured Right Long
Prostheses List by Category, Groups and Sponsor Page 348 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DE290 H-Plates Fixation plate for fusions and osteotomies Plates, Flat - 38mm x 16mm, $650.00
left,large, 38mm x 16mm,
right,large, 34mm x 16mm, left,
medium, 34mm x 16mm, right,
medium, 28mm x 16mm left,
small, 28mm x 16mm,
right,small
Plates, Wedge - 38mm x
16mm, 10mm wedge, left,
38mm x 16mm, 10mm wedge,
right, 36mm x 16mm, 8mm
wedge, left, 36mm x 16mm,
8mm wedge, right, 34mm x
16mm, 8mm wedge, right
Johnson & Johnson Medical Pty Ltd
DP675 Small / Large Fragment Set S/S Broad Bone Plate Stainless Steel 3-6 Hole for 1.5mm $149.00
DP695 Small / Large Fragment Set S/S Y-Plate Stainless Steel 2 + 2 + 4 or 4 + 4 + 4 Slots $184.00
DP719 Small / Large Fragment Set S/S Reconstruction Plate 4.5 - 6.5mm 3-8 Hole $209.00
LMA PacMed Pty Ltd
PM118 Orthofix eight-Plate Guided Growth Plate for correction of 12mm; 16mm $370.00
angular deformities, Titanium, two hole
plate, figure eight shaped
LMT Surgical Pty Ltd
LM033 Trimed Wrist Fixation System, Volar Stainless Steel Volar Peg Plate 3-hole, Right & $1,300.00
Peg Plate Left, 4 and 5 Peg; Volar Peg
Plate 5-hole, Right & Left, 4
and 5 Peg
LM062 ArgoMedical Pedofix Titanium fixed angle plate for foot surgery 2.7mm $650.00
Smith & Nephew Surgical Pty Ltd
SN013 TC 100 3.5mm Curved Reconstruction Sterile, 6 - 8 holes 70 - 94mm $183.00
plates
SN065 TC 100 4.5mm T-Buttress plates Sterile, 4 - 6 holes 80 - 112mm $170.00
SN068 TC 100 Plate: Condylar 1.5mm, 2.0mm &2.7mm $190.00
SN069 TC 100 3.5mm Reconstruction plates Sterile, Straight 9 - 11 holes 106 - 130mm $231.00
Prostheses List by Category, Groups and Sponsor Page 349 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SN075 TC 100 Plate: Reconstruction 3.5mm & 4.5mm, 10 - 15 holes $270.00
SN076 TC 100 Plate: Curved Reconstruction 3.5mm, 10 -18 holes $260.00
SN080 TC 100 4.5mm T-plate Sterile, 5 - 8 holes 100 - 148mm $204.00
SN098 TC 100 4.5mm Reconstruction plates Sterile, 14 - 16 holes 221 - 253mm $295.00
SN107 TC 100 4.5mm Condylar Buttress plates Sterile, right, 11 - 15 hole 221 - 285mm $480.00
SN109 TC 100 3.5mm Reconstruction plates Sterile, Straight 4 - 8 holes 46 - 94mm $170.00
SN126 TC 100 4.5mm Condylar Buttress plates Sterile, Left and right, 7 - 9 hole 158 - 190mm $451.00
SN134 TC 100 3.5mm Reconstruction plates Sterile, Straight 16 - 22 holes 190 - 263mm $380.00
SN143 TC 100 4.5mm Reconstruction plates 3 - 9 holes 45 - 141mm $183.00
SN569 TC 100 Plate Calcaneal Plate Sterile 60mm,70mm & 9 hole $420.00
SN570 TC 100 Plate Cloverleaf Plate 3-4 hole $180.00
SN571 TC 100 Plate Cloverleaf Plate 5-6 hole $380.00
SN572 TC 100 Plate Cloverleaf Plate 7-8 hole $397.00
SN573 TC 100 Plate Cloverleaf Plate 9 hole $442.00
SN574 TC 100 Plate Cobra Head Plate 8-11 hole $433.00
SN577 TC 100 Plate Hook Plate 123mm 4 hole $330.00
SN578 TC 100 Plate: Spoon & L-Buttress 3 - 18 holes $160.00
SN581 TC 100 Plate Lateral Tib Head Buttress Plate 3-7 hole Left & Right $450.00
SN582 TC 100 Plate Lateral Tib Head Buttress Plate 9-13 hole Left & Right $518.00
SN782 Peri-Loc Plates, Stainless Steel, Non-Locking, 4.5mm $407.00
Narrow, Lefts & Rights
SN784 Peri-Loc Plates, Stainless Steel, Non-Locking, 4.5mm. 18-22 hole $433.00
Broad, Left & Rights
SN796 Peri-Loc Plates, Stainless Steel, Locking, 3.5mm, 4 - 12 holes $506.00
Compression, Lefts and Rights
SN797 Peri-Loc Plates, Stainless Steel, Locking, 3.5mm, 14 - 18 holes $685.00
Compression, Lefts and Rights
SN798 Peri-Loc Plates, Stainless Steel, Locking, 3.5mm, 20 - 22 holes $740.00
Compression, Lefts and Rights
Prostheses List by Category, Groups and Sponsor Page 350 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SN800 Peri-Loc Plates, Stainless Steel, Non-Locking, 3.5mm, 4-10 holes $231.00
Reconstruction, Lefts and Rights
SN801 Peri-Loc Plates, Stainless Steel, Non-Locking, 3.5mm, 12-14 holes $340.00
Reconstruction, Lefts and Rights
Com
Advanced Surgical Design & Manufacture Ltd
AE126 Carpal Fusion Compression Plate 316L Stainless Steel Compression Plate, 2 2 Hole; and 3 Hole Plates $740.00 $945.00
hole and 3 hole
Integra Neurosciences Pty Ltd
IG061 Spider and Mini-Spider Limited Wrist Stainless Steel 8 hole spider plate, 6 hole mini- $2,200.00
Fusion System spider plate
Johnson & Johnson Medical Pty Ltd
JJ720 ALPS LFS 4.5mm locked narrow and broad 1-4 hole 1-4 hole $500.00
titanium compression plate
JJ721 ALPS LFS 4.5mm locked narrow and broad 5-10 5-10 hole $600.00
hole titanium compression plate
JJ722 ALPS LFS 4.5mm locked narrow and broad 11-20 11-20 hole $700.00
hole titanium compression plate
JJ727 ALPS LFS Offset, Reconstruction and 4.5mm Spider 4-25 holes $650.00
and T-plates, Titanium
Lifehealthcare Pty Ltd
LH445 Hinge Pediatric Plating System - Hinge Articulated growth-correction fixation plate 12mm, 16mm, 20mm (distance $370.00
Plate between anchoring points)
LMT Surgical Pty Ltd
LM050 Biotech Easy Lock Osteosystem Titanium and PEEK 2-10 holes straight $600.00
LM051 Biotech Easy Lock System Easy Lock Plating System Various $700.00
LM060 BioTech Xpode 4 PEEK curved and round plate Mini 1, 2, 3 & 4 $1,100.00
LM068 Normed fracture fixation plates Titanium plates, various sizes and shapes Various $450.00 $650.00
LM097 Memometal Anchorage Bone Plates Osteosynthesis Bone Plate System Length 41mm, 51.5mm, 53mm $450.00 $650.00
Thickness 1.3mm, 1.5mm
Medical & Optical Instruments Australia Pty Ltd
MO150 Acumed Congruent Plate System Foot & Ankle Plate, Titanium 4 to 9 Hole $470.00
Prostheses List by Category, Groups and Sponsor Page 351 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MO202 Acumed Bone Plate MCP Fusion Plate - Titanium 4 Hole left and right $572.00
MO208 Acumed Bone Plate Wrist Fusion Plate - Titanium Standard, Mini $2,092.00 $2,200.00
MO279 Anatomic Midshaft Forearm Plates Internal Fixation Plate Anatomic Forearm, Midshaft Ulna Plates: 6 hole $1,450.00
Ulna & Radius 80mm, 8 hole plate 100mm, 10
hole 130mm, 12 hole, 160mm,
Midshaft ulna shortening plates:
6 hole 80mm, Midshaft
Dorsolateral Radius Plates: 6
hole (80mm), 8 hole (100mm),
10 hole 9130mm) 12 hole
(160mm); Midshaft Volar
Radius Plates: 6 hole (80mm), 8
hole (100mm), 10 hole
(130mm), 12 hole (160mm)
Orthopaedic Solutions Pty Ltd
OE008 NexFix MTP Fusion System A bendable stainless steel bone plate and Left 2 + 3; Right 2 + 3 $730.00
screw system with unique low profile
locking screw option. Indicated for use in
primary MTP fusion
Smith & Nephew Surgical Pty Ltd
SN783 Peri-Loc Plates, Stainless Steel, Non-Locking, 4.5mm. 6-16 hole $320.00
Broad, Left & Rights
SN795 Peri-Loc Plates, Stainless Steel, Locking, 3.5mm $334.00
Compression & Tubular, Lefts and Rights
Stryker Australia Pty Ltd
SK398 Trochanteric Grip Dall-Miles Trochanteric Grip Plate 100mm - 200mm $2,550.00
SK399 Trochanteric Grip Dall-Miles Trochanteric Grip Plate 110mm - 210mm $4,000.00
SK402 Trochanteric Grip Dall-Miles Trochanteric Grip Plate, with 2 100mm - 200mm $3,652.00
Cables
SK403 Trochanteric Grip Dall-Miles Trochanteric Grip Plate, with 2 110mm - 210mm $5,102.00
Cables
Synthes Australia Pty Ltd
SY038 AO/ASIF Plates DHS Trochanteric stabilising plate 3-16 hole $680.00
SY093 AO/ASIF Plates Specially manufactured plate all sizes Custom made $3,605.00
Prostheses List by Category, Groups and Sponsor Page 352 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SY111 AO/ASIF Plates Specially manufactured plate 1.0mm - 6.5mm $3,914.00
Tornier Pty Ltd
TO030 Aequalis Humeral Plate Proximal Humeral Plate 90mm length with 3-holes shaft $1,400.00
and 120mm length with 5-hole
shaft
Group 16e: Dynamic - Hip
Johnson & Johnson Medical Pty Ltd
DP672 Small / Large Fragment Set S/S CHS Plate Standard & Short Barrel Sterile 2-8 Hole 95 to 150 Deg $348.00
Smith & Nephew Surgical Pty Ltd
SN468 Compression Hip Screw System Ambi Standard Barrel Plates 60mm -80mm, 2-3 slot $305.00
SN469 Compression Hip Screw System Ambi Standard Barrel Plates 100mm -220mm, 4-10 slot $500.00
SN470 Compression Hip Screw System Ambi Standard Barrel Plates 260mm+, 12-14 slot $660.00
SN471 Compression Hip Screw System Ambi Short Barrel Plates 100mm, 4-5 slot $440.00
SN473 Compression Hip Screw System Classic Standard Barrel Plates 60-140mm, 2-3 slot $338.00
SN475 Compression Hip Screw System Classic Standard Barrel Plates 260mm+, 12-14 slot $660.00
SN476 Compression Hip Screw System Classic Short Barrel Plates 100 - 120mm $465.00
SN479 Compression Hip Screw System Hip Screw Clip (ambi only) One size only $81.00
SN480 Compression Hip Screw System Intramedullary Hip Screw (IMHS), One size only $115.00
Centering Sleeve, Stainless Steel
SN488 Intermediate Osteotomy System Compressing One size only $114.00
SN492 Paediatric Osteotomy System Lag Screw 22mm- 40mm $421.00
Stryker Australia Pty Ltd
HW330 Omega Plus Compression Hip Screw Hip Sideplate - Standard Barrel - 2,3,4,5 hole 130-150 degrees $350.00
System Stainless Steel
Zimmer Pty Ltd
ZI157 Zimmer Internal Fixation Systems: Freelock/Versa-fx tube plate - Stainless 2 holes - 20 holes $695.00
Compression Hip Screw Steel
Prostheses List by Category, Groups and Sponsor Page 353 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Com
Johnson & Johnson Medical Pty Ltd
JJ737 Compression Hip Screw System Compression hip screw plate, stainless 25-38mm, 2-16 holes, 95-150 $1,215.00
steel degrees
Stryker Australia Pty Ltd
HW331 Omega Plus Compression Hip Screw Hip Sideplate - Short Barrel - Stainless 6,8,10,12 hole 130-150 degrees $675.00
System Steel
SK462 Stryker Compression Hip Screw System Omega3 compression Hip screw 130-150 degree, 2-12 gike, $875.00
47-207 mm
Group 16f: Dynamic Supracondylar
Smith & Nephew Surgical Pty Ltd
SN478 Compression Hip Screw System Classic Supracondylar Plate 90-95 6-12SL $740.00
SN490 Intermediate Osteotomy System Plate (hip screw) 90-150Deg $789.00
Stryker Australia Pty Ltd
HW332 Omega Plus Compression Hip Screw Supracondylar Sideplate - Stainless Steel 6,8,10,12,14 holes $570.00
System
Synthes Australia Pty Ltd
SY107 AO/ASIF Plates - Steel DCS DHS plate 95 - 150 degree, 2 - 22 hole, $1,215.00
length 25 - 38mm barrel
Com
Stryker Australia Pty Ltd
SK463 Stryker Compression Hip Screw System Omega3 Supracondylar Plate 95 hole, 6-14 hole, 111- $875.00
239mm
Synthes Australia Pty Ltd
SY104 AO/ASIF Plates Osteotomy plate - high tibial 95 deg condylarprox tibia , 50- $1,043.00
60 mm, displ 15-20mm
SY121 AO/ASIF Plates Condylar, angled plate 4-22 hole $1,200.00
SY122 AO/ASIF Plates Angled plate 4-22 hole $1,200.00
Prostheses List by Category, Groups and Sponsor Page 354 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 16g: Periarticular Anatomic
Johnson & Johnson Medical Pty Ltd
DP613 Small / Large Fragment Set Humeral and Radial Plate Titanium Various Wide - Narrow - Long - Extra $329.00
Long
DP615 Small / Large Fragment Set Universal Reconstruction Ribbon Titanium 3.5mm with 8 to 10 holes $535.00
DP617 Small / Large Fragment Set Universal Reconstruction Ribbon Titanium 3.5mm with 12-14 holes $796.00
DP618 Small / Large Fragment Set Universal Reconstruction Ribbon Titanium 3.5mm with 3 to 7 holes $402.00
DP689 Small / Large Fragment Set S/S Condylar Plate & Mini Condylar Plate All sizes $178.00
DP888 Calcaneal Periarticular Plate Calcaneal Periarticular Plate - Titanium Extra small to Ex Large $530.00
DP904 Periarticular Plating System Plate Calcaneal - Titanium Small - Large $528.00
DP905 Periarticular Plating System Fibula Composite Plate - Titanium 5 Hole $317.00
JJ681 Polyax Plating System Distal Femoral Locking Plate, Titanium 6-18 holes $2,000.00
JJ785 ALPS Hand Fracture System - Locking Locking plates, titanium, various shapes 1.0mm - 2.5mm locking plates $1,314.00
Plate
LMT Surgical Pty Ltd
LM054 Argomedical Malleolar Plate Titanium 6 - 10 Hole Plates $460.00
Medical & Optical Instruments Australia Pty Ltd
MO211 Acumed Locking Clavical Plating System Clavicle Plates Titanium Small, medium, J shape, left and $1,386.00
right
Stryker Australia Pty Ltd
SK038 Leibinger Titanium Implant system Profyle hand and small fragment plate system 2.3mm system L, compr 10 $1,410.00
hole T bar
SK366 Universal Distal Radius System Universal SMARTLook Locking Plates Standard, Narrow and Wide in $1,450.00
Long and short options
SK368 Stryker Plating System SPS Locking Plate System Distal Medial and Lateral tibia $1,450.00
3 Holes to 10 Holes left and
right
SK377 Stryker Plating System SPS Locking Plate System Distal Femur - 4 holes to 16 $1,500.00
holes, Left and Right
Prostheses List by Category, Groups and Sponsor Page 355 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK379 Stryker Plating System SPS Locking Plate System Proximal Humerus 3 Holes to $1,400.00
10 Holes Left and Right
SK381 Stryker Plating System Stryker locked plating system Distal Humerus, Lateral and $1,400.00
Medial, 1-8 holes
SK383 Stryker Plating System SPS Locking Plate System Proximal Tibia, Lateral and $1,450.00
Medial, 4 hole to 12 holes, left
and right
SK391 Leibinger Universal Distal radius System Universal Distal Radius SMARTLock Radial Column - Long and $1,350.00
Column Locking Plates Short; Ulna Column - Long and
Short, Left and Right
SK454 VariAx Plate Volar Plate, Polyaxial Locking Narrow & Standard; Short & $2,350.00
Long; Right & Left
SR071 Stryker Locking Plate System Calcaneus Locking Plates Small, Medium & Large $1,275.00
Synthes Australia Pty Ltd
SY163 LCP Plate Tibial Plate, Sterile/Non Sterile 1 - 24 hole $1,854.00
SY279 Small & Mini Fragment Plates Locking Distal Radius Plate System LCP Dorsal T, L, Straight $1,185.00
Plates 2.4mm Long/Short
Zimmer Pty Ltd
ZI153 Periarticular Plates Periarticular Tibial Plateau Plates - 2 holes - 14 holes Left & Right $1,219.00
Stainless Steel
ZI154 Periarticular Plates Periarticular Femoral Condylar Plates - 4 holes - 18 holes Left & Right $1,211.00
Stainless Steel
ZI243 Periarticular Plates Stainless Steel 2 - 20 Hole $974.00
ZI331 Zimmer Periarticular Locking Plates Periarticular Locking Plating System Various lengths and numbers of $1,400.00
holes
ZI398 High Tibia Osteotomy High Tibia Osteotomy - Ti alloy L shaped steel alloy plate; $964.00
Standard & Long
Com
Austofix
AX041 VRP Distal Radius Fixation System Volar Distal Radius Plate - Standard Standard, 3 and 4 hole, left and $1,200.00
Volar Distal Radius Plate - Standard right
Darco Australia
DC033 Charlotte Claw Locking Plate 2 hole and 4 hole compression plates, 2.7mm 2 holes - 15, 20 and $550.00
stainless steel, 2.7mm or 3.5mm screw 25mm; 3.5mm 2 holes and 4
fixation holes - 20, 25 and 30mm
Prostheses List by Category, Groups and Sponsor Page 356 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP906 Periarticular Plating System Medial Pilon Plate - Titanium 3 Hole $340.00
DP907 Periarticular Plating System Meta Plate - Titanium Sm - Lge 3 Hole $340.00
DP911 Periarticular Plating System Meta Plate - Titanium Sm -Lge 5 Hole $338.00
DP915 Periarticular Plating System Medial Pilon Plate - Titanium 5 Hole $346.00
DP916 Periarticular Plating System Medial Pilon Plate - Titanium 7 Hole $381.00
JJ618 Distal Radius Fracture Repair System DVR-A, distal volar radius locking plate, Standard, left & right $1,270.00
titanium
JJ619 Distal Radius Fracture Repair System DVR-A, distal volar radius locking plate, Narrow, wide, short, X-large, $1,450.00
titanium XX-large narrow-left & right
JJ620 Distal Radius Fracture Repair System DNP, dorsal nail plate, titanium Standard, left & right $1,180.00 $1,220.00
JJ621 Distal Radius Fracture Repair System Fragment locking plate, titanium Right, left, straight, Y $815.00 $845.00
JJ624 HI S3 Shoulder Fixation System S3 Shoulder Plate 3 Hole, Left & Right & 4 Hole, $1,400.00 $2,242.00
Left & Right
JJ625 HI S3 Shoulder Fixation System S3 Shoulder Plate, Titanium 6 - 8 Hole, Left & Right $1,470.00 $2,378.00
JJ626 HI S3 Shoulder Fixation System S3 Shoulder Plate, Titanium 11 - 14 Hole, Left & Right $1,450.00 $2,709.00
JJ686 Polyax Plating System Proximal Tibial Locking Plate, Titanium 2-14 holes $1,800.00
JJ729 ALPS Anatomic Locked plating system Anterolateral and Medial Distal Tibial 5-10 holes $1,800.00
Anatomic Locking Plate, Titanium
JJ730 ALPS-Anatomic Locked Plating system Anterolateral and Medial Distal Tibial 11-20 holes $1,800.00
Anatomic Locking Plate, Titanium
JJ811 ALPS Elbow System Locking plates Distal Humerus, Radius, Small - Large $1,500.00
Olecrannon, Coronoid
Lifehealthcare Pty Ltd
LH443 I.T.S. Distal Humeral Locking Plates Humeral Plates, Distal 4-7 holes, dorsolateral, left and $1,308.00
right; 8-10 holes, medial, left
and right (Screw diameter
3.5mm)
LH458 I.T.S. Pilon Plate Locking Pilon Plates 4.6 and 8-holes (Screw $1,219.00 $1,800.00
diameter: Cancellous 4.2mm;
Cortical 4.5mm)
LH459 I.T.S. Olecranon Plate Locking Olecranon Plates 6, 8, 10 and 12-holes (Screw $1,308.00
diameter: Cancellous 4.2mm;
Cortical 3.5mm)
Prostheses List by Category, Groups and Sponsor Page 357 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medical & Optical Instruments Australia Pty Ltd
MO194 Acumed Congruent Plate System Elbow plate titanium, locking radial head Locking radial head, 3 hole std $1,308.00
curve 31mm, 5 hole std curve
46mm, 3 hole curve 31mm, 5
hole curve 46mm
MO243 Polarus Proximal Humeral Plate Titanium Humeral Plate Left, Right, Large, Small, Two $1,470.00
Part
MO257 Acu-Loc Distal Radius Plate System Distal radius plate, titanium Volar, Dorsal, Distal Ulna, $1,675.00
Standard, Long, Extra long,
wide, narrow, left, right, extra-
articular
MO272 Acumed Tap Loc Elbow plates Variable angle locking plate system Medial / Lateral, lft and right, $1,550.00
Olecranon / Proximal Ulna left
and right, coronoid 6-20hole
MO278 Acumed Locking Calcaneal Plates Locking Plate, Calcaneal, Titanium Small, Medium & Large, Left $1,209.00 $1,680.00
& Right
MO319 Acumed Locking Scapula Plate System Locking Bone Plate, Scapula 4 hole, 6 hole, 9 hole, 10 hole, $470.00 $1,450.00
13 hole left and right
Smith & Nephew Surgical Pty Ltd
SM149 Peri-Loc PFP Proximal Femur Locking Plate - 360L 2H R & L 104MM, 4H R & L $1,800.00
stainless steel 144MM, 6H R & L 180MM,
9H R & L 234MM
SN022 Osteotomy Plates Blade, Adult osteotomy 4 hole 40 - 80mm $983.00
SN745 Peri-Loc 2.7mm, 3.5mm & 4.5mm Locking Plate, 3 - 19 Holes $1,314.00
StainlessSteel
SN829 Peri-Loc UE 2.7mm Locking Recon Plate 6-14 Holes 48mm - 113mm $1,314.00
SN831 Peri-Loc UE Locking plates SS: Distal Radius, 2.5-4.5mm, 3-14 holes $1,500.00
Olecrannon, Humerus, Clavicle
Stryker Australia Pty Ltd
SK499 Stryker Locking Plate system Variable angle locking plate for olecranon All lengths $1,308.00 $1,550.00
fractures
Synthes Australia Pty Ltd
SY037 AO/ASIF Plates Wrist fusion plate 2-28 hole $1,456.00
Prostheses List by Category, Groups and Sponsor Page 358 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SY059 AO/ASIF Plates Unilock, angled, straight, T, Y, condylar, 2mm - 50mm $1,545.00
DCP, LCDCP, left & right, mandible and
locking plates
SY118 AO/ASIF Plates 4.5mm, head buttress plate lateral tibial left 5 - 15 hole $1,246.00
& right
SY162 LCP Plate Distal Tibial Plate, sterile/non-sterile Dia 3.5 - 5.0mm, length 4-24 $1,800.00
hole
SY164 LCP Plate Distal Femoral Buttress Plate, Sterile/Non Dia 5.0mm, length 4-22 hole $1,854.00
Sterile
SY165 LCP Plate Tomofix Plate, Sterile/Non Sterile Dia 5.0mm, length 2-8 hole $1,212.00
SY166 LCP Plate Locking Proximal Humeral Plate, Dia 3.5mm, length 3-12 hole $1,376.00
sterile/non sterile
SY259 Locking Distal Radius Plate System Small & Mini Fragment Plates - Volar Plate LCP - Volar Plate 2.4mm Left $2,350.00
& Right, 2.4 Volar Plates
Straight
SY280 Small & Mini Fragment Plates Locking Distal Radius Ulna Column Plate 2.0mm - 2.4mm $1,715.00
System
SY283 LCP Plate LCP Olecranon Plate, left and right, non 2-20 hole plates $1,308.00
sterile/sterile
SY284 LCP Plate LCP Distal humerus plate, dorso-lateral, 2-20 hole plates $1,308.00
left and right, non sterile/sterile; LCP Distal
humerus plate, dorso-lateral with support,
left and right, non sterile/sterile; LCP Distal
humerus plate, medial, left and right, non
sterile/sterile
SY354 Small & Mini Fragment Plates LCP Radial Head Plates 2.4mm $1,320.00
SY376 LCP Plate Proximal Femur Plate 2-26 Hole $1,800.00
SY521 LCP Plate Distal Fibula Plate; Lateral, Posterolateral 2.7mm/3.5mm; 73mm-233mm $1,314.00
Length, 3-15 holes
Wright Medical Australia
WR048 Evolve Radial Head Plate Evolve Radial Plate System Stainless Steel 32mm x 20 - 26mm in 2mm $1,360.00
increments
WR049 Charlotte MTP Fusion System MTP plate, stainless steel Left & right, small & standard $600.00
WR050 Charlotte MTP Fusion System MTP plate, stainless steel Left & right, extended $730.00
Prostheses List by Category, Groups and Sponsor Page 359 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
WR051 Charlotte MTP Fusion System MTP plate screw, stainless steel 2.7 & 3.2 dia. 8-24mm length $95.00
in 2mm increments
WR052 Charlotte MTP Fusion System MTP plate, stainless steel, SLIM LINE Left & right $730.00
WR056 Locking Plate Titanium locking plates anatomically 2.7mm; neutral, 3-7mm spacer; $450.00
contoured for forefoot and midfoot 18-24mm length, 3.5mm;
osteotomies. Unique spacer widths in 1mm neutral, 2-8mm spacer; 12-
increments allow for controlled and 30mm length
maintained correction.
WR057 Lapidus Plate Titanium locking plate with unique stepped 3.5mm: neutral, 1-6mm step $510.00
displacement in 1mm increments permits
accurate plantarisation and lateralisation in
midfoot fusions.
WR058 Calcaneus Plate Titanium locking plate specifically designed 3.5mm universal sizing (R&L): $1,275.00
to have low profile (1.5mm thick) for easy S - 54mm, M - 64mm & L -
contouring 74mm
WR064 MPJ Fusion Plate Titanium locking plate with built-in 1- S, M, L $600.00
degree valgus angle for anatomic fixation of
1st MTP joint
WR065 Rearfoot Plate - RPS Unique extended plate geometry for plating 6 hole - 37mm, 8 hole - 50mm, $750.00
complex rearfoot reconstructions, uses 14 hole - 66mm
3.5mm locked screws for optimal bone
purchase.
WR066 Arthrodesis Flat Plate - AFP Flat plate intended for use in isolated tarsal 12, 14 & 16mm length $510.00
fusions, titanium locking plate, 2mm
thickness
WR067 Displacement Plate - DPS Unique steep plate design allows for 6, 8 & 10mm step $600.00
controlled fixation of displacement
calcaneal osteotomies. 3 step variations
allows for accurate corrections. 3.5mm
Titanium locking plate
WR069 TOM Plate Designed for base osteotomies and fusions L & R: neutral, 1-5mm step $540.00
of MT1 with correction achieved through
one cut. It is a titanium locking plate,
anatomically designed with a smaller radius
to fit the contour of the first metatarsal and
5 step variation in 1mm increments for
accurate correction.
Prostheses List by Category, Groups and Sponsor Page 360 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 17: Screws
Group 17a: Dynamic
Austofix
AX025 Austofix Femoral & Tibial Nailing System 6.2/6.5mm Hip Screw; high nitrogen s-s Dia 6.2 & 6.5mm; Lengths 70 - $189.00
120mm
AX054 Tectona Hip Plate - Standard Lag Screw Hip Lag Screw, sterile packed 12.5mm, 14.5mm $200.00
AX055 Tectona Hip Plate - Lag Screw HA Hip Lag Screw HA coated, sterile packed 12.5mm - lengths 50-145mm $300.00
coated
Johnson & Johnson Medical Pty Ltd
JJ684 Polyax Plating System Cancellous Non-Locking Screw, Titanium 40-100mm $220.00
Lifehealthcare Pty Ltd
LH358 Screws Diamond Carpal Screws 12, 14, 16mm $100.00
Orthotech Pty Ltd
OH371 Otis Plate Screws Screw for plate 27-70mm $91.00 $300.00
Synthes Australia Pty Ltd
SY109 AO/ASIF Plates DHS/DCS compression screw 36mm length $46.00
Zimmer Pty Ltd
ZI158 Zimmer Internal Fixation Systems: Freelock/Versa-fx lag screw - Stainless 50 mm - 150 mm long $247.00
Compression Hip Screw Steel
CN
Johnson & Johnson Medical Pty Ltd
DP668 Small / Large Fragment Set S/S CHS Lag Screw Stainless Steel Length 50-145mm $224.00
Medical & Optical Instruments Australia Pty Ltd
MO179 Acutrak Fixation Screw Acutrak Compression Screw Titanium 8mm to 50mm $425.00
MO180 Acutrak Headless Compression Screw Acutrak 4/5, 5/5, 6/7 Plus, cannulated, 25 - 80mm $425.00 $495.00
headless, variabled thread
Stryker Australia Pty Ltd
SK484 Stryker Cannulated Screw System Asnis III Cannulated screws 4.0 - 8.0 mm diameter $425.00
SR058 Stryker Cannulated Screw System Asnis Micro Cannulated screw 2.0mm-3.0mm, Diameters, $438.00
8mm-40mm lengths
Prostheses List by Category, Groups and Sponsor Page 361 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DT
Advanced Surgical Design & Manufacture Ltd
AE068 ASDM Clavicle Compression System Clavicle Compression PinTitanium 3.2 & 4.0 mm x 50mm - 130mm $243.00 $690.00
Screw, Double Threaded
DT, CN
Stryker Australia Pty Ltd
SK256 TwinFix Cannulated Compression Screw Diameter 3.2mm, lengths 14- $440.00
System 34mm
Wright Medical Australia
WR033 Charlotte Foot & Ankle System High demand compression screw, 6.5mm& 7.0mm dia, 40- $400.00
cannulated, stainless steel 110mm lengths in 5mm
increments
LK
Orthotech Pty Ltd
OH340 Fyxis plate screw Foot plate screw 9-55mm $300.00
Group 17b: Standard - ≥4.5mm
Advanced Surgical Design & Manufacture Ltd
AE012 ASDM Bone Screw Titanium 2.0 - 6.5mm dia, length 4- $41.00
150mm
Austofix
AX023 Austofix Femoral & Tibial Nailing System 4.0/4.8 Screws; Locking; dual thd; high Dia 4.0 - 4.8mm; Lengths 20- $120.00
nitrogen s-s 80mm
AX051 Tectona Hip Plate - Cortical Screw Cortical Screw, self tapping 4.5mm, lengths 28-46mm $30.00
B Braun Australia Pty Ltd
BB052 BRAUN AUST Intramedullary Nails Compression Screw 4.5mmx64mm-4.5mmx102mm $150.00
BB056 BRAUN AUST Intramedullary Nails Fixation Screws Dia 4.5mm-6mm,Length $55.00 $75.00
20mm-96mm
BB057 BRAUN AUST Intramedullary Nails Closure Screws Length 8mm-10mm $60.00
BB059 BRAUN AUST Intramedullary Nails Huckstep Fine Thread Screw 4.5mmx19mm-4.5mmx57mm $55.00 $80.00
BB271 Aesculap Schanz Screw Stainless steel All sizes $105.00
Prostheses List by Category, Groups and Sponsor Page 362 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Biomet Australia Pty Ltd
BH053 Comprehensive Shoulder - Screws Screw, Titanium (4.75 or 6.5)mm diam x 15- $145.00 $276.00
50mm length
BI915 Batcup 6.5mm Ti Cancellous Bone Screws 12mm to 45mm $180.00
Johnson & Johnson Medical Pty Ltd
DP605 Small / Large Fragment Set Cancellous Lag Screw Titanium 4.8 - 6.5mm $132.00
DP627 Small / Large Fragment Set Solid Cancellous Screw Titanium 4mm or 5mm Dia 10-76 mm $122.00
Length
DP632 Small / Large Fragment Set Solid Cancellous Screw Titanium 5.0mm Length 50 - 80mm $147.00
DP931 Small / Large Fragment Set Solid Cortical Screw Titanium 6.5mm x 40 - 100mm $116.00
JJ716 ALPS SFS Cortical Titanium Bone Screws 2.7-3.5 x6-70MM $120.00
JJ724 ALPS LFS Cancellous Titanium non-locking screws 6.5mm diameter $120.00
JJ726 ALPS LFS Cortical Titanium non- locking screws 4.5mm x 14-70mm $120.00
Lifehealthcare Pty Ltd
LH444 Hinge Pediatric Plating System - Screws 2 screws for articulated growth-correction 4.5 x 35mm, 4.5 x 30mm, 4.5 x $38.00 $200.00
fixation plate 25mm
Smith & Nephew Surgical Pty Ltd
SN014 TC 100 4.5mm Cortical Screws Hex, Cruciate or Self-tapping 14 - 60mm $19.00
SN018 TC 100 4.5mm Cortical Screws Hex, Cruciate or Self-tapping 100 - 145mm $60.00
SN061 TC 100 4.5mm Cortical Screws Hex, Cruciate or Self-tapping 62 - 95mm $35.00
SN284 Screws Cancellous 15mm - 50mm $185.00
SN593 TC 100 Screw 6.5mm Cancellous Screw 25 - 150mm length $35.00
SN595 TC 100 Screw 6.5mm Cancellous Screw Fully Threaded 6.5mm Diameter, 115mm- $129.00
150mm
SN602 TC 100 Screw 6.5mm Cancellous Screw Partially 6.5mm Diameter, 32mm thread, $60.00
Threaded 130mm+ Length
SN675 HTO Screws Titanium 4.5mm Diameter, 20 - 80mm $223.00
Length
SN770 Peri-Loc Fixation device, internal, locking and non- 5 & 6.5mm $80.00
locking, stainless steel, cortical and
cancellous screw
Prostheses List by Category, Groups and Sponsor Page 363 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SN793 Peri-Loc Fixation Device, Internal, Non-Locking, 4.5mm, 10mm -110mm length $70.00
Stainless Steel, Cortical & Cancellous
Screw
SN794 Peri-Loc Fixation Device, Internal, Non-Locking, 4.5mm, 115mm -130mm length $80.00
Stainless Steel, Cortical & Cancellous
Screw
Stryker Australia Pty Ltd
HW333 Omega Plus Compression Hip Screw Lag Screw - Standard - Stainless Steel 50-130mm length $195.00
System
HW334 Omega Plus Compression Hip Screw Lag Screw - Super - Stainless Steel 50-130mm length $260.00
System
HW335 Omega Plus Compression Hip Screw Compression Screw - Stainless Steel 25mm length $50.00
System
HW337 Omega Plus Compression Hip Screw Cancellous - Stainless Steel 6.5mm dia $50.00
System
SK047 Stryker Wedge Interference Screw Threaded biosteon screw for Dia 7 - 12mm, length 20 - 40mm $342.00 $566.00
ligment/tendon fixation
ST004 Stryker Plating System Screws - Cortical Titanium or Stainless Steel 10-20mm $25.00
4.5mm
ST005 Stryker Plating System Screws - 6.5mm Stainless Steel or Titanium 20-50mm $35.00
Cancellous
Synthes Australia Pty Ltd
SY069 AO/ASIF Screws Malleolar Screws 25mm - 110mm $108.00
SY082 AO/ASIF Screws Cancellous screws 10-150mm L $145.00
SY266 AO/ASIF Screws Malleolar Screws 20.0 - 45.0mm $95.00
Tornier Pty Ltd
TO047 Fixation Screw for Articular Implant Titanium D. 4.5mm, L 18 to 45mm $230.00
Zimmer Pty Ltd
ZI133 NexGen Knee High Tibial Osteotomy Screw - Ti 4.5 - 10 - 80 mm, 6.5 - 10 - $250.00
System 80 mm
ZI149 Periarticular Plates Periarticular 6.5mm Cancellous Screws - 16mm Thread - 35-90mm $159.00
Stainless Steel Long, 32mm Thread - 45-
90mm Long, Fully Threaded -
25-90mm Long
Prostheses List by Category, Groups and Sponsor Page 364 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI151 Periarticular Plates Periarticular 4.5mm Self Tapping Screws - 26 - 90mm $125.00
Stainless Steel
ZI204 Zimmer ECT Screws 4.5mm Cortical Screws 14 - 120mm $67.00
ZI205 Zimmer ECT Screws 4.5mm Self tapping Cortical Screws 14 - 70mm $70.00
ZI206 Zimmer ECT Screws 4.5 Malleo Screw 25 - 70mm $65.00
ZI207 Zimmer ECT Screws 6.5mm Cancellous Screws 25 - 110mm $125.00
ZI370 Cancellous Screws Orthopaedic Screws - Ti alloy 20 to 60 $148.00
ZI399 Cancellous Screws Screws- Cancell - Ti alloy 6.5/15 to 6.5/70mm $142.00
ZI400 Cortical Screws Screws- Cortical - Ti alloy 4.5/30 to 60mm $142.00
ZI596 NCB System NCB Screw Self Tapping 5.00mm x 14-85; 4.00mm x $155.00
14-48,
ZI598 NCB System NCB Cancellous Screws 4.5mm x 30-65, 5.0mm x 32- $155.00
90, 4.5mm x 30-65 C/FT
ZI599 NCB System NCB Cortical Screws 5.00mm x 14-85; 4.00mm x $155.00
14-90; 3.5mm x 14-75.
AB
ConMed Linvatec Australia Pty Ltd
LV055 Bionx Implants - Screws PLA Full Thread 3.5mm $340.00 $415.00
LV056 Bionx Implants - Screws PLA Full Thread 4.5mm $360.00 $435.00
LV058 Bionx Implants - Screws PLLA Lag Screw 3.5mm x 10-28mm $335.00 $415.00
LV059 Bionx Implants - Screws PLLA Lag Screw 3.5mm x 30-45mm $340.00 $415.00
LV060 Bionx Implants - Screws PLLA Lag Screw 4.5mm x 25-70mm $370.00 $450.00
Danex Medical Pty Ltd
XD011 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC 4.5 x 90mm $349.00
copolymer
Surgical Specialties
SQ058 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC 4.5 x 90mm $349.00
copolymer
AB, CN
ConMed Linvatec Australia Pty Ltd
LV057 Bionx Implants - Screws PLA Cannulated 4.5mm $380.00 $450.00
LV061 Bionx Implants - Screws PLLA Lag Screw 6.3mm Diameter $494.00 $550.00
Prostheses List by Category, Groups and Sponsor Page 365 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AB. CN
ConMed Linvatec Australia Pty Ltd
LV110 SmartScrew 2 Self Reinforced 96L/4D Copolymer length 10-70mm, diameter 2 to $370.00
4.5mm, shape fully/partial
threaded, cannulated/non-
cannulated
Cannulated
Darco Australia
DC037 Darco Headed Compression Screw Cannulated titanium compression screws 4.5mm x 8-60mm; 6.5mm x $185.00 $425.00
System 4.5, 6.5, 7.5 35-120mm; 7.5mm x 35-120mm
Cannulated, Double threaded, Locking
Orthopaedic Solutions Pty Ltd
OE015 NexFix 4.5MM Compression Screw The NexFix Compression Screw is a 4.5mm diameter x 14-40mm in $196.00 $365.00
stainless steel, cannulated, self tapping, and 2mm increments, 40-65mm in
self drilling fixation device for osteotomies, 5mm increments, with short and
fusions and fracture fixation of small bones long thread options
OE018 NexFix 6.5mm Compression Screw The NexFix Compression Screw is a 6.5mm diameter x 40-120mm $196.00 $445.00
stainless steel, cannulated, self tapping, and in 5mm increments with short
self drilling fixation device for osteotomies, and long thread options
fusions and fracture fixation of small bones
CN
Johnson & Johnson Medical Pty Ltd
DP592 Small / Large Fragment Set Cannulated Cancellous Lag Screw 6.5 - 8mm or 22 mm threaded $214.00
Titanium screw
DP598 Small / Large Fragment Set Cannulated Bone Screw 3.5 mm length 50-60 mm $98.00 $175.00
DP664 Small / Large Fragment Set S/S Cannulated Cancellous Screw 16 or 32 20-150mm $160.00
Thread
Smith & Nephew Surgical Pty Ltd
SN438 Hip Pin Cannulated 30-135mm $203.00
SN631 Cannulated Hip Pins Rush Nails, Round Bevil Point Hook Pins 20.3mm - 254mm $110.00
SN635 Cannulated Screw Partial Thread, Stainless Steel 6.5mm Diameter, 16&20mm $201.00
Thread, 20-135mm
Prostheses List by Category, Groups and Sponsor Page 366 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SN636 Cannulated Screw Partial Thread, Stainless Steel 6.5mm Diameter, 32mm thread, $228.00
45-130mm
SN637 Cannulated Screw Partial and Fully Threaded, Stainless Steel 5.5mm Diameter, 20-120mm $143.00
SN638 Cannulated Screw Partial and Fully Threaded, Stainless Steel 7.0mm Diameter, 30-150mm $150.00
SN639 Cannulated Screw 6.5mm & 7.0mm screw Titanium 30 - 150mm Length $163.00
SN641 Cannulated Screw 5.5mm screw Titanium 5.5mm Diameter 8x20mm- $150.00
32x120mm
SN643 Cannulated Screw 8mm Cannulated screws 8mm Diameter 65-125mm $207.00
SN644 Cannulated Screw 6.4mm Cannulated screws 6.4mm diameter 65-125mm $221.00
length
Synthes Australia Pty Ltd
SY292 Facet Interference Screw Cannulated Screw 7.5mm $500.00
Zimmer Pty Ltd
ZI176 Zimmer Internal Fixation Systems: Magna-FX - Stainless Steel 16 mm Thread - 30-30 mm; 32 $205.00
Cannulated Screw mm Thread - 40-120 mm;
Fully Threaded - 30-130 mm
Long
CN, DT
Medical & Optical Instruments Australia Pty Ltd
MO274 Acutrak 2 5.5mm Headless Compression Screw 8-mm - 50mm $425.00 $550.00
DT
Zimmer Pty Ltd
ZI180 Zimmer Internal Fixation Systems: Cannulated 4.5mm - Titanium 30 - 70mm $450.00
Herbert Bone Screw
ZI181 Zimmer Internal Fixation Systems: Cannulated 6.5mm - Titanium 25 mm - 100mm $490.00
Herbert Bone Screw
DT, CN
Orthotech Pty Ltd
OH343 Unima Screw Foot screw 7.2 7.2 x 50-120mm $450.00 $495.00
OH344 Unima Screw Foot screw 4.5 4.5 x 30-50mm $450.00
Prostheses List by Category, Groups and Sponsor Page 367 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Wright Medical Australia
WR034 Charlotte Foot & Ankle System Multi use compression screw, cannulated, 3.0 & 4.3mm dia. 10-60mm in $400.00
stainless steel 2mm increments
DT, CN, LK
Synthes Australia Pty Ltd
SY074 AO/ASIF Screws Steel Cannulated screws ≥4.50mm $313.00
LK
Austofix
AX021 S2 Nail System 6.2mm condylar screws 6.5mm x 60-85mm $175.00
AX053 Tectona Hip Plate - Locking Screw Locking screw, self tapping 5.0mm, lengths 28-46mm $180.00
B Braun Australia Pty Ltd
BB303 Position HTO Implant System - Locking Titanium cancellous and cortical screw, 30mm-78mm x 4.5mm & $223.00 $550.00
Screws locking head for solid plate fixation. 6.0mm diameter.
ConMed Linvatec Australia Pty Ltd
LV013 Soft Tissue Anchoring Implant - Cortical Soft Tissue Re-attachment - Titanium 30 - 80mm $175.00
Screw
LV014 Soft Tissue Anchoring Implant - Soft Tissue Re-attachment - Titanium 25 - 65mm $200.00
Cancellous Screw
Johnson & Johnson Medical Pty Ltd
JJ680 Polyax Plating System Cortical Locking Screw, Titanium 8-60mm $220.00
JJ683 Polyax Plating System Polyaxial Cancellous Locking Screw, 25-100mm $220.00
Titanium
JJ685 Polyax Plating System Cancellous Locking Screw, Polyaxial, 50-100mm $220.00
Titanium
JJ723 ALPS LFS Cancellous Titanium locking screws 26-100MM $185.00
JJ725 ALPS LFS Cortical Titanium locking screws 8-100MM $185.00
Lifehealthcare Pty Ltd
LH254 Total Wrist Implant System Carpal Screws 15, 18, 22, 26, 30mm $131.00
Smith & Nephew Surgical Pty Ltd
SM150 Peri-Loc PFP Proximal Femur Locking Screw - 360L 60MM X 22MM THRD - $244.00
stainless steel 130mm X 22MM THRD
60mm X Full Thread - 130mm
Full Thread
Prostheses List by Category, Groups and Sponsor Page 368 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SN768 Peri-Loc Fixation Device, Internal, Locking, 4.0mm -5.0mm $150.00
Stainless Steel, Cortical & Cancellous
Screw
SN769 Peri-Loc Fixation device, internal, locking and non- 5.7mm $150.00
locking, stainless steel, cortical and
cancellous screw
Stryker Australia Pty Ltd
HW260 Wichita Fusion Nail System Transverse Screw - Vitallium 30-60mm in 5mm increments $181.00
Zimmer Pty Ltd
ZI548 Zimmer Universal Locking System 2.7mm Universal Locking Screw Length:8mm; 10mm; 12mm; $170.00
14mm; 16mm; 18mm; 20mm;
22mm; 24mm; 26mm; 28mm;
30mm; 32mm; 34mm; 36mm;
38mm; 40mm; 42mm; 44mm;
46mm; 48mm; 50mm; 55mm;
60mm
LK, CN
Johnson & Johnson Medical Pty Ltd
JJ682 Polyax Plating System Polyaxial Cancellous Cannulated Locking 25-90mm $250.00
Screw, Titanium
LK, DT
Tornier Pty Ltd
TO046 Aequalis Reversed Shoulder - Fixation Titanium D45mm, L20 to 50mm $296.00
Screw for Articular Implant
Locking
Exactech Australia
EX046 Equinoxe Compression Screw The compression screw compresses the 4.5x18mm white, 4.5x22mm $145.00
glenoid plate to the bone while providing black, 4.5x26mm orange,
30 degrees of angular variability 4.5x30mm blue, 4.5x34mm
red, 4.5x38mm green,
4.5x42mm yellow, 4.5x46mm
purple
EX047 Equinoxe Glenosphere Locking Screw The Locking Screw locks compression one size $145.00
screws to the glenoid plate at a variable
angle
Prostheses List by Category, Groups and Sponsor Page 369 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Locking, Cannulated
Tornier Pty Ltd
TO051 Aequalis Humeral Nail Screws Screws for Aequalis Humeral Head. Proximal Screws length: From $95.00
Cannulated Proximal screws: 5mm 36 to 60 every 4mm Distal
Diameter cannulated Ti, PE insert with Screws length: From 20 to 32
thread inside. Distal screws 4.5mm every 2mm
Diameter, Ti.
Group 17c: Small – 2.71 – 4.49mm
Austofix
AX042 VRP Distal Radius Fixation System, 3.5mm Cortical Screw, Titanium 3.5mm diameter, 10mm-20mm $67.00
3.5mm Cortical Screw, Titanium lengths
AX052 Tectona Hip Plate - Compression Screw Comprssion screw, sterile packed Length 36mm. For compression $50.00
with Tectona Lag Screw
DJO Australasia Pty Ltd
DD037 Reverse Shoulder System Bone Screw 3.5 x 15mm to 5 x 30mm $225.00
Global Orthopaedic Technology
GO153 Reverse Shoulder System Bone Screw 3.5 x 15mm to 5 x 30mm $225.00
Integra Neurosciences Pty Ltd
IG080 Hintegra Total Ankle Prosthesis Cortical fixation screw, Composition - Length 12 - 42mm $100.00
Stainless Steel
IG099 Calcanea Variable Angle Screw Cortical Screw, Titanium Diameter 3.5mm, Length 20mm $159.00
to 45mm
Johnson & Johnson Medical Pty Ltd
DP040 Bone Screw Screw Cancellous Titanium Diameter 4.5-6.5mm $91.00
DP597 Small / Large Fragment Set Solid Cortical Screw Titanium 3.5 - 6.5mm; 10 - 120mm $98.00 $140.00
Length
DP638 Small / Large Fragment Set Solid Cancellous Bone Screw Full Thread 4mm Dia 50-110mm Length $180.00
Titanium
DP654 Small / Large Fragment Set S/S Cortical Screw Diameter - Stainless Steel 3.5 or 4.5 x 12 - 48mm Length $15.00
JJ633 HI S3 Shoulder Fixation System Set Screw, 90 Deg Locking One size $213.00 $220.00
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Billing Code Product Name Description Size Benefit Benefit Notations
Lifehealthcare Pty Ltd
LH373 Stability Sigmoid Notch Total DRUJ The Sigmoid Notch Radial Screw is a low The Sigmoid Notch screw is $250.00
System / Sigmoid Notch Screw profile self tapping cortical screw made of available in 2mm increments
implantable CoCr. It is designed to be from 18mm - 32mm and has a
placed bi cortical in the radius and is diameter of approx 4mm.
introduced into the Radial stem thru a hole.
It is placed into the stem and tightened
down
LMT Surgical Pty Ltd
LM075 Surgicraft Bone Screws Surgicraft Bone Screws 2-4mm diameter/10-40mm $145.00
length
Orthotech Pty Ltd
OH337 EOS Footset-Antares Footscrew 12-34mm $210.00 $480.00
Smith & Nephew Surgical Pty Ltd
SN002 TC 100 3.5mm Cortical Screws Hex, Cruciate or Self Tapping 45 - 85mm $38.00
SN007 TC 100 3.5mm Cortical Screws Sterile, Hex or Cruciate 10 - 40mm $15.00
SN606 TC 100 4mm Cancellous Screw Fully or Partially Threaded 10 - 20mm $14.00
SN607 TC 100 4mm Cancellous Screw 22 - 50mm $16.00
SN609 TC 100 4mm Cancellous Screw Fully or Partially Threaded 55mm + $21.00
SN612 TC 100 3.5mm Cortex Screw Hex, Cruciate or Self-tapping 85mm + $70.00
SN621 TC 100 3.5mm Cortex Screw Hex, Cruciate or Self-tapping 10 - 40mm $22.00
SN625 TC 100 Screw Malleolar Bone Screw, Sterile 25x12mm - 70x32mm $30.00
SN765 Peri-Loc 2.7mm & 4.0mm Non Locking Screw 10 - 80mm $50.00
SN766 Peri-Loc Fixation Device, Internal, Non-Locking, 3.5mm $50.00
Stainless Steel, Cortical & Cancellous
Screw Size: 3.5mm
SN792 Peri-Loc Fixation Device, Internal, Locking and 4.0mm, 80mm - 100mm length $70.00
Non-Locking, Stainless Steel, Cortical &
Cancellous Screw
SN833 Peri-Loc UE Self Tapping Cortex Non Locking Screw 2.5mm, 10-30mm length $50.00
Stryker Australia Pty Ltd
SK452 Stryker Plating System Self-Tapping/Cortical Sterile Screws 2.7mm - 4.5mm Diameter $90.00
Stainless Steel or Titanium Alloy 8mm - 150mm Length
Prostheses List by Category, Groups and Sponsor Page 371 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
ST006 Stryker Plating System Screws - Stainless Steel or Titanium, Full or Partial 10-60mm Screw Length $70.00
Cancellous 4.0mm Thread
Synthes Australia Pty Ltd
SY056 Cortex Screws 2.7mm - 5.0mm diameter, 5mm $93.00
- 150mm length
SY068 AO/ASIF Screws Cancellous,- ligament, bunionectomy, full 4.0mm dia / 10 - 105mm $91.00
& short thread
SY353 Cortex Screws Cortex Screws pack of four 2.7mm - 5.0mm diameter, $371.00
5.0mm - 100mm Length
Zimmer Pty Ltd
ZI150 Periarticular Plates Periarticular 4.0mm Cancellous Screws - Part thread - 30-60 mm, Full $105.00
Stainless Steel thread 30-110 mm
ZI152 Periarticular Plates Periarticular 3.5mm Self Tapping Screws - 10 - 80mm $136.00
Stainless Steel
ZI202 Zimmer ECT Screws 3.5mm Cortical Screws 10 - 130 mm $60.00
ZI203 Zimmer ECT Screws 4.0mm Cancellous Screws 10 - 60 mm $80.00
AB
ConMed Linvatec Australia Pty Ltd
LV066 Bionx Implants - screws Biofix PLA full threaded crosshead screw Dia 2mm, length 6 - 10mm $267.00 $345.00
LV067 Bionx Implants - screws Biofix PLA full threaded crosshead screw Dia 2mm, length 12 - 20mm; $288.00 $365.00
Dia 2.7mm, length 6 -24mm
AB & DT
Device Technologies Australia Pty Ltd
DE272 Bio-Compression Screw System Fixation Device 16mm, 18mm, 20mm, 22mm, $425.00 $850.00
24mm, 26mm
AB, CN
LMT Surgical Pty Ltd
LM089 BioComposites Little Grafter An absorbable cannulated compression 4mm diameter varying lengths $380.00 $560.00
screw providing fixation for small bone 13mm to 27mm
fractures
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Billing Code Product Name Description Size Benefit Benefit Notations
Cannulated
Darco Australia
DC036 Darco Headed Compression Screw Cannulated titanium compression screws 3.5mm x 8-60mm; 4.0mm x 8- $165.00 $425.00
System 3.5, 4.0 60mm
LMT Surgical Pty Ltd
LM098 Extremity Medical Compression Screw Compression Screw for fixation across 3.0mm, 4.5mm, 6.5mm $286.00 $440.00
System fragments
Cannulated, Double threaded
Orthopaedic Solutions Pty Ltd
OE016 NexFix 3.0mm Compression Screw The NexFix Compression Screw is a 3.0mm diameter x 10 - 34mm $196.00 $325.00
stainless steel, cannulated, self tapping, and length in 2mm increments
self drilling fixation device for osteotomies,
fusions and fracture fixation of small bones
CN
Johnson & Johnson Medical Pty Ltd
DP593 Small / Large Fragment Set Cannulated Cancellous Screw 4mm or 16mm or 32mm $227.00
Thread, 26-120mm Length
DP635 Small / Large Fragment Set Solid Cancellous Lag Screw Partial 4mm Dia 10-60mm Length $227.00
Thread Titanium
DP640 Small / Large Fragment Set Cancellous Cannulated Lag Screw Partial 4mm 10 to 70mm Length $225.00
Thread
DP643 Small / Large Fragment Set Cannulated Cancellous Screw Full 4 x 10 -100mm Length $186.00
Threaded - Stainless Steel
JJ715 ALPS SFS Cannulated Cancellous Titanium Bone 10-70MM $175.00
Screws
Smith & Nephew Surgical Pty Ltd
SN642 Cannulated Screw 2.5mm - 4.0mm Screw 2.5mm - 4.0mm Diameter 8 - $140.00
70mm length
Surgiplas Medical
SP037 OsteoMed Plating & Fixation System Screws - Cannulated Lag 3.0mm x (10 x 28)mm; 4.0mm $210.00
x (12 - 30)mm
SP038 OsteoMed Plating & Fixation System Screws - Cannulated Lag 3.0mm x (30 x 40)mm; 4.0mm $250.00
x (32 - 52)mm
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Billing Code Product Name Description Size Benefit Benefit Notations
Synthes Australia Pty Ltd
SY049 AO/ASIF Screws Mini cannulated screw 3.0mm dia / 8 - 40mm length $179.00
SY071 AO/ASIF Screws Steel Cannulated screws 2.7mm-4.49mm $175.00
Wright Medical Australia
WR068 Cannulated Screw Titanium cannulated screw intended for use 3.5mm diameter x 34, 36 & $155.00
in conjunction with a plate for fixation of 38mm
midfoot fusion
Zimmer Pty Ltd
ZI177 Zimmer Internal Fixation Systems: Mini Magna-FX - Stainless Steel 4 & 5mm diameters $216.00
Cannulated Screw
CN, DT
Surgiplas Medical
SP054 ExtremiFix Screws Headless Cannulated Compression Screw Diameter 2.0mm, 2.4mm, $425.00 $485.00
3.0mm, 4.0mm. Length 10mm
to 52mm.
DT, CN
Integra Neurosciences Pty Ltd
IG057 Kompressor Titanium compression screw 10-34mm $425.00
IG069 Bold Compression Screw Cannulated titanium 3mm diam 10-34mm length $286.00
IG070 ICOS Screw: Ideal Compression Screw Cannulated titanium 4.0mm diam 26-60mm length, $412.00
6.5mm diam 40-150mm length
IG107 Bold Compression Screw (Sterile) Cannulated Titanium 10-34mm $286.00
IG109 Qwix Screw Self drilling, self tapping, cannulated, Diameter 3.0mm-7.5mm, length $286.00
titanium screws. 10mm-120mm
LMT Surgical Pty Ltd
LM052 Ascension Compression Screw Titanium Compression Screw 2-5mm diameter ; 12 - 40mm $425.00
length
Smith & Nephew Surgical Pty Ltd
SM173 Peri-Loc Headless Cannulated Screw 3.0mm Headless Cannulated $286.00 $425.00
Screw 8mm - 40mm
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Billing Code Product Name Description Size Benefit Benefit Notations
Wright Medical Australia
WR062 Scarf Compression screw designed for forefoot 3.2mm diameter x 10-32mm $286.00
reconstructions, 1.1mm cannulated,
titanium, self tapping, self drilling, wide
thread for osteoporotic bone, long
threadless section for high compression.
LK
Austofix
AX003 Austofix Intramedullary Screws Humeral Head Screw, stainless steel 4.3mm $105.00 $145.00
Integra Neurosciences Pty Ltd
IG098 Calcanea Locking Screw Cortical Screw, Titanium Diameter 3.5mm, Length 20mm $235.00
to 45mm
Johnson & Johnson Medical Pty Ltd
JJ627 HI S3 Shoulder Fixation System Peg, Standard Stainless Steel 4mm x 20mm - 65mm $140.00 $254.00
JJ628 HI S3 Shoulder Fixation System Peg, Threaded Stainless Steel 4mm x 20mm - 65mm $150.00 $265.00
JJ629 HI S3 Shoulder Fixation System Peg, Threaded Stainless Steel 4mm x 37.5mm $160.00 $265.00
JJ630 HI S3 Shoulder Fixation System Peg, Threaded Stainless Steel 4mm x 40mm, 45, 47.5mm, $167.00 $265.00
50mm, 52.5mm, 55mm,
57.5mm, 60mm, 62.5mm,
65mm,
JJ631 HI S3 Shoulder Fixation System Screw, Multidirectional Stainless Steel 3.8mm x 20, 22, 24, 26, 28, $231.00 $265.00
30, 32, 34, 36 & 38
JJ632 HI S3 Shoulder Fixation System Screw, 90 Deg Locking Stainless Steel 3.8mm x 20, 22, 24, 26, 28, $185.00 $265.00
30, 32, 34, 36 & 38
JJ717 ALPS SFS Cortical Locking Titanium Bone Screws 6-70MM $170.00
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Billing Code Product Name Description Size Benefit Benefit Notations
Lifehealthcare Pty Ltd
LH420 SBi Precise SD Screw An anatomically contoured locking titanium 2.7mm Cortical, Locking, Self- $93.00
plate and titanium alloy screw/peg system Tapping 10-30mm
intended for fixation of distal radius 2.7mm Cortical, Non-Locking,
fractures via open reduction Self-Tapping 10-30mm
2.7mm Lag, Non-Locking,
Self-Tapping 10-30mm
3.5mm Cortical, Locking, Self-
Tapping 8-20mm
3.5mm Cortical, Non-Locking,
Self-Tapping 8-20mm
LH421 SBi Precise SD Smooth Peg (Locking) An anatomically contoured locking titanium 1.9mm Smooth Pegs, Locking $93.00
plate and titanium alloy screw/peg system 12-28mm
intended for fixation of distal radius
fractures via open reduction
LMT Surgical Pty Ltd
LM063 ArgoMedical Pedofix Titanium screws 2.7mm x 8 - 28mm Length $50.00
LM069 Normed Foot screws Titanium plates, various sizes and shapes multiple $50.00
LM093 New Clip Titanium Bone Screws Titanium Screws for fixation of plates to 4 mm diam x10mm length to $145.00 $180.00
bone 4mm 32mm and 4.5mm 10mm
to 35mm
Orthopaedic Solutions Pty Ltd
OE007 Nexfix MTP Fusion System Unique low profile stainless steel locking 3.2mm x 12mm, 14mm, 16mm, $130.00
screw for use with NexFix MTP Fusion 18mm, 20mm
plates, indicated for use in osteoporotic
bone
Smith & Nephew Surgical Pty Ltd
SN790 Peri-Loc Fixation Device, Internal, Locking, 3.5mm, 10mm - 85mm length $130.00
Stainless Steel, Cortical & Cancellous
Screw
Stryker Australia Pty Ltd
SK395 Stryker Plating System SPS Locking Plate System Locking Screws: 3.0mm - $185.00
6.5mm diameter
Prostheses List by Category, Groups and Sponsor Page 376 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
SK464 Stryker Locking Plate System Screw; Locking, Cancellous & Cortical Diameter 1.2 to 2.7mm, Length $140.00
2mm to 48mm
SR073 Stryker Locking Plate System Screw; Locking, Cancellous & Cortical Diameter 2.7 to 3.5mm, Length $235.00
10mm to 70mm
LK, CN
Integra Neurosciences Pty Ltd
IG093 Newdeal Screws/Lock Screws Screws - Cancellous, Cancellous Cancellous/Cancellous $180.00
cannulated, cortical, cortical cannulated cannulated - Diameter 6.5mm,
plus Lock screws Length 20mm - 100mm + Lock
Screw, Cortical - Diameter
5.0mm, Length 25mm - 45mm
+ Lock Screw, Cortical -
Diameter 4.5mm, Length 14mm
- 65mm + Lock Screw,
Cortical - Diameter 3.5mm,
Length 14mm - 32mm + Lo
IG108 Newdeal Surfix Style Screws Titanium bone screw +locking screw for Diameter 3.5mm, Length 10- $180.00
the fixation of specific Newdeal bone plates 50mm; Diameter 4.5mm, length
14-65mm; Diameter 6.5,
length 20-100mm
LK, DT
Tornier Pty Ltd
TO032 Aequalis Humeral Plate Screws Proximal humeral plate screws (Cancellous Proximal locking screws: 4mm, $140.00
self-tapping locking screws, Cortical self- cortical self tapping locking
tapping locking screws or Cortical Self- screws: 20 to 60mm length;
tapping compression screws) proxmial inferior locking
screws: 3.5mm, cortical self
tapping locking screws: 10 to
40mm length; distal
compression screws: 3.5mm,
cortical self-tapping
compression and locking
screws: 10 to 50mm length
Locking
Darco Australia
DC034 Charlotte Claw Locking Screws 3.5mm stainless steel locking screws for 3.5mm: 14-40mm $90.00
use with Claw Plate
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Billing Code Product Name Description Size Benefit Benefit Notations
LMT Surgical Pty Ltd
LM096 Memometal Anchorage Bone Screws Bone Plate Screws, locking and non- 3.0-3.5mm diameter, 8-40mm $38.00 $50.00
locking length
Group 17d: Mini - ≤2.7mm
Advanced Surgical Design & Manufacture Ltd
AE080 Carpal Fusion System Screw 316L Stainless Steel, Low Profile Custom 2 - 7 mm Diameter 12 - 24mm $440.00
Thread Screw Length
Biomet Australia Pty Ltd
BI768 Mandibular Fracture System Screw, IMF 2./2.4 Mandibular Fracture, 2.0 x(5 - 13)mm $47.00
Titanium
Device Technologies Australia Pty Ltd
DE214 Cortical Screw Titanium 10-24mm x 2.3mm $110.00
Integra Neurosciences Pty Ltd
IG071 Spin Screw: Snap Off Screw Titanium Diameter 2mm, Length 11- $286.00
14mm; Diameter 2.7mm,
Various Lengths; Diameter
3.0mm, Various Lengths
IG105 Spin Screw: Snap Off Screw (Sterile) Titanium Diameter 2-3mm, Length 10- $286.00
34mm
Johnson & Johnson Medical Pty Ltd
DP837 Peak Channelled Plate System Cortical Bone Screw 3.5mm $70.00 $118.00
JJ783 ALPS Hand Fracture System - CoCr Locking pegs & screws, threaded, partly 10 - 2.5mm x 4 - 40mm $170.00
Pegs threaded, CoCr
JJ784 ALPS Hand Fracture System - Titanium Pegs, threaded, partly threaded, titanium 1.0 - 2.5mm x 4 - 40mm $107.00
Pegs
Lifehealthcare Pty Ltd
LH334 Carpal Screw Titanium 2.5mm diameter in sizes 12mm $125.00
- 20mm length
Orthopaedic Solutions Pty Ltd
OE010 Nexfix MTP Fusion System Unique low profile stainless steel locking 2.7mm x 12mm, 14mm, 16mm, $96.00
screw for use with NexFix MTP Fusion 18mm, 20mm, 24mm, 28mm
plates, indicated for use in normal bone
Prostheses List by Category, Groups and Sponsor Page 378 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Orthotech Pty Ltd
OH335 EOS Footset - Entos Footscrew 11-14mm $425.00 $450.00
Smith & Nephew Surgical Pty Ltd
SM172 Peri-Loc 2.0mm Twist-Off Screw 2.0mm Twist-Off Screw 8mm, $286.00 $320.00
2.0mm Twist-Off Screw
10mm, 2.0mm Twist-Off
Screw 12mm, 2.0mm Twist-
Off Screw 14mm, 2.0mm
Twist-Off Screw 16mm,
2.0mm Twist-Off Screw 18mm
SN082 TC 100 2.7mm Cortical Screws Hex, Cruciate or Self-tapping 6 - 55mm $16.00
SN112 TC 100 2.0mm Cortical Screws Self Tapping, Hex or cruciate 6 - 38mm $19.00
SN540 TC 100 1.5mm Screw Hex, Cruciate or Self-tapping 6-24mm $13.00
Stryker Australia Pty Ltd
SK103 Stryker Plating System Cortical bone screws 2.7mm diameter, 22 - 80mm $28.00
lengths
Surgiplas Medical
SP051 CONTOUR Hand Screws Screws 1.2, 1.7 and 2.3mm in diameter $67.00
screws ranging between 4 and
24 mm in length.
Synthes Australia Pty Ltd
SY065 Cortex Screw Cortex Screw ≤2.7mm $67.00
SY352 Cortex Screws Cortex Screws pack of four 1.00mm 2.6mm diameter, 5mm $268.00
- 100mm length
Zimmer Pty Ltd
ZI199 Zimmer ECT Screws 1.5mm Cortical Screws 6 - 18mm $54.00
ZI200 Zimmer ECT Screws 2.0mm Cortical Screws 6 - 24mm $52.00
ZI201 Zimmer ECT Screws 2.7mm Cortical Screws 6 - 50mm $54.00
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Billing Code Product Name Description Size Benefit Benefit Notations
Absorbable
Orthopaedic Solutions Pty Ltd
OE022 Activa Screw The Activa Screw is a bioresorbable 2.7mm x 10, 12 , 14 , 16, 20 & $225.00 $380.00
device that maintains accurate alignment of 24mm
bone fractures, osteotomies, arthrodeses,
bone grafts and osteochondral fractures
after surgical procedure. The Activa Screw
possess' rigidity similar to bone which
decreases during the healing process,
transferring the load gradually to the bone.
The fixation material decomposes and the
site of implantation is replaced with new
bone.
Cannulated
Darco Australia
DC035 Darco Headed Compression Screw Cannulated titanium compression screws 2.7mm x 8-34mm $140.00 $425.00
System 2.7
Cannulated, Double threaded
Orthopaedic Solutions Pty Ltd
OE017 NexFix 2.5mm Compression Screw The NexFix Compression Screw is a 2.5mm diameter x 10 - 34mm $196.00 $293.00
stainless steel, cannulated, self tapping, and length in 2mm increments
self drilling fixation device for osteotomies,
fusions and fracture fixation of small bones
CN
Surgiplas Medical
SP035 OsteoMed Plating & Fixation System Screws - Cannulated Lag 2.0mm x (6 - 16)mm; 2.4mm x $220.00
(6 - 20)mm
SP036 OsteoMed Plating & Fixation System Screws - Cannulated Lag 2.0mm x (18 - 42)mm; 2.4mm $260.00
x (22 - 50)mm
Synthes Australia Pty Ltd
SY321 AO/ASIF Screw 2.4mm Cannulated Screw Short thread 15-40mm; Long $165.00
Thread 5-35mm
Prostheses List by Category, Groups and Sponsor Page 380 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
DT
LMT Surgical Pty Ltd
LM082 Fixos Screws Bone Fixation Screws 2mm diam. X11mm lenth to $286.00 $425.00
2mm x 16mm
Zimmer Pty Ltd
ZI178 Zimmer Internal Fixation Systems: Scaphiod - Titanium Scaphoid - 12 - 30mm length $360.00
Herbert Bone Screw
ZI179 Zimmer Internal Fixation Systems: Herbert/Whipple - Titanium 12 mm - 30 mm $420.00
Herbert Bone Screw
DT, CN, LK
Orthotech Pty Ltd
OH336 EOS Footset-Pyxis Footscrew 11-28mm $210.00 $450.00
LK
Austofix
AX043 VRP Distal Radius Fixation System, Threaded, non-threaded, partially threaded 2.0, 2.5, 2.6mm diameter, $120.00
Threaded, mpm-threaded, partially locking, non-locking screw, peg, titanium 14mm-30mm lengths
threaded locking, non-locking screw,
peg, Titanium
Biomet Australia Pty Ltd
BI929 Sternalock Screws Ti 2.4-2.7mm x 8-12mm $44.00
Johnson & Johnson Medical Pty Ltd
JJ622 Distal Radius Fracture Repair System Locking peg, threaded, partly threaded, 2.5mm x 14-40mm $125.00
smooth, titanium/cobalt chrome
JJ623 Distal Radius Fracture Repair System Locking cortical bone screw, titanium 2.5mm-3.5mm x 10-28mm $107.00
LMT Surgical Pty Ltd
LM041 Trimed Bearing Plate, Fixation Pegs The fixation pegs are made of medical Pegs - 2.3 x 10-34mm $140.00
grade 316 stainless steel Threaded or unthreaded pegs
LM048 Ascension Radial Head Locking Plate Titanium pre-formed anatomical radial 10mm - 40mm $160.00
and screws head Screws
LM061 BioTech Xpode 4 Screws titanium 6 - 70mm length $180.00
Medical & Optical Instruments Australia Pty Ltd
MO153 Acumed Congruent Plate System Screw Titanium 2.1, 2.7, 3.5, 4.0mm diameter, $94.00
6mm to 28mm length
Prostheses List by Category, Groups and Sponsor Page 381 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
MO249 ACU- LOC Distal Radius Plate System Threaded, non-threaded, locking, non- 2.3mm / 3.5mm diameter, 14- $145.00
locking screw, peg, Titanium 32mm length
Smith & Nephew Surgical Pty Ltd
SN832 Peri-Loc UE Self Tapping Cortex Locking Screw 2.5-2.7mm, 10-60mm length $130.00
Synthes Australia Pty Ltd
SY320 AO/ASIF Screw Locking Head Screw 2.0mm Length: 6-40mm $144.00
Wright Medical Australia
WR030 Evolve Locking Cancellous Bone The Evolve stainless steel locking screw 2.0mm x 14 - 28mm $100.00
Screws
Locking
Darco Australia
DC032 Charlotte Claw Locking Screws 2.7mm stainless steel locking screws for 2.7mm, 12-30mm $90.00
use with Claw Plate
Group 17e: Screw Washers
Austofix
AX027 Austofix Femoral & Tibial Nailing System Washer for screws; s-s Dia 11mm & 13mm $110.00
ConMed Linvatec Australia Pty Ltd
LV011 Soft Tissue Anchoring Implant - Spiked Soft Tissue Re-attachment - Titanium 1.3 x 14mm - 2.5 x 20mm $335.00
Washer
LV012 Soft Tissue Anchoring Implant - Flat Soft Tissue Re-attachment - Titanium 14, 17mm $162.00
Washer
Johnson & Johnson Medical Pty Ltd
DP646 Small / Large Fragment Set Washer Titanium - Flat/Cup/Countersink One size only $23.00
DP759 Small / Large Fragment Set S/S Washer Spiked, Standard, Cancellous, One size only $14.00
Cortical & Fastening Wire
JJ719 ALPS SFS Flat and cupped Titanium washers Flat and cupped $85.00
JJ728 ALPS LFS Flat and cupped Titanium washers 4.5-6.5mm $85.00
LMT Surgical Pty Ltd
LM001 TriMed Wrist Fixation System Washer . $115.00
LM066 TriMed Olecranon Sled Washer one size $200.00
Prostheses List by Category, Groups and Sponsor Page 382 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
LM081 Surgicraft Washers Fixation Washers 0.5-3mm $103.00
Medical & Optical Instruments Australia Pty Ltd
MO158 Polarus Humeral Rod System Polarus Washer 3.5mm $20.00
Orthopaedic Solutions Pty Ltd
OE019 NexFix Washer The NexFix Washer is a threaded circular 9mm, 11mm, 13mm $14.00 $45.00
piece of stainless steel through which is
inserted a NexFix Compression Screw.
The Compression Screw is locked to the
washer to form a headed screw that will
increase bone coverage and prevent the
screw from sinking into osteopenic bone.
Smith & Nephew Surgical Pty Ltd
SN449 Washer Screw washers 2, 7/3, 7/4, 0/4.5 $32.00
SN450 Washer For Cannulated screw systems, Titanium One size only $49.00
SN626 TC 100 Washers Stainless Steel 7-13mm $14.00
SN627 TC 100 Washers Titanium Non Sterile 4.5mm -13mm $23.00
SN628 TC 100 Washers Titanium Sterile 4.5mm -13mm $47.00
Stryker Australia Pty Ltd
ST040 Stryker Plating System - Washers & Nuts Stainless Steel or Titanium Nuts 5.0 or 4.5mm thickness; $18.00
Washers 7 - 13mm diameter
Synthes Australia Pty Ltd
SY092 AO/ASIF K-Wires, Pins, Washers etc. Washers/nuts 1.0mm - 16mm dia $103.00
Wright Medical Australia
WR060 Ring washer Screw Washers 2.7/3.7/4.0/4.5 $45.00
Zimmer Pty Ltd
ZI210 Zimmer Large-Frag System Washer/Spiked washer Small & Large $43.00
CN
Stryker Australia Pty Ltd
HW298 Asnis Guided Screw System Washer, Stainless Steel One size only $39.00
HW299 Asnis Guided Screw System Washer - Titanium 4, 5, 6.5,8mm $46.00
Prostheses List by Category, Groups and Sponsor Page 383 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Group 17f: Other
Biomet Australia Pty Ltd
BI829 EBI XFIX Vision System Screw, Transfixing, Stainless steel 4 - 6mm diameter $410.00
BI834 EBI XFIX DynaFix System Screw, VS Osteotomy System, Ti 6mm x (30mm-110mm) $131.00
Device Technologies Australia Pty Ltd
DE077 Cancellous Bone Screws Low Profile 4-6.5mm x 14-60mm $211.00
DE128 Cortical Screw Self locking screws, cancellous and cortical 3-6.5mm x 10-110mm $230.00
DE291 QuickFix Screw Small Bone Fixation - Metal 2mm x 10mm, 2mm x $425.00
11mm,2mm x 12mm, 2mm x
13mm, 2mm x 14mm, 3mm x
13mm x 3mm x 15mm, 3mm x
17mm, 3mm x 19mm
Johnson & Johnson Medical Pty Ltd
DP883 Barouk SCR Sys Staples and Buttons Barouk Screw System Button Prosthesis - 8-20mm $307.00
SS or Ceramic
DP893 Rockwood Clavical Pin Nut Clavical Pin S/S 2.5 to 4.5mm $135.00
Lifehealthcare Pty Ltd
LH343 Percufix Titanium Diameter: 2-2.5mm, Length 22- $390.00
40mm
Orthopaedic Solutions Pty Ltd
OE020 NexFix Compression Pin The NexFix Compression Pin is a tapered 2.0mm x 10mm, 2.0mm x $225.00 $275.00
stainless steel compression pin for use in 12mm, 2.0mm x 14mm, 2.0mm
maintaining alignment and providing x 16mm, 2.7mm x 20mm,
interfragmentary compression of small 2.7mm x 24mm, 3.5mm x
bones in osteotomies, fusions and fractures 25mm, 3.5mm x 30mm
until a stable bony union occurs. It is self
drilling for ease of insertion and is designed
with a variable pitch and buttress thread to
provide greater compression.
Prostheses List by Category, Groups and Sponsor Page 384 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
OE025 NexFix Snap-Off Screw The NexFix Snap-Off Screw System is a 2.0mm x 11mm, 2.0mm x $286.00 $380.00
self-drilling and self-tapping screw system 12mm, 2.0mm x 13mm, 2.7mm
for fixation of fractures, fusions and x 13mm, 2.7mm x 15mm,
osteotomies. The design allows the holding 2.7mm x 17 mm
device to break off once the screw head is
in contact with the distal cortex.
Smith & Nephew Surgical Pty Ltd
SN713 Trigen Stable-Lok Nut One Size Only $346.00
Stryker Australia Pty Ltd
HW259 Wichita Fusion Nail System Compression Screw - Vitallium One size only $1,152.00
HW297 Asnis Guided Screw System Guide Pin, Stainless Steel 1.4,2.0,3.2mm $60.00
Synthes Australia Pty Ltd
SY051 AO/ASIF K-Wires, Pins, Washers Seldrill 4.0/3.0mm & 4.0 - 6mm / 80 - $110.00
250mm L
SY173 AO/ASIF Screws Self drilling, Self Tapping, Conical Diameter 3.5 - 5.0mm, Length $178.00
Locking, Sterile/Non-Sterile 8 - 100mm
Wright Medical Australia
WR036 Charlotte Carolina Jones Fracture System Low profile, solid-core, surgical grade 4.5mm, 4.5mm, 6.5mm, $400.00
stainless steel screw, partially threatded 40mm-70mm overall screw
with thread length varying lengths
anthropometrically relative to overall screw
length, utilising specialised instruments for
IM placement in the 5th metatarsal
Zimmer Pty Ltd
ZI209 Zimmer Large-Frag System Cortical Nut for 4.5mm screw Small & Large $40.00
AB
Device Technologies Australia Pty Ltd
DE163 Bio-Post & Washers PLLA composition Implant 35mm - 50mm, $750.00
Washers 16mm
CN
Device Technologies Australia Pty Ltd
DE286 Low Profile Screw System Low Profile Screw 3.0 - 6.7mm x 18 - 120mm $310.00
Prostheses List by Category, Groups and Sponsor Page 385 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Lifehealthcare Pty Ltd
LH374 AutoFIX The Sbi AutoFIX Twin Pitch Cannulated 2.0mm and 2.5mm Cannulated $550.00
Compression Screw System implants are Compression Screw
indicated in the treatment of fractures,
nonunions, pseudarthrosis and
degenerative changes, as well as corrective
osteotomies geared towards a functionally
stable osteosynthesis
Zimmer Pty Ltd
ZI448 Cannulated Screw Ti alloy One size only $145.00
CN, DT
LMT Surgical Pty Ltd
LM049 BioTech Compression Screws Titanium and Stainless compression screws 1.7-10mm diameter/10-100mm $425.00
length
HA Coated
Biomet Australia Pty Ltd
BI820 EBI XFIX DynaFix System Screw, HA coated, cortical, cancellous Dia 2-6mm $274.00
LK
Integra Neurosciences Pty Ltd
IG092 Newdeal Lock Screws For use with Newdeal bone screws and Diameter 2.7mm - 6.5mm $114.00
plates
Synthes Australia Pty Ltd
SY050 AO/ASIF Screws Plate pin 1.8mm buttress pin 12 - 30mm $45.00
SY110 AO/ASIF Plates DHS/DCS locking device screw One size only $504.00
Group 18: Pins
AB
Johnson & Johnson Medical Pty Ltd
DP088 Orthosorb Absorbable Pin Orthosorb - Polydiaxanone Fixation Pins 3 40 x 1.3mm $298.00
pins per pkt
DP089 Orthosorb Absorbable Pin Orthosorb - Polydiaxanone 3 pins per pkt 40mm x 2mm $372.00
DP090 Orthosorb Absorbable Pin Orthosorb Pkt 1 - Polydiaxanone 1mm x 40mm x 1.3mm $734.00
Prostheses List by Category, Groups and Sponsor Page 386 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DP091 Orthosorb Absorbable Pin Orthosorb Pkt 1 - Polydiaxanone 40 x 2.0mm $736.00
DP093 Orthosorb Absorbable Pin Orthosorb -Polydiameterxanone 50 x 1.3mm $165.00
DP094 Orthosorb Absorbable Pin Orthosorb - Polydiaxanone 2 pins per pkt 40mm x 2.0mm $291.00
DP095 Orthosorb Absorbable Pin Orthosorb Arthroscopic Fix-Set - 40 x 1.3mm $671.00
Polydiaxanone 5 pins per pkt
Group 18a: K-Wires
Advanced Surgical Design & Manufacture Ltd
AE052 ASDM K-wire Stainless steel - sterile Dia 0.7 - 2.5mm, length 100 - $11.00
230mm
Biomet Australia Pty Ltd
BI857 Kirschner Wires Stainless Steel wire (1-3.2mm) diameter x (100 to $17.00
310mm) length
Integra Neurosciences Pty Ltd
IG073 K-Wire (Kirschner) Stainless steel 70mm, 100mm, 200mm length $40.00
Johnson & Johnson Medical Pty Ltd
DP092 Orthosorb Absorbable Pin Orthosorb K Wire - Stainless Steel 1 x 40mm x 1.3mm Pk 3 $206.00
Tapered Pins
DP793 Small / Large Fragment Set S/S K/Wire Stainless Steel 0.8 to 3.0 mm x 6-9" or 150- $7.00
500mm
DP809 Small / Large Fragment Set S/S K-wire standard 0.2-3.5mm $30.00
Lifehealthcare Pty Ltd
LH422 SBi K-Wire K-Wire 1.6mm $18.00
Medical & Optical Instruments Australia Pty Ltd
MO177 Acutrak Fixation Screw Wire Kirschner Stainless Steel 0.70mm to 1.6mm diameter, 4 $20.00
to 9in (10.16 to 22.86mm)
length
Stryker Australia Pty Ltd
HW368 Osteo Kirschner Wire K wire - Stainless Steel Diameter 1.0 - 2.0mm $11.00
SK117 Leibinger Screws Tenxor Kirschner Wires 1.5 - 2.0mm Diameter $125.00
SK213 Hoffmann II External Fixation System Hoffmann II Micro K-wire $127.00
Prostheses List by Category, Groups and Sponsor Page 387 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST007 Stryker Plating System - K Wires Stainless Steel or Titanium 150mm length in 1.25, 1.6, $18.00
2.0mm diameter
Synthes Australia Pty Ltd
SY087 AO/ASIF K-Wires, Pins, Washers etc - K-wire single ended 0.06 - 3.0mm / length 70 - $28.00
Steel 400mm
SY089 AO/ASIF K-Wires, Pins, Washers etc - K-wires threaded 0.25 & 15mm / dia .08 - $72.00
Steel 3.0mm & length 70-300mm
Trewavis Surgical Instruments Pty Ltd
TS001 Trewavis Surgical Kirschner Wires Composition: Stainless Steel, Model No: Dia 0.7-2.8mm, Length 100- $11.00
200-000-A to 200-930-K 230mm
Wright Medical Australia
WR063 K Wire Titanium or stainless steel, single or double 0.9 - 2.0mm $11.00
trocar
Zimmer Pty Ltd
ZI293 Zimmer Wires Stainless Steel Length 23cm, Thickness 2mm, $11.00
0-4mm, 8mm
ZI294 Zimmer Wires Stainless Steel Length 7, 6cm - 23cm, $11.00
Thickness 0mm, 7mm - 2mm,
0mm
AB
Johnson & Johnson Medical Pty Ltd
DP039 Orthosorb Absorbable Pin Orthosorb K-Wire L300 D2.0mm Thread Each $17.00
Group 18b: Threaded
Advanced Surgical Design & Manufacture Ltd
AE070 ASDM Steinmann Pin Steinmann Pin 2.8-5.0mm diameter $33.00
Biomet Australia Pty Ltd
BI232 Moore Pins Scan Pin, Stainless Steel 16mm x 51-152mm $210.00
Integra Neurosciences Pty Ltd
IG074 Tac-Pin (Threaded) Compression pin-titanium 1.7mm diam 15-25mm length $225.00
Prostheses List by Category, Groups and Sponsor Page 388 of 911
6 - SPECIALIST ORTHOPAEDIC
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Billing Code Product Name Description Size Benefit Benefit Notations
Medical & Optical Instruments Australia Pty Ltd
MO209 Acumed Congruent Plate System Threaded K-Wire - Titanium WT-1606STT: Length 15cm x $73.00
Diameter 0.62"; WT-0906STT:
Length 15cm x Diameter
0.35"; WS-2408STT length
20.32cm x Diameter 0.24cm
Smith & Nephew Surgical Pty Ltd
SN434 Half Pin Arrow 4-6mm x 20-80mm $205.00
SN435 Half Pins Hex Fix Titanium 4-6mm x 20-80mm $115.00
SN436 Half Pins Ilizarov Stainless Steel 4 x 120 -180mm 30mm 35mm $247.00
- thread 50mm conic
SN437 Hex Fix Pins Cancellous Crane Pin Threaded 5/8" - 1 1/4" $133.00
Stryker Australia Pty Ltd
ST038 Stryker Plating System - Reduction Pin 4.5mm Diameter, Stainless Steel One size only $175.00
ST884 Apex Pins Stainless Steel Orthopaedic Pins 2 - 6mm $135.00
AB
B Braun Australia Pty Ltd
BB060 BRAUN AUST Intramedullary Nails Isosorb Resorbable Fixation Pin 2mmx60mm-3.5mmx80mm $213.00
Device Technologies Australia Pty Ltd
DE126 Chondral Dart Polylactide Compositition Length 18mm $289.00 $409.00
HA
Stryker Australia Pty Ltd
SK483 HA Apex Pins HA coated bone screw 4-6mm diameters, various $274.00
lengths.
Prostheses List by Category, Groups and Sponsor Page 389 of 911
6 - SPECIALIST ORTHOPAEDIC
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Billing Code Product Name Description Size Benefit Benefit Notations
Group 18c Non-Threaded
Orthopaedic Solutions Pty Ltd
OE026 Nexa Wires/Pins The Nexa Wires are made of stainless 0.9 - 2.5mm x 100 - 250mm $11.00 $30.00
steel and of different lengths depending on
the instrument set. They are used as guides
during the surgery before implantation of
the final screw or implant. The Nexa Wires
are also designed to be used separately, if
required by the surgeon, and implanted
into the patient.
Smith & Nephew Surgical Pty Ltd
SN446 Steinmann Pins Skeletal Traction Pin-Cove Point 250mm+ $121.00
SN447 Steinmann Pins Non Threaded, Various Tips 9"x5/64 - 9"x3/16 $25.00
Stryker Australia Pty Ltd
ST890 Steinmann Pins Stainless Steel 7,9" $90.00
Trewavis Surgical Instruments Pty Ltd
TS002 Trewavis Surgical Steinmann Pins Composition: Stainless Steel, Model Nos: Dia 3.0 - 5.0mm $55.00
200 - 950-L to 200-970-Q
Zimmer Pty Ltd
ZI323 Zimmer Wires Stainless Steel Rushpins Diameter 2.4 - 6.4mm; Length $206.00
2.5 - 52.7cm
AB
ConMed Linvatec Australia Pty Ltd
LV050 Bionx Implants - Rods PGA, PLA or PLLA 1.5mm x 10-70mm $250.00 $325.00
LV051 Bionx Implants - Rods PGA, PLA or PLLA 2.0mm $275.00 $350.00
LV052 Bionx Implants - Rods PGA, PLA or PLLA 3.2mm x 30-70mm $300.00 $375.00
LV063 SmartNail Self-Reinforced 96L/4D PLA Bone 1.5mm O.D x 16, 20 & 25mm L $225.00 $431.00
Fixation Nail
LV084 SmartNail Self-reinforced 96L / 4D PLA Bone 2.4mm O.D x 16, 25, 35 & $220.00
Fixation Nail 45mm L
LV088 SmartPin Resorbable Bone Fixation Pin, Self-Reinforced PLLA 10, 20, 30 & 40mm $220.00
1.1mm
Prostheses List by Category, Groups and Sponsor Page 390 of 911
6 - SPECIALIST ORTHOPAEDIC
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Billing Code Product Name Description Size Benefit Benefit Notations
Danex Medical Pty Ltd
XD008 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Pin 1.5 & 2 mm dia x 20-50 $185.00
copolymer mm long
Device Technologies Australia Pty Ltd
DE273 Trim-IT Spin Pin Trim-IT Pin Fixation 1.5 - 2.0mm x 100mm $350.00
Surgical Specialties
SQ063 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Pin 1.5 & 2 mm dia x 20-50 $185.00
copolymer mm long
Absorbable
Orthopaedic Solutions Pty Ltd
OE021 Activa Pin The Activa pin is a bioreabsorbable 1.5mm x 50mm, 2.0mm x $225.00 $350.00
grooved pin device for fixation of bone 50mm
fractures, osteotomies, arthrodeses, and
osteochondral fractures. They are designed
to maintain structural function for up to 8
weeks and to completely resorb within 2
years, eliminating the need for implant
removal.
Group 19: Wires/Cables
Group 19a: Wires
Advanced Surgical Design & Manufacture Ltd
AE069 Threaded wires & pins Threaded wires & pins 1.0-5.0mm diametersvarious $89.00
threaded lengths
CK Surgitech Pty Ltd
AK004 Kirschner Wires Kirschner Wire 0.6mm to 3.0mm diameter / $6.00
various lengths
Johnson & Johnson Medical Pty Ltd
DP683 Small / Large Fragment Set S/S Cerclage Wire Loop Stainless Steel 0.8-1.2mm x 280-600 $17.00
Link Orthopaedics Australia
LO147 Bone Cerclage Wire Cerclage Wire Length 470mm, Diameter sizes $7.55
of 0.4mm, 0.5mm, 0.6mm,
0.7mm, 0.8mm. Packet size of
10
Prostheses List by Category, Groups and Sponsor Page 391 of 911
6 - SPECIALIST ORTHOPAEDIC
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Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SN440 Ilizarov Wires 300-370 length x 1-1.8mm $69.00
diameter
SN451 Wire Kirschner Various 1.3 - 304.8mm $11.00
SN459 Wire Suture 18Ga - 28Ga $80.00
SN460 Wire Cerclage 0.6mmx175mm - 0.8mmx200mm $14.00
Synthes Australia Pty Ltd
SY257 A/O/ASIF K-wires, Pins, Washers etc - Cerclage Wire - coils with and without eye 0.4-2.5mm $56.00
Steel - Sterile & Non Sterile
Zimmer Pty Ltd
ZI170 Zimmer Internal Fixation Systems: Cable Cable-Ready Pin - Stainless Steel 35, 40, 45, 65mm long $645.00
System
Com
Biomet Australia Pty Ltd
BI271 EBI XFIX Dynafix System Wire Straight or Olive with Washer, 160 or 200mm x (1.6 or $150.00
Chrome Cobalt 2.0mm)
LMT Surgical Pty Ltd
LM014 Trimed Marked K-Wire Stainless Steel Diameter 0.9 - 1.1mm $40.00
Smith & Nephew Surgical Pty Ltd
SN441 Ilizarov Wires with stopper 300-370 length x 1-1.8mm $155.00
diameter
Synthes Australia Pty Ltd
SY249 AO/ASIF K Wires, Pins Washers - Hybrid Pins - Spade point wires/reduction 1.5, 2.0mm Diameter $129.00
Steel/Ti Sterile & Non Sterile wires
Group 19b: Cables
Biomet Australia Pty Ltd
BI253 BMP Cable System Cable Chrome Cobalt 1.6mm or 2.0mm $348.00
BI256 BMP Cable System Cable, Stainless Steel 1.6mm or 2.0mm $320.00
Johnson & Johnson Medical Pty Ltd
DP232 Suture Wire Wire Suture Stainless Steel 10-36G $101.00
Prostheses List by Category, Groups and Sponsor Page 392 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medical & Optical Instruments Australia Pty Ltd
MO166 Osteo Clage Cable System CoCr, Stainless Steel Cable 850mm $336.00
Stryker Australia Pty Ltd
HW309 Dall Miles Cable Grip System - Vitallium Vitallium: Cable - Vitallium 1.6 and 2mm $355.00
Zimmer Pty Ltd
ZI161 Zimmer Internal Fixation Systems: Cable Cable-Ready Stainless Steel 1.3 mm $330.00
System
Com
Synthes Australia Pty Ltd
SY377 Orthopaedic Cable System Cable with Crimp 1.0mm - 1.7mm, 750mm $650.00
Group 19c: Other
Johnson & Johnson Medical Pty Ltd
DP363 Control Cable Control Cable sleeve One size only $240.00
Link Orthopaedics Australia
LO148 Thabe Titanium Cerclage Band with Thabe Titanium Cerclage Band is crimped 6.0mm wide, 240mm $450.00 $845.00
Lock at the lock
LO149 Bone Cerclage Band with Lock The Cerclage Band with a locking Complete, length with lock: $450.00 $845.00
mechanism consists of a band, 165mm, width 5mm
manufactured from stainless steel, 165mm
long and 5mm wide and a lock
Stryker Australia Pty Ltd
HW303 Dall Miles Cable Grip System - Stainless Stainless Steel: Cable & Sleeve - Stainless 1.6 and 2mm $360.00
Steel Steel
HW310 Dall Miles Cable Grip System - Vitallium Vitallium: Sleeve - Vitallium 1.6 and 2mm $225.00
HW315 Dall Miles Cable Grip System - Vitallium Vitallium: Cable and Sleeve - Vitallium 1.6 and 2mm $570.00
Zimmer Pty Ltd
ZI234 Cable System Cable Ready, Cable Button 2,5mm - 5,0mm $183.00
Prostheses List by Category, Groups and Sponsor Page 393 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Com
Synthes Australia Pty Ltd
SY378 Trochanteric Reattachment Device Titanium alloy reattachment device with Standard and Long $2,500.00
cables
Group 20: Wire/Cable Accessories
Group 20a: Locking Device
Medical & Optical Instruments Australia Pty Ltd
MO165 Osteo Clage Cable System CoCr, Stainless Steel Cable Sleeve 2mm $240.00
Smith & Nephew Surgical Pty Ltd
SN443 Reis Cable and Swage 1.6 & 2.0mm $330.00
SN733 Accord Orthopaedic Cable System, SS Button One Size Only $355.00
Plate Adapter
Group 20b: Other Fixation Devices
Biomet Australia Pty Ltd
BI254 BMP Cable System Cable Sleeve, Chrome Cobalt, Stainless One Size only $240.00
Steel
Medical & Optical Instruments Australia Pty Ltd
MO162 Tension Band Pin Stainless Steel 50 to 90mm $156.00
Smith & Nephew Surgical Pty Ltd
SM010 PLUS Endoprothetik Cerclage Systems CCG Band - Pure Titanium Length 27cm $450.00
SM011 PLUS Endoprothetik Cerclage Systems CCG-GF Band with fixation spikes - Pure Length 27cm $625.00
Titanium
SM033 PLUS Endoprothetik Cerclage System CCG Stabilizer with Band XS - L $1,290.00
Stryker Australia Pty Ltd
HW302 Dall Miles Cable Grip System - Stainless Stainless Steel: Trochanter Grip - Small, Medium, Large $545.00
Steel Stainless Steel
HW311 Dall Miles Cable Grip System - Vitallium Vitallium: Trochanter Grip - Vitallium Small, Medium and Large $545.00
HW313 Dall Miles Cable Grip System - Vitallium Vitallium: Grooved Button - Vitallium One size only $240.00
Prostheses List by Category, Groups and Sponsor Page 394 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK400 Trochanteric Grip Dall-Miles Trochanteric Grip with 2 Small, Medium and Large $1,400.00
Stainless Steel Cables
SK401 Trochanteric Grip Dall-Miles Trochanteric Grip with 2 Small, Medium and Large $1,750.00
Chrome Cobalt Cables
SR072 Dall miles Trochanteric grip with stainless steel dall miles trochanteric grip small, medium, large 43-53mm $900.00
divergent hooks with diverging proximal hooks
Synthes Australia Pty Ltd
SY057 AO/ASIF K-Wires, Pins, Washers etc Wire mount & spacer 2mm - 6mm $109.00
Group 21: Staples
Group 21a: Standard
ConMed Linvatec Australia Pty Ltd
LV015 Staple Fixation System Soft Tissue Re-attachment - Titanium 9.5 - 16.5mm $160.00
Device Technologies Australia Pty Ltd
DE062 Ligament Staples Cobalt Chromium Molybdenium Alloy 6mm - 16mm $135.00
DE292 QuickFix Staple System Compression Staple for Fusion 8mm 10mm $235.00
DE295 Compression Staple Compression staple for fusion 10x10mm 10x15mm 15x10mm $390.00 $698.00
15x15mm 20x20mm
Johnson & Johnson Medical Pty Ltd
DP880 Barouk System Staples TIFLEX Staple / Pin - Titanium 1.6 - 2.5 Dia 7-24mm width $217.00
13/15-36/50mm Length
Lifehealthcare Pty Ltd
LH375 StaFIX The StaFIX Staples are retained implants 6x6, 6x12,8x8, 8x16, 10x10, $300.00
and removable used primarily for the 10x20, 12x24
following applications: Synthesis of
fractures; Synthesis of osteotomies;
Arthrodesis; Reattachment of ligaments ot
tendons. The aim of the StaFIX staple is
to provide a effective fixation of the bone
fragments during healing.
Prostheses List by Category, Groups and Sponsor Page 395 of 911
6 - SPECIALIST ORTHOPAEDIC
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Billing Code Product Name Description Size Benefit Benefit Notations
Wright Medical Australia
WR037 Charlotte Foot & Ankle System Compression Staple, Stainless Steel 13, 15, 20, 25mm interaxis, leg $698.00
lengths 11, 13, 15, 17, 20 &
25mm, 10 Sizes in Total
WR038 Charlotte Foot & Ankle System Quick Staple, Stainless Steel One Size Only $235.00
Com
Orthocare Pty Limited
OC009 Orthomed Osteotomy & Ligament Osteotomy Staple. Cast Chromium-cobalt 5mm $110.00
Staples non-absorbable. Stainless Steel non-
absorbable. Non-sterile 57-73
OC010 Orthomed Osteotomy & Ligament Osteotomy Staple. Cast Chromium-cobalt 10mm $110.00
Staples non-absorbable. Stainless Steel non-
absorbable. Non-sterile 57-74
OC011 Orthomed Osteotomy & Ligament Osteotomy Staple. Cast Chromium-cobalt 15mm $110.00
Staples non-absorbable. Stainless Steel non-
absorbable. Non-sterile 57-75
OC012 Orthomed Osteotomy & Ligament Ligament Staple. Cast Chromium-cobalt 6mm $80.00
Staples staples, non-absorbable. Non-sterile
OC013 Orthomed Osteotomy & Ligament Ligament Staple. Cast Chromium-cobalt 8mm $80.00
Staples staples, non-absorbable. Non-sterile
OC014 Orthomed Osteotomy & Ligament Ligament Staple. Cast Chromium-cobalt 11mm $80.00
Staples staples, non-absorbable. Non-sterile
OC015 Orthomed Osteotomy & Ligament Ligament Staple. Cast Chromium-cobalt 16mm $80.00
Staples staples, non-absorbable. Non-sterile
Smith & Nephew Surgical Pty Ltd
SN463 Bone Staple Fixation - Osteotomy Fixation Staple 5mm- 14mm. $163.00
McConnel HTO PF 15mm 0-S
SN465 Bone Staple Fixation - Table Small -Medium 13mm - $205.00
16mm.
SN466 Bone Staple Krackow HTO 12,14,16mm $249.00
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Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW317 Rutherford Staple Ellison Arched Staple, Vitallium 9,12,15mm x 23mm $177.00
HW318 Rutherford Staple Ellison Flat Staple, Vitallium 8,11,14 x 23mm $135.00
Memory Staple
Johnson & Johnson Medical Pty Ltd
DP879 Barouk System Staples Memory Staple - Titanium Alloy 12-20mm Long $710.00
MM
Surgical Specialties
SQ046 OSSStaple Osteosynthesis Staple Dynamic Compression Implants OSS Asymmetric - 11x15x13, $405.00
Staple - Asymmetric Staples - 11x17x15, 11x17x19 &
Biocompatible Nitonol Construction 18x18x15
Group 21b: Small (hand/foot)
Darco Australia
DC019 Mini Staple For fixation of osteotomies of first phalanx 0° and 63°, 8-10mm x 10mm $285.00
(e.g. Akin), 1mm diameter, straight &
angled design
Integra Neurosciences Pty Ltd
IG075 Solustaple Standard Staple Stainless steel 90 deg & 26 degree 8 & 10mm length $235.00
IG104 Solustaple Standard Staple (Sterile) Stainless Steel 26°, 90°, 8-10mm $235.00
Johnson & Johnson Medical Pty Ltd
DP878 Barouk System Staples Varisation Staple Stainless Steel 26-90Deg x 8-10mm $193.00
Orthopaedic Solutions Pty Ltd
OE024 NexFix Closing Wedge Osteotomy The NexFix Closing wedge osteotomy 8mm x 90 deg, 8mm x 64 deg $300.00
Staples staples are made of stainless steel and are
intended to be used for internal fixation of
fusions, bone grafts and osteotomies in the
bones of the hand and foot following
alignment correction
Orthotech Pty Ltd
OH334 EOS Footset - Varisation staple Foot staple 8-10mm $307.00 $390.00
OH345 Pareous staple Foot staple 1.5mm 6-14 and 2.5mm 14-30 $307.00 $350.00
Prostheses List by Category, Groups and Sponsor Page 397 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Com
Integra Neurosciences Pty Ltd
IG103 Uni-Clip Compression Staple (Sterile) Stainless Steel, Notched and Non- Width 11-30mm, Length 13- $750.00
Notched 32mm
Lifehealthcare Pty Ltd
LH337 Memofix Staples Nitinol 10-17mm x 12-20mm Length $718.00
Smith & Nephew Surgical Pty Ltd
SN464 Bone Staple Fixation - Short Leg Xsmall - large $125.00
MM
Orthotech Pty Ltd
OH346 Eleos staple Foot staple 4-34/38mm $695.00
Surgical Specialties
SQ045 OSSStaple Osteosynthesis Staple Dynamic Compression Implants OSS Small wire 1.2-1.5 - Sizes $390.00
Staple - Biocompatible Nitonol 5x7x5, 7x9x7, 8x11x8,
10x11x10, 10x13x10,
12x15x12, 15x15x15,
18x15x18, 15x20x15,
18x20x18
Group 21c: Other
ConMed Linvatec Australia Pty Ltd
LV025 Staplizer Bone Staple Cartridge 5 Titanium staples per cartridge 7 x 7mm, 7 x 10mm, 10 x $295.00 $370.00
7mm, 10 x 10mm, 10 x 15mm,
13 x 7mm, 13 x 10mm, 13 x
15mm, 13 x 20mm, 16 x
10mm, 16 x 15mm, 16 x
20mm, 16 x 25mm
Prostheses List by Category, Groups and Sponsor Page 398 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Orthopaedic Solutions Pty Ltd
OE023 NexFix Compression Staples The NexFix Compression Staples are 10 mm in width, leg length $300.00 $350.00
made of stainless steel and are used for varies 13 mm - 20 mm
internal fixation of fractures, fusions, bone
grafts and osteotomies in the bones of the
hand and foot. It is designed so the
surgeon can control the amount of
compression they are applying across the
osteotomy/fracture site. Once compressed
the surgeon can also reduce the amount of
compression applied with the specialised
clamp provided. This does not affect the
final stability of the implant but allows for
greater control at the time of surgery.
Stryker Australia Pty Ltd
HW319 Rutherford Staple Ellison Soft Tissue Retainer, Vitallium 8,11,14mm $125.00
MM
LMT Surgical Pty Ltd
LM077 Memometal Memory Staples Memory Metal Implants 10 mm to 25 mm $600.00
Group 22: Soft Tissue Fixation Devices
Smith & Nephew Surgical Pty Ltd
SN426 ACL/PCL Reconstructions EndoButton 4 x 12mm, 4mm x 18mm $248.00
Group 22a: No Suture
Device Technologies Australia Pty Ltd
DE261 Pushlock Suture Anchor Knotless Suture Anchor 2.5 - 5.5 x 5 - 18.5mm $600.00
DE271 RetroButton Femoral Fixation Device 12mm Button with 15-60mm $369.00 $400.00
loops, 15mm Button with 15-
60mm loops
DE288 Swivelock Twist- in knotless suture anchor 4.5mm and 5.5mm diameters $600.00
Prostheses List by Category, Groups and Sponsor Page 399 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DE305 BioComposite PushLock The PushLock is a knotless anchor used 3.5mm - 5.5mm $600.00
for repair of soft tissue to bone. The unique
PushLock design allows the surgeon to
adjust the amount of tension on the tissue
intraoperatively allowing for precise tisse
reduction. The tissue is securely held in a
knotless fashion allowing for soft tissue
healing to bone.
DE306 BioComposite SwiveLock The SwiveLock is a 4.75 or 5.5mm twist- 4.75mm - 5.5mm $600.00
in knotless anchor. This anchor functions
very similar to the PushLock but with a
twist-in design. This anchor is available
with a b-TCP and PLLA anchor body and
PEEK eyelet.
Johnson & Johnson Medical Pty Ltd
JJ077 Mitek Polypropylene Meniscus Fastner Polypropylene anchor 6 & 8mm x 4mm $248.00
JJ083 Mitek GII Anchor Threader Tab Titanium Suture Anchor 2.4 x 8.8mm $287.00
JJ084 Mitek Rotator Cuff Anchor Threader Titanium Suture Anchor 2.8 x 11mm $287.00
Tab
JJ085 Mitek Super Anchor Threader Tab to Titanium Suture Anchor 2.8 x 11.4mm $287.00
bone
LMT Surgical Pty Ltd
LM070 Surgicraft Ligament Augmentation Woven Polyester Prosthetic Ligament Various $4,156.00 $4,200.00
Reconstruction System
LM085 ABC Prosthetic Ligament Cruciate prosthesis carbon fibre/polyester, 12.5cm - 18.5cm; ABC $3,600.00
ABC Carbon/Polyester Medial/Lateral Carbon Polyester & ABC
Collateral Ligament, ABC Polyester/ Polyester/Polyester - one size
Polyester Medial/Lateral Collateral only
Ligament
Smith & Nephew Surgical Pty Ltd
SN413 Shoulder Reconstruction 3.7mm TAG & Wedge Suture Wedge 3.7mm $135.00
SN420 ACL/PCL Reconstruction RCI Screws Titanium 7-11mm diameter, 25-40mm $178.00
length
SN423 ACL/PCL Reconstructions Acufex Tibial Fixation Anchor One size only $185.00
SN424 ACL/PCL Reconstructions Acufex Spiked Washer One size only $162.00
Prostheses List by Category, Groups and Sponsor Page 400 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SN425 ACL/PCL Reconstructions Cannuflex Silk & Soft Silk Interference 5.5 x 20mm - 9x30mm $185.00
Screw
SN427 ACL/PCL Reconstructions Fixation Button 12-17mm $35.00
SN432 ACL/PCL Reconstructions Tibial Post Screw Small, Standard $158.00
Stryker Australia Pty Ltd
HW374 Howmedica Mainstay Soft Tissue Anchor Without suture - Titanium 4.5, 3.5 and 2.7 anchor $152.00
SK023 ACL Wedge Interference Screw Threaded titanium screw for Dia 7 - 12mm, length 20 - 40mm $255.00
ligament/tendon fixation
SK024 Stryker Cross-screw Threaded titanium screw for 8mm x 40-60mm $455.00
ligament/tendon fixation
SK048 Stryker Cuff Anchor Titanium anchor kit for soft tissue Length 5-8mm $357.00
reattachment
AB
ConMed Linvatec Australia Pty Ltd
LV065 Bionx Implants - screws PLLA Screws (Contour Labral Nail) 3.5mm $333.00 $415.00
Device Technologies Australia Pty Ltd
DE059 Arthrex Meniscal Dart PLA 10mm - 14mm $304.00
Smith & Nephew Surgical Pty Ltd
SN414 Shoulder Reconstruction Suretac Absorbable Staple 6-8 x 16mm $273.00
SN415 Shoulder Reconstruction TAG Bioabsorbable Anchor Wedge 3.7mm $129.00
SN421 ACL/PCL Reconstructions Absorbable PLLA Screw 7-12mm diameter, 25-35mm $228.00
length
SN430 ACL/PCL Reconstructions EndoFix Bioabsorbable Screw 7 x 20mm - 9mm x30mm $185.00
Stryker Australia Pty Ltd
SK154 Stryker Cross-Screw HA/PLLA screw for ligament/tendon Dia 6mm: Length 40-60mm $350.00 $572.00
fixation
Zimmer Pty Ltd
ZI336 Polypin Resorbable Bone Pin Polylactide 1.5, 2.0, 2.7mm $246.00
ZI447 Bioresorbable Screw Polylactide One size only $260.00
Prostheses List by Category, Groups and Sponsor Page 401 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 22b: Single suture
Arthrocare Australasia Pty Ltd
AF002 AutoCuff System - Suture Cartridge SmartStitch Magnum Wire - Ultra high . $110.00
tensile strength
Biomet Australia Pty Ltd
BH056 Lactosorb Suture Anchor Threaded with 1 suture, PGA/PLA, (3.5, 5.5, 6.8)mm dia anchor $435.00 $444.00
polyethylene
BI320 Arthrotek Harpoon System Suture Anchor, Stainless Steel, Ti 1 to 5 $450.00
BI979 Hitch suture anchor Suture anchor with maxbraid sutures, PEEK 2.4mm $493.00 $600.00
ConMed Linvatec Australia Pty Ltd
LV005 Ultrafix MiniMite StitchPak Suture Soft Tissue Re-attachment - Stainless Steel 2.3mm predeployed diameter $338.00
Anchor
LV009 Revo Cancellous Screw Soft Tissue Re-attachment - Titanium 4mm diameter $335.00
LV010 Mini-Revo Screw Soft Tissue Re-attachment - Titanium 2.7mm diameter $340.00
LV024 Ultrafix MicroMite Small Joint Anchor Suture Anchoring Device - Titanium 1.5mm predeployed diameter $290.00 $385.00
LV078 UltraFix Knotless Minimite Suture Titanium Diameter 2.3mm $440.00 $520.00
Anchor
Device Technologies Australia Pty Ltd
DE198 Fastak Suture Anchor (Small Bone) With Fibrewire Suture Dia. 2.4mm x Length 7.5mm $430.00
DE225 Fastak Anchor Titanium with fibrewire suture 2.8mm x 11.7mm $355.00
Johnson & Johnson Medical Pty Ltd
JJ076 Mitek Ethibond Knotless Suture Anchor Titanium anchor 2.7 x 10.8 mm $385.00
JJ087 Mitek Tacit Quick Anchor Titanium Suture Anchor 2.0 x 3.6mm $255.00
JJ089 Mitek GII QuickAnchor Plus Titanium Anchor, with various sutures 2.4 x 8.8mm $346.00
JJ091 Mini Quick Anchor with Suture Anchor with Suture Anchor with Suture and $345.00
Multiple size needles
JJ096 Mitek Fastin Anchor Titanium Suture Anchor 3 x 8.4mm, 4 x 9.7mm, 5.2 x $281.00
11.5mm
JJ100 Micro Quick Anchor Titanium Suture Anchor 1.3 x 3.7mm $289.00
Prostheses List by Category, Groups and Sponsor Page 402 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Smith & Nephew Surgical Pty Ltd
SM162 SPYROMITE A non-absorbable polymer (PEEK) 2mm in diameter $440.00
anchor for use in ligament/tendon
reconstruction in small joint applications
SM163 DYNOMITE A non-absorbable polymer (PEEK) 2mm in diameter $440.00
anchor for use in ligament/tendon
reconstruction in small joint applications
SM177 RAPTORMITE 3.0 PK An non-absorbable polymer (PEEK) 3mm $435.00
suture anchor for use in ligament/tendon
reconstruction
Stryker Australia Pty Ltd
HW373 Howmedica Mainstay Soft Tissue Anchor With suture - Titanium 4.5 anchor with #2 and #5 $190.00
suture, 2.7 anchor with #0 suture
Tornier Pty Ltd
TO052 Piton Knotless Fixation Implant System System includes Piton Knotless anchors Anchor: one size. Suture: size 2 $730.00
(single) NiTi and two Force Fiber sutures in the system, options:
size #2 UHMWPE blue/white or black/white
Zimmer Pty Ltd
ZI182 Zimmer Internal Fixation Systems: Soft Statak/Mini-Statak - Suture, Stainless Steel 2, 5 mm - 5, 0mm $240.00
Tissue Re-attachment Device
AB
ConMed Linvatec Australia Pty Ltd
LV108 Bio Mini-Revo Suture Anchor Bioabsorbable Suture Anchor with Two 3.1mm O.D $430.00
#2 Hi-Fi Sutures
Johnson & Johnson Medical Pty Ltd
JJ231 Bioknotless Anchor System PLA absorbable material with various Dia 3.9mm, length 9mm $435.00
sutures
JJ307 Rapidloc Meniscal Repair PLA Tophat Composition: PLA Implant and Ethibond 2/0 $253.00
with Ethibond Suture Suture, non absorbable suture
JJ308 Rapidloc Meniscal Repair PLA Tophat Composition: PLA Implant and Panacryl Straight needle, 12 degree $253.00
with Panacryl Suture Suture curved needle, 27 degree
curved needle
JJ420 MiniLok Quick Anchor Plus with Suture Anchor composition is PLA Anchor with Suture and $438.00
Multiple size needles
Prostheses List by Category, Groups and Sponsor Page 403 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ421 MicroFix Anchor with Suture Anchor with suture Anchor with Suture and $438.00
Multiple size needles
JJ422 MiniLok Quick Anchor with Suture Anchor with Suture Anchor with Suture and $432.00
Multiple size needles
JJ424 Panalok RC Loop Anchor with Ethibond Anchor composition is PLLA One size only $440.00
Suture
JJ425 Panalok RC Loop Anchor with Panacryl Anchor composition is PLLA One size only $440.00
Suture
JJ426 Bioknotless RC Anchor with Panacryl Anchor composition is PLLA One size only $440.00
Suture
JJ429 Bioknotless RC Anchor with Ethibond Anchor composition is PLLA One size only $440.00
Suture
JJ461 RapidLoc Meniscal Repair System with PLA (absorbable) backstop and PDS One size only $257.00
PDS (absorbable) top hat and Panacryl
absorbable suture connecting the top hat
and backstop
JJ472 BioKnotless Anchor System PLA absorbable material with various Dia 3.9mm Length 9mm $493.00
sutures
JJ698 Bioknotless BR Bone Anchor System BIOKNOTLESS BR anchors with One size only $435.00 $498.00
Orthocord or Panacryl suture
Group 22c Multiple suture
Arthrocare Australasia Pty Ltd
AF008 ParaFix Anchor Tendon to bone anchor 5mm and 6.5mm $395.00
Biomet Australia Pty Ltd
BH057 Lactosorb Suture Anchor Threaded with 2 suture, PGA/PLA, (3.5, 5.5, 6.8)mm dia anchor $435.00 $444.00
polyethylene
ConMed Linvatec Australia Pty Ltd
LV001 Linvatec Super Revo Soft Tissue Anchor Contains screw, driver and sutures . $357.00
LV003 Ultrafix RC, Anchor Soft Tissue Re-attachment - Titanium 2.9mm predeployed diameter $300.00
LV006 Ultrafix RC StitchPak Suture Anchor Soft Tissue Re-attachment - Titanium 2.9mm predeployed diameter $325.00
LV027 Pre-Loaded Ultrafix RC Anchor Surgical Grade Stainless Steel, preloaded Dia 2.9mm, length 6.5mm $375.00 $445.00
with 2 #2 sutures
Prostheses List by Category, Groups and Sponsor Page 404 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LV090 Super Revo Suture Anchor with Hi-Fi Titanium Suture Anchor 5.0mm O.D x 14.2mm L $395.00
Suture
LV091 ThRevo Suture Anchor Titanium screw-in suture anchor 5.0mm OD x 14.2mm L $410.00
LV111 Presto PEEK Suture Anchor PEEK Optima Suture Anchor, pre- 2.9mm O.D x 11mm L $440.00
threaded with one or two sutures
LV112 CrossFT Suture Anchor PEEK Optima Suture Anchor with multiple 4.5mm, 5.5mm & 6.5mm $435.00 $460.00
sutures diameters
LV114 Super Revo-FT Suture Anchor Fully Threaded Suture Anchor pre- 5mm diameter $395.00 $460.00
threaded with two sutures
Device Technologies Australia Pty Ltd
DE196 Corkscrew Suture Anchor Titanium alloy with Fibrewire suture 3.5mm - 6.5mm $360.00
Johnson & Johnson Medical Pty Ltd
JJ093 Mitek Rotator Cuff Quick Anchor Plus Titanium Anchor, with various sutures 2.8 x 11mm $345.00
JJ095 Mitek Super Quick Anchor Plus Titanium Anchor, with various sutures 2.8 x 11.4mm $345.00
JJ097 Fastin RC Anchor System Titanium Anchor, with various sutures 5 & 6.5mm $281.00
JJ678 Versalok Bone Anchor System with Anchor, sterile, pre-mounted on inserter One size only $600.00
Orthocord shaft with 2 free strands of Orthocord
suture
JJ774 Healix PEEK Suture Anchor PEEK anchor with Orthocord suture 4.5 - 6.5mm anchor diameter $493.00 $550.00
LMT Surgical Pty Ltd
LM090 Memometal Anchor Fixation System Anchors Various $600.00
Smith & Nephew Surgical Pty Ltd
SN008 Rotorloc Absorbable PLA Suture - One size only $305.00
Anchor System
SN141 T-Bar Suture Retention System Fastfix One size only $335.00 $425.00
SN416 Shoulder Reconstruction Fastentor Suture Anchor One size only $290.00
SN417 T-Bar Suture Retention System T-Fix RCG 1.8mm $235.00
SN418 T-Bar Suture Retention System T-Fix Single & Double T-Fix Suture Bar, Straight $188.00
Needle, Double Suture
SN442 Mini TAG Suture Anchor 2.0mm 2.0mm $149.00
Prostheses List by Category, Groups and Sponsor Page 405 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SN651 OBL Anchor System Preloaded Soft Tissue Anchor System Anchor sizes - Titanium: 2.8, $255.00
Material: Titanium Alloy or Polyacetal 3.5, 4.0 5.0, 6.5mm Anchor
Polymer. Comes with Insertion device and size - Polymer: 5.0mm
2 Braided Polyester Sutures
SN652 OBL Anchor System Soft Tissue Anchor System Non- 4.0 and 6.5mm $218.00
preloaded Material: Titanium Alloy
SN714 TwinFix Quick-T 2.8 - 6.5mm $460.00
SN854 Fast-Fix Ultra Meniscal suture anchor One Size $400.00
Stryker Australia Pty Ltd
HW375 Howmedica Mainstay Soft Tissue Anchor Zip anchor - Titanium Sip 4.5 anchor with #5 suture $257.00
and #2 suture 2 strands, zip 3.5
anchor with #2 suture and #0
suture 2 strands, zip 2.7 anchor
with #0 suture
Tornier Pty Ltd
TO053 Insite™ Polymer Suture Anchors Polymer suture anchor pre loaded with 2 3mm, 5mm or 6.5mm $435.00
Force Fiber Sutures
TO054 Insite™ Titanium Suture Anchors Titanium suture anchor pre loaded with 2 3mm, 5mm or 6.5mm $360.00
Force Fiber® Sutures
AB
ConMed Linvatec Australia Pty Ltd
LV008 Preloaded Bio-Anchor Absorbable Soft Tissue Re-attachment - PLLA 3.5mm diameter $300.00 $360.00
Suture Anchor
LV089 Duet Suture Anchor with polyester suture Self-Reinforced 96L/4D PLA Copolymer 6.0mm O.D. x 16.5mm L $450.00
Anchor
LV092 Duet Suture Anchor System with Hi-Fi Self-Reinforced 96L/4D PLA Copolymer 6.0mm O.D. x 16.5mm L $460.00
Suture
LV093 Impact Suture Anchor System with Hi-Fi Self-Reinforced 96L/4D PLA Copolymer 3.5mm O.D. x 10.5mm L $460.00
Suture
Device Technologies Australia Pty Ltd
DE195 Corkscrew FT Suture Anchor with Fiberwire 3.5mm - 6.5mm $435.00
DE197 Bio - Fastak with Fibrewire suture 3mm x 11mm $440.00
DE220 Suturetak Suture Anchor Suture Anchor with Fiberwire 2.4 - 3.7mm diameter x 5 - $430.00
14mm length
Prostheses List by Category, Groups and Sponsor Page 406 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
JJ098 Panalok RC Anchor System Polylactic acid absorbable anchor with 2.9 x 11.0mm $437.00
absorbable and non-absorbable suture
JJ099 Panalok Anchor System Polylactic acid absorbable anchor with 4.1 x 6.0mm $435.00
absorbable and non-absorbable suture
JJ233 Panalok RC QuickAnchor Plus DS Anchor composed of PLA, Suture Anchor diameter 2.9mm, length $432.00
Panacryl Suture composed of PLA and PGA 11mm
JJ234 Panalok RC QuickAnchor Plus DS Anchor composed of PLA, Suture Anchor diameter 2.9mm, length $432.00
Ethibond Suture composed of polyester 11mm
JJ427 Lupine Loop Anchor System PLLA with various sutures Dia 3.9mm Length 9mm $440.00
JJ431 Lupine Loop Anchor System PLLA with various sutures Dia 3.9mm Length 9mm $440.00
JJ457 Spiralok Anchor System Spiralok Absorbable PLA Anchor with 5mm, 6.5mm $488.00
absorbable suture with needles
JJ458 Spiralok Anchor System Spiralok Absorbable PLA Anchor with 5mm, 6.5mm $493.00
non-absorbable suture without needles
JJ460 Spiralok Anchor System Spiralok Absorbable PLA Anchor with 5 & 6.5mm $487.00
non-absorbable suture with needles
JJ471 Spiralok Anchor System Spiralok Absorbable PLA Anchor with 5 - 6.5mm $488.00
absorbable suture without needles
JJ483 Spiralok Anchor System Spiralok Absorbable PLA Anchor with 5mm, 6.5mm $480.00
non-absorbable suture with or without
needles
JJ696 Lupine BR Anchor System Biocryl Rapide anchor with two strands of One size only $440.00 $483.00
Orthocord suture
Smith & Nephew Surgical Pty Ltd
SN703 Absorbable Suture Anchor Preloaded PLLA Suture Anchor 2.9mm, 5.0mm & 6.5mm $460.00
Stryker Australia Pty Ltd
SK451 XCEL Anchor Bio-absorbable Suture Anchor 2mm-10mm $440.00
Absorbable
Arthrocare Australasia Pty Ltd
AF033 Doubleplay Suture Implant Doubleplay Implant (TCP/PLLA) - 5.0mm and 6.5mm $435.00
Tricalcium phosphate and poly-L-lactide
Prostheses List by Category, Groups and Sponsor Page 407 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Device Technologies Australia Pty Ltd
DE302 BioComposite Corkscrew Suture Anchor The threaded design over the entire length 4.5mm - 5.5mm $435.00
of the suture anchor provides substantially
higher pull-out strength than comparable
anchors in poor quality bone. The fully
threaded design also prevents anchor "pull-
back" that may occur with countersunk
anchors. The internal drive mechanism
substantially increases resistance to
stripping during insertion into hard bone.
The recessed FiberWire suture eyelet is
self-aligning and minimizes suture abrasion
during knot tying.
DE304 BioComposite SutureTak Suture Anchor Absorbable suture anchor with a molded- 3mm $430.00
in suture eyelet. The unique suture eyelet
maintains its strength throughtout most of
the degradation cycle and eliminates suture
abrasion during knot tying. The flexible
eyelet eliminates the need to orientate the
eyelet during insertion to optimize suture
sliding
Johnson & Johnson Medical Pty Ltd
JJ803 HEALIX BR Anchor Biocryl Rapide anchor with suture 4.5-6.5mm $493.00
Group 22d: Other
Biomet Australia Pty Ltd
BI206 Arthrotek Ligament Fixation System Screw and washer. Ti Washer 14 - 18mm, Screw 24 $1,085.00
- 60mm,
BI233 Arthrotek Ligament Fixation System Suture Button, HMWPE 15mm, 19mm $185.00
BI239 Arthrotek Ligament Fixation System Interference Screw, Titanium 15-30mm $475.00
BI241 Gentle Threads Ligament Fixation Screws Screw, Graft Interference, PGA/PLA 7mm, 8mm, 9mm, 10mm $466.00
BI246 Arthrotek Ligament Fixation System Bone Mulch Screws, Titanium 10.5mm x (20-35mm) $445.00
BI920 EZLoc Femoral fixation Device Ligament Anchor, Ti, PE 7-8; 9-10mm x Short, std or $445.00
long.
Prostheses List by Category, Groups and Sponsor Page 408 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BI968 ToggleLoc Femoral Fixation Device 15mm-60mm $369.00
BI969 MaxFire Meniscal Repair Device one size $335.00
ConMed Linvatec Australia Pty Ltd
LV109 XO Button with Continuous Loop Titanium suspensor, fixation device for 4.5mm x 13.5mm with $369.00
femoral fixation in ACT and PCL repairs Continuous Loop lengths 15-
60mm
Device Technologies Australia Pty Ltd
DE070 TransFix Implant Screw System - Arthrex Titanium alloy 40mm & 50 mm $445.00 $744.00
DE071 Arthrex Spiked Washer Titanium alloy 14 - 15mm $162.00 $369.00
DE252 Tightrope Syndesmosis Repair Kit Titanium or stainless steel, with non One size only $589.00
absorbable Fiberwire suture material
DE299 Meniscal Cinch Meniscal Repair Device Universal One size only $335.00
DE303 Distal Biceps Repair Implant Set Surgical convenience pack that contains 2 2.6mm (Button), 7mm $248.00
different implants, sutures and instruments (Tenodesis Screw)
for the repair of ruptured tendons
Johnson & Johnson Medical Pty Ltd
JJ128 Cuff Link High density plastic link 8mm $579.00
JJ588 Femoral Intrafix System Screw and Sheath Fixation System for the 7 to 10mm $600.00
Femur in ACL repairs
Smith & Nephew Surgical Pty Ltd
SN428 ACL/PCL Reconstructions EndoButton CL 20-50mm $369.00
SN429 ACL/PCL Reconstructions EndoButton Tape One size only $159.00
SN777 GTS Sleeve Polypropylene non-absorbable woven mesh one size only $270.00
Synthes Australia Pty Ltd
SY417 Titanium Wire, Barb and Needle Titanium wire surture and needle with One size only $450.00
titanium alloy barb fixation
AB
ConMed Linvatec Australia Pty Ltd
LV021 BioStinger - V Bio - Absorbable Meniscal Repair Device - PLLA 10mm - 16mm $270.00
Meniscal Repair Device
Prostheses List by Category, Groups and Sponsor Page 409 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LV022 EndoPearl Bio-Absorbable Implant - ACL Fixation - PLLA 7mm - 9mm $164.00 $195.00
ACL Fixation
LV028 Pre-loaded BioStinger Bio-Absorbable Violet, PLLA 10, 13, 16mm $309.00 $350.00
Meniscal Repair Implant
LV071 Contour Meniscus Arrow 80L/20D, LPLA & PLLA 1.1mm x 10, 13,16mm $230.00 $285.00
LV072 Contour Meniscus Arrow 80L/20D, LPLA, Pre-loaded Cartridge 1.1mm x 10, 13,16mm $230.00 $285.00
Pack of 1
LV074 Contour Meniscus Arrow 80L/20D, LPLA, Pre-loaded Cartridge 1.1mm x 10, 13,16mm $690.00 $844.00
Pack of 3
LV107 Pinn-ACL CrossPin System Bioabsorbable, transverse femoral fixation 40mm/45mm/50mm Self- $465.00
device of soft tissue grafts in ACL and Reinforcved PLLA Crosspin,
PCL repairs. 8mm/9mm PLLA Graft
Harness
Device Technologies Australia Pty Ltd
DE068 Interference Screws ARTHREX Non-sheathed 7 x 28mm - 12 x 28mm $160.00
DE069 Interference Screws Bio-Cortical - PLA 8 x 17 - 11 x 17mm and 8 x 20 $299.00
- 10 x 20mm
DE072 Bio-Interference Screw PLA 7mm - 9mm $288.00
DE127 Bio-Transfix Composition Poly (L-lactide) Diameter 5mm, length 50mm $455.00 $957.00
DE166 Bio-Tenodesis Screw Composition PLLA Dia 5.5-9mm $570.00 $670.00
DE167 Bio-Interference Screw Composition - PLLA, delta tapered Dia6.5 - 10.5mm to 8 - 12mm $450.00 $550.00
x 28 - 35mm length
DE224 Retro Screw Composition PLLA 8-10mm x 20mm $340.00 $550.00
Johnson & Johnson Medical Pty Ltd
JJ078 Rigidfix ACL Cross Pin System Polylactic acid pin 2.7 & 3.3mm x 42mm $465.00
Smith & Nephew Surgical Pty Ltd
SN004 Bioabsorbable screw BioRCI-HA Screw, Medial, Portal, 7 x 20mm - 12 x 35mm $350.00
Reverse thread, Tibial specific, Trans-tibial
Stryker Australia Pty Ltd
SK176 Stryker Cuff Anchor Bio Zip PLLA anchor for soft tissue Dia 3 - 8mm $398.00
ligament/tendon fixation
Prostheses List by Category, Groups and Sponsor Page 410 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Absorbable
Johnson & Johnson Medical Pty Ltd
JJ815 RIGIDFIX BIOCRYL Cross Pin Cross pin composed of Biocryl 2.7mm & 3.3mm $465.00
(bioabsorbable TCP/PLA)
Smith & Nephew Surgical Pty Ltd
SM176 Biosure HA An absorbable polymer interference screw 6-12mm $303.00 $400.00
for use in ligament/tendon reconstruction
Group 23: Soft Tissue Fixation Screw
Group 23a: Standard
Advanced Surgical Design & Manufacture Ltd
AE097 Tibial Post Screw Titanium 5 - 6mm $158.00
ConMed Linvatec Australia Pty Ltd
LV016 Propel Interference Screws ACL Fixation - Titanium Diameter 7.0 - 9.0mm, Length $150.00
20 - 30mm
LV017 Guardsman Femoral Interference Screws ACL Fixation - Titanium Diameter 7.0 - 9.0mm, Length $185.00
20 - 30mm
LV018 Cannulated Interference Screws ACL Fixation - Titanium Diameter 7.0 - 9.0mm, Length $148.00
20 - 40mm
Stryker Australia Pty Ltd
ST830 Stryker Wedge Interference Screw Small threaded titanium screw for Diameter 7 - 9mm, Length 20 - $178.00
ligament/tendon fixation 25mm
AB
Danex Medical Pty Ltd
XD001 CPS Screw Hexalon Biodegradable Biodegradable ACL/PCL Recon Screw 6 x 20, 6 x 25, 6 x 30, 7 x 20, $275.00
ACL/PCL Reconstruction PLLA/PGA/TMC 7 x 25, 7 x 30, 8 x 20, 8 x 25,
8 x 30, 9 x 20, 9 x 25, 9 x 30,
10 x 30
Stryker Australia Pty Ltd
SK155 Wedge Interference screw Threaded PLLA screw with cross pin for Dia 7-12mm, Length 20- $163.00
ligament/tendon fixation 40mm; pin length standard
Prostheses List by Category, Groups and Sponsor Page 411 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Surgical Specialties
SQ067 CPS Screw Hexalon Biodegradable Biodegradable ACL/PCL Recon Screw 6 x 20, 6 x 25, 6 x 30, 7 x 20, $275.00
ACL/PCL Reconstruction PLLA/PGA/TMC 7 x 25, 7 x 30, 8 x 20, 8 x 25,
8 x 30, 9 x 20, 9 x 25, 9 x 30,
10 x 30
AB, CN
ConMed Linvatec Australia Pty Ltd
LV019 BioScrew Bioabsorbable Interference ACL Fixation - PLLA Diameter 7.0 - 9.0mm, Length $251.00 $330.00
Screw 20 - 30mm
LV077 BioScrew XtraLok Tibial Fixation Device PLLA Diameter 8, 9, 10, 11mm; $262.00 $335.00
Length 35 & 40mm
LV103 Matryx Interference Screw Matryx (SR-96L/4D PLA with ß-TCP) 7.3 x 20mm; 7.3 x 25mm; 7.3 x $420.00
Inteference Screw 30mm; 8 x 20mm; 8 x 25mm;
8 x 30mm; 9 x 20mm; 9 x
25mm; 9 x 30mm; 9 x 38mm;
10 x 25mm; 10 x 33mm; 10 x
38mm; 11 x 25mm; 11 x
33mm; 11 x 38mm
Johnson & Johnson Medical Pty Ltd
JJ127 Absolute Absorbable Interference Screw Polylactic acid screw 7 to11mm x (23 to 30mm) $230.00
JJ337 Biocryl - TCP/PLA Interference Screw Composition - Tricalcium Phosphate & 7x23mm; 7x30mm; 8x23mm; $303.00
Polylactic Acid 8x30mm, 9x23mm; 9x30mm;
10x23mm; 10x30mm; 11x30mm
JJ473 BioIntrafix Tibial Soft Tissue Fastener Absorbable composite (TCP/PLA) 6 to 10mm by length 30mm $350.00
fixation device (screw) used in conjunction
with a sheath for the repair of ACL Soft
Tissue Graft
JJ484 MILAGRO Interference Screw TCP/PLGA Interference ACL Screw 5-12mm $375.00 $450.00
System
Prostheses List by Category, Groups and Sponsor Page 412 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Absorbable, Cannulated
Arthrocare Australasia Pty Ltd
AF032 Bilok Screw (Parallel, Tapered, Bilok (TCP/PLLA) - Tricalcium phosphate Bilok Screw Tapered: Length $303.00 $345.00
ST)(Fixation device) and poly-L-lactide 20-35mm, Diameter 7-12mm
Bilok Screw parallel: Length
25-35mm, Diameter 7-9mm
Bilok Screw ST: Length 30-
35mm, Diameter 7-9mm
CN
Johnson & Johnson Medical Pty Ltd
JJ071 Mitek Kurosaka Advantage Fixation Titanium Screw Cannulated - Advantage 7 & 9mm x (15 to 40mm) $169.00
Screw
JJ072 Mitek Kurosaka Fixation Screw Titanium Screw Cannulated - Profile 7,8 & 9mm x (20 to 30mm) $169.00
Group 23d: Other
Advanced Surgical Design & Manufacture Ltd
AE094 ACL Fixation Screws Tapered Flat Head, Tappered, Titanium 9 - 11mm Diameter 30mm $178.00
Length
AB, CN
Johnson & Johnson Medical Pty Ltd
DY477 BioIntrafix Tibial Soft Tissue Fastener Absorbable composite (TCP/PLA) 30mm $345.00
(Sheath) fixation device (sheath) used in conjunction
with a screw
Absorbable, Cannulated
Device Technologies Australia Pty Ltd
DE297 BioComposite Interference Screw Soft Tissue Fixation Device 7mm - 35mm $303.00 $450.00
CN
Johnson & Johnson Medical Pty Ltd
JJ125 Intrafix Tibial Tapered Screw Plastic tapered screw 6 to 10mm x (15 to 30mm) $286.00
Prostheses List by Category, Groups and Sponsor Page 413 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 24: Soft Tissue Substitute
Group 24a: Biological (human or animal tissue derived)
Johnson & Johnson Medical Pty Ltd
DY136 Restore Orthobiologic Soft Tissue Restore Patch One size only $5,935.00
Implant
Group 24b: Non- Biological
Corin Australia Pty Ltd
CR032 Lars Ligamanet Augmentation Woven polyester prosthetic ligaments 60,80,100,120,160 & Y $4,156.00
reconstruction system shaped fibres
Group 25: External Fixateur Standard - any long bone and pelvis
Group 25a: Frame - circular (full/part)
Biomet Australia Pty Ltd
BI265 EBI XFIX Dynafix System Hybrid Fixation System, Stainless Steel, Rings - 1/3, 2/3, Rotating, $6,361.00
Aluminium 100mm-220mm. Ring Bolt -
Xsmall, adult. Ring to fixator
connector. Rotation adaptor -
male, female, Xsmall, adult.
Variable wire (1 size) or
Variable Screw Carriage (fixed
and angulating). Wire (1.6-2mm
x 350-400mm). Washer (9
Johnson & Johnson Medical Pty Ltd
DY223 Ace External Fixator Ring, aluminium 1/3 ring small 6" diameter $376.00
DY225 Ace External Fixator Ring, composite 1/3 ring large $446.00
DY226 Ace External Fixator Ring, composite 1/3 ring medium $423.00
DY227 Ace External Fixator Ring, composite 1/3 ring small $394.00
DY237 Ace External Fixator Ring, aluminium 2/3 ring, Medium - Large $908.00
DY238 Ace External Fixator Ring, composite 2/3 ring, medium - Large $908.00
DY240 Ace External Fixator Ring, aluminium 2/3 ring, small 6" diameter $411.00
Prostheses List by Category, Groups and Sponsor Page 414 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DY241 Ace External Fixator Ring, composite 2/3 ring, small $463.00
DY263 Ace External Fixator U rings, aluminium One size only $736.00
DY294 Bremer Halo Crown System Aluminium Crown & Vest Standard & 3D $3,035.00
LMA PacMed Pty Ltd
PM100 Orthopaedic External Fixation System - Hybrid Fixator One size only $2,159.00
Xcaliber External Fixator
PM108 Orthofix Limb Reconstruction System Adult and paediatric - Short, $6,500.00
Standard and Long
Synthes Australia Pty Ltd
SY194 Orthopaedic External Fixator Systems Curved and straight rod - carbon fibre 4mm - 11mm $1,353.00
SY197 Orthopaedic External Fixator Systems Hybrid Rings 11mm diameter 1/4 ring - $721.00
205mm diameter full ring
Com
Johnson & Johnson Medical Pty Ltd
JJ806 TEMPFIX External Fixation System - Sterile pack for external fixation of lower Sterile transfixing pin lower leg $2,288.00 $4,700.00
transfixing pin sterile kit extremity periarticular fractures frame kits
JJ807 TEMPFIX External Fixation System - Sterile pack for external fixation of lower Sterile half pin lower leg frame $2,288.00 $4,700.00
half pin sterile kit extremity periarticular fractures kits
Smith & Nephew Surgical Pty Ltd
SN032 Compass Universal Hinge Circular external hinged fixator, graphite One size only $8,530.00
composite
SN146 Taylor Spatial Frame Pre-assembled circular external fixator, One size only $9,925.00
carbon-fibre rings, telescopic rods
Stryker Australia Pty Ltd
SK364 Hoffman II External Fixation System Hoffman II Sterile Pre-Packs Sterile Tibia Kit $4,895.00
SK365 Hoffman II External Fixation System Hoffman II Sterile Pre-packs Sterile Ankle Kit $4,700.00
SK378 Hoffman II External Fixation System Hoffman II Sterile Pre-Packs Sterile Pelvic Kit $7,680.00
ST945 Monotube External Fixation System Anodized metal alloy, dynamic tube 15mm $4,780.00
assembly yellow
ST946 Monotube External Fixation System Anodized metal alloy, dynamic tube 20mm $4,945.00
assembly blue
ST947 Monotube External Fixation System Anodized metal alloy, dynamic tube 25mm $5,110.00
assembly red
Prostheses List by Category, Groups and Sponsor Page 415 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST948 Monotube External Fixation System Anodized metal alloy, dynamic tube 15mm $2,485.00
assembly yellow
ST949 Monotube External Fixation System Anodized metal alloy, dynamic tube 20mm $2,650.00
assembly blue
ST950 Monotube External Fixation System Anodized metal alloy, dynamic tube 25mm $5,110.00
assembly red
ST965 TenXor External Fixation System Anodized metal alloy, open ring 150, 180, 210, 250mm $1,105.00
ST966 TenXor External Fixation System Anodized metal alloy, ring clamp One size only $645.00
ST967 TenXor External Fixation System Anodized metal alloy, wire post, pin post One size only $595.00
ST968 TenXor External Fixation System Anodized metal alloy, ring to monotube One size only $1,215.00
triax tube clamp
ST971 TenXor External Fixation System Anodized metal alloy, with sliding clamp One size only $250.00
ST972 TenXor External Fixation System Anodized metal alloy,with sliding clamp One size only $645.00
and spacer
Synthes Australia Pty Ltd
SY422 Distraction Osteogenesis Ring System Femoral Arch Plate, Titanium 90mm-120mm, 180mm- $880.00
240mm
SY423 Distraction Osteogenesis Ring System Femoral Arch Plate, Carbon Fibre 90mm-120mm, 180mm- $1,350.00
240mm
SY424 Distraction Osteogenesis Ring System Half,5/8 Ring, MRI Safe, Titanium 80mm-240mm Diameter $908.00
SY425 Distraction Osteogenesis Ring System Full Ring, MRI safe, Titanium 140mm-200mm Diameter $1,365.00
SY426 Distraction Osteogenesis Ring System Half, 5/8 ring, carbon fibre 100mm-200mm Diameter $1,353.00
SY427 Distraction Osteogenesis Ring System Foot Plates, Carbon Fibre 100mm-180mm $3,000.00
Group 25b: Monolateral Device
Biomet Australia Pty Ltd
BI775 EBI XFIX DynaFix System Distal radius fixator, wristfix, sterile, One size only $2,460.00
complete
BI856 EBI XFIX Dynafix System Rail (Carbon Fiber) 100-420mm $2,950.00
Lifehealthcare Pty Ltd
LH327 MiniFix Finger Mini Fixator System One size $3,328.00
Prostheses List by Category, Groups and Sponsor Page 416 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LMA PacMed Pty Ltd
PM012 Orthofix External Fixation System Ankle Anodised aluminium and stainless steel One size only $4,607.00
Fixator
PM013 Orthofix External Fixation System Pennig Anodised aluminium and stainless steel One size only $3,991.00
Wrist Fixator
PM061 Orthofix External Fixation System Elbow Anodised aluminium and stainless steel One size only $5,440.00
Fixator
PM062 Orthofix External Fixation System Anodised aluminium and stainless steel One size only $5,220.00
Hybrid Fixator
PM063 Orthofix External Fixation System Knee Anodised aluminium and stainless steel One size only $5,955.00
Fixator
PM092 Orthopaedic External Fixation System - Complete System Sterile One size only $2,055.00
Radiolucent Wrist Fixator
PM098 Orthopaedic External Fixation System - Metadiaphyseal Fixator One size only $2,429.00
Xcaliber External Fixator
PM099 Orthopaedic External Fixation System - Articulated Ankle Fixator One size only $3,139.00
Xcaliber External Fixator
PM109 Orthofix External Fixation Systems MiniRail System Short, Standard, Long and $2,150.00
Articulated Horizontal and
Vertical Axis
PM110 Orthofix External Fixation Systems Pennig Minifixator Short, Standard, Long $4,800.00
Synthes Australia Pty Ltd
SY239 Orthopaedic External Fixator Systems External fixator clamp components, angled 1.25-8.0mm $536.00
piece with nut
Zimmer Pty Ltd
ZI484 Wristore Disposable External Fixation device for the Wristore Pack $998.00
treatment of distal radial fractures.
ZI602 Trans Fx LITE Ankle Implant Kit MRI Ankle Bridging Implant Kit Large $4,700.00 $4,935.00
ZI603 Trans Fx LITE - Pelvic Resuscitation Kit MRI Pelvic Resuscitation Kit Large $2,175.00
ZI604 Trans Fx LITE MRI Knee Spanning Implant Kit Large $4,895.00 $5,140.00
ZI605 Trans Fx LITE - Wrist Kit Wrist Spanning Frame Small $3,135.00
Prostheses List by Category, Groups and Sponsor Page 417 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Com
Biomet Australia Pty Ltd
BI264 EBI XFIX Dynafix System Distal Radius Fixator, Dimension, Stainless One size only $3,305.00
Steel, Aluminium
BI267 EBI XFIX Dynafix System Fixator Complete - includes T-Clamp, Standard, Small, Extra Small $5,108.00
Compression/Distraction, Dynamisation,
Articulating Ankle Clamp
BI272 EBI XFIX Dynafix System Distal Radius Fixator, Wristfix, Stainless One size only $2,065.00
Steel, Aluminium
BI776 EBI XFIX DynaFix System OptiROM Articulating Fixator Complete Small and Large $8,042.00
BI777 EBI XFIX DynaFix System Mini fixator/lengthener with comp/dist Small, Medium, Long, 100mm, $2,413.00
150mm
BI819 EBI XFIX Dynafix System Multi Axial Correction and Metaphyseal 4-8cm, Xsmall - Adult $5,075.00
Arc Module complete with T-clamp
Smith & Nephew Surgical Pty Ltd
SN708 Jet X Bar External Fixation Bar with Cap 100mm to 600mm $4,750.00
SN709 Jet X Central Modular Versitile Ankle Fixation Frame 99mm to 158mm $4,500.00
Group 25c: Rods
Biomet Australia Pty Ltd
BI832 EBI XFIX Vision System Rods, Bars, stainless Dia 9.5mm, 150-400mm length $185.00
steel/aluminium/carbon fibre
Johnson & Johnson Medical Pty Ltd
DY228 Ace External Fixator Threaded Rod, titanium 1/4" x 10cm $123.00
DY229 Ace External Fixator Threaded Rod, titanium 1/4" x 15cm $164.00
DY230 Ace External Fixator Threaded Rod, titanium 1/4" x 20cm $210.00
DY231 Ace External Fixator Threaded Rod, titanium 1/4" x 25cm $258.00
DY234 Ace External Fixator Titanium half pin thread 15-80mm, 155 x 5mm to 220 x $117.00
5mm
DY242 Ace External Fixator Stainless steel transfix pin 250/300 x 5mm with 40-70mm $263.00
thread
Prostheses List by Category, Groups and Sponsor Page 418 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DY243 Ace External Fixator Titanium Transfix Pin 250/300 x 5mm with 40-70mm $167.00
thread
DY248 Ace External Fixator Adaptor rod, titanium 8mm $180.00
DY268 Ace External Fixator Connecting rod, aluminium X-Short, short, medium or long $690.00 $1,062.00
Stryker Australia Pty Ltd
SK211 Hoffmann II External Fixation System Hoffmann II Micro Carbon rods 3mm (30-120mm) $68.00
SK212 Hoffmann II External Fixation System Hoffmann II Micro Stainless steel rods 3mm x (30- $52.00
120mm)
ST939 Hoffman II External Fixation System Anodised metal alloy, aluminium 8mm x 65-500mm $52.00
connecting rod
ST940 Hoffman II External Fixation System Anodised metal alloy, carbon connecting 8mm x 65-500mm $69.00
rod
ST942 Hoffman II External Fixation System Anodised metal alloy, curved aluminium Small, Medium, Large $90.00
rod semi-circular
ST943 Hoffman II External Fixation System Anodised metal alloy, adjustable Long, short $765.00
connecting rod
Synthes Australia Pty Ltd
SY196 Orthopaedic External Fixator Systems Rod/Bar 450mm length - 650mm Length $148.00
SY242 Orthopaedic External Fixator Systems External fixator clamp components, bar for 1.25-6.0mm $700.00
upper jaw
Com
Stryker Australia Pty Ltd
SK393 Hoffman II External Fixation System Hoffman II MRI 8mm Connecting rod (100mm - $155.00
500mm), 5mm Connecting rod
(100mm - 500mm), Semi
Circular Curve Rod
SK486 Hoffmann Xpress - connecting tube Hoffman Xpress External Fixation Device 15 mm diameter / 150 to 440 $155.00
- Adapted to fit the needs of medically mm in length
trained staff of such occupations as the
Armed Forces
ST962 Monotube External Fixation System Carbon tube yellow 015 150, 200, 250, 300mm $220.00
ST963 Monotube External Fixation System Carbon tube blue 015 150, 200, 250, 300mm $330.00
Prostheses List by Category, Groups and Sponsor Page 419 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST964 Monotube External Fixation System Carbon tube red 015 150, 200, 250, 300mm $420.00
Group 25d: Coupling Devices
Biomet Australia Pty Ltd
BI827 EBI XFIX Vision System Rod Clamps/Connector, stainless Dia 9.5mm $2,300.00
steel/aluminium
BI828 EBI XFIX Vision System Clamp/Rod, stainless steel/aluminium 4mm/6mm, 3-5 hole, 50-150mm $1,175.00
BI831 EBI XFIX Vision System Post, Bone Screw, Telescoping, stainless One size only $850.00
steel
BI854 EBI XFIX Dynafix System Rail Accessory (Adaptor, CD Support, Ex Small, Small, Adult, 4-6mm $1,020.00
Dynamization, Bridge)
Johnson & Johnson Medical Pty Ltd
DP391 Ace External Fixator Pin Holder Bolt - Titanium All sizes $47.00
DY236 Ace External Fixator Spacer with bolt, titanium 2.5-5mm $22.00
DY249 Ace External Fixator Pin holder adaptor, aluminium 90" $311.00
DY251 Ace External Fixator Anchor assembly, titanium One size only $308.00
DY252 Ace External Fixator Articulation, titanium One size only $904.00
DY253 Ace External Fixator Bolt clevis, titanium One size only $29.00
DY256 Ace External Fixator Locking nut, titanium One size only $36.00
DY257 Ace External Fixator Nut, stainless steel One size only $81.00
DY258 Ace External Fixator Position pins I/C foot plate, titanium One size only $105.00
DY259 Ace External Fixator Ring adapter bolt, titanium One size only $47.00
DY260 Ace External Fixator Ring connector, titanium One size only $199.00
DY262 Ace External Fixator Spherical nut and washer, titanium One size only $214.00
DY264 Ace External Fixator Universal joint, titanium One size only $360.00
DY266 Ace External Fixator Wire bolt hinge, titanium One size only $435.00
DY267 Ace External Fixator Wire fixation bolt, cannulated or slotted One size only $188.00
(stainless steel)
DY271 Ace External Fixator Ring adaptor, titanium One size only $209.00
Prostheses List by Category, Groups and Sponsor Page 420 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
SK206 Stryker External Fixation System Hoffmann II Micro Couplings, Rod to rod, Pin to $645.00
Rod and Multipin
SK374 Hoffman II External Fixation System Hoffman II MRI Posts 8mm and 5mm $111.00
ST937 Hoffman II External Fixation System Anodised metal alloy, 30 deg angled post, One size only $99.00
stainless steel
ST938 Hoffman II External Fixation System Anodised metal alloy, straight post, One size only $99.00
stainless steel
Synthes Australia Pty Ltd
SY091 AO/ASIF k-Wires, Pins, Washers etc Pinless pins/clips Asymetric small and large $767.00
SY199 Orthopaedic External Fixator Systems External fixator clamps, double clamp 4-6mm Diameter $510.00
SY201 Orthopaedic External Fixator Systems External fixator clamps, clamp or open 1.25-8.0mm Diameter $567.00
clamp
SY203 Orthopaedic External Fixator Systems External fixator clamps, tube to 11mm Diameter $769.00
tube/universal clamp
SY228 Orthopaedic External Fixator Systems External fixator clamp components, 1.25-8.0mm $403.00
vice/connecting plate
SY230 Orthopaedic External Fixator Systems External fixator clamp components, 1.25-6.0mm $361.00
intermediate piece
SY234 Orthopaedic External Fixator Systems External fixator clamp components, 3mm $2,564.00
angulator
SY236 Orthopaedic External Fixator Systems External fixator clamp components, halo 1.25-6.0mm $1,545.00
with visor
SY237 Orthopaedic External Fixator Systems 3 degree, 6 degree, 11 degree. Medium, 1.25-6.0mm $227.00
Large
SY238 Orthopaedic External Fixator Systems External fixator clamp components, 1.25-6.0mm $52.00
connecting tube
SY247 Orthopaedic External Fixator Systems External fixator clamp components, double 1.25-6.0mm $1,721.00
joint
SY420 Distraction Osteogenesis Ring System Wire Post MRI Safe Short, Long $585.00
Zimmer Pty Ltd
ZI606 Trans Fx LITE MRI Universal Clamp One size only $695.00
Prostheses List by Category, Groups and Sponsor Page 421 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Com
Biomet Australia Pty Ltd
BI853 EBI XFIX Dynafix System CD Clicker Ex Small, Small, Adult, 5-20cm $2,413.00
Stryker Australia Pty Ltd
SK373 Hoffman II External Fixation system Hoffman II MRI Pelvic Clamp $1,135.00
SK375 Hoffman II External Fixation System Hoffman II MRI Coupling Pin to Rod, Rod to Rod, Tube $770.00
to Rod, Pin Clamp Assembly
SK390 Hoffman II External Fixation System Hoffman II MRI Compression/Dystraction Tube, $770.00
Dynamisation Tube
SK485 Hoffmann Xpress - Universal Pin Clamp Hoffmann Xpress External Fixation Device One size to fit the Rod to Rod $770.00
- Adapted to fit the needs of medically
trained staff of such occupations as the
Armed Forces
SK487 Hoffmann Xpress - 5 Pin Clamp Posts Hoffmann Xpress External Fixation Device 2 categories, a 1 post clamp $770.00
- adapted to fit needs of medically trained and a 2 post clamp
staff of such occupations as the Armed
Forces
ST892 Hoffmann II Compact External Fixation Pin clamp assembly with no post One Size Only $695.00
System
ST935 Hoffman II External Fixation System Anodised metal alloy, rod to rod coupling 8/8mm $655.00
ST936 Hoffman II External Fixation System Anodised metal alloy, pin to rod coupling 8/4, 5mm $655.00
ST951 Monotube External Fixation System Anodized metal alloy, pin clamp yellow, 15, 20, 25mm $1,215.00
blue, red
ST952 Monotube External Fixation System Anodized metal alloy, single pin clamp 15, 20, 25mm $1,215.00
yellow, blue, red
ST953 Monotube External Fixation System Anodized metal alloy, T-Adapter yellow, 15, 20, 25mm $580.00
blue, red
ST954 Monotube External Fixation System Anodized metal alloy, tube to tube clamp 15, 20, 25mm, 15/20mm, $645.00
yellow, blue, red, yellow/blue, blue/red 20/25mm
ST955 Monotube External Fixation System Anodized metal alloy, hybrid clamp blue, One size only $1,215.00
hybrid clamp red
Prostheses List by Category, Groups and Sponsor Page 422 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Synthes Australia Pty Ltd
SY198 Orthopaedic External Fixator Systems Distractors and lengthening apparatus Mini - lengthening apparatus, $3,178.00
mini - distractor/lengthening
apparatus, medium and large
distractor
SY200 Orthopaedic External Fixator Systems External fixator clamps, transverse clamp 4-6mm Diameter $1,077.00
SY202 Orthopaedic External Fixator Systems External fixator clamps, clamp for hybrid 1.8-11mm Diameter $1,114.00
SY206 Orthopaedic External Fixator Systems External fixator clamps, adjustable clamp 4.0mm $1,390.00
SY224 Orthopaedic External Fixator Systems External fixator clamp components, angled 1.25-11.0mm $1,167.00
piece
SY418 Distraction Osteogenesis Ring System Bolt-connecting, clamp, eye, wire offset, One size $188.00
wire slotted, MRI safe.
SY419 Distraction Osteogenesis Ring System Spherical/Spacing Washer; Nut-Speed, 1mm-50mm $214.00
Square, Hexagonal, Standoff; MRI Safe
SY421 Distraction Osteogenesis Ring System Threaded Rod, MRI Safe 250mm-350mm $258.00
SY428 Distraction Osteogenesis Ring System Locking Hinge, MRI safe One Size $435.00
Group 25e: Accessories
Johnson & Johnson Medical Pty Ltd
DY245 Ace External Fixator TIP CapS, polyethylene 3-5mm $6.00
Synthes Australia Pty Ltd
SY195 Orthopaedic External Fixator Systems Protective caps for rods, protection caps One size only $10.00
SY233 Orthopaedic External Fixator Systems External fixator clamp components, angle 3mm $93.00
Group 26: External Fixateur Small - upper limb
Johnson & Johnson Medical Pty Ltd
DY386 Hoffman Wrist Kit Hoffman Sterile Wrist Kit One size only $1,565.00
Prostheses List by Category, Groups and Sponsor Page 423 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 26a: Frame -circular (full/part)
Com
Stryker Australia Pty Ltd
ST888 Howmedica Dynamic Joint Distractor Complete Y Body Frame - Stainless Steel One size only $4,070.00
Group 26b: Monolateral Device
Com
Lifehealthcare Pty Ltd
LH331 RadioFix Radio Fixator System One size $2,080.00
LH340 Poing Fix Wrist Fixator System One size $2,808.00
LH341 Wrist Fixator PFII Wrist Fixator System One size $2,912.00
Group 26c: Rods
Synthes Australia Pty Ltd
SY193 Orthopaedic External Fixator Systems Rod / Bar 2.0mm-15.0mm dia 20.0mm- $144.00
445mm L
Group 27: External Fixateur Mini - hand and foot
Group 27b: Monolateral Device
Com
Lifehealthcare Pty Ltd
LH342 MicroFix Finger Mini Fixator System one size $1,664.00
Group 27d: Coupling Devices
Synthes Australia Pty Ltd
SY205 Orthopaedic External Fixator Systems External fixator clamps, connecting clamp 3-4mm Diameter $328.00
Prostheses List by Category, Groups and Sponsor Page 424 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 31: Other Devices
Advanced Surgical Design & Manufacture Ltd
AE036 Opening Wedge Tibial Ostectomy Plate Titanium 6mm - 20mm $975.00
B Braun Australia Pty Ltd
BB312 Position HTO Implant System - Spacer Osteotomy Spacer Block, solid titanium. 5mm - 16mm $632.00 $950.00
Block with Fixation Screw Consists of block and fixation screw.
Biomet Australia Pty Ltd
BI005 Re-Unite Orthopaedic System Rotator Cuff Butress, Lactosorb; PGA/PLA One size only $430.00
BI855 EBI XFIX Dynafix System Wrench Ex Small, Small, Adult, 3-6mm $200.00
Global Manufacturing Technology Pty Ltd
GM050 Contile Fin II 6.5mm Ti Cnacellous Bone Screws 20 to 50mm $225.00
GM109 OsteoBridge OsteoBridge Interlocking Screw 18m to 56mm $403.00
GM110 OsteoBridge Nail 7mm, 8mm, 9mm, 10mm, $4,322.00
12mm, 14mm, 16mm & 18mm
GM111 OsteoBridge Spacer, Straight & Angled 25mm, 40mm, to 70mm $6,571.00
30mm, 40mm, to 70mm
20mm, 20mm, to 70mm
GM112 OsteoBridge OsteoBridge Reducing Sleeve 20mm, 25mm & 30mm $3,400.00
Global Orthopaedic Technology
GO092 C-Fix Cable Fixation System Titanium Leader Cable Assembly 1-1.3mm $1,200.00
GO197 SuperCable Trochanteric Grips and Trochanteric Grips - Titanium Short 50mm, 2 Hole Plate $4,000.00
Cable Plate System 135mm, 4 Hole Plate 190mm,
6 Hole Plate Straight, Right,
Left 245mm
GO198 SuperCable Trochanteric Grips and Locking Screw Titanium 5.0mm diameter 10mm to $185.00
Cable Plate System 50mm length
Prostheses List by Category, Groups and Sponsor Page 425 of 911
6 - SPECIALIST ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
GO199 SuperCable Trochanteric Grips and Compression Screws Titanium 4.5mm Diameter 10mm to 50 $185.00
Cable Plate System mm length
GO200 Iso-Elastic SuperCable Trochanteric Cable Plates Titanium 6 Hole 185mm, 8 Hole Straight $1,450.00
Grips and Cable-Plates System and Curved 240mm, 10 Hole
Straight and Curved 290mm
LMT Surgical Pty Ltd
LM086 Surgicraft Fixation Bollard One size only $475.00
Stryker Australia Pty Ltd
HW186 First Step High Tibial Osteotomy System Distal Component - Vitallium 30 to 55mm in 5mm increments $1,004.00
HW404 First Step High Tibial Osteotomy System Proximal Component 5mm, 10mm and 15mm steps, $632.00
60-90mm in 5mm increments
Synthes Australia Pty Ltd
SY130 AO/ASIF Arthrodesis system Arthrodesis 26 - 240mm $4,429.00
SY285 AO/ASIF Blade Helical blade 50-150mm length $515.00
Group 7: Wrist
Group 7f: Other
Lifehealthcare Pty Ltd
LH250 Diamond Plate/Carpal Button Carpal Fusion Plate Large, Small $2,092.00
LMT Surgical Pty Ltd
LM056 Ascension DRUJ Ulna Head, Implant Cobalt chromium stem with PyroCarbon 0, 1, 2, 3, 4 $2,300.00
System or Cobalt Chromium Articular Surface
Group 9: Elbow
Group 9g: Other
Stryker Australia Pty Ltd
HW213 Howmedica Modular Resection System Humeral Bearing - Vitallium One size only $175.00
Prostheses List by Category, Groups and Sponsor Page 426 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 1- Cardiothoracic Mechanical Valves
Group 1c - Bi-Leaflet, rotatable
Medtronic Australasia Pty Ltd
MC292 Advantage Heart Valve - Aortic Model A7760 - Pyrolytic carbon, PET Diameter 19-31 mm $6,000.00
A7760
MC324 Advantage Supra Aortic Heart Valve Mechanical Heart Valve Pyrolite Carbon Diameter (mm): 19 - 25 $6,000.00
leaflets Pyrolite carbon ring
MC681 Advantage Mitral Mechanical Heart Valve 23mm-33mm $6,000.00
MC980 Open Pivot Heart Valve (Model 500FA) Pyrolythic Carbon, Double Velour 16-33mm $6,000.00
Polyester, Titanium
Open Pivot Heart Valve (Model 500DM)
MC981 Open Pivot Heart Valve (Model Pyrolythic Carbon, Double Velour 16-33mm $6,000.00
501DA) Polyester, Titanium
Open Pivot Heart Valve (Model 501DM)
Reid Healthcare
RH001 Aortic On-X Prosthetic Heart Valve 27-29mm, 19mm, 21mm, $6,000.00
Models ONXA-19; ONXA-21; 23mm, 25mm, 25-33mm, 27-
ONXA-23; ONXA-25; ONXA-27/29; 29mm, 31-33mm, 23mm,
ONXM-23; ONXM-25; ONXM- 25mm
27/29; ONXM31/33; ONXMC25/33
Sorin Group
SA129 Optiform Mechanical Valve 19mm to 33mm $6,000.00
St Jude Medical Australia Pty Ltd
SJ037 St Jude Medical Aortic Expanded Cuff Aortic Expanded Cuff, Aortic Aortic Expanded 19 -31mm, $6,000.00
Heart Valve; St Jude Medical Aortic Hemodynamic Plus Cuff, Mitral Aortic Hemodynamic 17 -
Hemodynamic Plus Cuff Heart Valve; St Hemodynamic Cuff, Aortic & Mitral 27mm, Mitral Hemodynamic 17
Jude Medical Mitral Hemodynamic Plus Rotatable Cuff -27mm, Rotatable 17 - 33mm
Cuff Heart Valve; St Jude Medical
Mechanical Heart Valve Masters Series
SJ039 Regent Prosthestic Heart Valves Standard Cuff - Model 17AGFN-751 - Standard cuff - 17-23mm, Flex $6,500.00
23AGFN-751, Flex Cuff - Mode cuff - 17-23mm
17AGFN-756 - 23AGFN-756
Prostheses List by Category, Groups and Sponsor Page 427 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SJ116 Regent Prosthestic Heart Valves Standard Cuff - Model 25AGFN-751 - Standard cuff - 25-29mm, Flex $6,000.00
29AGFN-751, Flex Cuff - Mode cuff - 25-29mm
25AGFN-756 - 29AGFN-756
Group 1e - Tilting Disc, rotatable
Medtronic Australasia Pty Ltd
MC013 Medtronic Hall Heart Valve Aortic A7700/M7700 Titanium. Pyrolite. Dacron, A7700 - Diameter 20-31mm, $5,100.00 $5,625.00
Model A7700, Medtronic Hall Heart A7700EZ/M7700EZ Titanium. Pyrolite. M7700 - Diameter 23-33mm,
Valve Mitral Model M7700, Hall Easy PET A7700EZ - Diameter 19-
Fit Aortic Heart Valve Model A7700, 29mm, M7700EZ - Diameter
Hall Easy Fit Mitral Heart Valve Model 23-31mm
M7700
Group 1: Single Chamber ICD's
Generation 3
Guidant Australia Pty Ltd
GU148 Vitality 2 EL VR - Model T177 Single Chamber ICD 35cc; 90g $40,560.00
GU151 Vitality 2 VR - Model T 175 Single Chamber ICD 30cc; 82g $40,560.00
Sorin Group
SA139 OVATIO VR 6250 Titanium, single chamber, sterile, VR 29cc $40,560.00
6250, 34J
a
Sorin Group
SA149 PARADYM VR 8250 Single Chamber implantable cardioverter Dimensions: 58.4 x 73.4 x $42,640.00
defibrillator with rate response 11mm; Weight: 90 grams;
Volume: 32.6cc
St Jude Medical Australia Pty Ltd
SJ066 Atlas + VR - C Model V-193C ICD Single chamber implantable cardio-verter 38cc, 77g $42,640.00
defibrillator
SJ114 Atlas II VR-168 Single chamber cardioverter defibrillator 38cc, 77g $42,640.00
SJ121 Current VR 1107-36 Single Chamber Cardioverter Defibrillator 38cc 76g $42,640.00
Prostheses List by Category, Groups and Sponsor Page 428 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
a, d
Biotronik Australia Pty Ltd
BT098 Lumax 340 VR-T XL ICD-VR with 40 J output, bidirectional One Size Only $42,640.00 $45,640.00
Home Monitoring and High Longevity
Boston Scientific Australia Pty Ltd
BS136 TELIGEN 100 HE VR DF-1/IS-1 Single chamber ICD, High Energy with RF 31.5cc, 9.9mm $42,640.00
St Jude Medical Australia Pty Ltd
SJ124 Current RF VR 1207-36 Single Chamber Cardioverter Defibrillator 79g, 41cc $42,640.00
with RF Telemetry
SJ142 Analyst VR CD1217-36 Single Chamber Cardioverter Defibrillator 79g, 41cc $42,640.00 $44,640.00
with RF Telemetry and ST Segment
Monitoring
a, d, e
Boston Scientific Australia Pty Ltd
BS132 Teligen 100 HE VR 4-SITE Single chamber ICD, high energy with RF 30.5cc, 9.9mm $43,390.00
d
St Jude Medical Australia Pty Ltd
SJ216 AnalyST VR CD1217-30 Single chamber cardioverter defibrillator 73g, 37cc $40,560.00 $42,560.00
with RF telemetry and ST segment
monitoring
Generation 4
a, d
Biotronik Australia Pty Ltd
BT100 LUMAX 540 VR-T High Energy, Single-Chamber ICD Diamensions: 66*55*13 mm $43,920.00 $45,640.00
(Implantable Cardiac Defibrillator) with Volume/Weight : 37.2cc/92g
Advanced Patient Management Via unique
Home Monitoring Technology
incorporatin Automatic Threshold
Monitoring and Extended Longevity.
Medtronic Australasia Pty Ltd
MC813 Secura VR Model D234VRG Fully Automatic, Wireless Implantable 37cc, 68g $43,920.00
cardioverter defibrillator with high energy
capability and therapies for ventricular
tachyarrhythmia
Prostheses List by Category, Groups and Sponsor Page 429 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MI015 PROTECTA XT VR D354VRG Single chamber implantable cardioverter Volume 37cc, Mass 68g $43,920.00
defribillator with SmartShock Technology,
OptiVol 2.0 Fluid Status Monitoring and
Complete Capture Management
Specifications (DF-1)
St Jude Medical Australia Pty Ltd
SJ147 Current Accel VR RF CD1215-36 Single Chamber Cardioverter Defibrillator 79g, 38cc $43,920.00 $44,640.00
with RF Telemetry
SJ154 AnalyST Accel VR CD1219-36 Single Chamber Cardioverter Defibrillator 79g, 41cc $43,920.00 $44,640.00
with RF Telemetry and ST Segment
Monitoring
SJ242 Fortify VR CD1233-40 Single chamber cardioverter defibrillator 35cc, 75g $43,920.00
with 40J delievered energy
SJ251 Fortify ST VR CD1235-40 Single chamber cardioverter defibrillator 35cc, 75g $43,920.00
with 40J delivered energy and ST segment
monitoring
a, d, e
Medtronic Australasia Pty Ltd
MI024 PROTECTA XT VR D354VRM Single chamber implantable cardioverter Volume 37cc, Mass 68g $44,670.00
defibrillator with SmartShock Technology,
OptiVol 2.0 Fluid Status Monitoring and
Complete Capture Management
Specifications (DF-4)
St Jude Medical Australia Pty Ltd
SJ232 Current Accel VR CD1215-36Q Single Chamber Cardioverter Defibrillator 80g, 42cc $44,670.00
with RF Telemetry and SJ4 connector
SJ237 AnalyST Accel VR CD1219-36Q Single Chamber Cardioverter Defibrillator 79g, 41cc $44,670.00
with RF Telemetry and ST Segment
Monitoring and SJ4 connector.
SJ240 Fortify VR CD1233-40Q Single chamber cardioverter defribillator 35cc, 75g $44,670.00
with 40J delivered energy with SJ4
connector
Prostheses List by Category, Groups and Sponsor Page 430 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SJ247 Fortify ST VR 1235-40Q Single chamber cardioverter defibrillator 35cc, 75g $44,670.00
with 40J delivered energy and ST segment
monitoring and SJ4 connector
d
St Jude Medical Australia Pty Ltd
SJ212 AnalyST Accel VR CD1219-30 Single chamber cardioverter defibrillator 73g, 37cc $41,820.00 $44,560.00
with RF telemetry and ST segment
monitoring
SJ213 Current Accel VR RF CD1215-30 Single chamber cardioverter defibrillator 73g, 37cc $41,820.00 $44,560.00
with RF telemetry
Group 10: Pacemaker/ICD Extenders
Medtronic Australasia Pty Ltd
MC831 Medtronic Lead Extender Kit Model: 6984M: IS-1 BI Lead to IS-1 BI IPG; 37 - 50cm $530.00
6984M, 6981M, 6985M,6986M 6981M: IS-1 UNI Lead to IS-1 UNI
IPG; 6986M: 3.2mm BI Lead to IS-1 BI
IPG; 6985M: IS-1 UNI Lead to EPG
Group 11: Pacemaker/Lead Accessories
Medtronic Australasia Pty Ltd
MC036 Medtronic Lead End Cap Kit Model: Pin Plug Kits to Seal Unused Pacemaker One Size Per Model $80.00
5867-3M; Medtronic DF-1 Port Pin or Defibrillator Port; Sizing Sleeve -
Plug Kit: Model 6719, Medtronic IS-1 Silicone or Polyurethane
Port Pin Plug Kit: Model 6725;
Medtronic Upsizing Sleeve: Model
5866-45, Model 5866-46
Group 12: Coronary Stents
Sub-Group 1: General Purpose Drug eluting stents
Abbott Australasia Pty Ltd
AY023 Xience Everolimus Eluting Stent System Everolimus Eluting Stent System 2.25mm to 4.0mm widths, 8mm $3,450.00
to 28mm lengths
Prostheses List by Category, Groups and Sponsor Page 431 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AY037 Xience PRIME LL Everolimus Eluting Coronary Artery Stent, Drug Eluting XIENCE PRIME LL 2.50; $3,450.00
Coronary Stent; Xience PRIME 2.75; 3.00; 3.50; 4.0 x 33MM;
Everolimus Eluting Coronary Stent; XIENCE PRIME LL 2.50;
Xience PRIME SV Everolimus Eluting 2.75; 3.00; 3.50; 4.0 x 38MM;
Coronary Stent XIENCE PRIME SV 2.25 x
08; 12; 15; 18; 23; 28MM;
XIENCE PRIME 2.50 x 08;
12; 15; 18; 23; 28MM;
XIENCE PRIME 2.75 x 08;
12; 15; 18; 23; 28MM;
XIENCE PRIME 3.00 x 08;
12; 15; 18; 23; 28MM;
XIENCE PRIME 3.50 x 08;
12; 15; 18; 23; 28MM;
XIENCE PRIME 4.00 x 08;
12; 15; 18; 23; 28MM
Boston Scientific Australia Pty Ltd
BS099 Taxus Liberte Paclitaxel-Eluting 316L Stainless Steel Stent with Translute 2.0mm-5.0mm & 8.0mm- $3,450.00
Coronary Stent System Polymer and Paclitaxel 38mm
BS125 Promus Everolimus Coronary Stent Cobalt chromium alloy stent coated with a 2.25mm to 4.0mm diameter, $3,450.00
System blended polymer mixed with Everolimus. 8mm to 28mm length
BS175 PROMUS Element Platinum chromium alloy stent coated with 8mm to 38mm with a reference $3,450.00
a blended polymer mixed with everolimus. vessel diameter of 2.25mm -
4.0mm.
BS176 Taxus Element Platinum chromium alloy stent coated with (8mm to 38mm) with a $3,450.00
a blended polymer mixed with Paclitaxel reference vessel diameter of
2.25mm - 4.5mm
Johnson & Johnson Medical Pty Ltd
JJ302 CYPHER Sirolimus-Eluting Stent & Stainless steel coronary stent with Diameter 2.25 - 5.0mm, length $3,450.00
Delivery System Model CRS - 23300, Rapamycin (an immunosuppressive and 8-33mm
08225, 08250, 08275, 08300, 28225, antiproliferative drug) bound to the stent
28250, 28275, 28300, 33225, 33250, struts
33275, 33300, 13225, 13250, 13275,
18225, 18250, 18275, 18300, 23225,
23250, 23275, 23350, 23400, 08350,
08400, 2835
Prostheses List by Category, Groups and Sponsor Page 432 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ481 CYPHER SELECT Sirolimus-Eluting Stainless steel coronary stent with Diameter 2.25 - 5.0mm, length $3,450.00
Stent & Delivery System Sirolimus (an immunosuppressive and anti- 8 - 33mm
proliferative drug) bound to the stent by a
polymer. Model CRA-23300, 08225,
08250, 08275, 08300, 28225, 28250,
28275, 28300, 33225, 33250, 33275,
33300, 13225, 13250, 13275, 182
JJ587 CYPHER Select Plus Sirolimus Eluting Stainless steel coronary stent with Diameter 2.25 - 5.00mm, $3,450.00
Coronary Stent Sirolimus bound to the stent by a polymer Length 8 - 33mm
Medtronic Australasia Pty Ltd
MC732 Endeavour Drug Eluting Coronary Stent Cobalt Alloy, ABT - 578 Diameter: 2.25mm-4.5mm; $3,450.00
System Length: 8.00mm-38.0mm
MC769 Endeavor Sprint Drug Eluting Stent System Cobals Alloym ABT - 578 Diameter: 2.25mm-4.0mm; $3,450.00
Length: 8.0mm-30.0mm
MC816 Endeavor Resolute Drug Eluting Cobalt Alloy, ABT - 578, BioLinx Polymer Diameter:2.25mm-4.0mm; $3,450.00
Coronary Stent System Length: 8.00mm-30.0mm
Sub-Group 2: General Purpose Bare metal stents
Abbott Australasia Pty Ltd
AY028 Multilink Coronary Stent System - Vision Cobalt chrome stent 2.25mm to 4.0mm widths, 8mm $1,248.00
to 38mm lengths
AY039 MULTI-LINK 8 Coronary Stent The MULTI-LINK 8, MULTI-LINK 8 MULTI-LINK 8: Diam: 2.5, $1,248.00
System, MULTI-LINK 8 SV Coronary SV, MULTI-LINK 8 LL Coronary Stent 2.75, 3.0, 3.5, 4.0mm, Stent
Stent System and MULTI-LINK 8 LL System (CSS) is comprised of two main Length: 8, 12, 15, 18, 23,
Coronary Stent System components: the cobalt chromium (CoCr) 28mm; MULTI-LINK 8 SV
stent and the balloon expandable delivery CSS: Diam: 2.25mm, Stent
system. Length: 8, 12, 15, 18, 23,
28mm; MULTI-LINK 8 LL
CSS: Diam: 2.5, 2.75, 3.0, 3.5,
4.0mm, Stent Length: 33 and
38mm
Prostheses List by Category, Groups and Sponsor Page 433 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Atrium Australia - Pacific Rim Pty Limited
AC030 Cinatra Cobalt Chromium Coronary The Cinatra Cobalt Chromium Coronary Diameter range: 2.5mm - $1,248.00 $1,372.00
Stent System Stent System consists of a balloon 3.5mm. Length range: 8mm -
expandable Cobalt Chromium stent 25mm
premounted on a rapid exchange system
Bio Excel Australia Pty Ltd
BE001 Gazelle Coronary Stent Stainless Steel Diam 2.25-4.0mm Length 8- $1,248.00
28mm
Biotronik Australia Pty Ltd
BT082 PRO-Kinetic Cobalth Chromium coronary stent system 8-40mm length 2-5mm $1,200.00
diameter
Prostheses List by Category, Groups and Sponsor Page 434 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BT107 PRO-Kinetic Energy The PRO-Kinetic Energey stent is a The PRO-Kinetic Energy stent $1,248.00
tubular, balloon-expandable stent sculpted is available in 66 different
by laser from a single tube of L-605 cobalt diameter/length combinations.
chromium (CoCr) alloy. The stent It is available in lengths from
consists of circular segments at each end 8mm to 40mm. It is
followed by a transition zone and premounted on a delivery
helicoidally arranged struts in the middle. system which has nominal
Each loop of the helix is connected to the balloon diameters between
next loop by 3 longitudinal struts. The 2.0mm and 5.0mm.
stent surface is fully coated with a layer of
amorphous hydrogen-rich silicon carbide
(aSiC:H). This material has
semiconducting properties that efficiently
prevent the electron transfer from
fibrinogen to the metal surface in vitro.
Thereby the conversion from fibrinogen to
fibrin and it's depoisition at the stent
surface is reduced. Additionally, aSiC:H -
coated stents exhibit a lower adhesion and
activation of blood platelets and
leucocytes. Finally, the release of
potentially allergenic ions from a silicon
carbide coated stent is substantially
reduced in comparison to an uncoated
metal stent3. This coating is used on all
Biotronik coronary stents producedso far
and was subject to extensive clinical testing.
Boston Scientific Australia Pty Ltd
BS069 Liberte Coronary Stent System Consists of a balloon expandable stent, Stent lengths: 8,12,16,20,24,28 $1,248.00
pre-mounted on a Maverick 2 Monorail & 32 mm Stent diameters:
delivery catheter. 2.25, 2.5, 2.75, 3.0, 3.5, 4.0,
4.5 & 5.0 mm
Prostheses List by Category, Groups and Sponsor Page 435 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Imaxeon Pty Ltd
IX001 Amazonia CroCo Balloon expandable intracoronary cobalt Lengths: 8mm, 12mm, 16mm, $1,248.00
chromium stent premounted onto a rapid 20mm, 24mm, 28mm, 32, 36,
exchange delivery catheter and 40mm. Diameters:
2.25mm, 2.5mm, 2.75mm,
3.0mm, 3.5mm, 4.0mm, 4.50
and 5.00 mm in all lengths
Johnson & Johnson Medical Pty Ltd
DY534 Presillion Plus CoCr Coronary Stent on Cobalt Chromium, bare metal coronary Stent length 8 - 40mm x Stent $1,248.00
RX System stent Diameter 2.5 - 5.0 mm
JJ670 Presillion CoCr Coronary Stent on RX Cobalt Chromium, bare metal coronary Stent Length (mm) x Stent $1,248.00
System stent Diameter (mm) 8 x 2.50, 2.75,
3.0, 3.50, 4.0; 12 x 2.50, 2.75,
3.0, 3.50, 4.0; 17 x 2.50,
2.75, 3.0, 3.50, 4.0; 24 x 2.75,
3.0, 3.50, 4.0; 33 x 2.75, 3.0,
3.50, 4.0;
Medical Specialties Australia Pty Ltd
MS058 Arthos Pico Stent Implantation System Cobalt Chromium Stent Premounted on a Diameter: 2-4mm; Length: 8- $1,248.00
Rapid Exchange Delivery System 38mm
Medtronic Australasia Pty Ltd
MC329 Medtronic Driver, Micro Driver Cobalt Alloy Driver Stent: diameter (2.25 - $1,248.00
Coronary Stent System 4.5mm), length (8-30mm);
Micro-Driver Stent: diameter
(2.25 - 2.75mm), length (8 -
24mm)
MC932 Driver Sprint Coronary Stent System Cobalt Alloy Diameter: 2.25 - 4.5 mm; $1,248.00
Length: 8-30mm
MC956 Integrity Coronary Stent System Cobalt Alloy Coronary Stent Diameter: 2.25 - 4.5mm; $1,248.00
Length: 8 - 30mm
OrbusNeich Medical Pty Ltd
NM004 Blazer Coronary Stent Delivery System L605 Cobalt Chromium alloy balloon Expanded Stent Diameter 2.5 $1,248.00
expandable vascular prosthesis to 4.0mm, Stent Length 9 to
33mm
Terumo Corporation Australia
TU001 Tsunami Gold Stainless Steel mounted on balloon catheter Diameter 2.0mm - 4.0mm, $1,248.00
Length 8mm - 30mm length
Prostheses List by Category, Groups and Sponsor Page 436 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
TU044 Kaname Coronary Stent System BMS Coronary Stent Diameter: 2.5mm; 2.75mm; $1,248.00
3.0mm; 3.5mm; 4.0mm x
Lengths : 9mm; 12mm; 15mm;
18mm; 24mm; 28mm.
Sub-Group 3: Bare metal stents for specific indications
a, b
Abbott Australasia Pty Ltd
AY012 JoStent Coronary Stent Graft Stainless Steel/PTFE 9 - 26 mm x 2.5 - 5 mm $3,222.00
c.2
Imaxeon Pty Ltd
IX002 Nile CroCo Intracoronary stent pre-mounted on two Diameter : 2.50 - 3.50mm. $1,750.00
rapid exchange delivery systems for MB and 2.00-3.00mm SB
bifurcation lesions treatment Lengths 18 mm and 24 mm
c.3
Imaxeon Pty Ltd
IX003 Minvasys Nile Delta Coronary Stent Balloon expandable Amazonia Nile Delta 2.50mm diameter x $1,248.00
System intracoronary cobalt chromium stent 8mm length; Nile Delta 3.00mm
premounted onto a rapid exchange diameter x 8mm length
delivery catheter with tapered balloon.
Group 13: Special Purpose Percutaneous Cardiovascular Devices
Sub-Group 1: Intracardiac Defect Occluders
a
J T Medical Pty Ltd
JT001 Occlutech Figulla Flex ASD Occluder The Occlutech Figulla® Flex ASD 6, 7.5, 9, 10.5, 12, 15, 18, 21, $10,000.00
occluder is an implant for closure of an 24, 27, 30, 33, 36, 39, 40
Atrial Septal Defect of the heart (ASD
II=ASD of the Secundum Type) and is
deployed via a minimally invasive catheter
delivery system.
The Occlutech Figulla® Flex ASD is
intended for patients with substantiated
Left-Right-Shunt and a clear indication for
closure of the defect.
Prostheses List by Category, Groups and Sponsor Page 437 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JT002 Occlutech Figulla Flex PFO Occluder The Figulla® Flex PFO is an implant for 16/18, 23/25, 27/30 and 31/35 $10,000.00
closure of a patent foramen ovale (PFO)
defect in the heart and is deployed via a
minimally invasive catheter delivery system.
The Figulla® Flex PFO is intended for
patients with substantiated Right-Left-
Shunt in the contrast agent
echocardiography under Valsalva
maneuver and presence of a "cryptogenic",
paradoxical thromboembolism.
Pacing Importers Pty Ltd - Life Systems
PI020 'STARflex Rapid Transport Plus System The STARFlex Rapid Transport Plus 23mm, 28mm, 33mm and $10,200.00
System consists of two primary 38mm
components: 1) The device, a permanent
implant, which is constructed primarily of a
metal MP35N framework to which
polyester fabric is attached, and 2) The
delivery catheter, a Pebax based catheter
designed specifically to facilitate
attachment, loading, delivery and
deployment of the device to the defect.
The device and delivery catheter can be
packaged separately or pre-attached as a
single end item.
St Jude Medical Australia Pty Ltd
SJ091 Premere PFO Closure System Percutaneous, transcatheter, self- Left Atrial Anchor diameter $10,036.00
expanding, dual anchor, occlusion and 20mm, 25mm and 30mm
apposition device
SJ260 Amplatzer Duct Occluder Nitinol Wire Mesh 5 - 24mm $10,200.00
SJ261 Amplatzer Septal Occluder Nitinol Wire Mesh 4mm - 40mm $10,200.00
SJ262 Amplatzer Muscular VSD Occluder Nitinol Wire Mesh 4 - 24mm $10,200.00
SJ263 Amplatzer PFO Occluder Nitinol Wire Mesh 25mm & 35mm $10,200.00
SJ264 Amplatzer Membranous VSD Occluder Nitinol wire mesh, double disc occluder 4-24mm, Length 7-10mm $10,200.00
and delivery system
SJ267 AMPLATZER Duct Occluder II Self expandable multiple Nitinol wire mesh Waist diameter 3-6mm, $10,200.00
PDA occlusion device Nominal length 4-6mm
Prostheses List by Category, Groups and Sponsor Page 438 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
W L Gore & Associates
GT223 Helex 1.5 Septal Occluder The GORE HELEX Septal Occluder Diameters: 15, 20, 25, 30 and $10,200.00
consists of an implantable endoprosthesis 35mm
and a catheter delivery system. The
Occluder is comprised of a nickel-titanium
(Nitinol) wire frame covered with
expanded polytetrafluoroethylene
(ePTFE). The ePTFE is treated with
b
Abbott Australasia Pty Ltd
AY038 Coherex FlatStent EF PFO Closure In-tunnel PFO closure device and delivery 13mm & 19mm $10,200.00
System system
Sub-Group 3: Vascular Occlusion Devices
Denward Dell Pty Ltd TA Surimex
DW001 Nit-Occlud PDA Occlusion System Nitinol spiral coil and delivery system for Distal x Proximal Coil Diameter: $1,900.00
transcatheter occlusion of PDA 4x4mm, 5x4mm, 6x5mm,
10x6mm, 12x6mm, 14x6mm;
Introducer Sheath: 4F, 5F;
Length Introducer: 85cm,
105cm; Coil Length
configurated +-0.5mm: 3.5mm,
6.0mm, 6.5mm
DW002 Nit-Occlud PDA Occlusion System Nitinol spiral coil and delivery system for Distal x Proximal Coil Diameter: $1,650.00
(Medium) transcatheter occlusion of PDA 7 x 6mm, 9 x 6mm, 11 x 6mm,
12 x 6mm, 14 x 6mm;
Introducer Sheath: 5F; Length
Introducer: 85cm, 105cm; Coil
Length configurated +-0.5mm:
4.5; 5.0; 6.0
Prostheses List by Category, Groups and Sponsor Page 439 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 2 - Cardiothoracic Tissue Valves
Edwards Lifesciences Pty Ltd
EL032 Baxter Edwards Prima Plus Stentless Edwards Prima Plus. Porcine Valve; 19mm-29mm $4,841.00
Bioprosthesis Model 2500P Prosthetic Woven Polyester Cloth.
Heart Valve
Group 2a - Stented
Medtronic Australasia Pty Ltd
MC950 Mosaic Ultra Cinch II Small Aortic Root Bioprosthesis 19mm - 29mm $4,445.00 $5,650.00
MC962 Mosaic Cinch II Aortic Bioprosthesis 19mm -29mm $4,445.00 $5,345.00
(p)
St Jude Medical Australia Pty Ltd
SJ136 SJM Biocor Heart Valve Stented Porcine tissue valve Aortic Valves - Tissue Annulus $4,445.00
Diameter - 21 - 29mm
Mitral Valves - Tissue
Annulus Diameter - 25-35mm
SJ192 Epic Flexfit Triple-composite Bioprosthetic heart valve Aortic Valves 21-29mm tissue $4,445.00
annulus diameter, 14-20mm
total height. Mitral Valves 25-
33mm tissue annulus diameter,
15-20mm total height.
SJ201 Epic FlexFit Supra Triple-composite Bioprosthetic heart valve Tissue Annulus Diameter - $4,445.00
for supra-annular placement in the aortic 19mm-23mm. Total Height
position 14mm-16mm.
B (Bovine), E (Equine), P (Porcine)
Edwards Lifesciences Pty Ltd
EL030 CE Supra Annular Aortic Valve Model Carpentier-Edwards SAV Bioprosthesis. 19mm-33mm $4,445.00
2650 Carpentier-Edwards S.A.V Composition: Porcine Valve; Elgiloy Alloy;
Bioprosthesis Model 6650 Mitral Valve Silicone Rubber, Polytetrafluoroethylene
Prostheses List by Category, Groups and Sponsor Page 440 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC701 Mosaic Cinch, Aortic, Mitral Models 305cxx, 310cxx 19mm - 35mm $4,445.00 $5,345.00
MC771 Mosaic Ultra Small Aortic Root Bioprosthesis 19mm-29mm $4,445.00 $5,650.00
P
Medtronic Australasia Pty Ltd
MI007 Hancock II Aortic Valve Aortic bioprosthesis 21mm to 29mm $4,445.00
MI008 Hancock II Mitral Valve Mitral bioprosthesis 25mm to 33mm $4,445.00
MI009 Hancock II Ultra Aortic Valve Small aortic root bioprosthesis 21mm to 29mm $4,445.00
Group 2b - Stented, pericardial
Edwards Lifesciences Pty Ltd
EL056 Magna Mitral Carpentier-Edwards PERIMOUNT 25, 27, 29, 31 and 33mm $5,000.00 $5,690.00
Magna Mitral Bioprosthesis, Model
7000TFX
Sorin Group
SA130 Mitroflow Pericardial Bioprosthesis 19-27mm $5,000.00
(p) Pericardial
Edwards Lifesciences Pty Ltd
EL058 Magna Ease Carpentier - Edwards PERIMOUNT 19, 21, 23, 25, 27 and 29mm $5,000.00 $6,100.00
Magna Ease Bioprosthesis, Model
3300TFK
B (Bovine)
Sorin Group
SA155 Mitroflow Mitroflow Aortic Pericardial Heart Valve 19, 21, 23, 25, 27mm $5,000.00
(Model LX)
B (Bovine), E (Equine), P (Porcine)
Edwards Lifesciences Pty Ltd
EL031 Carpentier-Edwards Perimount Carpentier-Edwards Pericardial Models 2900/6900 19-33mm, $5,000.00
Pericardial Bioprosthesis - Models Bioprosthesis. Composition: Bovine Model 6900P 25, 27, 29, 31,
2900/6900 Carpentier-Edwards Pericardium; Elgiloy Alloy; Silicone 33mm
Perimount Plus Pericardial Bioprosthesis Rubber, Polytetrafluoroethylene
Mitral - Model 6900P
Prostheses List by Category, Groups and Sponsor Page 441 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
EL039 Edwards Perimount Magna Model 3000 Carpentier-Edwards Perimount Magna 19MM Aortic Pericardial $5,000.00 $5,690.00
composition: Glutaraldehyde treated Tissue Valve; 21MM Aortic
bovine pericardium/elgiloy wireform Pericardial Tissue Valve;
stent/polyester band/silicone rubber suture 23MM Aortic Pericardial
ring/polytetrafluoroethylene cloth/polyester Tissue Valve; 25MM Aortic
cloth. Pericardial Tissue Valve;
27MM Aortic Pericardial
Tissue Valve; 29MM Aortic
Pericardial Tissue Valve
Group 2c - Non-Stented
Medtronic Australasia Pty Ltd
MC015 Freestyle bioprosthesis Models 995xx, 995MSxx 19 - 35mm $5,110.00 $5,350.00
e
Medtronic Australasia Pty Ltd
MC982 3f Aortic Bioprosthesis (Model 1000) Model 1000 - EQUINE Pericardium 19 - 29 mm $5,000.00
Bioprostheseis (non stented)
Group 2: Dual Chamber ICD's
Generation 3
Guidant Australia Pty Ltd
GU149 Vitality 2 DR - Model T165 Dual Chamber ICD 30cc; 82g $43,680.00
GU150 Vitality 2 EL DR - Model T167 Dual Chamber ICD 30cc; 82g $43,680.00
Sorin Group
SA140 OVATIO DR 6550 Titanium dual chamber ICD, 29 cc 29cc $43,680.00
a
Boston Scientific Australia Pty Ltd
BS128 Confient RF HE Dual chamber ICD, high energy with RF 44cc, 87.5g $45,760.00
Sorin Group
SA147 Paradym DR 8550 Dual Chamber, High Energy, Implantable Weight: 90 grams; Volume: $45,760.00
Cardioverter Defibrillator with rate response 32.6cc; Dimensions: 58.4 x
73.4 x 11mm
Prostheses List by Category, Groups and Sponsor Page 442 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
St Jude Medical Australia Pty Ltd
SJ115 Atlas II+ DR V-268 Dual Chamber Cardioverter Defibrillator 39cc, 78g $45,760.00
SJ123 Current DR 2107 Dual Chamber Cardio-verter Defibrillator 39cc 78g $45,760.00
a, d
Biotronik Australia Pty Ltd
BT086 Lumax 340 DR-T ICD-DR 34 J with bidirectional Home One Size Only $45,760.00 $48,760.00
Monitoring. Dual chamber
BT101 Lumax 540 DR-T High Energy, Dual-Chamber ICD Diamensions: 66*55*13mm, $45,760.00 $48,760.00
(Implantable Cardiac Defibrillator) with Volume/Weight: 37.2cc/92g
Advanced Patient Management Via unique
Home Monitoring Technology
incorporating Automatic Ventricular
Threshold Monitoring
Boston Scientific Australia Pty Ltd
BS135 Teligen 100 DR DF-1/IS-1 Dual chamber ICD, high energy with RF 31.5cc, 9.9mm $45,760.00
St Jude Medical Australia Pty Ltd
SJ120 Current DR RF 2207 Dual Chamber Cardioverter Defibrillator 80g, 42cc $45,760.00
with RF Telemetry
SJ144 AnalyST DR Model CD2217-36 Dual Chamber cardioverter defibrillator 80g, 42cm $45,760.00 $47,760.00
with RF telemetry and ST Segment
Monitoring
a, d, e
Boston Scientific Australia Pty Ltd
BS134 TELIGEN 100 HE DR 4-SITE Dual Chamber ICD, high energy with RF 31.55cc, 9.9mm $46,510.00
IS4
c
Guidant Australia Pty Ltd
GU157 Vitality AVT - Model A155 Dual Chamber ICD with atrial therapies 30cc $43,680.00
Prostheses List by Category, Groups and Sponsor Page 443 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
d
St Jude Medical Australia Pty Ltd
SJ215 AnalyST DR CD2217-30 Dual chamber cardioverter defribillator 74g, 38cc $43,680.00 $45,680.00
with RF telemetry and ST segment
monitoring
Generation 4
a, c, d
Medtronic Australasia Pty Ltd
MC814 Secura DR Model D234DRG Fully Automatic, Wireless Implantable 37cc, 68g $47,130.00
cardioverter defibrillator with high energy
capability and therapies for ventricular and
atrial tachyarrhythmia
MI016 PROTECTA XT DR D354DRG Dual chamber implantable cardioverter Volume 37cc, Mass 68g $47,130.00
defribillator with SmartShock Technology,
OptiVol 2.0 Fluid Status Monitoring and
Complete Capture Management
Specifications (DF-1)
a, c, d, e
Medtronic Australasia Pty Ltd
MI025 PROTECTA XT DR D354DRM Dual chamber implantable cardioverter Volume 37cc, Mass 68g $47,880.00
defribillator with SmartShock Technology,
OptiVol 2.0 Fuild Status Monitoring and
Complete Capture Management
Sepcifications (DF-4)
a, d
St Jude Medical Australia Pty Ltd
SJ143 AnalyST Accel DR CD2219-36 Dual Chamber cardioverter defibrillator 80g, 42cc $47,130.00 $48,480.00
with RF telemetry and ST Segment
Monitoring
SJ153 Current Accel DR RF CD2215-36 Dual Chamber Cardioverter Defibrillator 80g, 42cc $47,130.00 $48,480.00
with RF Telemetry
SJ241 Fortify DR CD2233-40 Dual chamber cardioverter defibrillator 35cc, 76g $47,130.00
with 40J delivered energy
SJ248 Fortify ST DR CD2235-40 Dual chamber cardioverter defibrillator 35cc, 76g $47,130.00
with 40J delivered energy and ST segment
monitoring
Prostheses List by Category, Groups and Sponsor Page 444 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
a, d, e
St Jude Medical Australia Pty Ltd
SJ235 AnalyST Accel DR CD2219-36Q Dual chamber cardioverter defibrillator 80g, 41cc $47,880.00
with RF telemetry and ST segment
monitoring and SJ4 connector
SJ239 Current Accel DR CD2215-36Q Dual Chamber Cardioverter Defibrillator 80g, 41cc $47,880.00
with RF Telemetry and SJ4 connector
SJ249 Fortify DR CD2233-40Q Dual chamber cardioverter defibrillator 35cc, 76g $47,880.00
with 40J delivered energy
SJ250 Fortify ST DR CD2235-40Q Dual chamber cadioverter defibrillator with 35cc, 75g $47,880.00
40J delivered energy and ST segment
monitoring
d
St Jude Medical Australia Pty Ltd
SJ214 Current Accel DR RF CD2215-30 Dual chamber cardioverter defribillator 74g, 38cc $46,030.00
with RF telemetry
SJ217 AnalyST Accel DR CD2219-30 Dual Chamber cardioverter defibrillator 74g, 38cc $46,030.00
with RF telemetry and ST segment
monitoring
Group 3 - Cardiothoracic Valve Conduits
Group 3a - Mechanical Valve
Medtronic Australasia Pty Ltd
MC198 Medtronic Hall rotatable aortic valved Titanium, pyrolite, dacron 20 - 33mm $6,950.00
collagen impregnated conduit Model
R7700
MC979 Open Pivot Aortic Valved Graft (Model Pyrolythic Carbon, Double Velour 21- 33mm $6,950.00
502AG) Polyester, Titanium
Prostheses List by Category, Groups and Sponsor Page 445 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Sorin Group
SA128 CarboSeal Ascending Aortic Prosthesis, Mechanical Conduit AP 21-33mm, CP 21 - 33mm $6,950.00
sterile, CarboSeal Ascending Aortic
Prosthesis with Handle Model AP21,
Model AP23, Model AP25, Model
AP27, Model AP29, Model AP31,
Model AP33, Carboseal Valsalva
St Jude Medical Australia Pty Ltd
SJ036 St Jude Medical Coated Aortic Valved Coated Aortic Valved Graft 21mm - 33mm $6,950.00
Graft
SJ104 SJM Masters Series Aortic Valved St Jude Medical Mechanical Heart Valve Annulus Diameter 19-29mm $6,950.00
Prosthesis - VAVGJ sewn into the base of a woven polyester
fibre graft which has been impregnated
with bovine-derived gelatin
Group 3b - Tissue Valve, stented porcine
Medtronic Australasia Pty Ltd
MC012 Medtronic Hancock Valved Conduit Porcine bioprosthesis, dacron 12, 14, 16, 18, 20, 22, 25, $5,900.00 $6,800.00
Model 100/150 30mm.
Group 3: ICD's with CRT
Generation 2
Boston Scientific Australia Pty Ltd
BS129 LIVIAN CRT-D CRT-D with RF 40cc, 79.5g, 14.5mm $45,760.00
Guidant Australia Pty Ltd
GU147 Contak Renewal 4 CRT-D Model CRT-D One Size only $45,760.00
H190, Model H195
Sorin Group
SA138 OVATIO CRT-D 6750 Titanium, dual chamber ICD with CRT 30cc $45,760.00
a
Boston Scientific Australia Pty Ltd
BS130 LIVIAN CRT-D HE CRT-D, high energy with RF 44cc, 87.5g, 14.5mm $47,840.00
Prostheses List by Category, Groups and Sponsor Page 446 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Guidant Australia Pty Ltd
GU144 Contak Renewal 4 HE CRT-D Model CRT-D high energy One size only $47,840.00
H197, Model H199
Sorin Group
SA145 PARADYM CRT-D 8750 Implantable Cardioverter Defibrillator with 34cc, 94 grams; 61.8 x 73.4 x $47,840.00
Cardiac Resynchronisation therapy, High 11mm
Energy
St Jude Medical Australia Pty Ltd
SJ109 Atlas II+ HF V-367 Cardiac Resynchronisation Therapy 41cc, 79g $47,840.00
Defibrillator with V-V Timing
Programmability
a, c
Guidant Australia Pty Ltd
GU155 Contak Renewal 4 AVT HE CRT - D - Implantable Cardioverter Defibrillator with 40cc; 89g $47,840.00
Model M177, M179 cardiac resynchronisation Therapy
a, d
Biotronik Australia Pty Ltd
BT102 Lumax 540 HF-T High Energy, Three Chamber ICD Diamensions: 66*59*13 mm, $47,840.00 $53,000.00
(Implantable Cardiac Defibrillator) with Volume/Weight: 39.8cc/94g
Advanced Patient Management Via unique
Home Monitoring Technology
incorporating Automatic RV/LV Threshold
Monitoring and Extended Longevity.
Boston Scientific Australia Pty Ltd
BS139 COGNIS 100 HE (DF-1/IS-1 & DF- CRT-D high energy with RF 32.5cc, 9.9mm $47,840.00
1/LV-1)
St Jude Medical Australia Pty Ltd
SJ128 Promote RF CRT-D 3213 Cardiac Resynchronisation Therapy 43cc, 82g $47,840.00 $49,840.00
Defibrillator with RF Telemetry
a, d, e
Boston Scientific Australia Pty Ltd
BS138 COGNIS 100 HE 4-SITE CRT-D high energy with RF IS4 32cc, 9.9mm $48,590.00
Prostheses List by Category, Groups and Sponsor Page 447 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
c
Guidant Australia Pty Ltd
GU154 Contak Renewal 4 AVT CRT -D - Implantable Cardioverter Defibrillator with 37cc; 89g $45,760.00
Model M170 and M175 Cardiac Resynchronisation Therapy
Generation 3
a, c, d
Medtronic Australasia Pty Ltd
MC812 Consulta CRT-D Model D234TRK Fully Automatic, Wireless Implantable 38cc, 68g $52,000.00
cardioverter defibrillator with cardiac
resynchronization therapy (CRT), and
therapies for ventricular and atrial
tachyarrhythmia
MI017 Protecta XT CRT-D D354TRG Implantable Cardioverter Defibrillator with Volume 38cc, Mass 68g $52,000.00
Cardiac Resynchronisation therapy,
SmartShock Technology, OptiVol 2.0
Fluid Status Monitoring and Complete
Capture Management Specifications (DF-
1)
a, c, d, e
Medtronic Australasia Pty Ltd
MC983 Consulta CRT-D Model D214TRM Fully Automatic, Wireless Implantable 38cc $52,750.00
cardioverter defribillator with cardiac
resynchronization therapy (CRT), and
therapies for ventrilcular and atrial
tachyarrhythmia. DF-4 lead connector.
MI026 Protecta XT CRT-D D354TRM Implantable Cardioverter Defibrillator with Volume 38cc, Mass 68g $52,750.00
Cardiac Resynchronisation therapy,
SmartShock Technology, OptiVol 2.0
Fluid Status Monitoring and Complete
Capture Management Specifications (DF-
4)
a, d
St Jude Medical Australia Pty Ltd
SJ150 Promote Accel RF CD3215-36 Cardiac Resynchronisation Therapy 82g, 43cc $52,000.00
Defibrillator with RF Telemetry
Prostheses List by Category, Groups and Sponsor Page 448 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SJ246 Unify CRT CD3235-40 Cardiac Resynchronisation Therapy 36cc, 78g $52,000.00
Defibrillator with 40J delivered
SJ253 Promote Quadra CRT CD3239-40 Cardiac Resynchronisation Therapy 46cc, 88g $52,000.00
Defibrillator with 40J delivered energy and
VectSelect Quartet Programmable LV
pulse configuration
a, d, e
St Jude Medical Australia Pty Ltd
SJ236 Promote Accel CD3215-36Q Cardiac Resynchronisation Therapy 82g, 43cc $52,750.00
Defibrillator with RF Telemetry and SJ4
connector
SJ244 Unify CRT CD3235-40Q Cardiac Resynchronisation Therapy 36cc, 77g $52,750.00
Defibrillator with 40J delivered energy and
SJ4 connector
SJ252 Promote Quadra CRT CD3239-40Q Cardiac Resynchronisation Therapy 46cc, 88g $52,750.00
Defibrillator with 40J delivered energy and
VectSelect Quartet Programmable LV
pulse configuration and SJ 4 connector
d
St Jude Medical Australia Pty Ltd
SJ145 Promote Accel CD3215-30 Cardiac Resyncronisation Therapy 76g, 39cc $49,760.00
Defibrillator with RF Telemetry
Prostheses List by Category, Groups and Sponsor Page 449 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 4 - Cardiothoracic Atrio-Ventricular Rings and Bands
Group 4a - Ring, Standard
Edwards Lifesciences Pty Ltd
EL028 Baxter Sterile Grafts, Implants & Carpentier-Edwards Classic Annuloplasty 24mm-40mm $2,200.00
Prostheses, Non-Animal Origin Ring. Composition: Titanium Alloy;
Annuloplasty: Ring-Mitral Ring with Silicone Rubber; Polyester Fabric
Holder; Mitral Cosgrove-Edwards Carpentier-Edwards Physio Annuloplasty
Annuloplasty System Model 4600; Ring. Composition: Elgiloy Bands;
Classic Annuloplasty Ring-Tricuspid Polyester Film Strips; Silicone Rubber;
Polyester Cloth, Cosgrove-Edwards
Annuloplasty Band. Composition: Silicone
Rubber; Polyester Cloth. Carpentier-
Edwards Tricuspid Ring. Composition:
Titanium Alloy; Silicone Rubber; Polyester
Fabric
Medtronic Australasia Pty Ltd
MC005 Medtronic Duran Annuloplasty Ring; Annuloplasty Devices - Models 610R & Model 610R 25-35mm & $2,200.00
Duran Ancore Ring 620R; Duran 620R Silicone / Barium Sulphate, Dacron. Model 620R 23-35mm
Ancore Chordal Model 620RG
Sorin Group
SA127 AnnuloFlo Annuloplasty System Annuloflex Ring or AnnuloFlo Ring 26-36mm $2,200.00
St Jude Medical Australia Pty Ltd
SJ035 SJM Tailor Annuloplasty Ring Fully Flexible 25mm - 35mm $2,200.00
Group 4b - Ring, with modification
Edwards Lifesciences Pty Ltd
EL049 Edwards Etlogix Annuloplasty Ring Titanium/silicon/dacron polyester 24mm/26mm/28mm/30mm/32 $2,400.00
cloth/plastic template Mitral valve annular mm/34mmd
repair device designed specifically for
patients with Ischemic Mitral regurgitation
EL057 Geoform Geoform annuloplasty ring Model 4200 26, 28, 30 and 32mm $2,400.00
with Holder
Prostheses List by Category, Groups and Sponsor Page 450 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
EL059 Carpentier-Edwards PHYSIO ll Mitral PHYSIO II is a semi rigid mitral 24, 26, 28, 30, 32, 34, 36, 38, $2,400.00
Annuloplasty Ring annuloplasty ring, with an improved saddle 40mm
shape and global disease based design
Medtronic Australasia Pty Ltd
MC745 CG Future Composite Ring Semi-rigid mitral annuloplasty ring, with 24, 26, 28, 30, 32, 34, 36 & $2,400.00
anterior flexibility 38mm
MC844 Profile 3D Annuloplasty Ring 3D, rigid annuloplasty ring with physiologic Diameter (mm) 24 - 40mm $2,400.00
mitral valve shape
Sorin Group
SA150 MEMO 3D Memo 3D Semirigid Mitral Annuloplasty 24-38mm $2,400.00
Ring, with 3D flexibility and coasted with
Carbofilm
St Jude Medical Australia Pty Ltd
SJ087 St Jude Medical Rigid Saddle Ring Rigid Annuloplasty Ring 24 - 34mm $2,400.00
SJ195 Attune Flexible Adjustable Annuloplasty Flexible annuloplasty ring 25mm - 43mm $2,200.00
Ring
Group 4c - Band, Standard
Edwards Lifesciences Pty Ltd
EL050 Edwards MC3 Tricuspid Annuloplasty Annuloplasty Ring, 26mm to 36mm in 2mm $2,400.00
System titanium/silicone/polyester velour increment
cloth/plastic template
Group 4d - Band, with modification
Medtronic Australasia Pty Ltd
MC709 Posterior Annuloplasty Band; Colvin - Annuloplasty - Model 610B & 620B Model 610B: 25-35mm; $2,200.00
Galloway Future Band Model 638B; Silicone / Barium Sulphate, Dacron. Models 620B & 620BG: 23-
Duran Ancore Band 620B; Duran Models 638B semi-regid metal alloy core, 35mm, Model 638B - 26-
Ancore Chordal Model 620BG silicone coating, polyester knit fabric, kit 38mm
includes-band, malleable handle, template
with suture markers, sizers
St Jude Medical Australia Pty Ltd
SJ088 SJM Tailor Annuloplasty Band Flexible double-velour, polyester fabric 25 - 35mm $2,200.00
Prostheses List by Category, Groups and Sponsor Page 451 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 4: Single Chamber Pacemakers
Generation 2
St Jude Medical Australia Pty Ltd
SJ076 Verity Adx Model XL SR 5157 M/S Single Chamber multi-programmable rate- 11cc, 23g $5,928.00
implantable pacemaker adaptive pacing devices with extended
longevity
Generation 3
Biotronik Australia Pty Ltd
BT109 Entovis SR Fully automatic, extended longevity, single 53 x 39 x 6.5W x H x D [mm], $5,928.00
cFully automatic, extended longevity, single Size 1 [cm3], 25 Mass[g]
chamber pacemaker with Closed Loop
Stimulation.
BT113 Evia SR Fully automatic, extended longevity, single 53 x 39 x 6.5 W x H x D [mm], $5,928.00
chamber pacemaker with Closed Loop Size 10[cm3], 25 Mass [g]
Stimulation.
Boston Scientific Australia Pty Ltd
BS124 Insignia AVT 1192 Single chamber rate responsive pacemaker 10cc, 23.4g $5,928.00
BS145 Altrua 20 SR Single chamber rate responsive pacemaker 10cc - 15cc $5,928.00
BS147 Altrua 40 SR Single chamber rate responsive pacemaker 10cc - 15cc $5,928.00
BS149 Altrua 50 SR Single chamber rate responsive pacemaker 10cc - 15cc $5,928.00
BS152 Altrua 60 SR Single chamber rate responsive pacemaker 10cc - 15cc $5,928.00
Guidant Australia Pty Ltd
GU124 Insignia Entra SR Models 1195 & 1198 Single Chamber Rate Responsive One size only $5,928.00
Permanent Pacemaker
GU126 Insignia Plus SR Model 1194 Single Chamber Rate Responsive One size only $5,928.00
Permanent Pacemaker
GU139 Insignia Ultra SR Model 1190 Single Chamber Rate Responsive One size only $5,928.00
Pacemaker
Prostheses List by Category, Groups and Sponsor Page 452 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC728 Adapta Pacemaker SR PacemakerModels ADSR01, 9.7 - 11.0cc21.5 - 22.5g $5,928.00
ADSR06, ADSR03
Sorin Group
SA137 Symphony SR Titanium one size only $5,928.00
SA142 Reply™ SR Single chamber permenent pacemaker with 37 x 41.5 x 6.1mm $5,928.00
rate response modulation 19 Grams
7.5 cm3
SA143 ESPRIT SR Single Chamber Permanent Pacemaker Dimensions: 37.4 x 41.5 x $5,928.00
with Rate Response Modulation 6.1mm Weight : 19grams.
Volume: 7.5 cm3
St Jude Medical Australia Pty Ltd
SJ060 Identity ADx Model SR 5180 Single Chamber multi-programmable rate- 8cc, 18g $5,928.00
implantable pacemaker adaptive pacing device
SJ077 Verity Adx Models XL SR 5156 Single Chamber multi-programmable rate- 11cc, 23g $5,928.00
implantable pacemaker adaptive pacing devices with extended
longevity
SJ090 Victory SR 5610 single chamber rate responsive pacemaker 41x44x46mm 17g 8cc $5,928.00
SJ105 Zephyr SR 5620 Single Chamber Rate-Responsive 8cc, 17g $5,928.00
Pacemaker
SJ131 Zephyr XL SR 5626 Single-Chamber Rate-Responsive 23.5g and 10.4cc $5,928.00
Pacemaker
SJ205 Accent SR PM 1110 Single Chamber Rate Responsive 18g, 9.5cc $5,928.00
Pacemaker
SJ255 Accent ST PM1122 Single Chamber Pacemaker with ST 21g, 9.5cc $5,928.00
segment monitoring
SJ259 Accent MRI SR RF PM1224 Single Chamber Pacemaker with RF 23g, 13.1cc $5,928.00
Telemetry and MRI testing capability
a
St Jude Medical Australia Pty Ltd
SJ027 St Jude Medical Microny II SR+ Model Single Chamber Rate Responsive Volume 5.9cc, Weight 12.8gm $5,928.00
2525T Pacemaker Pacemaker
Prostheses List by Category, Groups and Sponsor Page 453 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
d
Biotronik Australia Pty Ltd
BT108 Entovis SR-T Fully automatic, extended longevity, single 53 x 39 x 6.5 W x H x D [mm], $5,928.00 $8,928.00
chamber pacemaker with Closed Loop Size 11 [cm3], 24 mass[g]
Stimulation & BIOTRONIK Home
Monitoring
BT110 Evia SR-T Fully automatic, extended longevity, single 53 x 39 x 6.5 W x H x D [mm], $5,928.00 $8,928.00
chamber pacemaker with Closed Loop Size 11 [cm3], 24 Mass [g]
Stimulation & BIOTRONIK Home
Monitoring
St Jude Medical Australia Pty Ltd
SJ200 Accent SR RF PM1210 Single Chamber Pacemaker with RF 23g, 12.8cc $5,928.00 $7,928.00
telemetry
SJ257 Accent ST RF PM1222 Single Chamber Pacemaker with ST 12.8g, 23g $5,928.00
Segment Monitoring and RF Telemetry
Group 5 - Cardiothoracic Membranes and Patches
Group 5a - Tissue
Advanced Biomedical Pty Ltd
AB066 Supple Peri-Guard (10 x 16cm) Model No PC1016SN - 10 x 16 Bovine 10 x 16cm $760.00
pericardium patch
AB067 Supple Peri-Guard (8 x 14cm) Nodel No PC0814SN - 8 x 14 Bovine 8 x 14cm $700.00
pericardium patch
AB068 Supple Peri-Guard (6 x 8cm) Model No PC0608SN -6 x 8cm Bovine 6 x 8cm $610.00
pericardium patch
AB069 Supple Peri-Guard (4 x 4cm) Model No PC0404SN - 4 x 4cm Bovine 4 x 4cm $350.00
pericardium patch
Edwards Lifesciences Pty Ltd
EL033 Baxter Augmentation / Substitution Edwards Pericardial Patch. Bovine 10cm x 16cm $760.00
Material, Human or Animal Origin, Pericardium.
Sterile Pericardial Patch.
Group 5b - Synthetic, Cardiovascular
Tag Medical
TM040 Repel - CV Bioresorbable Adhesion Barrier 18cmx13.5cmx137 microns $550.00
Prostheses List by Category, Groups and Sponsor Page 454 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
W L Gore & Associates
GT117 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm Thickness 2 x 9cm $240.00
GT118 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm - 3 x 6cm $280.00
0.6mm - 2.5cm x 15cm & 5cm
x 7.5cm
GT120 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 5 x 15cm $521.00
GT121 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 10 x 15cm $945.00
GT126 Acuseal Cardiovascular Patch Vascular ePTFE 0.5mm Thickness 1 x 9cm; 0.8 $223.00
x 7.5cm
GT127 Acuseal Cardiovascular Patch Cardiac ePTFE 0.5mm Thickness 3 x 6cm & 5 $270.00
x 7.5cm
Group 5c - Synthetic, Non-cardiovascular
W L Gore & Associates
GT122 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 6 x 12cm $360.00
GT123 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 8 x 16cm $643.00
GT124 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 12 x 12cm $748.00
GT125 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 15 x 20cm $1,455.00
Group 5: Dual Chamber Pacemakers
Generation 1
Boston Scientific Australia Pty Ltd
BS123 Insignia AVT 882 Dual chamber VDD pacemaker 10.0cc, 23.5g $5,200.00
BS150 Altrua 50 VDD Dual chamber VDD pacemaker 10cc - 15cc $5,200.00
Generation 2
Medtronic Australasia Pty Ltd
MC713 Adapta Pacemaker VDDR PacemakerModels ADVDD01 11.1cc23.6g $6,760.00
St Jude Medical Australia Pty Ltd
SJ054 Identity ADx Model VDR 5480 Single Chamber multi-programmable rate- 8cc, 18g $6,760.00
implantable pacemaker adaptive pacing device with extended
longevity
Prostheses List by Category, Groups and Sponsor Page 455 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Generation 3
Boston Scientific Australia Pty Ltd
BS126 Insignia AVT 1292 Dual chamber rate responsive pacemaker 10.8cc, 25.4g $9,360.00
BS144 Altrua 20 DR Dual chamber rate responsive pacemaker 10cc - 15cc $9,360.00
BS146 Altrua 40 DR Dual chamber rate responsive pacemaker 10cc - 15cc $9,360.00
BS148 Altrua 50 DR Dual chamber rate responsive pacemaker 10cc - 15cc $9,360.00
BS151 Altrua 60 DR Dual chamber rate responsive pacemaker 10cc - 15cc $9,360.00
Guidant Australia Pty Ltd
GU120 Insignia Plus DR Model 1297, Insignia Dual Chamber Rate Responsive One size only $9,360.00
Plus DR Model 1298 Permanent Pacemaker
GU121 Insignia Entra DR Models Dual Chamber Rate Responsive One size only $9,360.00
1294,1295,1296 Permanent Pacemaker
GU140 Insignia Ultra DR Model 1291 Dual Chamber Rate Responsive One size only $9,360.00
Pacemaker
GU141 Insignia Ultra DR Model 1290 Dual Chamber Rate Responsive One size only $9,360.00
Pacemaker
Sorin Group
SA136 Symphony DR 2550 Active Implantable pacemaker 1 size only $9,360.00
SA141 Reply™ DR Dual Chamber permanent Pacemaker with 8cc, Weight: 20grams, $9,360.00
Rate Response Modulation Dimensions:41.2 x 41.5 x 6.1mm
SA144 ESPRIT DR Dual Chamber Permanent Pacemaker with 8cc, Weight: 20grams, $9,360.00
Rate Response Modulation Dimensions:41.2 x 41.5 x 6.1mm
St Jude Medical Australia Pty Ltd
SJ051 Verity Adx Implantable Pacemaker, Dual - Chamber, multi-programmable, 45x52x6mm,11cc, 23g, 5mm $9,360.00
Models XL DR 5356 and XL DR rate-responsive pacemaker withAF or 6mm M/S
5357M/S suppression
Prostheses List by Category, Groups and Sponsor Page 456 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SJ059 Identity ADx Models DR 5380 and XL Dual-Chamber, multi-programmable, rate- ADx DR 5380: 43x44x6mm, $9,360.00
DR 5386 adaptive pacing devices with AF 18g and 8ccADx XL DR
suppression 5386: 44x52x6mm, 23.5g and
11cc
SJ089 Victory XL DR 5816 and DR 5810 Dual Chamber Rate Responsive 44x52x6mm; 23.5g; 11cc $9,360.00
Pacemakers
Generation 4
Biotronik Australia Pty Ltd
BT111 Entovis DR Fully automatic, extended longevity, Dual 53 x 43 x 6.5W x H x D [mm], $11,440.00
Chamber Pacemaker with Closed Loop Size 11 [cm3], 26 Mass [g]
stimulation & Vp Suppression
BT112 Evia DR Fully automatic, extended longevity, Dual 53 x 43 x 6.5 W x H x D [mm], $11,440.00
Chamber Pacemaker with Closed Loop Size 11 [cm3], 26 Mass [g]
stimulation & Vp Suppression.
Medtronic Australasia Pty Ltd
MC726 Adapta Pacemaker DR PacemakerModels ADDR01, 11.1-14.2cc23.6g-31.3g $11,440.00
ADDRS1, ADDRL1, ADDR06,
ADDR03
St Jude Medical Australia Pty Ltd
SJ103 Zephyr XL DR 5826 and DR 5820 Dual Chamber Rate-Responsive 5826 - 23.5g, 11cc and 5820 - $11,440.00
Pacemaker 18g, 8.5cc
SJ193 Accent DR PM 2112 Dual Chamber Pacemaker 19g, 10.5cc $11,440.00
SJ256 Accent ST PM2122 Dual Chamber Pacemaker with ST 10.5cc, 19g $11,440.00
segment monitoring
SJ258 Accent MRI DR RF PM2224 Dual Chamber Pacemaker with RF 24g, 13.1cc $11,440.00
Telemetry and MRI testing capability
b
Medtronic Australasia Pty Ltd
MC933 Advisa DR MRI SureScan Model A3DR01 Digital dual chamber 13cc, 22g $11,780.00
pacemaker with SureScan Technology
(OAE-DDDR) MR Conditional with MVP
Mode, Complete Capture Management
Diagnostic (ACM, RVCM), AT/AF Suite
Diagnostics and Therapies, OptiVol Fluid
Status Monitoring, and Therapy Guide
Feature
Prostheses List by Category, Groups and Sponsor Page 457 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC934 Advisa DR Model A5DR01 Digital dual chamber 13cc, 22g $11,780.00
pacemaker (OAE-DDDR) MVP mode
with Complete Capture Management
Diagnostic (ACM, RVCM) AT/AF Suite
Diagnostics and Therapies, OptiVol Fluid
Status Monitoring, and Therapy Guide
Feature
d
Biotronik Australia Pty Ltd
BT114 Evia DR-T Fully automatic, extended longevity, Dual 53 x 44.5 x 6.5 W x H x D $11,440.00 $14,440.00
Chamber Pacemaker with Closed Loop [mm], Size 12 [cm3], 25 Mass
stimulation, Vp Suppression and [g]
BIOTRONIK Home Monitoring
BT115 Entovis DR-T Fully automatic, extended longevity, Dual 53 x 44.5 x 6.5 W x H x D $11,440.00 $14,440.00
Chamber Pacemaker with Closed Loop [mm], Size 12 [cm3], 25 Mass
stimulation, Vp Suppression and [g]
BIOTRONIK Home Monitoring
St Jude Medical Australia Pty Ltd
SJ196 Accent DR RF PM2212 Dual chamber Pacemaker with RF 236, 12.8cc $11,440.00 $13,440.00
telemetry
SJ254 Accent ST RF PM2222 Dual Chamber Pacemeker with ST 23g, 12.9cc $11,440.00
Segment Monitoring and RF Telemetry
Group 6 - Cardiothoracic Assisted Anastomic Devices
Medtronic Australasia Pty Ltd
MC680 Spyder Proximal Anastomotic Device 6-clip assembly $590.00
Group 6: CRT Pacemakers
Generation 2
Guidant Australia Pty Ltd
GU142 Contak Renewal TR2 CRT - P Model CRT-P 45x54x8.5mm, 14cc, 26gm $12,480.00
H140, Model H145
Prostheses List by Category, Groups and Sponsor Page 458 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
St Jude Medical Australia Pty Ltd
SJ072 Frontier II - Model 5596 Biventricular Cardiac Resynchronisation 49mm(h) x 52(1) x 6(t), 25g $12,480.00
Device with AF suppression algorithm -
Titanum
d
Biotronik Australia Pty Ltd
BT085 Stratos LV-T Multiprogrammable Biventricular DDDRV One size only $12,480.00 $15,480.00
with Home Monitoring
Generation 3
St Jude Medical Australia Pty Ltd
SJ194 Anthem PM3112 CRT Pacemaker Cardiac Resynchronisation Therapy 21g, 11.5cc $13,520.00 $14,560.00
Pacemaker
b
Medtronic Australasia Pty Ltd
MI012 Consulta CRT-P Cardiac Resynchronisation Therapy One size only $13,520.00
Pacemaker, Model C3TR01
d
St Jude Medical Australia Pty Ltd
SJ207 Anthem RF PM3212 CRT Pacemaker with RF telemetry 25g, 13.7cc $13,520.00 $14,560.00
Group 7 - Cardiothoracic Assisted Fixation Devices
Group 7a Valvular
Medtronic Australasia Pty Ltd
MC714 U-Clips (Valve Repair) Double Arm, Mitral Valve Repair 2-packs $510.00
Group 7b Related to anastomosis
Medtronic Australasia Pty Ltd
MC765 U-Clips Nitinol Clips, 8-pack Needle Lengths: 6.5mm - $336.00
9.5mm, 8-pack
MC772 U-Clips Nitinol Clips, 2-pack Needle Lengths: 6.5mm - $84.00
9.5mm, 2-Pack
Prostheses List by Category, Groups and Sponsor Page 459 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 7c Related to skeletal fixation
s
Advanced Biomedical Pty Ltd
AB074 FLEXIGRIP (Various Sizes) Nitinol Sternal Closure Clips - various sizes 20mm - 40mm $80.00 $140.00
Group 7: ICD Leads
Sub -Group 1: Coronary Sinus Leads
Medtronic Australasia Pty Ltd
MC026 Medtronic Transvene SVC Lead Model Model 6937-35, Model 6937-52, Model 35 - 110cm x 660mm $2,340.00
6937; 6937-58, Model 6937-110; Silicone;
Sub -Group 2: Subcutaneous Leads
Guidant Australia Pty Ltd
GU123 Endotak SQ Array XP Lead Model 0085 Sub-Q Array for high DFT 70cm $4,680.00
Medtronic Australasia Pty Ltd
MC251 Implantable Subcutaneous Defibrillator Silicone and Platinum Alloy Lengths 41-85cm inclusive $4,680.00
Lead Model 6996SQ 41cm, 58cm, 85cm
Sub -Group 5: Transvenous/ Steroid/ Passive Leads
Biotronik Australia Pty Ltd
BT092 Linox TD Fractal and steroid coated passive fixation 65, 74 or 100cm length and 16 $9,360.00
quadripolar ICD lead or 18mm electrode spacing
BT093 Linox T Passive fix RV bipolar fractal coated 65, 75cm length $9,360.00
steroid ICD lead
BT119 Linox SMART TD Linox SMART TD is a family of ICD Length: Linox SMART TD $9,360.00
leads with an active fixation helix. The 65/16 65cm, Linox SMART
fixation helix is comprised of platinum TD 65/18 65cm, Linox
iridium alloy. SMART TD 75/18 75cm;
Lead Body Diameter: 7.8Fr
Prostheses List by Category, Groups and Sponsor Page 460 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Guidant Australia Pty Ltd
GU115 Endotak Reliance Lead Passive Dual Coil 59cm, 64cm, 90cm $9,360.00
GU158 Endotak Reliance SG Passive Passive Single Coil wih GORE ePTFE 54cm - 90cm $9,360.00
covered coils
GU159 Endotak Reliance G Passive Passive Dual Coil with GORE ePTFE 54cm - 90cm $9,360.00
covered coils
Medtronic Australasia Pty Ltd
MC002 Medtronic Sprint Quattro Lead Model Silicone and polyurethane 65-100cm $9,360.00
6944RV/SVC 65cm; Model
6944RV/SVC 75cm; or Model
6944RV/SVC 100cm; Medtronic Sprint
Quattro Lead Model 6944RV/SVC
58cm
Sorin Group
SA148 ISOLINE 2CT Passive fixation, steroid eluting, intergrated Lead body is 7.8 French $9,360.00
bipolar, dual shock coil defibrillation lead. diameter whilst 65cm in length
St Jude Medical Australia Pty Ltd
SJ130 Riata ST Optim 7070/1 Passive Fixation, True bipolar, Dual Coil, 60, 65 and 70cm length, 7Fr $9,360.00
Steroid Eluting, Endocardial Defibrillation introducer
Leads with Optim insulation overlay
SJ158 Durata 7170, 7171 Passive fixation, true bipolar, dual coil, 60, 65 and 70cm $9,360.00
steroid eluting, endocardial defibrillation
leads with Optium insulation overlay
a
Boston Scientific Australia Pty Ltd
BS170 Endotak Reliance S 4-SITE Passive fixation single coil defibrillation 50-70cm $9,360.00
leads & 4-SITE connector.
BS180 Endotak Reliance G 4-SITE Passive fixation dual coil defibrillation leads 50-70cm $9,360.00
with ePTFE covered coils & 4-SITE
connector
BS181 Endotak Reliance SG 4-SITE Passive fixation single coil defibrillation 50-70 $9,360.00
leads with ePTFE covered coil & 4-SITE
connector
Prostheses List by Category, Groups and Sponsor Page 461 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BS183 Endotak Reliance 4-SITE Passive fixation dual coil defibrillation leads 50-70cm $9,360.00
with 4-SITE connector
St Jude Medical Australia Pty Ltd
SJ245 Durata 7170Q, 7171Q and 7172Q 7170Q/7171Q - passive fixation, bipolar, 52, 58 and 65cm, 7F $9,360.00
dual coil, 7172Q - passive fixation, bipolar introducer
- single coil steroid eluting endocardial
defibrillation leads with Optim insulation
overlay and SJ4 quadripolar lead connector
Sub -Group 6: Transvenous/ Steroid/ Active Leads
Biotronik Australia Pty Ltd
BT084 Linox SD Fractal coated and steroid electrode, 65, 75cm length, 16, 18mm $9,000.00 $9,360.00
active fixation quadrapolar elec dis
BT096 Linox S Active fix RV bipolar fractal coated steroid 65, 75cm length $9,000.00 $9,360.00
IC lead
BT120 Linox SMART SD Linox SMART SD is a family of ICD Length: Linnox SMART SD $9,000.00
leads with an active fixation helix for the 60/16 61.2cm; Linnox SMART
therapy of tachycardia arrhythmia. The SD 65/16 65cm; Linnox
active fixation helix is comprised of SMART SD 65/18 65cm;
platinum iridium alloy. Linnox SMART SD 75/18
75cm; Lead Body Diameter:
7.8Fr
Guidant Australia Pty Ltd
GU163 ENDOTAK RELIANCE G Active Active Dual Coil with GORE ePTFE 59-90cm $9,000.00
covered coils
GU164 ENDOTAK RELIANCE SG Active Active Single coil with GORE ePTFE 59-90cm $9,000.00
covered coils
Medtronic Australasia Pty Ltd
MC208 Medtronic Sprint Quattro Secure Lead Leads, Defibrillator, Implantable, Silicone, 58-100cm $9,000.00
Model 6947 58cm; Model 6947 65cm; polyurethane, platinized tantalum coils,
Model 6947 75cm; Model 6947 100cm steroid eluting tip
MC834 Sprint Quattro Secure S Model 6935, Active Fixation Single Coil 52 - 100cm $9,000.00
Defibrillation Lead
Prostheses List by Category, Groups and Sponsor Page 462 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Sorin Group
SA146 ISOLINE 2CR Active fixation, steroid eluting, integrated Lead body is 7.8 French $9,000.00 $9,360.00
bipolar, dual coil defibrillation lead diameter whilst 65cm in length
St Jude Medical Australia Pty Ltd
SJ122 Riata ST Optim 7020/1/2 and 7030/1 7020/1 - Active fixation, true bipolar, 60, 65 and 75cm length and $9,000.00 $9,360.00
7022 - Active fixation, true bipolar - single 7Fr introducer
coil, 7030/1 - Active fixation, integrated
bipolar, dual coil steroid eluting
endocardial defibrillation leads with Optim
insulation overlay
SJ157 Durata 7120, 7121, 7122, 7130, 7131 Active fixation bipolar, dual-coil/single coil 60, 65, 75cm $9,000.00 $9,360.00
Steroid-eluting Endocardial Defibrillation
Leads
a
Boston Scientific Australia Pty Ltd
BS174 Endotak Reliance SG 4-SITE Active fixation single coil defibrillation 50-70cm $9,000.00
leads with ePTFE covered coil & 4-SITE
connector.
BS178 Endotak Reliance 4-SITE Active fixation dual coil defibrillation leads 50-70cm $9,000.00
with 4-SITE connector
BS179 Endotak Reliance S 4-SITE Active fixation single coil defibrillation 50-70mm $9,000.00
leads & 4-SITE connector
BS182 Endotak Reliance G 4-SITE Active fixation dual coil defibrillation leads 50-70cm $9,000.00
with ePTFE covered coils & 4-SITE
connector.
St Jude Medical Australia Pty Ltd
SJ230 Durata 7120Q, 7121Q and 7122Q 7120/1Q - Adtive fixation, true bipolar; 52cm, 58cm and 65cm $9,000.00 $9,360.00
7122Q - Active fixation true bipolar -
single coil steroid eluting endocardial
defibrillation leads with Optim insulation
overlay and SJ4 quadripolar lead
connector.
Prostheses List by Category, Groups and Sponsor Page 463 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SJ233 Riata ST Optim 7020Q, 7021Q, 7022Q 7020/1Q - Active fixation, true bipolar; 52cm, 58cm and 65cm $9,000.00 $9,360.00
7022Q - Active fixation true bipolar -
single coil steroid eluting endocardial
defibrillation leads with Optim insulation
overlay and SJ4 quadripolar lead
connector.
Sub -Group 7: Epicardial Patches
Medtronic Australasia Pty Ltd
MC027 Model 6721 Unipolar Epicardial Patch Model 6721S-50, Model 6721M-50, 370, 660, 840mm $2,340.00
Leads S/M/L Model 6721L-50; Silicone
Group 8 - Cardiothoracic Grafts (Proximal Aorta)
Group 8b Modified Tube
Terumo Corporation Australia
TU036 Gelweave Valsalva Graft Woven vascular prosthesis, polyester, Diameter 24 - 34 mm, Overall $3,320.00
gelatin sealed length 18.4 - 19.6cm
Group 8c Tube with one side branch
Terumo Corporation Australia
TU038 Gelweave Graft Straight Thoracic Graft, with antiflo side 20 -34 mm x 20-40 cm $1,715.00
branch, Polyester, woven, gelatin sealed
Group 8d Tube with multiple side branches (more than 1)
Terumo Corporation Australia
TU037 Gelweave Plexus Graft Multi Branched, for Aortic Arch 20 - 34 mm x 40 cm $2,150.00
reconstruction, Polyester, Woven, gelatin
sealed
Prostheses List by Category, Groups and Sponsor Page 464 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 8: Pacemaker Leads
Sub-Group 1: Non-transvenous, Bi-Polar, Steroid
Boston Scientific Australia Pty Ltd
BS153 Myopore Bipolar sutureless myocardial pacing lead 25-54cm $1,716.00
Medtronic Australasia Pty Ltd
MC011 Capsure EPI steroid eluting bipolar Silicone 25 - 60cm $1,716.00
epicardial lead Model 4968 - ventricle
St Jude Medical Australia Pty Ltd
SJ132 Myodex 1084T Steroid-Eluting Bipolar Sutureless 35cm and 54cm $1,716.00
Myocardial Pacing Lead with Titanium
Nitride Electrodes
SJ140 Myodex 1084T and FasTac Flex Lead Steroid -Eluting Bipolar Sutureless 35cm and 54cm, Lead implant $1,716.00 $1,966.00
Implant Tool Myocardial Pacing Lead with Titanium tool - 44cm
Nitride Electrodes and Lead implant tool
with articulating distal end.
Sub-Group 11: Transvenous, Multi-Polar, Passive Steroid, Left Ventricular
Biotronik Australia Pty Ltd
BT095 Corox OTW BP; Corox OTW-S BP; Coronary Sinus bipolar steroid 77, 87 cm length $6,240.00
BT121 Corox OTW-L BP Corox OTW-L BP is a bipolar coronary Length: 75, 85cm; Diameter: $6,240.00
sinus lead, intended for permanent 5.4F
implantation in the venous system and left
ventricular pacing with appropriate single
or multi chamber cardiac pacemakers or
ICDs as part of cardiac resynchornisation
therapy (CRT). The lead body is insulated
with silicone and coated with polyurethane.
Guidant Australia Pty Ltd
GU138 Easytrak 2, Model 4514, 4515, 4516, Bipolar, passive fixation . $6,240.00
4517, 4518, 4519, 4520
GU153 Easytrak 2 Is-1 Lead - Models 4542, Bipolar, passive fixation 80 to 100cm $6,240.00
4543 & 4544
Prostheses List by Category, Groups and Sponsor Page 465 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
GU156 Easytrak 3 Lead - Models 4521, 4522, Bipolar, passive fixation 80 to 100cm $6,240.00
4523, 4524, 4525, 4526 and 4527
GU162 Easytrak 3 IS-1 Lead Bipolar, passive fixation Sizes 80 to 100cm $6,240.00
GU165 Acuity Steerable Lead Bipolar, passive fixation 80cm, 90cm ,100cm $6,240.00
Medtronic Australasia Pty Ltd
MC699 Attain OTW Model 4194 Lead Model 4194 78cm, 88cm $6,240.00
MC811 Attain Ability 4196 LV Lead Over the wire dual electrode left 78, 88, and 103 cm $6,240.00
ventricular lead
MI013 Attain Ability Plus 4296 Over the wire electrode left ventricular lead 78cm, 88cm $6,240.00
MI014 Attain Ability Straight 4396 Over the wire dual left ventricular lead 78cm, 88cm $6,240.00
St Jude Medical Australia Pty Ltd
SJ139 Quickflex 1156T and XL 1158T Bipolar, Steroid-Eluting, Titanium Nitride Length 75 and 86cm $6,240.00
Coated Elextrodes, Guidewire/Stylet-
Placed Left Heart Lead with Fast-PassTM
Coating
SJ243 Quartet 1458Q Quadripolar, Left Ventricular Pacing Lead 75, 86 and 92cm, 5 French $6,240.00
with Optim Lead Insulation introducer
a
St Jude Medical Australia Pty Ltd
SJ208 Quick Flex µ 1258T 4F Bipolar Left Ventricular Pacing Lead 75cm, 86cm, 92cm $6,240.00
Sub-Group 13: Transvenous, Active, Steroid, Left Ventricular
Medtronic Australasia Pty Ltd
MC730 Attain StarFix LV Lead Over the wire left Ventricular Lead 78, 88, 103cm $5,000.00
Sub-Group 2: Non-transvenous, Uni-Polar, Steroid
Medtronic Australasia Pty Ltd
MC053 Capsure EPI steroid eluting unipolar Silicone 25 - 50cm $1,544.00
epicardial lead Model 4965 ventricle
Prostheses List by Category, Groups and Sponsor Page 466 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Sub-Group 3: Non-transvenous, Uni-Polar, Non-Steroid
Medtronic Australasia Pty Ltd
MC009 Medtronic Epicardial Pacing Leads IS-1 Silicone 35 - 53cm $1,144.00
Model 5071
Sub-Group 4: Transvenous, Uni-Polar, Passive, Steroid, Right Ventricular/Atrial
Medtronic Australasia Pty Ltd
MC254 CapSure Sense pacemaker lead Models Titanium Nitride 30 - 85cm $1,248.00
4073
Sub-Group 6: Transvenous, Uni-Polar, Passive, Steroid, Left Ventricular
Biotronik Australia Pty Ltd
BT070 Corox OTW UP Steroid Coronary Sinus Lead 77, 87cm $3,120.00
Boston Scientific Australia Pty Ltd
BS133 Acuity Spiral Unipolar passive fixation 80, 90 & 100cm $3,120.00
Medtronic Australasia Pty Ltd
MC225 Attain Over the Wire Model 4193 Titanium, polyurethane 78-88cm $3,120.00
St Jude Medical Australia Pty Ltd
SJ079 QuickSite Model 1056K Unipolar, Steroid Eluting, Titanium Nitride 75cm, 6F and 86cm, 6F $3,120.00
Electrode, Guidewire/Stylet-placed Left
Heart Lead with Fast-Pass Coating
Sub-Group 8: Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT066 Selox ST Transvenous Bipolar Passive Steroid 53 and 60cm lengths $1,248.00
Ventricular Pacing Lead, fractal coated
BT067 Selox JT Fractal coated steroid electrode 45 and 53cm lengths $1,248.00
BT117 Siello JT The Siello JT is a family of sub 6F, steroid- Length: Siello T 45 cm; Siello T $1,248.00
eluting, transvenous, endocardial, bipolar 53 cm; Diameter: 5.6Fr
passive-fixation leads that carries a j-
shaped distal end.
Prostheses List by Category, Groups and Sponsor Page 467 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BT118 Siello T The Siello T is a family of sub 6F, steroid- Length: Siello T 53cm; Siello T $1,248.00
eluting, transvenous, endocardail, bipolar 60cm Diameter: 5.6Fr
passive-fixation leads that carries a j-
shaped distal end.
Guidant Australia Pty Ltd
GU009 Fineline II Sterox IROX Lead Bipolar passive fixation 52cm, 58cm $1,248.00
GU011 Fineline II Sterox IROX Lead Bipolar passive fixation 52cm, 58cm $1,248.00
GU012 Fineline II Sterox IROX Lead Bipolar, passive fixation 45cm, 52cm $1,248.00
GU023 Guidant Aust Selute Picotip Steroid Model 4035, Model 4064 45cm, 52cm, 59cm $1,248.00
Eluting Bipolar Lead
Medtronic Australasia Pty Ltd
MC010 Medtronic Capsure SP Novus Model Bipolar, steroid, pasive fixation pacing lead 45 -110cm $1,144.00
5092
MC229 Medtronic Capsure SP Novus Model Bipolar, steroid, passive fixation pacing lead 30-100cm $1,180.00
5594 Lead
MC336 Medtronic Capsure Z Novus Model Silicone; Contents: 1 x lead with anchoring 45-58cm $1,248.00
5054 Pacing Lead sleeve, stylet & guide, 1 x vein lifter, 2 x
fixation tools, extra stylets
MC337 Medtronic Capsure Z Novus Model Silicone; Contents: 1 x lead with anchoring 45-58cm $1,248.00
5554 Pacing Lead sleeve, stylet & guide, 1 x vein lifter, 2 x
fixation tools, extra stylets
MC372 CapSure Sense pacemaker lead Models Bipolar, steroid, passive fixation pacing lead CapSure Sense Lead Model $1,248.00
4074 & 4574 4074 - 30cm to 85cm;
CapSure Sense Lead Model
4574 - 30cm to 53cm
Prostheses List by Category, Groups and Sponsor Page 468 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Sorin Group
SA152 Refino ER Series Steroid eluting passive fixation pacing lead. The lead comes in 44, 48, 52 $1,248.00
Permanent pacing lead, Model Refino and 58cm lengths and has a
ER, is indicated for the pacing and sensing 6.0F (polyurethane 6.3F
of the ventricle. This permanent pacing (silicone) lead body
lead is used in conjunction with an IS-1
compatible implantable pulse generator
(pacemaker). Pernanent pacing leads,
Models Refino ERJ and ERJU are
indicated for the pacing and sensing of the
atrium. This permanent pacing lead is used
in conjunction with and IS-1 compatible
implantable pulse generator (pacemaker).
SA154 Petite ER Series Steroid eluting passive fixation pacing lead. The lead comes in 44, 48, 52, $1,248.00
Permanent pacing lead, Petite ER series, 58, 70 and 78cm lengths and
is indicated for the pacing and sensing of has a 4.8 F lead body.
the ventricle. This permanent pacing lead
is used in conjunction with an IS-1
compatible implantable pulse generator
(pacemaker). Permanent pacing lead,
Petite ERJ series, is indicated for the
pacing and sensing of the atrium. This
permanent pacing lead is used in
conjunction with an IS-1 compatible
implantable pulse generator (pacemaker).
St Jude Medical Australia Pty Ltd
SJ082 Isoflex S, Models 1646T, 1642T and endocardial, Steroid Eluting, Silicone, 34cm, 40cm, 46cm, 52cm, $1,248.00
1636T Passive Fixation Pacing Leads with Fast- 58cm, 85cm, 7F, 120cm 8F
Pass Coating
SJ146 Isoflex 1944T & 1948T Passive-Fixation, Bipolar, Steriod Eluting, 46cm, 52cm, 58cm $1,248.00
Endocardial Pacing Lead with Optim
insulation
b
Guidant Australia Pty Ltd
GU028 Guidant Aust Selute Picotip VDD Lead VDD bipolar, passive fixation . $1,544.00
Prostheses List by Category, Groups and Sponsor Page 469 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC052 Medtronic Capsure VDD2 Model 5038 Silicone; Contents: 1 x lead with anchoring 11.5cm, 13.5cm, 15.5cm $1,544.00
AV Pacing Lead sleeve, stylet & guide, 1 x vein lifter, 2 x
fixation tools, extra stylets
Sub-Group 9: Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atrial
Biotronik Australia Pty Ltd
BT083 Setrox S Bipolar active fixation lead with fractal length 45, 53, 60cm $1,248.00
coated and steroid eluting electrode
BT097 Dextrus (marketed by Boston Scientific) Bipolar, silicone, active fixation, steroid 7Fr, with 45cm, 53cm and $1,248.00
eluting, pacing lead 60cm length options
BT116 Siello S The Siello S is a family of sub 6F, steroid- Length: Siello S45 cm; Siello $1,248.00
eluting, trasvenous, endocardial, bipolar S53 cm; Siello S 60 cm;
active-fixation leads with an Diameter: 5.6Fr
extendable/retractible, electrically active
screw.
Guidant Australia Pty Ltd
GU013 Fineline II EZ Sterox IROX Lead Bipolar, active fixation 45cm, 52cm, 58cm $1,248.00
GU016 Fineline II EZ Sterox IROX Lead Bipolar, active fixation 45cm, 52cm, 58cm $1,248.00
GU122 Flextend Lead Models 4086, 4087 & Bipolar, active fixation 45,52,59cm $1,248.00
4088
Medtronic Australasia Pty Ltd
MC008 Medtronic Capsurefix Model 5568 Bipolar, steroid, active fixation pacing lead 30 - 85cm $1,215.00
Pacing Leads
MC338 Medtronic Capsurefix Novus Model Silicone; Contents: 1 x lead with anchoring 45-85cm $1,248.00
5076 Pacing Lead sleeve, stylet & guide, 1 x vein lifter, 2 x
fixation tools, extra stylets
MC833 CapSureFix Novus Model 4076 Pacing Active fixation pacemaker lead 45 - 85cm $1,248.00
Lead
MC936 CapSure Fix MRI Pacing Lead Model 5086, MRI Conditional 42, 52, 58 cm $1,248.00
Prostheses List by Category, Groups and Sponsor Page 470 of 911
CARDIO-THORACIC
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Billing Code Product Name Description Size Benefit Benefit Notations
Sorin Group
SA151 Physique ER Series Steroid eluting active fixation pacing lead. The lead comes in 44, 48, 52 $1,248.00
Permanent pacing lead, Model Physique and 58cm lengths and has a
ER is indicated for the pacing and sensing 4.8F lead body
of the ventricle or atrium. This permanent
pacing lead is used in conjunction with a
compatible implantable pulse generator.
Permanent pacing lead, Model Physique
ERJ is indicated for the pacing and sending
of the atrium. This permanent pacing lead
is used in conjunction with a compatible
implantable pulse generator (pacemaker)
IS-1.
SA153 PY2-ER Series Steroid eluting active fixation pacing lead. The lead comes in 44, 48, 52, $1,248.00
Permanent pacing lead PY2-ER series, is 58cm lengths and has a 6.3F
indicated for pacing and sensing of the lead body
ventricle and/or atrium of the heart. This
lead is used in conjunction with a
compatible implantable pulse generator
(Pacemaker)
St Jude Medical Australia Pty Ltd
SJ073 Tendril SDX Models 1688T and 1688TC Endocardial Steroid-Eluting Active 100cm, 25cm, 34cm, 40cm, $1,248.00
Fixation Pacing Lead 46cm, 52cm, 58cm, 85cm, 7F
SJ118 OptiSense 1699T/1699TC Endocardial, Bi-polar Active-fixation 40-58cm $1,248.00
Pacing Leads with Optim Insulation
SJ125 Tendril ST 1788T/TC and 1782TC Endocardial Bipolar Steroid-Eluting Active 40cm, 46cm, 52cm, 58cm, 65cm $1,248.00
Fixation Pacing Leads
SJ129 Tendril ST 1888TC and 1882TC Endocardial Bi-polar Steroid-Eluting 46-65cm $1,248.00
Active Fixation Pacing Leads
SJ151 OptiSense Model 1999 Active-Fixation Bipolar, Steroid Eluting, 40, 46 & 52cm $1,248.00
endocardial, atrial pacing lead with Optim
insulation
SJ238 Tendril STS 1988TC and 2088TC Endocardial Bi-polar Steroid-Eluting 46cm, 52cm and 58cm $1,248.00
Adtive Fixation Pacing Leads
Prostheses List by Category, Groups and Sponsor Page 471 of 911
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
a
Medtronic Australasia Pty Ltd
MC301 Model 3830 PACING LEADS Active fixation pacemaker lead 59 - 75 cm $2,600.00
Composition: Insulation is polyurethane,
Electrodes are Titanium Nitride coated
Platinum, the screw is steriod-coated
Group 9: Pacemaker/ICD Adaptors
Medtronic Australasia Pty Ltd
MC246 DF-I Y-Adaptor/Extender Model 6726 Silicone Lengths 25cm, 37cm $500.00
25cm & 37cm
MC778 Oscor Adaptor Adaptor for LV-1 lead to unipolar and 10cm, 17cm and 40cm $500.00
bipolar IS-1
MC832 Adaptor Kit Model 5866-24M, 5866- Silicone 14cm $500.00
40M, 5866-37M, Bipolar Lead Adaptor
Kit Model 2872
Prostheses List by Category, Groups and Sponsor Page 472 of 911
EAR, NOSE & THROAT
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Billing Code Product Name Description Size Benefit Benefit Notations
2.1.2 Cochlear Implants
2.1.2.4 Cochlear Implants - Implantable Auditory Stimulator - Generation 4
Advanced Bionics Australia Pty Ltd
BD006 Harmony ™ HiResolution® Bionic Ear The HiRes 90K with HiFocus 1j Electrode Straight array (1j). 56.0mm (L) $12,570.00
System - HiRes 90K Implant Cochlear is the implanted component of the x 28.0mm (W) x 3.0mm (D)
Stimulator with HiFocus 1j Electrode HiResolution Bionic Ear System. It
receives information through an RF
transmission coil, processes the information
and then sends the resulting signal to an
electrode array implanted in the cochlea. It
consists of receiving/transmitting coil,
Stimulator electrodes and HiFocus 1j
Electrode array.
BD007 Harmony ™ HiResolution® Bionic Ear - The HiRes 90K with HiFocus Helix Helix (coiled) electrode array - $13,570.00
HiRes 90K Implant Cochlear Stimulator Electrode is the implanted component of 56.0mm (L) x 28.0mm (W) x
with HiFocus Helix Electrode the HiResoulution Bionic Ear System. It 3.0mm (D)
receives information through an RF
tranmission coil, precesses the information
and then sends the resulting signal to an
electrode array implanted in the cochlea. It
consists of receiving/transmitting coil,
Stimulator electronics and HiFocus Helix
Electrode array
Cochlear Limited
CO024 Nucleus Freedom Implant with Straight Speech processor and accessories - Initial One size only $12,570.00
Electrode
Pacing Importers Pty Ltd - Life Systems
PI011 Sonata Ti 100 Cochlear Implant Cochlear implant, titanium casing, 24 Stimulator Housing: $12,570.00
independent current sources, sequential L 17.3 mm, W 24.8 mm, Thin
and parallel stimulation modes up to 5.9 mm (Weight 8.6g)
50,074 pulses per sec, 19 or 24 oval- Electrode:
shaped platinium electrodes, different sizes Standard (31.5 mm), Medium
(20.9mm), Compressed/Short
(12.1mm),
FLEXsoft (26.4 mm)
Prostheses List by Category, Groups and Sponsor Page 473 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
PI021 CONCERTO Ultra small minimally invasive titanium Stimulator Housing: L 17.3 mm, $12,570.00
cochlear implant with five atraumatic W 25.4 mm, Thin 4.5 mm
electrode options. Includes sequential and (Weight 7.6g)
parallel stimulation, comprehensive Electrode: Standard (26.4 mm),
diagnostic toolkit and safety features such FLEXsoft (26.4 mm), Medium
as unique implant ID and output capacitors (20.9mm), FLEXeas
for each channel. (20.9mm), Compressed
(12.1mm)
Electroacoustic, Hybrid Technology
Pacing Importers Pty Ltd - Life Systems
PI018 Sonata TI with FLEX EAS electrode Cochlear Implant with atraumatic electrode One size $12,570.00
specifically designed for partial deafness
& hearing preservation surgery
Hybrid Technology
Cochlear Limited
CO043 Nucleus Hybrid L 24 Implant A Nucleus Freedom cochlear implant One size $12,570.00 $13,570.00
featuring a special 16mm, 22 contact point
electrode array
Perimodiolar
Cochlear Limited
CO021 Nucleus Freedom Implant with Contour Model C124RE (CA), Generation 4 one size only $13,570.00
Advance Electrode Cochlear implant with perimodiolar
electrode array. Titanium casing,
removable magnet, 22 half-banded
platinum electrodes, moulded in a durable
silicone seal
CO046 Cochlear™ Nucleus® CI512 Cochlear Model CI512, 5th generation cochlear One Size $13,570.00
Implants with Contour Advance Electrode implant with perimodiloar electrode array.
Titanium casing, removable magnet, 22
half-banded platinum electrodes, moulded
in a durable silicone seal.
Prostheses List by Category, Groups and Sponsor Page 474 of 911
EAR, NOSE & THROAT
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Billing Code Product Name Description Size Benefit Benefit Notations
CO055 Cochlear Nucleus Cl513 cochlear Model Cl513, 5th generation cochlear One Size $13,570.00
implant with Contour Advance Electrode implant with enhanced perimodiolar
electrode array. Titanium casing,
removable magnet. 22 platinum
intracochlear electrodes, moulded with a
silicone elastomer carrier, and spaced over
a 15mm active array. Diameter of
electrodes: 0.8mm at the basal end,
tapering to 0.5mm at the apical electrode
band.
2.1.3 Speech Processors
2.1.3.4 Initial - Generation 4
Advanced Bionics Australia Pty Ltd
BD008 Harmony™ HiResolution® Bionic Ear The Auria Harmony Processor is an Sound Processor Size 54 mm $11,500.00
System - Behind The Ear Sound external component of the HiRes Bionic (H) x 13mm (TH) x 21 mm
Processor - Auria Harmony Sound Ear System. This processor is intended to (w). Headpiece Diameter: 28.1
Processor (INITIAL Order) deliver HiResolution sound to a cochlear mm
implant by converting sound waves
(received via a microphone) into an
electrical signal which is then transmitted to
the implant via a headpiece. This listing
includes sound processor, headpiece,
earhooks, powercels, rechargers, cables
and essential accessories.
BD011 Harmony™ HiResolution® Bionic Ear The Platinum Sound Processor is a body PSP only one size; 2.69' x $11,500.00
System -Body worn sound processor - worn component of the HiRes Bionic Ear 2.19" x 0.81"
Platinum Series Processor (PSP) System. This processor is intended to Headpiece cable : options 18,
INITIAL Order deliver HiResolution sount to a cochlear 24, 32, 42 and 48 inches
implant by converting soundwaves
(received via a microphone in the Platinum
Headpiece) into an electrical signal that is
then transmitted to the implant via the
headpiece. This listing consists of the
sound processor, headpiece, connecting
cables, and essential accessory kit.
Prostheses List by Category, Groups and Sponsor Page 475 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Cochlear Limited
CO022 Nucleus Freedom Speech Processor - Speech processor (modular) and One size only $11,500.00
Initial accessories
CO048 Cochlear™ Nucleus® CP810 Sound The ear level sound processor of the One size $11,500.00
Processor - INITIAL Nucleus 5 cochlear implant system with
multiple wearing options and a remote
control.
Pacing Importers Pty Ltd - Life Systems
PI009 OPUS 2 Speech Processor Cochlear implant speech processor, fine 54.0mm x 35.1mm x 8.7mm $11,500.00
structure speech processing, remote
control, interface for assistive listening
devices according to the international
hearing aid standard (initial patient kit)
Electroacoustic
Cochlear Limited
CO044 Freedom Hybrid Sound Processor The modular sound processor of the One size $12,950.00
(Initial) Cochlear Hybrid system provides dual
electrical and acoustic processing within a
single device. Acoustic amplication is
delivered through the acoustic component
and electrical stimuation via the Nucleus
Hybrid L24 implant.
Pacing Importers Pty Ltd - Life Systems
PI019 DUET 2 Audio Processor for Electric and Acoustic 50.6mm x 8.5mm x 59.7mm $12,950.00
Stimulation (2nd Generation EAS)
2.1.3.7 Replacement - Generation 3
Cochlear Limited
CO019 ESPrit 3G Speech Processor - Speech processor, Generation 3 Cable lengths: 6, 8, 10, 20, 28cm $6,790.00
Replacement
Prostheses List by Category, Groups and Sponsor Page 476 of 911
EAR, NOSE & THROAT
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Billing Code Product Name Description Size Benefit Benefit Notations
2.1.3.8 Replacement - Generation 4
Advanced Bionics Australia Pty Ltd
BD009 Harmony™ HiResolution® Bionic Ear The Auria Harmony Processor is an Sound Processor - one size 54 $8,050.00
System -Behind The Ear Sound external component of the HiRes Bionic mm (H) x 13mm (TH) x 21 mm
Processor - Auria Harmony Sound Ear System. This processor is intended to (W)
Processor (REPLACEMENT Order) deliver HiResolution sound to a cochlear
inplant by converting sound waves
(received via a microphone) into an
electrical signal which is then transmitted to
the implant via a headpiece. This listing
Processor only.
BD012 Harmony™ HiResolution® Bionic Ear The Platinum Sound Processor is a body PSP: one size; 2.69' x 2.19" x $8,050.00
System - Body worn Platinum Sound worn component of the HiRes Bionic Ear 0.81"
Processor (PSP) REPLACEMENT System. This processor is intended to
Order deliver HiResolution sount to a cochlear
implant by converting soundwaves
(received via a microphone in the Platinum
Headpiece) into an electrical signal that is
then transmitted to the implant via the
headpiece. This listing comes with the
processor only.
Cochlear Limited
CO023 Nucleus Freedom Speech Processor Speech processor, and accessories - one size only $8,050.00
REPLACEMENT
CO049 Cochlear™ Nucleus® CP810 Sound The ear level sound processor of the One size $8,050.00
Processor - REPLACEMENT Nucleus 5 cochlear implant system with
multiple wearing options and a remote
control.
Pacing Importers Pty Ltd - Life Systems
PI010 Opus 2 Speech Processor Replacement Cochlear implant speech processor, fine 54.0mm x 35.1mm x 8.7mm $8,050.00
structure speech processing, remote
control, interface for assistive listening
devices according to the international
hearing aid standard (replacement kit)
Prostheses List by Category, Groups and Sponsor Page 477 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Electroacoustic
Cochlear Limited
CO045 Freedom Hybrid Sound Processor The modular sound processor of the One size $9,065.00
(Replacement) Cochlear Hybrid system provides dual
electronic and acoustic processing within a
single device. Acoustic amplication is
delivered through the acoustic component
and electrical stimulation is delivered via
the Nucleus Hybrid L24 implant.
2.1.4 Cochlear Implants, Accessory Kit or Item
Advanced Bionics Australia Pty Ltd
BD010 Harmony ™ HiResolution® Bionic Ear 1x HPwcable; 1x direct connect various $500.00
System - Behind the Ear Sound earhook; 1x standard earhook;
Processor Auria Harmony Essential 1x audio cable; 1x monitor
Accessory Kit earphone.
BD013 Harmony ™ HiResolution® Bionic Ear 1x HP cable; 1x Auxiliary various $500.00
System - Body worn Sound Processor - microphone; 1x telephone
Platinum Series Processor (PSP) adaptor; 1x monitor earphone
Essential Accessory Kit
2.1.4.1 Cochlear Implants - Accessory Kit or Item, Initial
Cochlear Limited
CO020 Nucleus Cochlear Implant Accessory Kit Accessory set consists of accessory Lapel microphone comes in $500.00
- ESPrit 3G Speech Processor adapter cable, lapel microphone & lapel lengths of 40-150cm
clip, battery cover set and accessory case
Prostheses List by Category, Groups and Sponsor Page 478 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
2.1.5 Implantable Bone Conduction Hearing System
2.1.5.1 Implantable bone conduction hearing system, Sound processor, Generation 1 - Body worn
Cochlear Limited
CO033 Baha Cordelle II sound processor A powerful sound processor for the Baha One Size $6,000.00
hearing system with a bodyworn unit and a
head worn transducer. Available in three
colours. Body worn sound processor for
the Baha hearing system.
2.1.5.4 Implantable bone conduction hearing system, Sound processor, Generation 2 - Head worn
Cochlear Limited
CO040 Baha Divino sound processor Head worn digital sound processor for the One Size $6,000.00
Baha hearing system. Available in four
colours and left and right side orientations.
CO041 Baha Intenso sound processor Head worn digital sound processor for the One size $6,000.00
Baha hearing system. Available in four
colours.
CO047 Cochlear™ Baha® BP100 sound Fully programmable head worn sound One size - 30 x 21 x 12mm $6,500.00 $6,900.00
processor processor for the Baha implantable bone
conduction hearing system
2.1.5.5 Implantable bone conduction hearing system, Osseointegration abutment
Cochlear Limited
CO025 Baha Abutment Snap Coupling Titanium abutment delivered with a gold 5.5mm - 9035, 8.5mm - 90410 $895.00
screw and holder, individually packaged
and sterile. The 5/5mm is for standard use
and the 8.5mm for patients that have
persistent regrowth of subcutaneous tissue
CO032 Flange fixture - self tapping fixture with Self tapping titanium flange fixture with Self Tapping 4mm and 3mm $1,930.00
pre-mounted abutment abutment in two sizes: 3mm and 4mm with BAHA Abutment
Prostheses List by Category, Groups and Sponsor Page 479 of 911
EAR, NOSE & THROAT
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Billing Code Product Name Description Size Benefit Benefit Notations
CO050 Baha BA210 Abutment Titanium abutments compatible with 5.5mm and 8.5mm $895.00
hexagonal coupling Baha implants
CO052 Baha BA300 abutment. Titanium abutment of the Baha BI300 6mm and 9mm $895.00
implant system.
2.1.5.6 Implantable bone conduction hearing system, Cover screw
Cochlear Limited
CO028 BAHA - Cover screw unigrip Titanium coverscrews, individually One size only $142.00
packaged and delivered sterile. The cover
screws are used to prevent bone
overgrowth of the implant.
CO054 Baha Cover Screw conical Titanium cover screw of the Baha BI300 One size $142.00
implant system used in the two-stage
surgery.
2.1.5.7 Implantable bone conduction hearing system, Osseointegration fixture
Cochlear Limited
CO030 Self tapping fixture with pre-mounted Self tapping titanium flange fixture Self Tapping 4mm and 3mm $1,035.00
fixture mount premounted with a disposable fixture
mount. Available in two sizes: 3mm and
4mm. Used in two stage surgical
procedures.
CO051 Baha BI300 implants Titanium self-tapping fixture of the Baha 3mm and 4mm $1,035.00
BI300 implant system with TiObaslt
surface.
2.1.5.8 Implantable bone conduction hearing system, Osseointegration abutment and fixture
Cochlear Limited
CO053 Baha BIA300 implants with abutments Pre-mounted self tapping titanium implant 3mm implant with 6mm $1,930.00
and abutment of the BI300 implant system, abutment, 4mm implant with
for the Baha FAST surgery. 6mm abutment, 4mm implant
with 9mm abutment.
Prostheses List by Category, Groups and Sponsor Page 480 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
2.1.5.9 Implantable bone conduction hearing system, Sound Processor, Generation 3 - Head worn
Cochlear Limited
CO056 Cochlear™ Baha® BP110 sound Fully programmable head worn sound One size $6,000.00 $6,500.00
processor processor for the Baha implantable bone
conduction hearing system
2.1.6 Ossicle/Middle Ear Prosthesis
2.1.6.1 Ossicle/Middle Ear Prosthesis, Stapes - Metal
LMA PacMed Pty Ltd
PM032 K-Piston Gold/Titanium ID 0.4,0.6mm $104.00 $222.00
Medtronic Australasia Pty Ltd
MC922 Middle Ear Prostheses Stapes 0.4 - 1.17mm x 0.9 - 4.0mm x $104.00 $190.00
4.0 x 10.2mm; 4.0 - 4.75mm
Olympus Australia
OL022 Piston: Stapes Prosthesis a) Armstrong. Platinum, b) McGee. a) 0.6x3.5-0.8x5mm, b) $104.00
Stainless steel, c) Richards. Teflon & 0.6x3.25-0.8x5.5mm, c)
platinum 0.4x4-0.4x5mm
OL023 Piston: Stapes Prosthesis Fisch-Type Platinum or Stainless Steel 0.4mm x 6mm $104.00
Extra large
Medtronic Australasia Pty Ltd
MC918 The Big Easy Piston Big Easy Range - MRI Safe, Triple Width 0.4 - 1.17mm x 0.9 - 4.0mm x $104.00 $350.00
Platinum Band, Double Width Platinum 4.0 x 10.2mm; 4.0 - 4.75mm
Shaft with Offset Versions
2.1.6.2 Ossicle/Middle Ear Prosthesis, Stapes - Non-metal
Medtronic Australasia Pty Ltd
MC923 Middle Ear Prostheses Stapes 0.4 - 1.17mm x 0.9 - 4.0mm x $104.00 $190.00
4.0 x 10.2mm; 4.0 - 4.75mm
Olympus Australia
OL012 Canal Wall Prosthesis Grote, HA Small - Large $104.00 $543.00
Prostheses List by Category, Groups and Sponsor Page 481 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
OL014 Ossicular Prosthesis Attic Defect Plate, HA 7-14mm $104.00 $335.00
OL018 Piston: Stapes Prosthesis a) Schuknecht Malleus att Piston. Stainless a) 0.6x5.5mm-0.8x6.5, b) $104.00
steel, b) Cawthorne. Fluoroplastic, c) 0.3x0.8x3.5-0.3x0.8x6mm, c)
Fluoroplastic, d) Schuknecht. Stainless 0.6x0.6x3.5-0.8x0.6x6mm,
steel, e) Causse. Fluoroplastic d) 0.4x3.5-0.5x5mm, e) one
size only
OL024 Piston: Stapes Prosthesis Platinum Fluoroplastic 0.6x3.5mm - 0.8x5mm $104.00
OL025 Piston: Stapes Prosthesis Platinum Fluoroplastic 0.6x3mm - 0.8x5.75mm $104.00
OL075 Piston: Stapes Prosthesis Smart: Nitinol/Flouroplastic 0.5, 0.6, 0.8 x 3.75-4.75mm $104.00 $535.00
2.1.6.5 Ossicle/Middle Ear Prosthesis, Middle Ear Bone, Malleus - Metal
Medtronic Australasia Pty Ltd
MC924 Middle Ear Prostheses Malleus 0.4 - 1.17mm x 0.9 - 4.0mm x $190.00
4.0 x 10.2mm; 4.0 - 4.75mm
2.1.6.6 Ossicle/Middle Ear Prosthesis, Middle Ear Bone, Malleus - Non-Metal
Medtronic Australasia Pty Ltd
MC919 Prostheses Malleus Hydroxyapatite 0.6 - 4.0mm x 2.7 - 5.0mm x $190.00
1.5 - 10.0mm
2.1.6.9 Ossicle/Middle Ear Prosthesis, Middle Ear Bone, TORP or PORP
PORP
LMA PacMed Pty Ltd
PM028 Stapes Bell/Aerial/Angular Prosthesis/Piston - 1.75 - 7.00mm $300.00 $401.00
Gold/Titanium
Medtronic Australasia Pty Ltd
MC262 Partial Ossicular Reconstruction Implant Malleus + Incus 0.4 - 1.17mm x 2.2 - 8.8mm x $300.00 $360.00
3.5 - 10.0mm
MC920 Flex H/A Incus Necrosis Prostheses 2.5 - 4.0mm x 10.0mm $300.00 $360.00
MC921 Middle Ear Prostheses Malleus+ Incus Small, Medium, Large, 0.6 x $300.00 $360.00
2.2 x 8.0mm
Prostheses List by Category, Groups and Sponsor Page 482 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Olympus Australia
OL016 Ossicular Prosthesis - PORP Sheehy plastipore, Drum to stapes, Grote One size only $300.00
Malleus to stapes, modified, centered or
offcentered
OL017 Ossicular Prosthesis - PORP/TORP Goldenberg Malleable/HA One Size Only $300.00 $580.00
TORP
Medtronic Australasia Pty Ltd
MC260 Middle Ear Prosthesis Total Ossicular Reconstruction Implants 0.6 - 0.8mm x 3.0 - 4.0mm x $404.00
7.0 - 8.0mm
MC261 Universal Ossicular Reconstruction Malleus + Incus + Stapes 0.6 - 1.17mm x 0.3 - 4.0mm x $404.00
Implants - Titanium 4.75 - 8.0mm
MC263 Total Ossicular Reconstruction Implant Malleus + Incus + Stapes 0.5 - 0.6mm x 3.5 - 6.0mm and $404.00
One Size Only
O R Paradigm Pty Ltd
OS001 ALTO Prosthesis Adjustable Length Titanium Ossicular Head Size 2.5mm x 3.5mm; $404.00 $750.00
Chain Reconstruction Prosthesis Length 2.0mm - 8.0mm; Distal
Diameter 0.8mm - 1.2mm
Olympus Australia
OL013 Ossicular Prosthesis Malleus, Incus and Goldenberg Footplate - HA One size only $404.00
Stapes
OL015 Ossicular Prosthesis Incus a) Applebaum HA, b) Goldenberg HA, a) small - large, b) one size $404.00
c) Kartusch HA , d) Grote HA, e) Wehrs only, c) short, medium, long, d)
(single & double notched) HA 7-10mm, e) short, average,
medium, long
OL019 Ossicular Prosthesis -TORP a) black spanner strut HA, b) black oval a) one size only, b) 7-10mm, c) $404.00 $675.00
top TORP HA, c) black oval top PORP, 0.5-0.7mm
universal, HA/fluoroplastic
OL020 Ossicular Prosthesis -TORP Fisch plastipore, Causse modified One size only $404.00
plastipore, Shea modified plastipore/
fluoroplastic, Austin modified plastipore,
Tilt top plastipore
OL021 Ossicular Prosthesis -TORP a) Shea malleable, HA/plastipore, b) Shea a) one size only, b) 4-8mm $104.00
plastipore
OL073 Dornhoffer Prostheses Hydroxyapetite head/HAPEX shaft PORP 0.8mm Shaft Dia TORP, $404.00
and TORP 1.3mm Shaft Diameter PORP
Prostheses List by Category, Groups and Sponsor Page 483 of 911
EAR, NOSE & THROAT
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Billing Code Product Name Description Size Benefit Benefit Notations
OL074 Ossicular Chain Prosthesis Micron adjustable TORP/PORP. Titanium 2-10mm, 2-5mm $404.00
2.1.7 Ventilation Tube/Grommet
2.1.7.10 Ventilation Tube/Grommet, Silicone, Short Term
LMA PacMed Pty Ltd
PM090 Tympo Vent Otological ventilation tubes, armstrong Length 3.8 - 10.0mm $20.00
AB, Medium
Medtronic Australasia Pty Ltd
MC279 Medtronic Vent Tubes Antimicrobial Ventilation Tube 1.02 - 1.27mm x 2.7 - 9.1mm $20.00 $22.00
Medium
Medtronic Australasia Pty Ltd
MC276 Medtronic Vent Tubes Silicone 0.76 - 1.27mm x 1.0 - 7.5mm $20.00
2.1.7.11 Ventilation Tube/Grommet, Silicone, Medium Term
Medtronic Australasia Pty Ltd
MC927 Medtronic Vent Tube 1.02 - 1.52mm x 1.3 - 12.0mm $20.00
Olympus Australia
OL027 Ventilation Tube Shepard grommet, fluoroplastic or silicon, 1.02 -1.14mm $20.00
vent tube w/wire.
OL032 Ventilation Tube T-Tube Richards Modified Soft Silicon 1.32mm $20.00
OL035 Ventilation Tube Grommet - Sha Mini. Teflon 0.76mm $20.00
OL036 Ventilation Tube Shah. Teflon, Silicon 5.1mm $20.00
OL055 Ventilation Tube Collar Button Silicon 1.27mm $20.00
OL058 Ventilation Tube Donaldson Silicon 1.14mm $20.00
OL059 Ventilation Tube Donaldson Soft Silicon 1.14mm $20.00
OL060 Ventilation Tube Donaldson Silicon w/Tab 1.14mm $20.00
OL061 Ventilation Tube Donaldson Fluoroplastic 1.14mm $20.00
OL063 Ventilation Tube Duravent Silicon 1.27mm $20.00
OL066 Ventilation Tube Shea w/Tab - Silicone 0.76mm $20.00
Prostheses List by Category, Groups and Sponsor Page 484 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
OL067 Ventilation Tube Shea Parasol w/Tab Small Flange - Silicone 1.02mm $20.00
OL068 Ventilation Tube Shea Parasol w/Tab - Silicone 1.02mm $20.00
OL069 Ventilation Tube Shea Parasol w/Tab - Silicone 1.52mm $20.00
AB
Olympus Australia
OL030 Ventilation Tube T-Tube Richards Silicon, Soft Silicon, 1.14mm $20.00
Ultrasil
OL031 Ventilation Tube T-Tube Richards Modified Silicon & 1.32mm $20.00
Ultrasil
OL033 Ventilation Tube Butterfly T-Tube Silicon & Ultrasil Silicon - one size only. Ultrasil - $20.00
one size only.
OL034 Ventilation Tube Armstrong Beveled Grommet Ultrasil 1.14mm $20.00
Silicon w/Tab
OL052 Ventilation Tube Collar Button Ultrasil Silicon 1.27mm $20.00
OL062 Ventilation Tube Donaldson Ultrasil Silicon 1.14mm $20.00
OL064 Ventilation Tube Duravent Blue Ultrasil 1.27mm $20.00
AB, Medium
Medtronic Australasia Pty Ltd
MC270 Medtronic Vent Tubes Antibacterial/Antimicrobial 1.27 x 2.9 x 1.3mm $20.00 $22.00
MC280 Medtronic Vent Tube Antibacterial/Antimicrobial 1.02 - 1.52mm x 1.3 - 12.0mm $20.00 $22.00
Medium
CoreMed Pty Ptd
RC009 Ventilation Tubes - Silicone Armstrong Grommet, Donaldson w & w/o 1.1mm & 1.5mm lumen $20.00
Tab, Paparella 1 and Paparella 2 (1.5mm)
Medtronic Australasia Pty Ltd
MC278 Medtronic Vent Tubes Silicone 0.76 - 1.27mm x 1.5 - 12.0mm $20.00
Prostheses List by Category, Groups and Sponsor Page 485 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Small
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG012 Micromedics Ventilation Tubes Micromedics; Paparella-I / $20.00
Paparella-II; 1.14mm / 1.42mm
lumen; Silicone; box of 6 / box
of 50
MG013 Micromedics Ventilation Tubes Micromedics; T-tubes; $20.00
(12x10)/(5x8)/(5x4)/(8x5.5);
1.14mm / 1.27mm / 1.4mm
lumen ; silicone; box of 6 / box
of 50;
2.1.7.12 Ventilation Tube/Grommet, Silicone, Long Term
LMA PacMed Pty Ltd
PM068 Tympo Vent Otological ventilation tubes, short medium Length 2.8 $20.00
term, star tube, silicone
PM072 Tympo Vent Otological ventilation tubes, short medium Length 12.4 $20.00
term, shepard with tail, silicone/blue
PM074 Tympo Vent Otological ventilation tubes, paparella with Length 2.2mm $20.00
tab
PM079 Tympo Vent Otological ventilation tubes, t-tube Length 6 - 12mm $20.00
Medium
CoreMed Pty Ptd
RC002 Ventilation tube Ventilation tube - Silicone - T-tube, T-tube 1.1mm; 1.27mm lumen $20.00
grommet
RC003 Ventilation Tubes - Collar Button Teflon, w/o wire 1.10mm, 1.25mm, 1.50mm $20.00
lumen
Endocorp Pty Ltd
EC031 Exmoor Plastics Ear Vent Drains - With tab, silicone rubber 1.1 mm lumen dia x 2.25 mm $20.00
Donaldson Grommet inner flange dia x 2.25 mm
outer flange dia x 0.76 inter
flange. 2.25 mm total length
Prostheses List by Category, Groups and Sponsor Page 486 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
2.1.7.13 Ventilation Tube/Grommet, Other Material, Short Term
LMA PacMed Pty Ltd
PM075 Tympo Vent Otological ventilation tubes, collar button, Length 1.5mm $20.00
tubingen type gold, gilded silver
2.1.7.14 Ventilation Tube/Grommet, Other Material, Medium Term
Medical Specialties Australia Pty Ltd
MS057 NeoZoline Otological Ventilation Tubes Armstrong, Collar Button, Shepard, 1.10mm, 1.14mm, 1.27mm, $20.00
Reuter, Donaldson, Paparella, Shah 1.40mm, 0.76mm
Small
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG003 Micromedics Ventilation Tubes Micromedics;Shepard;1.0mm / $20.00
1.14mm lumen;Fluroplastic /
Silicone;w.tab / w.wire;box of 6
/ box of 50
MG011 Micromedics Ventilation Tubes Micromedics; Donaldson; $20.00
1.14mm lumen; Silicone /
Fluroplastic; w.tab; box of 6 /
box 50
MG014 Micromedics Ventilation Tubes Micromedics; Armstrong; $20.00
bevelled straight / grommit /
w.wire; 7mm / 7.5mm /
1.14mm; silicone / fluroplastic;
box of 6 / box of 50
2.1.7.15 Ventilation Tube/Grommet, Other Material, Long Term
LMA PacMed Pty Ltd
PM083 Tympo Vent Otological ventilation tubes, long term, Length 1.5 $20.00 $27.00
collar button - tubingen type, titanium
PM086 Tympo Vent Otological ventilation tubes, short medium Length 1.6 $20.00 $27.00
term, reuter bobbin without holes, titanium
Prostheses List by Category, Groups and Sponsor Page 487 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AB
Olympus Australia
OL065 Ventilation Tube Paparella w/tab Fluoroplastic, Silicon, Soft 1.02 - 2.03mm $20.00
Silicon, Ultrasil
2.1.7.2 Ventilation Tube/Grommet, Stainless Steel, Medium Term
Olympus Australia
OL041 Ventilation Tube Bobbin - Reuter Stainless Steel 1mm $20.00
OL042 Ventilation Tube Bobbin - Reuter Stainless Steel Without Wire 1.14-1.27mm, $20.00
w/wire 1mm
Medium
Medtronic Australasia Pty Ltd
MC271 Medtronic Vent Tubes Stainless Steel 1.02 - 1.27mm, 1.58 - 2.7mm $20.00
2.1.7.5 Ventilation Tube/Grommet, Titanium Alloy, Medium Term
Olympus Australia
OL056 Ventilation Tube Collar Button Titanium 1.14mm $20.00
OL057 Ventilation Tube Collar Button Titanium 1.27mm $20.00
Medium
CoreMed Pty Ptd
RC007 Ventilation Tubes - Shepherd Titanium, w/o wire 1.00mm, 1.25mm lumen $20.00
RC008 Ventilation Tubes - Shepherd Titanium with wire 1.00mm, 1.25mm lumen $20.00
Medtronic Australasia Pty Ltd
MC272 Medtronic Vent Tubes Titanium 1.02 - 1.52mm x 0.9 - 4.45mm $20.00
2.1.7.6 Ventilation Tube/Grommet, Titanium Alloy, Long Term
Medium
CoreMed Pty Ptd
RC004 Ventilation Tubes - Collar Button Teflon w/wire, and titanium w/o wire 0.76mm, 1.00mm, 1.25mm, $20.00
1.50mm lumen
RC005 Ventilation Tubes - Collar Button Titanium w wire 1.00mm, 1.25mm, 1.50mm $20.00
lumen
Prostheses List by Category, Groups and Sponsor Page 488 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
2.1.7.7 Ventilation Tube/Grommet, Plastic, Short Term
AB, Small
Medtronic Australasia Pty Ltd
MC269 Medtronic Vent Tubes Activent Antimicrobial Ventilation Tube 1.02 - 1.27mm x 0.9 - 2.4mm $20.00 $22.00
Medium
Endocorp Pty Ltd
EC019 Exmoor Plastics Ear Vent Drains - Teflon 1.14 mm lumen dia x 2.24 mm $20.00
Collar Button inner flange dia x 2.24 mm
outer flange dia x 1.27 inter
flange. 1.78 mm total length
EC020 Exmoor Plastics Ear Vent Drains - Teflon 1.14 mm lumen dia x 3.0 mm $20.00
Collar Button inner flange dia x 3.0 mm outer
flange dia x 1.27 inter flange.
1.78 mm total length
EC021 Exmoor Plastics Ear Vent Drains - Teflon 1.4 mm lumen dia x 2.55 mm $20.00
Collar Button inner flange dia x 2.55 mm
outer flange dia x 0.85 inter
flange. 1.35 mm total length
EC022 Exmoor Plastics Ear Vent Drains - Teflon 1.75 mm lumen dia x 2.85 mm $20.00
Collar Button inner flange dia x 2.85 mm
outer flange dia x 0.95 inter
flange. 1.46 mm total length
EC024 Exmoor Plastics Ear Vent Drains - Teflon Shephards Drain 1.14 mm lumen dia x 2.36 mm $20.00
Shepards Drain inner flange dia x 2.36 mm
outer flange dia x 1.42 inter
flange. 2.41 mm total length
Small
Endocorp Pty Ltd
EC026 Exmoor Plastics Ear Vent Drains - Teflon Shephards Drain with wire 0.97 mm lumen dia x 2.08 mm $20.00
Teflon Shephards Drain with wire inner flange dia x 2.08 mm
grasping feature outer flange dia x 1.42 inter
flange. 2.41 mm total length
Prostheses List by Category, Groups and Sponsor Page 489 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC268 Medtronic Vent Tubes Fluoroplastic 0.76 - 1.52mm x 2.1 - 9.5mm $20.00
x 1.0 - 12.0mm
2.1.7.8 Ventilation Tube/Grommet, Plastic, Medium Term
LMA PacMed Pty Ltd
PM065 Tympo Vent Otological ventilation tubes, short medium Length 2.2 $20.00
term, Donaldson fluoroplastic/blue
PM066 Tympo Vent Otological ventilation tubes, straight tube Length 7.0 - 7.2mm $20.00
PM088 Tympo Vent Otological ventilation tubes, donaldson, Length 1.5mm - 9.8mm $20.00
reuter bobbin, shepard
PM089 Tympo Vent Otological ventilation tubes, short medium Length 1.8 $20.00
term, bevel bobbin, fluoroplastic/blue
PM091 Tympo Vent Otological ventilation tubes, short medium Length 2.0 $20.00
term, collar button, fluoroplastic/blue
Olympus Australia
OL028 Ventilation Tube Shepard, fluoroplastic, w/Tab & wire 1.02 -1.14mm $20.00
OL039 Ventilation Tube Armstrong Beveled Plain End Fluoroplastic One size only $20.00
OL040 Ventilation Tube Armstrong Beveled Plain End Silcon One size only $20.00
OL048 Ventilation Tube Collar Bobbin Fluoroplastic 1.27mm $20.00
OL049 Ventilation Tube Collar Bobbin Fluoroplastic 0.75mm $20.00
OL050 Ventilation Tube Collar Bobbin Fluoroplastic 1.14mm $20.00
OL051 Ventilation Tube Collar Bobbin Fluoroplastic 1.27x0.5mm $20.00
OL053 Ventilation Tube Collar Button Fluoroplastic Blue 1.27mm $20.00
OL054 Ventilation Tube Collar Button Fluoroplastic w/Wire 1.27mm $20.00
OL070 Ventilation Tube Straight Fluoroplastic or Polyethylene 0.89 x 12mm, 0.86 x 7mm, $20.00
1.14 x 12mm, 1.14 x 7mm
Prostheses List by Category, Groups and Sponsor Page 490 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AB
Olympus Australia
OL029 Ventilation Tube Shepard, Ultrasil Silicon & Blue Poly 1.02 - 1.14mm $20.00
AB, Medium
Medtronic Australasia Pty Ltd
MC273 Medtronic Vent Tubes Fluoroplastic 1.02 - 1.27mm x 1.3 - 3.0mm $20.00 $22.00
Medium
Endocorp Pty Ltd
EC018 Exmoor Plastics Ear Vent Drains - Without hole, teflon 1.14 mm lumen dia x 2.54 mm $20.00
Reuter Bobbin inner flange dia x 2.54 mm
outer flange dia x 0.76 inter
flange. 1.52mm total length
Medtronic Australasia Pty Ltd
MC925 Vent Tube Fluoroplastic 1.02 - 1.27mm x 1.0 - 3.5mm $20.00
Small
CoreMed Pty Ptd
RC006 Ventilation Tubes - Shepherd Teflon, w or w/o wire 1.15mm lumen $20.00
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG015 Micromedics Ventilation Tubes Micromedics; Collar Button; $20.00
1.27mm lumen; fluroplastic; box
of 6 / box of 50
MG016 Micromedics Ventilation Tubes Micromedics;Reuter $20.00
Bobbin;1.0mm / 1.14mm
lumen; fluroplastic; box of 6 /
box of 50
MG017 Micromedics Ventilation Tubes Micromedics; Shah with wire; $20.00
mini 0.76mm lumen;
fluroplastic; box of 6 / box of 50
2.1.7.9 Ventilation Tube/Grommet, Plastic, Long Term
Olympus Australia
OL037 Ventilation Tube Shah. Teflon, Fluorplastic w/Wire 1.14mm $20.00
Prostheses List by Category, Groups and Sponsor Page 491 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
OL038 Ventilation Tube Shah. Teflon, Fluorplastic without Wire 1.14mm $20.00
OL043 Ventilation Tube Bobbin - Reuter Fluoroplastic 1mm I.F 1mm $20.00
Without Holes
OL044 Ventilation Tube Bobbin - Reuter Fluoroplastic 1mm I.F 1.14mm $20.00
Without Holes
OL045 Ventilation Tube Bobbin - Reuter Fluoroplastic 1mm I.F 1.14mm $20.00
w/wire
OL046 Ventilation Tube Bobbin - Reuter Fluoroplastic 1mm I.F 1.14mm $20.00
OL047 Ventilation Tube Bobbin - Reuter Fluoroplastic 0.5mm I.F 1.27mm $20.00
AB, Medium
Medtronic Australasia Pty Ltd
MC926 Medtronic Vent Tube Activent Antimicrobial Ventilation Tube 1.14 - 1.27mm x 0.9 - 3.0mm $20.00 $22.00
Medium
Medtronic Australasia Pty Ltd
MC277 Medtronic Vent Tubes Fluoroplastic, C-Flex 0.89 - 1.52mm x 2.3 - 12.0mm $20.00
2.2.1 Nasal Prosthesis, Septal Button
Olympus Australia
OL026 Septal Button Plastipore One size only $149.00
Silicone
Medtronic Australasia Pty Ltd
MC264 Septal Button Silicone 3cm $149.00
2.3.1 Tracheal Speaking Valve
LMA PacMed Pty Ltd
PM057 Provox Voice Prosthesis Long term indwelling; Silicone 4.5,6,8,10,12.5mm $102.00 $331.00
PM117 Passy-Muir Speaking Valve Tracheostomy and Ventilator 15mm I.D./ 22 & 23mm O.D. $102.00
Prostheses List by Category, Groups and Sponsor Page 492 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
2.3.3 Vocal Chord Medialisation Implant
Olympus Australia
OL071 Vocal Cord Medialisation Implant Vocom Larynx Medial Implant - 3 - 7mm Head $345.00
Hydroxylapatite
OL072 Vocal Cord Medialisation Implant Vocom Shim for Medial Implant - 1mm - 3mm Offset $345.00
Hydroxylapatite
2.3.5 Tracheal Reconstruction and Thyroplasty Prostheses
2.3.5.1 Tracheal Reconstruction and Thyroplasty Prostheses, Thyroplasty Graft, ePTFE
Medtronic Australasia Pty Ltd
MC255 Medtronic Xomed Australia Material ePTFE - expanded polytetrafluroethyelene 0.75cm x 40cm x 0.6mm; $1,110.00
Implantable Sterile - Gore Thyroplasty 0.4cm x 20cm x 0.6mm; 0.6cm
x 20cm x 0.6mm
2.3.5.2 Tracheal Reconstruction and Thyroplasty Prostheses, Thyroplasty Graft, Silicone
Endotherapeutics Pty Ltd
ET040 Vox Implants Vox Implants are solid, irregularly One size only $8,200.00
textured, medical grade
Polydimethylsiloxane Elastomer implants
suspended in a hydrogel carrier
LMA PacMed Pty Ltd
PM033 Montgomery Thyroplasty Implant Silicone 6,7,8,9,10,11,12 $1,172.00
System
PM102 Tracheal Cannula System Short and long term Cannula (Medical Diameter 9-13mm; Length 37m $298.00
Grade Silicone) & 101mm
PM103 Tracheal Cannula System Cannula Speaking Valves (Medical Grade 4-10 $125.00
Plastic)
PM104 Montgomery Safe-T-Tube Paediatric, Standard, Thoracic, Extra- Paediatric/Standard - $471.00
Long, Tapered and Hebeler in clear and Clear/Radioplaque
radiopaque
Prostheses List by Category, Groups and Sponsor Page 493 of 911
EAR, NOSE & THROAT
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
PM106 Montgomery Safe-T-Tube Paediatric, Standard, Thoracic, Extra- ID 8/10, 10/13, 12, 15, 18mm; $471.00 $549.00
Long, Tapered, Hebeler and HMS, in Length 76, 77, 79, 159, 163mm
clear and radiopaque
PM107 Laryngeal Keel 12-16mm Keel $275.00
Medical Vision Australia Pty Ltd
MF001 Endoxane Silicone tracheal and bronchial stents - 10 - 20mm diameter, 20 - $1,000.00
Dumon 60mm length
MF002 Tracheobronxane Silmet Nitinol wire - tracheal and bronchial 12 - 20mm diameter, 20 - $2,500.00
stenets - Dumon 90mm length
Medtronic Australasia Pty Ltd
MC265 Silicone Blocks Netterville Phonoform Block - Right, Left, Right - One size only, Left - $275.00
Wedge & Strip One size only, Wedge - One
size only & Strip - One size only
Cement
Endotherapeutics Pty Ltd
ET031 Serenocem Cement Reaction bonded polymer composite One size only - box of 2 $1,560.00
formed by the neutralisation gelletation of a
basic inorganic ionomer
ET032 Serenocem Granules Reaction bonded polymer composite 0.5 - 1mm granules, 1gm or $1,070.00
formed by the neutralisation gelletation of a 5gm; 2 - 3mm granules, 1gm or
basic inorganic ionomer 5gm - 3 pouches
Prostheses List by Category, Groups and Sponsor Page 494 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3.1.1 Brachytherapy, Hepatic, Yttrium 90, Standard dose
Sirtex Medical Products
SE001 SIR-Spheres including Delivery Biocompatible microspheres 20-60mm One size only $8,230.00
Apparatus (microns) in diameter containing yttrium-
90. Delivery apparatus is PVC tubing,
ABS stopcocks, acrylic holders and
stainless steel needles with PE hubs
3.1.2 Brachytherapy, Prostatic I-125
3.1.2.1 Standard Dose
CMS Alphatech Pty Ltd
CL001 Advantage I-125 Pre-load Advantage I-125 Pre-load consists of Stranded seeds are pre-loaded $6,500.00
stranded Advantage I-125 seeds pre- in brachytherapy needles in a
loaded on prescription into brachytherapy prescribed configuration; up to
needles specifically for treatment of an 120 seeds
individual patient. They arrive sterile and
pre-packaged ready for use in theatre
CL002 Advantage I-125 Seed Advantage I-125 seeds are sealed 3mm x 0.5mm silver rod within $6,500.00
radioactive sources containing Iodine-125 4.5 x 0.8mm sealed titanium
for interstitial brachytherapy capsule, up to 120 seeds
MD Solutions Pty Ltd
MB001 Vari-Strand Vari-Strand consists of variable stranded Variable (individually $6,500.00 $7,150.00
seed configurations in pre-loaded needles prescribed) stranded seed
for the purpose of delivering radioactive configurations in pre-loaded
seeds for the treatment of prostate cancer. needles delivered in a sterilized
Varistrand Multiple is delivered in a tray.
sterilized tray and opened in the operating
the
Prostheses List by Category, Groups and Sponsor Page 495 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Oncura Pty Limited
ON001 Iodine 125 - 'Rapid Strand' Rapid Strand consists of 10 welded One size each $6,500.00
Brachytherapy Implant, Iodine 125 - titanium capsules containing iodine-125
'OncoSeeds' Brachytherapy Implant absorbed onto a silver rod. OncoSeeds
consists of the loose seeds only. Per
Patient up to 120 seeds.
3.1.2.2 Single seed or partial dose
CMS Alphatech Pty Ltd
CL003 Advantage I-125 Seed The Advantage I-125 seed is a sealed 3mm x 0.5mm silver rod within $65.00
radioactive source containing Iodine-125 4.5 x 0.8mm sealed titanium
for interstitial brachytherapy capsule
MD Solutions Pty Ltd
MB002 Vari-Strand Vari-Strand consists of a single stranded Single (individually prescribed) $65.00 $82.00
seed in a pre-loaded needle for the seed in a pre-loaded needle
purpose of delivering a radioactive seed delivered in a sterilized tray.
for the treatment of prostate cancer.
Varistrand Single is delivered in a s
Nucletron Pty Limited
NU001 selectSeed Nucletron selectSeed Model # 130002 One size only $82.00
consists of cylindrical silver rod, coated
with radioactive Iodine-125 layer. Active
silver rod is encapsulated in hollow titanium
tube. Laser welding, using sperical shaped
end welds, seals the tube.
Oncura Pty Limited
ON002 Iodine 125 - Rapid Strand I-125 Rapid Strand, code IMC 7000, One size only $65.00
Brachytherapy Implant; OncoSeeds consists of 10 welded titanium capsules
Brachytherapy Implant containing iodine 125. This assembly is
sterile, the acitivity of the capsules "seeds"
is available from 0.18mCi to 0.70mCi.
Individual I-125 capsules (seeds) are also
available as OncoSeeds IMC6711. To be
used only if more than 120 seeds are used
per patient.
Prostheses List by Category, Groups and Sponsor Page 496 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ON004 RAPID Strand Rx Seeds I-125 RAPID Strand Rx, pre-loaded Custom $65.00 $71.50
titanium capsules containing iodine 125.
To be used only if more than 100 seeds
are used per patient. Benefit is per seed.
3.2.1 Infusion Ports and Injection Ports
3.2.1.1 Infusion Port, single lumen
Allergan Australia Pty Limited
AW003 Rapid Port Tack Implantable acetal copolymer disk Outside diameter for the tack $170.00
assembly, rotor assembly with three 30.5mm diameter by 5.6mm
stainless steel fasteners. The fasteners, Height. The wires extend 3mm
when deployed by rotating the rotor, below the bottom surface.
extend about 3mm below the undersurface
of the Tack
B Braun Australia Pty Ltd
BB082 Celsite Epoxy Single Access Port Epoxy/titanium Standard/small/baby $485.00
BB084 Celsite Single Access Port MBS/PSU Standard/small $485.00
BB086 Celsite Epoxy Peritoneal Port Epoxy/titanium 32x27x13mm $485.00 $560.00
Covidien Pty Ltd
AS052 Chemosite Implantable Venous Access Port - Single Lumen (ChemoSite*) 7-9 french; 10.5 french. $485.00 $600.00
System
Smiths Medical Australasia Pty Ltd
SI001 Injection/Infusion Ports, Sterile - PORT- Port - single lumen One size only $485.00
A-CATH II Trans Arterial
Percuataneous System
SI003 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm O.D. PolyFlow $485.00
A-CATH P.A.S Port T2 System Polyurethane Catheter
SI005 Injection/Infusion Ports, Sterile - PORT- Port - single lumen One size only $485.00
A-CATH Peritoneal System
SI007 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.3 mm silicone catheter $485.00
A-CATH Arterial Titanium System
Prostheses List by Category, Groups and Sponsor Page 497 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SI008 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.8 mm silicone catheter & 9 $485.00
A-CATH Titanium Venous Portal French introducer set
SI010 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9mm polyurethane catheter $485.00
A-CATH Implantable Access System -
Venous Portal, with introducer set
SI012 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter $485.00
A-CATH Low Profile Implantable
Venous System, with introducer set
SI014 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.8 mm silicone catheter $485.00
A-CATH II Titanium Venous System,
with introducer set
SI016 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter $485.00
A-CATH II Titanium Venous System
with introducer set
SI017 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.6 mm polyurethane catheter $485.00
A-CATH Titanium Venous System with
introducer set
SI019 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter $485.00
A-CATH II Low Profile Titanium
Venous System with introducer set
SI020 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.2 mm O.D. polyurethane $485.00
A-CATH II Epidural Low Profile catheter
System
SI021 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 0.9 mm O.D. polyurethane $485.00
A-CATH II Intraspinal Low Profile catheter
System
3.2.1.2 Infusion Port, multiple lumen
B Braun Australia Pty Ltd
BB083 Celsite Epoxy Dual Access Port Epoxy/titanium Standard/small/baby $615.00 $800.00
Prostheses List by Category, Groups and Sponsor Page 498 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Smiths Medical Australasia Pty Ltd
SI023 Injection/Infusion Ports, Sterile - PORT- Port - dual lumen 3.4 mm silicone catheter $615.00
A-CATH II Dual Lumen Titanium
Venous system and introducer set
3.2.2 External Infusion Pumps, Balloon Based
Allied Medical Limited
AH006 Dosifuser Non electronic, elastomeric balloon driven, 65ml - 140mm x 45mm x $165.00
ambulatory infusion pump, which can be 40mm; 100ml - 140mm x
supplied in a variety of volumes and flow 52mm x 50mm; 150 - 140mm
rates to meet different clinical applications. x 55mm x 55mm; 250ml -
Its primary purpose is for continuous 140mm x 60mm x 60mm
delivery of fluids/medications.
Loxo Medical Pty Ltd
LP001 Accufuser Continuous Continuous flow rate ambulatory and Volume 60ml, 100ml, 300ml, $165.00 $300.00
disposable silicone balloon infusion pump 600ml
LP002 Accufuser Selectus, Accufuser Varicon Ambulatory and disposable silicone Volume 60ml, 100ml, 300ml, $165.00 $375.00
balloon infusion pump 600ml
LP003 Accufuser Plus, Accufuser EasyBolus, Ambulatory and disposable silicone Volume 60ml, 100ml, 300ml, $165.00 $450.00
Accufuser Omnibus balloon infusion pump with bolus function 600ml
Surgical Specialties
SQ036 Painbuster C bloc Continuous Nerve Block kit -provides 400ml $260.00 $320.00
continual flow of local anaesthetic near a
nerve
SQ037 Painbuster C Bloc Continuous Nerve Block Kit -provides 400-600ml $260.00 $450.00
continual flow of local anaesthetic near a
nerve, with options of variable flow rate,
bolus or dual flow.
Ultimate Medical Pty Ltd
UM001 LA Bubble Balloon based local anaesthetic infusion One size only $185.00
system
Prostheses List by Category, Groups and Sponsor Page 499 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3.2.3 External Infusion Pumps, Battery Powered
3.2.3.5 External Infusion Pump, Battery Powered, Other Pharmacy, Generation 2
Allied Medical Limited
AH004 AMBIT Infusion Pump The AMBIT PCA is an external 55mm x 36mm x 175mm $4,950.00
programmable electronic ambulatory
infusion pump used for the delivery of fluid
and medications via intravenous, epidural,
subcutaneous or regional routes. It can be
programmed with different delivery profiles
which include basal rate only, basal rate
with PCA (Patient Controlled Analgesia)
or PCA Bolus Only. It is operated in
conjunction with a AMBIT disposable
administration cassette
Hospira Pty Limited
HO001 GemStar Infusion Pump Infusion pump, general purpose Approx. 14.0 cm H x 9.7 cm $4,950.00
W x 5.1cm D
Medical Specialties Australia Pty Ltd
MS021 Medical Specialties "Walkmed Infusion Ambulatory Infusion Pump System, Walkmed Infusion Pump $4,950.00
Pump System" Powered Drug Infusion Administration Sets and Accessories System
System and Ancillary Equipment
(McKinley, USA)
Smiths Medical Australasia Pty Ltd
SI034 CADD-PRIZM VIP (Variable Infusion Pump One size only $4,950.00
Profile) Model 6100; CADD-PRIZM
PCS Ambulatory Infusion Pump, Model
6100
SI037 CADD Legacy 1 Model 6400 Pump One size only $4,950.00
Ambulatory Infusion Pump
SI038 CADD Legacy Plus Model 6500 Pump One size only $4,950.00
Ambulatory Infusion Pump
SI039 CADD Legacy PCA Model 6300 Pump One size only $4,950.00
Ambulatory Infusion Pump
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Billing Code Product Name Description Size Benefit Benefit Notations
3.2.3.6 External Infusion Pump, Battery Powered, Programmable flow rate and Programmable bolus
Loxo Medical Pty Ltd
LP004 Accumate 1100 Infusion Pump Ambulatory infusion pump One size only $450.00 $4,950.00
Stryker Australia Pty Ltd
SK461 PainPump 2 Programmable or Preset pump with bolus 250ml & 400ml kits $450.00
option and digital display providing
controlled infusion of a Local Anaesthetic
directly into a surgical site for post-
operative pain management
SR069 Painpump 2 Programmable pump with bolus option and 250ml & 400ml Dual Site kits $450.00
digital display providing controlled infusion
of a local anaesthetic directly into dual
surgical sites for post-operative pain
management
Reprogrammable
Stryker Australia Pty Ltd
SR068 PainPump 2 Continuous Peripheral Re-programmable & refillable pumps with 400ml kits $450.00 $700.00
Nerve Block Kit & PainPump 2 bolus option nd digital display providing
BlockAid Kit controlled infusion of a local anaesthetic
directly innervating the surgical site for
post-operative pain management.
3.2.4 External Infusion Pumps, Spring Powered
3.2.4.1 External Infusion Pump, Spring powered, fixed flow rate
Baxter Healthcare Pty Ltd
BX246 Infusor Sterile infusor devices, spring or elastomer SV Half day, 5ml/hr, 60ml vol. $85.00
driven LV 10, 10ml/hr, 240ml vol. SV
Single day, 2ml/hr, 48ml vol.
LV 5, 5ml/hr, 240ml vol.
Prostheses List by Category, Groups and Sponsor Page 501 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
BX247 Intermate Sterile infusor devices, spring or SV 200 - 200ml/hr, 100ml vol. $85.00
elastomeric driven SV 100 - 100ml/hr, 100ml vol.
LV 250, 250ml/hr, 275ml vol.
SV 50 - 50ml/hr, 100ml vol.
LV 100 - 100ml/hr, 275ml vol.
LV 50, 50ml/hr, 275ml vol
BX248 Infusor Sterile infusor devices, spring or elastomer LV 2, 2ml/hr, 275 ml vol; LV $85.00
driven 1.5, 1.5ml/hr, 275ml vol; SV
Multi day, 0.5ml/hr. 60ml vol;
SV Seven day, 0.5ml/hr, 96ml
vol
BX281 Baxter Folfusor Folfusor SV 0.5mL/hr 120mL (Baxter 120mL Maximum Volume $85.00
Code 2C4700K), Folfusor SV 2.5mL/hr
120mL (Baxter Code 2C4711K),
Folfusor SV 5mL/hr 120mL (Baxter Code
2C4705K). The Baxter Folfusor is a
disposable infusion pump used in an
ambulatory setting for the continuous
infusion of intravenous medications. The
codes listed above represent three
separate flow rates specific to
Chemotherapy protocols.
Orthotech Pty Ltd
OH122 PC2000 Pain Control Infusion Pump Plastic spring loaded drug delivery device 0.5ml - 4ml $85.00 $130.00
Connector
Biomechanical analyser, Set
Cosuda Pty Ltd
CU001 BeeLINE MotIV Infusion Pump (275ml) External infusion pump, spring powered, 275ml infuser reservoir = 19cm $220.00 $260.00
fixed flow rate, 275ml set: set includes (7.5") x 7cm (2.8")
reservoir, introducer needle, tubing set,
priming/flushing syringes, saturation
catheter, dressing, syringes. 30min - 7 day
infusion
CU002 BeeLINE MotIV Infusion Pump (100ml) External infusion pump, spring powered, 100ml infusor reservoir = 13cm $220.00 $260.00
fixed flow rate, 100ml set: set includes (5.1") x 7cm (2.8")
reservoir, introducer needle, tubing set,
priming/flushing syringes, saturation
catheter, dressing, syringes. 30min - 7 day
infusion
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Billing Code Product Name Description Size Benefit Benefit Notations
Set
Orthotech Pty Ltd
OH065 PC2000 Pain Control Infusion Pump Plastic spring loaded drug delivery device 0.5 ml - 4 ml $260.00 $310.00
Surgical Specialties
SQ030 PainBuster Kit includes catheter, introducer needle, 270ml volume x 2 lines x 2 ml $260.00 $472.00
flow restrictor, filter, bolus per hour; 270ml x 2ml, 5ml
bolus; 270ml x 1-7ml/hr
SQ031 PainBuster Kit includes catheter, introducer needle, 100ml volume x 2 ml per hour $260.00
flow restrictor, filter
SQ032 PainBuster Kit includes catheter, introducer needle, 270ml volume x 2 ml per hour $260.00 $315.00
flow restrictor, filter
SQ033 PainBuster Kit includes catheter, introducer needle, 270ml volume x 5 ml per hour $260.00 $315.00
flow restrictor, filter
SQ034 Painbuster Kit includes catheter, introducer needle, 270ml x 4ml/hr, dual; 400ml x $260.00 $640.00
flow restrictor, filter 4ml per hour, dual
SQ035 Painbuster Kit includes catheter, introducer needle, 400ml $260.00 $472.00
flow restrictor, filter, 2 - 14ml/hour
3.2.4.2 External Infusion Pump, Spring powered, fixed flow rate + bolus
Baxter Healthcare Pty Ltd
BX250 Basal/Bolus and Multirate Infusors Sterile infusor devices, spring or elastomer Basal/Bolus 60, Basal 0.5ml/hr, $150.00
driven Bolus 0.5ml/hr x 65ml;
Basal/Bolus 15, Basal 0.5ml/hr,
Bolus 2ml/hr x 65ml;
Basal/Bolus infusor, Basal
2ml/hr, Bolus 2ml/hr x 65ml;
Multirate 5, 7 or 12 ml/hr x 300
ml; Multirate 2, 4, or 6 ml/hr x
300 ml; Multirate 2, 3, o
Orthocare Pty Limited
OC001 Pain Care 2000 Pain Care 2000 System One size only $235.00
OC003 Pain Care 2000L Pain Care 2000L System One Size Only $235.00
Prostheses List by Category, Groups and Sponsor Page 503 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
OC006 Breg Paincare 3000 100ml Continuous Infusion device (delivers 100cc reservoirL=10.4cm, $260.00
2ml/hr) with additional 4ml bolus. Code # D=3.0cm, W=7.4cm
10314
OC007 Breg Paincare 3200 200ml Continuous Infusion device (delivers 200cc reservoirL=10.4cm, $260.00
4ml/hr) with additional 4ml bolus Code # D=6.5cm, W=7.4cm
11030
OC008 Breg Paincare 4200 200ml Continuous Infusion device (delivers 200cc reservoirL=10.4cm, $260.00
2ml/hr) with additional 4ml bolus Code # D=6.0cm, W=7.0cm
11090
3.2.4.3 External Infusion Pump, Spring powered, variable flow rate
Baxter Healthcare Pty Ltd
BX249 Multirate with PCM Sterile infusor devices, spring or elastomer Multirate 5, 7 or 12 ml/hr with $300.00
driven PCM
3.2.5 Infusion Pump Accessory
Nipro Asia Pty Ltd co Sutherland Medical
NQ001 Surefuser Surefuser 50ml. Sterile infusion devices, Volume of 50ml at 10ml/hr, or $50.00
spring or elastometric driven. Various flow at 4.2ml/hr, or at 2.1ml/hr, or at
rates 1.0ml/hr, or at 0.7ml/hr or at
0.4ml/hr or at 0.3ml/hr
NQ002 Surefuser Surefuser 100ml. Sterile infusion devices, Volume of 100ml at 200ml/hr, $50.00
spring or elastometric driven. Various flow or at 100ml/hr, or at 20ml/hr, or
rates at 8.3ml/hr, or at 4.2ml/hr, or
at 2.0ml/hr, or at 0.8ml/hr or at
0.6ml/hr
NQ003 Surefuser Surefuser 250ml. Sterile infusion devices, Volume of 250ml at 125ml/hr, $50.00
spring or elastometric driven. Various flow or at 62.5ml/hr, or at 10ml/hr,
rates or at 5ml/hr, or at 3.5ml/hr, or
at 2.0ml/hr, or at 1.5ml/hr
Prostheses List by Category, Groups and Sponsor Page 504 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
3.2.5.1 Infusion Pump Accessory Kit
Hospira Pty Limited
HO005 Crono infusion system syringes Infusion syringes for use with the Crono 10-50 ml $7.00
pump
Medtronic Australasia Pty Ltd
MC285 Medtronic MiniMed Insulin Pump Insulin Infusion Pump System One size only $18.00
Infusion Sets - Insertion Device Administration Set - Serters
3.2.5.2 Infusion Pump Administration Cassette
Allied Medical Limited
AH005 AMBIT Infusion Pump Cassette Single use sterile disposable administration 20mm x 10mm x 15mm $35.00
set for use with the AMBIT Infusion
Pump. The cassette contains a rotary
mechanism that pumps the infusion solution
at an accurate and controlled rate. The
cassette includes an administration line with
a solution bag spike and an inline air filter
Baxter Healthcare Pty Ltd
BX245 Patient Control Module Sterile infusor devices, spring or elastomer Module 0.5ml dose, Module 2 $28.00
driven ml dose
Hospira Pty Limited
HO003 Gemstar infusion system administration Administration cassette and set for use 2.2 micron filter $35.00
cassette and set with Gemstar infusion pump series
Smiths Medical Australasia Pty Ltd
SI024 Medication Cassettes (50ml & 100ml) Pump 50 mL $21.00
SI025 Medication Cassettes (50ml & 100ml) Pump 100 mL $28.00
Prostheses List by Category, Groups and Sponsor Page 505 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
3.2.5.3 Infusion Pump Administration Reservoir
Australasian Medical & Scientific Ltd
AN006 Animas IR 1200/2020 Insulin Infusion Sterile, indicated as reservoir for insulin by Cartridge Capacity - 2.0mL or $8.00
Cartridge (Insulin Infusion Pump the Animas Infusion Pump, not intended 200 units. Packs of 10
IR1200/2020 Series) for use with any other infusion device.
Loxo Medical Pty Ltd
LP006 Accumate 1100 Reservoir Bag Reservoir bag 150ml, 250ml, 500ml $8.00
Medical Specialties Australia Pty Ltd
MS022 Medical Specialties "Walkmed Drug Ambulatory Infusion Pump System, Walkmed Drug Administration $8.00
Administration Reservoir" (McKinley, Administration Sets and Accessories Reservoirs
USA)
MS039 Medical Specialties "Deltec Cozmo Drug Infusion Reservoir 3ml Cartridges - Box 25 $8.00
Ancillary Equipment"
Medtronic Australasia Pty Ltd
MC989 Medtronic MiniMed Insulin Pump Insulin Infusion Pump Reservoir 1.8ml - 3.0ml $8.00
Reservoir
Roche Diagnostics Australia Pty Ltd
RO050 Infusion pump administration reservoir Infusion pump administration reservoir 25/5/ea $8.00
Smiths Medical Australasia Pty Ltd
SI036 Flexible Medication Reservoir, 250ml Pump 250 mL $8.00
Model 21-6167-24
3.2.5.4 Infusion Pump Administration Set
Australasian Medical & Scientific Ltd
AN003 Animas Insulin Infusion Sets (INFUSION SET, COMFORT, 23", Packs of 10 $8.00
HOSP 10, INFUSION SET,
COMFORT 43", HOSP 10. Inset II,
6mm and 9mm. Inset 30, 13mm) Needle
guard, soft cannula, adhesive tape,
introducer needle, cannula housing, tubing,
connector needle, circular protective cap
and disconnect cover.
Prostheses List by Category, Groups and Sponsor Page 506 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
AN004 Animas Insulin Infusion Set (INFUSION SET, COMFORT, 23", Packs of 10 $8.00
STD 5/5 AND INFUSION SET,
COMFORT, 43" STD 5/5) Needle guard,
soft cannula, adhesive tape, introducer
needle, cannula housing, tubing, connector
needle, circular protective cap and
disconnect cover.
Loxo Medical Pty Ltd
LP005 Accumate 1100 Tubing Set A-type (Luer type) tubing set, B-type 160.5 cm, 174cm $7.00
(spike type) tubing set
Medical Specialties Australia Pty Ltd
MS023 Medical Specialties "Walkmed Drug Ambulatory Infusion Pump System, Walkmed Drug Administration $7.00
Administration Sets" (McKinley, USA) Administration Sets and Accessories Sets
MS040 Medical Specialties/Unomedical "Deltec Drug Infusion Set Box of 20 $7.00
Cozmo Ancillary Equipment"
Medtronic Australasia Pty Ltd
MC286 Medtronic MiniMed Paradigm Insulin Insulin Infusion Pump System 6-17mm cannula / needle 45- $18.00
Pump Infusion Sets Administration Set - Infusion Set 110cm tubing
Roche Diagnostics Australia Pty Ltd
RO012 Disetronic Infusion Sets Tender I 17/60 Pack 10 $8.00 $15.00
RO042 Accu-Chek Infusion Set Protective Blue Cap Cap $1.00
RO045 Infusion pump administration set; Rapid- Infusion pump administration set; Rapid- Various lengths $4.00
Dlink Dlink
RO046 Infusion pump administration cannula Infusion pump administration cannula; Various lengths $7.00
Rapid-Dlink
RO048 Infusion pump administration set; Infusion pump administration set Various lengths and diameters $7.00
Tenderlink 1/Flexlink
RO049 Infusion pump administration cannula; Infusion pump administration set 13, 17mm $7.00
Tenderlink 1
Smiths Medical Australasia Pty Ltd
SI026 CADD Administration Set 175cm For use with SI036 250 mL $7.00
TOTM tubing
Prostheses List by Category, Groups and Sponsor Page 507 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
SI027 CADD Administration Sets, 198cm, with Pump 198 cm $7.00
Bag Spike & Add-on Anti-siphon
Valve, TOTM Plasticized Tubing, Model
No. 21-7057-24
SI028 Extention Set (30" & 60") Pump 76 cm $7.00
SI029 Extension Set (30" & 60") Pump 152 cm $7.00
SI040 Adminstration Set Bag Spike, Integral Anti-Siphon Valve 196cm Bag Spike, Box of 12 $7.00
SI041 Administration Set High Volume, with 0.2 Micron Filter, Male Box of 15 $7.00
Luer, Add On Anti Syphon Valve
SI042 Extension Set Microbore TOTM with 0.22 Filter, M/M 152cm $7.00
Luers, for Flolan
SI044 Administration Set High Volume, TOTM- Plasticized Blue 305cm $7.00
Striped with 1.2 Micron Filter, Male Luer,
Add On Anti-Siphon Valve
3.2.5.5 Infusion Pump Accessory, Other
Orthocare Pty Limited
OC002 Pain Care 2000 Y Accessory Kit One size only $80.00
OC004 Pain Care 2000L Y Accessory Kit One Size Only $80.00
OC005 Pain Care 2000L Multiport Catheter 54" One Size Only $54.00
Roche Diagnostics Australia Pty Ltd
RO047 Infusion pump administration cannula; Infusion pump administration cannula Various lengths $7.00
FlexLink
3.2.6 Pharmaceutical Beads
Biomet Australia Pty Ltd
BI280 Septopal Chain Septopal Beads PMMA, Stainless Steel 30 bead chain $575.00 $750.00
Device Technologies Australia Pty Ltd
DE275 DC Bead Drug delivery embolisation system 100-300, 300-500, 500-700, $1,650.00 $1,950.00
700-900 (microns)
Prostheses List by Category, Groups and Sponsor Page 508 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
3.2.7 Vascular Access and Dialysis Catheter
3.2.7.1 Central venous catheter
Triple lumen
Cook Medical Australia Pty Ltd
WC122 Cook Central Venous Long Term Cook TPN triple lumen catheter set Fr 8, length 90cm $270.00
Catheter
3.3.1 Enteral feeding tube (general)
3.3.1.1 Enteral feeding tube, initial
Thermo Fisher Scientific Australia Pty Ltd
FT003 Corflo Max 20fg PEG Kit Complete Sterile enteral feeding tube with accessories 20fg $178.00
with 7fg Snare - "Pull Type"
FT004 Corflo Max 20fg PEG Kit "Pull Type" Sterile enteral feeding tube with accessories 20fg $178.00
3.3.2 Gastrostomy tube
3.3.2.1 Gastrostomy tube, initial
Abbott Australasia Pty Ltd
AY002 Flexiflo inverta PEG kit Basic, Flexiflo Composition - biocompatible silicone tube. 20F $205.00
inverta PEG kit with snare Items included in kit/product - Sliding
retention disc, Insertion wire, Gastrostomy
tube with attached Dilator Catheter,
seldinger needle 14g, magna port
connector, scalpel, Snare (in kit with snare)
Bard Australia Pty Ltd
BA047 Gastrostomy Tube Silicone Tubes and Replacement Tubes 12Fr - 28Fr $205.00
Boston Scientific Australia Pty Ltd
BS141 EndoVive Initial Feeding Tube Silicone enteral feeding tube Up to 24 Fr $205.00
Cook Medical Australia Pty Ltd
WC072 Passport Low Profile Device Enteral/Gastrostomy FEEDING TUBE French Sizes: $205.00
20.0, 24.0 Length:
1.2,1.7,2.4,3.4,4.4 cm
Prostheses List by Category, Groups and Sponsor Page 509 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
WC185 Percutaneous Endoscopic Gastrostomy PEG Enteral Feeding Kit - Push or Pull 18, 20, 24 FR $205.00
(PEG) System System
WC199 Cook Gastronomy Tubes Russell Gastronomy Set 14fr, 17cm $205.00
Device Technologies Australia Pty Ltd
DE296 Pull PEG System Initial placement percutaneous endoscopic 20Fr; 60cm $205.00 $365.00
gastrostomy kit
Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA015 Entristar Skin Level Gastrostomy Kits Skin level non-balloon internal retention 12fg x 1.2cm, 12fg x 1.5cm, $205.00 $235.00
bolster gastrostomy kit, including Entristar 12fg x 2.0cm, 12fg x 2.5cm,
gastrostomy tube, accessory bolus and 12fg x 3.0cm, 12fg x 3.5cm,
continuous feeding tubes, syringes for 12fg x 4.0cm, 12fg x 4.5cm,
inflation and flushin. Patient handbook 12fg x 5.0cm, 16fg x 1.5cm,
16fg x 1.7cm, 16fg x 2.0cm,
16fg x 2.4cm, 16fg x 2.7cm,
16fg x 3.0cm, 16fg x 3.5cm,
20fg x 1.5cm, 20fg x 2.0cm,
20fg x 2.5cm, 20fg x 3.0cm,
20fg x 3.5cm, 20fg x 4.0cm,
20fg x 4.5cm, 20fg x 5.0cm
KA017 NutriPort Balloon Skin Level Skin level silicone balloon gastrostomy kit, 12fg x 0.8 - 5.0cm, 14fg x 0.8 $205.00
Gastrostomy Kit including NutriPort gastronomy tube, - 5.0cm, 16fg x 0.8 - 5.0cm
accessory bolus and continuous feeding
tubes, syringes for inflation and flushing,
Patient handbook
Kimberly-Clark Australia Pty Limited
KI001 Kimberly-Clark Aust Pty Ltd Enteral 68914 MIC Gastrostomy Tubes Model MIC* Percutaneous $205.00
Feeding Kit 100 Series Endoscopic Gastrostomy
(P.E.G) Feeding Tubes/Kits 14,
20, 24 French #0630 Series
PUSH (OTW) Method &
#0640Series PULL Method
KI002 Kimberly-Clark Aust Pty Ltd Enteral 68914 MIC Gastrostomy Tubes Model MIC* Percutaneous $205.00
feeding kit, Mic* Percutaneous 100 Series Endoscopic Gastrostomy (P.E.
Endoscopic Gastrostomy (P.E.G) G) Feeding BASIC Tubes/Kits
Feeding Tubes/Kits 14, 20, 24 French#0644 Series
PULL Method
Prostheses List by Category, Groups and Sponsor Page 510 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
KI004 Kimberly-Clark Aust Pty Ltd Enteral 68914 MIC Gastrostomy Tubes Model MIC-KEY* Low Profile $205.00
feeding kit, MIC-KEY Low Profile 100 Series Gastrostomy Feeding
Gastrostomy Feeding Tubes/Kits Tubes/Kits 14 - 24 French, 0.8
cm - 4.5 cm
Sherwood Davis & Geck
SG001 Gastrostomy Tube EntriStar Single Pass PEG 16fg, 20fg $205.00
Thermo Fisher Scientific Australia Pty Ltd
FT001 Corflo Cubby LPGD Kit Low profile gastronomy device 12 - 24fg x 1.0 - 4.5cm $205.00
3.3.2.2 Gastrostomy tube, subsequent
Abbott Australasia Pty Ltd
AY005 Flexiflo balloon gastrostomy tube Composition - biocompatible silicone. 16 french, 18 french, 20 french $90.00
Items included in kit/product - sliding
retention disc and opened edged feeding
port
Boston Scientific Australia Pty Ltd
BS142 EndoVive Replacement Feeding Tube Silicone enteral feeding tube Up to 28 Fr $90.00
Cook Medical Australia Pty Ltd
WC070 Gastrostomy Tube PEG Balloon Replacement Tube - Single 14, 18, 24fr $90.00
Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA016 Kangaroo Gastrostomy Feeding Tubes 100% silicone gastrostomy with internal 12fg, 14fg, 16fg, 18fg, 20fg, $90.00
retention balloon 22fg, 24fg
Kimberly-Clark Australia Pty Limited
KI003 Kimberly-Clark Aust Pty Ltd Enteral 68914 MIC Gastrostomy Tubes Model Feeding Adaptors (Universal or $90.00
feeding kit, Mic* Percutaneous 100 Series Bolus) for use with 14, 20 &24
Endoscopic Gastrostomy (P.E.G) F MIC* PEG's#0135 ˆ
Feeding Tubes/Kits Series
KI005 Kimberly-Clark Aust Pty Ltd Enteral 68914 MIC Gastrostomy Tubes Model SECUR-LOK* Extension Sets $90.00 $120.00
feeding kit, MIC-KEY Low Profile 100 Series & Bolus Feeding Sets 30.5 cm
Gastrostomy Feeding Tubes/Kits & 60.9 cm
Prostheses List by Category, Groups and Sponsor Page 511 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
KI007 MIC* Gastrostomy Feeding Tube; Medical Grade Silicone Construction. 12fr - 3-5ml balloon, 14fr - 3- $90.00 $110.00
MIC* Bolus Gastrostomy Tube Silicone Internal Inflatable Retention 5ml balloon, 16fr - 3-5ml
Balloon, SECU-LOK* External Retention balloon, 18fr - 7-10ml balloon,
Ring, Universal Feeding Port Connector, 20fr - 7-10ml balloon, 22fr - 7-
Medication Port, Dual Exit Ports, Tapered 10ml balloon, 24fr - 7-10ml
Distal Tip, Radiopaque Strip, Sterile. balloon, 26fr - 7-10ml balloon,
28fr - 7-10ml balloon, 30fr - 7-
10ml balloon,
Nutricia Australia Pty Ltd
NF001 Flocare Gastrostomy tube (G-tube) The Flocare Gastrostomy tube can be Ch10, 14, 18, 20 $90.00
used as a replacement of an existing
gastrostomy tube (PEG or G-tube) or as
an initial gastrostomy tube during a surgical
intervention. This balloon tube is made of
medical grade silicone.
Thermo Fisher Scientific Australia Pty Ltd
FT002 Corflo Gastronomy Replacement Device Dual and triple gastronomy tubes Dual 12 - 24fg 5 - 20cc $90.00
balloon; Triple 16 - 24fg 20cc
balloon
3.3.3 Jejunostomy tube
3.3.3.1 Jejunostomy tube
Cook Medical Australia Pty Ltd
WC098 Cook Jejunostomy Catheters Composition - Catheter Radiopaque 12fr, length 60cm $170.00
Stripe, includes Wireguide, Airplug,
Fixation Device
WC099 Cook Jejunostomy Catheters Composition - Catheter Radiopaque 9fr, Length 60cm $170.00
Stripe, includes Wireguide, Airplug,
Fixation Device
Prostheses List by Category, Groups and Sponsor Page 512 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Kimberly-Clark Australia Pty Limited
KI006 Kimberly-Clark MIC* Transgastric- Medical Grade Silicone Construction, 16-22 French - 45cm jejunal $500.00 $720.00
Jejunal Feeding Tubes (Surgical Silicone Internal Retention Balloon, length - 7-10ml balloon
Placement Kits) SECUR-LOK* External Retention ring,
Universal Jejunal Feeding Port Connector,
Gastric Decompression Port, Multiple
Gastric & Jejunal Exit Ports, Tungsten
Weighted Jejunal Portion, Tapered Distal
Tip, Radiopaque Stripe, Sterile
KI008 MIC-KEY Low Profile Transgastric- 100% medical grade silicone tube. 40/60 16, 18 and 22Fr, 1.0 to 3.5cm $170.00 $520.00
Jejunal Feeding Tube tungsten weighted jejunal post pyloric stomal length, 15 to 45cm
feeding tube. Gastric drainage ports, jejunal length
jejunal feeding ports
KI009 MIC Transgastric-Jejunal Feeding Tube 100% medical grade silicone tube. 40/60 16, 18, 22Fr, 15 to 45cm $500.00
tungsten weighted jejunal post pyloric jejunal length, 7-10ml balloon
feeding tube. Gastric drainage ports, volume
jejunal feeding ports
3.3.4 Caecostomy Tube
Cook Medical Australia Pty Ltd
WC197 Cook Irrigation Catheter Chait Percutaneous Cecostomy Catheter 10fr, Standard or Extra Long $355.00
3.4.1 Adjustable gastric band with port
Allergan Australia Pty Limited
AW001 Lap-Band Adjustable Gastric Banding - AP-small and AP-large $3,300.00
(LAGB) System
AW016 Lap-Band AP with RapidPort EZ Adjustable gastric banding system with AP small and AP large $3,300.00
Rapid Port EZ access port. The Rapid
Port EZ access port allows for a sutureless
fixation of the port of the Lap-Band to the
stomach fascia or muscle
Prostheses List by Category, Groups and Sponsor Page 513 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Alliance Surgical
AA009 Bioring Gastric Band Adjustable gastric banding kit Small and large $3,300.00
Endotherapeutics Pty Ltd
ET042 Soft Gastric Banding System Sterile long term implant for the treatment One size only $3,300.00 $3,400.00
of obesity. Supplied in kit format with
catheter, port and huber needles
ET056 Soft Basket Band. INFUSION PORT. TITANIUM PORT 9.8CMS/13.3CMS $300.00 $400.00
ET058 Soft Basket Band Adjustable Gastric Band Implant 115 MM CUFF $3,000.00 $3,500.00
Johnson & Johnson Medical Pty Ltd
JJ831 Ethicon Endo-Surgery curved adjustable Silicone One size only $3,300.00
gastric band with sutureless port and
applier
JJ832 Swedish Adjustable Gastric Band Silicone One size only $3,300.00
Lifehealthcare Pty Ltd
LH003 Adjustable Peri Gastric Belt-Midband Silicon moulded peri gastric band and Peri gastric band - 2.2 x 17.5 x $3,264.00
implantable chamber 0.8cm, Implantable chamber -
one size only
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG002 Heliogast Adjustable Gastric Band Silicone and Titanium HAGE (evolution), small band - $3,264.00
inner diameter 26mm; HAGA
(advanced), large band - inner
diameter 28mm
Rymed Pty Ltd
RY001 MiniMizer Adjustable Gastric Band Silicon elastomer 14mm wide, 16.6cm band two $2,200.00
phase closure, 1: 31mm inner
diameter, phase 2: 26mm inner
diameter. 40cm silicon tube
attached
Prostheses List by Category, Groups and Sponsor Page 514 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Surgeons Choice Australia Pty Ltd
SH004 MiniMizer gastric band. Adjustable Silicone band which is placed The gastric band comes in one $3,000.00 $3,300.00
around the upper part of the stomach to size, but could come with a
reduce the volume and speed of intake of small or medium sized port.
food. 14mm wide, 16.6cm band two
phase closure, 1: 31mm inner
diameter, phase 2: 26mm inner
diameter. 40cm silicon tube
attached.
3.4.2 Gastric band Injection Port (replacement)
Allergan Australia Pty Limited
AW002 Lap-Band Access Port For use with the Lap-Band Adjustable Standard, low profile $620.00
Gastric Banding System
AW017 RapidPort EZ (replacement port) Replacement port for use with the Lap- Access port assembly $620.00
Band adjustable grastric banding system Access port 3cm diameter x
1.2cm
Septum 1.4cm diameter
Alliance Surgical
AA008 Bioring Gastric Band Replacement Port Bioring gastric band access port with Diameter 34mm; height $620.00
catheter and connector 10.4mm
Johnson & Johnson Medical Pty Ltd
JJ444 Ethicon Endo-Surgery Gastric band Implantable infusion port & locking One size only $620.00
sutureless port and applier connector for adjustable gastric band.
Replacement port & locking connector for
use with adjustable gastric band.
Prostheses List by Category, Groups and Sponsor Page 515 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Lifehealthcare Pty Ltd
LH413 Miband Access Port (replacement) A device, metallic or non- metallic, Port Size - 10.6mm High, $620.00
implanted in a patient for a short or long- 24.7mm Base width- One Size
term delivery of fluid or medications to the only
vascular system or other anatomical
region. The device consists of a housing,
self-sealing septum and a catheter
connection mechanism. The device may be
implanted in a variety of anatomical
locations.
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG018 HAGA Acess Port Access Port contains Titanium and Silicone Standard $618.00
Surgeons Choice Australia Pty Ltd
SH005 MiniMizer gastric band (injection port) Adjustable Silicone band which is placed Small or medium sized port. $300.00 $620.00
around the upper part of the stomach to
reduce the volume and speed of intake of
food. The injection port is used to inflate or
deflate the gastric band therefore adjusting
the diameter of the band.
3.5.1 Resorbable
Johnson & Johnson Medical Pty Ltd
JJ432 SURGICEL Nu knit Absorbable High density , oxidised regenerated 2.5 x 8.75cm $15.00 $30.00
Haemostat cellulose, the material is biocompatible and
also bactericidal.
3.5.2 Haemostatic occluder pin
Design for Vision Pty Ltd
DV024 Haemorrhage Occluder Pin with Designed to control severe presacral Two sizes: 10mm and 14mm $430.00
applicator bleeding during pelvic surgery.
Prostheses List by Category, Groups and Sponsor Page 516 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
3.5.3 Haemostatic powder
Johnson & Johnson Medical Pty Ltd
JJ636 Spongostan Absorbable Haemostatic 1 g Porcine Absorbable Haemostatic 1 gram $47.00 $50.00
Gelatin Powder Gelatin Powder
Lifehealthcare Pty Ltd
LH408 Geli Putty(Powder, 1g) Geli Putty is a single- use, water insoluble, 1 gram $47.00
fully bioabsorbable gelatin powder
comprising milled sponges( Gelita-Spon)
made from 100% pharmacuetical grade
porcine gelatin mixed with sterile liquid
(e.g. saline or antibiotic solution) prior to
use to for
Tag Medical
TM047 PerClot Standard PerClot Polysaccharide Hemostatic 1 gram $47.00 $120.00
System
TM048 PerClot Standard PerClot Polysaccharide Hemostatic 3 gram $141.00 $228.00
System
3.5.4 Haemostatic sponge
Lifehealthcare Pty Ltd
LH405 Gelita-Spon Absorbable Gelatin Gelita- Spon IR is a sterile, single-use, fully GS-322-Gelita-Spon IR $10.00 $45.00
Sponge-Gelita- Spon IR Sponge bioabsorbable gelatin sponge indicated to Sponge; 200s-3x2x2mm
achieve rapid haemostasis(e.g. surgically or
trauma induced) by tamponade, and GS- 344- Gelita-
arterial embolisation. also indicated for use Spon IR Sponge; 100s-
as a vehicle for a wide range of therapeutic 4x4x4mm
agentsm including antibiotics, thrombin
and chemotherapeutics without reduction
in the sponge's haemostatic effect.
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Billing Code Product Name Description Size Benefit Benefit Notations
LH410 Gelita-Spon Absorbable Gelatin Sponge 'Gelita-Spon Anal-Vaginal Tampon is a 3x8cm $17.00
Anal-Vaginal Tampon sterile, single use, fully bioabsorbable
gelatin sponge indicated to achieve rapid
haemostasis by tamponade, also indicated
for use as a vehicle for a wide range of
therapeutic agents, including antibiotics,
thrombin and chemotherapeutics without
reduction in the sponge's haemostatic
effect.
LH411 Gelita-Spon Absorbable Gelatin Sponge GelitaSpon ENT Sponge is a sterile, single 8x5x1 cm & 1x1x1cm $10.00
- Gelita-Spon ENT Sponge use, water insoluble, fully bioabsorbable,
firm, high-density gelatin sponge indicated
to achieve rapid haemostasis during ENT
surgery .
LH412 Gelita-Spon Absorbable Gelatin Gelita-Spon Dental Cube is a sterile, GS-310 - Gelita-Spong Dental $3.00
Sponge-Gelita- Spon Dental Cube single-use, indicated to achieve rapid Cubes; 50s - 10 x 10 x 10mm
haemostasis dental surgery (oral bone and
soft tissue), a void filler to mitigate against
the risk of sclerosis created by tooth
extraction, root amputations, and the
removal of cysts, tumours and impacted
teeth. its absorptive capacity being a
function of the amount of gelatin
incorporated and, hence, the physical size
of the sponge. also indicated for use as a
vehicle for a wide range of therapeutic
agents.
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Billing Code Product Name Description Size Benefit Benefit Notations
LH414 Gelita-Spon Absorbable Gelatin Gelita-Spon Standard is a sterile, single- GS-010-Gelita-Spon Standard; $10.00
Sponge-Gelita- Spon Standard use, fully bioabsorbable gelatin sponge 10s-80x50x10m GS-060-
indicated to achieve rapid haemostasis(e.g. Gelita-Spon Standard Size 12-
surgically or trauma induced)by 7; 10s-60x20x7mm
tamponade, and arterial embolisation . also
indicated for use as a vehicle for a wide GS-060-Gelita-Spon
range of therapeutic agents, including Standard Size 12-7; 10s-
antibiotics, thrombin and 60x20x7mm
chemotherapeutics without reduction in the
sponge's haemostatic effect. GS-650- Gelita Spon Standard
Size 200; 10s-125x80x10mm
GS-110-Gelita-Spon
Standard Size Special 20; 20s-
80x50x1mm
GS-950-
Gelita-Spon Standard Film;
20s-200x70x0.5mm
3.5.4.1 Haemostatic sponge, 0-10cm2
Johnson & Johnson Medical Pty Ltd
JJ014 Surgicel ORIGINAL Absorbable Oxidised regenerated cellulose gauze, the 1.25 x 5cm $10.00 $13.00
Haemostat material is biocompatible and also
bactericidal
JJ015 Spongostan Absorbable Haemostat Dental (Box of 24) 10 x 10 x 10mm $3.00
JJ023 Surgicel Nu-Knit Absorbable Haemostat High density, oxidised regenerated 2.5 x 2.5cm $10.00 $19.00
cellulose, the material is biocompatible and
also bactericidal
3.5.4.2 Haemostatic sponge, 11-30cm2
Johnson & Johnson Medical Pty Ltd
JJ006 Spongostan Absorbable Haemostat Anal 20s (Box of 20) 80 x 30mm $17.00
JJ007 Spongostan Absorbable Haemostat Anal 5s (Box of 5) 80 x 30mm $17.00
Prostheses List by Category, Groups and Sponsor Page 519 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
JJ009 Surgicel Fibrillar Absorbable Haemostat Fibrous fleece, oxidised regenerated 2.5 x 5.1cm $15.00 $40.00
cellulose, the material is biocompatible and
also bactericidal
Pfizer Australia Pty Ltd
PU059 Gelfoam Sterile Sponge Sterile, pliable, nonantigenic surgical 12 - 20mm x 60mm x 7mm, $17.00 $22.00
sponge prepared from specially treated individually packaged for use
purified gelatine solution
3.5.4.3 Haemostatic sponge, 31-75cm2
Johnson & Johnson Medical Pty Ltd
JJ003 Spongostan Absorbable Haemostat Standard (Box of 20) 70 x 50 x 10mm $10.00
JJ005 Spongostan Absorbable Haemostat Special (Box of 20) 70 x 50 x 1mm $10.00
JJ008 Surgicel Nu-Knit Absorbable Haemostat High density, oxidised regenerated 7.5 x 10cm $10.00 $38.00
cellulose, the material is biocompatible and
also bactericidal
JJ013 Surgicel ORIGINAL Absorbable Oxidised regenerated cellulose gauze, the 5 x 7.5cm $10.00 $22.00
Haemostat material is biocompatible and also
bactericidal
JJ030 Surgicel Fibrillar Absorbable Haemostat Fibrous fleece, oxidised regenerated 5.1 x 10.2cm $15.00 $73.00
cellulose, the material is biocompatible and
also bactericidal
Lifehealthcare Pty Ltd
LH424 Gelitacel Oxidised Resorbable Cellulose Gelitacel is a white, single-use, non-toxic, 5 x 7 cm $10.00 $18.00
Gauze (15) sterile, bioarbsorbable, weakly acidic,
viscose-free, knitted haemostatic fabrci
(USP)
3.5.4.4 Haemostatic sponge, 76-200cm2
Johnson & Johnson Medical Pty Ltd
JJ004 Spongostan Absorbable Haemostat Film (Box of 20) 200 x 70 x 0.5mm $30.00
JJ012 Surgicel ORIGINAL Absorbable Oxidised regenerated cellulose gauze, the 5-10.2 x 20-35cm $30.00 $40.00
Haemostat material is biocompatible and also
bactericidal
JJ029 Surgicel Fibrillar Absorbable Haemostat Fibrous fleece, oxidised regenerated 10.2 x 10.2cm $45.00 $114.00
cellulose, the material is biocompatible and
also bactericidal
Prostheses List by Category, Groups and Sponsor Page 520 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
Lifehealthcare Pty Ltd
LH423 Gelitacel Oxidised Resorbable Cellulose Gelitacel is a white, single use, non-toxic, 5 x 35 cm, 10 x 20 cm $30.00 $37.00
Gauze (10) sterile, hydorphilic bioabsorbable, weakly
acidic, viscose-free, knitted haemostatic
fabric (USP)
Pfizer Australia Pty Ltd
PU060 Gelfoam Sterile Sponge Sterile, pliable, nonantigenic surgical 100 - 80mm x 125mm x 10mm $30.00 $72.00
sponge prepared from specially treated in individual packet
purified gelatine solution
3.5.4.5 Haemostatic sponge, >200cm2
Johnson & Johnson Medical Pty Ltd
JJ433 SURGICEL Nu knit Absorbable High density , oxidised regenerated 15.2 x 22.9cm $60.00 $106.00
Haemostat cellulose, the material is biocompatible and
also bactericidal.
3.5.5 Haemostatic matrix, biological
3.5.5.11 Accessory item for haemostatic matrix - extender
Johnson & Johnson Medical Pty Ltd
MN041 Endoscopic Applicator Extender used as an adjunct to 34cm extender $31.00
haemostasis when control of bleeding by
ligature or conventional surgical
procedures is ineffective or impractical
3.5.5.2 Sponge 11-30cm2
Antibiotic
Australasian Medical & Scientific Ltd
AN009 Collatamp G Biodegradeable collagen implant with 5cm x 5cm x 0.5cm $135.00
gentamicin
3.5.5.4 Sponge 76-200cm2
Antibiotic
Australasian Medical & Scientific Ltd
AN008 Collatamp G Biodegradable collagen implant with 10cm x 10cm x 0.5cm, 20cm x $307.00
gentamicin 5cm x 0.5cm
Prostheses List by Category, Groups and Sponsor Page 521 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
3.5.5.6 Liquid 0-10ml
Baxter Healthcare Pty Ltd
BX258 FloSeal Hemostatic Matrix FloSeal is a proprietary combination of 5ml $700.00
collagen-derived particles and topical
thrombin. It is not sponge, but is a high
viscosity gel for haemostasis. Clinical
proven to control bleeding from capillary
oozing to arterial spurting, FloSeal
functions on w
BX259 FloSeal Hemostatic Matrix FloSeal is a proprietary combination of 10ml $1,000.00
collagen-derived particles and topical
thrombin. It is not sponge, but is a high
viscosity gel for haemostasis. Clinical
proven to control bleeding from capillary
oozing to arterial spurting, FloSeal
functions on w
Johnson & Johnson Medical Pty Ltd
JJ640 Surgiflo Haemostatic Matrix Absorbable Porcine Gelatin Matrix Pre- 6ml of gelatin gel per kit. $450.00
packaged in a Syringe Mixing with 2ml-5ml of saline
or thrombin produces 8ml-11ml
of haemostatic matrix.
3.6.1 Biliary Stents
CK Surgitech Pty Ltd
AK003 Biliary Stents Biliary stent, straight, curved, bended, 5.0 to 11.5 french $35.00
pigtails and double pigtail
Cook Medical Australia Pty Ltd
WC269 Fusion Marathon Biliary Stent Biliary Plastic Stent with anti-reflux sleeve Stent diameter: 10FR; Lengths $300.00
preloaded on the OASIS delivery device 5 to 15cm
Prostheses List by Category, Groups and Sponsor Page 522 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3.6.1.1 Biliary stent, wall not reinforced
Boston Scientific Australia Pty Ltd
BS054 Flexima Biliary Stent Polyurethane Biliary Stent Diameters up to 12Fr & lengths $200.00
up to 15cm
BS055 RX Biliary Stent Polyurethane Biliary Stent Diameters up to 12Fr & lengths $200.00
up to 15cm
BS066 Biliary Drainage Stent, Amsterdam C-Flex or Polyurethane Biliary Stent Diameters up to 12Fr & lengths $200.00
Biliary Stent up to 15cm
BS173 NaviFlex Plastic Stent Plastic stent manufactured individually or 5-18cm length, 7-10 FR $200.00
pre loaded on a delivery catheter, diameter
indicated for the treatment of bilary
strictures.
BS184 Advanix Plastic Stent Plastic stent manufactured individually or 5-18cm length, 7-10 FR $200.00
pre loaded on a delivery catheter, diameter
indicated for the treatment of bilary
strictures.
Cook Medical Australia Pty Ltd
WC001 Cotton-Huibregste Biliary Stent Set 7 - 11.5Fr, Length 5 - 15cm $200.00
WC006 Cotton-Leung Biliary Stent Only 6 - 11.5Fr, Length 3 - 20cm $82.00
WC008 Cotton-Huibregste Biliary Stent Only 7 - 11.5Fr, Length 5 - 21cm $82.00
WC012 Zimmon Biliary Stent Only . 5 - 11.5Fr, Length 3 - 18cm $82.00
WC013 Zimmon Biliary Stent Set Double pigtail plastic biliary stent with 5 - 11.5Fr, Length 2 - 18cm $200.00
delivery system
WC064 Tannenbaum Biliary Stent only Plastic biliary stent with proximal and distal Diameter: 8.5,10,11.5 FR. $150.00
flaps Length Between Flaps: 5 -->15
cm
WC078 Cook Biliary Stents Composition Plastic, includes Stent, French 7.0, length 4cm $268.00
Wireguide & Positioner
WC106 Cotton-Leung Biliary Stent Set Polyethylene Stent preloaded on an Oasis Diameter 7 - 11.5 FR, length 5 $200.00
Introduction System - 15cm
WC108 Geenan Pancreatic Stent Set Radiopaque Polyethylene Stent with or Diameter 3 - 11.5 FR, Length 2 $200.00
without ductal flaps - includes pushing - 15cm
catheter
Prostheses List by Category, Groups and Sponsor Page 523 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
WC166 Solus Biliary Stent Set Double Pigtail with OASIS introducer. Diameter 10 FR, Length:1 - 15 $268.00
Sof-flex material - with radiopaque bands. cm Between pigtails
WC228 Tannenbaum Biliary Stent Set preloaded Plastic Biliary Stent 8.5 - 11.5 Fr, 5 - 15 cm $200.00
on the OASIS Introduction System
WC267 Cotton-Leung Biliary Stent Only Cotton-Leung Biliary Stent Only 6 - 11.5 Fr; Length 3 - 20cm $82.00
Olympus Australia
OL003 Bile Duct Stent Polyethylene Stents 7FR - 12FR 3cm - 15cm $82.00
OL008 Olympus Biliary Stent Set Radio-opaque Polyethglare Stent Set 7Fr 3cm - 15cm, 8Fr 3cm - $82.00 $195.00
15cm, 10Fr 3cm - 15cm
Percutaneous, Transhepatic
Cook Medical Australia Pty Ltd
WC017 Cotton-Leung Biliary Stent Set nil provided 7 - 11.5Fr, Length 5 - 18cm $200.00
Preloaded
Cook Medical Australia Pty Ltd
WC216 Fanelli Laparoscopic Endobiliary Stent Fanelli stent (double flange white 7.0 French diameter x 6cm $585.00
Set polyehtylene), tracer Hybrid .035"X150cm length double flange stent
Guide (slippery wire), 8.5 Fr Introducer loaded in an 8.5 fr delivery
and Pusher Catheter (TFE) System with system.
four radiopaque accuracy markers, two
way terminal adapter
3.6.1.2 Biliary stent, reinforced wall, covered
Boston Scientific Australia Pty Ltd
BS052 Wallstent Biliary Stent Monofilament wire, self-expanding stent Diameters up to 10mm & $2,750.00
lengths up to 100mm
BS070 Wallstent RX Biliary Stent Monofilament wire, self-expanding stent Diameters up to 10mm & $3,025.00
lengths up to 100mm
BS117 WallFlex RX Biliary Stent Platinol, self-expanding stent Diameters up to 10mm & $3,025.00
lengths up to 100mm
Endotherapeutics Pty Ltd
ET038 SX-Ella Biliary Stent Uncovered, self-expanding nitinol stent Dia 8-12mm, length 50-77mm $3,025.00 $3,200.00
Prostheses List by Category, Groups and Sponsor Page 524 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
Pyramed Pty Limited
PY020 Niti-S Biliary Covered Stent Niti-S Biliary self expanding nitinol stent Diameter 8mm and 10mm Stent $3,025.00
fully covered with a silicone membrane and lengths 40-120mm
a nylon drawstring for removal. Stent
delivery system is designed for use TTS for
endoscopic or percutaneous procedures
PY027 Niti-S ComVi Biliary Stent (Fully The Niti-S ComVi Biliary Stent (Fully 8mm to 10mm diameter x 4cm $3,025.00 $3,920.00
Covered) Covered) is comprised of 2 Nitinol D-type to 12cm length
stents with a layer of polytetraethylene
(PTFE) between that fully envelopes the
proximal and distal ends of the stent,
resulting in an integrated structure designed
to prevent tissue invasion.
Antimicrobial
W L Gore & Associates
GT116 Gore Biliary Endoprostheses ePTFE Short or Long Catheter 8- $3,025.00 $3,605.00
10mmx4-8cm
3.6.1.3 Biliary stent, reinforced wall, uncovered/bare metal
Bard Australia Pty Ltd
BA124 Memotherm Biliary Stent Nitinol. Includes deployment system Sizes - Diameter 8 - 10mm, $2,225.00
Length 40 - 100mm
Boston Scientific Australia Pty Ltd
BS051 Wallstent Biliary Stent Monofilament wire, self-expanding stent Diameters up to 10mm & $2,225.00
lengths up to 100mm
Cook Medical Australia Pty Ltd
WC174 Zilver Biliary Stent System Self expanding Metal Biliary Stent System Diameters: 6, 8, 10mm; $2,225.00
Lengths: 4, 6,8cm
WC200 Fusion Zilver Biliary Stent System Self expanding Metal Biliary Stent with Diameters: 6, 8 & 10mm; $2,225.00
Fusion Introducer System length: 4, 6 & 8cm
WC270 Zilver Biliary Stent System Self expanding metal biliary stent system Diameters 6, 8, 10mm; Lengths $2,225.00
4, 6, 8 cm
Prostheses List by Category, Groups and Sponsor Page 525 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
Endotherapeutics Pty Ltd
ET039 SX-Ella Tips Stent Uncovered, self-expanding nitinol stent Dia 10-14mm, length 52-77mm $2,225.00 $3,600.00
Olympus Australia
OL011 X-Suit NIR Biliary Metal Stent The Medinol X-Suit® Biliary Metallic 8 or 10mm diameter - 40, 60, $2,225.00
Stent consists of a self-expanding 80 or 100 mm length, 7.5F
noncovered Nitinol stent integrated into a
delivery system.
Pyramed Pty Limited
PY002 Optimed Biliary Sinus Stent Nickel Titanium Alloy 4 - 12 x 30 - 100mm $2,225.00
PY003 Optimed Biliary Sinus Stent Nickel Titanium Alloy 6 - 14mm x 30 - 200mm $2,225.00
PY018 Niti-S Biliary Stent D-Type Niti-S Biliary Stent D-Type Uncovered. 10mm Diameter x 50 - 120mm $2,225.00 $3,000.00
Deployed via stent delivery system for use length
TTS or percutaneously
PY019 Niti-S Biliary Stent Y-Type and T-Type Niti-S Biliary is a self expanding metal 10mm Diameter x 5 - 10cm $2,225.00 $3,000.00
stent, made from Nitinol uncovered. Stent Length
Y-Type for TTS approach, T-Type for
percutaneous approach.
3.6.2 Colonic Stents
3.6.2.2 Colonic stent, wall reinforced
Cook Medical Australia Pty Ltd
WC100 Colonic Z Stent with Introduction System Composition of Stent Stainless Steel, Dia 25mm, length 4, 6, 8, 10, $1,600.00
includes Stent Introducer Set 12cm
Self-expanding
Bard Australia Pty Ltd
BA088 Memotherm Stents Colorectal, Nitinol, Self-expanding 25-30mm D, 60-100mm $3,060.00
Length
Boston Scientific Australia Pty Ltd
BS071 Ultraflex Precision Colonic Stent Nitinol, self expanding stent Diameters up to 30mm & $3,060.00
lengths up to 150mm
Prostheses List by Category, Groups and Sponsor Page 526 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
Pyramed Pty Limited
PY023 Niti-S Colorectal Stent D-type Niti-S D- type Colorectal self-expanding Diameters: 18 - 28mm Lengths: $3,060.00 $3,498.00
metal stent made from Nitinol in unique D 60 - 120mm
mesh construction, uncovered OTW or
TTS. With string for ease of removal.
PY024 Niti-S Colorectal Stent Niti-S Colorectal self-expanding metal Stent Dimensions mm: $3,060.00
stent made from Nitinol. Stent PTFE 18x26x30, 18x24x30,
covered and uncovered OTW or TTS with 20x26x30, 22x30x30,
string for ease of removal. 24x30x30, 20x28x30 Length
mm: 30-90
3.6.3 Oesophageal Stents
CK Surgitech Pty Ltd
AK002 Stent, oesophageal, dudodenal, rectal, self expandable nitinol stent with introducer 20,30,40,50,60,70,80,90,100, $850.00
biliary system 110,120mm
3.6.3.2 Oesophageal stent, reinforced wall, covered
Boston Scientific Australia Pty Ltd
BS089 WallFlex Oesophageal Stent Nitinol, self expanding stent Diameters up to 30mm & $3,500.00
lengths up to 150mm
BS102 Polyflex Oesophageal Stent Polyester braided material encapsulated Diameters up to 30mm & $2,300.00
with silicone, self expanding stent lengths up to 150mm
Cook Medical Australia Pty Ltd
WC068 Esophageal Anti-reflux Stent Self Expanding Metal Stent with Flared End Diameter: 25mm $2,200.00
Polyurethane coating and Dua anti-reflux Shaft Diameter: 18mm
valve Length: 8, 10, 12, 14cm
WC246 Evolution Oesophageal Metal Stent Oesophogeal Self Expanding Metal Stent 8, 10, 12.5 and 15cm Lengths, $3,500.00
with controlled release delivery system 25mm flared ends with 20mm
body or 23mm flared ends with
18mm body
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Billing Code Product Name Description Size Benefit Benefit Notations
Pyramed Pty Limited
PY021 Niti-S Oesophageal Fully Covered Stent Niti-S Oesophageal fully covered self Diameter16mm x 24mm, $3,500.00
expanding nitinol stent with a covering of 18mm x 26mm, 20mm x 28mm
PTFE or silicone and nylon drawstring for and 22mm x 30mmLength
removal or repositioning. 60-150mm
PY022 Niti-S Oesophageal Double Stent Niti-S Oesophageal Double self-expanding Diameter16mm x 24mm, $3,500.00 $3,550.00
metal stent made from Nitinol, with an 18mm x 26mm, 20mm x 28mm
antimigration outer uncovered wire Length60-150mm
construction to allow the mesh to embed in
the oesophageal wall. Also with anti-reflux
valve inner polyurethane layer to prevent
tumour ingrowth. String for retrieval or
repositioning.
3.6.3.3 Oesophageal stent, reinforced wall, uncovered/bare metal
Boston Scientific Australia Pty Ltd
BS046 Ultraflex Oesophageal Stent; Ultraflex Nitinol, self expanding stent Diameters up to 30mm & $2,500.00
Oesophageal NG Stent lengths up to 150mm
Endotherapeutics Pty Ltd
ET001 Ferx Ella Esophageal Stent Kit includes esophageal stent, introducer, Diam 20mm, Length 80 - 160mm $3,500.00
balloon catheter
ET045 Boubella Esophageal Stent Self expandable stainless steel wire stent Length 90 - 195mm $3,500.00 $3,800.00
with anti-reflux valve
Mayo group
CM025 ALIMAXX-E Esophageal Stent System Esophageal stent, radiopaque, self Diameter 18-22mm, Length $2,500.00
expanding nitinol covered stent, 70-120mm
premounted on a delivery system
3.6.4 Pancreatic Stents
3.6.4.1 Pancreatic stent, wall not reinforced
Cook Medical Australia Pty Ltd
WC079 Zimmon Pancreatic Stent Single pigtail with radio-opaque band Diameter 4 - 10FR, Length 2 - $85.00
18cm
WC123 Geenen Pancreatic Stent Straight plastic pancreatic stent with or Diameter 3 - 11.5 FR, length 2 $85.00
without ductal flaps - 20cm
Prostheses List by Category, Groups and Sponsor Page 528 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
WC212 Zimmom Pancreatic Stent Single pigtail radio-opaque Polyethylene Diameter 3 - 7 FR, Length 3 - $85.00
Stent with or without ductal flaps 18cm
WC271 Geenen Pancreatic Stent Straight plastic pancreatic stent with or Diameter 3 - 10 Fr; length 2 - $85.00
without ductal flaps 15cm
3.6.5 Other enteral Stents
Cook Medical Australia Pty Ltd
WC268 Evolution Enteral Metal Stent Enteral Metal Stent Diameter 22 to 25mm body; 27 $3,250.00
to 30mm flanges. Length: 6 to
12cm
3.6.5.1 Other enteral stent, reinforced wall, covered
Boston Scientific Australia Pty Ltd
BS053 Wallstent Enteral Stent Monofilament wire, self-expanding stent Diameters up to 30mm & $3,000.00
lengths up to 150mm
BS090 WallFlex Enteral Stent Nitinol, self expanding stent Diameters up to 30mm & $3,500.00
(Duodenal/Colonic) lengths up to 150mm
Pyramed Pty Limited
PY017 Niti-S Pyloric Stent D-type Niti-S Pyloric self-expanding metal stent Diameter: 16 - 18mm Length: $3,000.00 $3,050.00
D-type made from Nitinol in D mesh 40 - 120mm
construction, uncovered, OTW or TTS
3.6.6 Tracheobronchial Stents
3.6.6.1 Tracheobronchial stent, reinforced wall, covered
Boston Scientific Australia Pty Ltd
BS047 Ultraflex Tracheobronchial Stent Nitinol, self expanding stent Diameters up to 25mm & $3,000.00
lengths up to 80mm
BS101 Polyflex Airway Stent Polyester braided material encapsulated Diameters up to 25mm & $2,300.00
with silicone, self expanding stent lengths up to 80mm
Prostheses List by Category, Groups and Sponsor Page 529 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
BS103 Dynamic (Y) Stent Bifurcated Tracheobronchial stent. Diameters up to 25mm & $3,000.00
Bronchial Limbs made of silicone and lengths up to 120mm
tracheal stem made of silicone with
embedded stainless steel c-shape rings.
Pyramed Pty Limited
PY025 Niti-S Tracheal Stent Tracheal Nitinol Self Expanding Metal 16mm to 20mm diameter x 3cm $3,000.00 $3,395.00
Stent, ePTFE covered with retrieval suture to 10cm length
PY026 Niti-S Bronchial Stent Bronchial Nitinol Self Expanding Metal 10mm to 14mm diameter x 3cm $3,000.00 $3,395.00
Stent, Expanded Poly Tetra Fluoro to 6cm length
Ethylene (ePTFE) covered, with retrieval
suture
Nitinol
Mayo group
CM026 AERO Tracheobronchial Stent System Radiopaque self-expanding nitinol stent Diameter 10-18mm, length 20- $3,000.00
and delivery system 80mm
3.6.7 Other Non-vascular, Non-urological Stents
3.6.7.1 Other non-vascular, non-urological, stent, reinforced wall, covered
Integra Neurosciences Pty Ltd
IG002 NeuraGen NeuraGen is a semi-permeable Type 1 2mm x 2cm, 3mm x 2cm, 4mm $1,250.00
collagen tube for peripheral nerve repair. It x 2cm, 5mm x 2cm, 6mm x
provides a protective environment and 2cm, 7mm x 2cm, 1.5mm x
conduit for axonal regrowth across a nerve 3cm, 2mm x 3cm, 3mm x 3cm,
gap. It is biocompatible and completely 4mm x 3cm, 5mm x 3cm, 6mm
resorbed. The open collagen structure x 3cm, 7mm x 3cm
facilitates suture placement. It has a
resilient structure that maintains an open
lumen throughout the process of axonal
growth.
Prostheses List by Category, Groups and Sponsor Page 530 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
IG003 NeuraWrap NeuraWrap nerve protector is designed to 3mm x 2cm, 3mm x 4cm, 5mm $1,250.00
provide an interface between the nerve x 2cm, 5mm x 4cm, 7mm x
and the surrounding tissues. NeuraWrap 2cm, 7mm x 4cm, 10mm x
remains in place during the active phase of 2cm, 10mm x 4cm
tissue healing and is completely resorbed
after tissue response has resolved. The
porous outer layer of NeuraWrap
comprises a tubular matrix that
mechanically resists compression from
surrounding tissue and excludes scar tissue
ingrowth. The semi-permeable inner
membrane allows passage of small
molecules (ie water, ions, metabolites,
nutrients) but prevents the escape of
endogenous growth factors (Nerve
Growth Factor). NeuraWrap provides a
new alternative for the treatment of
peripheral nerve injuries.
3.6.7.2 Other non-vascular, non-urological, stent, wall not reinforced
LMT Surgical Pty Ltd
LM017 Neurotube Bioabsorbable nerve conduit made of 2.3mm - 8mm $1,430.00
polyglycolic acid
LM080 Neurolac A bioresorbable tension-less Nerve repair 1.5mm x 3cm to 10.0mm x $1,500.00
guide 3cm
3.7.2 Pleural/Intraperitoneal Drainage Catheters
3.7.2.1 Pleural drainage catheter
CareFusion 316 Pty Ltd
ZQ005 Pleurx Pleurx Pleural Catheter Mini Kit Catheter 24cm x 15.5Fr $425.00
ZQ007 PleurX® Pleural Catheter Drainage Pleural Catheter kit with Drainage system Catheter 24cm x 15.5 FR; 500 $425.00 $975.00
System with 10 x 1000 mL or 500mL vacuum mL or 1000 mL vacuum bottles
bottle set. Refer to CI005 for catheter
alone if preferred.
Prostheses List by Category, Groups and Sponsor Page 531 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3.7.2.2 Intraperitoneal drainage catheter
CareFusion 316 Pty Ltd
ZQ004 Pleurx Pleurx Peritoneal Catheter Mini Kit Catheter 71.0cm x 15.5 Fr $395.00
ZQ006 PleurX® Peritoneal Catheter Drainage Peritoneal Catheter kit with Drainage Catheter 71cm x 15.5FR; $395.00 $975.00
System system with 10 x 1000 mL or 500mL 500mL or 1000mL vacuum
vacuum bottle set. Refer to CI004 for bottles
catheter alone if preferred.
Gytech Pty Ltd
GP002 Rocket IPC Pleural/Peritoneal Tunnelled Rocket IPC Pleural/Peritoneal Tunnelled 16fg x 69cm silicone catheter $425.00
Catheter Insertion kit Catheter Insertion kit with 600ml vacuum with cuff, 600ml Vacuum Bottle
bottle
GP003 Rocket IPC Pleural/Peritoneal Tunnelled Rocket IPC Pleural/Peritoneal Tunnelled 16fg x 69cm silicone catheter $425.00
Catheter Insertion kit Catheter Insertion kit with a choice of with cuff, 2000ml bag, 600ml
2000ml bag with non return valve or bottle
600ml vacuum bottle
3.7.3 Endobronchial Valve
Medtel Australia Pty Ltd
ME190 Pulmonx Valve intended to improve lung function in 4.0 (4 to 7 mm) and 5.5 (5.5 to $6,300.00
patients with heterogenous emphysema by 8.5mm)
controlling air flow with a one-way valve
and to treat patients with pulmonary air
leak.
3.8.1 Adhesion Barrier
3.8.1.1 Sheet
Absorbent
Covidien Pty Ltd
AS138 Prevadh Adhesion Prevention film 12x12cm, 17x12cm $345.00 $690.00
Endotherapeutics Pty Ltd
ET051 Surgiwrap Bio Absorbable Antiadhesion Barrier All sizes with and without suture $345.00 $500.00
holes
Prostheses List by Category, Groups and Sponsor Page 532 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
Genzyme Australasia Pty Ltd
GE006 Seprafilm Adhesion Barrier Sodium hyaluronate carbomethylcellulose 13cm x 15cm $345.00
membrane
Johnson & Johnson Medical Pty Ltd
JJ010 Interceed Absorbable Adhesion Barrier Oxidized Regenerated Cellulose 7.6cm x 10.2cm $172.00 $175.00
JJ464 Divide Absorbable Adhesion Barrier Oxidised regenerated cellulose 3.8 x 5.1cmm $172.00 $213.00
Tag Medical
TM044 TissuePatch3 Synthetic Self-Adhesive Surgical Sealant 50mm x 25mm $380.00
Film
TM045 TissuePatch3 Synthetic Self-Adhesive Surgical Sealant 50mm x 50mm $550.00
Film
TM046 TissuePatch3 Synthetic Self-Adhesive Surgical Sealant 50mm x 100mm $755.00
Film
3.8.1.2 Gel/Liquid
Absorbent
Covidien Pty Ltd
AS178 SprayShield Adhesion Barrier System Polymer Kit with Air Assisted Sprayer, 10ml $362.00 $585.00
Single-use.
Johnson & Johnson Medical Pty Ltd
JJ700 Ethicon Intercoat Absorabable Adhesion Combination of Polyethylene Oxide (PEO) 2 x 20ml Sterile Syringes, 1x $500.00
Barrier Gel and Sodium Carboxymethylcellulose Applicator
stabilised with Calcium and made isotonic
with Sodium Chloride. Kit contains 2 x
20ml Sterile Syringes, 1 x Applicator
Lifehealthcare Pty Ltd
LH001 Oxiplex Absorbable Adhesion Barrier Oxiplex Absorbable Adhesion Barrier gel 3ml in sterile 3ml syringe $1,300.00
Gel (Oxiplex is a co-polymer gel composed of
carboxymethylcellulose and polyethylene.)
Medtronic Australasia Pty Ltd
MC618 Medishield Medishield is a co-polmer gel composed 3cc Syringe $1,300.00
of carboxymethylcellulose and
polyethylene.
Prostheses List by Category, Groups and Sponsor Page 533 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
3.8.1.3 Spray
Absorbent
Baxter Healthcare Pty Ltd
BX260 ADEPT Adhesion Reduction Solution ADEPT Adhesion Reduction Solution is a 1500ml $250.00
single use, sterile fluid for intraperitoneal
administration. ADEPT is intended to be
used as an instillate for the reduction of
adhesions following abdominal surgery.
3.8.2 Ligating Clips
Ebos Group Pty Ltd
EB132 Frankenman Linear Cutter Stapler Single use, reloadable, linear cutter stapler 61mm; 81mm; 100mm $470.00
containing titanium staples
EB133 Frankenman Linear Stapler Reloads Linear stapler single use reload with 32mm; 46mm; 60mm; 90mm $240.00
titanium staples
EB134 Frankenman Linear Stapler Linear stapler preloaded with titanium 32mm; 46mm; 60mm; 90mm $320.00
staples
EB135 Frankenman Linear Cutter Reloads Single use, linear cutter reload cartridge 61mm; 81mm; 100mm $240.00
containing titanium staples
3.8.2.1 Ligating clips with disposable applier
Boston Scientific Australia Pty Ltd
BS171 Resolution II Haemostasis Clip Pre-loaded endoscopically applied clip, 7Fr, 11mm jaw opening $145.00
radiopaque stainless steel & cobalt chrome.
C. R. Kennedy
CK003 Endox Visu-Loc Clip Applier Single-use laparoscopic clip applier Medium, Large $250.00
CK Surgitech Pty Ltd
AK005 Clip applier Automatic clip applier with trigger handle Shaft diameter 10mm, length $140.00
10mm x 33cm with medium/large clips 33cm, medium/large clips
Prostheses List by Category, Groups and Sponsor Page 534 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
ConMed Linvatec Australia Pty Ltd
LV076 Richard Allan Endoscopic Accessories Titanium endoscopic clips with applier Medium-Large, 9mm closed. $258.00
20 clips
LV086 Reflex 5mm Automatic Clip Applier Autofeeding disposable clip applier. medium/large $328.00
Contains 15 non absorbable polymer
locking clips
Covidien Pty Ltd
AS006 Ligation Clips - Disposable clip applier Surgiclip Small $222.00
and ligating clips
AS011 GIA*, ILA* Staplers Titanium 75mm (3.8mm, 4.8mm) $250.00 $294.00
AS018 TA* Stapler; DST Series* Linear Premium Multifire TA* Disposable DST TA60-3.5; DST TA60-4.8 $320.00
Staplers Surgical Stapler and Loading Unit;
Titanium staples used for hemostatic
closure of specific organs and blood
vessels (ex bowel, stomach and lung).
AS019 PI*, Stapler Premium Multifire TA* Disposable 30mm (2.5, 3.5, 4.8mm) $250.00 $264.00
Surgical Stapler and Loading Unit
AS035 Roticulator* Roticulator 30 30mm (3.5, 4.8mm) $680.00 $715.00
AS036 Roticulator* Roticulator 55 55mm (3.5, 4.8mm) $799.00
AS037 ROTICULATOR* Polysorb 55 Disposable Loading Unit 55mm (3.5, 4.8mm) $680.00 $715.00
AS045 STAT TACK* and Endoscopic Tacker Endoscopic TACKER*; Titanium; 20 tacks; 30 tacks; 5mm; 4mm, $435.00
Device; PROTACK* Hernia Stapling Titanium Surgical Stapler. 4.8mm (10 staples).
Product; ENDO UNIVERSAL*
AS072 Staples and Disposable Stapler Applier Titanium, curved, PPCEEA*; Titanium 21-34mm; 21, 25, 28, 31, $780.00
and staples; PPCEEA*. Surgical Stapler. 34mm.
AS073 ENDOCLIP*; Acuclip Single use Titanium Surgical Stapler 5mm (12 clips); One size only. $435.00
Endoscopic Multiple Clip Applier.
AS074 ENDOCLIP* Titanium Surgical Stapler 10mm (ML, M, L)-(20 clips) $435.00
AS075 ENDO TA* Titanium Surgical Stapler 30mm $435.00 $606.00
AS077 ENDO GIA* Titanium Surgical Stapler 30 - 35mm $435.00 $615.00
AS095 STAT TACK* and Endoscopic Tacker STAT TACK* One size only $250.00
Device
AS110 DFS Disposable Fascia Stapler Stainless Steel One Size Only $250.00
Prostheses List by Category, Groups and Sponsor Page 535 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
AS113 DST Series* GIA* Linear Cutter Stapler single use, reloadable stapler 60mm length: sizes 2.5mm, $320.00 $354.00
and single use loading units 3.8mm, 4.8mm
AS115 DST Series* GIA* Linear Cutter Stapler Single use, reloadable stapler 80mm length; Sizes 3.8 and $470.00
and single use loading units 4.8mm
AS119 DST Series* EEA* Circular Stapler Circular staplers 21mm to 33mm $780.00 $820.00
AS131 Ligation Clips - Disposable clip applier Surgiclip Medium $250.00
and ligating clips
AS132 Ligation Clips - Disposable clip applier Surgiclip Large $285.00
and ligating clips
AS133 TA* Stapler; DST Series* Linear Premium Multifire TA* Disposable 30mm (2.5, 3.5, 4.8mm); DST $320.00 $370.00
Staplers Surgical Stapler and Loading Unit; TA45-3.5; DST TA45-4.8;
Titanium staples used for hemostatic DST TA30-3.5; DST TA30-
closure of specific organs and blood 4.8; DST TA30V3.
vessels (ex bowel, stomach and lung).
AS179 EEA Haemorrhoid and Prolapse Stapler Stapling instrument for control of rectal 33mm Circular Stapling line, $725.00
prolapse and haemorrhoid disease. 3.5 mm and 4.8mm Staple leg
length.
Ebos Group Pty Ltd
EB130 Frankenman Circular Stapler Curved intraluminal stapler preloaded with 21mm; 25mm; 28mm; 32mm $780.00
titanium staplers.
EB131 Frankenman Haemorrhoidal (CPH) Circular stapler for rectal prolapse and Outside diameter: 32.5mm; $725.00
Stapler haemorrhoids preloaded with titanium 34.5mm
staples
Endotherapeutics Pty Ltd
ET061 Stomaphyx, Stomaphyx Serosafuse Stomaphyx Serosafuse Fasteners One Size $150.00 $500.00
Fasteners
ET062 Stomaphyx Stomaphyx One Size $300.00 $4,000.00
ET064 AMI HAL-RAR Flexi Procedure Kit Doppler guided Haemorrhoidal Arterial One size, several components $725.00 $980.00
Ligation and Recto-Anal Repair System.
HAL Haemorrhoidal Ligating sutures,
doppler/ultrasound proctoscope,
flexiprobe, knot pusher
Johnson & Johnson Medical Pty Ltd
JJ037 Ligaclip* Multiple Clip Applier Metal/plastic applier preloaded with 3-12 mm; 20 clips per applier $250.00 $255.00
titanium clips
JJ038 Ligaclip* Multiple Clip Applier Metal/plastic applier preloaded with 3-12 mm; 30 clips per applier $300.00
titanium clips
Prostheses List by Category, Groups and Sponsor Page 536 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ039 Ligaclip* Multiple Clip Applier Metal/plastic applier preloaded with 5; 20 clips per applier $250.00
titanium clips; reloadable
JJ041 Proximate* Intraluminal Stapler Metal/plastic circular straight stapler 21 - 33 mm $780.00
preloaded with titanium staples
JJ042 Proximate* Intraluminal Stapler Metal/plastic circular curved stapler 21 - 33mm $780.00 $799.00
preloaded with titanium staples
JJ043 Proximate* Linear Cutter with Staples Metal/Plastic linear cutter preloaded with 50 - 60mm $364.00
titanium staples
JJ044 Proximate* Linear Cutter with Staples Metal/Plastic linear cutter preloaded with 75 - 80mm $470.00 $488.00
titanium staples
JJ045 Proximate* Linear Cutter with Staples Metal/Plastic linear cutter preloaded with 100mm $470.00 $560.00
titanium staples
JJ049 Proximate* Linear Stapler Metal/Plastic linear stapler preloaded with 30mm $320.00 $380.00
titanium staples
JJ050 Proximate* Linear Stapler Metal/Plastic linear stapler preloaded with 55 - 60mm $320.00 $400.00
titanium staples, manual closure
JJ051 Proximate* Linear Stapler Metal/Plastic linear stapler preloaded with 55 - 60mm $320.00 $400.00
titanium staples, automatic closure
JJ052 Proximate* Linear Stapler Metal/Plastic linear stapler preloaded with 90mm $320.00 $420.00
titanium staples
JJ056 Proximate Articulating Linear Stapler Articulating linear stapler preloaded with 55mm $799.00 $863.00
titanium staples
JJ184 Endopath Multi Stapler Endoscopic titanium stapler with staples 11mm shaft diameter $470.00 $550.00
JJ186 Ligaclip Endoscopic Multiclip Applier Metal/plastic stapler with titanium clips 10-12 mm shaft diameter, $470.00
medium to large clip
JJ187 Ligaclip Allport 5mm Clip Applier Metal/plastic stapler with titanium clips 5mm shaft diameter $320.00 $414.00
JJ188 Endopath Linear Cutter Metal/plastic cutter-stapler with titanium 45mm; short shaft $435.00 $712.00
staples
JJ189 Endopath Linear Cutter Metal/plastic cutter-stapler with titanium 45mm; long shaft $435.00 $770.00
staples
JJ191 Endopath Linear Cutter Metal/plastic cutter-stapler with titanium 35mm $435.00 $696.00
staples
JJ443 Proximate Intraluminal Stapler PPH Proximate Hemorrhoidal Circular Stapler One Size Only $725.00 $754.00
PPH
Prostheses List by Category, Groups and Sponsor Page 537 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
JJ482 LIGAMAX 5mm Endoscopic Clip LIGAMAX 5mm Endoscopic Clip Applier Medium / Large $412.00 $428.00
Applier
JJ564 Echelon Endocutter Reload Echelon Endocutter Reload 60 and 45mm $244.00
JJ812 CONTOUR Curved Cutter Stapler Curved cutter and stapler for 40mm $650.00
gastrointestinal transaction and resection.
Med-Chem Surgical Pty Ltd
ML004 Touchstone Linear Cutter Stapler 60mm A device that incorporates a disposable 60mm length in staple line with $350.00
staple cartridge that lays a double choice of 2.5mm, 3.8mm and
staggered row of staples on each side of a 4.5mm titanium staples
cutting knife. Used for extensive bowel,
gastric, gynaecological and thoracic
surgical stapling procedures.
ML005 Touchstone Linear Cutter Stapler 80mm A device that incorporates a disposable 80mm length in staple line with $380.00
staple cartridge that lays a double choice of 3.8mm and 4.5mm
staggered row of staples on each side of a titanium staples
cutting knife. Used for extensive bowel,
gastric, gynaecological and thoracic
surgical stapling procedures.
ML006 Touchstone Linear Cutter Stapler A device that incorporates a disposable 100mm length in staple line with $380.00
100mm staple cartridge that lays a double choice of 3.8mm and 4.5mm
staggered row of staples on each side of a titanium
cutting knife. Used for extensive bowel,
gastric, gynaecological and thoracic
surgical stapling procedures.
ML011 Touchstone Linear Stapler A device housing a staple cartridge that 30, 45, 60 and 90mm staple $320.00
places a double staggered row of staples lines in 2.5, 3.5 or 4.8mm
into appropriate target tissue. staples
ML012 Touchstone Circular Stapler A surgical implanting device for placing s external dimesnion - 25mm, $699.00
specific size of double staggered row of 29mm or 33mm
titanium staples in a circular fashion in the
large bowel, small bowel or oesophagus to
maintain function of the digestive tract. A
suitable size is used to match the lumen size
of the patient's digestive tract
Prostheses List by Category, Groups and Sponsor Page 538 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
ML013 Touchstone Prolapse Haemorrhoid A surgical implanting device for placing a 33mm is the external diameter $680.00
Stapler specific size of double staggered row of of the device.
titanium staples in a circular fashion in the
Anal and/or Rectal region for the
circumferential excision of the prolapsed
distal rectal muscosa, as described by Dr.
Longo, Italy.
Medical Specialties Australia Pty Ltd
MS056 THD Slide Transanal Haemorrhoidal Dearterilisation one size only $725.00 $980.00
and Pexis System
N Stenning & Co Pty Ltd
NG023 Hemoclip Plus Ligation System Small and Medium 15 small preloaded clips and 20 $250.00
medium preloaded clips
NG043 Weck Hem-o-lok Hem-o-lok Automatic Endo Applier 15 Clips per applier $309.00
Olympus Australia
OL009 Rotatable Clip fixing device Endoscopic Mechanical Standard or long clip length, 9 $145.00
or 11mm jaw opening
OL010 Ligation device Disposable pre-assembled applier and Sheath Length 1650-2300mm $145.00
ligating loop
Sole Health Care Products Pty Ltd
PS001 Linear Stapler Single use surgical stapler preloaded with 30mm (4.5mm & 3.8mm), $320.00
titanium staples. 45mm (4.5mm & 3.8mm),
60mm (4.5mm & 3.8mm),
75mm (4.5mm & 3.8mm) and
90mm (4.5mm & 3.8mm)
PS003 Hemorrhoid Stapler Surgical Hemorrhoidal Circular Stapler 32mm (3.8mm), 34mm (3.8mm $680.00
with staple leg lengths specifically designed & 4.5mm), 36mm (4.0mm &
to perform Stapled Hemorrhoidectomies 4.5mm)
and Stapled Transanal Rectal Resection
(S.T.A.R.R) procedures.
PS004 Circular Stapler Surgical Circular Stapler pre loaded with 21mm (4.2mm), 24mm $625.00
titanium staples used to anastomose organs. (4.5mm), 26mm (4.5mm),
29mm (4.8mm), 32mm
(5.0mm), and 34mm (5.0mm)
Prostheses List by Category, Groups and Sponsor Page 539 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
PS005 Linear Cutter Single use surgical stapler and cutter pre 55mm (3.85mm), 55mm $364.00
loaded with titantium staples. (4.5mm), 75mm (3.85mm),
75mm (4.5mm), 100mm
(3.85mm), 100mm (4.5mm)
Tag Medical
TM049 Anastoclips Vessel Closure System (VCS) Small, Medium, Large, Extra $450.00
Large
Endoscopic
Applied Medical Australia Pty Ltd
MH014 Direct Drive laparoscopic clip applier Single-use, sterile 10mm laparscopic clip 10mm shaft diameter with $220.00
with TiGold titanium clips applier with 20 medium-large size titanium medium-large size clips.
clips
Boston Scientific Australia Pty Ltd
BS082 Resolution Clip Device Pre-loaded endoscopically applied clip, 7Fr, 11mm jaw opening $145.00
radiopaque stainless steel & cobalt chrome.
Cook Medical Australia Pty Ltd
WC213 Endoscopic Clipping Device TriClip Endoscopic Clipping Device 7Fr - 3 Prong 12mm, 8Fr - 3 $145.00
prong 12mm
Johnson & Johnson Medical Pty Ltd
JJ568 Echelon Endocutter Multifire disposable surgical stapling 60mm and 45mm $435.00 $618.00
insturment 60mm and 45mm
3.8.2.2 Ligating clips without disposable applier
B Braun Australia Pty Ltd
BB016 Challenger Ligating Clips Challenger Ligating Clips Titanium Multifire Medium-large $65.00
BB294 Aesculap Ligating Clips Aesculap Ligating Clips- Ligation Clips PL561T- Large $12.00
Titanium;
BB297 Aesculap Ligating Clips Aesculap Ligating Clips Titanium PL565T - Small $10.00
BB298 Aesculap Ligating Clips Aesculap Ligating Clips Titanium PL566T - small cardiopack of $35.00
24
BB299 Aesculap Ligating Clips Aesculap Ligating Clips Titanium PL567T - medium $12.00
BB300 Aesculap Ligating Clips Aesculap Ligating Clips Titanium PL568T - medium/large $12.00
Prostheses List by Category, Groups and Sponsor Page 540 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BB301 Challenger Ligating Clips Challenger Ligating Clips Titanium Multifire PL572 - small/medium $70.00
BB321 Pneumatic Challenger Multifire Clips Challenger TI-P SM-Ligat. Clips 12 small-medium, medium-large $75.00
Cartridge (PL574T) Challenger TI-P
ML-Ligat. Clips 12 Cartridge (PL579T)
C. R. Kennedy
CK001 Microline Pentax Disposable 10ml Disposable cartridge containing 19 surgical medium/large clip $109.00
Titanium K2 Clip Cartridge grade titanium clips delivered using a re-
usable hand piece applier
CK002 Microline Pentax Disposable 10ml Disposable cartridge containing 10 surgical Medium/Large Clip $88.00
Titanium K2 clip Cartridge grade titanium clips delivered using a
reusable hand piece applier.
CK004 System: Microline Pentax Reposable Disposable cartidge, containing 18 large Large clip - 10mm clip applier $150.00
"Gemini-L Clip Applier" surgical grade titanium clips delivered using
a re-usable hand piece applier
Covidien Pty Ltd
AS001 Endoclip Disposable Loading Unit; Single use loading unit with 8 titanium clips; One size only $42.00 $69.00
MultApplier Disposable loading unit. Disposable clip cartridge with 8 titanium
clips
AS013 ILA* 52 Reloading Unit Titanium. Multifire 60 Cartridge 90 50 - 60mm (2.5mm, 3.8mm) $160.00
Premium Disposable Loading Unit with
Titanium Staples, 50 Premium Disposable
Loading Unit with Titanium Staple,
Inverted Linear Anastomosis Cartridges
3944, 3943, 3978, 3946, 3945, 3976,
3977
AS016 GIA*, ILA* Reloading Unit Titanium. Multifire 60 Cartridge, Inverted 90mm (3.8, 4.8mm) $400.00 $503.00
Linear Anastomosis Cartridges 3944,
3943, 3978, 3946, 3945, 3976, 3977
AS017 GIA*, ILA* Reloading Unit Titanium. Multifire 60 Cartridge, Inverted 100mm (3.8,4.8mm) $400.00
Linear Anastomosis Cartridges 3944,
3943, 3978, 3946, 3945, 3976, 3977
Prostheses List by Category, Groups and Sponsor Page 541 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AS025 TA* Reloading Units; DST Series* Premium Multifire TA* Disposable 30mm (2.5, 3.5, 4.8mm); DST $245.00
Linear Stapler Disposable Loading Units Surgical Stapler and Loading Unit; TA90-3.5 DLU; DST TA90-
Titanium staples used for hemostatic 4.8 DLU; DST TA45-3.5
closure of specific organs and blood DLU; DST TA45-4.8 DLU;
vessels (ex bowel, stomach and lung) DST TA60-3.5 DLU; DST
TA60-4.8 DLU; DST TA30-
3.5 DLU; DST TA30-4.8
DLU; DST TA30V3 DLU.
AS026 PI*, Reloading Unit Premium Multifire TA* Disposable 30mm (2.5, 3.5, 4.8mm) $160.00
Surgical Stapler and Loading Unit
AS033 Power Stapler and Staples (Powered LDS Instrument & Cartridges (Disposable One size only $355.00
LDS*) Loading Unit)
AS076 ENDO TA* reloading unit Titanium Surgical Stapler DLU 30mm -2.5, 30mm-3.5 $200.00
AS081 ENDO GIA* reloading unit Titanium Surgical Stapler DLU 30 - 35mm; 45mm; 60mm. $250.00
AS091 VERSA TACK* stapler Titanium Surgical Stapler 4, 4.8mm (10 staples) $272.00
AS092 ENDO - Herna reloading unit; VERSA Titanium Surgical Stapler DLU 4mm, 4.8mm (10 staples). $160.00
TACK* reloading unit.
AS102 DST Series* Linear Staplers Titanium staples used for hemostatic DST TA90-3.5; DST TA90-4.8 $355.00 $398.00
closure of specific organs and blod vessels
(ex bowel, stomach and lung)
AS114 DST Series* GIA* Linear Cutter Stapler Single Use Loading Units 60mm length: Sizes 2.5mm, $240.00
and single use loading units 3.8mm, 4.8mm
AS116 DST Series* GIA* Linear Cutter Stapler Single Use Loading Units 80mm length: Sizes 3.8 and $355.00 $367.00
and single use loading units 4.8mm
AS117 DST Series* GIA* Linear Cutter Stapler Single use, reloadable stapler 100mm length: Sizes 3.8 and $460.00
and single use loading units 4.8mm
AS118 DST Series* GIA* Linear Cutter Stapler Single use loading units 100mm length: Size 3.8 and $335.00
and single use loading units 4.8mm
AS177 Duet TRS Reload with Tissue Single use loading units with tissue 45mm and 60mm staple line $456.00
Reinforcement reinforcement material for use with Endo length; 3.5mm and 4.8mm
GIA Universal stapling devices staple leg-length
Johnson & Johnson Medical Pty Ltd
JJ033 Ligaclip* Ligating Clips - titanium Titanium clips contained in a plastic 3-5mm; 6 clips per cartridge $12.00
cartridge
JJ034 Ligaclip* Ligating Clips - titanium Titanium clips contained in a plastic 9-12 mm; 6 clips per cartage $12.00 $17.00
cartridge
Prostheses List by Category, Groups and Sponsor Page 542 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
JJ035 Ligaclip* Ligating Clips - titanium Titanium clips contained in a plastic 3-5 mm; 20 clips per cartridge $25.00 $32.00
cartridge
JJ040 Ligaclip* 20/20 Reload Unit Metal reload cartridge containing titanium 5 mm; 20 clips $25.00 $104.00
clips
JJ046 Proximate* Linear Cutter Staple Reload Plastic linear cutter reload cartridge 50 - 60mm $242.00
Unit containing titanium staples
JJ047 Proximate* Linear Cutter Staple Reload Plastic linear cutter reload cartridge 75 - 80mm $335.00 $341.00
Unit containing titanium staples
JJ048 Proximate* Linear Cutter Staple Reload Plastic linear cutter reload cartridge 100mm $335.00 $348.00
Unit containing titanium staples
JJ053 Proximate* Linear Stapler Reload Unit Plastic linear stapler reload cartridge 30mm $240.00
containing titanium staples
JJ054 Proximate* Linear Stapler Reload Unit Plastic linear stapler reload cartridge 55 - 60mm $240.00
containing titanium staples
JJ055 Proximate* Linear Stapler Reload Unit Plastic linear stapler reload cartridge 90mm $240.00 $257.00
containing titanium staples
JJ190 Endopath ETS Linear Cutter reload Titanium staple cartridge 45mm $250.00
JJ192 Endopath ETS Linear Cutter reload Titanium staple cartridge 35mm $250.00
JJ475 Proximate Contour Curved Cutter/Stapler Contour Curved Cutter/Stapler 30 & Blue (3.85mm) & Green $240.00 $263.00
40mm reload cartridges (4.5mm)
LMT Surgical Pty Ltd
LM042 Synovis Microclip Malleable titanium clip 1.5-2.5mm x 2-3.5mm $25.00
Med-Chem Surgical Pty Ltd
ML007 Touchstone Linear Cutter Stapler A disposable staple cartridge used in 60mm length in staple line with $250.00
Cartridge (Reloads) 60mm conjunction with a matched Touchstone choice of 2.5mm, 3.8mm and
Linear Cutter Stapler that lays a double 4.5mm titanium staples
staggered row of staples on each side a
cutting knife. Used for extensive bowel,
gastric, gynaecological and thoracic
surgical stapling procedures.
ML008 Touchstone Linear Cutter Stapler A disposable staple cartridge used in 80mm length in staple line with $280.00
Cartridge (Reloads) 80mm conjunction with a matched Touchstone choice of 3.8mm and 4.5mm
Linear Cutter Stapler that lays a double titanium staples
staggered row of staples on each side a
cutting knife. Used for extensive bowel,
gastric, gynaecological and thoracic
surgical stapling procedures.
Prostheses List by Category, Groups and Sponsor Page 543 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
ML009 Touchstone Linear Cutter Stapler A disposable staple cartridge used in 100mm length in staple line with $280.00
Cartridge (Reloads) 100mm conjunction with a matched Touchstone choice of 3.8mm and 4.5mm
Linear Cutter Stapler that lays a double titanium staples
staggered row of staples on each side a
cutting knife. Used for extensive bowel,
gastric, gynaecological and thoracic
surgical stapling procedures.
ML010 Touchstone Linear Stapler Cartridge A device housing a staple cartridge that 30, 45, 60 and 90mm staple $210.00
places a double staggered row of staples lines in 2.5, 3.5 or 4.8mm
into appropriate target tissue. staples
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG030 Haemostatic Ligating Clips Titanium Ligating Clips Small - Large (6 Clips per $8.00
cartridge)
MG031 Haemostatic Ligating Clips Titanium Ligating Clips Small, medium (24 clips per $32.00
pouch)
N Stenning & Co Pty Ltd
NG006 Horizon Ligating Clips Ligation Clips Titanium Small (6 per cartridge) $12.00
NG007 Horizon Ligating Clips Ligation Clips Titanium Small (24 per cartridge) $42.00
NG008 Horizon Ligating Clips Ligation Clips Titanium Medium (6 per cartridge), $12.00
Micro (6 per cartridge)
NG009 Horizon Ligating Clips Ligation Clips Titanium Medium (24 per cartridge) $42.00
NG010 Horizon Ligating Clips Ligation Clips Titanium Medium/Large (6 per cartridge) $12.00 $18.00
NG011 Horizon Ligating Clips Ligation Clips Titanium Medium/Large (24 per $42.00 $47.00
cartridge)
NG012 Horizon Ligating Clips Ligation Clips Titanium Large (6 per cartridge) $12.00 $22.00
NG013 Horizon Ligating Clips Ligation Clips Titanium Large (24 per cartridge) $43.00 $57.00
NG014 Hemoclip Titanium Clips Small, Medium (25 per $25.00 $31.00
cartridge); Large (15 per
cartridge)
NG016 Hemoclip Titanium Clips Medium (10 per cartridge) $18.00
NG017 Hemoclip Titanium Clips Small (10 per cartridge) $18.00
NG018 Hemoclip Titanium Clips Med-large (10 per cartridge) $18.00
NG019 Hemoclip Titanium Clips Large (10 per cartridge) $20.00 $21.00
Prostheses List by Category, Groups and Sponsor Page 544 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
NG020 EZLoad Ligating Clips Titanium Clip Small (25 per cartridge); Med- $20.00 $27.00
Large, Large (10 per cartridge)
NG021 EZLoad Ligating Clips Titanium Clip Medium (25 per cartridge) $42.00
NG022 EZLoad Ligating Clips Titanium Clip Small, Medium (10 per $18.00 $34.00
cartridge)
NG025 Hem-o-Lok Polymer Non-Absorbable Hem-o-lok Medium (M), Medium-Large Small, Medium, Medium- $42.00 $46.00
Ligating Clip (ML) and Large (L) Polymer Clips Large, Large
NG044 Hem-o-lok Polymer Non-Absorbable Hem-o-lok Extra-large (XL) Polymer Extra-large (XL) $45.00 $62.00
Ligating Clip Clips
Olympus Australia
OL001 Individual Ligating Clip Rotatable Clip Fixing Device. Pack of 50 MD-59 - 90 degree, standard; $12.00
clips MD-850 - 135 degree,
standard; HX-600-090 -
standard, sterile; HX-600-135
- standard, sterile
Sole Health Care Products Pty Ltd
PS002 Linear Stapler Cartridge Reloading cartridge containing titanium 30mm (3.8mm & 4.5mm), $56.00
staples for use with the Linear Stapler 45mm (3.8mm & 4.5mm),
60mm (3.8mm & 4.5mm),
75mm (3.8mm & 4.5mm) and
90mm (3.8mm & 4.5mm)
PS006 Linear Cutter Cartridge Reloading cartridge containing titanium 55mm (3.85mm & 4.5mm), $160.00
staples for use with the Linear Cutter. 75mm (3.85mm & 4.5mm) and
100mm (3.85mm & 4.5mm).
Bariatric
Covidien Pty Ltd
AS030 TA* Reloading Units Premium Multifire TA* Disposable 90mm (3.5mm, 4.8mm) $724.00
Surgical Stapler and Loading Unit
Resorbable
Johnson & Johnson Medical Pty Ltd
JJ036 Absolok* Extra Absorbable Ligating Polydioxanone clips contained in a plastic Small to Extralarge $90.00 $94.00
Clips cartridge
Prostheses List by Category, Groups and Sponsor Page 545 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
3.8.2.3 Ligating clips with disposable applier, open surgical
ConMed Linvatec Australia Pty Ltd
LV081 Open Clip Applier Titanium 25 medium size titanium clips $158.00
Covidien Pty Ltd
AS046 Endo GIA* Universal Stapling System; Multifire 30 disposable stapler with 12mm; One size only. $415.00
Versafire GIA*. titanium staples; Disposable surgical
stapling instruments or cartridges.
AS135 DST™ Series EEA™ XL Circular Stapler 5 sizes $780.00
Endoscopic
Covidien Pty Ltd
AS137 Endo Clip III Laparoscopic 5mm Clip Applier 5mm $435.00
3.8.2.5 Ligating Suture
Endotherapeutics Pty Ltd
ET065 HAL-RAR HAL-Ligating Suture, AMI HAL-Ligating One size $12.00 $100.00
suture, prosthetic component of AMI
HAL-RAR Doppler System
3.8.3 Mesh, Soft Tissue Closure, Non-metallic, Polypropylene, Polyester
3.8.3.1 0-100cm2 polypropylene, polyester
Atrium Australia - Pacific Rim Pty Limited
AC009 Atrium polypropolene mesh - surgical Polypropolene - Pre-shaped with hole 6.5 x 12.5cm $77.00 $200.00
mesh
AC010 Atrium polypropolene mesh - surgical Polypropolene 5 x 10cm $77.00 $82.00
mesh
B Braun Australia Pty Ltd
BB088 Premilene Mesh Polypropylene 3x10cm $77.00
BB089 Premilene Mesh Polypropylene 4.5x10cm $77.00
BB090 Premilene Mesh Polypropylene 4.5x10cm $77.00
BB091 Premilene Mesh Polypropylene 4.5x10cm $77.00
BB093 Premilene Mesh Polypropylene 6x14cm $77.00
Prostheses List by Category, Groups and Sponsor Page 546 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
BB094 Premilene Mesh Polypropylene 6x13.5cm $77.00
BB095 Premilene Mesh Polypropylene 7.5x7.5cm $77.00
BB096 Premilene Mesh Polypropylene 4.5x105cm $77.00
BB098 Premilene Mesh Polypropylene 10x10cm $77.00
BB099 Premilene Mesh Polypropylene 6x14cm $77.00
BB183 OPTILENE MESH Polypropylene Mesh 7.5x7.5cm, 5 pieces $77.00
BB186 OPTILENE MESH Polypropylene Mesh 5 x 10cm, 5 pieces $77.00
BB188 OPTILENE MESH Polypropylene Mesh 4.5x10cm, 5 pieces $77.00
BB190 OPTILENE MESH Polypropylene Mesh 4.5x10cm $77.00
BB191 OPTILENE MESH Polypropylene Mesh 6x14cm, 5 pieces $77.00
Bard Australia Pty Ltd
BA070 Bard Mesh Flat mesh Small - 1" x 4" / 2" x 4" / 2" x $77.00
12" / 3 " x 6" / Pre-shaped 1.8"
x 4" / Pre-shaped 2.4" x 5.4"
Covidien Pty Ltd
AS055 Mesh Polyproplene; Monofilament Multifilament Polypropylene; Monofilament 7.6cm x 12.7cm Surgipro* $77.00
Polyproplylene. Polypropylene. mesh (3 x 5 inch)
AS057 Mesh Polyproplene; Monofilament Multifilament Polypropylene; Monofilament 2.5cm x 10.2cm Surgipro* $77.00
Polyproplylene. Polypropylene. mesh (1 x 4 inch)
AS174 Parietene-Monofiliment Polypropylene Parietene-Monofiliment Polypropylene 6 x 11cm, 15 x 10, 15 x 15cm $77.00
Mesh standard mesh/light mesh
EMT Healthcare Pty Ltd
EM023 Biomesh P1/P3 Reinforcement Mesh Macro porous 100% polypropylene mesh 2.3 x 10cm $77.00
for laproscopic and open surgical
approaches
EM024 Biomesh P1/P3 Reinforcement Mesh Macro porous 100% polypropylene mesh 5 x 10cm $77.00
for laproscopic and open surgical
approaches
Johnson & Johnson Medical Pty Ltd
JJ174 Prolene Mesh Small polypropylene monofilament non 2.5cm x 10cm $77.00 $80.00
absorbable mesh
JJ177 Prolene Mesh Small keyhole polypropylene monofilament 4.6cm x 10.2cm $77.00 $165.00
non absorbable mesh
Prostheses List by Category, Groups and Sponsor Page 547 of 911
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Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ178 Prolene Mesh Large keyhole polypropylene 6cm x 13.7cm $77.00 $120.00
monofilament non absorbable mesh
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG001 Aspide Surgimesh Monofilament polypropylene 6x11cm thread 0.14mm $77.00
MG004 Aspide Surgimesh Monofilament polypropylene 8 x 12cm Thread 0.14mm $77.00
3D Complex
Bard Australia Pty Ltd
BA061 Bard Mesh PerFix Plug Small, Medium, Large $263.00
BA071 Bard Mesh 3D Mesh Large Left $263.00
BA072 Bard Mesh 3D Mesh Medium Left $263.00
BA073 Bard Mesh 3D Mesh Large Right $263.00
BA074 Bard Mesh 3D Mesh Medium Right $263.00
Covidien Pty Ltd
AS124 Parietene-Monofilament Polypropylene Parietene-Monofilament Polypropylene 06 x 12 cm $263.00
mesh mesh Plug and Patch
AS130 Parietex-Multifilament Polyester Mesh Parietex-Multifilament Polyester Mesh Plug 6 cm, 8 cm $263.00
AS167 Parietex Multifilament Polyester Mesh Parietex-Multifilament Polyester Mesh 13 x 09 cms, 14 x 09 cms $205.00
Three-dimensional/Ease Grip, with Slit
Johnson & Johnson Medical Pty Ltd
JJ180 Prolene Hernia System BI-LAYER POLYPROPYLENE NON MEDIUM TO EXTENDED $263.00 $268.00
ABSORBABLE
JJ413 Prolene *3D Patch Polypropylene Mesh Sterile Three-dimensional device consisting 5.49cm x 12.50cm 3DPatch $263.00 $280.00
of a flat mesh onlay patch secured to a large with preshaped overlay
formed expandable diamond-shaped mesh
patch component.
JJ414 Prolene *3D Patch Polypropylene Mesh Sterile Three-dimensional device consisting 5.49cm x 12.50cm 3D Patch $263.00 $280.00
of a flat mesh onlay patch secured to a with medium preshaped overlay
formed expandable diamond-shaped mesh
patch component.
Prostheses List by Category, Groups and Sponsor Page 548 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
JJ415 Prolene *3D Patch Polypropylene Mesh Sterile Three-dimensional device consisting 5.49cm x 12.50cm 3D Patch $263.00 $280.00
of a flat mesh onlay patch secured to a medium with extended overlay
formed expandable diamond-shaped mesh
patch component.
JJ416 Prolene *3D Patch Polypropylene Mesh Sterile Three-dimensional device consisting 5.49cm x 12.50cm 3D Patch $263.00 $280.00
of a flat mesh onlay patch secured to a large with extended overlay
formed expandable diamond-shaped mesh
patch component.
3D Complex, Laminated
Atrium Australia - Pacific Rim Pty Limited
AC011 Atrium polypropolene mesh - surgical Polypropolene mesh plug Small, Medium, Large and $350.00
mesh Extra Large
Bard Australia Pty Ltd
BA083 Bard Mesh Kugel Patch Small Oval 8 x 12cm $350.00
BA085 Bard Mesh Kugel Patch Small Circle 8 x 8cm $350.00
BA132 Bard Modified Kugel Hernia Patch The Bard Modified Kugel Hernia Patch is 7.5 cm (3") diameter $350.00
a self-expanding, non-absorbable, sterile
prosthesis. It consists of two layers of
monofilament, polypropylene mesh; an
extruded monofilament PET polymer "ring"
provides memory, adds stability to the
device. The p
BA133 Bard Modified Kugel Hernia Patch The Bard Modified Kugel Hernia Patch is 10 cm (4") diameter $350.00
a self-expanding, non-absorbable, sterile
prosthesis. It consists of two layers of
monofilament, polypropylene mesh; an
extruded monofilament PET polymer "ring"
provides memory, adds stability to the
device. The p
BA134 Bard Modified Kugel Hernia Patch The Bard Modified Kugel Hernia Patch is 11.5 cm (4.5") diameter $350.00
a self-expanding, non-absorbable, sterile
prosthesis. It consists of two layers of
monofilament, polypropylene mesh; an
extruded monofilament PET polymer "ring"
provides memory, adds stability to the
device. The p
Prostheses List by Category, Groups and Sponsor Page 549 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
Covidien Pty Ltd
AS068 Surgipro Non Absorbable Polypropylene Medium and Large $69.00
Polypropylene Hernia Mate Plug System
3D Complex, Partially Absorbable
Atrium Australia - Pacific Rim Pty Limited
AC039 C-QUR Mesh Plug Sterile, knitted polypropylene small, medium $263.00 $1,095.00
monofilament mesh material for tissue
reinforcement with a coating derived from
a biological oil composed of fatty acids,
lipids and glycerides (BAO -
Bioabsorbable Oil Coating)
Laminated
B Braun Australia Pty Ltd
BB104 Premilene Mesh Self Forming Plug All sizes, small, medium, large $226.00
BB192 Premilene Mesh Premilene Nonabsorbable Polypropylene Self-Forming Plug-Small, 5 $226.00
Surgical Suture Material Low Profile. pieces
BB193 Premilene Mesh Premilene Nonabsorbable Polypropylene Self-Forming Plug-Medium, 5 $226.00
Surgical Suture Material Low Profile. pieces
BB195 OPTILENE MESH Polypropylene Mesh Self-Forming Plug-Large, 5 $226.00
pieces
Partially Absorbable
Atrium Australia - Pacific Rim Pty Limited
AC031 C-QUR Mesh Sterile, knitted polypropylene 0 - 100 sq cm $77.00 $495.00
monofilament mesh material for tissue
reinforcement with a coating derived from
a biological oil composed of fatty acids,
lipids and glycerides (BAO -
Bioabsorbable Oil Coating)
Prostheses List by Category, Groups and Sponsor Page 550 of 911
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Billing Code Product Name Description Size Benefit Benefit Notations
3.8.3.2 101-200cm2 polypropylene, polyester
Atrium Australia - Pacific Rim Pty Limited
AC005 Atrium polypropolene mesh - surgical Polypropolene 7.5 x 15cm $85.00 $120.00
mesh
B Braun Australia Pty Ltd
BB092 Premilene Mesh Polypropylene 5x30cm $85.00
BB097 Premilene Mesh Polypropylene 7.5x15cm $85.00
BB100 Premilene Mesh Polypropylene 10x15cm $85.00
BB181 OPTILENE MESH Polypropylene Mesh 5x30cm, 5 pieces $85.00
BB187 OPTILENE MESH Polypropylene Mesh 10 x 15cm, 5 pieces $85.00
BB189 OPTILENE MESH Polypropylene Mesh. 7.5 x 15cm, 5 pieces $85.00
Covidien Pty Ltd
AS168 Parietex Multifilament Polyester Mesh Parietex-Multifilament Polyester Folding 14x10cms $85.00 $205.00
Mesh/Bidimensional with integrated folding
system with slit
AS172 Mesh Polyproplene; Monofilament Multifilament Polypropylene; Monofilament 15.3cm x 15.3cm Surgipro* $85.00
Polyproplylene; SURGIPRO* Non Polypropylene; SURGIPRO, Non- mesh (6 x 6 inch); SPMM46:
Absorbable Monofilament Asborbable Polypropylene Monofilament 10.2cm x 15.3cm (4 x 6 inch).
Polypropylene Mesh Mesh.
AS175 Parietene-Monofiliment Polypropylene Parietene-Monofiliment Polypropylene 15 x 10cm $85.00
Mesh standard mesh/light mesh
EMT Healthcare Pty Ltd
EM021 Biomesh P1/P3 Reinforcement Mesh Macro porous 100% polypropylene mesh 8 x 13cm $85.00
for laproscopic and open surgical
approaches
EM025 Biomesh P1/P3 Reinforcement Mesh Macro porous 100% polypropylene mesh 7 x 15cm, 10 x 15cm $85.00
for laproscopic and open surgical
approaches
Johnson & Johnson Medical Pty Ltd
JJ175 Prolene Mesh Medium polypropylene monofilament non 7.6cm x 15cm $85.00
absorbable mesh
JJ566 PROLENE Mesh Polypropylene Mesh 10 x 15cm $85.00
Prostheses List by Category, Groups and Sponsor Page 551 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG005 Aspide Surgimesh Monofilament polypropylene 10 x 13cm Thread 0.14mm $85.00 $120.00
MG006 Aspide Surgimesh Monofilament polypropylene 10 x 15cm Thread 0.14mm $85.00 $120.00
3D Complex
Covidien Pty Ltd
AS128 Parietex-Multifilament Polyester Mesh Parietex-Multifilament Polyester 13 x 09 cm, 15 x 10 cm, 16 x $205.00
Anatomical Mesh Standard / With Slit and 12cm
Folding / With Slit and No Touch System
AS164 Parietex Multifilament Polyester Mesh Parietex-Multifilament Polyester Standard 13 x 09 cms, 15 x 10 cms $205.00
Mesh/Bidimensional rigid, Three
dimensional
AS166 Parietex Multifilament PolyesterMesh Parietex-Multifilament Polyester 12 x 08 cms $263.00
Preshaped Mesh Three-dimensional/Ease
Grip, with Slit
AS169 Parietex Multifilament Polyester Mesh Parietex-Multifilament Polyester 14x10cms $205.00
Anatomical Anatomical Mesh/Bidimensional/Three
dimensional with integreated folding system.
3D Complex, Laminated
Bard Australia Pty Ltd
BA086 Bard Mesh Kugel Patch Large Circle 12 x 12cm $460.00
BA087 Bard Mesh Kugel Patch Medium Oval 11 x 14cm $460.00
3D Complex, Partially Absorbable
Atrium Australia - Pacific Rim Pty Limited
AC040 C-QUR Mesh Plug Sterile, knitted polypropylene large and extra large $205.00 $1,360.00
monofilament mesh material for tissue
reinforcement with a coating derived from
a biological oil composed of fatty acids,
lipids and glycerides (BAO -
Bioabsorbable Oil Coating)
Laminated
B Braun Australia Pty Ltd
BB194 Premilene Mesh Premilene Nonabsorbable Polypropylene Self-Forming Plug-Large, 5 $250.00
Surgical Suture Material Low Profile. pieces
Prostheses List by Category, Groups and Sponsor Page 552 of 911
GENERAL MISCELLANEOUS
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Billing Code Product Name Description Size Benefit Benefit Notations
Partially Absorbable
Atrium Australia - Pacific Rim Pty Limited
AC032 C-QUR Mesh Sterile, knitted polypropylene 101 - 200 sq cm $85.00 $755.00
monofilament mesh material for tissue
reinforcement with a coating derived from
a biological oil composed of fatty acids,
lipids and glycerides (BAO -
Bioabsorbable Oil Coating)
3.8.3.3 201-300cm2 polypropylene, polyester
Atrium Australia - Pacific Rim Pty Limited
AC007 Atrium polypropolene mesh - surgical Polypropolene 15cm x 15cm $85.00 $140.00
mesh
B Braun Australia Pty Ltd
BB101 Premilene Mesh Polypropylene 15x15cm $85.00
BB184 OPTILENE MESH Polypropylene Mesh 15x15cm, 5 pieces $85.00
Bard Australia Pty Ltd
BA157 Bard Mesh Flat Mesh Medium - 6" x 6" $85.00
Covidien Pty Ltd
AS173 Mesh Polyproplene; Monofilament Multifilament Polypropylene; Monofilament 15.3cm x 15.3cm Surgipro* $85.00
Polyproplylene; SURGIPRO* Non Polypropylene; SURGIPRO, Non- mesh (6 x 6 inch)
Absorbable Monofilament Asborbable Polypropylene Monofilament
Polypropylene Mesh Mesh.
AS176 Parietene-Monofilament Polypropylene Parietene-Monofilament Polypropylene 15 x 15cm $85.00
Mesh standard mesh/light mesh
EMT Healthcare Pty Ltd
EM022 Biomesh P1/P3 Reinforcement Mesh Macro porous 100% polypropylene mesh 15 x 15cm $85.00
for laproscopic and open surgical
approaches
Johnson & Johnson Medical Pty Ltd
JJ222 Prolene Mesh - medium Constructed of knitted filaments of Medium - 6" x 6" $85.00 $120.00
extruded polypropylene identical to that
used in Prolene suture. Material is approx.
0.027mm thick. Non-absorbable mesh
for tension free-inguinal hernia techniques.
Prostheses List by Category, Groups and Sponsor Page 553 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG007 Aspide Surgimesh Monofilament polypropylene 15 x 15cm Thread 0.14mm $85.00
3D Complex
Bard Australia Pty Ltd
BA138 Bard 3DMax Mesh The Bard 3DMax Mesh is a sterile Extra Large Left 5" x 7" $300.00
prosthesis constructed of monofilament
polypropylene mesh. 3DMax mesh is a
three-dimensional, anatomically formed
prosthesis for use in laparoscopic hernia
repair.
BA139 Bard 3DMax Mesh The Bard 3DMax Mesh is a sterile Extra Large Right 5" x 7" $300.00
prosthesis constructed of monofilament
polypropylene mesh. 3DMax mesh is a
three-dimensional, anatomically formed
prosthesis for use in laparoscopic hernia
repair.
Covidien Pty Ltd
AS165 Parietex Multifilament Polyester Mesh Parietex-Multifilament Polyester Standard 15 x 15 cms $300.00
Anatomical Mesh/Bidimensional Rigid, Three
dimensional
3D Complex, Laminated
Bard Australia Pty Ltd
BA084 Bard Mesh Kugel Patch Large Oval 14 x 18cm $555.00
Partially Absorbable
Atrium Australia - Pacific Rim Pty Limited
AC033 C-QUR Mesh Sterile, knitted polypropylene 201 - 300 sq cm $85.00 $955.00
monofilament mesh material for tissue
reinforcement with a coating derived from
a biological oil composed of fatty acids,
lipids and glycerides (BAO -
Bioabsorbable Oil Coating)
3.8.3.4 301-400cm2 polypropylene, polyester
Covidien Pty Ltd
AS122 Parietene-Monofilament Polypropylene Parietene-Monofilament Polypropylene 20 x 20 cm $229.00
mesh standard mesh / light mesh
Prostheses List by Category, Groups and Sponsor Page 554 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AS170 Parietex-Multifilament Polyester Mesh Parietex-Multifilament Polyester Standard 20 x 20cm $229.00
Mesh/Bi-dimensional, Bi-dimensional
Rigid, Three dimensional
Partially Absorbable
Atrium Australia - Pacific Rim Pty Limited
AC034 C-QUR Mesh Sterile, knitted polypropylene 301 - 400 sq cm $229.00 $1,235.00
monofilament mesh material for tissue
reinforcement with a coating derived from
a biological oil composed of fatty acids,
lipids and glycerides (BAO -
Bioabsorbable Oil Coating)
3.8.3.5 401-500cm2 polypropylene, polyester
Partially Absorbable
Atrium Australia - Pacific Rim Pty Limited
AC035 C-QUR Mesh Sterile, knitted polypropylene 401 - 500 sq cm $229.00 $1,625.00
monofilament mesh material for tissue
reinforcement with a coating derived from
a biological oil composed of fatty acids,
lipids and glycerides (BAO -
Bioabsorbable Oil Coating)
3.8.3.6 501-600cm2 polypropylene, polyester
B Braun Australia Pty Ltd
BB182 OPTILENE MESH Polypropylene Mesh 20x30cm, 5 pieces $229.00
Partially Absorbable
Atrium Australia - Pacific Rim Pty Limited
AC036 C-QUR Mesh Sterile, knitted polypropylene 501 - 600 sq cm $229.00 $1,960.00
monofilament mesh material for tissue
reinforcement with a coating derived from
a biological oil composed of fatty acids,
lipids and glycerides (BAO -
Bioabsorbable Oil Coating)
Prostheses List by Category, Groups and Sponsor Page 555 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3.8.3.7 >600cm2 polypropylene, polyester
Atrium Australia - Pacific Rim Pty Limited
AC006 Atrium polypropolene mesh - surgical Polypropolene 30 x 30cm $229.00
mesh
AC008 Atrium polypropolene mesh - surgical Polypropolene 26 x 36cm $229.00
mesh
B Braun Australia Pty Ltd
BB102 Premilene Mesh Polypropylene 26x36cm $229.00
BB103 Premilene Mesh Polypropylene 30x30cm $229.00
BB185 OPTILENE MESH Polypropylene Mesh 30x30cm, 5 pieces $229.00
Bard Australia Pty Ltd
BA158 Bard Mesh Flat Mesh Large - 10" x 14" $229.00
Covidien Pty Ltd
AS056 Mesh Polyproplene; Monofilament Multifilament Polypropylene; Monofilament 35.6cm x 22.9cm Surgipro* $229.00
Polyproplylene. Polypropylene. mesh (14 x 9 inch).
AS123 Parietene-Monofilament Polypropylene Parietene-Monofilament Polypropylene 30 X 30 cm, 30 x 32 cm $229.00
mesh standard mesh / light mesh/ X-shaped mesh
AS171 Parietex-Multifilament Polyester Mesh Parietex-Multifilament Polyester Standard 30 x 30cm $229.00
Mesh/Bi-dimensional, Bi-dimensional
Rigid, Three dimensional
Johnson & Johnson Medical Pty Ltd
JJ172 Mersilene Mesh Non-absorbable polyester mesh 30cm x 30cm $229.00 $275.00
JJ176 Prolene Mesh Large polypropylene monofilament non 30cm x 30cm $229.00 $275.00
absorbable mesh
Partially Absorbable
Atrium Australia - Pacific Rim Pty Limited
AC037 C-QUR Mesh Sterile, knitted polypropylene 601 - 1000 sq cm $229.00 $2,965.00
monofilament mesh material for tissue
reinforcement with a coating derived from
a biological oil composed of fatty acids,
lipids and glycerides (BAO -
Bioabsorbable Oil Coating)
Prostheses List by Category, Groups and Sponsor Page 556 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AC038 C-QUR Mesh Sterile, knitted polypropylene 1000 sq cm + $229.00 $3,775.00
monofilament mesh material for tissue
reinforcement with a coating derived from
a biological oil composed of fatty acids,
lipids and glycerides (BAO -
Bioabsorbable Oil Coating)
3.8.4 Mesh, Soft Tissue Closure, Non-metallic, PTFE/ePTFE
3.8.4.1 0-100cm2, PTFE/ePTFE
W L Gore & Associates
GT065 Gore-Tex ePTFE Mycro-Mesh ePTFE 1mm Thickness 2.5 x 10cm $206.00
Biomaterial
GT066 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness 5 x 10cm $206.00
(Rectangle), 5 x 10cm (Key
Hole)
GT067 Gore-Tex Mycro-Mesh ePTFE 1mm Thickness 5 x 13cm $206.00
(Configured for Vaginal
Prolapse), 5 x 15cm
GT074 Gore-Tex Mycro-Mesh Biomaterial Configured for Inguinal Hernia repair ePTFE 1mm Thickness 6cm x 12cm $206.00
GT092 Gore-Tex Dual Mesh ePTFE 1mm Thickness 7.5 x 10cm $206.00 $313.00
GT093 Gore-Tex Dual Mesh ePTFE 1mm Thickness 8 x 12cm $206.00 $403.00
Antimicrobial
W L Gore & Associates
GT104 Gore-Tex DualMesh PLUS ePTFE 1mm Thickness 7.5 x 10cm $206.00 $390.00
GT201 Dualmesh Plus Biomaterial ePTFE 8cm x 12cm x 1mm $206.00 $390.00
Complete Biomaterial
W L Gore & Associates
GT229 GORE INFINIT Mesh Gore Infinit Mesh 6.5cm x 13cm $206.00
Laminated
Bard Australia Pty Ltd
BA160 Bard Crurasoft Patch Dual sided mesh with PTFE mesh on one 7cm x 6cm Small $350.00
side and ePTFE mesh on the other side
Prostheses List by Category, Groups and Sponsor Page 557 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BA161 Bard Crurasoft Patch Dual sided mesh with PTFE mesh on one 11cm x 8cm Large $350.00
side and ePTFE mesh on the other side
3.8.4.2 101-200cm2, PTFE/ePTFE
W L Gore & Associates
GT071 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness Oval 10 x $310.00
15cm
GT094 Gore-Tex Dual Mesh ePTFE 1mm Thickness Oval 10 x $310.00 $605.00
15cm
GT099 Gore-Tex Dual Mesh ePTFE 2mm Thickness Oval 10 x $310.00 $923.00
15cm
Antimicrobial
W L Gore & Associates
GT202 Dualmesh Plus Biomaterial ePTFE, oval 10cm x 15cm x 1mm $310.00 $633.00
GT206 Dualmesh Plus Biomaterial ePTFE, oval 10cm x 15cm x 2mm $310.00 $1,020.00
Complete Biomaterial
W L Gore & Associates
GT231 GORE INFINIT Mesh Gore Infinit Mesh 7.5cm x 15cm; 10cm x 15cm; $310.00
5cm x 30cm
3.8.4.3 201-300cm2, PTFE/ePTFE
W L Gore & Associates
GT072 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness Oval 15 x $420.00 $881.00
19cm
GT095 Gore-Tex Dual Mesh ePTFE 1mm Thickness Oval 15.0 x $420.00 $1,040.00
19.0cm
GT100 Gore-Tex Dual Mesh ePTFE 2mm Thickness Oval 15 x $420.00 $1,846.00
19cm
Antimicrobial
W L Gore & Associates
GT107 Gore-Tex DualMesh PLUS ePTFE 15.0 x 19.0cm x 1mm Oval $420.00 $1,167.00
GT207 Dualmesh Plus Biomaterial ePTFE, oval 15cm x 19cm x 2mm $420.00 $2,029.00
Prostheses List by Category, Groups and Sponsor Page 558 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Complete Biomaterial
W L Gore & Associates
GT230 GORE INFINIT Mesh Gore Infinit Mesh 15cm x 15cm $420.00
3.8.4.5 401-500cm2, PTFE/ePTFE
W L Gore & Associates
GT068 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness 18 x 24cm $655.00 $1,288.00
GT096 Gore-Tex Dual Mesh ePTFE 1mm Thickness 18 x 24cm $655.00 $1,622.00
GT101 Gore-Tex Dual Mesh ePTFE 2mm Thickness 18 x 24cm $655.00 $2,430.00
Antimicrobial
W L Gore & Associates
GT203 Dualmesh Plus Biomaterial ePTFE 18cm x 24cm x 1mm $655.00 $1,823.00
GT208 Dualmesh Plus Biomaterial ePTFE, 18cm x 24cm x 2mm $655.00 $2,952.00
3.8.4.6 501-600cm2, PTFE/ePTFE
W L Gore & Associates
GT069 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness 20 x 30cm $755.00 $1,777.00
GT097 Gore-Tex Dual Mesh ePTFE 1mm Thickness 20 x 30cm $755.00 $2,271.00
GT102 Gore-Tex Dual Mesh ePTFE 2mm Thickness 20 x 30cm $755.00 $3,400.00
Antimicrobial
W L Gore & Associates
GT084 Gore-Tex MycroMesh Plus ePTFE 1mm Thickness 20cm x 30 $755.00 $1,926.00
GT204 Dualmesh Plus Biomaterial ePTFE 20cm x 30cm x 1mm $755.00 $2,544.00
GT209 Dualmesh Plus Biomaterial ePTFE, 20cm x 30cm x 2mm $755.00 $3,986.00
3.8.4.7 >600cm2, PTFE/ePTFE
W L Gore & Associates
GT070 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness Oval 26 x $855.00 $2,333.00
34cm
GT098 Gore-Tex Dual Mesh ePTFE 1mm Thickness Oval 26 x $855.00 $2,960.00
34cm
Prostheses List by Category, Groups and Sponsor Page 559 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
GT103 Gore-Tex Dual Mesh ePTFE 2mm Thickness Oval 26 x $855.00 $4,440.00
34cm
Antimicrobial
W L Gore & Associates
GT087 Gore-Tex MycroMesh Plus ePTFE 1mm thickness Oval 26 x 34cm $855.00 $2,536.00
GT205 Dualmesh Plus Biomaterial ePTFE, oval 26cm x 34cm x 1mm $855.00 $3,373.00
GT210 Dualmesh Plus Biomaterial ePTFE, oval 26cm x 34cm x 2mm $855.00 $5,192.00
3.8.5 Mesh, Soft Tissue Closure, Non-metallic, Absorbable
3.8.5.1 0-100cm2, Absorbable
3D Complex, Complete Biomaterial
Cook Medical Australia Pty Ltd
WC243 Surgisis Biodesign Anal Fistula Plug Surgisis Biodesign Anal Fistula Plug is a 0.6cm Width Tapering to $1,000.00
small intestine submucosal porcine derived, 0.2cm Width x 9.5cm Length.
rolled and shaped collagen matrix, non Conical Shape
cross-linked, that signals the body and
provides support for native tissue
remodeling, healing and closure of anal
fistulas
WC245 Surgisis Biodesign Recto-Vaginal Fistula Small intesting submucous porcine collagen 2mm width x 5.5cm length; $1,000.00
Plug matrix, non-crosslinked, supports native 4mm wide tapering to 2mm
tissue remodelling, healing and closure of wide x 5.5cm length; 7mm wide
recto-vaginal fistulas. Conical shpe with tapering to 2mm wide x 5.5
attached button. length.
W L Gore & Associates
GT258 BIO-A Tissue Reinforcement BIO-A Tissue Reinforcement - Configured 7cm x 10cm $250.00 $800.00
for Hiatal Hernia
Complete Biomaterial
W L Gore & Associates
GT256 BIO-A Tissue Reinforcement BIO-A Tissue Reinforcement 8cm x 8cm $87.00 $450.00
Complete Biomaterial, Laminated
Cook Medical Australia Pty Ltd
WC177 Surgisis Soft Tissue Graft Surgical Mesh composed of Sub-Intestinal Length - 10cm, Width - 7cm; $786.00
Submucosa (SIS) Length - 7cm, Width - 4cm
Prostheses List by Category, Groups and Sponsor Page 560 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Laminated, Complete Biomaterial
Cook Medical Australia Pty Ltd
WC284 Surgisis Biodesign Hiatal Hernia Graft Surgisis Biodesign Hiatal Hernia Graft is an 7 x 10cm rectangular and U- $522.00 $786.00
extracellular collagen matrix, non cross- shaped
linked sterile graft material, that provides
support for damaged tissues and assists in
host tissue regeneration and remodelling of
the diaphragmatic wall following surgical
repair for paraoesophageal and hiatal
hernia.
3.8.5.2 101-200cm2, Absorbable
Complete Biomaterial
W L Gore & Associates
GT257 BIO-A Tissue Reinforcement BIO-A Tissue Reinforcement 9cm x 15cm $87.00 $600.00
Complete Biomaterial, Laminated
Cook Medical Australia Pty Ltd
WC255 Surgisis Biodesign 4-layer Tissue Graft Surgisis Soft Tissue Graft Length 20cm, Width 7cm $900.00
Laminated, Complete Biomaterial
Cook Medical Australia Pty Ltd
WC242 Biodesign Surgisis Hernia Graft Biodesign Hernia Graft is 8-layer 13cm x 15cm $696.00
perforated and quilted porcine sis collagen
matrix, non cross-linked, remodelable and
resorbable tissue graft
WC244 Biodesign Surgisis 8-layer Tissue Graft Biodesign Surgisis 8-layer Tissue Graft is 8 13cm x 15cm $696.00
layers of compressed and perforated
porcine sis collagen matrix, non cross-
linked, remodelable and resorbable tissue
graft
WC265 Biodesign Surgisis Inguinal Hernia Graft Biodesign Surgisis Inguinal Hernia Graft is 10cm x 15cm $348.00 $400.00
a biologically derived [porcine] sis
collagen, non cross-linked graft, that
remodels into strong host tissue
reinforcement for the inguinal floor
Prostheses List by Category, Groups and Sponsor Page 561 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
WC266 Biodesign Surgisis Inguinal Hernia Graft Biodesign Surgisis Inguinal Hernia Graft is 8cm x 15cm $348.00 $400.00
a biologically derived [porcine] sis
collagen, non cross-linked graft, that
remodels into strong host tissue
reinforcement for the inguinal floor
3.8.5.3 201-300cm2, Absorbable
Johnson & Johnson Medical Pty Ltd
JJ173 VICRYL Mesh Polyglactin 910 - synthetic absorbable 15cm x 15cm $87.00 $128.00
mesh.
Laminated, Complete Biomaterial
Cook Medical Australia Pty Ltd
WC247 Biodesign Surgisis 8-Layer Tissue Graft Biodesign Surgisis 8-layer Tissue Graft is 8 13cm x 22cm $696.00 $1,286.00
layers of compressed and perforated
porcine sis collagen matrix, non cross-
linked, remodelable and resorbable tissue
graft
WC249 Biodesign Surgisis Hernia Graft Biodesign Hernia Graft is 8-layer 13cm x 22cm $696.00 $1,486.00
perforated and quilted porcine sis collagen
matrix, non cross-linked, remodelable and
resorbable tissue graft
3.8.5.4 301-400cm2, Absorbable
Laminated, Complete Biomaterial
Cook Medical Australia Pty Ltd
WC248 Biodesign Surgisis 8-Layer Tissue Graft Biodesign Surgisis 8-layer Tissue Graft is 8 20cm x 20cm $960.00 $1,755.00
layers of compressed and perforated
porcine sis collagen matrix, non cross-
linked, remodelable and resorbable tissue
graft
WC250 Biodesign Surgisis Hernia Graft Biodesign Hernia Graft is 8-layer 20cm x 20cm $960.00 $1,955.00
perforated and quilted porcine sis collagen
matrix, non cross-linked, remodelable and
resorbable tissue graft
Prostheses List by Category, Groups and Sponsor Page 562 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3.8.5.6 501-600cm2, Absorbable
Laminated, Complete Biomaterial
Cook Medical Australia Pty Ltd
WC251 Biodesign Surgisis Hernia Graft Biodesign Hernia Graft is 8-layer 20cm x 30cm $2,016.00 $3,450.00
perforated and quilted porcine sis collagen
matrix, non cross-linked, remodelable and
resorbable tissue graft
3.8.5.7 >600cm2, Absorbable
Johnson & Johnson Medical Pty Ltd
JJ020 Vicryl Mesh 1 sheet/box Large - 30cm x 30cm $252.00 $285.00
3.8.6 Mesh, Soft Tissue Closure, Non-metallic, Composite
3.8.6.1 0-100cm2, Composite
3D Complex, Laminated
Bard Australia Pty Ltd
BA096 Bard Composix Kugel Hernia Patch Small Oval w/e PTFE 8 x 12 cms $390.00
BA099 Bard Composix Kugel Hernia Patch Small Circle w/e PTFE 8 x 8cms $390.00
BA136 Bard Ventralex Hernia Patch The Bard Ventralex Patch is a self- 4.3 cm x 4.3 cm (1.7" x 1.7") $390.00
expanding, non-absorbable, sterile
prosthesis. Two layers of monofilament,
polypropylene mesh are stitched to an
ePTFE sheet; an extruded monofilament
PET polymer "ring" provides memory,
adds stability to the device. The
BA137 Bard Ventralex Hernia Patch The Bard Ventralex Patch is a self- 6.4 cm x 6.4 cm (2.5" x 2.5") $390.00
expanding, non-absorbable, sterile
prosthesis. Two layers of monofilament,
polypropylene mesh are stitched to an
ePTFE sheet; an extruded monofilament
PET polymer "ring" provides memory,
adds stability to the device. The
BA179 Bard Ventralex Hernia Patch Bard Ventrlex Hernia Patch, Large 8cm x 8cm $390.00
Prostheses List by Category, Groups and Sponsor Page 563 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3D Complex, Laminated, Partially Absorbable
Bard Australia Pty Ltd
BA210 Ventrio Hernia Patch Three layer, mesh/ePTFE with absorbable 7.6cm Diameter, 8x12cm $390.00
polydioxanone monofilament.
Johnson & Johnson Medical Pty Ltd
JJ816 Proceed™ Ventral Patch 3D, sterile, self expanding, partially medium (6.4cm x 6.4cm) $390.00 $485.00
absorbable, flexible laminate mesh for
hernia or other abdominal, fascial defect
repair that require addition of a reinforcing
or bridging material to obtain the desired
surgical result.
JJ817 Proceed™ Ventral Patch 3D, sterile, self expanding, partially small (4.3cm x 4.3cm) $390.00 $485.00
absorbable, flexible laminate mesh for
hernia or other abdominal, fascial defect
repair that require addition of a reinforcing
or bridging material to obtain the desired
surgical result.
3D Complex, Partially Absorbable
Johnson & Johnson Medical Pty Ltd
JJ602 ULTRAPRO Plug Partially Absorbable Synthetic Surgical Small- Onlay patch plug: 12cm $275.00
Mesh Device x 7.5cm, 5cm rim diameter,
3cm anchor diameter; Medium-
Onlay patch plug: 12cm x
7.5cm, 5cm rim diameter, 4cm
anchor diameter; Large- Onlay
patch plug: 12cm x 7.5cm, 5cm
rim diameter, 5cm anchor
diameter
Laminated
Bard Australia Pty Ltd
BA065 Bard Mesh Composix Ventral mesh 2" x 4" $365.00
Laminated, Partially Absorbable
Covidien Pty Ltd
AS139 Parietex Composite 9F Dual sided polyester meshes with a 9cm round $365.00 $450.00
resorbable adhesion-prevention
hydrophilic film
Prostheses List by Category, Groups and Sponsor Page 564 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AS161 Parietene ProGrip Mesh (PRE- Pre-Cut, slit mesh with self gripping 12 x 8cm elliptic $365.00 $450.00
SHAPED) overlapping flap - right or left
Johnson & Johnson Medical Pty Ltd
JJ446 PROCEED Surgical Mesh PROCEED Surgical Mesh B1 2x4 (inches) $365.00 $390.00
Partially Absorbable
Johnson & Johnson Medical Pty Ltd
JJ240 VYPRO II Mesh Composition - equal part Vicryl polyglactin Small 6 x 11cm $95.00
yarn - non-absorbable Prolene
polypropylene yarn. Partly absorbable
lightweight mesh for tension free-inguinal
hernia techniques
JJ465 ULTRAPRO Mesh ULTRAPRO Mesh S3 6 x 11cm $95.00
Titanium
Medical Specialties Australia Pty Ltd
MS043 TiPLUG/TiPATCH System Titanized polypropylene composite. TiPLUG $95.00 $127.00
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
MS044 TiPLUG/TiPATCH System Titanized polypropylene composite. TiPATCH $95.00 $127.00
Prosthetic warp-knitted fabric made of
monofilament polypropylene threads with
an encapsulating titanic coating.
3.8.6.2 101-200cm2, Composite
Surgeons Choice Australia Pty Ltd
SH006 Swing-Contact Mesh Flat Three-Dimensional polyester prosthesis 8cm x 13cm, 9cm x 13cm, $120.00 $290.00
with grips, coated with polyurethane for 10cm x 15cm, 15 x 15cm,
Open and laparoscopic surgery, 142g/m2 15cm x 20cm
SH007 Swing-Contact Mesh Pre Shaped Three-Dimensional polyester prosthesis 10cm x 13cm, 11cm x 14cm, $120.00 $340.00
Anatomical Reversible with grips, coated with polyurethane for 12 x 15cm, 12cm x 16cm,
Open and laparoscopic surgery, 142/m2 10cm x 13cm, 11cm x 15cm
SH008 Swing-Contact Mesh Pre Shaped Three-Dimensional anatomical polyester 11cm x 15cm, 12cm x 16cm $120.00 $415.00
Anatomical with/without slit prosthesis coated with polyurethane for
pre-peritoneal placement with grips,
142g/m2
Prostheses List by Category, Groups and Sponsor Page 565 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3D Complex, Laminated
Bard Australia Pty Ltd
BA097 Bard Composix Kugel Hernia Patch Medium Oval w/e PTFE 11 x 14 cms $690.00
BA100 Bard Composix Kugel Hernia Patch Large Circle w/e PTFE 12 x 12cms $690.00
BA162 Bard CK Parastomal Patch Bard CK Parastomal Patch 12.5 x 15.5cm, 15.5 x 20.5cm $690.00
3D Complex, Laminated, Partially Absorbable
Bard Australia Pty Ltd
BA202 Ventrio Hernia Patch Three layer, mesh/ePTFE with absorbable 11.4cm Diameter, 11x14cm $690.00
polydioxanone monofilament.
3D Complex, Partially Absorbable
Johnson & Johnson Medical Pty Ltd
JJ585 Ultrapro Hernia System Ultrapro Hernia System. Mesh Made Small to Large Oval $275.00 $300.00
From Composite of Monocryl & Prolene
Laminated
Bard Australia Pty Ltd
BA066 Bard Mesh Composix Ventral mesh 3" x 6" $436.00
BA067 Bard Mesh Composix Ventral mesh 4" x 8" $436.00
BA101 Bard Composix E/X Mesh Elliptical 4" x 6" (10 x 15cm) $436.00
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG020 Surgimesh XB non-adherent Intra-abdominal implant biface Tintra R 12.5cm, 15cm $436.00 $875.00
Laminated, Partially Absorbable
Bard Australia Pty Ltd
BA186 SEPRAMesh IP Bioresorbable Polypropylene & polyglycolic acid 3 x 6 inch $436.00
Coating/Permanent Mesh polymer mesh coated with a biopolymer: a
bioresorbable coating of modified sodium
hyaluronate, carboxymethylcellulose &
polyethylene glycol based hydrogel.
Prostheses List by Category, Groups and Sponsor Page 566 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BA187 SEPRAMesh IP Bioresorbable Polypropylene & polyglycolic acid 4 x 8 inch $436.00
Coating/Permanent Mesh polymer mesh coated with a biopolymer: a
bioresorbable coating of modified sodium
hyaluronate, carboxymethylcellulose &
polyethylene glycol based hydrogel.
Covidien Pty Ltd
AS140 Parietex Composite 12F Dual sided polyester meshes with a 12cm round $436.00 $550.00
resorbable adhesion-prevention hydrophlic
film
AS141 Parietex Composite 15F Dual sided Polyester meshes with a 15cm round $436.00 $650.00
resorbable adhesion-prevention
hydrophilic film
AS143 Parietex Composite 1510F Dual sided polyester meshes with a 15x10cm square $436.00 $1,050.00
resorbable adhesion -prevention
hydrophilic film
AS148 Parietex Composite 1510OS Dual sided polyester meshes with a 15x10cm square $436.00 $1,050.00
resorbable adhesion-prevention
hydrophilic film
AS151 Parietex Composite Hiatal Hernia Mesh Composite Mesh 8x8cm, 9x8cm, 8.5x8cm $436.00 $575.00
AS152 Parietene Composite 12 Dual sided polypropylene mesh with 12cm round $436.00 $550.00
resorbable adhesion-prevention
hydrophilic film
AS153 Parietene Composite 1510 Dual sided polypropylene mesh with 15x10cm Square $436.00 $1,050.00
resorbable adhesion-prevention
hydrophilic film
AS162 Parietene ProGrip Mesh (FLAT) Mesh with self gripping FLAT 15 x 9cm RECTANGLE $436.00 $500.00
Johnson & Johnson Medical Pty Ltd
JJ447 PROCEED Surgical Mesh PROCEED Surgical Mesh R1 3x6 inches $436.00 $510.00
JJ448 PROCEED Surgical Mesh PROCEED Surgical Mesh N1 4x6 inches oval $436.00 $602.00
JJ449 PROCEED Surgical Mesh PROCEED Surgical Mesh D1 4x8 inches $436.00 $580.00
MN091 PHYSIOMESH Flexible composite mesh 7x15cm, rectangular shape $436.00 $565.00
MN092 PHYSIOMESH Flexible Composite Mesh 10x15cm, oval shape $436.00 $665.00
Prostheses List by Category, Groups and Sponsor Page 567 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Partially Absorbable
Johnson & Johnson Medical Pty Ltd
JJ241 VYPRO II Mesh Composition - equal part Vicryl polyglactin Medium 12 x 10cm $120.00 $135.00
yarn - non-absorbable Prolene
polypropylene yarn. Partly absorbable
lightweight mesh for tension free-inguinal
hernia techniques
JJ242 VYPRO II Mesh Composition - equal part Vicryl polyglactin Large 15 x 10cm $120.00 $135.00
yarn - non-absorbable Prolene
polypropylene yarn. Partly absorbable
lightweight mesh for tension free-inguinal
hernia techniques
JJ466 ULTRAPRO Mesh ULTRAPRO Mesh P3 10 x 12cm $120.00 $135.00
JJ467 ULTRAPRO Mesh ULTRAPRO Mesh N3 10 x 15cm $120.00 $135.00
JJ565 ULTRAPRO Mesh Composite Mesh 7.6cm x 15cm $103.00
Titanium
Medical Specialties Australia Pty Ltd
MS030 TiMESH light Prosthetic warp-knitted fabric made of 10 x15 cm TiMESH light $120.00 $240.00
monofil polypropylene threads with an
encapsulating titanic coating
3.8.6.3 201-300cm2, Composite
3D Complex, Laminated
Bard Australia Pty Ltd
BA098 Bard Composix Kugel Hernia Patch Large Oval w/e PTFE 14 x 18 cms $799.00
3D Complex, Laminated, Partially Absorbable
Bard Australia Pty Ltd
BA207 Ventrio Hernia Patch Three layer, mesh/ePTFE with absorbable 14x18cm $799.00
polydioxanone monofilament.
Laminated
Bard Australia Pty Ltd
BA068 Bard Mesh Composix Ventral mesh 6" x 8" $560.00
BA102 Bard Composix E/X Mesh Elliptical 6" x 8" (15 x 20cm) $560.00
Prostheses List by Category, Groups and Sponsor Page 568 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG021 Surgimesh XB non-adherent Intra-abdominal implant biface Tintra M 22x15x10cm $560.00 $1,475.00
Laminated, Partially Absorbable
Bard Australia Pty Ltd
BA188 SEPRAMesh IP Bioresorbable Polypropylene & polyglycolic acid 6 x 8 inch $560.00
Coating/Permanent Mesh polymer mesh coated with a biopolymer: a
bioresorbable coating of modified sodium
hyaluronate, carboxymethylcellulose &
polyethylene glycol based hydrogel.
Covidien Pty Ltd
AS144 Parietex Composite 2015F Dual sided polyester meshes with a 20x15cm square $560.00 $1,500.00
resorbable adhesion-prevention
hydrophilic film
AS149 Parietex Composite 2015OS Dual sided polyester meshes with a 20x15cm square $560.00 $1,500.00
resorbable adhesion-prevention
hydrophilic film
AS154 Parietene Composite 1515 Dual sided polypropylene mesh with 15x15cm $560.00 $1,300.00
resorbable adhesion-prevention
hydrophilic film
AS155 Parietene Composite 2015 Dual sided polypropylene mesh with 20x15cm Oval $560.00 $1,500.00
resorbable adhesion-prevention
hydrophilic film
Johnson & Johnson Medical Pty Ltd
JJ450 PROCEED Surgical Mesh PROCEED Surgical Mesh M1 6x6 inches $560.00 $845.00
JJ451 PROCEED Surgical Mesh PROCEED Surgical Mesh G1 6x8 inches oval $560.00 $1,045.00
MN093 PHYSIOMESH Flexible Composite Mesh 15x15cm, square shape $560.00 $930.00
MN094 PHYSIOMESH Flexible Composite Mesh 15x20cm, rectagular shape $560.00 $1,150.00
MN095 PHYSIOMESH Flexible Composite Mesh 15x20cm, Oval Shape $560.00 $1,150.00
Partially Absorbable
Johnson & Johnson Medical Pty Ltd
JJ019 Vypro Mesh Vicryl/Prolene Composite Mesh Medium - 15cm x 15cm $152.00
Prostheses List by Category, Groups and Sponsor Page 569 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ243 VYPRO II Mesh Composition - equal part Vicryl polyglactin Extra large 15 x 15cm $152.00
yarn - non-absorbable Prolene
polypropylene yarn. Partly absorbable
lightweight mesh for tension free-inguinal
hernia techniques
JJ468 ULTRAPRO Mesh ULTRAPRO Mesh M3 15 x 15cm $152.00 $170.00
Titanium
Medical Specialties Australia Pty Ltd
MS033 TiMESH light Prosthetic warp-knitted fabric made of 15 x 15cm TiMESH light $152.00 $288.00
monofil polypropylene threads with an
encapsulating titanic coating
MS035 TiMESH light Prosthetic warp-knitted fabric made of 20 x 15cm TiMESH light $152.00 $288.00
monofil polypropylene threads with an
encapsulating titanic coating
3.8.6.4 301-400cm2, Composite
Laminated, Partially Absorbable
Covidien Pty Ltd
AS142 Parietex Composite 20F Dual sided polyester meshes with a 20cm round $780.00 $1,050.00
resorbable adhesion-prevention
hydrophilic film
3.8.6.5 401-500cm2, Composite
3D Complex, Laminated
Bard Australia Pty Ltd
BA127 Composix Kugel Hernia Patch Extra large oval - w/e PTFE 20cm X 25cm $1,070.00
BA131 Bard Composix Kugel Hernia Patch The Bard Composix Kugel Hernia Patch is Extra Large Oval w/e PTFE $1,070.00
a self-expanding, non-absorbable, sterile 18cm x 23cm
prosthesis. Two layers of monofilament,
polypropylene mesh are stitched to an
ePTFE sheet; an extruded monofilament
PET polymer "ring" provides memory,
adds stability to the
Prostheses List by Category, Groups and Sponsor Page 570 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BA135 Bard Composix Kugel Hernia Patch The Bard Composix Kugel Hernia Patch is Oval w/e PTFE 16cm x $1,070.00
a self-expanding, non-absorbable, sterile 31.2cm
prosthesis. Two layers of monofilament,
polypropylene mesh are stitched to an
ePTFE sheet; an extruded monofilament
PET polymer "ring" provides memory,
adds stability to the
3D Complex, Laminated, Partially Absorbable
Bard Australia Pty Ltd
BA206 Ventrio Hernia Patch. Three layer, mesh/ePTFE with absorbable 16x31cm, 20x25cm. $1,070.00
polydioxanone monofilament.
Laminated
Bard Australia Pty Ltd
BA069 Bard Mesh Composix Ventral mesh 8" x 10" $1,003.00
BA103 Bard Composix E/X Mesh Elliptical 7" x 9" (18 x 23cm) $1,003.00
BA104 Bard Composix E/X Mesh Elliptical 8" x 10" (20 x 25 cm) $1,003.00
Laminated, Partially Absorbable
Covidien Pty Ltd
AS145 Parietex Composite 2520F Dual sided polyester meshes with a 25x20cm Oval $1,003.00 $2,200.00
resorbable adhesion-prevention
hydrophilic film
AS150 Parietex Composite 2520OS Dual sided polyester meshes with a 25x20cm Square $1,003.00 $2,200.00
resorbable adhesion-prevention
hydrophilic film
AS156 Parietene Composite 2520 Dual sided polypropylene mesh with 25x20cm Oval $1,003.00 $1,950.00
resorbable adhesion-prevention
hydrophilic film
Johnson & Johnson Medical Pty Ltd
JJ452 PROCEED Surgical Mesh PROCEED Surgical Mesh H1 8x10 inches oval $1,003.00 $2,080.00
MN096 PHYSIOMESH Flexible Composite Mesh 20x25cm, oval shape $1,003.00 $2,290.00
Partially Absorbable
Johnson & Johnson Medical Pty Ltd
JJ469 ULTRAPRO Mesh ULTRAPRO Mesh T1 15x30cm $220.00
Prostheses List by Category, Groups and Sponsor Page 571 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3.8.6.6 501-600cm2, Composite
Laminated, Partially Absorbable
Bard Australia Pty Ltd
BA189 SEPRAMesh IP Bioresorbable Polypropylene & polyglycolic acid 8 x 12 inch $1,050.00
Coating/Permanent Mesh polymer mesh coated with a biopolymer: a
bioresorbable coating of modified sodium
hyaluronate, carboxymethylcellulose &
polyethylene glycol based hydrogel.
Covidien Pty Ltd
AS146 Parietex Composite 3020F Dual sided polyester meshes with a 30x20cm oval $1,050.00 $2,700.00
resorbable adhesion-prevention
hydrophilic film
AS157 Parietene Composite 3020 Dual sided polypropylene mesh with 30x20cm Oval $1,050.00 $2,400.00
resorbable adhesion-prevention
hydrophilic film
Johnson & Johnson Medical Pty Ltd
JJ453 PROCEED Surgical Mesh PROCEED Surgical Mesh J1 8x12 inches $1,050.00 $2,400.00
MN097 PHYSIOMESH Flexible Composite Mesh 20x30cm, rectangular shape $1,050.00 $2,640.00
3.8.6.7 >600cm2, Composite
3D Complex, Laminated
Bard Australia Pty Ltd
BA128 Composix Kugel Hernia Patch Extra large oval - w/ePTFE 25cm X 33cm $1,270.00
3D Complex, Laminated, Partially Absorbable
Bard Australia Pty Ltd
BA205 Ventrio Hernia Patch Three layer, mesh/ePTFE with absorbable 22x27cm, 27x35cm. $1,270.00
polydioxanone monofilament.
Laminated
Bard Australia Pty Ltd
BA063 Bard Mesh Composix Ventral mesh 10"x14" $1,122.00
BA064 Bard Mesh Composix Ventral mesh 12"x12" $1,122.00
BA105 Bard Composix E/X Mesh Elliptical 10" x 13" (25 x 33 cm) $1,122.00
BA106 Bard Composix E/X Mesh Rectangle 10" x 14" (25 x 36 cm) $1,122.00
Prostheses List by Category, Groups and Sponsor Page 572 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG022 Surgimesh XB non-adherent Intra-abdominal implant biface Tintra L 30x30x20cm $1,122.00 $1,850.00
Laminated, Partially Absorbable
Covidien Pty Ltd
AS147 Parietex Composite 3728F Dual sided polyester meshes with a 37x28cm oval $1,122.00 $3,200.00
resorbable adhesion-prevention
hydrophilic film
Johnson & Johnson Medical Pty Ltd
JJ454 PROCEED Surgical Mesh PROCEED Surgical Mesh T1 10x13 inches oval $1,122.00 $2,730.00
JJ455 PROCEED Surgical Mesh PROCEED Surgical Mesh W1 10x14 inches $1,122.00 $2,620.00
JJ456 PROCEED Surgical Mesh PROCEED Surgical Mesh L1 12x12 inches $1,122.00 $2,620.00
MN098 PHYSIOMESH Flexible Composite Mesh 25x35cm, oval shape $1,122.00 $2,885.00
MN099 PHYSIOMESH Flexible Composite Mesh 30x35cm, rectangular shape $1,122.00 $2,885.00
MN100 PHYSIOMESH Flexible Composite Mesh 30x50cm, rectangular shape $1,122.00 $2,885.00
Partially Absorbable
Johnson & Johnson Medical Pty Ltd
JJ179 VYPRO Mesh Vicryl (polyglactin 910) / Prolene 30cm x 30cm $280.00 $300.00
(polypropylene) composite mesh
JJ470 ULTRAPRO Mesh ULTRAPRO Mesh L1 30x30cm $280.00 $300.00
Titanium
Medical Specialties Australia Pty Ltd
MS038 TiMESH Extra Large Prosthetic warp-knitted fabric made of Extra Large TiMESH $280.00 $1,810.00
monofil polypropylene threads with an
encapsulating titanic coating
Prostheses List by Category, Groups and Sponsor Page 573 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3.8.7 Staples, Wound (non-bone)
W L Gore & Associates
GT224 GORE SEAMGUARD® Bioabsorbable As packaged, GORE SEAMGUARD Ethicon Endo-Surgery $230.00
Staple Line Reinforcement Bioabsorbable Staple Line Reinforcement Endopath ETS45; Ethicon
constitutes preformed porous Endo-Surgery Endopath
bioabsorbable sheets held into the form of ETS45; Ethicon Endo-Surgery
sleeves (one cartridge device, one anvil Endopath EZ45; Ethicon Endo-
device) through the use of a non- Surgery Endopath Echelon 45,
absorbable polyester braided suture. A TY Ethicon Endo-Surgery
Endopath Echelon 60; Ethicon
Endo-Surgery Endopath ETS
Flex 60; USS Endo GIA Unive
GT228 GORE SEAMGUARD® Bioabsorbable As packaged, GORE SEAMGUARD Ethicon Endo-Surgery $230.00 $322.00
Staple Line Reinforcement, Endoscopic Bioabsorbable Staple Line Reinforcement ENDOPATH 25 and
Staplers constitutes preformed PROXIMATE 25; Ethicon
Endo-Surgery ENDOPATH 29
and PROXIMATE 29; Ethicon
Endo-Surgery ENDOPATH
33 and PROXIMATE 33;
Autosuture CEEA 25;
Autosuture CEEA 28;
Autosuture CEEA 31;
Autosuture CEEA 34;
Autosuture DST Series
3.8.7.1 Staples, wound (non-bone) with disposable applier
Bard Australia Pty Ltd
BA203 PermaFix Open or Laparoscopic Permanent Fixation 15 Fasteners; 30 Fasteners $435.00
System.
Covidien Pty Ltd
AS134 DST Series EEA Or Vil Accessory 21mm, 25mm $435.00
AS158 ABSORBATACK ™ Larposcopic Absorbable Fixation Device 5mm, 10 tacks $435.00 $500.00
Prostheses List by Category, Groups and Sponsor Page 574 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AS160 ABSORBATACK ™ Laparoscopic Absorbable Fixation Device 5mm, 20 tacks $435.00 $550.00
Johnson & Johnson Medical Pty Ltd
DY541 EES Linear Cutter Single use, reloadable stapler Length 55mm $80.00
DY542 EES Linear Cutter Single Use, reloadable stapler Length 75 mm $115.00
Resorbable
Bard Australia Pty Ltd
BA204 SorbaFix Open of Laparoscopic Absorbable 15 Fasteners; 30 Fasteners $435.00
Fixation System.
3.8.7.2 Staples, wound (non-bone) cartridge, without disposable applier
Johnson & Johnson Medical Pty Ltd
DY539 EES Linear Cutter Single Use Loading Units 55mm $240.00
DY540 EES Linear Cutter Single Use Loading Units 75mm $355.00
3.8.8 Tissue Adhesive, Internal
3.8.8.1 Glue, tissue, biological
Baxter Healthcare Pty Ltd
BX214 TISSEEL Two Component Fibrin Active ingedients:Sealer Protein Solution & 2.0 ml (containing 1.0 ml of $380.00
Sealant Syringe Thrombin Solution - deep-frozen Sealer Protein Solution and 1.0
ml of Thrombin Solution)
BX215 TISSEEL Two Component Fibrin Active ingedients:Sealer Protein Solution & 4.0 ml (containing 2.0 ml of $700.00
Sealant Syringe Thrombin Solution - deep-frozen Sealer Protein Solution and 2.0
ml of Thrombin Solution)
BX216 TISSEEL Two Component Fibrin Active ingedients:Sealer Protein Solution & 10.0 ml (containing 5.0 ml of $1,400.00 $1,762.00
Sealant Syringe Thrombin Solution - deep-frozen Sealer Protein Solution and 5.0
ml of Thrombin Solution)
Prostheses List by Category, Groups and Sponsor Page 575 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BX283 ARTISS Fibrin Sealant 2ml ARTISS is a proprietary fibrin sealant with The two components are $380.00
4UI/ml human thrombin. It is two- formulated as two sterile frozen
component fibrin sealant made from solutions. Each solution is
pooled human plasma, a double virus- presented in a separate pre-
inactivated (vapour heated and loaded chamber (1ml) of a
solvent/detergent treated) and frozen (≤ - double chamber syringe. One
20°C) plasma derived biological agent. chamber contains sealer protein
solution with aprotinin while the
other chamber contains
thrombin solution with calcium
chloride, resulting in a 2ml total
volume of product for use.
BX284 ARTISS Fibrin Sealant 4ml ARTISS is a proprietary fibrin sealant with The two components are $700.00
4UI/ml human thrombin. It is two- formulated as two sterile frozen
component fibrin sealant made from solutions. Each solution is
pooled human plasma, a double virus- presented in a separate pre-
inactivated (vapour heated and loaded chamber (2ml) of a
solvent/detergent treated) and frozen (≤ - double chamber syringe. One
20°C) plasma derived biological agent. chamber contains sealer protein
solution with aprotinin while the
other chamber contains
thrombin solution with calcium
chloride, resulting in a 4ml total
volume of product for use.
10ml
Advanced Biomedical Pty Ltd
AB004 BioGlue Surgical Adhesive - 10ml Model No BG3510-5-A (BioGlue One size only $1,030.00
Syringe System Surgical Adhesive)
5ml
Advanced Biomedical Pty Ltd
AB003 BioGlue Surgical Adhesive - 5ml Syringe Model No BG3515-5-A (BioGlue One size only $630.00
System Surgical Adhesive)
Prostheses List by Category, Groups and Sponsor Page 576 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3.8.8.2 Glue, tissue, synthetic
Covidien Pty Ltd
AS163 Vacuseal Vascular Sealant System 5ml Polymer Kit, Sterile, Single-use 1 kit/box $685.00
0.5ml
Johnson & Johnson Medical Pty Ltd
JJ576 Ethicon Omnex Surgical Sealant Omnex Surgical Sealant 0.5 ml $280.00
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG033 Glubran 2 Synthetic cyanoacrylic surgical glue. N- 0.25ml, 0.5ml $280.00
Butyl (2) cyanoacrylate and
methacryloxysulfolane co-monomer.
1ml
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG032 Glubran 2 Synthetic cyanoacrylic surgical glue. N- 1ml $300.00
Butyl (2) cyanoacrylate and
methacryloxysulfolane co-monomer.
2ml
Baxter Healthcare Pty Ltd
BX252 CoSeal Surgical Sealant Composition: two synthetic polyethelene 2ml $320.00
glycols (PEG's), COH102 and COH206,
premixed and filled into one syringe, a
dilute hydrogen chloride solution and a
sodium phosphate/sodium carbonate
solution
4ml
Baxter Healthcare Pty Ltd
BX253 CoSeal Surgical Sealant Composition: two synthetic polyethelene 4ml $600.00
glycols (PEG's), COH102 and COH206,
premixed and filled into a syringe, a dilute
hydrogen chloride solution and a sodium
phosphate sodium carbonate solution
Prostheses List by Category, Groups and Sponsor Page 577 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
8ml
Baxter Healthcare Pty Ltd
BX254 CoSeal Surgical Sealant Composition: two synthetic polyethelene 8ml $1,120.00
glycols (PEG's), COH102 and COH206,
premixed and filled into a syringe, a dilute
hydrogen chloride solution and a sodium
phosphate sodium carbonate solution
3.8.8.3 Accessory item for tissue adhesive – extender
Advanced Biomedical Pty Ltd
AB009 BioGlue Surgical Adhesive - Syringe Model No BGAT-10-SY (BioGlue One size only $31.00
Applicator Tip Extender Surgical Adhesive)
Baxter Healthcare Pty Ltd
BX261 Tisseel Duplospray MIS Applicator Two component Fibrin Sealant containing A 20cm long dual lumen metal $62.00
20cm human derived fibrinogen and thrombin. cannula
BX262 TISSEEL DUPLOCATH 180cm Ttwo component Fibrin Sealant containing A 180cm long double lumen $26.00
human derived fibrinogen and thormbin. flexible application catheter
BX263 COSEAL Spray Accessory Kit A hydrogel that acts as a sealant by One size available $26.00
adhering to itself and the tissues it contacts.
COSEAL is designed to completely seal
suture lines along vascular reconstructions
to prevent fluids from leaking.
BX264 TISSEEL DUPLOTIP 20g x 26.4cm Ttwo component Fibrin Sealant containing A 26.4cm long dual umen $26.00
derived fibrinogen and thrombin. applicator
BX265 TISSEEL DUPLOTIP 5mm x 31.8cm Ttwo component Fibrin Sealant containing A 31.8cm long dual lumen $31.00
human derived fibrinogen and thormbin. applicator
BX267 TISSEEL DUPLOSPRAY MIS Two component Fibrin Sealant containing A 40 cm long dual lumen metal $62.00
APPLICATOR 40 cm human derived fibrinogen and thrombin. cannula
BX268 TISSEEL DUPLOCATH 35cm Two component Fibrin Sealant containing A 35cm long double lumen $31.00
MIC/MIS human derived fibrinogen and thormbin. flexible application catheter
Prostheses List by Category, Groups and Sponsor Page 578 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BX269 TISSEEL Easyspray Set Ttwo component Fibrin Sealant containing One size $14.00
human derived fibrinogen and thrombin.
BX270 COSEAL Applicator Tips 10 cm COSEAL, which is listed on the A 10cm long applicator tip $26.00
Prostheses List, is a hydrogel that acts as a
sealant by adhering to itself and the tissues
it contacts. COSEAL is designed to
completely seal suture lines along vascular
reconstructions to prevent fluids from
leaking. Thi
BX271 TiSSEEL DUPLOTIP 20g x 10.4cm Two component Fibrin Sealant containing 10.4cm long dual lumen $26.00
human derived fibrinogen and thrombin. applicator
BX272 TISSEEL DUPLOCATH 25cm Ttwo component Fibrin Sealant containing A 25cm long double lumen $26.00
human derived fibrinogen and thormbin. flexible application catheter
BX273 Floseal Endoscopic Applicator Used as an adjunct to haemostasis when A 35cm long disposable $31.00
control of bleeding by ligature or cannulated applicator.
conventional surgical procedures is
ineffective or impractical.
BX274 TISSEEL DUPLOTIP 20G x 5.3cm Two component Fibrin Sealant containing A 5.3 cm long dual lumen $26.00
human derived fibrinogen and thrombin. applicator.
BX275 COSEAL Extended Applicator 22 cm COSEAL, which is listed on the A 22 cm long malleable $26.00
Prostheses List, is a hydrogel that acts as a applicator
sealant by adhering to itself and the tissues
it contacts. COSEAL is designed to
completely seal suture lines along vascular
reconstructions to prevent fluids from
leaking. Thi
BX276 Floseal Curved Applicator TIP 8 cm FLOSEAL, which is listed on the An 8cm long curved metal $26.00
Prostheses List, is used as an adjunct to applicator tip
haemostasis when control of bleeding by
ligature or conventional surgical
procedures is ineffective or impractical.
This applicator is an 8 cm curved metal tip,
which is attached t
BX277 TISSEEL DUPLOSPRAY MIS Two component Fibrin Sealant containing A 30 cm long dual lumen metal $62.00
APPLICATOR 30 cm human derived fibrinogen and thrombin. cannula
Prostheses List by Category, Groups and Sponsor Page 579 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BX278 Floseal Curved Applicator Tip 10 cm FLOSEAL is used as an adjunct to A 10cm long curved metal $26.00
haemostasis when control of bleeding by applicator tip
ligature or conventional surgical
procedures is ineffective or impractical.
This applicator is an 10 cm curved metal
tip, which is attached to the FLOSEAL
syringe (sold separately)
BX279 Coseal Duplospray Applicator 30cm COSEAL, which is listed on the 30cm $62.00
Prostheses List, is a hydrogel that acts as a
sealant by adhering to itself and the tissues
it contacts. COSEAL is designed to
completely seal suture lines along vascular
reconstructions to prevent fluids from
leaking. This
BX280 Coseal Duplospray Applicator 20cm COSEAL, which is listed on the Protheses 20 cm $62.00
List, is a hydrogel that acts as a sealant by
adhering to itself and the tissues it
contacts. COSEAL is designed to
completely seal suture lines along vascular
reconstructions to prevent fluids from
leaking. This a
BX282 Floseal Special Applicator Tips Floseal Malleable and Trimmable 14cm $26.00
Applicator Tips specifically designed for
use with Floseal Haemostatic Matrix
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG035 Glubran 2 Catheter for Laparoscopy Catheter for laparoscopic application of One size only $26.00
Glubran 2.
MG036 Glubran 2 Spray Device Spray device for application of Glubran 2 One size only $62.00 $175.00
3.8.8.4 Accessory item for tissue adhesive – applicator tip
Advanced Biomedical Pty Ltd
AB008 BioGlue Surgical Adhesive - Syringe Model No BGAT-SY (BioGlue Surgical One size only $26.00
Standard Applicator Tip Adhesive)
AB010 BioGlue Surgical Adhesive - Syringe Model No BGAT-27-SY (BioGlue One size only $26.00
Applicator Tip Extender Surgical Adhesive)
Prostheses List by Category, Groups and Sponsor Page 580 of 911
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AB065 BioGlue Surgical Adhesive - Syringe Model No BGAT-RT-SY (BioGlue One size only $62.00 $250.00
Rigid Applicator Tip 34cm Surgical Adhesive)
Baxter Healthcare Pty Ltd
BX266 TISSEEL DUPLOSPRAY MIS Ttwo component Fibrin Sealant containing Packs of 10 sterile packs each $20.00
APPLICATOR REPLACEMENT TIPS human derived fibrinogen and thrombin. containing 2 tips and an
installation tool
Morton Surgical Pty Ltd ta Matrix Surgical Company
MG034 Glubran 2 Applicators Dispensing tip/Drop control device for 5-6 and 7-8 French $26.00
applying Glubran 2.
3.8.8.6 Patch - Adhesive peristrips (for internal implantation)
Advanced Biomedical Pty Ltd
AB012 Peri-Strips Dry Model No PSD 4506 One size only $350.00
AB013 Peri-Strips Dry Model No PSD 6006 One size only $350.00
AB018 Peri-Strips Dry Model No PSD 4506 One size only $350.00
AB020 Peri-Strips Dry Model No PSD 8006 One size only $350.00
3.8.8.7 Powder (for pleurodesis)
Medical Vision Australia Pty Ltd
MF003 Steritalc Sterile granules of talc implanted in pleural 3 grams & 4 grams $60.00
space to act as permanent adhesive
Prostheses List by Category, Groups and Sponsor Page 581 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.1.1 Aneurysm Clip, metal/alloy
B Braun Australia Pty Ltd
BB108 Aneurysm Clip Yasargil 4.5mm x 150g to 25.0mm x $215.00 $230.00
200g
BB109 Aneurysm Clip Yasargil Phynox Mini 2.8mm x 110g to 7.0mm x $205.00
130g
BB110 Aneurysm Clip Yasargil Titanium 4.9mm x 150g to 20.0mm x $258.00
200g
BB111 Aneurysm Clip Yasargil Titanium Mini 2.8mm x 110g to 7.0mm x $270.00
110g
BB112 Aneurysm Clip Yasargil Reinforcing, Titanium/Phynox One size only $422.00
BB175 Yasargil Aneurysm Clip System Phynox temporary clips are manufactured 3mm - 20mm length, phynox $230.00
from phynox. temporary clips.
BB176 Yasargil Aneurysm Clip System Titanium termporary clips are 3mm- 25mm length, titanium $280.00
manufactured from titanium temporary clips.
Johnson & Johnson Medical Pty Ltd
JJ134 Aneurysm Clips Stainless steel Reinforcing (booster) Clip Blade length 2-9.5 mm $460.00
JJ136 Aneurysm Clips Stainless steel large clip, curved Blade 6mm diameter, 7.5mm $420.00
length
JJ137 Aneurysm Clips Stainless steel large clip, right-angled Blade 6mm diameter, 5mm $408.00
length
JJ138 Aneurysm Clips Stainless steel large clip, right-angled Blade 6mm diameter, 7.5- $378.00
15mm length
JJ139 Aneurysm Clips Stainless steel large clip, 30 degree angle Blade length 12mm $424.00
JJ140 Aneurysm Clips Stainless steel large clip, bayonet Blade length 5-12mm $445.00
JJ141 Aneurysm Clips Stainless steel large clip, fenestrated Blade 6mm diameter, 24mm $408.00
length
JJ142 Aneurysm Clips Stainless steel large clip, fenestrated tandem Blade 6mm diameter, 6 mm $378.00
length
JJ143 Aneurysm Clips Stainless steel standard clip, straight to 4.5-10mm length $258.00
right angled
Prostheses List by Category, Groups and Sponsor Page 582 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ144 Aneurysm Clips Stainless steel standard clip, side angle 0.6mm diameter, 10mm length $260.00
JJ146 Aneurysm Clips Stainless steel standard clip, slightly curved 0.6mm diameter, 15mm length $278.00
JJ147 Aneurysm Clips Stainless steel standard clip, right angle 0.6mm diameter, 5.5 mm length $269.00
JJ148 Aneurysm Clips Stainless steel standard clip, straight to 0.5-0.6mm diameter, 5-15mm $295.00
right angle length
JJ149 Aneurysm Clips Stainless steel standard clip, straight to 5-25mm length $370.00
curved
JJ150 Aneurysm Clips Stainless steel standard clip, slightly curved 16mm length $370.00
JJ151 Aneurysm Clips Stainless steel standard clip, bayonet 9mm length $345.00
JJ152 Aneurysm Clips Stainless steel standard clip, bayonet 15mm length $350.00
JJ153 Aneurysm Clips Stainless steel standard clip, curved 10-14mm length $365.00
JJ154 Aneurysm Clips Stainless steel standard clip, slightly curved 8-20mm length $408.00
to curved
JJ155 Aneurysm Clips Stainless steel standard clip, bayonet to 6-25mm length $406.00
right angle
JJ217 Aneurysm Clips Stainless steel large clip Blade 4-6mm diameter, 5- $378.00
25mm length
Lifehealthcare Pty Ltd
LH116 Aneurism Clip Sugita Clips, Standard Slightly Curved, One Size Each $460.00
LH117 Aneurism Clip Sugita Clip, Temporary Straight/S, Sugita One Size Each $405.00
Clip, Temporary Straight/L
LH118 Aneurism Clip Sugita Clips: Standard Straight-Short One Size Each $342.00
#1/Long #2
LH119 Aneurism Clip Sugita Titanium Anneurysm Clips: One Size Each $269.00
Standard Straight/s, Straight-L, Bayonet,
Angled, Straight-Small, STD Temp-STD
Small, STD Temp-Straight/Large, STD
Temp-Bayonet, STD Temp-CVD, Mini
Straight-Small, Mini Straight/Large, Mini
Curve, Mini Angled, Mini Curve
Prostheses List by Category, Groups and Sponsor Page 583 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LH147 Aneurism Clip Sugita Titanium Clips: Standard Slight One Size Each $318.00
Angle, Side CVD, CVD, Angled,
Bayonet-Small/Large, Straight-Medium,
Slight CVD, Straight Large, L Angle-
Small/Medium/Large, 45D CVD
Small/Medium/Large, STD Temp Slight
CVD, Temp Mini Straight/Large, Temp
Mini Angle,
LH148 Aneurism Clip Sugita Titanium Clips: Standard Side CVD One Size Each $420.00
Bayonet, Small CVD, Side Angled, Slight
CVD, J Angle-Small/Medium/Large, Slight
CVD Small, Temp Mini Straight Slim,
Standard L Curved- Small/Large, Mini
Straight Slim, Curve Slim,
LH149 Aneurism Clip Sugita Titanium Clips: Booster One Size Each $435.00
LH150 Aneurism Clip Sugita Clips: Mini Straight Slim, CVD Slim One Size Each $460.00
LH151 Aneurism Clip Sugita Clips: Fenest, Lrg L Shaped W/CVD One Size Each $500.00
LH152 Aneurism Clip Sugita Clips, Mini CVD Slim One Size Each $618.00
LH153 Aneurism Clip Sugita Clips, Long One Size Each $620.00
LH154 Aneurism Clip Sugita Clip, Large Straight/Short One Size Each $220.00
LH155 Aneurism Clip Sugita Clip, Temporary Bayonet, Bent One Size Each $230.00
LH156 Aneurism Clip Sugita Clip, STD Sideward CVD One Size Each $236.00
LH157 Aneurism Clip Sugita Clip, Large Sideward Bent, Bent, One Size Each $296.00
Bayonnet-Short/Large, Straight-
Medium/Long
LH158 Aneurism Clip Sugita Clip, Large L Shaped- One Size Each $319.00
Short/Medium/Large, Large J Shaped-
Short/Medium/Large, Fenest Large
Straight-S/M/L, Large Bent-S/M/L,
Fenest Large L Shaped-S/M/L
LH162 Aneurism Clip Sugita Clip, Large Slightly Crv-Short/Long One Size Each $390.00
Prostheses List by Category, Groups and Sponsor Page 584 of 911
NEUROSURGICAL
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Billing Code Product Name Description Size Benefit Benefit Notations
LH163 Aneurism Clip Sugita Clip, Large 45 D Angle/s, Slightlyn One Size Each $380.00
Crv/s, Temporary Slighly Crv, Mini
Straight Slim, Large 1/4 CVD, Mini
LH164 Aneurism Clip Sugita Clip, Large Straight, Bayonet, Mini One Size Each $400.00
Bayonet
LH165 Aneurism Clip Sugita Clip, Large L Shaped W/CRV-S/L, One Size Each $410.00
1/4 CVD-S/L
LH166 Aneurism Clip Sugita Clip, Large 45D Angle-M/L One Size Each $400.00
LH167 Aneurism Clip Sugita Clip, Fenest Large L Shaped-L, One Size Each $460.00
Bayonet
LH168 Aneurism Clip Sugita Clip, Fenest Large L Shaped One Size Each $224.00
W/CVD
LH169 Aneurism Clip Sugita Clips, Standard Bayonnet, Bent, One Size Each $236.00
Sideward Bent, Sideward Curve, Slight
Bent
LH170 Aneurism Clip Sugita Clips, Standard Sideward Curve, One Size Each $370.00
Curved
LH171 Aneurism Clip Sugita Clips, Standard Slight CVD, CVD 11mm length x 1.2 width, $342.00
closing force 125-160gms;
9mm length x 1.2 width, closing
force 120-155gms
LH294 Mizuho - Titanium Fenestrated Aneuysm Straight (S/M/L), Bent (S/ M/L), L- Closing Force 95 to 160 gms $568.00
Clips Shaped (S/M/L), Bayonet, L Shaped
curved to left (S/M/L), L-Shaped curved
to right (S/M/L)
4.1.2 Aneurysm Clip, other
B Braun Australia Pty Ltd
BB290 T-Bar Yasargil Aneurysm Clip T-Bar Yarsargil Aneurysm Clip, Titanium, 5mm-9mm, 45 Deg $620.00 $680.00
Permanent Standard Fenestrated
BB291 T-Bar Yasargil Aneurysm Clip T-Bar Yarsargil Aneurysm Clip, Titanium, 5mm-13mm, 90 Deg $620.00 $680.00
Permanent Standard Fenestrated
Prostheses List by Category, Groups and Sponsor Page 585 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BB292 T-Bar Yasargil Aneurysm Clip T-Bar Yarsargil Aneurysm Clip, Pyhnox 5mm-9mm, 45 Deg $460.00 $482.00
Cobalt Alloy, Permanent Standard
Fenestrated
BB293 T-Bar Yasargil Aneurysm Clip T-Bar Yarsargil Aneurysm Clip, Pyhnox 5mm-13mm, 90 Deg $460.00 $482.00
Cobalt Alloy, Permanent Standard
Fenestrated
Johnson & Johnson Medical Pty Ltd
JJ131 Aneurysm Clips Stainless steel Graft Clip (with teflon graft) Blade 2-5mm diameter, 3-7mm $598.00
length
4.1.3 AVM Clips
B Braun Australia Pty Ltd
BB218 Kopitnik Microneurosurgical AVM Clips Composition: Phynox (Cobalt-base-alloy) 2mm, 3mm, 4mm, 5mm - $240.00
straight. 2mm, 3mm, 4mm,
5mm - curved.
Johnson & Johnson Medical Pty Ltd
JJ130 Aneurysm Clips Stainless steel alloy AVM Micro Clip Blade length 2-9.5 mm $270.00
Lifehealthcare Pty Ltd
LH159 Aneurism Clip Sugita Clip, Temporary Mini Straight, 5-7mm length x 1.2mm width, $328.00
Bent, Mini Straight/Short, Bent, closing force 125gms
SDEWARD CVD, CVD
LH160 Aneurism Clip Sugita Clip, Mini CVD 4mm length x 1.2mm width, $331.00
closing force 120 & 124gms
LH161 Aneurism Clip Sugita Clip, Mini CVD 5mm length x 1.2mm width, $366.00
closing force 132gms
4.2.1 Repair, Graft, Synthetic, Large (>50cm2)
B Braun Australia Pty Ltd
BB015 Neuro-Patch Polyesterurethane 12 x 14cm $655.00
BB113 Neuropatch Dura Substitute Polyurethane 6 x 14cm $352.00
Prostheses List by Category, Groups and Sponsor Page 586 of 911
NEUROSURGICAL
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Billing Code Product Name Description Size Benefit Benefit Notations
Covidien Pty Ltd
AS180 Duraseal Dural Sealant DuraSeal is a Synthetic, absorbable, 5ml of hydrogel sealant $835.00
Polyethylene Glycon, hydrogel sealant
used as an adjunct to sutured dural repair
to achieve watertight closure.
Integra Neurosciences Pty Ltd
IG046 DuraGen Collagen dural graft matrix 7.5cm x 7.5cm $1,120.00
IG047 DuraGen Plus Collagen dural graft matrix 7.5cm x 7.5cm $1,120.00
IG048 DuraGen Suturable Collagen dural graft matrix 7.5cm x 7.5cm $1,120.00
IG049 DuraGen Collagen Dural graft matrix 10cm x 12.5cm $1,890.00
IG051 DuraGen Suturable Collagen dural graft matrix 10cm x 12.5cm $1,890.00
IG059 DURAGEN PLUS Collagen Dural Graft Matrix 10cm x 12.5cm $1,890.00
IG060 DURAGEN PLUS Collagen Dural Graft Matrix 12.5cm x 17.5cm $2,400.00
W L Gore & Associates
GT054 Preclude Spinal Membrane ePTFE 0.7mm Thickness 6 x 6cm $472.00
GT055 Preclude Spinal Membrane ePTFE 0.7mm Thickness 6cm x 12cm $785.00
GT056 Preclude Dura Substitute ePTFE 0.3mm Thickness 2 x 10cm $492.00
GT057 Preclude Dura Substitute ePTFE 0.3mm Thickness 5 x 6 cm $707.00
GT058 Preclude Dura Substitute ePTFE 0.3mm thickness 6 x 10cm $1,335.00
GT059 Preclude Dura Substitute ePTFE 0.3mm thickness 10 x 12cm $2,372.00
Biological
Johnson & Johnson Medical Pty Ltd
JJ743 Duraform Dural Graft Implant - 3" x 3" Collagen-based dural graft implant 3" x 3" (7.5 x 7.5cm) $1,120.00
(7.5 x 7.5cm)
JJ744 Duraform Dural Graft Implant - 4" x 5" Collagen-based dural graft implant 4" x 5" (10x12.5cm) $1,890.00
(10x12.5cm)
Medtronic Australasia Pty Ltd
MC753 Durepair Dura Substitute, Collagen 3" x 3" $1,120.00
MC754 Durepair Dura Substitute, Collagen 4" x 5" $1,890.00
Prostheses List by Category, Groups and Sponsor Page 587 of 911
NEUROSURGICAL
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Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
SK494 DuraMatrix Resorbable Collagen Dura Substitute 4" x 5" (10cm x 12.5cm) $1,890.00
Membrane
SK495 Dura Matrix Resorbable Collagen Dura Substitute 3" x 3" (7.5cm x 7.5cm) $1,120.00
Membrane
4.2.2 Repair, Graft, Synthetic, Medium (11-49cm2)
B Braun Australia Pty Ltd
BB114 Neuropatch Dura Substitute Polyurethane 6 x 8cm $291.00
BB115 Neuropatch Dura Substitute Polyurethane 4 x 10cm $257.00
BB116 Neuropatch Dura Substitute Polyurethane 4 x 5cm $240.00
BB117 Neuropatch Dura Substitute Polyurethane 2 x 10cm $254.00
Covidien Pty Ltd
AS181 DuraSeal Xact Spinal Dural Sealant Xact Dural Sealant for spine )Packaged in 2ml vial $800.00
sterile single use disposable tray with
MicroMyst Applicator & precurser
syringes)
Integra Neurosciences Pty Ltd
IG040 DuraGen Collagen dural graft matrix 2.5cm x 7.5cm $545.00
IG041 DuraGen Plus Collagen dural graft matrix 2.5cm x 7.5cm $545.00
IG042 DuraGen Suturable Collagen dural graft matrix 2.5cm x 7.5cm $545.00
IG043 DuraGen Collagen dural graft matrix 5cm x 5cm $605.00
IG044 DuraGen Plus Collagen dural graft matrix 5cm x 5cm $605.00
IG045 DuraGen Suturable Collagen dural graft matrix 5cm x 5cm $605.00
Prostheses List by Category, Groups and Sponsor Page 588 of 911
NEUROSURGICAL
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Billing Code Product Name Description Size Benefit Benefit Notations
W L Gore & Associates
GT233 Gore Preclude® Vessel Guard Gore Preclude® Vessel Guard is an 5cm x 6cm $707.00 $775.00
ePTFE Membrane with a tight
microstructure providing a vessel friendly
interface while preventing penetration of
fibroblasts. It is indicated as a cover for
vessels following anterior vertebral surgery
to reduce the risk of potential vessel
damage during a revision surgery by
providing a plane of dissection.
Biological
Johnson & Johnson Medical Pty Ltd
JJ741 Duraform - 1" x 3" (2.5x7.5cm) Collagen-based dural graft implant 1x3"(2.5x7.5cm) $545.00
JJ742 Duraform Dural Graft Implant - 2" x Collagen-based dural graft implant 2'x2' (5x5cm) $605.00
2"(5x5cm)
Stryker Australia Pty Ltd
SK493 DuraMatrix Resorbable Collagen Dura Substitute 1" x 3" (2.5cm x 7.5cm) $545.00
Membrane
SK496 DuraMatrix Resorbable Collagen Dura Substitute 2" x 2" (5cm x 5cm) $605.00
Membrane
4.2.3 Repair, Graft, Synthetic, Small (<10cm2)
B Braun Australia Pty Ltd
BB118 Neuropatch Dura Substitute Polyurethane 1.5 x 3cm $72.00
Integra Neurosciences Pty Ltd
IG038 DuraGen Collagen dural graft matrix 2.5cm x 2.5cm $330.00 $360.00
IG039 DuraGen Plus Collagen dural graft matrix 2.5cm x 2.5cm $330.00 $360.00
Biological
Johnson & Johnson Medical Pty Ltd
JJ740 Duraform Dural Graft Implant - 1" x 1" Collagen-based dural graft implant 1'x1' (2.5x2.5cm) $330.00
(2.5x2.5cm)
Prostheses List by Category, Groups and Sponsor Page 589 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC750 Durepair Dura Substitute, Collagen 1" x 1" $360.00
MC751 Durepair Dura Substitute, Collagen 2" x 2" $605.00
MC752 Durepair Dura Substitute, Collagen 1" x 3" $545.00
Stryker Australia Pty Ltd
SK492 DuraMatrix Resorbable Collagen Dura Substitute 1" x 1" (2.5cm x 2.5cm) $330.00 $360.00
Membrane
4.3.1 Ventricular Catheters
Integra Neurosciences Pty Ltd
IG025 Right Angle Ventricular Catheter Silicone, integral right angle 3-11cm $310.00
Medtronic Australasia Pty Ltd
MC583 CSF - Ventricular Catheters PSM Non metallic latex free. Barium ID 1.3mm OD 2.5mm Length $212.00
Range impregnated, include stainless steel stylet. 15cm, 23cm; ID 1.2mm OD
Model Nos 41101, 41115, 41207, 2.1mm Length 15cm, 23cm
41103, 41308, Proximal ventricular
catheter.
MC639 Ventricular Catheter PSM range with Translucent silicone elastomer with Barium 15-23cm $249.00
Bioglide impregnated stripe. Catheter surface
bonded with Hydrogel.
4.3.1.1 Drainage Catheter, with impregnated antibiotics
Drainage Catheter
Johnson & Johnson Medical Pty Ltd
JJ160 Hakim Ventricular and Peritoneal Silicone ventricular/peritoneal catheter Peritoneal Catheter length 80 $675.00
Catheter set with Bactiseal Silicone cm, Ventricular Catheter length
15 cm
JJ163 Hakim Ventricular Catheter with Silicone antibiotic impregnated catheter. Ventricular Catheter length 14 cm $469.00
Bactiseal Silicone
4.3.1.2 Drainage Catheter, without impregnated antibiotics
Integra Neurosciences Pty Ltd
IG012 Shunt Ventricular 14.5cm - 23cm $475.00
Prostheses List by Category, Groups and Sponsor Page 590 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
IG014 Heyer Schulte Portnoy Flanged Composition - silicone with tantalum Length 18cm, outer diameter $475.00
Ventricular Catheter markings 8mm
IG030 Cardiac/Peritoneal Catheters SiliconDistal Catheter, ID 1.3mm, OD 90cm, barium impregnated $185.00
2.5mm silicone catheter, closed or
open ended, with or without slits
IG031 Ventricular Catheters Silicon Ventricular Catheter 15cm - 25cm, optional flanges $185.00
or right angle or endoscopic tip.
ID 1.3mm, OD 2.5mm
Johnson & Johnson Medical Pty Ltd
JJ218 HOLTER Intracranial Pressure Shunt HOLTER Ventricular Catheter, packaged 3 - 7cm and 15cm $149.00
sterile, silicone rubber
JJ227 Codman Medos Straight Ventricular 14cm, packaged sterile, silicone rubber 14cm $149.00
Catheter
JJ263 ACCU-FLO Intracranial Pressure shunt ACCU-FLO barium ventricular catheter, One size only $154.00
packaged sterile, silicone rubber
4.3.2 CSF Drainage Catheter
Medtronic Australasia Pty Ltd
MC857 Small Lumen Peritoneal Catheter CSF Distal Catheter ID - 0.7mm OD - 2.5mm $185.00 $235.00
Length - 120cm
4.3.2 Valves
4.3.2.1 Valves, Programmable
Medtronic Australasia Pty Ltd
MC643 Strata Valve with Bioglide PSM range CSF Flow Valve. Polypropylene and 13-16mm x 35-47mm $2,350.00
acetal plastic base. Silicone elastomer
dome.
Prostheses List by Category, Groups and Sponsor Page 591 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Antisyphon Device
Johnson & Johnson Medical Pty Ltd
JJ219 Hakim Programmable Valve System Fixed pressure hydrocephalus shunt, One size only $3,250.00
packaged sterile, stainless steel and ruby
valve mechanism, silicone rubber
ventricular and peritoneal catheters. In line
or right angled with reservoir. Valve can
be reprogrammed non-invasively 18
pressure settings a
Antisyphon Device, Priming Device
Johnson & Johnson Medical Pty Ltd
JJ437 Codman Hakim Programmable Valves 18 different pressure settings and One Size Only $3,250.00
with Siphonguard SIPHONGUARD technology
Antisyphon Device, Priming Device, Reservoir
Medtronic Australasia Pty Ltd
MC641 Strata Valve Unitised with Bioglide PSM CSF Flow Valve. Polypropylene and One size only $2,700.00
range acetal plastic base. Silicone elastomer
dome.
Priming Device
Johnson & Johnson Medical Pty Ltd
JJ158 Hakim Programmable Valve System Standard system. Silicone casing without One size only $2,800.00
catheter; stainless steel ruby ball in cone
mechanism with variable pressure
JJ436 Codman Hakim Programmable Valves 18 different pressure settings, various One Size Only $2,700.00
models
Priming Device, Reservoir
Johnson & Johnson Medical Pty Ltd
JJ159 Hakim Programmable Valve System Standard system. Silicone casing with Peritoneal Catheter length 80 $3,140.00
catheter; stainless steel ruby ball in cone cm, Ventricular catheter length
mechanism with variable pressure 14 cm
Medtronic Australasia Pty Ltd
MC642 Strata Valve Assembly with Bioglide CSF Flow Valves. Polypropylene and One size $2,038.00 $2,730.00
PSM range acetal plastic base. Silicone elastomer
dome.
Prostheses List by Category, Groups and Sponsor Page 592 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC644 Strata Valve NSC (non siphon control) CSF Flow Valve. Polypropylene and 13-16mm x 23-32mm (0.5- $2,020.00
PSM range acetal plastic base. Silicone elastomer 2.0)
dome.
4.3.2.2 Valves, Non-programmable
Integra Neurosciences Pty Ltd
IG001 Horizontal-Vertical (H-V) Lumbar valve The H-V Lumbar Valve adjusts to changes 903-325A 85-125 205-285 $1,060.00
system in posture to maintain pressure small children, 903-335A 85-
appropriate levels in both standing and 125 265-365 tall children,
recumbent positions. Has a unique anti- adults, 903-345A 85-125
gravity mechanism automatically increasing 325-445 tall adults, 903-320A
flow resistance when the patient resumes a 50-80 170-240 small
standing or sitti children, 903-330A 50-80
230-320 tall children, adults,
903-340A 50-80, 290-400
tall
IG004 Spetzler Lumbar-Peritoneal Shunt System Shunt, CSF Reservoir, In-line valve Catheter length 80 - 105cm, $1,080.00
Reservoir small & large, Valve
pressure range low - high
IG005 Novus Hydrocephalic Shunt Kit Pressure range low, medium Standard, mini $2,155.00
IG015 Cordis Omnishunt System, Hakim Valve Hakim Valve System Drainage Cath 110 cm, F7. $1,030.00
Series Vent. Cath 15cm, F8.
IG016 Cordis Standard Valve System Atlas Valve System Drainage Cath 110 cm, F7. $1,190.00
Hydrocephalus Valves Vent. Cath 15cm, F8.
IG018 Precision Flow-OSV II Valve System Ventricular/Atrial OSV11-Ventricular Drainage Cath 110 cm, F7. $1,725.00
/Atrial Hydrocephalus Shunt Ventricular Catheters 7,9,13 &
15 cm
IG019 Precision Flow-OSV II Valve System Ventricular/Peritoneal OSV11- Drainage Cath 110 cm, F7. $1,725.00
Ventricular/Peritoneal Hyrocephalus Shunt Ventricular Catheters 7,9,13 &
15 cm
IG026 Contour-Flex Valves Silicone encased CSF Valve Smal (24mm Length) or $1,066.00
Regular (28mm Length), low
medium or high pressure
IG028 Equi Flow Valves Valve only Small (35mm length) or Regular $1,285.00
(40mm length); low,
low/medium and medium
pressure
Prostheses List by Category, Groups and Sponsor Page 593 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
JJ161 Codman-Medos Non-programmable Silicone fixed pressure lumber/peritoneal Peritoneal Catheter length 25- $375.00
Valve System catheter, James design 80cm
JJ162 Codman-Medos Non-programmable Silicone fixed pressure lumber/peritoneal Peritoneal Catheter length 65 cm $870.00
Valve System catheter, Holter design
Medtronic Australasia Pty Ltd
MC530 Hydrocephalus Shunt Ventricular/Atrial, CSF Flow Control 38cm-90cm $450.00
Shunts, Cont Small Valve
MC531 Hydrocephalus Shunt Ventricular/Peritoneal. CSF Flow Control 12mm-90cm $893.00
Valves, BioGlide Contoured,
Ventriculostomy Kit-E, Neonatal Delta
Snap Shunt
MC532 Hydrocephalus Shunt With Hydrostatic Valve, Delta 12mm-90cm $1,110.00
Valves/Shunts/BioGlide, Vent Catheters
Antisyphon Device, Priming Device
Johnson & Johnson Medical Pty Ltd
JJ438 Codman Hakim Precision Valves with features 5 operating pressures and Pressure settings 10, 40, 70, $1,500.00
Siphonguard, Right Angle Reservoir SIPHONGUARD technlogy 100 and 130mmH2O
JJ439 Codman Hakim Precision Valve with features 5 operating pressures and Pressure settings 10, 40, 70, $1,500.00
Siphonguard, Inline Reservoir SIPHONGUARD technology 100 and 130mmH2O
Priming Device
Johnson & Johnson Medical Pty Ltd
JJ440 Codman Hakim Precision Valve, Right features 5 operating pressures 10, 40, 70, 100, and $1,390.00
Angle Reservoir 130mmH2O
Priming Device, Reservoir
Medtronic Australasia Pty Ltd
MC647 Delta Valve with Bioglide PSM range CSF Flow Valve. Polypropylene and 36-40mm x 9-20mm (0.5-2.0) $1,500.00
acetal plastic base. Silicone elastomer
dome. Surface of valve bonded with
hydrogel (Bioglide surface modification).
Prostheses List by Category, Groups and Sponsor Page 594 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC648 Delta Valve Unitised with Bioglide PSM CSF Flow Valves. Polypropylene and 8-13.5cm x 90-120cm (0.5- $1,990.00
range acetal plastic base. Silicone elastomer 2.0)
dome. Unitised system includes the valve,
integral ventricular and peritoneal catheter
(all components connected). Surface of
valve bonded with hydrogel (Bioglide
surface modificat
4.3.2.3 Shunt Device, with ventricular/peritoneal catheter and valve
Integra Neurosciences Pty Ltd
IG017 Precision Flow-OSV II Valve System Lumbar peritoneal OSV11- Lumber Catheter 80cm, F5 $1,725.00
Lumboperitoneal System Hydrocephalus Peritoneal Catheter 110cm, F7
Shunt
IG027 Contour Flex Valve Shunt Assemblies Shunt Assembly: silicone encased valve, Small (24mm Length) or regular $1,335.00
silicone ventricular and peritoneal catheters (28mm Length); low,
low/medium and medium
pressure; various catheter and
valve configurations
IG029 Equi Flow Shunt Assemblies CSF Shunt, includes silicone ventricular Small (35mm length) or Regular $1,690.00
and peritoneal catheters, silicone encased (40mm length); low,
overdrainage control valve low/medium and medium
pressure; various kit
configurations
Johnson & Johnson Medical Pty Ltd
JJ156 Hakim Precision Valve System Precision valve standard. Silicone casing & Peritoneal Catheter length 80 $1,110.00
catheter; stainless steel ruby ball in cone cm, Ventricular catheter length
mechanism with fixed pressure 14 cm
JJ157 Hakim Precision Valve System Precision valve and pre-chamber. Silicone Peritoneal Catheter length 80 $1,320.00
casing & catheter; stainless steel ruby ball cm, Ventricular catheter length
in cone mechanism with fixed pressure 14 cm
Prostheses List by Category, Groups and Sponsor Page 595 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC640 Strata Shunt, Unitised Adjustable CSF valve with five symmetric 8-13.5cm x 9-120cm $2,560.00
performance level steps. Includes strata
valve, pre-attached ventricular catheter,
and a pre-attached peritoneal catheter.
Right Angle Clip. Disposable Quick
Release Ventricular Catheter Introducer.
Disposable Sub
MC645 Strata Valve Unitised NSC (non siphon Adjustable CSF valve with five symmetric 8-120cm $2,406.00
control) PSM range performance level steps. Includes a strata
valve, pre-attached ventricular catheter,
and a pre-attached peritoneal catheter.
Right Angle Clip. Disposable Quick
Release Ventricular Catheter Introducer.
MC646 Strata Valve Assembly NSC (non siphon Adjustable CSF valve with five One size $2,245.00
control) PSM range symmetrical performance level steps.
Includes a strata valve, an integral distal
peritoneal catheter and catheter passer,
and a female leur adaptor and prefill
tubing. Polypropylene and acetal plastic
base. Silicone elastome
MC649 Delta Shunt Unitised Delta valve is a fixed pressure CSF valve, Delta Unitised Shunt small $1,725.00
available in four performance levels. Delta (Distal 65cm-90cm, ventricular
Unitised shunt includes a delta valve, pre- 11cm) - 0.5, 1.0, 1.5 and 2.0.
attached ventricular catheter, and a pre- Delta Unitised Shunt regular
attached peritoneal catheter. Right Angle (Distal 90cm, ventricular
Clip. Disposable Quick Release Ventricular catheter 13cm) - 0.5, 1.0, 1.5
and 2.0
MC650 Delta Shunt Assembly Delta valve is a fixed CSF pressure valve, 90-120cm (0.5 - 2.0) $1,560.00
available in four performance levels.
Includes an Integral (distal) Peritoneal
Catheter, Disposable Peritoneal Catheter
Passer, Female Luer Adapter and Prefill
Tubing.
Prostheses List by Category, Groups and Sponsor Page 596 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC651 Delta Valve Assembly with Bioglide CSF Flow Valves. Polypropylene and 90-120cm (0.5, 1.0, 1.5, 2.0) $1,775.00
PSM range acetal plastic base. Silicone elastomer
dome. Assembly system includes the valve,
integral peritoneal catheter, female luer
adapter and prefill tubing. Surface of the
valve bonded with hydrogel (Bioglide
surface modifica
MC652 Strata Shunt Assembly Adjustable CSF valve with five symmetric 90-120cm $2,406.00
performance level steps. The assembly
includes an Integrated (distal) Peritoneal
Catheter. Disposable Peritoneal Catheter
Passer. Female Luer Adapter and Prefill
tubing.
Drainage Catheter
Johnson & Johnson Medical Pty Ltd
JJ220 Hakim Precision Valve System Fixed pressure hydrocephalus shunt, One size only $1,500.00
packaged sterile, stainless steel and ruby
valve mechanism, silicone rubber
ventricular and peritoneal catheters. In line
or right angled with reservoir. Opening
pressure H20; Very high 130mm, high
100mm, medium 70mm
JJ221 Hakim Precision Valve System Fixed pressure hydrocephalus shunt, One size only $1,390.00
packaged sterile, stainless steel and ruby
valve mechanism, silicone rubber
ventricular and peritoneal catheters. In line
or right angled with reservoir. Opening
pressure H20; Very high 130mm, high
100mm, medium 70mm
4.3.3 Drainage Catheter
4.3.3.2 Drainage Catheter, without impregnated antibiotics
Integra Neurosciences Pty Ltd
IG009 Heyer-Schulte Pudenz Ventricular - small, standard, right-angled $185.00
Catheter
IG010 Shunt Components - catheter: Atrial 55cm - 60cm, Low - High $450.00
pressure range
IG011 Shunt Peritoneal 90 - 120cm $350.00
Prostheses List by Category, Groups and Sponsor Page 597 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
IG020 Atrial Catheter Components - catheter: Atrial Atrial Length: 46cm, F7. OD: $165.00
Catheters Hydrocephalux Valve 2.1mm; ID:1.1mm
Accessories
IG021 Peritoneal Catheter Peritoneal Catheters Length: 91cm, F7. OD: $180.00
2.1mm; ID:1.1mm
Johnson & Johnson Medical Pty Ltd
JJ225 HOLTER Intracranial Pressure Shunt HOLTER distal peritoneal catheter, 90cm in length $155.00
packaged sterile, silicone
JJ226 HOLTER Intracranial Pressure Shunt HOLTER distal peritoneal catheter 90cm in length $247.00
Salmon, packaged sterile, silicone
JJ229 Codman Medos Peritoneal Catheter 85cm, packaged sterile, silicone rubber 85cm $185.00
JJ261 ACCU-FLO Intracranial Pressure shunt ACCU-FLO catheter, packaged sterile, 91cm in length $197.00
silicone rubber
Medtronic Australasia Pty Ltd
MC584 CSF - Distal Catheters Non metallic and latex free, Models Distal cardiac/peritoneal $185.00
43418,43103,43111,43209,43522,4355 catheters ID 1.3mm OD 2.5mm
1,27211 Length 90cm, 96cm, 110cm,
120cm, ID 1.2mm, OD 2.1mm,
Length 90cm, 75cm, 58cm
MC638 Peritoneal Catheter PSM range with Translucent silicone elastomer with Barium 60-90cm $255.00
Bioglide impregnated stripe. Catheter surface
bonded with Hydrogel.
MC735 Rivulet Ventricular Catheter 4cm - 23cm $310.00
4.3.4 Antisyphon Device
Johnson & Johnson Medical Pty Ltd
JJ164 Siphonguard CSF Control Device PET shell anti-siphon device for shunt One size only $390.00
Medtronic Australasia Pty Ltd
MC529 Hydrocephalus Shunt Lumbar peritoneal 84cm $450.00
Prostheses List by Category, Groups and Sponsor Page 598 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.3.5 Unishunt
4.3.5.1 Unishunt, Cranial
Integra Neurosciences Pty Ltd
IG023 Cordis Omnishunt System Silicone and Synthetic ruby Very low to very high pressures $775.00
IG024 Gravity Compensating Accessory Silicone/Stainless steel low, medium & high pressures $880.00
IG032 Burr Hole Valve Shunt Assemblies Shunt Assembly: silicone encased valve, 16mm or 12mm base; low, $650.00
silicone ventricular and peritoneal catheters medium or high pressure,
various kit configurations
4.3.6 CSF Valve for Hydrocephalus Treatment
4.3.6.2 Hydrocephalus Device, CSF Valve for Hydrocephalus Treatment, Adjustable Valve
Medtronic Australasia Pty Ltd
MC928 Strata NSC L-P Shunt Lumboperitoneal Shunt 44mm x 23mm x 12mm $2,700.00
Antisyphon Device
Medical Specialties Australia Pty Ltd
MS003 Sterile Hydrocephalic Shunts Plastic/magnetic. Programmable valve. 3, 8 settings $2,700.00
Programmer kit and shunts kit.
4.3.6 Reservoir
Integra Neurosciences Pty Ltd
IG006 Heyer-Schulte Spetzler Lumbar- - Small, large $425.00
Peritoneal Low Pressure Flushing
Reservoir
IG008 Heyer-Schulte Ommaya CSF Reservoir Standard, side-inlet, convertible, mini 1.5 - 2.5cm and mini $717.00
IG013 Shunt Reservoir Standard, Large $390.00
Prostheses List by Category, Groups and Sponsor Page 599 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
IG033 Reservoirs Shunt component 9mm to 25mm, with or without $512.00
convertible outlet port, burr
hole or flat bottom style
Johnson & Johnson Medical Pty Ltd
JJ165 Burr Hole Button Stainless steel ventriculostomy reservoir One size only $375.00
JJ166 Burr Hole Button Silicone or stainless steel ventriculostomy 14mm diameter $450.00
reservoir
JJ167 Burr Hole Button Silicone ventriculostomy reservoir, flat One size only $260.00
bottom
JJ168 Burr Hole Button Silicone ventriculostomy reservoir, standard One size only $172.00
JJ169 Burr Hole Button Silicone ventriculostomy reservoir, large One size only $355.00
JJ170 Burr Hole Button Silicone or stainless steel ventriculostomy One size only $335.00
reservoir, low profile
JJ171 Burr Hole Button Silicone or stainless steel ventriculostomy 24mm diameter $400.00
reservoir
Medtronic Australasia Pty Ltd
MC534 Pressure valve (anti-siphon device or Neonatal Reservior, CSF Lumbo 2 - 90cm $720.00
flushing valve or flush pump) Peritoneal
4.3.7 Shunt Attachments
4.3.7.1 Connectors
Integra Neurosciences Pty Ltd
IG007 Heyer-Schulte Connectors for Pudenz straight, Pudenz right angled, Each in one size $143.00
Neurosurgical Use Pudenz three-way (Y) Threaded straight,
Threaded right angled, Double threaded
straight
IG022 Connectors Silicone and Stainless Steel Straight, right angle, Y, T $396.00
Johnson & Johnson Medical Pty Ltd
JJ228 Codman Medos Connector Codman Medos stainless steel shunt One size only $38.00
connector straight
JJ262 ACCU-FLO Intracranial Pressure shunt ACCU-FLO three way connector, One size only $143.00
packaged sterile, metal or plastic
Prostheses List by Category, Groups and Sponsor Page 600 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ264 ACCU-FLO Intracranial Pressure shunt ACCU-FLO right angle connector, One size only $70.00
packaged sterile, metal or plastic
4.3.7.2 Right Angled Guides
Integra Neurosciences Pty Ltd
IG052 Electa right angle guide Silicone One Size Only $200.00
4.4.1 Implantable Pulse Generator for DBS
St Jude Medical Australia Pty Ltd
SJ171 ANS Spinal Cord Stimulation System Implantable Pulse Generator - Genesis One size only $17,450.00
(SCS) GENESIS Model 3608
4.4.1.1 Implantable Pulse Generator, single channel
St Jude Medical Australia Pty Ltd
SJ197 Libra Deep Brain Stimulation System - Implantable pulse generator for deep brain 50mm x 54mm x 14mm $9,050.00
Libra IPG - 6608 stimulation - 8 channel
Single Channel
Medtronic Australasia Pty Ltd
MC228 Soletra Model 7426 Neurostimulator Sterility - Ethylene Oxide. One size only $9,050.00
Neurostimualtor comprised of electronic
circuitry and a battery, which are
hermatically sealed in a titanium case
4.4.1.2 Implantable Pulse Generator, dual channel
Medtronic Australasia Pty Ltd
MC838 Medtronic ACTIVA PC ACTIVA PC Dual channel primary cell One size only $15,060.00 $18,500.00
Neurostimulator for Deep Brain neuro stimulator for Deep Brain
Stimulation Stimulation (37601)
MC946 Medtronic ACTIVA RC ACTIVA RC Dual channel rechargeable One size only $15,060.00 $24,000.00
Neurostimulator for Deep Brain neurostimulator for Deep Brain Stimulation
Stimulation (37612)
Prostheses List by Category, Groups and Sponsor Page 601 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
St Jude Medical Australia Pty Ltd
SJ202 Brio DBS Implantable Pulse Generator Dual Channel 16 Contact rechargeable 29g, 17cc $15,060.00 $19,150.00
6788 IPG
SJ206 Libra XP DBS IPG 6644 Implantable pulse generation for deep 76mm x 58mm x 14mm $15,060.00
brain stimulation - Dual 4 Channel
Dual Channel
Medtronic Australasia Pty Ltd
MC001 Kinetra Dual Channel Implantable Pulse Titanium, polyurethane One size only $15,060.00
Generator Model 7428
4.4.2 Patient programmer for single channel DBS system
Medtronic Australasia Pty Ltd
MC249 Access Therapy Controller Handheld device used with the Kinetra and One size only $1,400.00
Soletra Implantable Pulse Generators
4.4.2.2 Patient programmer for dual channel DBS system
St Jude Medical Australia Pty Ltd
SJ204 Brio DBS Patient Controller 6856 Patient Controller for DBS One size only $1,400.00
4.4.3 Lead for DBS system
4.4.3.2 Permanent lead for DBS system
Quadripolar
Medtronic Australasia Pty Ltd
MC244 Medtronic Australasia DBS Lead Model Deep brain stimulation lead with four 28 - 40cm $4,150.00
3389, Medtronic quadripolar Itrel II- platinum iridium electrodes Models 3387
7424DBS, Active Implantable Stimulator and 3389. Electrode spacing is 1.5mm
& Ancillary Equipment apart for Model 3387 and 0.5mm apart
for Model 3389. PTFE, polyurethane,
platinum/iridium, nickel alloy, tungsten
Prostheses List by Category, Groups and Sponsor Page 602 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.4.4 Lead extension
Medtronic Australasia Pty Ltd
MC305 Low Profile Impedance Extension Kit for Silicone Rubber 25, 40, 51, 66, 95cm $1,510.00 $2,100.00
DBS Model 7482
MC852 Medtronic Extension for Deep Brain Medtronic ACTIVA Stretch Coil 40cm, 60cm, 95cm $1,948.00 $2,500.00
Stimulation Extension for use with ACTIVA RC and PC
MC940 Pocket Adaptors for Deep Brain Pocket Adaptors for Deep Brain 25.5cm and 27.4cm $1,510.00 $1,750.00
Stimulation Stimulation (Single and Dual Channel)
4.4.5 Accessory kit
Medtronic Australasia Pty Ltd
MC841 Medtronic MicroTargeting Electrodes Microelectrodes used for intra-operative Various $950.00 $1,500.00
recording of neuronal activity
MC842 Medtronic Screening Cable (Twist Screening Cable with Twist Lock for One size only $300.00
Lock) Intraoperative testing
MC843 Medtronic Screening Cable (Alligator Screening Cable with Alligator Clip for One size only $300.00
Clip) Intraoperative testing
St Jude Medical Australia Pty Ltd
SJ198 MicroTargeting Electrodes Microtargeting mono- and bipolar- 100-300mm $950.00
electrodes
SJ199 Guardian Burr Hole Cover System Cranial Burr Hole Cover 14 - 17mm outer diameter $400.00 $800.00
DBS Lead Securement Device
Medtronic Australasia Pty Ltd
MC767 Stimloc Burr Hole Cover 14mm $400.00 $550.00
MER Cable
Medtronic Australasia Pty Ltd
MC764 Microelectrode Cable Cable used for intracranial recording of One size $150.00 $200.00
neural activity prior to DBS
Prostheses List by Category, Groups and Sponsor Page 603 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MER Electrode
Medtronic Australasia Pty Ltd
MC766 MicroTargeting Electrodes Electrode used for intracranial recording of 276.5mm $950.00 $1,500.00
neural activity prior to DBS
Revision Kit
Medtronic Australasia Pty Ltd
MC770 Snap Lid Connector Connector for implanted lead to external 2.5" x 5.0" $300.00
Implantable Pulse Generator
4.5.1 Pulse Generator for Pain Management
4.5.1.2 Primary Cell (non-rechargeable system
Medtronic Australasia Pty Ltd
MC137 Medtronic A/Asia, Synergy Dual DCI - Pulse Generator: Synergy Dual One size only $17,250.00
Channel Implantable Pulse Generator Channel Implantable Pulse Generator
Model 7427, Active Implantable Model 7427. Materials - Titanium
Stimulators.
St Jude Medical Australia Pty Ltd
SJ210 Eon C IPG 3688 16 channel non-rechargeable multi- 49cc $19,150.00
program implantable pulse generator
4.5.1.3 Patient programmer
Medtronic Australasia Pty Ltd
MC247 Patient Activators Hand held device Models 7434 & 7435 to One size only $1,400.00
be used with Itrel III and Synergy
Implantable Pulse Generators
4.5.2 Implantable Neurostimulators
Medtronic Australasia Pty Ltd
MC945 Medtronic ACTIVA Recharging System Recharging System for Deep Brain One size only $1,346.00 $3,200.00
for Deep Brain Stimulation Stimulation
Prostheses List by Category, Groups and Sponsor Page 604 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Primary Cell (Non-rechargable system
Medtronic Australasia Pty Ltd
MC742 Prime Advanced Implantable Neurostimulator Dimensions: 65 x 49 x 15mm $18,650.00 $21,000.00
4.5.2.1 Rechargeable Implantable Neurostimulator
Boston Scientific Australia Pty Ltd
BS104 Precision SCS Implantable Pulse Rechargeable Neurostimulation System One Size Only $22,000.00
Generator Implantable Pulse Generator.
Medtronic Australasia Pty Ltd
MC746 Restore Advanced INS Implantable Neurostimulator Dimensions: 65 x 49 x 15mm $21,000.00 $24,000.00
MC929 Medtronic RestoreULTRA 16 Electrode Rechargeable implantable 22cc $19,150.00 $24,000.00
Neurostimulator Neurostimulator for pain management
(37712)
St Jude Medical Australia Pty Ltd
SJ133 Eon Mini Neurostimulation System - Eon Mini Neurostimulation System - 18cc, 29g $19,150.00 $22,000.00
Implantable Pulse Generator 3788 Implantable Pulse Generator 3788
SJ182 Eon Neurostimulation System Eon Neurostimulation Implantable Pulse Height = 59mm $19,150.00
Generator #3716
4.5.2.2 Patient Therapy Manager / patient programmer
Boston Scientific Australia Pty Ltd
BS106 Precision SCS External Patients Remote Hand held remote control External Patient One Size Only $1,350.00
Programmer Programmer
Medtronic Australasia Pty Ltd
MC943 Medtronic myStim Patient Programmer Patient programmer for Restore and Prime One size only $1,350.00 $1,500.00
Neurostimulation systems (Model 37743)
St Jude Medical Australia Pty Ltd
SJ172 ANS Spinal Cord Stimulation System Patient Programmer Model 3850 One size only $2,831.00
(SCS) GENESIS
SJ177 ANS Spinal Cord Stimulation System QuikLink Patient Programmer Model One Size Only $1,250.00
(SCS) GENESIS 3860
SJ183 Eon Neurostimulation System Eon Programmer #3851 . $2,831.00
Prostheses List by Category, Groups and Sponsor Page 605 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.5.2.3 External recharger
Boston Scientific Australia Pty Ltd
BS105 Precision SCS External Patient Recharger External Patient Recharging System: Base One Size Only $1,346.00
Station, charger, Cradle power supply,
charger base station
BS143 Precision SCS External Patient External Patient Recharging System: Base One size only $1,000.00 $3,000.00
Recharger System Station, Charger, Cradle power supply,
charger base station.
Hospira Pty Limited
HO004 Gemstar rechargeable system Rechargeable battery, docking station, AC One size $880.00
adaptor and carry case for use with the
Gemstar infusion system.
Medtronic Australasia Pty Ltd
MC692 Restore Rechargeable Neurostimulation External Patient Recharger System Model one size only $3,000.00
System 37752
St Jude Medical Australia Pty Ltd
SJ203 Brio DBS Charging System 6721 Charging System Model 6721 One size only $1,975.00 $3,000.00
SJ209 Eon Mini Neurostimulation System - Charging System Model 3721 One size only $1,975.00
Charging System Model 3721
SJ211 Eon Neurostimulation System - Mobile Mobile Charging System One size $1,975.00
Charging System 3711
4.5.3 Lead
Boston Scientific Australia Pty Ltd
BS158 Precision Connector M1 Lead extension for Precision SCS System 35. 55. 70 cm length $1,510.00
Surgical, 16-point lead
Medtronic Australasia Pty Ltd
MC942 Specify 2x8 Surgical Lead Surgical Lead 30cm and 65cm $8,000.00
Prostheses List by Category, Groups and Sponsor Page 606 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.5.3.1 Lead
St Jude Medical Australia Pty Ltd
SJ138 Lamitrode Lead - Tripole 16C Tripole 16C - 3214, 3128, 3219, 3220, 30-110cm $7,040.00 $7,640.00
3221
SJ168 ANS Spinal Cord Stimulation System Lamitrode Plate Electrode 60cm, 90cm, 110cm $7,040.00
(SCS)
SJ191 Lamitrode C Series Leads Lamitrode C Series, 16 Channel, Model # Length = 60cm $7,640.00
3289
Octapolar
Boston Scientific Australia Pty Ltd
BS109 Precision SCS Eight Contact Leads Eight contact percutaneous leads. 30cm to 70cm $4,164.00
St Jude Medical Australia Pty Ltd
SJ169 ANS Spinal Cord Stimulation System Lamitrode Dual 8 Plate Electrode Lead One size only $7,640.00
(SCS)
SJ184 Lamitrode S Series Leads Lamitrode S Series, 8 Channel, Model # Length = 30cm $7,040.00
3283
SJ185 Lamitrode S Series Lamitrode S Series, 8 Channel, Model # Length = 60cm, 90cm, 110cm $7,040.00
3286
SJ188 Lamitrode C Series Leads Lamitrode C Series, 8 Channel, Model # Length = 60cm, 90cm, $7,040.00
3245 110cmm
Octapolar, Percutanous
Medtronic Australasia Pty Ltd
MC690 Neurostimulation System - Octad Leads Octad Standard Lead Kit without 45, 60 & 75cm $4,370.00
Percutaneous Extension Model 3777,
MC710 Neurostimulation System - Octad Leads Octad Standard Lead Kit with 45, 60 & 75cm $4,230.00
Percutaneous extension model 3877
MC711 Neurostimulation System - Octad Leads Octad Compact Lead Kit without 45, 60 & 75cm $4,230.00
Percutaneous Extension Model 3778
MC712 Neurostimulation System - Octad Leads Octad Compact Lead Kit with 45, 60 & 75cm $4,230.00
Percutaneous Extension Model 3878
MC740 SCS Sub Compact Lead Octad Sub Compact Lead Kit without 45, 60 and 75cm $4,230.00 $4,750.00
Percutaneous Extension Model 3776
Prostheses List by Category, Groups and Sponsor Page 607 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC759 SCS Sub Compact Lead Ocatd Sub Compact Lead Kit with 45, 60 and 75cm $4,230.00 $4,750.00
Percutaneous Extension Model 3876
St Jude Medical Australia Pty Ltd
SJ161 ANS Spinal Cord Stimulation System Octrode Lead. 8 Electrode (thoracic or 30cm, 60cm, 90cm 110cm $4,293.00
(SCS) cervical placement).
Quadripolar
St Jude Medical Australia Pty Ltd
SJ186 Lamitrode S Series Leads Lamitrode S Series, 4 Channel, Model # Length = 30cm $7,040.00
3243
SJ187 Lamitrode S Series Leads Lamitrode S Series, 4 Channel, Model # Length = 60cm, 90cm, 110cm $7,040.00
3246
Quadripolar, Percutanous
St Jude Medical Australia Pty Ltd
SJ162 ANS Spinal Cord Stimulation System Quattrode Lead. 4 Electrode. 30cm, 60cm, 90cm 110cm $3,400.00
(SCS)
sixteen point leads
Boston Scientific Australia Pty Ltd
BS110 Precision SCS 16 Point Leads 16 contact point leads with independent 50cm - 70cm $8,000.00
current controlled.
Surgical
Medtronic Australasia Pty Ltd
MC135 Medtronic Australasia, Specify Lead DCI - Leads: Specify Lead Model 3998. 18cm x 1 $4,150.00
Model 3998, Active Implantable (dual lead) Materials - Silicone Rubber,
Stimulators & Ancillary Equipment Platinum/Iridium
MC361 2X4 Hinged Surgical Lead model 3999 Materials: silicone rubber, platinum-iridium, 30, 45 & 60cm $4,305.00
polyurethane
Trial or blank lead
Boston Scientific Australia Pty Ltd
BS118 Precision SCS Lead Blanks Lead Blank One Size Only $200.00
BS119 Precision SCS Trial Leads Trial Leads 30cm - 70cm $485.00
Trial or blank lead, Percutanous
St Jude Medical Australia Pty Ltd
SJ165 ANS Spinal Cord Stimulation System Trial Lead. Temporary Screening Lead 30cm, 60cm $485.00
(SCS)
Prostheses List by Category, Groups and Sponsor Page 608 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Triple array
Medtronic Australasia Pty Ltd
MC776 Specify 5-6-5 Surgical Lead Triple Array 16 Electrode Surgical Lead 30, 65cm $8,000.00
with Duraloc Technology
4.5.3.2 Lead extension
Boston Scientific Australia Pty Ltd
BS111 Precision SCS Lead Extensions Lead Extensions 25cm to 55cm $1,510.00
Medtronic Australasia Pty Ltd
MC734 Quadripolar Stretch-Coil Extensions Model 37082 Bifurcated, Silver and 20cm - 60cm $2,135.00 $3,500.00
Silicone Rubber
MC941 Pocket Adaptors for Spinal Cord Pocket Adaptors for Spinal Cord 25.5cm and 27.4cm $1,510.00 $1,750.00
Stimulation Stimulation (Single and Dual Channel)
Octapolar
Medtronic Australasia Pty Ltd
MC688 Neurostimulation System - Extensions 1 x 8 Synergy Extension Kit Model 7472; 20, 40 & 60cm $2,000.00
1 x 8 Extension Kit Model 37081
MC733 Quadripolar Stretch-Coil Extensions Model 37083 Single, Silver and Silicone 20cm - 60cm $1,948.00 $2,500.00
Rubber
Quadripolar
Medtronic Australasia Pty Ltd
MC315 Low Profile Impedance Extension Kit for Silicone rubber 10, 25, 40, 51, 66cm $1,510.00 $2,138.00
SCS Model 7489
St Jude Medical Australia Pty Ltd
SJ178 A127 Lead Extension A127 Lead Extension 15cm, 40cm, 60cm, 90cm $1,510.00
Trial or blank lead, Percutanous
St Jude Medical Australia Pty Ltd
SJ160 ANS Spinal Cord Stimulation System Lead Extensions - in addition to 3341, 60cm length $1,510.00
(SCS) 3342, 3343, 3382 and 3383, additional
model 3346 - Dual Quad Extension and
3386 - single octrode extension
Prostheses List by Category, Groups and Sponsor Page 609 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.5.4 Accessory/ accessory kit
Boston Scientific Australia Pty Ltd
BS120 Precision SCS Revision Pack Lead Revision Pack; Hex Wrench, One Size Only $800.00
Tunnelling Tool, Insertion Needles in
four(4) sizes
Medtronic Australasia Pty Ltd
MC694 Restore Rechargeable Neurostimulation External Patient Programmer Antenna One size only $178.00
System Model 37092
MC930 3550-P4 Passing Elevator Accessory Passing Elevator Accessory Kit One size $168.00
Kit
MC931 3550-63 Percutaneous Lead Introducer Percutaneous Lead Introducer Accessory One size only $168.00
Accessory Kit Kit
St Jude Medical Australia Pty Ltd
SJ170 ANS Spinal Cord Stimulation System Boots, Connectors, Anchors, Strain Relief One size only $730.00
(SCS)
SJ173 ANS Spinal Cord Stimulation System Communication Magnet Model 1210 One type only $150.00
(SCS) GENESIS
Implantable Accessory
Boston Scientific Australia Pty Ltd
BS121 Precision SCS IPG Port IPG Port Plug One Size Only $100.00
Medtronic Australasia Pty Ltd
MC687 Neurostimulation System - Accessory Lead Accessory Plug and Closed Boot Kit . $168.00
Kits Model 3550-29
MC731 Titan Anchor Silicone with titanium insert One size only $168.00
Revision Kit
Medtronic Australasia Pty Ltd
MC094 Stimulator Accessory Kit - Pisces Quad; Model 3550-10 revision kit. 1 x boot, 1 x One size only $545.00
Pisces Z Lead Revision Kit; Pisces twistlock anchor, 2 x silicone anchors, 1 x
Quad Revision Kit; Octad Revision Kit hex wrench, 1 x epidural needle 15 gauge,
1 x percutaneous extension (inline) with set
screws, 1 x ball-tipped (bent) 28cm stylet
for Pisces-Quad lead, 1 x ball-tipped (
Prostheses List by Category, Groups and Sponsor Page 610 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC689 Neurostimulation System - Lead Octad Lead Revision Kits Model 3550-26 30 & 45cm; 60 & 75cm $540.00
Revision Kits & 3550-27
4.6.1 Implantable Infusion Pump
VFR (Variable Flow Rate)
Medtronic Australasia Pty Ltd
MC313 Synchro Med II Pump Model No's 8637-20 & 8637-40, 20 ml & 40 ml $16,250.00
Composition - Titanium
4.6.1 Intrathecal Infusion Pump
4.6.1.3 Separate patient programmer / therapy manager
Hospira Pty Limited
HO002 Crono Pump Ambulatory infusion pump - Models: 10-50 ml $4,950.00
Crono 50, Crono PCA and Crono APO-
go II
Medtronic Australasia Pty Ltd
MC944 8835 Personal Therapy Manager for Personal Therapy Manager for One size only $1,350.00 $1,500.00
Synchromed Pumps SynchroMed II implantable infusion pumps
4.6.3 Catheter
Medtronic Australasia Pty Ltd
MC741 Indura Intrathecal Catheter Sutureless pump connector, Silicone, One size only $820.00 $1,100.00
Titanium and Nylon
Revision Kit
Medtronic Australasia Pty Ltd
MC774 8578 Sutureless Pump Connector Sutureless Pump Connector: Material One size only $600.00
radiopaque silicon titanium, nylon
MC817 Medtronic Intrathecal Catheter Revision Revision kit to repair proximal end of 66cm $500.00
Kit (Proximal) intrathecal catheter (8596SC)
MC818 Medtronic Intrathecal Catheter Revision Revision kit to repair distal end of 38.1cm $500.00
Kit (Distal) intrathecal catheter (8598A)
Prostheses List by Category, Groups and Sponsor Page 611 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.6.4 Accessories
Medtronic Australasia Pty Ltd
MC064 Implantable Drug Pump Accessories 8590-8, 8590-9 - Synchromed catheter 20cm; one size only; 38-60cm $163.00
accessory kit - Radiopaque silicone,
8590RAC - Right angled connector -
Titanium, polyurethane, 8591-38, 8591-
60, 8590-41 Tunnelling rods - Stainless
Steel, 8575 Synchromed connector (40
degree) with catheter access
4.7 Neurostimulation Therapies for Anti-seizure
Aurora BioScience Pty Ltd
RA001 VNS Therapy Pulse/Pulse Duo Model 102/102R Generator One size only $12,670.00
RA002 VNS Therapy Lead Model 302 One size only $3,400.00
4.8.1 Stent
4.8.1.1 Atherosclerotic stent
Boston Scientific Australia Pty Ltd
BS122 Wingspan Stent System Wingspan Self Expanding Nitonol Stent Stent diameters: 2.5mm to $8,750.00
and delivery catheter 4.5mm; Stent lengths: 9.0mm to
20.0mm
4.8.1.2 Neurovascular stent
Boston Scientific Australia Pty Ltd
BS098 Neuroform Microdelivery Stent System Nitinol Self-Expanding Stent, 3fr delivery Diameter 2.5 - 4.5 mmLength $7,500.00
catheter, peelable sheath, 2fr stabilising 10 - 30 mm
catheter, rotating haemostasis valve (x2)
Prostheses List by Category, Groups and Sponsor Page 612 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtel Australia Pty Ltd
ME185 Pharos Neurovascular Stent Balloon expandable stent for treatment of Diameter 2.0mm-5.0mm, length $7,500.00
intracranial artery stenosis and aneurysm 8mm-40mm
4.8.2 Embolisation, Intravascular Neurointerventional coils
Boston Scientific Australia Pty Ltd
BS027 Guglielmi Detachable Coil (GDC) Stretch-Resistant Bare Platinum Coil 2-20mm x 4-30cm $1,400.00
BS081 GDC 360 Shaped Detachable Coil Stretch-Resistant Bare Platinum Coil, 360 Length: 5cm to 40cm; $1,640.00
Shape Diameter: 2mm to 24mm
BS100 Matrix Detachable Coils PGLA-Coated, Stretch-Resistant, Length: 2cm to 40cm, $1,850.00
Platinum Coils Diameter: 2mm to 24mm
Cook Medical Australia Pty Ltd
WC061 Detachable Coil System Microembolisation Coils - Platinum 011/018 2-20mm diameter, 2 - $785.90
50cm length
Culpan Medical Pty
CB007 MicroPlex Coil System Kit includes delivery pusher, introducer Coil Size 10, 18 - Loop $1,505.00 $1,746.00
sheath, MCS complex coil Diameter 2-14mm,
16,18,20mm, Length 1-4cm, 6-
13cm, 15-21cm, 23-24cm, 26-
28cm, 30-34cm, 38-39cm, 43-
44cm, 49-50cm
Medtel Australia Pty Ltd
ME070 Micrus ACT Platinum Microcoil Delivery Platinum Coil Helical Stretch Resistant - 2mm $1,400.00
System x 1cm - 10mm x 30cm
ME085 Micrus ACT Platinum Microcoil Delivery Platinum Coil Helical - 2mm x 2cm - 10mm x $1,700.00
System 30cm
ME086 Micrus ACT Platinum Microcoil Delivery Platinum Coil Helical Soft Stretch Resistant - $1,700.00
System 2mm x 1cm - 4mm x 8cm
ME087 Micrus ACT Platinum Microcoil Delivery Platinum Coil Spherical - 2mm x 2.5cm - $1,545.00
System 19mm x 30cm
ME088 Micrus ACT Platinum Microcoil Delivery Platinum Coil Straight - 4mm x 10cm - 6mm $1,445.00
System x 30cm
Prostheses List by Category, Groups and Sponsor Page 613 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ME133 Micrus ACT Platinum Microcoil Delivery Cerecyte Helical Cerecyte - 2mm x 2cm $1,850.00
System - 10mm x 30cm
ME134 Micrus ACT Platinum Microcoil Delivery Cerecyte Helical Soft Stretch Resistant $1,850.00
System Cerecyte - 2mm x 1cm - 4mm
x 8cm
ME135 Micrus ACT Platinum Microcoil Delivery Cerecyte Spherical Cerecyte - 2mm x $1,850.00
System 2.5cm - 19mm x 30cm
ME183 Micrus Presidio Microcoil Sterile, single use, embolic coil used for the 11.5-50cm (length) $1,850.00
treatment of cerebral aneurysms
ME184 Micrus Cashmere Microcoil Sterile, single use, embolic coil used for the 2.5 cm - 30 cm (length) $1,950.00
treatment of cerebral aneurysms
ME188 Micrus DELTAPAQ Platinum Coil DELTAPAQ Platinum Coils for Coil Diameter from 1.5mm to $1,400.00
endovascular embolisation of microcoils, 10mm +/- .5mm Coil Length
featuring a traingular wind pattern for from 1cm -.1/+0.25 to 25cm
increased flexibility and comformance to +/- 1cm
shape of aneurysm
ME189 Micrus DELTAPAQ Cerecyte Coil DELTAPAQ Cerecyte Coils for Coil Diameter from 1.5mm to $1,400.00
endovascular embolisation of microcoils, 10mm +/- .5mm Coil Length
featuring a triangular wind pattern for from 1cm-.1/+0.25 to 25 cm
increased flexibility and conformance to +/- 1cm
shape of aneurysm.
*second generation, *hydrogel technology
Culpan Medical Pty
CB005 MicroPlex Coil System; Hydrocoil System HES Helical Coils Hydrocoils 2mm D x 3cm L - 10mm D x $2,266.00 $2,552.00
20cm L
CB006 MicroPlex Coil System; Hydrocoil System HES Helical Coils Hydrocoils 2mm D x 2cm L - 6mm D x $1,854.00 $2,088.00
10cm L
CB008 MicroPlex Coil System, Hydrocoil System HES Helical Coils Hydrocoils 6mm D x 10cm L - 20mm D x $2,600.00
20cm L
CB009 MicroPlex Coil System, Hypersoft System Microplex Hypersoft/Complex/Helical Coils 2mm D x 1cm L - 6mm D x $1,505.00 $1,746.00
8cm L2mm D x 4cm L -
6mm D x 15cm L5mm D x
20cm L - 20mm x 30cm L
2mm D x 2cm L - 4mm D x
10cm L5mm D x 15cm L -
10mm D x 30cm L
Prostheses List by Category, Groups and Sponsor Page 614 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.8.2.1 Embolisation, Intravascular Neurointerventional coils with guiding system
ev3 Australia Pty Ltd
EE028 LRS Actuator LRS Actuator is a sterile, hand held Length 5.75", Diameter 1", $350.00
mechanical unit with a thumb slide that Weight 28 grams
detaches the coil. When the slider is
retracted while the pusher is loaded, it
releases the coil into the targeted
vaculature. Coils cannot be deployed
without the use of the actuator.
Barrier, Absorbable, Adhesion Prevention
W L Gore & Associates
GT232 Gore Preclude® Vessel Guard Gore Preclude® Vessel Guard is an 6cm x 10cm $1,300.00 $1,460.00
ePTFE Membrane with a tight
microstructure providing a vessel friendly
interface while preventing penetration of
fibroblasts. It is indicated as a cover for
vessels following anterior vertebral surgery
to reduce the risk of potential vessel
damage during a revision surgery by
providing a plane of dissection.
Catheter, Infusion
ev3 Australia Pty Ltd
EE027 ev3 Micro Catheters For the delivery of therapeutic agents such Length: 135 - 170cm; $700.00
as embolisation coils and liquid embolics. Diameter: 3.0 - 1.3 Fr
The Rebar Micro Catheter is the only one
on the market which also delivers liquid
embolics.
Prostheses List by Category, Groups and Sponsor Page 615 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Embolisation Prostheses, Intravascular
Culpan Medical Pty
CB002 MicroVention HydroFrame HydroCoil For treatment of endovascular Loop diameter (mm)/length $1,836.00
Embolisation System (HES) embolisation of intracranial aneuryms and (cm): 3/6; 4/5; 4/8; 5/10; 5/15;
other neurovascular abnormalities such as 6/12; 6/19; 7/15; 7/28; 8/17;
arteriovenous malformations (AVM) and 8/33.
arteriovenous fistulae (AVF). The coils
are also intended for vascular occlusion of
blood vessels within the neurovascular
system to permanently obstruct blood flow
to an aneurysm or other vascular
malformation and for arterial and venous
embolisation in the peripheral vasculature.
CB003 MicroVention MicroPlex Coil system, MicroVention Cosmos Coil System is Diameter (mm)/Length (cm): $1,400.00 $1,471.00
Cosmos Complex Coil designed to provide a stable periphery 3/6; 4/8; 4/12; 5/15; 5/18;
frame and greater volume fill. The Cosmos 5/22; 6/17; 6/18; 6/19; 6/22;
coils are made of platinum alloy (pt/W: 6/26; 7/22; 7/23; 7/31; 8/25;
92/8). The coil is attached to a V-TrakTM 8/27; 8/37; 9/31; 10/36; 11/39;
delivery pusher via the polyolefin 12/43; 13/47; 14/51; 15/55;
elastomer member. The delivery pusher is 16/52; 18/59; 20/65; 22/63;
a variable stiffness, stainless steel/Pt, 24/68.
tapered mandrel. The pusher consists of a
radiopaque positioning marker that is
inserted into a hand held battery powered
Vgrip Detachment Controller.
Leads, Dorsal Column, Implantable
Percutaneous, Quadripolar
Medtronic Australasia Pty Ltd
MC827 Medtronic Pisces Quad Leads Pisces Quad Lead (3487A), Pisces Quad Various $3,400.00
Compact Lead (3887), Pisces Quad Plus
Lead (3888)
Prostheses List by Category, Groups and Sponsor Page 616 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Peripheral
Medtronic Australasia Pty Ltd
MC829 Medtronic On Point Lead On point peripheral nerve lead kit (3987A) 25cm $3,400.00
Quadripolar, Surgical
Medtronic Australasia Pty Ltd
MC828 Medtronic Resume Surgical Leads Surgical Leads - Resume II (3587A), 25cm $3,400.00
Resume TL (3986A)
Mesh, surgical
LMT Surgical Pty Ltd
LM084 Polyganics Flexiglide A bioresorbable co polyester sheet. The 2cm x 3cm to 13cm x 20cm $1,300.00 $1,400.00
product is designed to maintain its integrity
to support soft tissue
Plugs
Medtronic Australasia Pty Ltd
MC825 Medtronic Percutaneous Quad extension Percutaneous extension (in line connector One size only $168.00
for quadripolar leads only)
MC826 Medtronic Accessory Kit for Deep Brain Boots accessory kit for DBS (3550-25) N/A $168.00
Stimulation
Prosthesis, internal, stent, vascular
Culpan Medical Pty
CB001 MicroPLex Coil System, Compass The compass (MicroPlex Coil System) is a Compass 18 Complex - D 4 $1,200.00
Complex Coil 3 dimensional platinum coil. (mm) L 9 (cm) - D 20 (mm) L
60 (cm).
CB004 MicroPlex Coil System, Hydrosoft HydroSoft is a hydrogel-based platimum Loop D. 2(mm) & L 1(cm) - D $1,200.00 $1,850.00
coil with an inner hydrogel core. 6 (mm) & L 8 (cm)
Prostheses List by Category, Groups and Sponsor Page 617 of 911
NEUROSURGICAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
N Stenning & Co Pty Ltd
NG053 Leo Plus Self-Expanding Intracranial The Leo Plus is a Self-Expanding D 2.5 L 12 mm, 18 mm, 25 $6,558.00 $7,345.00
Stent Intracranial Stent constructed from braided mm. D 3.5 L 12 mm, 18 mm,
Nitinol wire. The Leo Plus is pre loaded 25 mm, 35 mm, D 4.5 L 15
onto its on quidewire an introducer. mm, 20 mm, 25 mm, 30 mm,
40 mm, 50 mm. D 5.5 L 25
mm, 30 mm, 35 mm, 50 mm,
75 mm.
Resinous Compounds, Cranial
Johnson & Johnson Medical Pty Ltd
JJ303 Cranioplastic Kit (Type 1) Cranioplastic kit containing 2 complete 30grams $240.00
sets. Consists of 2 bags of sterile powder,
2 vials sterile liquid, 2 sterile matrix bags
Stimulators, Electrical, Brain
St Jude Medical Australia Pty Ltd
SJ148 Libra Deep Brain Stimulation System - DBS Leads 6142-6145 1.5mm electrode 25-40cm $4,150.00
Leads 6142 - 6149 and space 1.5mm; 6146-6149 1.5mm
electrode and 0.5mm space
SJ149 Libra Deep Brain Stimulation System - 4 Channel DBS Lead Extension 50-60cm $2,000.00
Lead Extensions 6345 and 6346
Vascular Reconstruction Device and Deliver - Stent, vascular,
Johnson & Johnson Medical Pty Ltd
JJ650 Cordis Enterprise Vascular Closed Cell Design Nitinol Neurovascular 4.5 mm in diameter and 4 $7,500.00
Reconstruction Device and Delivery different lengths: 14mm, 22mm,
System 28mm and 37mm
Prostheses List by Category, Groups and Sponsor Page 618 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.4.2 Wrist
6.4.2.2 Carpal or tarsal bone fixation screw
Johnson & Johnson Medical Pty Ltd
DP868 Barouk Screw System Barouk Screw - Titanium 10-34mm Length $210.00
6.7.1 Trauma and general accessories
6.7.1.3.1 End Cap
titanium
Johnson & Johnson Medical Pty Ltd
DP366 Supacondylar Nail System Solid End Cap Titanium Unsterile or Sterile One size only $57.00
6.7.10 Soft Tissue Fixation Devices
6.7.10.4 Other
Device Technologies Australia Pty Ltd
DE301 Suture Button Multiple hole button for fixation of bone to 2.6mm - 7.5mm $248.00
bone or soft tissue to bone, and are
intended as fixation posts, a distribution
bridge, or for distributing suture tension
over areas of ligament or tendon repair
6.7.2 External Fixator
6.7.2.5 External Fixator, Screws and pins
Synthes Australia Pty Ltd
SY090 AO/ASIF K-Wires, Pins, Washers etc - Steinmann pins/schanz screws 2.5 - 5.0, length 60mm - 300mm $89.00
Steel
6.7.2.5.1 External Fixator, Set Screw
Johnson & Johnson Medical Pty Ltd
DY244 Ace External Fixator GRUB screw ACE/FISCHER, titanium 5mm $2.00
Prostheses List by Category, Groups and Sponsor Page 619 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.7.2.5.3 External Fixator, Bone Fixation Pin
Peg
Johnson & Johnson Medical Pty Ltd
DY246 Ace External Fixator Peg, titanium 5mm $81.00
skull Immobilisation
Johnson & Johnson Medical Pty Ltd
DY295 Bremer Halo Crown System Titanium Skull Pins Standard & Hi-Fix $451.00
6.7.2.6.1 External Fixator, Olive wire
Johnson & Johnson Medical Pty Ltd
DY221 Ace External Fixator Wire bayonet point - stainless steel 1.8mm $41.00
packet of 3
Johnson & Johnson Medical Pty Ltd
DY220 Ace External Fixator Olive wire bayonet point - stainless steel, 1.5 or 1.8mm $260.00
packet of 3
6.7.2.8.7.2 External Fixator, total system, Unspecified, medium
Stryker Australia Pty Ltd
SK396 Hoffman II External Fixation System Hoffman II Compact Sterile Pre-Packs Sterile Wrist Kit $4,855.00
6.7.3.1 Internal Fixation, other Fixation
6.7.3.1.7.1 Cerclage Wire
Medical & Optical Instruments Australia Pty Ltd
MO196 Osteo Clage Cable System Cerclage wire and sleeve 500mm $435.00
6.7.3.2.1.1.1 Intramedullary Nail, femur
Cannulated
Synthes Australia Pty Ltd
SY123 AO/ASIF Intermedullary Nails Femoral reamed, tibial nail 9 - 19mm , length 200 - $649.00
500mm.
Prostheses List by Category, Groups and Sponsor Page 620 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.7.3.2.1.1.4 Intramedullary Nail, tibia
titanium
Biomet Australia Pty Ltd
BI286 Uniflex Tibial Nail Tibial Nail, Titanium 8-14mm x 240-420mm $950.00
6.7.3.2.1.4.5 Intramedullary Nail, non-specific anatomic site, 10 - 13 mm diameter
Device Technologies Australia Pty Ltd
DE061 Fixion Nailing System Stainless Steel 18x 6.7mm - 440 x 12mm $1,990.00
6.7.3.3.1.1.4 Internal Fixation Plate, Trochanteric
Johnson & Johnson Medical Pty Ltd
DP670 Small / Large Fragment Set S/S Tronchanteric Support Plate Small-Large $503.00
6.7.3.3.1.1.6 Internal Fixation Plate, fibula
Titanium
Johnson & Johnson Medical Pty Ltd
DP912 Periarticular Plating System Fibula Composite Plate - Titanium 11 Hole $397.00
DP913 Periarticular Plating System Fibula Composite Plate - Titanium 7 Hole $360.00
DP914 Periarticular Plating System Fibula Composite Plate - Titanium 9 Hole $383.00
6.7.3.3.1.1.9 Internal Fixation Plate, Metatarso phalangeal
Medical & Optical Instruments Australia Pty Ltd
MO191 Acumed Congruent Plate System Metatarsal osteotomy plate - titanium Right, left $465.00
6.7.3.3.1.2.7 Internal Fixation Plate, wrist
LMT Surgical Pty Ltd
LM037 Trimed Bearing Plate The Bearing Plate is a stainless Steel plate 3 - 9 holes $1,450.00
that has stainless Steel pegs and Screws
for Fixation
Prostheses List by Category, Groups and Sponsor Page 621 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.7.3.3.2 Internal Fixation Plate, general, small fragment
Titanium, compression, locking, More complex shape
Johnson & Johnson Medical Pty Ltd
JJ718 ALPS - Anatomic Locked Plating Titanium locking spider plates Small - large and offset $550.00
System
6.7.3.3.2.3 Internal Fixation Plate, general, small fragment, 11-20 holes
Titanium, compression, locking
Johnson & Johnson Medical Pty Ltd
JJ712 ALPS - Anatomic Locked Plating 3.5MM Titanium LOCKING 11-20 hole plates $600.00
System COMPRESSION PLATE
6.7.3.3.3.2 Internal Fixation Plate, general, large fragment, 5-10 holes
Johnson & Johnson Medical Pty Ltd
DP673 Small / Large Fragment Set S/S SCS Plate Sterile 3-9 Hole $631.00
6.7.3.5.4 Fixation screw, Break-off
Johnson & Johnson Medical Pty Ltd
DP882 Twistoff Screw TwistOff Screw Titanium 11-14mm Long $320.00
DY412 Hand and Foot Fracture Systems FRS Screw 10mm to 34mm L x 2.5mm $309.00
Diameter
6.7.3.5.6 Fixation screw, compression
Medical & Optical Instruments Australia Pty Ltd
MO005 HBS Bone screw Compression - standard, high Length 10 - 30mm $330.00
Cannulated
Synthes Australia Pty Ltd
SY322 AO/ASIF Screws Headless Compression Screw 2.0mm - Short Thread 4-40mm; Long $196.00
8.0mm Thread 4-40mm
Prostheses List by Category, Groups and Sponsor Page 622 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.7.3.5.7.1 Fixation screw, cortical or bone, otherwise unspecified, 4mm to 7 mm diameter or size
Johnson & Johnson Medical Pty Ltd
DP665 Small / Large Fragment Set S/S CHS Compression Screw - Stainless Steel Neutral to +2 $35.00
Locking
Synthes Australia Pty Ltd
SY278 AO/ASIF Cortex Screws Locking Head Screws 2.0mm 7.3mm $180.00
titanium
Johnson & Johnson Medical Pty Ltd
DP338 Tibial Nail System Solid Cortical Titanium Screw Unsterile or 6.5mm x 20 -120mm $130.00
Sterile
DP342 Femoral Nail System Solid Cortical Screw Titanium Sterile or 4.5 or 5.5mm x 20-80mm $64.00
Unsterile
6.7.3.5.7.3 Fixation screw, cortical or bone, otherwise unspecified, < 4mm diameter
Johnson & Johnson Medical Pty Ltd
DP650 Small / Large Fragment Set S/S Cortical Screw - Stainless Steel 1.5 - 4mm x 22 - 44mm Length $19.00
DP655 Small / Large Fragment Set S/S Cortical Self Tapping Screw 3.5 - 6.5mm; 6 - 110mm Length $14.00
Medical & Optical Instruments Australia Pty Ltd
MO195 Acumed Congruent Plate System Screw - titanium 2.7, 3.5, 4.0mm dia, 30 - 65 $120.00 $147.00
length
MO273 Acumed Tap-Loc Tap screws, Tap-Loc Screws diameter 2.7mm - 3.5mm, $120.00 $160.00
length 36mm-60mm
Locking
Wright Medical Australia
WR059 Titanium Screw Locking, non-locking or cannulated, for 8-40mm, 2.7mm or 3.5mm $90.00
use only with Darco titanium plates, self-
tapping
Prostheses List by Category, Groups and Sponsor Page 623 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI486 Zimmer Periarticular Locking Screws Stainless Steel Periarticular Locking 2.4mm, 2.7mm, 3.5mm, $170.00
screws to accompany Periarticular 4.5mm, 5.5mm, and 8mm to
Locking Plates 60mm in 2mm increments and
60mm to 100mm in 5mm
increments.
6.7.3.6.1.3 Cable System, Cable and Sleeve
Johnson & Johnson Medical Pty Ltd
DP364 Control Cable with Sleeve Control Cable with sleeve One size only $350.00
6.7.5 Orthopaedic reconstruction, general
Global Orthopaedic Technology
GO180 Actifuse Flow Actifuse Flow 3ml $1,080.00
GO181 Actifuse Flow Actifuse Flow 5ml $1,300.00
GO182 Actifuse Flow Actifuse Flow 1.5ml $1,080.00
GO183 Actifuse ABX MIS Actifuse ABX MIS, Applicator and 7.5ml $2,300.00
Cartridge, 7.5ml
GO184 Actifuse ABX MIS Actifuse ABX MIS, Refill Cartridge, 7.5ml 7.5ml $1,560.00
6.7.5.2.2 Bone Substitute, >1cc or 1gm, to <= 5cc or 5gm
Global Orthopaedic Technology
GO162 Actifuse ABX Easyfill Putty Actifuse ABX Easyfill Putty - A silicate 5ml $1,300.00 $1,540.00
substituted synthetic bone graft
< = 3cc
Global Orthopaedic Technology
GO161 Actifuse ABX Easyfill Actifuse ABX Easyfill - A silicate 1.5mL to 4mL $1,080.00 $1,200.00
substituted synthetic bone graft
Prostheses List by Category, Groups and Sponsor Page 624 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.7.5.2.3 Bone Substitute, >5cc or 5gm, <=12cc or 12gm
Global Orthopaedic Technology
GO051 Actifuse Actifuse Sterile, hydroxyapatite-based 10ml, 2-5 & 5-10mm $1,200.00
bone matrix
GO057 Actifuse Actifuse Sterile, hydroxyapatite-based 10ml, 2-5 & 5-10mm $1,430.00
bone matrix
GO062 Actifuse Actifuse Sterile, hydroxyapatite-based 10ml. 2-5mm $1,000.00
bone matrix
GO163 Actifuse ABX Easyfill Putty Actifuse ABX Easyfill Putty - A silicate 10ml $2,300.00
substituted synthetic bone graft
6.7.5.2.5 Bone Substitute, >18cc or 18gm, <=25cc or 25gm
Global Orthopaedic Technology
GO052 Actifuse Actifuse Sterile, hydroxyapatite-based 20ml, 2-5 & 5-10ml $2,300.00
bone matrix
GO058 Actifuse Actifuse Sterile, hydroxyapatite-based 20ml. 2-5 & 5-10mm $1,779.00
bone matrix
GO063 Actifuse Actifuse Sterile, hydroxyapatite-based 20ml. 2-5mm $1,550.00 $1,600.00
bone matrix
6.7.5.2.6 Bone Substitute, >26cc or 26gm
Global Orthopaedic Technology
GO054 Actifuse Actifuse Sterile, hydroxyapatite-based High Volume Grafting Kit. 2-5 $4,500.00
bone matrix & 5-10mm
GO059 Actifuse Actifuse Sterile, hydroxyapatite-based High Volume Grafting Kit. 2-5 $4,500.00
bone matrix & 5-10mm
GO068 Actifuse Actifuse Sterile, hydroxyapatite-based High Volume Grafting Kit. 2-5 $4,500.00
bone matrix & 5-10mm
Prostheses List by Category, Groups and Sponsor Page 625 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6.7.7 Limb preservation, resection and lengthening systems
6.7.7.2.2 Limb preservation and lengthening, proximal femur
cementless
Johnson & Johnson Medical Pty Ltd
DY187 Limb Preservation System Beaded, 'Porocoat' Standard & Neutral, 15deg Left & Right in $6,990.00
Trochanter Replacement both styles
Bone matrix implant, artificial
Global Orthopaedic Technology
GO177 ACTIFUSE ABX Putty Actifuse AVX Putty - A silicated 20ml $4,600.00
substituted synthetic bone graft.
Grafts, Bone
Zimmer Pty Ltd
ZI265 Continuum hip system Hedrocel AVN Rod 3mm - 12mm block $3,208.00
Group 1- Fixation: Bone Screw
Group 1a - Pedicle Bone Screw, Monoaxial
B Braun Australia Pty Ltd
BB226 S4 Spinal System Monoaxial Screw - titanium various sizes Diameter 4.5mm & 5mm - all $930.00 $1,200.00
lengths 25 - 60mm
BB227 S4 Spinal System Monoaxial Screw - titanium various sizes Diameter 6.0mm, 7.0mm & $930.00 $1,200.00
8.0mm - all lengths 25 - 60mm
Biomet Australia Pty Ltd
BH070 Synergy/Polaris Spinal System Open/Closed Screws 5.5 to 8.0mm dia $930.00 $1,300.00
BH083 Synergy Spinal System Iliac Screw 6.0 - 10.0mm $930.00 $1,300.00
BH097 Array Spinal System Titanium Alloy Modular Spinal System - 5.5 - 7.5mm x 30 - 55mm $930.00 $1,300.00
fixed screw
Prostheses List by Category, Groups and Sponsor Page 626 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Global Orthopaedic Technology
GO105 OctaFix Occipital Cervical Plating System Closed Screw 4mm $900.00 $1,004.00
GO203 Malibu Spinal System Monoaxial Screw Monoaxial Bone Screw 4.5mm x 25mm - 9.5mm x 80mm $930.00
Johnson & Johnson Medical Pty Ltd
DP306 Moss Miami (Stainless Steel) Monoaxial Screws 5 - 8mm x 25 - 60mm $930.00
DP407 Moss Miami (Titanium) Monoaxial Screw 5 - 8mm x 25 - 80mm $930.00
DP489 Isola Paediatric System (Stainless Steel) Cable Wire Screw 4.75 - 6.35mm x 25 - 30mm $610.00
DP576 Kaneda Anterior Scoliosis System S/S Open Screw - Standard or Blunt 3/16" - 6.25mm x 25 - 50mm $930.00
DP847 Moss Miami 4mm Anterior System (SS) Screws - Monoaxial 6mm x 25 - 55mm $930.00
DY078 Kaneda SR Anterior Kaneda SR Anterior Open Screw 1/4"-6.25mm x 25-60mm, 3/16" $930.00
DY309 Frontier Anterior Scoliosis System Bone Screws 5.5 x 25-40mm, 6.5 x 25- $930.00
(Titanium) 60mm, 7.5 x 35-60mm
DY401 Monarch Monoaxial Pedicle Screw Monarch Monoaxial Pedicle Screw 4.75mm - 8.5mm x 25 to $930.00
80mm length
DY441 Expedium Spine System Monoaxial Screw 4 to 10mm diameter x 20- $930.00
100mm length
JJ645 Monoaxial Screw - Expedium Anterior Monoaxial Screw - Titanium Diameters 5-7mm x Lengths $930.00
Spine System 20-60mm
JJ772 Anterior Isola System Open Monoaxial Screw 20-60mm $930.00
Lifehealthcare Pty Ltd
LH450 DSS Pedicle Screw The DSS Pedicle Screw is a mono-axial 5.0mm diameter x 30, 35, 40, $930.00
pedicle screw designed for implantation in 45, 50, 55, 60mm length
the posterior throacolumbar spine for 6.0mm diameter x 30, 35, 40,
skeletally mature patients 45, 50, 55, 60mm length
7.0mm diameter x 30, 35, 40,
45, 50, 55, 60mm length
8.0mm diameter x 30, 35, 40,
45, 50, 55, 60mm length
Prostheses List by Category, Groups and Sponsor Page 627 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LSS Surgical Pty Limited
LS021 SOCORE Spinal System - Monoaxial Pedicle Screw - Monoaxial Diameter 45mm 25mm to $930.00
40mm Length. Diameter 5mm
30mm to 50mm Length.
Diameter 6mm 30mm to 55mm
Length. Diameter 7mm 30mm
to 50mm Length. Diameter
8mm 40mm
Medtronic Australasia Pty Ltd
MC402 CD Horizon Pedicle Screws Diameter 4.5 - 7.5mm Length $930.00 $1,037.00
25 - 80mm
MC503 CD Horizon Fixed Angle Screw 25 - 90mm $930.00 $1,037.00
MC860 Silo Fixed Screw 4.5 - 8.5mm Diameter $930.00
MC967 CD HORIZON Spinal System - Fixed CD HORIZON SOLERA Fixed Angle Diameter: 4.0mm - 10.5mm $930.00 $1,130.00
Angle Screw Screw Length: 15mm - 110mm
Nuvasive Australia and NZ Pty Ltd
NV001 SpheRx Cannulated Fixed Axis Screw 4.5 - 8.5mm diameter25 - $990.00
65mm length
NV051 SpheRx II Anterior (Fixed Screw) When used as a pedicle screw fixation 5.5/6.5/7.5mm x (45-55mm) $930.00
system, the SpheRx II anterior spinal
system, of which the fixed screw is a
component, is intended to provide
immobilisation and stabilisation of spinal
segments in skeletally mature patients as an
adjunct to fusion in the treatment of the
following acute and chronic instabilities or
deformities of the posterior thoracic,
lumbar, and sacral spine: Degenerative disc
disease; Degenerative spondylolisthesis
with objective evidence of neurologic
impairment; Fracture; Dislocation;
Scoliosis; Kyphosis; Spinal Tumour;
and/or; Failed previous fusion
(pseudoarthrosis)
Prostheses List by Category, Groups and Sponsor Page 628 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
NV056 Armada (Fixed Screw) The Armada deformity system, of which 4.0/4.5/5.0/5.5/6.5/7.5 x 25- $930.00
the fixed screw is a component, is intended 55mm
to provide immobilisation and stabilisation
of spinal segments in skeletally mature
patients as an adjunct to fusion in the
treatment of the following acute and
chronic instabilities or deformities of the
posterior thoracic, lumbar and sacral spine:
Degenerative disc disease, Degenerative
spondylolisthesis with objective evidence
of neurologic impairment, Fracture,
Dislocation, Scoliosis, Kyphosis, Spinal
tumour and Failed previous fusion
(pseudoarthrosis)
Orthotech Pty Ltd
OH357 Novel Mono screw Mono axial pedicle screw 4.0-8.5 $900.00 $1,050.00
Scient'x Australia
SX032 Isobar TTL Monoaxial Screw In Module Monoaxial Pedicle Screw Diameter 4.5mm; 5.5mm; $930.00
6.2mm; 7mm - Length 25mm;
30mm; 35mm; 40mm; 45mm;
50mm; 55mm
SX046 Zodiac Spinal Fixation System - Open monoaxial screw Diameter: 4.0mm, 4.5mm, $930.00 $1,037.00
monoaxial screw, open 5.5mm, 6.5mm, 7.5mm,
8.5mm. Length: 20mm, 25mm,
30mm, 35mm, 40mm, 45mm,
50mm, 55mm, 60mm, 70mm,
75mm, 80mm.
SX047 Zodiac Spinal Fixation System - Closed monoaxial screw Diameter: 7.5mm, 8.5mm. $930.00 $1,188.00
monoaxial screw, closed Length: 25mm, 30mm, 35mm,
40mm, 45mm, 50mm, 55mm,
60mm, 70mm, 75mm, 80mm.
Signature Spine
SV011 Romeo Monoaxial Pedicle Screws Titanium alloy 5mm diameter: 30, 35, 40 and $930.00
45mm lengths. 6mm and 7mm
diameter: 30, 35, 40, 45 and
50mm lengths
Prostheses List by Category, Groups and Sponsor Page 629 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW385 Xia Spine System Monoaxial Screw Dia 4.5 - 8.5mm Length 25 - $930.00 $1,103.00
60mm
Synthes Australia Pty Ltd
SY549 Pangea Spinal System Preassembled Monoaxial Pedicle Screw - Diameter, 4.0mm to 10mm, $930.00
Thoracic, Lumbar and Sacral Spine Length, 20mm to 120mm
SY567 Spinal Fixation System Matrix Preassembled Monoaxial Pedicle 4.00mm - 9.00mm; 20mm - $930.00
Screw 100mm Length
Zimmer Pty Ltd
ZI476 Silhouette Spinal System Implants Fixed Screw with Tab Extensions 5.5 x 25mm to 8.5 x 60mm $930.00
ZI513 Optima Spinal System - Monoaxial Monoaxial Pedicle screw system Dia 4-8mm, length 20-60mm $930.00
Pedicle Screw System
ZI669 Incompass Thoracolumbar Fixation System, Fixed 4.5 - 8.5mm $930.00
Angle Screw Open
ZI670 Incompass Thoracolumbar Fixation System, Fixed 4.5 - 8.5mm $930.00
Angle Screw Closed
ZI684 OctaFix Occipital Cervical Plating System Closed Screw 4mm $900.00 $1,004.00
ZI702 Java screw system Monoaxial pedicle screw diam 4.5 lg 35, 40, 45; diam 5 $930.00 $1,275.00
lg 35, 40,45, 50,55, 60; diam
5.5 lg 35, 40, 45, 50, 55; diam
6 lg 35, 40, 45, 50, 55, 60;
diam 6.5 lg 35, 40, 45, 50, 55,
60; diam 7 lg 35, 40, 45, 50,
55, 60; diam 7.5 lg 35, 40, 55,
60; diam 8 lg 35, 40, 45, 50,
55, 60
1 - System
Synthes Australia Pty Ltd
SY175 Universal Spine System (USS) Pedicle Screw - USSII 25 - 140mm $1,215.00 $1,350.00
SY192 Universal Spine System (USS) Pedicle screw Length 70 - 140mm $1,215.00 $1,517.00
2 - Cannulated
Johnson & Johnson Medical Pty Ltd
JJ820 Viper Spinal System - monoaxial screw Monoaxial screw 30 - 80mm $960.00 $1,060.00
Prostheses List by Category, Groups and Sponsor Page 630 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Orthotech Pty Ltd
OH355 Novel Cannulated Mono screw Mono axial cannulated pedicle screw 5.5-8.5 $960.00 $1,050.00
Zimmer Pty Ltd
ZI687 OctaFix Occipital Cervical Plating System Bone Screw 3.5 - 4.0mm $960.00
ZI725 DTL Pedicle Screw HA coated, Monaxial D: 5.2mm, 6.00mm, 6.4mm, $930.00
7.2mm, 8.00mm. L: 35mm -
55mm
3 - With Cap / Cover Plate
Orthotech Pty Ltd
OH354 Novel Reduction Mono screw Mono axial REDUCTION pedicle screw 5.5-8.5 $900.00 $1,450.00
Scient'x Australia
SX001 Isobar TTL Monoaxial Screw D: 4.5 - 8mm, L: 25 - 50mm $990.00
4 - Closed
Johnson & Johnson Medical Pty Ltd
DP449 Kaneda SR (Smooth Rod) Anterior (TI) Closed Screw 1/4" - 6.25mm x 25 - 60mm $930.00
DP577 Kaneda Anterior Scoliosis System S/S Closed Screw - Standard or Blunt 3/16" - 6.25mm x 25 - 60mm $930.00
JJ773 Anterior Isola System Closed Monoaxial Screw 20-80mm $930.00
Lifehealthcare Pty Ltd
LH247 Blackstone - Spinal Fixation System - Composition - Titanium 5.5mm x 40mm, 5.5mm x $930.00
Mono Axial Screws 45mm, 6.5mm x 40mm and
6.5mm x 45mm
Medtronic Australasia Pty Ltd
MC823 CD Horizon Legacy Fixed Iliac Screw 5.5mm to 8.5mm Diameter $1,188.00
c - Complex
Medtronic Australasia Pty Ltd
MC636 CD Horizon Eclipse Dual Head Screws 20-60mm $1,037.00
MC862 Silo Sagittal Screw 4.5 - 8.5mm Diameter $1,037.00
Prostheses List by Category, Groups and Sponsor Page 631 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 1b - Pedicle Bone Screw, Polyaxial
Austofix
AX084 Fortex Pedicle Screw system - Pedicle Polyaxial pedicle screw 4.75, 5.5, 6.5, 7.5, 8.25mm $1,330.00
Screw diameter. 30, 35, 40, 45, 50,
55mm lengths
Austspine Pty Ltd
AJ022 Smartloc Spinal Fixation Polyaxial Pedicle Screw and Reduction Length 30mm - 50mm $1,330.00
System/Polyaxial Pedicle Screw & screw Diameter 4.5mm, 5.5mm,
Reduction Screw 6.5mm, 7.0mm, 8.0mm
B Braun Australia Pty Ltd
BB224 S4 Spinal System Polyaxial Screw - titanium various sizes All sizes $1,330.00 $1,550.00
BB225 S4 Spinal System Polyaxial Screw - Titanium various sizes Diameter 6.0mm, 7.0mm & $1,330.00 $1,550.00
8.0mm - all lengths 25 - 60mm
Biomet Australia Pty Ltd
BH094 Altius Occipito-Cervico-Thoracic Screws 8mm to 32mm $600.00
(OCT) System
BH098 Array/Ballista Spinal System Titanium Alloy Modular Spinal System - 5.5 - 7.5mm x 30 - 55mm $1,330.00 $1,400.00
multiaxial screw
BH116 Polaris Spine System Polaris, Polyaxial screw, Titanium (4.75-8.5)mm dia x (30-55) $1,330.00
mm length
Emergo Asia Pacific Pty Ltd
ER014 Denali Spinal System / Polyaxial Pedicle Polyaxial Pedicle Screw Diameter: 4.5, 5.5, 6.5, 7.5, $1,330.00
Screw 8.5mm and Length:
25,30,35,40,45,50,55,60,65m
m
ER017 Mesa Spinal System / Polyaxial Pedicle Polyaxial Pedicle Screw 4.5, 5.5, 6.5, 7.5, 8.5mm $1,330.00 $1,500.00
Screw
ER026 Capsian OCT Spinal System - Mini cervico-thoracic posterior rigid fixation Diameter: 3.5mm and 4.0mm $1,330.00
Mesa Polyaxial Screw system screwsLength: 10mm - 20mm
(2mm increments)25mm -
50mm (5mm increments)
Prostheses List by Category, Groups and Sponsor Page 632 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Euros Orthopaedics Australia Pty Ltd
EU001 e.Spine PEDICULAR SCREW spine Pedicular Screw for sacral-thoraco- Diameter 4.35 Length 25, $1,330.00
lumbar osteosynthesis Diameter 4.35 Length 30,
Diameter 4.35 Length 35,
Diameter 5 Length 35,
Diameter 5 Length 40,
Diameter 5 Length 45,
Diameter 6 Length 40,
Diameter 6 Length 45,
Diameter 6.5 Length 40,
Diameter 6.5 Length 45,
Diameter 6.5 Length 50,
Diameter 7 Length 35,
Diameter 7 Length 40,
Diameter 7 Length 45,
Diameter 7 Length 50.
Global Orthopaedic Technology
GO202 Malibu Spinal System Polyaxial Screw Polyaxial screw 4.5mm x 20mm - 8.5mm x $1,330.00
110mm in 5mm increments
GO211 Malibu Spinal System Polyaxial Polyaxial Reduction Screw 4.5mm x 25mm - 40mm in $1,330.00
Reduction Screw 5mm increments
5.5mm x 25mm - 50mm in
5mm increments
6.5mm x 35mm - 55mm in
5mm increments
7.5mm x 35mm - 55mm in
5mm increments
GO214 Sierra Spinal System, Polyaxial screw Polyaxial bone screw 3.5mm - 4.5mm diameter $1,330.00 $1,644.00
10mm 50mm Length
Health Care Surgical Pty Ltd
HC008 S14 Biospine Screw Polyaxial Screw 3.5-7mm, 25-50mm $1,330.00
Johnson & Johnson Medical Pty Ltd
DP307 Moss Miami (Stainless Steel) Polyaxial Screws 4.35 - 8mm x 25 - 90mm $1,330.00
DP408 Moss Miami (Titanium) Polyaxial Screw 4.35 - 8mm x 25 - 90mm $1,330.00
DP848 Moss Miami 4mm Anterior System (SS) Screws - Polyaxial 6mm x 25 - 55mm $1,330.00
DY171 Monarch Spinal System Pedicle Screws - Polyaxial 4.75 - 8.5 mm x 25 - 80mm $1,330.00
DY339 Summit Cervical Rod System Mini Polyaxial Screw Standard or High 3.5mm x 12-50mm $1,330.00
Prostheses List by Category, Groups and Sponsor Page 633 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DY440 Expedium Spine System Di Polyaxial Screw 4 -10mm diameter 20 -100mm $1,330.00
length
DY442 Summit SI System Polyaxial Screw - Mini Favoured Angle 3.5 or 4mm diameter x 12- $1,330.00
48mm length
DY557 Expedium Spine System Si Polyaxial Screw 4.35 - 11mm x 20 - 100mm $1,330.00
JJ586 Expedium Uni-Planar deformity correction (Titanium) 4.35-10mm Diameter, 20- $1,330.00
100mm Length
JJ593 Mountaineer OCT Spinal System CT Minipolyaxial Screw - Favoured Angle 3.5-4.35mm x 10 - 50mm $1,330.00
and Medial/Lateral
JJ738 Expedium Spine System DI Favoured Angle Reduction Tab 4.35-10mm Diameter 20 - $1,330.00
Polyaxial Screw 100mm Length
LSS Surgical Pty Limited
LS015 SOCORE Spinal System - Pedicle Pedicle Screw- Polyaxial. Pedicle Screw - Diameter 4mm 25mm to 40mm $1,330.00
Screws Reduction Length. Diameter 5mm 30mm
to 50mm Length. Diameter
6mm 30mm to 55mm length.
Diameter 7mm 30mm to 50mm
Length. Diameter 8mm 40mm
Medtronic Australasia Pty Ltd
MC501 CD Horizon Multi-Axial screw (Stainless Steel) 25 - 80mm $1,330.00 $1,422.00
MC502 CD Horizon Multi-axial screw (Titanium) 25 - 80mm $1,330.00 $1,380.00
MC545 Vertex Spinal System Screws Diameter 3.5 - 4.5mm Length 6 $1,330.00 $1,644.00
- 52mm
MC579 CD Horizon Spondylolisthesis Screw Diameter: 4.5 - 7.5, Length: $1,330.00 $1,655.00
25mm - 50mm
MC675 CD Horizon Legacy Screw Diameter 4.0 - 10.5mm $1,330.00 $1,530.00
MC861 Silo Mutliaxial Screw 4.5 - 8.5mm Diameter $1,330.00
MC969 CD HORIZON Spinal System - Multi- CD HORIZON SOLERA Multi-Axial Diameter: 4.0mm - 10.5mm $1,330.00 $1,530.00
Axial Screw Screw Length: 15mm - 110mm
Prostheses List by Category, Groups and Sponsor Page 634 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Nuvasive Australia and NZ Pty Ltd
NV024 VuePoint screw (multi axial) The VuePoint system, of which the 3.5mm x (10-34mm)3.5mm x $1,330.00
VuePoint screw (multi axial) is a (24-36mm)4.0mm x (10-
component, is intended to promote fusion 40mm)4.5mm x (10-40mm)
of the cervical spine and occipito-thoracic
junction (occiput-T3) and is indicated for
degenerative disc disease (as defined by
back pain of disco
NV048 SpheRx PPS (Screw Shank) When used as a pedicle screw fixation 4.5/5.5/6.5/7.5/8.5mm x (25- $555.00 $665.00
system, the SpheRx PPS spinal system, of 50mm)
which the screw shank is a component, is
intended to provide immobilisation and
stabilisation of spinal segments in skeletally
mature patients as an adjunct to fusion in
the treatment of the following acute and
chronic instabilities or deformities of the
posterior thoracic, lumbar and sacral spine:
Degenerative disc disease; degenerative
spondylolisthesis with objective evidence
of neurological impairment; Fracture;
Dislocation; Scoliosis; Kyphosis; Spinal
tumour; and/or Failed previous fusion
(pseudoarthrosis)
NV057 Armada (Reduction Screw) The Armada deformity system, of which 4.5-8.5mm x 20-120mm $1,330.00
the reduction screw is a component, is
intended to provide immobilisation and
stabilisation of spinal segments in skeletally
mature patients as an adjunct to fusion in
the treatment of the following acute and
chronic instabilities or deformities of the
posterior thoracic, lumbar and sacral spine:
Degenerative disc disease, Degenerative
spondylolisthesis with objective evidence
of neurologic impairment, Fracture,
Dislocation, Scoliosis, Kyphosis, Spinal
tumour and Failed previous fusion
(pseudoarthrosis)
Prostheses List by Category, Groups and Sponsor Page 635 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
NV062 SpheRx II Anterior (Polyaxial Screw) When used as a pedicle screw fixation 5.5/6.5/7.5mm x (25-50mm) $1,330.00
system, the SpheRx II anterior spinal
system, of which the polyaxial screw is a
component, is intended to provide
immobilisation and stabilisation of spinal
segments in skeletally mature patients as an
adjunct to fusion in the treatment of the
following acute and chronic instabilities or
deformities of the posterior thoracic,
lumbar, and sacral spine: Degenerative disc
disease; Degenerative spondylolisthesis
with objective evidence of neurologic
impairment; Fracture; Dislocation;
Scoliosis; Kyphosis; Spinal Tumour;
and/or; Failed previous fusion
(pseudoarthrosis)
Orthotech Pty Ltd
OH358 Novel Mono screw Poly axial pedicle screw 4.0-8.5 $1,330.00
Scient'x Australia
SX031 Isobar TTL Polyaxial Screw In Module Polyaxial Pedicle Screw Diameter 4.5mm; 5.5mm; $1,330.00
6.2mm; 7mm - Length 25mm;
30mm; 35mm; 40mm; 45mm;
50mm; 55mm
SX044 Zodiac Spinal Fixation System - Non-cannulated polyaxial screw, including Diameter: 4.0mm, 4.5mm, $1,330.00 $1,380.00
polyaxial screw, non-cannulated uniplanar, high top and sacral 5.0mm, 5.5mm, 6.5mm,
7.5mm, 8.5mm. Length: 20mm,
25mm, 30mm, 35mm, 40mm,
45mm, 50mm, 55mm, 60mm,
65mm, 70mm, 75mm, 80mm,
85mm, 90mm, 95mm, 100mm.
Signature Spine
SV003 Romeo Polyaxial Pedicle and Reduction Available in standard and reduction screw Standard - 5mm diameter: 30, $1,330.00
Screws variants. Titanium alloy 35, 40, 45mm length. 6 and
7mm diameter: 30, 35, 40, 45
and 50mm length. Reduction -
6mm diameter: 35, 40 and
45mm.
Prostheses List by Category, Groups and Sponsor Page 636 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
HW384 Xia Spine System Polyaxial Screw Dia: 4mm - 10.5mm Length: $1,330.00 $1,605.00
20mm - 100mm
SK225 Oasys-Occipito Cervico Thoracic Multiaxial Screw 3.5mm x 10mm - 40mm $1,330.00
System 4.0mm x 10mm - 50mm
4.5mm x 20mm - 52mm
Synthes Australia Pty Ltd
SY007 Click'X Spinal Fixation System Pedicle Screw: Preassembled Length 25-80mm $1,330.00
SY289 USS llio-Sacral Fixation system Polyaxial screw 20mm to 140mm $1,330.00 $1,390.00
SY309 Axon Spinal System Variable axis screw 3.0mm - 4.5mm diameter, 4mm $1,330.00
to 60mm length
SY337 Universal Spinal System (USS) Polyaxial Pedicle Screw, titanium 4.0mm to 9.00mm $1,330.00 $1,700.00
SY441 Synapse Posterior Cervical Polyaxial Screw System 3.5mm-4.5mm Diameter; 8mm- $1,330.00
50mm Length
SY447 Spinal Fixation System Universal Reduction Screw 4.0mm - 9.0mm Diameter; $1,330.00 $1,400.00
20mm-100mm Length
SY548 Pangea Spinal System Preassembled Polyaxial Pedicle Screw - Diameter, 4.0mm to 10mm, $1,330.00 $1,790.00
Thoracic, Lumbar and Sacral Spine Length, 20mm to 120mm
SY565 Spinal Fixation System Matrix Preassembled Polyaxial Pedicle 4.00mm - 9.00mm; 20mm - $1,330.00
Screw 100mm Length
SY566 Spinal Fixation System Matrix Reduction Screw 4.0mm - 8.00mm; 20mm - $1,330.00
65mm Length
Zimmer Pty Ltd
ZI475 Silhouette Spinal System Implants Polyaxial Screw Assembly with Tabs 5.5 x 25mm to 8.5 x 60mm $1,330.00
ZI514 Optima Spinal System - Polyaxial Polyaxial Pedicle Screw System $1,330.00
Pedicle Screw System
ZI616 SEQUOIA PEDICLE SCREW SYSTEM Polyaxial Screw 4.5mm - 8.5mm dia, 25mm- $1,330.00
60mm length
ZI637 BacFix (Thoracolumbar System) Multi axial bone screw - Nitinol 5 - 8mm x 30 - 60mm $1,330.00
ZI643 BacFix (Thoracolumbar System) Smooth profile flexible angle screw - 5 - 8mm x 30 - 60mm $1,330.00
Titanium alloy
Prostheses List by Category, Groups and Sponsor Page 637 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI660 Nex-Link Spinal Fixation System, Polyaxial Screws 3.5mmx10mm - $1,330.00
4.00mmx22mm; 4.5 x 20-
40mm(5mm increments);
5.5mm x 20-45mm (5mm
increments)
ZI668 Incompass Thoracolumbar Fixation System, Polyaxial 5.5 - 7.5 $1,330.00
Screw Open
ZI705 Java screw system Poly axial screw TL pedicle screw diam 4 lg 35; $1,330.00 $1,475.00
diam 5 lg 35, 40, 45, 50, 55;
diam 6 lg 35, 40, 45, 50, 55;
diam 7 lg 35, 40, 45, 50, 55;
diam 5.5 lg 35, 40, 45, 50, 55,
60; diam 6 lg 60; diam 6.5 lg
35, 40, 45, 50, 55, 60; diam 7
lg 60; diam 7.5 lg 35, 40, 45,
50, 55, 60
1 - System
B Braun Australia Pty Ltd
BB011 Spine System Evolution Screw Dia 5 - 8mm, length 30 - 55mm $665.00
Biomet Australia Pty Ltd
BH079 Synergy/Polaris Spinal System Variable Locking Screws 4.75-8.5mm $665.00 $950.00
Synthes Australia Pty Ltd
SY179 Spinal Fixation System Pedicle Screw (without head) L:30-100mm, D:4-9mm $665.00
SY379 Universal Spine System (USS) USS II Polyaxial/Lotus Screw or Head Head 5mm / 6mmScrew $665.00 $850.00
diameter 4,5,6,7,8mm, Length -
20-110mm
Prostheses List by Category, Groups and Sponsor Page 638 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
1b
Nuvasive Australia and NZ Pty Ltd
NV067 Armada (Polyaxial Screws) The Armada deformity system, of which Polyaxial Screw $1,330.00
the polyaxial screw is a component, is 4.5-10.0mm x 25-120mm
intended to provide immobilisation and lliac Screw
stabilisation of spinal segments in skeletally 6.5/7.5/8.5/9.5mm
mature patients as an adjunct to fusion in (60/70/80/90/100mm)
the treatment of the following acute and Provisional locking screw size
chronic instabilities or deformities of the ranges from
posterior thoracic, lumbar and sacral spine: 4.0mmx25-45mm,
Degenerative disc disease, Degenerative 4.5mmx25-45mm,
spondylolisthesis with objective evidence 5.0mmx25-50mm,
of neurologic impairment, fracture, 5.5mmx25-55mm,
Dislocation, Scoliosis, Kyphosis, Spinal 6.5mmx30-55mm
tumour and Failed previous fusion Uniplanar Screw
(pseudoarthrosis) 5.0/5.5/6.5mm x
25/30/35/40/45/50/55mm
2 - Cannulated
Emergo Asia Pacific Pty Ltd
ER025 Denali cannulated polyaxial screw Cannulated polyaxial pedicle screw Diameter: 5.5mm, 6.5mm and $1,330.00
7.5mm Length: 35 to 55mm
Medtronic Australasia Pty Ltd
MC439 CD Horizon Cannulated Pedicle Screw 20mm - 80mm $1,390.00 $1,650.00
MC586 CD Horizon Sextant Percutaneous Cannulated titanium percutaneous multi Dia 3.5 to 9.5mm, Length 15 to $1,390.00 $1,582.00
Cannulated Multi Axial Screw axial screw 65mm
MC736 Vertex Max Cannulated Screw Posterior cannulated cervical screw Diameter 3.5 - 4.5mmLength $1,390.00 $1,639.00
20 - 60mm
MC968 CD HORIZON Spinal System - CD HORIZON SOLERA Cannulated Diameter: 4.5mm - 10.5mm $1,390.00 $1,590.00
Cannulated Multi-Axial Screw Multi-Axial Screw Length: 15mm - 110mm
Nuvasive Australia and NZ Pty Ltd
NV019 System: SphRX Component: Cannulated Polyaxial Screw, Fixation 45-7.5mm Diameter; 25-80mm $1,390.00
Cannulated Polyaxial Screw Bone Screws Length
Orthotech Pty Ltd
OH356 Novel Cannulated poly screw Poly axial cannulated pedicle screw 5.5-8.0 $1,390.00
Prostheses List by Category, Groups and Sponsor Page 639 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Scient'x Australia
SX045 Zodiac Spinal Fixation System - Cannulated polyaxial screw, including high Diameter: 4.5mm, 5.5mm, $1,390.00 $1,582.00
polyaxial screw, cannulated top and sacral 6.5mm, 7.5mm. Length: 30mm,
35mm, 40mm, 45mm, 50mm,
55mm, 60mm.
SX050 Illico MIS Posterior Fixation System - Cannulated polyaxial screw, including Diameter: 4.5mm, 5.5mm, $1,390.00 $1,582.00
screw sacral and high top 6.5mm, 7.5mm. Length: 30mm,
35mm, 40mm, 45mm, 50mm,
55mm, 60mm.
Stryker Australia Pty Ltd
SR042 MANTIS Screw, Cannulated, Multiaxial, Ti 4.5mm - 7.5mm x 25mm - 60mm $1,390.00 $1,700.00
Synthes Australia Pty Ltd
SY336 Click'x Spinal System Cannulated Screws 4.0mm to 9.0mm $1,390.00
SY461 Pangea Spinal System Preassembled Polyaxial Pedicle Screw - Diameter, 4.0mm to 10mm. $1,390.00 $1,790.00
Thoracic, Lumbar and Sacral Spine, Length, 20mm to 120mm
Cannulated
Zimmer Pty Ltd
ZI681 Pathfinder Minimally invasive pedicle fixation system Cannulated Polyaxial Screws $1,390.00 $1,530.00
6.5 - 7.5mm
2: Canulated
Johnson & Johnson Medical Pty Ltd
DY556 Expedium Spine System Si Polyaxial Screw 4.35 - 11mm x 20 - 100mm $1,330.00
2-Cannulated
Johnson & Johnson Medical Pty Ltd
JJ835 Viper Spine System Polyaxial and Uniplanar Screw, with and 30-100mm $1,390.00
without tab
2-Cannulated, 5-Dual Thread
Johnson & Johnson Medical Pty Ltd
JJ836 Viper Spine System Polyaxial screw with cortical fixation 30-60mm $1,390.00 $1,520.00
Prostheses List by Category, Groups and Sponsor Page 640 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3 - With Cap / Cover Plate
Lifehealthcare Pty Ltd
LH240 Spinal Fixation System Multi screw - Titanium 5.5 x 35mm up to 55mm in $1,330.00
5mm increments; 6.5 x 35mm
up to 60mm in 5mm increments;
7.5 x 35mm up to 60mm in
5mm increments
LH280 Blackstone - Posterior Cervical System Mini-Multi-Axial Screw 3.5-4mmx10-30mm (2mm $1,330.00
increments)
Orthotech Pty Ltd
OH353 Novel Reduction Poly Screw Poly axial REDUCTION pedicle screw 5.5-8.5 $1,330.00
Scient'x Australia
SX002 Isobar TTL Polyaxial Screw D: 4.5 - 8mm, L: 30 - 55mm $1,330.00
3 - With Cap / Cover Plate, 2 - Cannulated
Lifehealthcare Pty Ltd
LH310 ICON Modular Spinal Fixation System Screw 4.5mm - 8.5mm x 25-80mm $665.00
4 - Closed
Medtronic Australasia Pty Ltd
MC822 CD Horizon Legacy Multiaxial Iliac Screw 5.5mm to 8.5mm Diameter $1,330.00
C - Complex
Medtronic Australasia Pty Ltd
MC749 Legacy HA Coated Screw Hydroxyapatite coated pedicle screw 4.5mm - 8.5mm $1,330.00 $1,758.00
Group 1c - Bone Screw, Standard
Austofix
AX060 Spider Cervical Plating System - Spider Titanium, Self Tapping and Self Drilling 4.0 - 4.25mm, lengths 12- $200.00
Screw 16mm
B Braun Australia Pty Ltd
BB068 Caspar Screws Stainless Steel 10mm-28mm $10.00
BB069 Caspar Screws Titanium 10mm-28mm $29.00
Biomet Australia Pty Ltd
BH101 Interpore Bone Plate System TPS Screw 14 - 22mm $250.00 $850.00
Prostheses List by Category, Groups and Sponsor Page 641 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BH104 Vuelock (Anterior Cervical Plate) Vuelock Bone Screws 12mm - 16mm $200.00 $350.00
BH108 Anterior Cervical Plate System Titanium Cancellous Bone Screw 4 - 20mm $200.00 $260.00
Emergo Asia Pacific Pty Ltd
ER023 Cayman Thoracolumbar Plate System / Self tapping screw that lags plate to bone Length: 20mm to 54mm $250.00
Bone Screw and forms an autogenic lock with plate. Diameter: 6mm and 7mm
Available in two diameters and a variety of
lengths
Global Orthopaedic Technology
GO223 Sierra Spinal System Occipital Screw Occipital Screw 6mm x 14mm $200.00 $240.00
Johnson & Johnson Medical Pty Ltd
DP830 Profile Anterior Thoracolumbar Plate Cancellous Screw 6mm x 20 - 60mm $250.00
System
DP833 Profile Anterior Thoracolumbar Plate Graft Screw 15 - 30mm $250.00
System
DY110 Carbon Fibre Cages Stackable Cage Titanium Interface Screws M4 / M5 $250.00
DY300 Slim-loc Anterior Cervical Plate System Screws self tapping 4.5 x 12 - 26mm $200.00 $230.00
DY301 Slim-loc Anterior Cervical Plate System Screws - Large Diameter 4.8 x 12-16mm $200.00 $230.00
DY302 Slim-loc Anterior Cervical Plate System Screws - Self Drilling 4.5 x 12-18mm $200.00 $230.00
DY333 Summit Cervical Rod System Occipital Bone Screw 4.5 - 5.25 Dia x 6 -16mm length $220.00
DY338 Summit Cervical Rod System Cortical, Cancellous and Rescue Screws 3.5-4.5mm x 12-48mm $150.00 $200.00
DY452 Swift Spine System Titanium Anterior Cervical Plate System - 10 - 18mm $200.00 $539.00
3.8mm Self-Drilling/Tapping Screw
DY453 Swift/Eagle Anterior Cervical System Titanium Self Drilling/Self Tapping Screw 4.2mm x 10-18mm $200.00 $539.00
DY454 Swift Spine System Titanium Anterior Cervical Plate System - 10 - 28mm $200.00 $539.00
3.8mm Bicortical Screw
DY455 Swift Spine System Titanium Anterior Cervical Plate System - 10mm $200.00 $539.00
Graft Screw
DY478 Uniplate ACP System Rescue Screw 12-18mm $200.00 $539.00
Prostheses List by Category, Groups and Sponsor Page 642 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DY479 Uniplate ACP System Primary Screw 12-18mm $200.00 $372.00
JJ512 Skyline Cervical Plate System Skyline anterior cervical screw, titanium Self drilling 3.8mm, 10-18mm $200.00 $539.00
JJ513 Skyline Cervical Plate System Skyline anterior cervical screw. Titanium Self tapping 3.8mm, 10-26mm $200.00 $539.00
JJ514 Skyline Cervical Plate System Skyline anterior cervical screw. Titanium Self Tapping 4.3mm, 10-18mm $200.00 $539.00
JJ515 Skyline Cervical Plate System Skyline anterior cervical screw. Titanium Bi-cortical 10-18mm $200.00 $539.00
JJ519 AEGIS ALP AEGIS ALP Bone Screws, Titanium 24-36mm $250.00 $559.00
JJ528 Eagle/Eagle Plus Anterior Cervical Plate Cervical Screw Titanium 3.8mm x 10-20mm $200.00 $539.00
JJ529 Eagle/Eagle Plus Anterior Cervical Plate Cervical Screw Titanium 3.8mm x 10-26mm $200.00 $539.00
JJ530 Eagle/Eagle Plus Anterior Cervical Plate Cervical Screw Titanium 4.3mm x 10-20mm $200.00 $539.00
JJ531 Eagle/Eagle Plus Anterior Cervical Plate Cervical Screw Titanium Self drilling 4.3mm 10 - 18mm $200.00 $539.00
JJ690 Mountaineer OCT Spinal System - OC Occipital - titanium bone screw 4.5 - 5.25 x 6 - 16 $240.00
screw
Lifehealthcare Pty Ltd
LH194 Blackstone Medical Inc Anterior Bone Screw, Primary/Rescue Screw 12, 14, 16mm $200.00
Cervical Plate System
LH275 Blackstone - Posterior Cervical System Occipital Screw 6, 8, 10, 12, 14mm $220.00
LH325 Lumbar Screw ECF in PEEK optima 32, 36, 40, 44, 48, 52, 56, 60, $250.00
65mm
LH364 Unity Lumbar Plate Unity Bone Screw 6-7mm $250.00 $300.00
LH398 Blackstone Medical ACP Bone Screw Titanium Alloy Bone Screw 4.1mm x 10mm - 18mm. $200.00
4.5mm x 10mm - 18mm
Prostheses List by Category, Groups and Sponsor Page 643 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LH447 Pillar SA The Pillar SA PEEK Spacer system is 5.0x25, 30, 35mm screws $250.00
comprised of a variety of implants
manufactured from PEEK-OPTIMA LT
as described by ASTM F-2026, with
tantalum markers as described by ASTM
F-560. The implants are available in
multiple footprint sizes a variety of heig
LSS Surgical Pty Limited
LS018 MATRIS Cervical Plate System Cervical Screws 4mm 10mm to 24mm $200.00 $800.00
LS019 MATRIS Cervical Plate System Cervical Screws 4.5mm 12mm to 22mm $200.00 $800.00
Medtronic Australasia Pty Ltd
MC296 Vertex Spinal System Occipital Screws 3.0 - 5.0 mm diameter, 4 - 30 $220.00 $250.00
mm length
MC310 Centerpiece TiMesh LP Screw $150.00 $250.00
MC343 Venture Self Drilling Screws single or multi level plate construct, titanium 4.0mm x 8mm - 21mm ; 4.5mm $200.00
alloy x 8mm -21mm variable Angled
MC344 Venture Self Drilling Screws single or multi level plate construct, titanium 4.0mm x 8mm - 21mm, 4.5mm $200.00
alloy x 8mm - 21mm Fixed Angled
MC347 Venture Self tapping Screws Single or multi level plate construct, 4.0mm x 8mm - 21mm; 4.5mm $200.00
titanium alloy. x 8mm - 21mm Variable
Angled
MC348 Venture Self tapping Screws Single or multi level plate construct, 4.0mm x 8mm - 21mm; 4.5mm $200.00
titanium alloy. x 8mm - 21mm Fixed Angled
MC384 Colorado 2 Pedicle Screw Diameter 4.5 - 8.5mm Length $600.00 $933.00
30 - 80mm
MC423 Atlantis Fixed Angle Cancellous Screw 10-20mm $200.00
MC424 Atlantis Variable Angle Cancellous Screw 10-20mm $200.00
MC482 Axis Cervical Plating System Screw: Cancellous 6 - 24mm $250.00
MC483 Axis Cervical Plating System Screw: Cortical 26 - 54mm $150.00 $250.00
MC511 Premier Anterior Cervical Plate System Screws 10 20mm $200.00
Prostheses List by Category, Groups and Sponsor Page 644 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC611 Vantage Vantage Plates and Screws; Thoracic Screw 5.5 x 15-50mm $250.00 $582.00
MC613 Vantage Vantage Plates and Screws; ATL Screw 6.5 x 30-55mm $250.00 $642.00
MC656 Pyramid Pyramid Bone Screws 6.5mm Diameter, 20 -60mm $250.00 $430.00
length in 5mm increments
MC988 Sovereign Spinal System - Screws Sovereign Spinal System - Screws 20 - 35mm $200.00 $250.00
Nuvasive Australia and NZ Pty Ltd
NV023 VuePoint Screw (occipital bone) The VuePoint system, of which the 4.5mm x (6/8/10/12/14mm) $220.00
VuePoint screw (occipital bone) is a 5.0mm x (6/8/10/12/14mm)
component, is intended to promote fusion
of the cervical spine and occipito-thoracic
junction (occiput-T3) and is indicated for
degenerative disc disease (as defined by
back pain of di
NV036 XLP bolt The XLP system, of which the XLP bolt is 5.5mm x $250.00
a component, is indicated for use via a (25/30/35/40/45/50/55/60/65m
lateral or anterolateral surgical approach, m)6.5mm x
above the bifurcation of the great vessels in (25/30/35/40/45/50/55/60/65m
the treatment of thoracic and m)
thoracolumbar (T1-L5) spine instability or
via the an
NV039 Halo Bone Screw The Halo System, of which the Halo bone 5.5mm x $250.00
screw is a component, is indicated for use (20/22/24/26/28/30/32/34mm)
via a lateral or anterolateral surgical 6.5mm x
approach above the bifurcation of the great (20/22/24/26/28/30/32/34mm)
vessels in the treatment of thoracic and
thoracolumbar (T1-L5) spine instability or
via
NV041 Helix Mini bone screw The Helix Mini system, of which the Helix 4.0mm x (11/13/15mm) $200.00
Mini bone screw is a component, is 4.5mm x (11/13/15mm)
intended for anterior screw fixation of the
cervical spine. These implants have been
designed to provide stabilisation as an
adjunct to cervical fusion. Indications for
the use o
Prostheses List by Category, Groups and Sponsor Page 645 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
NV044 Helix Bone Screw The Helix system, of which the Helix bone 4.0mm x (11/13/15/17/19mm) $170.00
screw is a component, is intended for 4.5mm x (13/15/17/19mm)
anterior screw fixation of the cervical
spine. These implants have been designed
to provide stabilisation as an adjunct to
cervical fusion. Indications for the use of
this im
NV052 Leverage LFS (Bone Screw) The Leverage LFS, of which the bone 2.6/3mm x 5-8mm $150.00
screw is a component, is intended for use
in the lower cervical and upper thoracic
spine (C3 to T3) in laminoplasty
procedures. Leverage LFS is used to hold
allograft material in place in order to
prevent the allograft
NV070 Helix-Revolution (screw) Bone Screw 4 x 11-19mm; 4.5 x 11-19mm $200.00 $300.00
NV072 Brigade standalone ALIF (screw) Bone screw 4.5 x 20-35mm; 5.5 x 20- $250.00
35mm
Orthotech Pty Ltd
OH053 Interpore Bone Plate System TPS Screw 14 - 22mm $250.00 $850.00
OH064 Anterior Cervical Plate System Titanium Cancellous Bone Screw 4 - 20mm $200.00 $260.00
OH253 Intext Cervical Plate/Intext Screws Intext cervical plate, including (2 - part) Screws/ Revision Screws - dia $200.00 $350.00
fixation screws 4.4mm, length 11 - 18mm
OH255 Hartshill Cancellous bone screws for 6.5mm diam - 25 - 30mm $250.00 $320.00
Horseshoes/STALIF each length, 5.5mm diam - 25 -
30mm length
OH256 Cancellous Screws For use with Stalif Implants 5.5mm x 25mm (for use with $250.00 $380.00
37mm Stalif), 6.5mm x 30mm
(for use with 41/45mm Stalif),
6.5mm x 25mm (for use with
41/45mm Stalif). Pack of 4
screws.
OH304 ADD / ADDplus Cancellous bone screw, titanium. The length = $200.00 $470.00
cancellous bone screw is used for the 12,14,16,18,20,24,26mm
biocortical fixation. The outer diameter is
4mm.
Scient'x Australia
SX012 Stella Screw D: 4-4.5mm, L: 12-20mm $200.00
Prostheses List by Category, Groups and Sponsor Page 646 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SX054 Trestle Anterior Cervical Plating System Titanium allow self drilling screws, self Diameter: 4.0mm, 4.5mm. $200.00
- screw tapping screws, self tapping rescue screws; Length: 10mm - 20mm (1mm
fixed and variable angle increments)
Signature Spine
SV006 Tryptik Anterior Cervical Plate bone Tryptik Anterior Cervical Plate bone The produc is available in 2 $200.00 $300.00
screw screws are designed to have a low profile diameters, namely 3.8 and
and lock into the plate on insertion to 4.5mm. The 3.8mm screw is
prevent back out. The screw is made o available in 4 lenghts: 12, 14,
Titanium 16 and 18mm while the 4.5mm
screw is available in 3 lenghts,
14, 16 and 18mm
Stryker Australia Pty Ltd
HW393 Xia Spine System Bone Screw One size only $250.00
HW409 Aviator Anterior Cervical Plating System Anterior Cervical Plate System - Screw 4 - 4.35mm diameter, 10 - $200.00 $261.00
- Screw 18mm length
SK223 Oasys-Occipito Cervico Thoracic Cortical Screws 3.5mm x 6mm - 24mm $150.00
System 4.0mm x 6mm - 54mm
4.5mm x 6mm - 16mm
SK489 THOR Anterior Screw Anterior Plate Screw: Stardard and Dia: 6 - 6.5mm $250.00
Compression
ST914 REFLEX Anterior Cervical Plating Screw Diameter 4 - 4.5mm lengths $200.00 $261.00
System 10mm - 20mm
Synthes Australia Pty Ltd
SY187 Cervifix Posterior Cervical System Screw Dia 3.2 - 4.5mm, Length 6 - $150.00
55mm
SY299 Vectra Anterior Spinal System Locking Screw 10mm to 26mm $200.00 $300.00
SY334 Arch Fixation System Screws, titanium 2.0mm - 2.4mm screws, 4 to $150.00 $181.00
12mm
SY339 Vectra T Anterior Spinal System Self tapping, self drilling Titanium 4.0/4.5mm. 12mm to 20mm $250.00 $300.00
SY362 Universal Spine System (USS) Pedicle Hook Screw Length 20 - 40mm $250.00
SY381 Axon Occipital Fusion System Occipital Screws 4.5mm / 5.0mm diameter Length 4 - 18mm $220.00
Titanium Alloy
Zimmer Pty Ltd
ZI487 Trinica Screw Titanium Screws, fixed and variable angle. 4.2mm x 12/14/16/18mm; $250.00
4.6mm x 12/14/16/18mm
Prostheses List by Category, Groups and Sponsor Page 647 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI517 Trinica Anterior Lumbar/Sacral Screw Screw, Titanium, Fixed or Variable Axis 22 to 34mm lengths $250.00
ZI646 AcuFix Cancellous bone screw - Anterior cervical 4mm x 10 - 18mm $150.00 $195.00
plate system - Titanium
ZI647 AcuFix Self tapping wide root screw - Anterior 4mm x 10 - 18mm $150.00 $195.00
cervical plate system - Titanium
ZI648 AcuFix Rescue screw - Anterior cervical plate 4.5mm x 10 - 18mm $150.00 $195.00
system - Titanium
ZI686 OctaFix Occipital Cervical Plating System Primary Bone Screw 3.5mm $150.00 $880.00
ZI701 Java screw system Secondary sacral screw Size 6 L 35 $120.00 $1,575.00
1 - System
Johnson & Johnson Medical Pty Ltd
DP046 VSP System (Titanium) Pedicle/Sacral Screw 4.75-8.5mm x 25-88mm $600.00
DP473 Isola System (Stainless Steel) Iliac Screw 6.25 & 7.0mm $570.00
DP492 Isola System (Titanium) Iliac Screws 6.25mm & 7.0mm $570.00
DP831 Profile Anterior Thoracolumbar Plate Cancellous Bolt 7mm x 25 - 60mm $600.00
System
DY121 VSP System (Stainless Steel) Pedicle Screw & Sacral Screw 4.75-8.5mm x 25-88mm $600.00 $760.00
DY170 Monarch Spinal System Bolts - Pedicle & Reduction 4.75 - 8.5 mm x 30 - 55mm $600.00
Medtronic Australasia Pty Ltd
MC458 TSRH 3D Screw 4.5 -8.5mm diameter $600.00 $760.00
MC459 TSRH 3D Extended Post Screw 30 - 60mm $600.00 $760.00
MC986 Vertex Spinal System Posted Screws Diameter 3.5 - 4.5mm $200.00 $760.00
Length 10 - 52mm
Nuvasive Australia and NZ Pty Ltd
NV031 Traverse Bolt The Traverse system, of which the 6.5mm x $600.00
Traverse bolt is a component, is indicated (25/30/35/40/45/50/55/60/65m
for use as an adjunct to fusion via a lateral m)7.5mm x
or anterolateral surgical approach, above (25/30/35/40/45/50/55/60/65m
the bifurcation of the great vessels, in the m)
treatment of thoracic and thoracolumbar
(T1-L
Prostheses List by Category, Groups and Sponsor Page 648 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
NV034 Traverse Bone Screw The Traverse system, of which the 5.5mm x $250.00
Traverse bone screw is a component, is (25/30/35/40/45/50/55/60/65m
indicated for use as an adjunct to fusion via m)6.5mm x
a lateral or anterolateral surgical (25/30/35/40/45/50/55/60/65m
approach, above the bifurcation of the m)
great vessels, in the treatment of thoracic
and thoracolumbar
Stryker Australia Pty Ltd
SK502 Trio Spinal Fixation System Screw Diameter: 4.5 - 8.5mm $600.00
Length: 25 - 60mmStandard
and Long Post
SR039 Techtonix System Screw, titanium 5-6mm x 25mm-60mm $600.00
Synthes Australia Pty Ltd
SY149 Universal Spine System (USS) Schanz Screws 5-7mm dia $140.00
2 - Cannulated
Johnson & Johnson Medical Pty Ltd
JJ603 McGuire Bone Screw Cancellous Bone Screw 3.5mm x 8 - 60mm $307.00
Medtronic Australasia Pty Ltd
MC447 UCSS Cortical Screws 30 - 50mm $210.00 $657.00
MC448 UCSS Cortical Lag Screws 36 - 50mm $210.00 $657.00
Nuvasive Australia and NZ Pty Ltd
NV005 Triad Facet Screw Cannulated 3.5 - 4.5mm diameter20- $307.00
70mm length
Orthotech Pty Ltd
OH254 Intext Cervical Plate/Intext Screws Intext cervical plate, including (2-part) Screws/Revision Screws - dia $260.00
fixation screws 4.4mm, length 11 - 18mm -
Pack of 3
OH365 AxiaLIF Facet Screw Percutaneous 360 degree fusion at L5 - S1 4/5mm x 25-40mm $280.00 $1,110.00
Synthes Australia Pty Ltd
SY141 Spinal Plate/Plate System AO/ASIF Cannulated/self tapping screw (odontoid) 3.5mm dia, 36-50mm length $260.00 $544.00
Spinal Implants
SY302 TeleFix Spinal System Posterior Screw 20mm to 70mm in length $250.00 $587.00
SY303 TeleFix Spinal System Anterior Screw 20mm to 70mm in length $250.00 $587.00
Prostheses List by Category, Groups and Sponsor Page 649 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4 - Closed
Medtronic Australasia Pty Ltd
MC462 Zephir Cancellous Screw 13-17mm $210.00
Scient'x Australia
SX009 Antelys Screw D: 5mm, L: 32.5 to 50mm $210.00
Synthes Australia Pty Ltd
SY148 Universal Spine System (USS) Pedicle Hook Screw Length 20- 40mm $210.00
5
Biomet Australia Pty Ltd
BH115 Solitare Anterior Spinal System Fixation screw 20-35mm $480.00
5 - Dual Thread Screw
Emergo Asia Pacific Pty Ltd
ER016 Pyrenees Cervical Plate System / bone Self-drilling, self-tapping and bone Diameter: 4.0, 4.35 and $240.00
Screw reduction screws for fixating the Pyrenees 4.5mm. Length: 10,12,14 and
plate to bone 16mm
Synthes Australia Pty Ltd
SY140 Spinal Plate/Plate System AO/ASIF Anterior thoracolumbar screws - locking Locking screw 7.5mm, length $480.00
Spinal Implants 25 - 55mm
SY251 Ventrofix - MIS Screw 25-65mm $480.00
SY291 Anterior Tension Band Locking Screw 22mm to 36mm $480.00
SY297 SynFix Spinal system Locking Screw 10mm to 40mm, 4.0mm $480.00
diameter
5-Dual Thread Screw
Emergo Asia Pacific Pty Ltd
ER035 Caspian OC screw The Caspian OC screw is used to fixate 4.5mm diameter. 6-16mm $220.00
the Caspian OC plate to the occiput length in 1mm increments
5.25mm diameter. 6-16mm
length in 1mm increments
6 - Expansion Head
Synthes Australia Pty Ltd
SY449 Cervical Spine Locking Plate (CSLP) QuickLock Screw 4.0 or 4.5mm Diameter, 12- $300.00 $470.00
System 20mm Length
Prostheses List by Category, Groups and Sponsor Page 650 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
6 - Expansion Screw / Expansion head screw
B Braun Australia Pty Ltd
BB158 Aesculap Cervical System Titanium with locking mechanism Dia 4 - 4.5mm, length 10 - 28mm $300.00 $450.00
Global Orthopaedic Technology
GO224 Sonoma Vaiable Bone Screw Vaiable Bone Screw 4.0mm x 10mm - 20mm $300.00
4.5mm x 10mm - 18mm
GO225 Sonoma Limited Angle Bone Screw Limited Angle Bone Screw 4.0mm x 10mm - 18mm $300.00
4.5mm x 10mm - 18mm
Lifehealthcare Pty Ltd
LH382 Signus Anterior Cervical Plate - Bone Provides stability in patients undergoing 4.0 & 4.5mm diameter x 12- $300.00
Screws anterior cervical spine fusion procedures. It 16mm length
consists of a pre-contoured titanium plate,
secured onto the spinal vertebrae by either
fixed or variable angle colour coded
screws. These screws have an integral lock
Orthotech Pty Ltd
OH305 ADD / ADDplus Osmium Screw including bolt, titanium. length = 14, 16, 18mm with $300.00 $500.00
The osmium screw is a two-component outer diameter of 5mm
system consisting of a screw and a bolt.
Expansion of the screw is achieved by
inserting the bolt. Hyper-expansion of the
screw is not possible.
Synthes Australia Pty Ltd
SY181 Cervical Spine Locking Plate (CSLP) Expansion Head Screw Dia 3.5 - 4.5mm, Length 12 - $300.00
System 25mm
c - Collar / Sleeve
Nuvasive Australia and NZ Pty Ltd
NV007 Gradient Cervical Plates Bone Screw 4.0 - 4.7mm diameter10 - $200.00
20mm length
C - Complex
Surgical Specialties
SQ061 CPS Bioabsorbable Fixation System Anterior Cervical Plate System: 10-20mm $260.00
PLGA/TMC Copolymer Screws
Prostheses List by Category, Groups and Sponsor Page 651 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Cannulated
Nuvasive Australia and NZ Pty Ltd
NV073 Radian Facet Screw System, (Facet Cannulated Facet Screw Fully threaded 4.5-6.0mm x $210.00 $307.00
Screw) 20-55mm
Partially Threaded 4.5-6.0mm x
20-55mm
Dual Thread Screw
Lifehealthcare Pty Ltd
LH469 Chesapeake Spinal System - Fixation Locking screw for the Chesapeake Spinal 5.5 Diameter screws in 20mm, $240.00 $480.00
Screw System 25mm and 30mm lengths
Group 10 - Fixation: C-Ring
Biomet Australia Pty Ltd
BH077 Synergy Spinal System C-Ring 4.75 - 6.35mm $365.00
Medtronic Australasia Pty Ltd
MC436 CD-Horizon C-ring One size only $365.00
Synthes Australia Pty Ltd
SY145 Universal Spine System (USS) Half Ring SS, Standard, Self-Holding $365.00
SY360 Universal Spine System (USS) Half Ring SS, Standard, Self-Holding $365.00
Group 11 - Fixation: Other
Medtronic Australasia Pty Ltd
MC637 CD Horizon Spire Plate One size $1,425.00
Nuvasive Australia and NZ Pty Ltd
NV064 Affix Plate Spinous process plate with an integrated 25mm - 55mm $1,425.00
canted-coil locking mechanism.
Zimmer Pty Ltd
ZI330 Trabecular Metal Spinal Devices Composition - Trabecular Metal Various heights, sizes and $5,580.00
diameters
Prostheses List by Category, Groups and Sponsor Page 652 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI536 Trabecular Metal Spinal Devices Composition Trabecular Metal Various heights, diameters and $5,580.00
sizes
ZI537 Trabecular Metal Spinal Device Composition Trabecular Metal Various heights, sizes and $5,580.00
diameters
Group 12 - Spacer: Fusion Cage / Interbody
Group 12a - Fusion Cage / Interbody, Integral Fixation
Biomet Australia Pty Ltd
BH114 Solitare Anterior Spinal System Interbody fusion cage Narrow (28mm), medium $5,200.00 $6,500.00
(34mm), and wide (40mm) 12
to 20mm heights. 6 deg and 12
deg angles
Lifehealthcare Pty Ltd
LH468 Chesapeake Spinal System The Chesapeake Spinal System is a multi- Footprint 24 X 30mm, $5,200.00 $7,250.00
screw construct providing stability to the Lordosis 5, 10 and 15 degrees,
anterior column in order to facilitate solid Height 11-21 mm length in
bony fusion 2mm increments
Footprint 28 X 36mm,
Lordosis 5, 10 and 15 degrees,
Height 11-21 mm length in
2mm increments
Medtronic Australasia Pty Ltd
MC987 Sovereign Spinal System - Interbody Sovereign Spinal System - Interbody Small - 32mm x 23mm, $5,200.00 $5,850.00
Spacer Spacer with Coverplate Medium - 37mm x 27mm,
Large - 42mm x 30mm
Nuvasive Australia and NZ Pty Ltd
NV071 Brigade (implant) Interbody fusion implant 10-20mm x 34/38/42 x $5,200.00 $6,500.00
24/28/32/30mm
Orthotech Pty Ltd
OH257 Stalif Interbody Spinal Fusion Implant: 37mm x 11, 13, 15mm; 41mm $5,200.00
Retroperitoneal/Transperitoneal x 11, 13, 15mm; 45mm x 11,
13, 15mm; 37mm x 17mm,
41mm x 17mm, 45mm x 17mm
Prostheses List by Category, Groups and Sponsor Page 653 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Scient'x Australia
SX010 PCB Plate-Cage Titanium cervical plate-cage L: 14-16mm, W: 12-15mm, $2,700.00
Cage Height: 4.5-8mm, Plate
Height: 23-29mm
Synthes Australia Pty Ltd
SY298 SynFix Spinal System Interbody fusion cage prefilled or unfilled 5mm to 19mm $6,500.00 $7,250.00
Group 12b - Fusion Cage / Interbody, No Integral Fixation
Austofix
AX067 Calix Interbody Spacer Cervical cage, PEEK Heights 5-12mm. Lordotic and $2,503.00
Convex
B Braun Australia Pty Ltd
BB070 Prospace Block Titanium 9mm-11mm $3,600.00
BB211 KLA Anterior Lumbar Cage System Anterior Lumbar Cage - PEEK 9mm x 5 degrees, 11mm x 5 $3,600.00 $4,250.00
degrees, 13mm x 5 degrees,
11mm x 9 degrees, 13mm x 9
degrees, 15mm x 9 degrees,
13mm X 13 degrees, 15mm X
13 degrees
BB217 Samarys Anterior Cervical Cage System Anterior Cervical Cage - PEEK L15 x w17 x h5mm, L15 x $2,503.00 $2,800.00
w17 x h6mm, L15 x w17 x
h7mm, L15 x w17 x h8mm,
L13 x w17 x h5mm, L13 x
w17 x h6mm, L15 x w20 x
h5mm, L15 x w20 x h6mm
BB252 T. Lif Intervertebral Cage System T.Lif PEEK Intervertebral Cage All sizes $3,600.00 $5,000.00
BB278 Aesculap Interbody Cage Interbody cage All sizes $3,600.00
Biomet Australia Pty Ltd
BH105 GEO Structure Vertebral Cage - PLIF 3 dimensional titanium intervertebral cage One size only $3,000.00 $4,100.00
BH110 C-Thru Anterior Spine System Cervical Cage - PEEK Lordotic 5-12mm, Parallel 5- $2,503.00
12mm, Convex 5-12mm
Prostheses List by Category, Groups and Sponsor Page 654 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Emergo Asia Pacific Pty Ltd
ER021 Aleutian ALIF An anterior lumbar interbody spacer Footprints: 24mm x 30mm, $3,600.00
designed to stabilise and maintain the 28mm x 36mm Heights: 9mm to
intervertebral space 21mm
ER022 Aleutian TLIF A tranforaminal posterior lumbar interbody 27mm Long, 10mm wide in a $3,600.00
spacer designed to stabilise and maintain range of heights from 7mm to
the intervertabral space 17mm
Global Orthopaedic Technology
GO201 Cambria Interbody Cage PEEK Cervical Interbody Cage 13mm x 12mm, 15mm x $2,503.00
13mm, 17mm x 13mm height -
5mm - 12mm
GO229 Ventura Interbody Cage PEEK Lumbar Interbody Cage Medial Lateral 9mm - 1mm x $3,600.00
A/P 28mm. Height 7mm - 17mm
Health Care Surgical Pty Ltd
HC005 Swingo Lumbar Cage 7-14mm $3,000.00
HC006 Squale Cervical Cage 4-10mm $2,503.00
Johnson & Johnson Medical Pty Ltd
DP510 Brantigan I/F Cage PLIF C/F Cage Straight / Wedge $3,000.00
DP511 Brantigan I/F Cage ALIF C/F Cage Small - Large, 21.5 - 29mm $3,600.00
DP514 Brantigan I/F Cage Cervical Brantigan Cage Standard/Large 4-10mm $2,503.00 $2,668.00
DP515 I/F Ramp PLIF C/F Ramp 7-15 x 9-17 x 21 - 25 mm $3,000.00
DP851 Surgical Titanium Mesh System Standard & Trapezoidal 10-16mm x 8-17mm Hgt $3,000.00
DY406 Leopard 5 Lodotic Carbon Fibre Body Carbon Fibre cage 7 - 18mm $3,600.00 $3,915.00
Fusion Device
DY407 Leopard Parallel Carbon Fibre Body Carbon Fibre Cage 7 - 18mm $3,600.00 $3,690.00
Fusion Device
DY422 Saber Cage PLIF Cage Parallel/Wedge $3,000.00
JJ520 CONCORDE Spine System Parallel Carbon Fibre Interbody Fusion 7 - 18mm $3,600.00
Device
JJ521 CONCORDE Spine System Lordotic Carbon Fibre Interbody Fusion 7 - 13mm $3,600.00
Device
JJ569 Cougar Spine System Anterior/lateral Lumbar Interbody Fusion Small - Large, 10 -65mm $3,600.00 $3,690.00
Cage, Carbon Fibre Reinforced Polymer
(CFRP)
Prostheses List by Category, Groups and Sponsor Page 655 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Lifehealthcare Pty Ltd
LH181 Rabea Peek Vertebral Body Fusion Composition - peek, spinal implant 4, 5, 6, 7 x 12 x 14mm, 8 x 12 $2,503.00
Implant x 16mm
LH252 Signus - Semial Composition - PEEK Height (ant) 7.80, 10.40, $3,600.00
13.20; Diameter 38, 43, 48;
Height (post) 5.4, 8.0, 8.1,
10.8; Angle 5.00, 10.40
LH303 Nubic Cervical Fusion Implant in interbody fusion 4x13x14mm, 5x13x14mm, $2,503.00
of the Cervical Spine 6x13x14mm, 7x13x14mm,
8x13x14mm
LH316 Magerl/Kimba Cage Endless Carbon Fibre (ECF) in PEEK- 7, 8, 9, 11, 13, 15mm $3,600.00
Optima
LH370 Signus Mobis Lumbar TLIF Cage Peek-Optima Lumbar intervertebral TLIF 6, 7, 8, 9, 10, 11, 12, 13, 14, $3,600.00
cage 16, 18mm heights
LH393 Blackstone Construx Mini PEEK VBR The Construx Mini is an anterior Cervical 12mm x 12mm 5 degrees $2,503.00
System Interbody PEEK Cage lordotic. 5mm-12mm in 1mm
increments. 12mm x 12mm,
Parallel. 5mm - 12mm in 1mm
increments. 15mm x 12mm, 5
degrees lordotic. 5mm - 12mm
in 1mm increments. 15mm x
12mm, Parallel. 5mm-12mm in
1mm increments
LH394 Blackstone Medical Pillar AL Anterior Lumbar Interbody Fusion PEEK 26mm x 20mm, 7 degrees $3,600.00
cage (lordotic). 8-20mm height in
2mm increments. 30mm x
24mm, 0 degrees (parallel).
8mm 18mm height in 2mm
increments. 30mm x 24mm, 7
degrees (lorotic). 10-22mm
height in 2mm increments.
30mm x 24mm, 12 degrees
(lordotic). 12-24mm heigh
LH396 Blackstone Medical Pillar TL Transforaminal Lumbar Interbody Fusion 9mm x 27mm, 0 degrees $3,600.00
PEEK cage (parallel). 8mm -16mm height in
1mm increments. 9mm x
27mm, 8 degrees (lordotic).
8mm -16mm height in 1mm
increments
Prostheses List by Category, Groups and Sponsor Page 656 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LH446 Pillar SA The Pillar SA PEEK Spacer system is 37Wx28Dx7º 12.5, 14, 16, $3,600.00
comprised of a variety of implants 18mmH37Wx28Dx12º 12.5,
manufactured from PEEK-OPTIMA LT 14, 16, 18mmH
as described by ASTM F-2026, with 40Wx28Dx7º 12.5, 14, 16,
tantalum markers as described by ASTM 18mmH40Wx28Dx12º 12.5,
F-560. The implants are available in 14, 16, 18mmH
multiple footprint sizes a variety of heig 43Wx28Dx7º 12.5, 14, 16,
18mmH43Wx28Dx12º 12.5,
14, 16, 18mmH
37Wx32Dx7º 12.5, 14, 16,
18mmH37Wx32Dx12º 12.5,
14, 16, 18mmH40W
LSS Surgical Pty Limited
LS013 DIVA Cervical PEEK Cage System Cervical Cage PEEK Standard Cervical PEEK Cage $2,503.00 $3,340.00
Sizes 4 to 8. Small Cervical
PEEK Cage Sizes 4 to 7
Medtronic Australasia Pty Ltd
MC413 Cornerstone Cage Sterile and Non-sterile 4 - 14mm $2,503.00
MC589 Affinity Anterior cervical cage System The Affinity Cage is constructed of titanium 6mm to 14mm $2,503.00
alloy - kit includes trials, reamers and
inserters.
MC602 Union Verte-Stack 8 - 20mm $3,600.00
MC673 Verte-Stack Perimeter Cage Extra Small, Small, Medium, $3,600.00 $5,907.00
Large, Extra Large
MC685 Verte-Stack Crescent PEEK Height 6 - 18mm $3,600.00 $5,907.00
MC974 Capstone Cage TLIF Vertebral Body Spacer Length: 32mm - 36mm $3,600.00
MC975 Capstone Cage DLIF Vertebral Body Spacer Length: 40mm - 60mm $3,600.00
Nuvasive Australia and NZ Pty Ltd
NV010 CoRoent Cervical Cage small $2,503.00
NV011 CoRoent PLIF cage LN, LT $3,000.00
NV012 CoRoent TLIF cage LW, LC $3,600.00
NV013 CoRoent XLIF cage XL $3,600.00
Prostheses List by Category, Groups and Sponsor Page 657 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
NV014 CoRoent ALIF cage XLR $3,600.00
Orthotech Pty Ltd
OH128 Anterior Lumbar Cage Titanium or PEEK Height 2 - 20mm $3,600.00 $4,100.00
OH131 Anterior Cervical Cage Peek 12 x 15, 12 x 17, 14 x 17, 14 x $2,503.00
19
OH316 Impix-C+ - Cervical Cage Impix-C+ Pre-filled Cervical Cage 12.5mm x 14mm x 5mm, $2,503.00 $2,950.00
12.5mm x 14mm x 6mm,
12.5mm x 14mm x 7mm,
14.5mm x 16mm x5mm,
14.5mm x 16mm x 6mm,
14.5mm x 16mm x 7mm,
14.5mm x 16mm x 8mm,
14.5mm x 16mm x 9mm
Scient'x Australia
SX007 Antelys Cage H: 9-15mm $3,600.00
SX014 CBK Cage PEEK L: 15mm, W: 13mm, H: 4.5-9mm $2,503.00
SX033 Olys PEEK TLIF Cage Length 28mm, 35mm: Height $3,600.00
7mm, 9mm, 11mm, 13mm
SX055 Novel Anterior Lumbar Interbody Spinal PEEK lumbar fusion cage Small: 26mm wide x 23mm $3,600.00
Spacer System depth; height: 8mm - 20mm
(2mm increments); 7° or 12°
lordotic
Medium: 32mm wide x 26mm
depth; height: 8mm - 20mm
(2mm increments); 7° or 12°
lordotic
Large: 36mm wide x 30mm
depth; height: 10mm - 20mm
(2mm increments); 7° or 12°
lordotic
Prostheses List by Category, Groups and Sponsor Page 658 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SX056 Novel Cervical Spacer System PEEK Vertebral body replacement, Small: 12mm width x 12mm $2,503.00
cervical depth; heaight: 12mm (1mm
increments)
Medium: 12mm width x 14mm
depth; heaight: 12mm (1mm
increments)
Large: 14mm width x 16mm
depth; heaight: 12mm (1mm
increments)
SX059 Novel TL Spinal Spacer System PEEK fusion cage Standard design: $3,600.00 $4,000.00
Small: 22mm width x 10mm
depth; height: 7mm - 14mm
(1mm increments); 0° or 5°
lordosis
Medium: 24mm width x 10mm
depth; height: 7mm - 17mm
(1mm increments); 0° or 5°
lordosis
Large: 28mm width x 10mm
depth; height: 7mm - 17mm
(1mm increments); 0° or 5°
lordosis
X-Large: 30mm width x 10mm
depth; height: 7mm - 17mm
(1mm increments); 0° or 5°
lordosis
Tapered design:
Small: 22mm width x 10mm
depth; height: 6mm - 15mm
(1mm increments); 5° lordosis
Medium: 24mm width x 10mm
depth; height: 6mm - 15mm
(1mm increments); 5° lordosis
Large: 28mm width x 10mm
depth; height: 6mm - 15mm
(1mm increments); 5° lordosis
Prostheses List by Category, Groups and Sponsor Page 659 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Signature Orthopaedics
SF002 VerteLoc™ PEEK TLIF Cage 9mm x 7mm x 23mm (w x h x $3,600.00
l), 9mm x 8mm x 23mm, 9mm x
9mm x 23mm, 9mm x 10mm x
23mm, 11mm x 12mm x
23mm, 11mm x 13mm x
23mm, 9mm x 7mm x 27mm,
9mm x 8mm x 27mm, 9mm x
9mm x 27mm, 9mm x 10mm x
27mm, 9mm x 11mm x 27mm,
11mm x 12mm x 27mm, 11mm
x 13mm x 27mm
Signature Spine
SV005 Juliet TLIF Cage PEEK cage with built in anatomical 4 thicknesses - 8, 10, 12 and $3,600.00
angulations 14mm
SV010 Juliet Anterior Lumbar Cage PEEK cage with built in anatomical shape. All 26 mm length. 10, 12, 14 $3,600.00
The cage has built in stabilising Titanium and 16mm height. 5 or 10
spike to stabilise the implant in the disc degree slope.
space.
SV013 Tryptik Anterior Cervical Cage Tryptik Anterior Cervical Cages are The product is available in 2 $2,503.00
manufactured from PEEK and are sizes, the 12mm cage is
anatomically shaped to fit between available in 3 thicknesses, while
vertebral bodies. The cages have large the 14mm cage is available in 4
graft windows for graft to increase the rate thicknesses 5, 6, 7, and 8mm
of fusion. The cage also features 4
stabilising spikes that provide stability and
resist expulsion from the vertebral body
space.
Stryker Australia Pty Ltd
HW406 Aria Spinal System / Peek DLIF PEEK DLIF Interbody Spacer H: 8-18mm L: 40-60mm W: $3,600.00
Interbody Spacer 18-22mm 0-8 degree lordosis
SR050 AVS TL Peek Spacer System Transforaminal Lumbar Interbody Fusion 7-18mm x 25--30mm. 0-4 $3,600.00
cage, PEEK degree
SR066 AVS AL PEEK Spacer System Anterior Lumbar Interbody Fusion Cage 22mm deep x 28mm wide x $3,600.00
10mm - 50mm height and
28mm deep x 33mm wide x
10mm-50mm height. Both
base sizes come in 4 degree
and 8 degree angulations
Prostheses List by Category, Groups and Sponsor Page 660 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SR082 UniLIF PEEK Unilateral Lumbar Interbody Fusion Width 11mm, Height 6mm to $3,600.00
Cage 13mm, Length 30mm - 33mm
ST712 Solis Cervical Cage PEEK Cervical Interbody Cage 12/4-12/9 and 14/4-14/9 $2,503.00
Synthes Australia Pty Ltd
SY137 Syncage Interbody fusion cage 12 -19mm Height $3,600.00 $3,690.00
SY273 Cervios IBF Cage Interbody Fusion Cage Height 5-10mm (1mm $2,503.00 $2,781.00
increments)
SY300 Travios Interbody fusion cage, prefilled or unfilled 5mm to 19mm $3,600.00 $4,258.00
SY439 OPAL Cage Spacer 7-177mm, 10 x 28-32mm $3,600.00 $4,258.00
SY453 Oracle Lumbar Interbody Fusion Cage 40-55mm M/L x 22mm A/P, $3,600.00 $3,690.00
9-17mm Height
SY570 T-PAL Interbody Fusion Cage System - Lumbar 7-17mm $3,600.00
Zimmer Pty Ltd
ZI482 Spine-Tech BAK Cervical Implant Cervical Cage 6 x 12mm, 8 x 12mm, 10 x $2,503.00
12mm, 12 x 12mm
ZI657 Traxis (non sterile) Titanium Interbody Implant 9-13mm $3,600.00
ZI658 Traxis Peek-Optima (sterile) Vue Radiolucent Implant 12mm $3,600.00
ZI679 InFix Interbody Fusion System Strut Small - Large $1,082.00
ZI688 Cadence (non sterile) Titanium Interbody Implant 9-15mm $3,600.00
ZI689 Cadence Peek - Optima (sterile) Vue Radiolucent Implant 9-13mm $3,600.00
ZI690 Fortitude (non sterile) Titanium Interbody Implant 12mm $2,503.00 $6,120.00
ZI691 Fortitude Peek-Optima (sterile) Vue Radiolucent Implant 12mm $2,503.00 $5,670.00
ZI693 InFix Interbody Fusion System Strut Small - Large $3,600.00
ZI695 Anterior Lumbar Cage Titanium or PEEK Height 2 - 20mm $3,600.00 $4,100.00
ZI696 Fidji Cervical Cage 12 x 15, 12 x 17, 14 x 17, 14 x $2,503.00
19
1
Signature Spine
SV012 Juliet Posterior Lumbar Interbody Cage PEEK cage built in anatomical slope. All 22mm length. 8, 10, 12 and $3,000.00
14mm heights. 0 or 5 degrees
anatomical slope.
Prostheses List by Category, Groups and Sponsor Page 661 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
1 - Paired
Austspine Pty Ltd
AJ009 Kasios KAGE Cervical interbody PEEK cage for anterior Height 4mm - 10mm $2,503.00
cervical surgery
AJ020 Vigor PEEK Lumbar Interbody Fusion Rotatable posterior lumbar interbody Heights: 10mm, 11mm, 12mm, $3,000.00
Cage fusion cage 14mm, 16mm and Lengths:
24mm and 26mm
B Braun Australia Pty Ltd
BB215 Adonys Posterior Lumbar Cage System Posterior Lumbar Cage - PEEK - Standard 8mm x 4 degrees, 12mm x 4 $3,000.00
degrees, 8mm x 10 degrees,
12mm x 10 degrees
BB216 Adonys Posterior Lumbar Cage System Posterior Lumbar Cage - Short 8mm x 4 degrees, 10mm x 4 $3,000.00
degrees, 12mm x 4 degrees,
8mm x 10 degrees, 10mm x 10
degrees, 12mm x 10 degrees
Biomet Australia Pty Ltd
BH106 Ibex Interbody Cage Lumbar Cage 7-17mm $2,503.00 $3,500.00
Emergo Asia Pacific Pty Ltd
ER020 Aleutian AN PLIF An insert-and-rotate posterior lumbar 22mm and 28mm long, 8.5mm $3,000.00
interbody spacer designed to stabilise and wide in a range of heights from
maintain the intervertebral space 6mm to 17mm
Johnson & Johnson Medical Pty Ltd
JJ699 Iriom ramp Carbon fibre fusion ramp 5 degrees and 7.5 degree $3,000.00
lordosis, 9-17 mm anterior
heights
Lifehealthcare Pty Ltd
LH182 Tetris Lumbar Fusion Implant System Titanium or peek, spinal implant 8-12mm x 11mm $3,000.00
LH395 Blackstone Medical Pillar PL Posterior Lumbar Interbody Fusion PEEK 9mm x 23mm, 0 degrees $3,000.00
Cage (parallel). 8mm - 16mm height
in 1mm increments. 9mm x
23mm, 8 degrees (lordotic).
8mm-16mm height in 1mm
increments
Prostheses List by Category, Groups and Sponsor Page 662 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LSS Surgical Pty Limited
LS023 DIVA PEEK Lumbar Cage PEEK Lumbar Cage Posterior & Anterior Posterior Cages 0, 4 & 8 $3,000.00 $3,340.00
degrees Length 20mm & 25mm
T8 to T14. Anterior Cages 4
& 8 degrees T9 to T16
Medtronic Australasia Pty Ltd
MC456 Interfix Titanium Cage 12 x 20mm - 24 x 50mm $3,000.00
MC457 LordoTec Cage (LT-Cage) Titanium, PEEK 18-28mm $3,000.00
MC577 R90 Spacer Spinal Implant (Peek) Height 7 - 16mmLordosis 6 - $3,000.00 $3,800.00
18 degrees
MC976 Capstone Cage PLIF Vertebral Body Spacer Length: 22mm - 26mm $3,000.00
Orthotech Pty Ltd
OH129 Posterior Lumbar Cage Titanium or PEEK Height 7 - 20mm $3,000.00 $3,900.00
OH317 IMPIX-LR IMPIX - lr Lumbar Ramp 8x20x0DEG, 13X20X0DEG, $3,000.00 $4,100.00
14X20X0DEG, 9X20X4DEG,
10X20X4DEG,
11X20X4DEG,
12X20X4DEG,
13X20X4DEG,
14X20X4DEG,
10X20X8DEG,
11X20X8DEG,
12X20X8DEG,
13X20X8DEG,
14X20X8DEG,
12X20X12DEG,
13X20X12DEG,
14X20X12DEG,
8X25X0DEG, 9X25X0DEG,
10X25X0DEG,
11X25X0DEG, 12X2
Scient'x Australia
SX013 CC-CO Cages PEEK Polymer L: 23.5mm, W: 10-13.5mm, H: $3,000.00
8-14mm
Prostheses List by Category, Groups and Sponsor Page 663 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
ST711 PEEK Interbody Cages Peek lumbar cages poly ether ether ketone Size 7-18mm $3,000.00
0, 4 & 8 degree
Synthes Australia Pty Ltd
SY088 Plif Cage: Cage Contact fusion cage - bone compression Width 8 - 11mm / height 9 - $3,000.00
screw for PLIF cage 15mm
SY274 Plivios IBF Cage Interbody Fusion Cage Height 7-17mm $3,000.00
SY340 PlivioPore Ti PLIF cage Height 7 - 17mm / width 7 - $3,000.00 $3,670.00
13mm
Zimmer Pty Ltd
ZI483 Spine-Tech BAK "L" Cage Lumbar Cage 9 x 20mm, 9 x 24mm, 11 x $3,000.00
20mm, 13 x 20mm, 13 x
24mm, 15 x 20mm, 15 x
24mm, 17 x 24mm, 17 x 28mm
ZI615 ARDIS LUMBAR INTERBODY A lumbar interbody fusion cage H 8 to 16mm; W 9 & 11mm; L $3,000.00 $3,600.00
SPINAL CAGE 22 to 34mm
ZI694 Posterior Lumbar Cage Titanium or PEEK Height 7 - 20mm $3,000.00 $3,900.00
1 - Paired (PLIF)
Global Orthopaedic Technology
GO228 Pacifica Interbody Cage PEEK Lumbar Interbody cages std and Medium Lateral 9mm - 11mm x $3,000.00
lordotic A/P 20mm - 24mm. Height
7mm - 17mm
Prostheses List by Category, Groups and Sponsor Page 664 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
1 - Paired PLIF
Scient'x Australia
SX058 Novel SD Spinal Spacer System Self-distracting PEEK fusion cage Small: $3,000.00 $3,500.00
9mm width x 22mm depth;
height: 8mm - 20mm (1mm
increments)
11mm width x 22mm depth;
height: 8mm - 20mm (1mm
increments)
Medium:
9mm width x 25mm depth;
height: 8mm - 20mm (1mm
increments)
11mm width x 25mm depth;
height: 8mm - 20mm (1mm
increments)
Large:
9mm width x 28mm depth;
height: 8mm - 20mm (1mm
increments)
11mm width x 28mm depth;
height: 8mm - 20mm (1mm
increments)
1 Paired (PLIF)
Biomet Australia Pty Ltd
BH109 ESL Spine System PLIF Cage Short 8-14mm, Medium 8- $3,000.00
14mm, Long 8-14mm
Group 12c - Fusion Cage / Facet joint
Signature Orthopaedics
SF004 ZygoLoc Facet Fusion Cage 3-15mm $1,500.00
Prostheses List by Category, Groups and Sponsor Page 665 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 14 - Replacement: Disc
Group 14a - Single Implant
Medtronic Australasia Pty Ltd
MC585 Maverick Artificial Disc Cobalt Chrome 8mm - 14mm $9,550.00 $13,028.00
Group 14b - Multi-Component Implant
1 - End Plate
Johnson & Johnson Medical Pty Ltd
DY356 In Motion Lumbar Artificial Disc End Plates Parallel & Oblique Small, medium, large $4,200.00
Synthes Australia Pty Ltd
SY327 Spine Solutions Prodisc Artificial mechanical disc, superior plate 3 Degree, 6 Degree, 11 $4,200.00
component Degree, Medium, Large
SY329 Spine Solutions Prodisc Artificial mechanical disc, inferior plate 0 Degree, 3 Degree, 8 $4,200.00
component Degree,Medium, Large
2 - Core
Johnson & Johnson Medical Pty Ltd
DY359 In Motion Lumbar Artificial Disc Sliding Core 7.5mm, 8.5mm, 9.5mm, 10.5mm $1,150.00
Synthes Australia Pty Ltd
SY328 Spine Solutions Prodisc Artificial mechanical disc, polyethylene inlay 10,12,14mm, Medium, Large $1,150.00
Group 15 - Replacement: Nucleus
Medtronic Australasia Pty Ltd
MC617 Nucleus Replacement Spinal Disc Thickness 5-25mm, Diameter $5,900.00
10-50mm
Group 16 - Replacement: Vertebral Body
Group 16a - Telescoping Cage - Integral Fixation
Biomet Australia Pty Ltd
BH100 Interpore Bone Plate System TPS Bone Plate 20 - 56cm $2,300.00 $3,500.00
Prostheses List by Category, Groups and Sponsor Page 666 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Orthotech Pty Ltd
OH052 Interpore Bone Plate System TPS Bone Plate 20 - 56cm $2,300.00 $3,500.00
OH303 ADD / ADDplus Addplus is a winged anterior distraction ADDplus, diameter 12mm, $2,300.00 $4,600.00
device and is also used for vertebral height 13-18mm. 6°
column replacement which can be used for ADDplus, diameter 12mm,
the anterior cervical column and for the height 17-26mm. 6°
cervico-thoracic transition. The Adplus ADDplus, diameter 12mm,
effects the reconstruction, support and height 25-41mm. 6°
stabilization ADDplus, diameter 12mm,
height 40-65mm. 6°
Group 16b - Telescoping Cage - No Integral Fixation
B Braun Australia Pty Ltd
BB288 Aesculap Vertebral Body System Vertebral Body System, Titanium Alloy All sizes $4,300.00 $6,000.00
Johnson & Johnson Medical Pty Ltd
DY420 X-Tenz Telescopic VBR Cage 16mm $4,300.00 $4,911.00
DY421 X-Tenz Telescopic VBR Cage 22mm $4,300.00 $4,911.00
DY429 X-Tenz Telescopic VBR Cage 26mm $4,300.00 $4,911.00
DY430 X-Tenz Telescopic VBR Cage 28mm $4,300.00 $4,911.00
JJ516 X-Tenz Lordotic Cage X-tenz Lordotic Cage, Titanium $4,300.00
JJ517 X-Tenz Lordotic Cage X-tenz Lordotic Cage, Titanium $4,300.00
JJ782 X-MESH - Expandable Cage System Telescoping, vertebral body replacement Footprint/diameter 10-40mm, $4,300.00 $5,864.00
device variable height range
Medtronic Australasia Pty Ltd
MC507 LIFT/VERTE-SPAN Vertebral Body Cages Short - Extra Long $4,300.00
MC820 T2 Expandable vertebral body replacement Diameters: 13 - 31mm $4,300.00
cage
Prostheses List by Category, Groups and Sponsor Page 667 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Orthotech Pty Ltd
OH301 Obelisc vertebral body replacement Centre PieceMade from titanium. diameter - 20mm, height 20- $4,300.00 $5,000.00
28mmdiameter - 20mm,
height 25-37mmdiameter -
20mm, height 32-47mm
diameter - 20mm, height 40-
62mmdiameter - 20mm,
height 53-87mmdiameter -
20mm, height 76-132mm
Scient'x Australia
SX035 TeCorp Vertebral Body Replacement TeCorp Cervical All sizes $3,100.00 $5,000.00
System
SX036 TeCorp Vertebral Body Replacement TeCorp Thoracic All sizes $4,300.00 $5,395.00
System
SX037 TeCorp Vertebral Body Replacement TeCorp Lumbar All sizes $4,300.00 $5,395.00
System
Stryker Australia Pty Ltd
SK448 VLIFT Vertebral Body Replacement System, DIS Diameters 12 to 22mm $4,300.00 $6,574.00
Implant
Synthes Australia Pty Ltd
SY341 Expandable Cage Titanium Synex II, Titanium Height 14mm-123mm $4,300.00 $4,315.00
SY343 Expandable Cage Titanium Synex, Titanium, with endplates Height 14mm - 93mm, Angle 0 $4,300.00 $5,395.00
- 40 degree
SY356 ECD - Expandable Corpectomy Device Vertebral body replacement system, Angle 4.5Deg/7Deg, Height $3,100.00 $5,440.00
PEEK/Titanium 17mm - 70mm
Group 16c - Telescoping Cage - End Plate
Medtronic Australasia Pty Ltd
MC540 LIFT/ VERTE-SPAN End plates (caps) Angulation: -8 - 7 degrees; left $1,200.00 $1,325.00
and right
Prostheses List by Category, Groups and Sponsor Page 668 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Orthotech Pty Ltd
OH302 Obelisc vertebral body replacement End PieceMade from titanium. diameter - 20mm, angle 0° $1,200.00
diameter - 20mm, angle 5°
diameter - 20mm, angle 10°
diameter - 24mm, angle 0°
diameter - 24mm, angle 5°
diameter - 24mm, angle 10°
diameter - 26mm, angle 0°
diameter - 26mm, angle 5°
diameter - 26mm, angle 10°
Stryker Australia Pty Ltd
SK339 VLIFT End cap Diameters 12 to 22mm $1,200.00
Synthes Australia Pty Ltd
SY342 Expandable Cage Titanium Synex II, Titanium endplate Angle 0 - 40 degree. Endplate $1,200.00
Size 19x20, 22x25, 26x30
Zimmer Pty Ltd
ZI678 InFix Interbody Fusion System Endplate Small - Large $1,200.00
ZI680 InFix Interbody Fusion System Endcap 8-10mm $1,200.00
Group 16d - Stackable Cage
Johnson & Johnson Medical Pty Ltd
DP513 Stackable Corpectomy CFRP Cage Stackable Cage Thoracic/Lumbar Xsmall-Xlarge $4,400.00
System
DY322 Carbon Fibre Interbody Fusion Device Stackable C/F Cage System Wedges 11 Degree Small-Large $4,400.00
Lifehealthcare Pty Ltd
LH389 Signus Athlet VBR System - Main Body Peek Vertebral Body Replacement System 12, 18, 24, 30, 36 and 42mm $4,400.00
(Main body) lengths
LH397 Signus Athlet VBR System - End Body Peek Vertebral Body Replacement System 4, 6, 8mm heights $4,400.00
(End body)
Medtronic Australasia Pty Ltd
MC603 Union Verte-Stack 8 - 20mm $4,400.00
MC606 Union Verte-Stack Centre Piece 5-40mm $4,400.00
Prostheses List by Category, Groups and Sponsor Page 669 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC632 Verte-Stack XS Centre Piece. Stackable Corpectomy Height 5-50mm $4,400.00 $5,005.00
Device.
Group 16e - Mesh
Johnson & Johnson Medical Pty Ltd
DP427 Surgical Titanium Mesh System Various shapes 10- 26 x 15 -150mm $3,605.00 $6,072.00
DP438 Surgical Titanium Mesh System Mesh - Oblong 12 - 13 x 15 -17mm x 10 - $3,605.00 $6,325.00
20mm
Lifehealthcare Pty Ltd
LH284 Blackstone - Surgical Mesh 4 lobe, 6 lobe 4 lobe: 12 x 15mm, 8mm - 17 x $3,605.00
22, 15mm, 6 lobe: (diameter x
height) 10 - 16 x 10 - 16mm
(2mm increments), 7 - 70mm
Medtronic Australasia Pty Ltd
MC378 Pyramesh Titanium Surgical Mesh 51 - 500mm $3,605.00 $4,700.00
MC379 Pyramesh Titanium Surgical Mesh 5 - 50mm $3,605.00
MC449 Pyramesh Angled 25 - 150mm $3,605.00
MC450 Pyramesh Curved / Round 20 - 150mm $3,605.00
MC451 Pyramesh Ovoid 8 - 130mm $3,605.00
Nuvasive Australia and NZ Pty Ltd
NV015 Titanium Mesh Oval/Flat/Long/Round 10mm - 16mm Diameter, 6mm $3,605.00
- 14mm Length
NV016 Titanium Mesh Oval/Flat/Long/Round 10mm - 16mm Diameter, $3,605.00
15mm - 90mm Length
NV017 Titanium Mesh Oval/Flat/Long/Round 20mm + Diameter, 30mm - $3,605.00
90mm Length
Scient'x Australia
SX057 Novel CP Corpectomy Spinal Spacer PEEK vertebral body replacement, Small: 14mm width x 12mm $3,605.00
System thoracolumbar depth; height: 10mm - 50mm
(2mm increments)
Medium: 17mm width x 15mm
depth; height: 10mm - 50mm
(2mm increments)
Prostheses List by Category, Groups and Sponsor Page 670 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
SK338 VBOSS/VLIFT Titanium Available from 10 to 25mm in $3,605.00
Diameter and from 8 to 120mm
in Length
Synthes Australia Pty Ltd
SY293 Synmesh Mesh, Oblong 6mm - 88mm $3,605.00
SY294 Synmesh Mesh, Round 6mm - 88mm $3,605.00
Group 16f - Mesh - End Plate
Johnson & Johnson Medical Pty Ltd
DY087 Surgical Titanium Mesh System End Plate or Screws or End Cap (Round / 10-33mm $250.00
Oblong / Trapezoidal)
DY088 Surgical Titanium Mesh System Rings (Standard and Angled) 17-26mm x 22-33mm $1,325.00
Lifehealthcare Pty Ltd
LH282 Blackstone - End Ring Surgical Mesh [Surgical mesh X Angle] 10- $195.00
16mm (2mm increments) X 0-
2.5 degrees
Medtronic Australasia Pty Ltd
MC539 Pyramesh End ring/cap 10 - 25mm $1,325.00
MC821 T2 End Cap 13-31 mm, 0, 4, 8, 15 degree $1,325.00
lordosis
Stryker Australia Pty Ltd
SK424 VBOSS End cap Sizes 10 to 25mm $1,325.00
Synthes Australia Pty Ltd
SY295 Synmesh End rings round/oblong $1,325.00
Group 17 - Bone Graft: Bone Substitute
Group 17c - Bone Substitute, Non-Resorbable - Non-Structural
Heraeus Kulzer Australia Pty Ltd
HK002 Osteopal V Single mix PMMA 26 grams powder; 10ml liquid $230.00
Prostheses List by Category, Groups and Sponsor Page 671 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
2 - with Complex kit
Arthrocare Australasia Pty Ltd
AF007 Parallax Vertebroplasty Bone Cement Sterile Sealed Percutaneous Standard $1,200.00
Vertebroplasty Bone Cement
Group 2 - Fixation: Coupling
a - Nut
Biomet Australia Pty Ltd
BH069 Synergy/Polaris Spinal System Hex Nut / Cap Nut 3mm $177.00 $400.00
BH081 Synergy/Polaris Spinal System Variable Locking Screw Nut 13.8mm $177.00 $420.00
BH102 Interpore Bone Plate System TPS Locked Nut 3mm $177.00 $650.00
Health Care Surgical Pty Ltd
HC009 S14 Biospine Nut Nut One Size Only $170.00
Johnson & Johnson Medical Pty Ltd
DP058 Isola System (Stainless Steel) Modular Cross Connector Hex Nut One size only $177.00
DP074 Isola System (Titanium) Modular Cross Connector Hex Nut One size only $177.00
DP304 Moss Miami (Stainless Steel) Inner Screw and Outer Nut 3 - 5mm $177.00
DP460 Isola System (Titanium) Right Hand Nut 5/16" $177.00
DP475 Isola System (Stainless Steel) Right Hand Nut 5/16" $177.00
DP834 Profile Anterior Thoracolumbar Plate Locking Outer Nut One size only $177.00
System
DY098 Moss Miami (Titanium) Pin Nut One size only $177.00
DY107 Carbon Fibre Cages Stackable Cage Titanium Interface Screw One size only $177.00
Nuts
DY340 Summit Cervical Rod System Mini Polyaxial Outer Nut One size only $177.00
DY341 Summit Cervical Rod System Pin Nut with Flange or No Flange One size only $177.00
JJ601 Mountaineer Oct Spinal System Transverse Connector Outer Nut One size only $177.00
JJ763 Moss Miami (Titanium) Outer nut One Size $177.00 $225.00
Medtronic Australasia Pty Ltd
MC399 TSRH Spinal Implant System 3D - Nut, Eyebolt locknot, locknut 1/2 Each in one size $177.00
inch, locking screws, double hex, flush
break, universal breakoff
Prostheses List by Category, Groups and Sponsor Page 672 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC435 Colorado Spinal System Break off Nut One size only $177.00
MC615 Vantage Vantage Plates and Screws; Lock Nut One Size Only $177.00
Nuvasive Australia and NZ Pty Ltd
NV032 Traverse Lock Nut The Traverse system, of which the One Size $170.00
Traverse lock nut is a component, is
indicated for use as an adjunct to fusion via
a lateral or anterolateral surgical
approach, above the bifurcation of the
great vessels, in the treatment of thoracic
and thoracolumbar
NV037 XLP Lock Nut The XLP system, of which the XLP lock One size $170.00
nut is a component, is indicated for use via
a lateral or anterolateral surgical approach,
above the bifurcation of the great vessels
in the treatment of thoracic and
thoracolumbar (T1-L5) spine instability or
via the
Orthotech Pty Ltd
OH054 Interpore Bone Plate System TPS Locked Nut 3mm $177.00 $650.00
Scient'x Australia
SX004 Isobar TTL Nut Blocker, Hemispherical $605.00
Synthes Australia Pty Ltd
SY174 Universal Spine System (USS) Nut Standard, SS $177.00
SY186 Cervifix Posterior Cervical System Nut One size only $177.00
Zimmer Pty Ltd
ZI477 Silhouette Spinal System Implants Nut, Connector, Transverse 1 size $177.00
ZI479 Silhouette Spinal System Implants Nut, Locking, Polyaxial 1 size $177.00
ZI638 BacFix (Thoracolumbar System) Serrated tooth locking clip - Titanium alloy Nominal, deep $177.00 $190.00
a - Nut, b - Set Screw / Locking Screw
Johnson & Johnson Medical Pty Ltd
DY293 Crossover System (Titanium) Crossover Nut or Ball Screw One size only $170.00 $250.00
Prostheses List by Category, Groups and Sponsor Page 673 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
b - Set Screw / Locking Screw
Austspine Pty Ltd
AJ024 Smartloc Spinal Fixation System / Set Set screw for poyaxial pedicle screw 8mm diameter, 5mm height $170.00
Screw
B Braun Australia Pty Ltd
BB230 S4 Spinal System Set Screw - titanium one size $170.00 $230.00
Biomet Australia Pty Ltd
BH076 Synergy Spinal System Point/Double Hex Set Screw 4.75 - 6.35mm $170.00 $390.00
BH087 Array/Ballista Spinal System Titanium Alloy Modular Spinal System - one size $170.00 $290.00
set screws
BH091 Altius Occipito-Cervico-Thoracic Locking and CAP Nuts one size only $170.00 $450.00
(OCT) System
Emergo Asia Pacific Pty Ltd
ER015 Denali Spinal System / ATR Set Screw Set Screw 8mm diameter and 4mm height $170.00
ER029 Caspian OCT Spinal System - Set cervico-thoracic posterior rigid fixation one size only $170.00
Screw system
Global Orthopaedic Technology
GO213 Sierra Spinal System Set Screw Set Screw 3.5mm $177.00
Johnson & Johnson Medical Pty Ltd
DP463 Isola System (Titanium) Set Screw 6.35mm $170.00
DP501 Isola System (Stainless Steel) Set Screw One size only $170.00
DP832 Profile Anterior Thoracolumbar Plate Locking Inner Screw One size only $170.00
System
DY103 Isola System (Stainless Steel) Modular Cross Connector Set Screw One Size Only $170.00
DY106 Isola System (Titanium) Modular Cross Connector Set Screw One size only $170.00
DY108 Isola System Titanium, Locking Screw 60-120mm $170.00 $429.80
DY345 Summit Cervical Rod System Transverse Connector Screw One size only $170.00
DY432 Expedium Spine System Si Screw Set 4.35 - 7.5mm $170.00 $370.00
DY444 Summit SI System Inner Set Screw one size $170.00 $225.00
JJ524 VIPER Spine System Viper Single Innie Set Screw One size $170.00 $370.00
JJ594 Mountaineer OCT Spinal System CT Inner Set Screw One size only $170.00
Prostheses List by Category, Groups and Sponsor Page 674 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ600 Mountaineer Oct Spinal System Transverse Connector Inner Screw One size only $170.00
JJ656 SI Set Screw - Expedium Anterior Spine Single Innie Set Screw - Titanium one size only $170.00
System
JJ691 Mountaineer OCT Spinal System - Inner Titanium inner screw One size only $170.00 $225.00
screw
JJ762 Moss Miami (Titanium) Inner set screw One Size $170.00 $225.00
JJ791 Expedium Spine System - Unitised Set Unitised Set Screw one size $170.00
Screw
Lifehealthcare Pty Ltd
LH243 Spinal Fixation System Set screw spinal system One size only $170.00
LH281 Blackstone Set Screw Titanium One size only $170.00
LH283 Blackstone - Standard Ring Screw Titanium One size only $62.00
LH313 ICON Modular Spinal Fixation System Set Screw one size only $170.00
LH452 DSS Breaking Nut The DSS Breaking Nut is a set screw that One size only $170.00
locks the DSS pedicle screw for final
tightening. It is an integral part of the DSS
pedicle screw system, is used every time
and can not be used on its own.
LH456 DSS Fusion Coupler Set Screw The DSS Fusion Coupler set screw locks DIA700-04 for 20mm - 22mm $170.00
the telescoping fusion couplers rigidly in fusion coupler
place. This set screw can only be used for DIA70022-04 for 22mm -
this purpose, is used every case and can 25mm / 25mm - 31mm / 31mm
not be used for any other purpose. - 43mm fusion couplers
LSS Surgical Pty Limited
LS020 SOCORE Spinal System- Locking Screw Locking Screw Standard & Mini $170.00 $300.00
Medtronic Australasia Pty Ltd
MC394 CD Horizon Set screw Each in one size $177.00
MC504 CD Horizon Breakoff Set Screw 25 - 55mm $170.00
MC546 Vertex Spinal System Set screw One size only $170.00
MC609 CD Horizon Spinal System Percutaneous Set Screw 25 - 60mm $170.00 $250.00
MC654 Engage Breakoff Set Screw one size only $170.00
Prostheses List by Category, Groups and Sponsor Page 675 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC667 SiLo Set Screw One Size only $170.00
MC674 CD HORIZON Spinal System - Set Set Screw 3.5mm - 6.35mm $170.00 $250.00
Screw
Nuvasive Australia and NZ Pty Ltd
NV002 SpheRx Cannulated Lock Screw one size $170.00
NV045 SpheRx PPS (Lock Screw) When used as a pedicle screw fixation 5.5mm/6.25mm $142.00 $170.00
system, the SpheRx PPS spinal system, of
which the lock screw is a component, is
intended to provide immobilisation and
stabilisation of spinal segments in skeletally
mature patients as an adjunct to fusion in
the treatment of the following acute and
chronic instabilities or deformities of the
posterior thoracic, lumbar and sacral spine:
Degenerative disc disease; degenerative
spondylolisthesis with objective evidence
of neurological impairment; Fracture;
Dislocation; Scoliosis; Kyphosis; Spinal
tumour; and/or Failed previous fusion
(pseudoarthrosis)
Orthotech Pty Ltd
OH309 Cosmic implant system Cosmic Locking Screw - titanium one size $170.00 $500.00
OH351 Novel set screw Set screw 4-10mm $170.00 $350.00
Stryker Australia Pty Ltd
SK112 XIA/Oasys Spine System Buttress thread locking nut 3.5mm - 6mm $170.00
Synthes Australia Pty Ltd
SY010 VentroFix Set screw One size only $170.00
SY135 Cervical Spine Locking Plate (CSLP) Locking Screw One size only $170.00
System
SY152 Universal Spine System (USS) Set Screw Standard $170.00
SY286 USS llio-Sacral Fixation system Locking Screw one size only $170.00 $490.00
SY304 TeleFix Spinal System Posterior Locking Screw One size only $170.00
SY308 Axon Spinal System Locking Set screw One size only $170.00
Prostheses List by Category, Groups and Sponsor Page 676 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SY383 Synmesh Locking Screw, Low Profile, For Synmesh Small, Large $170.00
End Rings
SY440 Synapse Locking Screw One size $170.00
Zimmer Pty Ltd
ZI511 Optima Spinal System - Set Screw Screw set One size only $170.00 $333.00
ZI625 SEQUOIA PEDICLE SCREW SYSTEM Closure Top One size only $170.00 $400.00
ZI641 BacFix (Thoracolumbar System) Non-threaded wedge with serrated teeth - 5.5 - 6mm $170.00 $204.00
Titanium alloy
ZI659 Nex-Link Spinal Fixation System, Closed Screw Set 4.0mm $170.00 $300.00
Screw
ZI665 Incompass Thoracolumbar Fixation System, Closed 5.5mm $170.00 $300.00
Implant Set Screw
ZI698 Java screw system Java Blocker Set screw $170.00 $325.00
ZI699 Universal Clamp Locking Screw . $170.00 $550.00
ZI706 Nex-Link Spinal Fixation System, Open Screw 4.00mm $170.00 $900.00
Closure
b - Set Screw/Locking Screw
Nuvasive Australia and NZ Pty Ltd
NV061 Armada (Lock Screw) The Armada deformity system, of which One Size $170.00 $177.00
the lock screw is a component, is intended
to provide immobilisation and stabilisation
of spinal segments in skeletally mature
patients as an adjunct to fusion in the
treatment of the following acute and
chronic instabilities of deformities of the
posterior thoracic, lumbar, and sacral
spine: Degenerative disc disease,
Degenerative spondylolisthesis with
objective evidence of neurologic
impairment, Fracture, Dislocation,
Scoliosis, Kyphosis, Spinal tumour and
Failed previous fusion (pseudoarthrosis)
Scient'x Australia
SX048 Zodiac Spinal Fixation System - set screw Set screw Diameter: 9.5mm, 10.8mm. $177.00
Prostheses List by Category, Groups and Sponsor Page 677 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
B Set Screw
Austofix
AX085 Fortex Pedicle Screw Set Screw Pedicle Screw Set 3.1mm height $177.00
b.1a and 1b - Set Screw / Locking Screw
Scient'x Australia
SX034 Isobar TTL Inner nut Inner Locking Nut One size only $170.00 $605.00
b.1b - Set Screw / Locking Screw
Nuvasive Australia and NZ Pty Ltd
NV022 VuePoint screw (inner set) The VuePoint system, of which the Tulip & Laminar Hook - One $170.00
VuePoint screw (inner set) is a component, SizeOffset & Occipital
is intended to promote fusion of the Connector - One SizeParallel
cervical spine and occipito-thoracic Rod Connector - One Size
junction (occiput-T3) and is indicated for Inline Rod Connector - One
degenerative disc disease (as defined by SizeCross Connector - One
back pain of discoge Size
c - Collar / Sleeve
Synthes Australia Pty Ltd
SY151 Universal Spine System (USS) Sleeve 3.5 - 6mm $225.00
SY363 Universal Spine System (USS) Sleeve 3.5 - 6mm $158.00 $225.00
Zimmer Pty Ltd
ZI480 Silhouette Spinal System Adjustable Transverse Connector Sleeve 12 - 90mm lengths $225.00
with Set Screw
d - Cap / Cover Plate
B Braun Australia Pty Ltd
BB064 Socon Spinal System Socon Clamps One size only $650.00 $1,020.00
Biomet Australia Pty Ltd
BH068 Synergy/Polaris Spinal System Sliders 4.75 - 6.35mm dia $650.00
Johnson & Johnson Medical Pty Ltd
DY303 Monarch Spinal System Typhoon Cap and Domed Nuts One size only $605.00
Lifehealthcare Pty Ltd
LH193 Blackstone Top Locking Plate Holds bone screws and anterior cervical One size only $650.00
plate in place
Prostheses List by Category, Groups and Sponsor Page 678 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LH365 Unity Lumbar Plate Unity Cover Plate 17-28mm $650.00
LH448 Pillar SA The Pillar SA PEEK Spacer system is 37W, 40W, 43W, cover plates $650.00
comprised of a variety of implants
manufactured from PEEK-OPTIMA LT
as described by ASTM F-2026, with
tantalum markers as described by ASTM
F-560. The implants are available in
multiple footprint sizes a variety of heig
Orthotech Pty Ltd
OH310 Cosmic implant system Cosmic Cap - titanium one size $650.00
Synthes Australia Pty Ltd
SY412 Lotus System Cap One size $650.00
SY448 Spinal Fixation System Locking Cap One Size $650.00
d - Cap / Cover Plate, C - Complex
Johnson & Johnson Medical Pty Ltd
DY311 Frontier Anterior Scoliosis System Twist on Internal Cap One size only $605.00
(Titanium)
JJ647 Expedium Spine System - Dual Innie Set DI Set Screw one size only $605.00
Screw
Medtronic Australasia Pty Ltd
MC657 Pyramid Pyramid Cover Plate and Set Screw 17mm - 35mm length in 2 mm $605.00 $1,271.00
increments
e
Global Orthopaedic Technology
GO204 Malibu Spinal System Locking Cap Locking cap with integral set screw 5.5mm and 6.35mm $400.00 $760.00
e - Block ' Clamp / Screw head
Global Orthopaedic Technology
GO217 Sierra Spinal System Locking Cap Locking Cap 3.5mm $400.00 $760.00
e - Block / Clamp / Screw head
Biomet Australia Pty Ltd
BH080 Synergy/Polaris Spinal System Variable Locking Screw Seat 5.5-6.35mm $760.00
BH082 Synergy/Polaris Spinal System Variable Locking Screw Reduction Seat 4.75-6.35mm $760.00
Prostheses List by Category, Groups and Sponsor Page 679 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP072 Isola System (Titanium) Modular Cross Connector J-Hooks 4.7-6.35mm $400.00
DP073 Isola System (Titanium) Modular Cross Connector Plates 0 - 70mm $400.00 $569.00
DP453 Isola Paediatric System (Stainless Steel) Threadless TRC - Closed or Open Body 3/16" $760.00 $920.00
without or with Rod
DY337 Summit Cervical Rod System Open Cable Connector One size only $760.00
JJ599 Mountaineer OCT Spinal System Transverse Connector Plate 21 - 56mm $760.00
Lifehealthcare Pty Ltd
LH311 ICON Modular Spinal Fixation System Multi-axial body assembly 5.5mm $760.00
Medtronic Australasia Pty Ltd
MC294 Vertex Spinal System Occipital Buttons Bolt 6 - 30 mm Length $760.00
MC307 Vertex Spinal System Occipital Buttons Nut 12mm Diameter $760.00
MC377 Colorado Spinal System Colorado 2 Clamp . $760.00
MC434 Colorado Spinal System Connector for Sacral & Ilio-Sacral Plate One size only $760.00
MC608 TSRH Connector Small, Medium, Large $760.00 $1,055.00
Scient'x Australia
SX005 Isobar TTL Clamp Snap-on, Short, Long and $760.00
Monobloc
SX016 Easys Straddler - titanium alloy one size $760.00
Stryker Australia Pty Ltd
SK250 Trio Spinal Fixation System Titanium - Offset Connector, Two Step Offset Connector - Small, $760.00
Locking Connector, Variable Offset Medium, Large
Connector
Synthes Australia Pty Ltd
SY178 Spinal Fixation System Pedicle screw head 5 - 6mm $760.00
SY382 Axon Occipital Fusion System Occipital Clamp Titanium Alloy 1 or 2 holes $760.00 $1,000.00
SY414 USS Micro-Crosslink Crosslink Clamp One size only $400.00 $1,174.00
SY415 USS Micro-Crosslink Crosslink Clamp Rod One size only $400.00 $1,283.00
Zimmer Pty Ltd
ZI488 Silhouette Transverse Connector Insert Titanium one size only $760.00
Prostheses List by Category, Groups and Sponsor Page 680 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
e - Block/Clamp/Screw head
Medtronic Australasia Pty Ltd
MC985 Vertex Spinal System Connectors Small, medium, large $760.00 $1,055.00
Nuvasive Australia and NZ Pty Ltd
NV065 SpheRx PPS (Tulip Screw) When used as a pedicle screw fixation 5.5mm/6.25mm $633.00 $760.00
system, the SpheRx PPS spinal system, of
which the tulip screw is a component, is
intended to provide immobilisation and
stabilisation of spinal segments in skeletally
mature patients as an adjunct to fusion in
the treatment of the following acute and
chronic instabilities or deformities of the
posterior thoracic, lumbar and sacral spine:
Degenerative disc disease; degenerative
spondylolisthesis with objective evidence
of neurological impairment; Fracture;
Dislocation; Scoliosis; Kyphosis; Spinal
tumour; and/or Failed previous fusion
(pseudoarthrosis)
f - Other
Johnson & Johnson Medical Pty Ltd
DP075 Isola System (Stainless Steel) Modular Cross Connector Plates 0 - 70mm $400.00 $569.00
DP076 Isola System (Stainless Steel) Modular Cross Connector J-Hooks 1/4 & 3/16" $400.00
DP422 Moss Miami 4mm Anterior System (SS) 12 Sided Outie One size only $400.00
DP459 Isola System (Titanium) Jaw Clamp 1/4" & 3/16" $400.00
DP474 Isola System (Stainless Steel) Jaw Clamp 1/4" & 3/16" $400.00
DP580 Kaneda Anterior Scoliosis System S/S Radiused Caps for Open Screws 3/16" $400.00
DY109 Carbon Fibre Cages Stackable Cage Titanium Protective Sleeve 5-15mm $225.00
DY185 Monarch Spinal System Plate J-Hooks 3.5 - 11 mm $400.00 $550.00
DY344 Summit Cervical Rod System Transverse Connector Hook One size only $550.00
Nuvasive Australia and NZ Pty Ltd
NV009 Gradient Cervical Plates Slotted Hole/Round Cover assembly one size $400.00
Prostheses List by Category, Groups and Sponsor Page 681 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Scient'x Australia
SX015 Easys Connector Bar - titanium L: 40-100mm $400.00
Synthes Australia Pty Ltd
SY006 Click'X Spinal Fixation System Cap One size only $424.00
SY008 VentroFix Clamp Single, Double, Fracture, Left, $1,500.00
Right
SY144 Universal Spine System (USS) Fracture Clamps Cranial, Standard, Low Profile $400.00 $1,278.00
SY146 Universal Spine System (USS) Cross Link Rod 40-80mm length $400.00
SY307 Pangea Spinal System Locking Cap One size only $424.00
SY326 Spinal Plate/Plate System AO/ASIF Internal fixator - cross link clamp One size only $400.00 $1,174.00
Spinal Implants
SY357 ECD - Expandable Corpectomy Device Locking clip, PEEK/Titanium Universal $300.00
SY359 Universal Spine System (USS) Fracture Clamps Cranial, Standard, Low Profile $400.00 $1,278.00
SY361 Universal Spine System (USS) Cross Link Rod 40 - 80mm Length $400.00
Zimmer Pty Ltd
ZI478 Silhouette Spinal System I Adjustable Transverse Connector Rod 1 size $400.00
ZI664 Incompass Thoracolumbar Fixation System, Open 5.5mm $400.00
Implant Closure Top
ZI682 Pathfinder Minimally invasive pedicle fixation system Open Implant Closure Top $400.00
5.5mm
Group 2 - Bone Screw, Coupling
b - Set Screw
Signature Spine
SV001 Romeo Set Screws Titanium alloy One size $170.00
Group 4 - Fixation: Connector
Group 4a - In-line
Biomet Australia Pty Ltd
BH092 Altius Occipito-Cervico-Thoracic Domino Adjustable CC Left & Right One size only $760.00
(OCT) System
Prostheses List by Category, Groups and Sponsor Page 682 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Emergo Asia Pacific Pty Ltd
ER011 Denali Spinal System / In-Line Fixation In-line connector for linking rods Varied $760.00
Connector
Global Orthopaedic Technology
GO206 Malibu Spinal System In-line Connector In-line Connector 5.5mm and 6.35mm $760.00
GO216 Sierra Spinal System Parallel Connector In-line connector 3.5-3.5 - 6.35mm $760.00
Johnson & Johnson Medical Pty Ltd
DP305 Moss Miami (Stainless Steel) Axial Connector 4/4mm to 5/7mm $760.00
DP413 Moss Miami (Titanium) Axial Connector 5mm/5mm $760.00
DP462 Isola System (Stainless Steel) Wedding Band 1/4 " & 3/16" $760.00
DP466 Isola System (Titanium) Wedding Band 1/4" & 3/16" $760.00
DP490 Isola Paediatric System (Stainless Steel) Wedding Band 3/16" $760.00
DY184 Monarch Spinal System Dual Rod Connectors End to End or Side 4.75 to 6.35mm $760.00
by Side
DY518 Isola System (Stainless Steel) Domino Connector 1/4" & 3/16" $760.00
JJ635 Expedium Spine System – Dual Rod Dual Rod Connector 4.75, 5.5 & 6.35mm $760.00
Connector
JJ794 Mountaineer OCT Spinal System Dual Rod Connectors 3.5 - 3.5mm, 3.5 - 4.75mm, $760.00
3.5 - 5.5mm, 3.5 - 6.35mm
JJ795 Mountaineer OCT Spinal System Adjustable axial Connector 3.5 - 3.5mm, 3.5 - 4.75mm, $760.00 $1,060.00
3.5 - 5.5mm
Medtronic Australasia Pty Ltd
MC407 CD Horizon Domino 3.2mm, 3.5mm, 4.5mm, $760.00
5,5mm, 6.35mm
MC409 CD Horizon Domino & Axial Connector 4.5mm, 5.5mm and 6.35mm $760.00
MC542 Vertex Spinal System Connector Length 10 - 13mm; diameter $760.00
3.2 - 6.35mm
MC635 CD Horizon Legacy In-Line Connector Length 40-110mm $760.00 $1,600.00
Prostheses List by Category, Groups and Sponsor Page 683 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Nuvasive Australia and NZ Pty Ltd
NV021 VuePoint inline connector The VuePoint system, of which the 3.5mm x (3.5/4.5/6.5)mm $760.00
VuePoint inline connectors are a
component, is intended to promote fusion
of the cervical spine and occipito-thoracic
junction (occiput-T3) and is indicated for
degenerative disc disease (as defined by
back pain of discog
NV066 Armada (In-line connectors) The Armada deformity system, of which 5.5/6.25 x 5.5mm $760.00
the in-line connector is a component, is
intended to provide immobilisation and
stabilisation of spinal segments in skeletally
mature patients as an adjunct to fusion in
the treatment of the following acute and
chronic instabilities or deformities of the
posterior thoracic, lumbar and sacral spine:
Degenerative disc disease, Degenerative
spondylolisthesis with objective evidence
of neurological impairment, Fracture,
Dislocation, Scoliosis, Kyphosis, Spinal
tumour and Failed previous fusion
(pseudoarthrosis)
Scient'x Australia
SX040 Zodiac Spinal Fixation System - Axial In-line rod connector Length: 31.75mm $760.00
Domino rod connector
Stryker Australia Pty Ltd
HW386 Xia Spine System Rod Clamp - Parallel, Axial One size only $760.00
Synthes Australia Pty Ltd
SY011 VentroFix Parallel connector 6.0/6.0mm $760.00 $919.00
SY015 CerviFix Posterior Cervical System Parallel connector 3.5/3.5, 3.5/5.0, 3.5/6.0 $760.00 $919.00
SY147 Universal Spine System (USS) Connectors Parallel, In-line, Transverse, $760.00 $1,000.00
SS, 15 - 25mm
SY442 Synapse Parallel Connector 3.5/3.5-6.0mm $760.00 $919.00
Zimmer Pty Ltd
ZI609 Optima Spinal Fixation System Optima Spinal Fixation System - Rod Small, Large, 2 Hole, 3 Hole, 4 $760.00 $919.00
Connectors Hole
Prostheses List by Category, Groups and Sponsor Page 684 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
C - Complex
Johnson & Johnson Medical Pty Ltd
DP495 Isola Paediatric System (Stainless Steel) Growth/Tandem Connector 3/16" $1,060.00
JJ792 Expedium 4.5 System Tandem Expedium extended growth Tandem 40 - 80mm $1,060.00 $1,670.00
Connectors Connectors
Group 4b - Offset
Biomet Australia Pty Ltd
BH075 Synergy/Polaris Spinal System Lateral Connectors (Closed Rod) 4.75 - 6.35mm $760.00 $920.00
Emergo Asia Pacific Pty Ltd
ER010 Denali Spinal System / Offset Fixation Offset connector for linking rods Varied $760.00
Connector
Global Orthopaedic Technology
GO218 Sierra Spinal System Lateral Connector lateral connector 3.5mm $760.00
Johnson & Johnson Medical Pty Ltd
DP060 VSP System (Stainless Steel) Sacral Connector - Left & Right Offset One size only $760.00
DP454 Isola System (Titanium) Slotted Connectors Standard or Extended 1/4" & 3/16" $760.00
or Offset or Angled or Open or Twister
DP469 Isola System (Stainless Steel) Slotted Connectors - Standard or 1/4" & 3/16" $760.00
Extended or Offset or Angled or Open or
Twister
DP842 Moss Miami (Stainless Steel) Sacral Extender 5mm x 5 - 20mm length $760.00
DP843 Moss Miami (Titanium) Sacral Extender 5.5mm x 5 - 20mm in length $760.00
DY094 Isola Paediatric System Stainless Steel, Slotted Connector 3/16" $760.00
Downsized
DY186 Monarch Spinal System Band Clamp Connector 6.35 & 5.5mm $760.00
DY305 VSP System (Titanium) Sacral Connector - Left & Right Offset One size only $760.00
DY342 Summit Cervical Rod System Connectors Left or Right or Neutral One size only $600.00
DY443 Summit SI System Connectors Various $600.00
DY519 Isola System (Stainless Steel) Offset Connector 1/4" & 3/16" $760.00
Prostheses List by Category, Groups and Sponsor Page 685 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DY544 Monarch Spinal System Slotted Connectors One size only $760.00
(Straight/Extended/Offset/Twister/Mini
Offset)
JJ607 Expedium Spine System Lateral Connector, Open or Closed 4.5-6.35mm x 20 -500mm $760.00
with/without rod length
JJ692 Mountaineer OCT Spinal System - Lateral Offset, Cable and J Hook One size only $760.00
Lateral Offset, Cable and J Hook Connector
Connector
Lifehealthcare Pty Ltd
LH312 ICON Modular Spinal Fixation System Offset body assembly 8, 11, 14mm $600.00 $760.00
Medtronic Australasia Pty Ltd
MC376 Colorado Spinal System Colorado 2 Connector For 5mm rod and 5.5mm rod $760.00
MC665 Engage Connector Small, Medium, Large $760.00
MC668 CD HORIZON Spinal System - Iliac Iliac Lateral Connector 10mm - 60mm $760.00
Lateral Connector
MC676 SiLo Lateral Connector 10-40mm $760.00
Nuvasive Australia and NZ Pty Ltd
NV029 VuePoint offset connector The VuePoint system, of which the 11mm, 25mm, 30mm - Offset $600.00
VuePoint offset connectors are a Lateral Connector3.5mm x
component, is intended to promote fusion (3.5/4.5/5.5/6.25mm) - Offset
of the cervical spine and occipito-thoracic Rod-to-Rod connectorEyelet
junction (occiput-T3) and is indicated for Connector (Occipital) - One
degenerative disc disease (as defined by Size
back pain of discog
Prostheses List by Category, Groups and Sponsor Page 686 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
NV049 Armada (Offset Connectors) The Armada deformity system, of which 5.5mm x 20-120mm $760.00
the offset connector is a component, is
intended to provide immobilisation and
stabilisation of spinal segments in skeletally
mature patients as an adjunct to fusion in
the treatment of the followinga cute and
chronic instabilities or deformities of the
posterior thoracic, lumbar and sacral spine:
Degenerative disc disease, Degenerative
spondylolisthesis with objective evidence
of neurologic impairment, Fracture,
Dislocation, Scoliosis, Kyphosis, Spinal
tumour and Failed previous fusion
(pseudoarthrosis)
Orthotech Pty Ltd
OH350 Novel cross link Cross Link 16-56mm $760.00 $950.00
Scient'x Australia
SX041 Zodiac Sponal Fixation System - rod Offset rod connector Length: 9.2mm, 15.75mm $760.00
connector, offset
SX042 Zodiac Spinal Fixation System - offset Offset connector 10mm, 15mm, 20mm, 30mm, $760.00
connector 45mm, 60mm.
Stryker Australia Pty Ltd
HW391 Xia Spine System Connector - Axial, Dual, Offset 4.5mm - 6mm $760.00
HW392 Xia Spine System Sacral Block One size only $760.00
Synthes Australia Pty Ltd
SY012 CerviFix Posterior Cervical System Clamp Left, Right, Medial, Lateral, $600.00
Pedicle, Lamina
SY287 USS llio-Sacral Fixation system Transconnecting bar One size only $760.00 $1,100.00
SY288 USS llio-Sacral Fixation system Sacral clamp One size only $760.00 $1,420.00
SY310 Axon Spinal System transverse bar one size only $600.00
SY366 Axon Spinal System transverse bar one size only $600.00
Zimmer Pty Ltd
ZI610 Optima Spinal Fixation System Optima Spinal Fixation System - Rod Various Sizes - Open & Closed $760.00 $919.00
Connectors
Prostheses List by Category, Groups and Sponsor Page 687 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI666 Incompass Thoracolumbar Fixation System, Offset 9.5 - 30mm $760.00 $817.00
Connector Open
ZI667 Incompass Thoracolumbar Fixation System, Offset 7.5 - 30mm $760.00 $817.00
Connector Closed
ZI685 OctaFix Occipital Cervical Plating System Screw Offset Connector $600.00 $759.00
ZI697 Java screw system Sacral fixation Left and right $760.00 $1,550.00
1 - System
Johnson & Johnson Medical Pty Ltd
JJ739 Expedium Spine system Open and closed Polyaxial connectors 5.5 x 6.35 x 20-200mm $760.00 $960.00
with or without end tab
Group 4c - Transverse (Rod-to-Rod)
Austofix
AX058 Capless LI Pedicle screw system - X Titanium, lowprofile transverse low profile, multiple sizes, 25- $920.00
Link cross connector - Fixed crossconnector 35mm
B Braun Australia Pty Ltd
BB228 S4 Spinal System S4 Cross & Lateral Offset Connector Rigid 7 - 41mm $920.00 $1,250.00
Biomet Australia Pty Ltd
BH074 Synergy/Polaris Spinal System Fixed Transverse Connectors 10.5 - 31.5mm $920.00 $1,200.00
Global Orthopaedic Technology
GO205 Malibu Spinal System Lateral Connector Lateral Connector 30mm - 60mm $920.00
Health Care Surgical Pty Ltd
HC010 S14 Biospine Connector Transverse Telescopic Connector 30 - 75mm $920.00
Johnson & Johnson Medical Pty Ltd
DP450 Kaneda SR (Smooth Rod) Anterior (TI) Plates Small/Large - Caudal or $920.00
Rostral
DP451 Kaneda SR (Smooth Rod) Anterior (TI) Transverse Coupler 1/4" x 13 - 16mm $920.00
DY100 Isola System (Stainless Steel) Threadless TRC - Closed or Open Body 1/4" & 3/16" $920.00
with or without Rod
DY545 Monarch Spinal System Threaded Connector One size only $920.00
Prostheses List by Category, Groups and Sponsor Page 688 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ652 Cross Connector - Expedium Anterior Drop and Lock One Piece Connector- 13 to 20mm $920.00
Spine System Titanium
MN044 Crossover System (Titanium) Crossover connector Size 1 - 12, 18 - 107mm $1,350.00
Nuvasive Australia and NZ Pty Ltd
NV020 VuePoint Fixed Cross Connector The VuePoint system, of which the 26mm-50mm $760.00
VuePoint fixed cross connector is a
component, is intended to promote fusion
of the cervical spine and occipito-thoracic
junction (occiput-T3) and is indicated for
degenerative disc disease (as defined by
back pain of dis
NV055 SpheRx II Anterior (Fixed Connector) When used as a pedicle screw fixation 12-22mm $920.00
system, the SpheRx II anterior spinal
system, of which the fixed connector is a
component, is intended to provide
immobilisation and stabilisation of spinal
segments in skeletally mature patients as an
adjunct to fusion in the treatment of the
following acute and chronic instabilities or
deformities of the posterior thoracic,
lumbar, and sacral spine: Degenerative disc
disease; Degenerative spondylolisthesis
with objective evidence of neurologic
impairment; Fracture; Dislocation;
Scoliosis; Kyphosis; Spinal Tumour;
and/or; Failed previous fusion
(pseudoarthrosis)
Orthotech Pty Ltd
OH308 Cosmic implant system Cosmic Cross Links - titanium Bonit coating cosmic transversal stabilizer, $920.00 $1,500.00
drop on leftcosmic transversal
stabilizer, drop on right
Stryker Australia Pty Ltd
SK227 Oasys-Occipito Cervico Thoracic Ti-6A1-4V Transverse Connector; Offset $760.00
System Connector; Rod to Rod
Connector
SK241 Xia Spinal System Titanium or Stainless Steel Cross 15-20mm $920.00
Connector
Prostheses List by Category, Groups and Sponsor Page 689 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI661 Nex-Link Spinal Fixation System, Transverse 4.00mm Rod x 25mm - 45 $760.00 $800.00
Connectors length; 4.00mm Rod x 4.00mm
& 5.5mm (band), 4.00mm Rod
x 4.00 &5.5mm (inline)
1
Signature Spine
SV004 Romeo Pedicle System Hooks Titanium alloy One size $820.00
1 - System
Austofix
AX057 Capless LI Pedicle screw system - X Titanium, lowprofile transverse dual Low profile, Multiple sizes, 37- $1,350.00
Link cross connector - Variable articulation crossconnector 80mm
Austspine Pty Ltd
AJ023 Smartloc Spinal Fixation Cross link for Smartloc Spinal Fixation Telescopes to 70mm $1,350.00
System/Transverse Link System
B Braun Australia Pty Ltd
BB229 S4 Spinal System S4 Cross, Rod & Cable Connector - Variable 28 - 75mm $1,350.00 $1,500.00
Titanium
Biomet Australia Pty Ltd
BH073 Synergy/Polaris Spinal System Adjustable Transverse Connector With 3 - 6cm $1,350.00
Rod/Clamp
BH088 Array Spinal System Titanium Alloy Modular Spinal System - Large, Medium, Small, Xsmall, $1,350.00
cross connector 24mm, 22mm, 20mm, 18mm,
16mm
BH093 Altius Occipito-Cervico-Thoracic Connector 15, 30, 45 L&R $760.00
(OCT) System
Emergo Asia Pacific Pty Ltd
ER019 Mesa Spinal System / Natural Bridge Transverse Connector Mini: 14mm-22mm, Small: $1,350.00
Transverse Connector 38mm-43mm, Medium: 43mm-
53mm, Large: 53mm-73mm,
X-Large: 73mm-93mm
Global Orthopaedic Technology
GO222 Sierra Spinal System CrosBar CrossBar Small, medium, large, x-large $1,350.00
Prostheses List by Category, Groups and Sponsor Page 690 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
DP301 Moss Miami (Stainless Steel) Transverse Connector - Complete One size only $1,350.00
DP412 Moss Miami (Titanium) Transverse Connector - Complete One size only $1,350.00
DP470 Isola System (Stainless Steel) Transverse Rod Connector or Dual Rod 1/4" & 3/16" $1,350.00
Connector
DP499 Isola System (Titanium) Transverse Connector or Dual Rod 1/4" & 3/16" $1,350.00
Connector
DY306 Isola System (Titanium) Threadless TRC - open body with or 1/4" & 3/16" $1,350.00
without rod
DY336 Summit Cervical Rod System Cross Connector One size only $1,350.00
JJ766 Expedium SFX Cross Connector Fixed Length Cross Connector 15mm - 36mm Length, 4.5, $1,350.00
System 5.5, 6.35mm rod diameter
JJ767 Expedium SFX Cross Connector Variable Length Cross Connector 26mm - 100 mm Length, 4.5, $1,350.00
System 5.5, 6.35mm rod diameter
Lifehealthcare Pty Ltd
LH239 Spinal Fixation System Multi Axial Cross Connector Assembly - 30mm - 75mm in 5mm $1,350.00
Titanium/Lateral Offset increments
LH278 Blackstone - Posterior Cervical System Cross-Connector 20, 25, 30, 35, 40, 45, 50mm $1,350.00
LSS Surgical Pty Limited
LS016 SOCORE Spinal System - Crosslink Crosslink 45mm, 55mm, 65mm $1,350.00
Medtronic Australasia Pty Ltd
MC408 CD Horizon Crosslink, Plate, Multi-span late, Offset 60 - 200mm $1,350.00
plate, Transverse links
MC496 Tenor Transverse Links - Titanium 40-100mm $1,350.00
MC590 Vertex Reconstruction System Crosslink Composition - titanium alloy. The system One size only $1,350.00
Bar allows for the adaptation of components
from other Sofamor Danek systems to
provide for constructs tailor made for
individual cases.
MC634 CD HORIZON Spinal System - X10 X10 CROSSLINK Plate Multi-Span Plate: 25-81mm $1,350.00 $2,990.00
CROSSLINK
MC708 CD HORIZON Spinal System - X10 X10 CROSSLINK Plate Fixed Plate: 16mm - 40mm $1,350.00
CROSSLINK
Prostheses List by Category, Groups and Sponsor Page 691 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Nuvasive Australia and NZ Pty Ltd
NV003 SpheRx Transverse X-Connector 45 - 100mm $1,350.00
NV047 Armada (Arch, Adjust. Trans Connector) The Armada deformity system, of which 45-50mm, 50-60mm, 60- $1,350.00
the Arch, Adjustable Transverse 70mm
Connector is a component, is intended to
provide immobilisation and stabilisation of
spinal segments in skeletally mature
patients as an adjunct to fusion in the
treatment of the following acute and
chronic instabilities or deformities of the
posterior thoracic, lumbar and sacral spine:
Degenerative disc disease, Degenerative
spondylolisthesis with objective evidence
of neurologic impairment, Fracture,
Dislocation, Scoliosis, Kyphosis, Spinal
tumour and Failed previous fusion
(pseudoarthrosis)
NV063 Armada (Fixed cross connector) The Armada deformity system, of which 5.5mm x 20-60mm $1,350.00
the fixed cross connector is a component, 5.5mm, 5.5mm-6.35mm
is intended to provide immobilisation and 5.5, 15mm-40mm x 200mm
stabilisation of spinal segments in skeletally
mature patients as an adjunct to fusion in
the treatment of the following acute and
chronic instabilities or deformities of the
posterior thoracic, lumbar and sacral spine:
Degenerative disc disease, Degenerative
spondylolisthesis with objective evidence
of neurologic impairment, Fracture,
Dislocation, Scoliosis, Kyphosis, Spinal
tumour and Failed previous fusion
(pseudoarthrosis)
Stryker Australia Pty Ltd
HW390 XIA Spine System Cross Link Length 20mm - 99mm $1,350.00
Synthes Australia Pty Ltd
SY250 Universal Spine System Low Profile Transconnector 18-83mm length $1,350.00 $2,456.00
SY398 Axon Spinal System - Transconnector Axon Transconnector 60mm - 75mm $1,350.00
Prostheses List by Category, Groups and Sponsor Page 692 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Zimmer Pty Ltd
ZI510 Optima Spinal System - Transverse Link Transverse Link Assembly Small, Medium, Large $1,350.00
Assembly
ZI623 SEQUOIA PEDICLE SCREW SYSTEM SpeedLink II Ti Small, Medium, Large $1,350.00
ZI644 BacFix (Thoracolumbar System) SpeedLink fixed distance rod - Titanium 5.5 - 6mm x 15 - 35mm $1,350.00 $1,450.00
alloy
ZI645 BacFix (Thoracolumbar System) SpeedLink adjustable length rod - 5.5 - 6mm x 39.5 - 75mm $1,350.00 $1,670.00
Titanium alloy
ZI704 Java screw system Transverse connector Length 52, 62, 72, 82 $1,350.00
1 - System or Adjustable
Global Orthopaedic Technology
GO210 Malibu Spinal System CrossBar CrossBar 5.5mm and 6.35mm diameter $1,350.00
rods 23mm - 75mm length
options
1- system or adjustable
Scient'x Australia
SX038 Zodiac Spinal Fixation System - Crosslink: adjustable bridge xx-small, x-small, small, $1,350.00 $2,990.00
adjustable bridge medium, large.
Diameter: 5.5mm; Length: 23-
75mm
1-System
Euros Orthopaedics Australia Pty Ltd
EU004 e.Spine Transverse Link Titanium spine transverse link Lengths 35, 46, 60, 70 mm $760.00
Synthes Australia Pty Ltd
SY569 Spinal Fixation System Matrix Snap-on Transconnector 21mm - 90mm Length $1,350.00
Prostheses List by Category, Groups and Sponsor Page 693 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 5 - Fixation: Hook
Nuvasive Australia and NZ Pty Ltd
NV058 Armada (Hook - Various) The Armada deformity system, of which Pedicle - Small/Medium, $820.00
the hook is a component, is intended to 5.5mm
provide immobilisation and stabilisation of
spinal segments in skeletally mature Lamina - 6/8/10mm x 5.5mm
patients as an adjunct to fusion in the
treatment of the following acute and Angled - 5.5mm
chronic instabilities or deformities of the
posterior thoracic, lumbar and sacral spine: Offset - 5.5mm
Degenerative disc disease, Degenerative
spondylolisthesis with objective evidence
of neurologic impairment, Fracture,
Dislocation, Scoliosis, Kyphosis, Spinal
tumour and Failed previous fusion
(pseudoarthrosis)
Group 5a - Open
B Braun Australia Pty Ltd
BB002 Aesculap Hook System Laminar Hook, Left & Right Thick & Thin $820.00
Biomet Australia Pty Ltd
BH071 Synergy Spinal System Open/Closed Offset Hooks 4mm $820.00 $950.00
BH072 Synergy Spinal System Open/Closed Hooks Pedicle/Laminar 4.75 - 6.35mm dia $820.00 $950.00
BH089 Array Spinal System Titanium Alloy Modular Spinal System - one size $820.00 $990.00
laminar hook and pedicle hook
BH095 Altius Occipito-Cervico-Thoracic Hook and OC Screws Hook: 12mm to 14mm (L&R), $820.00 $1,200.00
(OCT) System OC Screws: 6mm to 20mm
Emergo Asia Pacific Pty Ltd
ER013 Denali Spinal System / Open Hook Thoracic and Lumbar Open Hooks Various blade and throat sizes $820.00
ER028 Caspian OCT Spinal System - Hook cervico-thoracic posterior rigid fixation 3.5mm Posterior Cervical hook $820.00
system
Prostheses List by Category, Groups and Sponsor Page 694 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Euros Orthopaedics Australia Pty Ltd
EU003 e.Spine Hook Titanium Spine hook Transverse process. Pedicular, $820.00
Lumbar laminar, Thoracic
laminar, Right offset lumbar
laminar, Left offset lumbar
laminar hooks.
Global Orthopaedic Technology
GO207 Malibu Spinal System Hooks Hook 5.5mm x 5.5mm - 9.0mm x $820.00
9.5mm
GO221 Sierra Spinal System, Hooks Hooks 4.0mm and 6.0mm $820.00
Johnson & Johnson Medical Pty Ltd
DP299 Moss Miami (Stainless Steel) Hooks - Pedicle One size only $820.00
DP300 Moss Miami (Stainless Steel) Hooks - Laminar as Wide or Narrow or Various Sizes $820.00
Angled or Reduced Distance Supra-
laminar or Offset or Extended Body
DP329 Moss Miami (Stainless Steel) Hooks - Translation (Pedicle/Reduced One size only $820.00
Distance/Narrow/Wide Blade)
DP410 Moss Miami (Titanium) Hooks - Pedicle 3-5 mm $820.00
DP411 Moss Miami (Titanium) Hooks - Laminar as Wide or Narrow or One size only $820.00
Angled or Reduced Distance Supra-
laminar or Offset or Extended Body
DP418 Moss Miami (Titanium) Hooks - Translation One size only $820.00
DP465 Isola System (Titanium) Open Hook and / or Cap 1/4" & 3/16" x 3.5-11mm $400.00 $820.00
DP472 Isola System (Stainless Steel) Open Hook Cap or Open 1/4" & 3/16" x 5-11mm $820.00
DP487 Isola Paediatric System (Stainless Steel) Side Tightening Hook - Opened/Closed 3/16" x 3.5mm - 11mm $820.00
DP845 Moss Miami 4mm Anterior System (SS) Hooks 4mm $820.00
DY304 Monarch Spinal System Hooks - Open (Pedicle/Narrow 5-11mm $820.00
Tapered/Wide Blade)
DY438 Expedium Spine System Hooks, Right, Left, Angled, Offset, 4.25 - 12mm including narrow - $820.00
Extended, Reduced Bladed wide
JJ595 Mountaineer OCT Spinal System CT Hook 3.5mm - Small, Medium, Large $820.00
JJ761 Moss Miami (Titanium) Slotted Hook One Size $820.00 $1,050.00
Prostheses List by Category, Groups and Sponsor Page 695 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ765 Moss Miami (Stainless Steel) Slotted Hook One Size $820.00
Lifehealthcare Pty Ltd
LH270 Blackstone - Posterior Hook Titanium Large/Angled/Offset/Left/Right/ $820.00
Narrow/Wide/ThoracicLaminar
/Lumbar Laminar
LSS Surgical Pty Limited
LS014 SOCORE Spinal Spinal - Hooks, Hooks, Pedicle/Laminar Standard, Medium and Offset $820.00
Pedicle/Laminar
Medtronic Australasia Pty Ltd
MC375 Colorado Spinal System Open Hooks 5.5mm - 6.35mm $820.00
MC397 TSRH Spinal Implant System 3D - Hook, Offset, left, right, laminar, Large - small $820.00
pedicle, Stainless steel, Titanium
MC406 CD HORIZON Spinal System - Hook Hook - various Extra Small - Large $820.00
MC591 Vertex Reconstructive System Laminar Composition - titanium alloy 4.5 - 6.0mm $820.00
Hook
MC677 SiLo Hook Right, left, front $820.00
Nuvasive Australia and NZ Pty Ltd
NV004 SpheRx Hooks one size $820.00
NV030 VuePoint hook (laminar) The VuePoint system, of which the 5.0mm, 7.0mm $820.00
VuePoint hook (laminar) is a component,
is intended to promote fusion of the
cervical spine and occipito-thoracic
junction (occiput-T3) and is indicated for
degenerative disc disease (as defined by
back pain of discogenic
Scient'x Australia
SX006 Isobar TTL Hooks Small, Large, offset $820.00
SX039 Zodiac Spinal Fixation System - hook Hooks: laminar, thoracic, pedicle; offset Small, large $820.00
and angled; narrow and elevated
Stryker Australia Pty Ltd
HW405 Xia Spine System Hooks Laminar and Pedicle Hooks $820.00 $1,375.00
SK222 Oasys-Occipito Cervico Thoracic Ti-6A1-4V Hook, Standard Short; Hook, $820.00
System Standard Tall; Hook, Offset,
Right; Hook Offset, Left
Prostheses List by Category, Groups and Sponsor Page 696 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Synthes Australia Pty Ltd
SY306 Pangea Spinal System Pedicle and Lamina Hooks Extra small to Extra Large $820.00
SY325 Universal Spine System Hook Small, Medium, Large, Lamina, $820.00
Thoracic, Pedicle
SY443 Synapse Lamina Hook, Top Loading right, left, straight, short, long $820.00
Zimmer Pty Ltd
ZI527 Optima Spinal Fixation System - Hooks Titanium Alloy Various $820.00
ZI642 BacFix (Thoracolumbar System) Hook - Titanium alloy 6.5 - 11mm $820.00
ZI662 Nex-Link Spinal Fixation System, Cervical Hooks 5 & 7mm $820.00
ZI671 Incompass Thoracolumbar Fixation System, Hooks 5.5mm $820.00
Group 5b - Closed
Biomet Australia Pty Ltd
BH099 Synergy Spinal System Infant Hooks 4.75mm $820.00 $980.00
Emergo Asia Pacific Pty Ltd
ER012 Denali Spinal System / Closed Hook Thoracic and Lumbar Closed Hooks Various blade and throat sizes $820.00
Global Orthopaedic Technology
GO121 Incompass Thoracolumbar Fixation System, Hooks 5.5mm $820.00
Johnson & Johnson Medical Pty Ltd
DP464 Isola System (Titanium) Closed Hooks 1/4" x 3/16" x 5-11mm $820.00
DP471 Isola System (Stainless Steel) Closed Hooks 1/4" & 3/16" x 3.5-11mm $820.00
DY178 Monarch Spinal System Hooks - Closed (Narrow Tapered / wide 5 - 11 mm $820.00
Blade)
Medtronic Australasia Pty Ltd
MC724 Colorado Spinal System Closed Hooks 5.5mm-6.35mm $820.00
Synthes Australia Pty Ltd
SY013 CerviFix Posterior Cervical System Hook Small, Large, Left, Right $820.00
SY568 Spinal Fixation System Pedicle and Lamina Hooks, straight, Small, Medium, Large $820.00
angled, off-set
Zimmer Pty Ltd
ZI692 Incompass Thoracolumbar Fixation System, Hooks 5.5mm $820.00
Prostheses List by Category, Groups and Sponsor Page 697 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
C - Complex
Synthes Australia Pty Ltd
SY039 Spinal Plate/Plate System AO/ASIF Spondylolysis hook screw (complete) Screw 45 - 60mm $820.00
Spinal Implants small & large
Group 6 - Fixation: Plate
Group 6a - Integral Fixation
Austofix
AX061 Spider Cervical Plating System - Spider Titanium, Anterior Cervical Plate System - 22-54mm $1,400.00 $1,600.00
Plate
Biomet Australia Pty Ltd
BH103 Vuelock (Anterior Cervical Plate) Vuelock (Anterior Cervical Plate) Level 1-4, 12mm - 92mm $1,400.00 $2,600.00
BH107 Anterior Cervical Plate System Titanium Locking Plate 20 - 140mm $1,400.00 $2,600.00
Emergo Asia Pacific Pty Ltd
ER024 Cayman Thoracolumbar Plate System / A thoracolumbar plate system consisting of 22mm to 109mm $2,400.00
Plate plates of various lengths and sizes and a
range of fixation screws
Johnson & Johnson Medical Pty Ltd
DY522 Slim-loc Anterior Cervical Plate System Plates - various levels 22-55mm $1,400.00 $1,800.00
DY523 Swift Spine System Titanium Anterior Cervical Plate System - 15 - 55mm $1,400.00 $1,800.00
Various size plates
DY524 Uniplate Spinal System Titanium Anterior Cervical Plate 13-55mm $1,400.00 $1,600.00
DY525 Swift Spine System Titanium Anterior Cervical Plate System - 46-55mm $1,400.00 $1,800.00
Corpectomy Plate
JJ518 AEGIS ALP Curved anterior lumbar plate 4-25mm $2,400.00
JJ695 Mountaineer OCT Spinal System - OC Titanium Occipital Plate 31 - 45mm $1,400.00 $1,740.00
Plate
JJ793 Eagle/Eagle Plus Anterior Cervical Plate Anterior Cervical Plate 12-55mm $1,400.00 $1,800.00
JJ800 Skyline Cervical Plate System Skyline anterior cervical plate. Various size 12-55mm $1,400.00 $2,010.00
plates, Titanium
Prostheses List by Category, Groups and Sponsor Page 698 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Lifehealthcare Pty Ltd
LH363 Unity Lumbar Plate Unity Plate 17-28mm $2,400.00
LH429 Blackstome Medical Inc Anterior Titanium alloy plate L1-L2 22mm - 54mm $1,400.00
Cervical Plate System
LH430 Blackstone Medical ACP - Level 1 & 2 Titanium Alloy ACP L1-L2 22mm - 54mm $1,400.00
LSS Surgical Pty Limited
LS026 MATRIS Cervical Plate System Cervical Plate 20mm to 55mm < 55 $1,400.00 $2,700.00
Medtronic Australasia Pty Ltd
MC346 Venture Anterior Cervical Plate Single or multi level plate, titanium alloy 20mm - 50mm $1,400.00 $1,500.00
and Nitinol
MC418 Atlantis Anterior Cervical Plate Plate 19.0mm - 47.5mm $1,400.00 $1,450.00
MC419 Atlantis Anterior Cervical Plate Anterior Cervical Plate 50mm - 55mm $1,400.00 $1,450.00
MC610 Vantage Vantage plates and Screws; Thoracic Plate 3.5 - 8cm $2,400.00 $3,700.00
MC612 Vantage Vantage Plates and Screws; ATL Plate 4 - 10cm $2,400.00 $3,700.00
MC661 Pyramid Pyramid Plate 17mm - 35mm $2,400.00 $2,675.00
MC706 Venture Anterior Cervical Plate Single or multi level plate, titanium alloy 52.5mm - 55mm $1,400.00 $1,450.00
and Nitinol
MC819 Pyramid +4 Anterior Plate Height: 33mm - 45mm $2,200.00 $3,700.00
MC863 Zephir Anterior Cervical Plate Anterior Cervical Plate 22.5mm - 55mm $1,400.00 $1,600.00
MC865 Premier Anterior Cervical Plate Anterior Cervical Plate 23mm - 55mm $1,400.00 $1,600.00
Nuvasive Australia and NZ Pty Ltd
NV008 Gradient Cervical Plates Titanium Anterior Plate 11 - 110mm $1,400.00
NV068 Helix-Revolution (Plate 20-54mm) Anterior Cervical Plate 20-54mm $1,400.00 $1,600.00
NV069 Helix-Revolution (plate 56-110mm) Anterior Cervical Plate 56-110mm $1,800.00 $2,000.00
Orthotech Pty Ltd
OH063 Anterior Cervical Plate System Titanium Locking Plate 20 - 140mm $1,400.00 $2,600.00
Scient'x Australia
SX008 Antelys Plate H: 19-23mm $1,400.00 $3,000.00
SX011 Stella Anterior cervical plate - titanium L: 21-121mm $1,400.00
Prostheses List by Category, Groups and Sponsor Page 699 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SX052 Trestle Anterior Cervical Plating System Titanium alloy anterior cervical plate 12mm - 54mm $1,400.00 $1,800.00
- Plate
Stryker Australia Pty Ltd
HW408 Aviator Anterior Cervical Plating System Anterior Cervical Plate - Integral Locking One, two and three level up to $1,400.00
- Plate 55mm in length
SK488 THOR Anterior Plate Anterior Plate, 22mm to 100mm $2,200.00
SR085 Reflex Anterior Cervical Plate System Plate ≤55mm $1,400.00
Synthes Australia Pty Ltd
SY139 Spinal Plate/Plate System AO/ASIF Anterior thoracolumbar plate - locking 40mm - 109mm $2,400.00 $3,168.00
Spinal Implants
SY290 Anterior Tension Band Plate 30mm to 110mm $2,200.00 $2,833.00
SY459 Vectra T Anterior Spinal System Titanium ≤55 $1,300.00 $1,600.00
SY520 Vectra Anterior Spinal System Cervical Plate ≤55 $1,300.00 $1,600.00
Zimmer Pty Ltd
ZI489 Trinica Select Anterior Cervical Plate Titanium plate for anterior cervical spine. Plates for 1 or 2 levels are from $2,400.00
Used to assist spinal fusion. Attached to 22 to 52mm long in 2mm
the bone using screws. increments; Plates for 3 levels
are from 51-72mm long in 3mm
increments
ZI518 Trinica Anterior Lumbar Plate Lumbar Plate, Titanium 37-51mm lengths $2,400.00
ZI519 Trinica Anterior Lumbar Plate Sacral Plate, Titanium 33-51mm lengths $2,400.00
ZI649 AcuFix 1 segment SlimLine plate - Anterior 20 - 34mm $1,400.00 $1,550.00
cervical plate system - Titanium
ZI650 AcuFix 2 segment SlimLine plate - Anterior 34 - 54mm $1,400.00 $1,550.00
cervical plate system - Titanium
ZI651 AcuFix 3 segment SlimLine plate - Anterior 47 - 71mm $1,800.00
cervical plate system - Titanium
ZI652 AcuFix 4 segment SlimLine plate - Anterior 68 - 92mm $1,800.00
cervical plate system - Titanium
ZI653 AcuFix 2 segment Corpectomy plate - Anterior 34 - 54mm $1,400.00 $1,550.00
cervical plate system - Titanium
ZI654 AcuFix 3 segment Corpectomy plate - Anterior 53 - 77mm $1,800.00
cervical plate system - Titanium
ZI655 AcuFix 4 segment Corpectomy plate - Anterior 68 - 101mm $1,800.00
cervical plate system - Titanium
Prostheses List by Category, Groups and Sponsor Page 700 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI656 AcuFix 3 segment SlimLine plate - Anterior 47 - 71mm $1,800.00
cervical plate system - Titanium
ZI672 AcuFix 1 segment ThinLine plate 20 - 36mm $1,400.00 $1,550.00
ZI673 AcuFix 2 segment ThinLine plate 34 - 54mm $1,400.00 $1,550.00
ZI674 AcuFix 1 segment Ant-Cer dynamic plate 24 - 32mm $1,400.00 $1,550.00
ZI675 AcuFix 2 segment Ant-Cer dynamic plate 34 - 54mm $1,400.00 $1,550.00
ZI676 AcuFix 3 segment Ant-Cer dynamic plate 50 - 71mm $1,800.00
ZI677 AcuFix 4 segment Ant-Cer dynamic plate 68 - 96mm $1,800.00
ZI707 AcuFix 2 segment SlimLine plate - Anterior 34 - 54mm $1,400.00 $1,450.00
cervical plate system - Titanium
1 - Cervical Plate > 55mm
Austofix
AX062 Spider Cervical Plating System - Spider Titanium, anterior cervical plate system 56-77mm $1,800.00
Plate
Johnson & Johnson Medical Pty Ltd
DY299 Slim-loc Anterior Cervical Plate System Plates - three level 56-78mm $1,800.00
JJ527 Eagle/Eagle Plus Anterior Cervical Plate Anterior Cervical Plate 56-100mm $1,800.00 $1,927.00
JJ801 Skyline Cervical Plate System Skyline anterior cervical plate. Various size 56-105mm $1,800.00 $2,010.00
plates. Titanium
Lifehealthcare Pty Ltd
LH192 Blackstone Medical Inc Anterior Titanium alloy plate L3 56mm - 90mm $1,800.00
Cervical Plate System
LH386 Blackstone Medical ACP - 3 Level Titanium Alloy Anterior Cervical Plate - 3 56mm - 90mm $1,800.00
Level
LSS Surgical Pty Limited
LS027 MATRIS Cervical Plate System Cervical Plate 57mm to 80mm > 55 $1,800.00 $2,700.00
Medtronic Australasia Pty Ltd
MC858 Atlantis Anterior Cervical Plate Anterior Cervical Plate 57.5mm - 110mm $1,800.00 $1,870.00
MC859 Venture Anterior Cervical Plate Single or multi level plate, titanium alloy 57.5mm - 150mm $1,800.00 $2,000.00
and Nitinol
MC864 Zephir Anteior Cervical Plate Anterior Cervical Plate 57.5mm - 70mm $1,800.00 $1,870.00
Prostheses List by Category, Groups and Sponsor Page 701 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC866 Premier Anterior Cervical Plate Anterior Cervical Plate 57.5mm - 90mm $1,800.00 $1,870.00
Stryker Australia Pty Ltd
SR084 Reflex Anterior Cervical Plate System Plate >55mm $1,800.00
Synthes Australia Pty Ltd
SY458 Vectra T Anterior Spinal System Titanium >55 $1,700.00 $2,000.00
SY519 Vectra Anterior Spinal System Cervical Plate >55 $1,700.00 $2,000.00
1 - Cervical Plate >55mm
Johnson & Johnson Medical Pty Ltd
DY529 Swift Spine System Titanium Anterior Cervical Plate System - 56 - 115mm $1,800.00
Corpectomy Plate
Scient'x Australia
SX053 Trestle Anterior Cervical Plating System Titanium alloy anterior cervical plate 57mm - 100mm $1,800.00 $2,000.00
- plate >55mm
Stryker Australia Pty Ltd
HW407 Aviator Anterior Cervical Plating System Anterior Cervical Plate - Integral Locking Three and four level greater $1,800.00
- Plate longer than 55mm than 55mm in length
C - Complex
Synthes Australia Pty Ltd
SY301 TeleFix Spinal System Rod/Plate construct 40mm to 140mm in length $2,400.00 $3,168.00
Group 6b - No Integral Fixation
B Braun Australia Pty Ltd
BB067 Caspar Cervical Plate Titanium and Steel 24mm-90mm $1,300.00 $1,600.00
BB135 Aesculap Cervical System Titanium, rigid Medium 34 - 64mm length $1,300.00 $1,600.00
BB153 Aesculap Cervical System Titanium, rigid Small 20 - 32mm Length $1,300.00 $1,400.00
BB167 MACS Stabilisation Plates Titanium, rigid Length 45 - 100mm $2,200.00
BB248 PACH Plate Titanium 28 & 32mm $2,200.00
Biomet Australia Pty Ltd
BH096 Altius Occipito-Cervico-Thoracic TI Occipital Plate 35-45mm, 40-50mm, 45- $2,250.00 $2,800.00
(OCT) System 55mm
Emergo Asia Pacific Pty Ltd
ER030 Pyrenees Cervical Plate 1 and 2 level cervical plate 18mm to 54mm $1,300.00 $1,700.00
Prostheses List by Category, Groups and Sponsor Page 702 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ER034 Caspian OC Plate Occipital Plate for posterior 40mm & 50mm $2,250.00
occipital/cervical/thoracic fixation
Global Orthopaedic Technology
GO212 Sierra Spinal System Occipital Plate Occipital Plate 25mm-35mm $2,250.00
30mm-40mm
40mm-50mm
45mm-55mm
32mm-40mm
GO226 Sonoma Anterior Cervic Plate Anterior Cervic Plate <55 $1,400.00 $1,600.00
Johnson & Johnson Medical Pty Ltd
DP828 Profile Anterior Thoracolumbar Plate Plates - Thoracolumbar 50 - 120mm $2,200.00 $2,490.00
System
DP829 Profile Anterior Thoracolumbar Plate Plates - High Thoracic 40 - 110mm $2,200.00 $2,490.00
System
DY174 Monarch Spinal System Bone Plate ½ to 1½ or 2 - 3 or 3½ $2,200.00
DY332 Summit Cervical Rod System Occipital Plates "Y" or "T" or transoral 31-45mm, small - large $2,250.00
DY543 VSP System (Stainless Steel) VSP Bone Plate 1/2 to five slot, single, double or $1,670.00
triple
JJ694 Mountaineer OCT Spinal System - Titanium Occipital - Lateral Washer Plate One size only $2,250.00
Lateral washer plate
MN043 VSP System (Titanium) VSP Bone Plate 1/2 to five slot, single, double or $1,670.00
triple
Lifehealthcare Pty Ltd
LH276 Blackstone - Posterior Cervical System Occipital Anchor 31, 37, 45, 50mm $925.00
LH431 Signus Anterior Cervical Plate - L1-L2 Pre-contoured titanium plate, secured onto 22mm - 54mm $1,300.00
the spinal vertebrae by either fixed or
variable angle colour coded screws.
Medtronic Australasia Pty Ltd
MC293 Vertex Spinal System Occipital Plate 24 - 40 mm length $2,250.00 $2,843.00
MC403 Colorado Spinal System Colorado 2 Plate Range length 20 - 60mm $1,670.00
MC432 Colorado Spinal System Sacral Plate Left/right $1,670.00
MC433 Colorado Spinal System Ilio-Sacral Plate Left/right $1,670.00
Prostheses List by Category, Groups and Sponsor Page 703 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Nuvasive Australia and NZ Pty Ltd
NV027 VuePoint Keel Plate (occipital) The VuePoint system, of which the 35/40/45mm $2,250.00
VuePoint Keel Plate (occipital) is a
component, is intended to promote fusion
of the cervical spine and occipito-thoracic
junction (occiput-T3) and is indicated for
degenerative disc disease (as defined by
back pain of di
NV033 Traverse Plate The Traverse system, of which the Fixed Plate - Size $2,200.00
Traverse Plate is a component, is indicated 15/20/25/30/35/40/45/50/55/6
for use as an adjunct to fusion via a lateral 0/65/70/80/90mm
or anterolateral surgical approach, above Compression Plate - Size
the bifurcation of the great vessels, in the 45/50/55/60/65/70/75/80/85/9
treatment of thoracic and thoracolumbar 5/105mm
(T1-
NV035 XLP Lateral Plate The XLP system, of which the XLP lateral 6-20mm $2,200.00
plate is a component, is indicated for use
via a lateral or anterolateral surgical
approach, above the bifurcation of the
great vessels in the treatment of thoracic
and thoracolumbar (T1-L5) spine
instability or vi
NV038 Halo Plate The Halo System, of which the Halo Plate Lumbar Plate (32mm-46mm) $2,200.00
is a component, is indicated for use via a Sacral Plate (32mm-46mm)
lateral or anterolateral surgical approach 2-level Plate (76mm-100mm)
above the bifurcation of the great vessels in
the treatment of thoracic and
thoracolumbar (T1-L5) spine instability or
via the a
NV040 Helix Mini Plate The Helix Mini System, of which the Helix 20mm-50mm (2mm $1,300.00
Mini plate is a component, is intended for increments)
anterior screw fixation of the cervical
spine. These implants have been designed
to provide stabilisation as an adjunct to
cervical fusion. Indications for the use of thi
Prostheses List by Category, Groups and Sponsor Page 704 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
NV043 Helix Plate The Helix system, of which the Helix plate 18-54mm $1,300.00
is a component, is intended for anterior
screw fixation of the cervical spine. These
implants have been designed to provide
stabilisation as an adjunct to cervical
fusion. Indications for the use of this implant
Orthotech Pty Ltd
OH263 Intext Cervical Plate/Intext Screws Intext cervical plate, including (2 - part) Plates - width 13mm, Height $1,300.00 $2,600.00
fixation screws 4mm - 9mm, width 17mm,
height 4mm - 9mm
Signature Spine
SV002 Tryptik Anterior Cervical Plate (>55mm) Tryptik Anterior Cervical Plate is designed The product is available in 5 $1,700.00
to have a low profile with screw holes that lenghts, 60, 65, 70, 80 and
allow for up to 20 degree angulations. The 90mm
plate is made of Titanium
SV007 Tryptik Anterior Cervical Plate Tryptik Anterior Cervical Plate is designed The product is available in 8 $1,300.00
to have low profile with screw holes that lengths, 20, 25, 30, 35, 40, 45,
allow for up to 20 degree angulations. The 50, 55mm
plate is made of Titanium
Stryker Australia Pty Ltd
SK226 Oasys-Occipito Cervico Thoracic Occipital Plate Mini, SML, MED, LGE, LGE $2,250.00
System Long, 100 deg, 130 deg
SR038 Techtonix Plate, titanium 22mm-58mm $1,670.00
Synthes Australia Pty Ltd
SY365 Cervical Spine Locking Plate (CSLP) VA Plate Length 23 - 109mm $1,300.00 $1,600.00
System
SY380 Axon Occipital Fusion System Occipital Plate Medial / Lateral, Pure 50mm / 60mm width, 3 or 4 $2,250.00
titanium holes
SY455 Cervical Spine Locking Plate (CSLP) Plate - Special Manuf. ≤55 $1,300.00 $1,600.00
System
SY457 Cervical Spine Locking Plate (CSLP) Small Stature Plate ≤55 $1,300.00 $1,600.00
System
SY462 Posterior Cervical Plate System Cervical Spine Reconstruction Plate ≤55 $1,070.00
Prostheses List by Category, Groups and Sponsor Page 705 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SY464 Cervical Spine Locking Plate (CSLP) VA Plate ≤55 $1,300.00 $2,524.00
System
1 - Cervical Plate > 55mm
B Braun Australia Pty Ltd
BB140 Aesculap Cervical System Titanium, rigid Large 67 - 103mm length $1,700.00 $1,800.00
Emergo Asia Pacific Pty Ltd
ER031 Pyrenees Cervical Plate 3, 4 and 5 level cervical plate 57mm to 110mm $1,700.00 $1,900.00
Lifehealthcare Pty Ltd
LH432 Signus Anterior Cervical Plate - L3-L4 Pre-contoured titanium plate, secured onto 56mm - 100mm $1,700.00
the spinal vertebrae by either fixed or
variable angle colour coded screws.
Nuvasive Australia and NZ Pty Ltd
NV042 Helix Plate The Helix system, of which the Helix plate 56mm-90mm $1,600.00
is a component, is intended for anterior
screw fixation of the cervical spine. These
implants have been designed to provide
stabilisation as an adjunct to cervical
fusion. Indications for the use of this
implant
Synthes Australia Pty Ltd
SY183 Posterior Cervical Plate System Plate 22-33 holes $1,070.00
SY454 Cervical Spine Locking Plate (CSLP) Plate - Special Manuf. >55 $1,700.00 $2,000.00
System
SY456 Cervical Spine Locking Plate (CSLP) Small Stature Plate >55 $1,700.00 $2,000.00
System
SY463 Posterior Cervical Plate System Cervical Spine Reconstruction Plate >55 $1,470.00 $1,500.00
SY465 Cervical Spine Locking Plate (CSLP) VA Plate >55 $1,700.00 $2,524.00
System
1 – Cervical Plate > 55mm
Global Orthopaedic Technology
GO227 Sonoma Anterior Cervical Plate Anterior Cervical Plate >55 $1,800.00 $2,524.00
2 - Laminoplasty Plates
Medtronic Australasia Pty Ltd
MC299 Centerpiece TiMesh LP Open Door (OD) Plate $750.00
Prostheses List by Category, Groups and Sponsor Page 706 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC309 Centerpiece TiMesh LP French Door (FD) Plate $750.00
MC947 Centrepiece TiMesh LP Open Door Graft (GP) Plate $750.00
MC948 Centrepiece TiMesh LP Trough Plate $750.00
Nuvasive Australia and NZ Pty Ltd
NV054 Leverage LFS (Traditional Plate) The Leverage LFS, of which the traditional 8/9.5/11/12.5mm $750.00
plate is a component, is intended for use in
the lower cervical and upper thoracic
spine (C3 to T3) in laminoplasty
procedures. Leverage LFS is used to hold
allograft material in place in order to
prevent the all
Synthes Australia Pty Ltd
SY335 Arch Fixation System Pre contoured mini titanium plates 4 to 16mm $1,070.00
C - Complex
Surgical Specialties
SQ064 CPS Bioabsorbable Fixation System Anterior Cervical Plate System: 19-60mm $1,870.00
PLCA/TMC Copolymer
C - Complex, 1 - Cervical Plate > 55mm
Surgical Specialties
SQ065 CPS Bioabsorbable Fixation System Anterior Cervical Plate System: 62.5-110mm $2,270.00
PLCA/TMC Copolymer
Group 7 - Fixation: Rod
Group 7a - Standard
Austofix
AX059 Capless Li Pedicle screw system - rod Titanium rod. Straight and pre- bent Straight and pre- bent, multiple $443.00
sizes, 40-300mm
Austspine Pty Ltd
AJ021 Smartloc Spinal Fixation System / Fixation Rod for Smartloc Spinal Fixation 40mm - 80mm $430.00
Fixation Rod System
B Braun Australia Pty Ltd
BB219 S4 Spinal System S4 Straight Rod - Titanium 30 - 60mm $443.00 $600.00
BB220 S4 Spinal System S4 Straight Rod - Titanium 70mm - 180mm $443.00 $600.00
Prostheses List by Category, Groups and Sponsor Page 707 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BB221 S4 Spinal System S4 Straight Rod - Titanium 200mm - 500mm $443.00 $750.00
BB222 S4 Spinal System S4 Pre-bent Rod - Titanium 35mm - 55mm $443.00 $700.00
BB223 S4 Spinal System S4 Pre-bent Rod - Titanium 60 - 240mm $443.00 $725.00
Biomet Australia Pty Ltd
BH066 Synergy/Polaris Spinal System Rods 5cm - 14cm $443.00 $650.00
BH067 Synergy/Polaris Spinal System Rods 30 - 60cm $443.00 $850.00
BH085 Array Spinal System Titanium Alloy Modular Spinal System - 5.5mm x 510mm $443.00 $900.00
Alloy rod
BH086 Array/Ballista Spinal System Titanium Alloy Modular Spinal System - 5.5mm x 30 - 100mm $443.00 $850.00
Pre-Bent Rod
BH090 Altius Occipito-Cervico-Thoracic Rod 8 to 24cm x 3.5mm Occipital $443.00 $750.00
(OCT) System and Curved Rod
Emergo Asia Pacific Pty Ltd
ER018 Mesa Spinal System / Rod Straight and contoured 5.5mm diameter Straight: 30mm - 500mm and $430.00 $1,200.00
rods Contoured: 35mm - 150mm
ER027 Caspian OCT Spinal System - Rod cervico-thoracic posterior rigid fixation Diameter: 3.5mmLength: $443.00
system - Rod 1.80mm - 240mm
Euros Orthopaedics Australia Pty Ltd
EU002 e.Spine Rod Titanium spine rod Diameter 5.5, Lengths $443.00
40,50,60, 70,90,110,130,160,
220, 440mm
Global Orthopaedic Technology
GO208 Malibu Spinal System Rods Rod 5.5mm x 30mm - 600mm $443.00
6.35mm x 100mm
GO209 Malibu Spinal System ESS CoNiCr Rods Rod CoNiCr Precontored 5.5mm x 100mm - 600mm $443.00 $600.00
GO215 Sierra Spinal System Occipital Rod Occipital Rod 60, 75, 90 degrees $443.00
GO219 Sierra Spinal System Rod Precurved Rod 3.5mm x 20mm - 100m $443.00
Health Care Surgical Pty Ltd
HC007 S14 Biospine Rod Rod 40 - 150mm $443.00
Johnson & Johnson Medical Pty Ltd
DP315 Moss Miami (Stainless Steel) Pre-Cut Rod 5mm x 30 - 600mm $443.00
DP394 Moss Miami (Titanium) Pre-Cut Rod 5.5mm x 30 - 90mm $443.00
Prostheses List by Category, Groups and Sponsor Page 708 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
DP400 Moss Miami (Titanium) Rod - Standard 5.5mm x 12 - 48cm $443.00 $548.00
DP452 Kaneda SR (Smooth Rod) Anterior (TI) Pre Cut Rod 1/4" x 45 - 150mm $443.00
DP461 Isola System (Titanium) Spinal Rod 1/4" & 3/16" x 18" & 24" $443.00
DP476 Isola System (Stainless Steel) Eye Rod 1/4" & 3/16" x 18" - 24" $443.00 $698.00
DP477 Isola System (Stainless Steel) Spinal Rod Standard 1/4" & 3/16" x 18" & 24" $443.00
DP488 Isola Paediatric System (Stainless Steel) Pre-Bent Rod 3/16 " $443.00
DP494 Isola Paediatric System (Stainless Steel) Wedding Band 3/16" $443.00
DP505 Anterior Isola System (SS) Rod with Hex End 1/4" x 18" $443.00
DP846 Moss Miami 4mm Anterior System (SS) Rods 4.0mm x 30 - 48cm $443.00 $548.00
DY182 Monarch Spinal System Rods 6.35 & 5.5mm x 35-600mm $443.00
DY310 Frontier Anterior Scoliosis System Spinal Rod 4.75 x 200-450mm $443.00 $828.00
(Titanium)
DY313 Monarch Spinal System Rods - Pre Cut/Lordosed 6.35 & 5.5mm x 45 - 95mm $443.00
DY318 Isola System (Stainless Steel) Pre-Cut Rod 3/16" x 35 - 90mm $443.00
DY343 Summit Cervical Rod System Rod 3mm x 70-200mm $443.00
DY436 Expedium Spine System Rod - Pre - lordosed or straight 5.5 - 6.35mm diameter x 30- $443.00
95mm
DY554 Expedium Spine System Rod 4.5 - 7.5 Diameter x 120 - $443.00
600mm
JJ523 VIPER Spine System Viper Pre-lordosed Rod, Titanium 35 - 75mm $443.00
JJ596 Mountaineer OCT Spinal System CT Dual Diameter Rod 3.5 - 4.75mm x 420 - 600 mm, $443.00
3.5 - 5.5mm x 420 - 600mm,
3.5 - 6.35mm x 420 - 600mm
JJ597 Mountaineer OCT Spinal System CT Rod 3.5mm x 60 - 200mm $443.00
JJ644 Extra long rod - Expendium Anterior Rod - Titanium 5.5mm x 450mm $443.00
Spine System
JJ648 Pre-cut rod - Expedium Anterior Spine Rod - Titanium Diameter 5.5mm x lengths 45- $443.00
System 150mm
JJ671 Viper2 Spinal System Straight, Kyphosed and Lordosed Rods 30-480mm $430.00 $672.40
Prostheses List by Category, Groups and Sponsor Page 709 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ693 Mountaineer OCT Spinal System - Pre- Pre-bent Titanium Rod 3.5 x 200 - 85mm or 3.5 x 120 $430.00
bent Rod - 85 mm
JJ760 Moss Miami (Titanium) Swedge Rod One Size $443.00 $1,050.00
JJ764 Moss Miami (Stainless Steel) Swedge Rod One Size $443.00 $612.00
JJ809 Viper 2 Spine System - Cobalt Chrome Cobalt Chrome Rod 100-600mm $443.00 $900.00
Rods
Lifehealthcare Pty Ltd
LH241 Spinal Fixation System Rod - Titanium 40mm to 100mm in 10mm $443.00
increments
LH242 Spinal Fixation System Rod - Titanium 110 to 450mm (110, 120, 140, $443.00
160, 180, 200, 450mm)
LH277 Blackstone - Posterior Cervical System Occipital Rod One size only $443.00
LH279 Blackstone - Posterior Cervical System Rods - Titanium 3.0mmx70, 120, 200mm $443.00
LH360 Spinal Fixation System Pre Lordosed Rods 40mm to 100mm in 10mm $443.00
increments
LSS Surgical Pty Limited
LS022 SOCORE Spinal System - Standard and Standard and Pre-Bent Rod Diameter 5.5mm 40mm to $443.00
Pre-Bent Rod 500mm Length.
Medtronic Australasia Pty Ltd
MC295 Vertex Spinal System Pre - curved rod 150 - 300 mm length $443.00 $710.00
MC382 Colorado Spinal System Colorado 2 Rod 5.0mm and 5.5mm, length $443.00
range 50 - 600mm
MC396 TSRH Spinal Implant System 3D - Rod Diam 4.75 - 6.35mm, Length $443.00
25mm - 80cm
MC404 CD HORIZON Spinal System - Rod Rod 30mm - 600mm $443.00
MC440 CD Horizon Eclipse: 4.5mm Rod 40 - 600mm $443.00
MC497 Tenor Rod (5.5mm) - Titanium 40 - 240mm $443.00
MC544 Vertex Spinal System Rod 80 - 240mm $443.00 $520.00
MC587 CD Horizon Spinal System Percutaneous Rod 5.5 x 25mm to 5.5 x 350mm $443.00 $834.00
Nuvasive Australia and NZ Pty Ltd
NV018 System: SpheRX. Component: Rods - Rods - Dual/Pre Bent Ball 17.5 - 500mm $443.00
Dual/Pre Bent Ball
Prostheses List by Category, Groups and Sponsor Page 710 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
NV025 VuePoint rod The VuePoint system, of which the rod is a 60mm x 3.5mm, 120mm x $443.00
component, is intended to promote fusion 3.5mm, 240mm x 3.5mm
of the cervical spine and occipito-thoracic
junction (occiput-T3) and is indicated for
degenerative disc disease (as defined by
back pain of discogenic origin with degener
NV028 VuePoint rod (pre-bent) The VuePoint system, of which the 240mm $443.00
VuePoint pre-bent rod is a component, is
intended to promote fusion of the cervical
spine and occipito-thoracic junction
(occiput-T3) and is indicated for
degenerative disc disease (as defined by
back pain of discogenic o
NV059 SpheRx II Anterior (Rod) When used as a pedicle screw fixation 25-150mm $443.00
system, the SpheRx II anterior spinal
system, of which the rod is a component, is
intended to provide immobilisation and
stabilisation of spinal segments in skeletally
mature patients as an adjunct to fusion in
the treatment of the following acute and
chronic instabilities or deformities of the
posterior thoracic, lumbar, and sacral
spine: Degenerative disc disease;
Degenerative spondylolisthesis with
objective evidence of neurologic
impairment; Fracture; Dislocation;
Scoliosis; Kyphosis; Spinal Tumour;
and/or; Failed previous fusion
(pseudoarthrosis)
Prostheses List by Category, Groups and Sponsor Page 711 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
NV060 Armada (Rod) The Armada deformity system, of which 5.5mm x $443.00 $760.00
the rod is a component, is intended to (25/30/35/40/45/50/55/60/65/7
provide immobilisation and stabilisation of 0/75/80/85/90/100/120)
spinal segments in skeletally mature
patients as an adjunct to fusion in the 300/500mm
treatment of the following acute and
chronic instabilities or deformities of the
posterior thoracic, lumbar and sacral spine:
Degenerative disc disease, Degenerative
spondylolisthesis with objective evidence
of neurologic impairment, Fracture,
Dislocation, Scoliosis, Kyphosis, Spinal
tumour and Failed previous fusion
(pseudoarthrosis)
Orthotech Pty Ltd
OH311 Cosmic implant system Cosmic Rod (40,50,60,70,80mm) - titanium diameter - 6.25mm, length - $443.00 $780.00
40mmdiameter - 6.25mm,
length - 50mmdiameter -
6.25mm, length - 60mm
diameter - 6.25mm, length -
70mmdiameter - 6.25mm,
length - 80mm
OH312 Cosmic implant system Cosmic Rod (100, 120, 200mm)- titanium diameter - 6.25mm, length - $443.00 $780.00
100mmdiameter - 6.25mm,
length - 120mmdiameter -
6.25mm, length - 200mm
diameter - 6.25mm, length -
70mmdiameter - 6.25mm,
length - 80mm
OH352 Novel Rods Rod 5.5, 6.0, 6.5 $430.00
Scient'x Australia
SX003 Isobar TTL Rod L: 45-450mm $443.00
SX043 Zodiac Spinal Fixation System - rod Rods: straight and pre-bent; Pure Titanium, Diameter: 5.5mm. Length: 3cm, $443.00
Alloyed Titanium (TA6V ELI) or Colbalt 3.5cm, 4cm, 4.5cm, 5cm,
Chromium 5.5cm, 6cm, 6.5cm, 7cm,
7.5cm, 8cm, 8.5cm, 9cm,
9.5cm, 10cm, 11cm 12cm,
13cm, 17cm, 20cm, 25cm,
30cm, 45cm, 50cm, 60cm.
Prostheses List by Category, Groups and Sponsor Page 712 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SX049 Illico MIS Posterior Fixation System - rod Titanium rods: straight and pre-bent Diameter: 5.5mm. Length: 3cm, $443.00 $834.00
3.5cm, 4cm, 4.5cm, 5cm,
5.5cm, 6cm, 6.5cm, 7cm,
7.5cm, 8cm, 8.5cm, 9cm,
9.5cm, 10cm, 11cm, 12cm,
13cm, 14cm, 15cm, 16cm,
17cm, 20cm, 21cm, 22cm,
23cm, 24cm, 25cm, 26cm,
27cm, 28cm, 29cm, 30cm.
Signature Spine
SV008 Romeo Pedicle System Transverse Rod Titanium alloy rods for connection between 5.4mm diameter. 4 lengths. $443.00
hooks (TR) in transverse connector
assemblies.
SV009 Romeo Pedicle System Rod Supplied non-sterile. Pre-bend for lengths 5.4mm diameter: 30, 40, 50, $443.00
up to 80mm. Titanium alloy. 60, 70, 80, 90, 100, 110, 120,
140, 160, 180, 200, 220, 240
and 350mm lengths
Stryker Australia Pty Ltd
SK224 Oasys-Occipito Cervico Thoracic Rods - Ti-6A1-4V or Vitallium Diameter 3.5mm, Length $443.00
System 25mm-350mm
Synthes Australia Pty Ltd
SY143 Universal Spine System (USS) Rods Length 40 - 500mm $443.00 $900.00
SY444 CerviFix Posterior Cervical System Rod: Straight or pre bent 3.5mm diameter, 120-250mm $443.00 $900.00
length
SY564 Spinal Fixation System Matrix Rods 20mm - 500mm length $443.00
Zimmer Pty Ltd
ZI481 Silhouette Spinal System Implants Rod 5.5 dia x 10cm, 20cm and $443.00
47cm length
ZI512 Optima Spinal System - Rod Rod Dia 5-7mm, length 40-400mm $443.00
ZI624 SEQUOIA PEDICLE SCREW SYSTEM Sequoia Rod CP Ti 30mm - 510mm length $443.00
ZI639 BacFix (Thoracolumbar System) Spinal rod, rigid/flex - Titanium alloy 5.5 - 6mm x 50 - 125mm $443.00
ZI640 BacFix (Thoracolumbar System) Spinal rod, rigid/flex - Titanium alloy 5.5 - 6mm x 300 - 600mm $443.00 $560.00
ZI663 Nex-Link Spinal Fixation System, Spinal Rod 120 & 240mm $443.00
Prostheses List by Category, Groups and Sponsor Page 713 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ZI700 Java screw system Precontoured rod Rod length $443.00 $735.00
30/40/50/60/70/80/90/100
ZI703 Java screw system Straight rods Rod length $443.00 $750.00
30/40/50/60/70/80/90/100
1
Global Orthopaedic Technology
GO220 Sierra Spinal System Transitional Rod Transitional Rod 3.5mm diameter / 5.5mm or $443.00
6.35mm
1 - Dual Diameter
Johnson & Johnson Medical Pty Ltd
DY334 Summit Cervical Rod System Transition Rod 3.0/4.0/3.0mm $550.00
DY335 Summit Cervical Rod System Dual Diameter Rod 3.0/4.75-5.5mm x 150-600mm $550.00
Nuvasive Australia and NZ Pty Ltd
NV026 VuePoint rod (transition) The VuePoint system, of which the 3.5mm to 5.5mm $443.00
VuePoint transition rod is a component, is
intended to promote fusion of the cervical
spine and occipito-thoracic junction
(occiput-T3) and is indicated for
degenerative disc disease (as defined by
back pain of discogenic
Synthes Australia Pty Ltd
SY446 CerviFix Posterior Cervical System Rod: Tapered 3.5/5.0 - 3.5/6.0 dual diameter, $550.00 $900.00
300 -500mm
2 - Shaped
Johnson & Johnson Medical Pty Ltd
DY555 Expedium Spine System Contoured Scoliosis Rod 4.5 - 7.5 Diameter x - 320 - $600.00
455mm
Stryker Australia Pty Ltd
HW389 XIA Spine System Rod - Titanium alloy, Stainless Steel 30 - 600mm $600.00
Synthes Australia Pty Ltd
SY385 Speciality Rods Scoliosis / J/S Rod, Precontoured, 5mm, 6mm diameter. Left / $600.00 $1,123.00
Titanium / Stainless Steel Right50mm - 500mm length
Prostheses List by Category, Groups and Sponsor Page 714 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
2 - Shaped, C - Complex
Medtronic Australasia Pty Ltd
MC505 Orfil L-Shaped Rods 5-510mm $600.00
C - Complex
Johnson & Johnson Medical Pty Ltd
DP485 Isola System (Stainless Steel) Dual Diameter Rod 3/16" to 1/4" x 18 - 24" $443.00
DY105 Isola System (Titanium) Eye Rod 1/4" x 18" $443.00 $698.00
Group 7b - Telescoping
Biomet Australia Pty Ltd
BH084 Synergy Spinal System Growth Rod 30 - 60cm $1,350.00 $1,600.00
Lifehealthcare Pty Ltd
LH457 DSS Fusion Coupler The DSS Fusion Coupler is a telescoping 20mm - 22mm22mm - 25mm $1,350.00
coupler that rigidly joins the DSS pedicle 25mm - 31mm31mm - 43mm
screws.
Group 7d - Dual Unit
Medtronic Australasia Pty Ltd
MC537 Danek Unit Rod System Scoliosis Rods Widths 3/16", 5.5mm or $1,460.00
6.35mm; lengths 25 x 45cm
MC707 Danek Unit Rod System Scoliosis S-Rods Widths 5.5 - 6.35mm; left and $1,460.00
right
Orthotech Pty Ltd
OH264 Hartshill: Ransford Occipito-cervical - Titanium loop 100 degree 9mm - 20mm $2,250.00
OH265 Hartshill: Ransford Extra long cross linked - titanium loop 100 degree 45cm x 15mm $2,250.00
OH266 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam 3-5cm length $1,460.00
OH270 Hartshill Rectangle Stainless steel posterior 6mm diam 15 - 19cm length $1,460.00 $1,710.00
thoracic/thoracolumbar fusion system
Synthes Australia Pty Ltd
SY384 Speciality Rods Unit Rod, Titanium / Stainless Steel 5mm, 6mm diameter250mm - $1,460.00
500mm length
Prostheses List by Category, Groups and Sponsor Page 715 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 8 - Fixation: Plate-Rod
Medtronic Australasia Pty Ltd
MC509 CD Occipital-Cervical Loop CD Occipital-Cervical Loop One size only $3,020.00
MC543 Vertex Spinal System Plate/rod 80 - 240mm $3,020.00
Synthes Australia Pty Ltd
SY184 Posterior Cervical Plate System Plate - rod Special Manufacture - One size $3,020.00
only
SY445 CerviFix Posterior Cervical System Occipital Plate Rod one size $3,020.00
Zimmer Pty Ltd
ZI683 OctaFix Occipital Cervical Plating System Occipital Plate $3,020.00
Group 9 - Fixation: Washer/Staple
Group 9a - Washer
Emergo Asia Pacific Pty Ltd
ER033 ARI Anterior Staple System - Washer The ARI Anterior Staple System - washer One size only $235.00
Johnson & Johnson Medical Pty Ltd
DP049 VSP System (Titanium) Washers - Standard / Tapered 3 & 5mm $235.00
DP430 Moss Miami (Stainless Steel) Washers - slotted, angled Slotted/Angled or 3-5mm $235.00
DY127 VSP System (Stainless Steel) Washers - Standard / Tapered $235.00
DY176 Monarch Spinal System Washer One size only $235.00
JJ649 Washer & Single Hole Staple - Washer and Single Hole Staple - Titanium One size only $235.00
Expedium Anterior Spine System
JJ758 Anterior Isola System Washer One Size only $235.00 $357.00
JJ768 Frontier Anterior Scoliosis System Washer One size only $235.00 $686.00
JJ770 Expedium Spine System Washer Various $235.00 $408.00
JJ830 Moss Miami (Titanium) Washers - slotted / angled One size only $235.00
Lifehealthcare Pty Ltd
LH267 Blackstone - Fixed System Washer Titanium One Size Only $235.00
Prostheses List by Category, Groups and Sponsor Page 716 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
LH268 Blackstone - Washer Titanium 2/4/6mm $235.00
LH269 Blackstone - Spacer Titanium 3/5mm $235.00
LH451 DSS Spacer The DSS Spacer is an integral component One size only $235.00
of the DSS pedicle screw construct. It is
used on the mono-axial DSS screw and is
used each time a screw is placed. It can
not be used on its own.
LH453 DSS Washer The DSS Washer is a washer that is an One size only $235.00
integral part of the DSS construct. The
DSS construct can not be used without
the washer nor can the washer be used as
a separate implant.
Nuvasive Australia and NZ Pty Ltd
NV006 Triad Facet Screw Washer One size $235.00
NV053 SpheRx II Anterior (Washer) When used as a pedicle screw fixation Small, Medium & Large $235.00
system, the SpheRx II anterior spinal
system, of which the washer is a
component, is intended to provide
immobilisation and stabilisation of spinal
segments in skeletally mature patients as an
adjunct to fusion in the treatment of the
following acute and chronic instabilities or
deformities of the posterior thoracic,
lumbar, and sacral spine: Degenerative disc
disease; Degenerative spondylolisthesis
with objective evidence of neurologic
impairment; Fracture; Dislocation;
Scoliosis; Kyphosis; Spinal Tumour;
and/or; Failed previous fusion
(pseudoarthrosis)
Synthes Australia Pty Ltd
SY150 Universal Spine System (USS) Washers Pointed, Flat, 4.2 - 7mm $235.00 $408.00
Zimmer Pty Ltd
ZI636 BacFix (Thoracolumbar System) Anterior washer - Titanium alloy Small, standard $235.00 $268.00
Prostheses List by Category, Groups and Sponsor Page 717 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
1c
Nuvasive Australia and NZ Pty Ltd
NV074 Radian Facet Screw System (Washer) Washer one size $235.00
Group 9b - Staple
Biomet Australia Pty Ltd
BH078 Synergy Spinal System Washers Single/Double 16mm - 21mm $410.00 $1,100.00
Emergo Asia Pacific Pty Ltd
ER032 ARI Anterior Staple System - Staple A non-cervical anterolateral thoracolumbar Single Hole Design and Dual $410.00
screw stabilization as an adjunct to fusion. Hole Design: 13mm, Left &
Right; 16mm, Left & Right;
18mm, Left & Right.
Johnson & Johnson Medical Pty Ltd
DP581 Kaneda Anterior Scoliosis System S/S Staple Single or Double Hole Small - Large $410.00
JJ643 Dual Hole Staple - Expendium Anterior Dual Hole Staple - Titanium Small to Xlarge - 4 sizes $410.00
Spine System
JJ657 Single Hole Staple - Expedium Anterior Single Hole Staple - Titanium One Size Only $410.00
Spine System
JJ759 Anterior Isola System Single hole staple 16 - 22mm $410.00
JJ769 Frontier Anterior Scoliosis System Staple Single and dual hole $410.00 $686.00
JJ771 Expedium Spine System Staple Various $410.00
JJ829 Moss Miami (Titanium) Staple Washer One size only $410.00
Lifehealthcare Pty Ltd
LH271 Blackstone - Staple Titanium 2/4/6mm $410.00
Medtronic Australasia Pty Ltd
MC431 Colorado Spinal System Staple One size only $410.00
MC437 CD-Horizon Staples 10 - 30mm $410.00
MC614 Vantage Vantage Plates and Screws; Staple One Size Only $410.00 $1,150.00
(rostral/caudal)
Prostheses List by Category, Groups and Sponsor Page 718 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Nuvasive Australia and NZ Pty Ltd
NV046 SpheRx II Anterior (Staple - Various) When used as a pedicle screw fixation Small, Medium & Large $410.00
system, the SpheRx II anterior spinal
system, of which the staple (various) is a
component, is intended to provide
immobilisation and stabilisation of spinal
segments in skeletally mature patients as an
adjunct to fusion in the treatment of the
following acute and chronic instabilities or
deformities of the posterior thoracic,
lumbar, and sacral spine: Degenerative disc
disease; Degenerative spondylolisthesis
with objective evidence of neurologic
impairment; Fracture; Dislocation;
Scoliosis; Kyphosis; Spinal Tumour;
and/or; Failed previous fusion
(pseudoarthrosis)
NV050 SpheRx II Anterior (Staple - Single Hole) When used as a pedicle screw fixation Small, Medium & Large $410.00
system, the SpheRx II anterior spinal
system, of which the staple (single hole) is
a component, is intended to provide
immobilisation and stabilisation of spinal
segments in skeletally mature patients as an
adjunct to fusion in the treatment of the
following acute and chronic instabilities or
deformities of the posterior thoracic,
lumbar, and sacral spine: Degenerative disc
disease; Degenerative spondylolisthesis
with objective evidence of neurologic
impairment; Fracture; Dislocation;
Scoliosis; Kyphosis; Spinal Tumour;
and/or; Failed previous fusion
(pseudoarthrosis)
Stryker Australia Pty Ltd
SK242 Xia Spinal System Titanium or Stainless Steel Single Hole Staple; Dual Hole $410.00
Staples (Caudal/Rostral) -
Small, Medium, Large
Prostheses List by Category, Groups and Sponsor Page 719 of 911
ORTHOPAEDIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
C - Complex
Medtronic Australasia Pty Ltd
MC592 CD Horizon System SMA Staple Length 4-10mm $1,240.00 $1,421.00
MC593 CD Horizon System SMA Staple Length 12-18mm $1,595.00
Hip F - Accessory
Group 30h - Mesh
Johnson & Johnson Medical Pty Ltd
DP223 Thackray Mesh Stainless Steel Ortron 90 mesh 200x200mm $144.00
Stryker Australia Pty Ltd
HW044 Exeter Hip System X-Change Revision Mesh - Stainless Steel Acetabular, Femoral and Flat $889.00
Mesh
HW045 Exeter Hip System X-Change Revision Mesh -Rim - Small $886.00
Stainless Steel
HW046 Exeter Hip System X-Change Revision Mesh - Rim - Large $855.00
Stainless Steel
HW048 Trochanteric Mesh Stainless Steel Small/Large $510.00
Zimmer Pty Ltd
ZI329 CPT Impaction Grafting Mesh Titanium Femoral or acetabular mesh 6 sizes acetabular rim (small $3,367.00
and large), medial wall (small
and large), flat and femoral
meshes
Group 30z - Other
Stryker Australia Pty Ltd
HW194 Howmedica Modular Resection System Femoral Joint - Vitallium One size only $3,572.00
Prostheses List by Category, Groups and Sponsor Page 720 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.1.1 Mesh for Bone Fixation
7.1.1.10 CMF, 0.2 to 0.49mm thick, 1 to 10 cm2 area
Medical & Optical Instruments Australia Pty Ltd
MO298 Martin Level One Fixation Mesh, Titanium 0.2 to 0.49mm thick, 1 to $350.00
10cm² area
Complex
Synthes Australia Pty Ltd
SY485 Mesh Plate Titanium malleable mesh plates 0.2mm-0.4mm, 1-10cm2 $725.00 $1,000.00
Complex - Orbital
Medical & Optical Instruments Australia Pty Ltd
MO303 Martin Level One Fixation Mesh, Titanium 0.2 to 0.49mm thick, 1 to $644.00
10cm² area
Synthes Australia Pty Ltd
SY481 Oribital Floor Mesh Plate Titanium orbital floor mesh plates <0.5mm $725.00 $1,048.00
Resorbable
Biomet Australia Pty Ltd
BI399 Lactosorb Resorbable Panel or Sheet, Solid or Holed, PGA/PLA 0.25mm x 25x25mm $450.00
Craniomaxillofacial Fixation System
Medical & Optical Instruments Australia Pty Ltd
MO299 Martin Level One Fixation Resorb x & Mesh PDLLA (resorbable) 0.20 to 0.49mm thick, 1 to 10 $450.00
SonicWeld cm2 area
7.1.1.11 CMF, 0.2 to 0.49mm thick, 11 to 25 cm2 area
Australian Surgical Innovations Pty Ltd
AI005 ASI Plates and Screws Mesh . $700.00
Biomet Australia Pty Ltd
BH031 W Lorenz Osteosynthesis Mesh 1.5mm system, precontoured, titanium 40 x 40 x 0.3mm profile $725.00 $900.00
Johnson & Johnson Medical Pty Ltd
JJ732 Bioplate - Biomesh 1MC 1MC (0.3mm) thick titanium malleable 36 x 43mm $700.00
mesh
Prostheses List by Category, Groups and Sponsor Page 721 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ797 BIOPLATE Biomesh Titanium mesh for cranial fixation system 1.5mm diam, 0.6mm thickness, $510.00
36mm x 52mm
Medtronic Australasia Pty Ltd
MC889 TiMesh Square-rectangular Gridmesh Panel 11 to 25 cm2 area $700.00
Stryker Australia Pty Ltd
ST390 Luhr Fixation System Luhr Micro and Pan Fixation Systems: 40x60mm $700.00
Micro mesh Vitallium
Surgiplas Medical
SP080 Plates Micro, Mini Mesh 50mm x 37, 36 x 50mm, $700.00
Mesh 11 to 25cm2 area
SP107 OsteoMed Plating & Fixation System Plates 40 x 40mm Osteoform Mesh, $700.00 $1,250.00
Mesh 11 to 25cm2 area.
Synthes Australia Pty Ltd
SY479 Mesh Plate Titanium malleable mesh plates <0.2mm-0.49mm, 11-25 cm2 $700.00 $960.00
Complex - Orbital
Medical & Optical Instruments Australia Pty Ltd
MO304 Martin Level One Fixation Mesh Ttianium 0.20 to 0.49mm thick, 11 to 25 $725.00
cm2 area
Resorbable
Biomet Australia Pty Ltd
BI400 Lactosorb Resorbable Cover, Solid or Holed, PGA/PLA (0.25, 0.5, 0.75mm) x 38x38mm $680.00 $850.00
Craniomaxillofacial Fixation System
BI401 Lactosorb Resorbable Cover, Solid or Holed, PGA/PLA 0.25mm x 50x50mm $680.00 $1,300.00
Craniomaxillofacial Fixation System
Surgical Specialties
SQ049 Inion GTR Biodegradable System PLGA/TMC Copolymer: membrane & a) 30 x 40mm membrane kit; b) $680.00
tacks 6 tack kit and applicator
7.1.1.12 CMF, 0.2 to 0.49mm thick, 26 to 50 cm2 area
Biomet Australia Pty Ltd
BH022 W Lorenz Osteosynthesis System Panel, Regular or Small Grid. Titanium (80,85) x (50-53)mm x (0.3 or $850.00 $1,315.00
0.2mm)
BI604 W Lorenz Osteosynthesis System Sheet, 1mm System. Titanium 85x50x0.2mm $700.00 $1,127.00
Prostheses List by Category, Groups and Sponsor Page 722 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BI645 W Lorenz Osteosynthesis System Mesh panel. 1.5mm System Titanium 83 x 51mm x(0.3 or 0.2mm) $700.00 $1,127.00
Johnson & Johnson Medical Pty Ltd
JJ256 BIOPLATE Biomesh Titanium cranial biomesh, packaged non- 0.45mm thickness, 60 x 60mm $700.00
sterile
Medtronic Australasia Pty Ltd
MC914 TiMesh Titanium Rigid Fixation Bone FlexMesh 1.5mm System. Composition: 26 to 50 cm2 area; 0.3mm $700.00 $1,000.00
Grafting and Plating System Titanium thick
Surgiplas Medical
SP068 Plates Micro, Mini, Maxi Mesh 50mm x 74mm Mesh 26 $700.00
to 50cm2 area
Complex - Cranium
Synthes Australia Pty Ltd
SY490 Mesh Plate Titanium Contourable mesh plate - mastoid <0.2 to 0.49mm, >25cm2 $850.00
Resorbable
Medical & Optical Instruments Australia Pty Ltd
MO188 Martin Level One Fixation Resorb x & Mesh, PDLLA (resorbable) 0.20 to 0.49mm thick, 26 to $1,490.00
SonicWeld Rx 50cm² area
7.1.1.13 CMF, 0.2 to 0.49mm thick, 51 to 100 cm2 area
Johnson & Johnson Medical Pty Ltd
JJ257 BIOPLATE Biomesh Titanium cranial biomesh, packaged non- 0.45mm thickness, 85 x 90mm $1,400.00
sterile
Medical & Optical Instruments Australia Pty Ltd
MO127 Martin Level One Fixation Mesh, Titanium 0.20 to 0.49mm thick, 51 to $1,400.00 $2,200.00
100cm² area
Medtronic Australasia Pty Ltd
MC524 TiMesh Isogrid Panel One size only $1,400.00
MC525 TiMesh Sugar Mesh Panel / Grid 11 x 7.5cm $1,400.00
MC887 TiMesh Titanium Mesh Panel 51 to 100 cm2 area $1,400.00
MC890 TiMesh Square-rectangular Gridmesh Panel 51 to 100 cm2 area $1,400.00
MC912 TiMesh Titanium Rigid Fixation Bone FlexMesh 1.0mm system. Composition: 51 to 100 cm2 area; 0.3mm $1,400.00
Grafting and Plating System Titanium thick
Prostheses List by Category, Groups and Sponsor Page 723 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC916 TiMesh Titanium Rigid Fixation Bone FlexMesh 1.5mm System. Composition: 51 to 100 area; 0.3mm thick $1,400.00
Grafting and Plating System Titanium
Stryker Australia Pty Ltd
ST391 Luhr Fixation System Luhr Micro and Pan Fixation Systems: 60x100mm $1,400.00
Micro mesh Vitallium
ST855 Leibinger Titanium Implant System Mesh: Micro, Dumbach, Dynamic Diameter 1.0mm - 2.3mm; 90 x $1,400.00
90mm to 200 x 200mm
Surgiplas Medical
SP078 Plates Micro, Mini Mesh Sheet 100mm x 74mm $1,400.00
Mesh 51 to 100cm2 area
SP109 OsteoMed Plating & Fixation System Plates 90 x 90mm Osteoform Mesh, $1,400.00
Mesh 51 to 100cm2 area.
Synthes Australia Pty Ltd
SY488 Mesh Plate Titanium Contourable mesh plate <0.2 to 0.49mm 51 to 100cm2 $1,400.00
Resorbable
Biomet Australia Pty Ltd
BI998 Lactosorb Resorbable Panel or Sheet, Solid or Holed, PGA/PLA 0.25mmx100x100mm $1,750.00 $2,150.00
Craniomaxillofacial Fixation System
7.1.1.14 CMF, 0.2 to 0.49mm thick, 101 to 200 cm2 area
Biomet Australia Pty Ltd
BH024 W Lorenz Osteosynthesis System Pre-contoured Neuro Mesh, titanium 163 x 115 x 0.3mm $1,480.00
Johnson & Johnson Medical Pty Ltd
JJ798 BIOPLATE Biomesh Titanium cranial biomesh, packaged non 132 x 134mm, 0.45mm $1,480.00 $1,770.00
sterile thickness
Medtronic Australasia Pty Ltd
MC888 TiMesh Titanium Mesh Panel 100 to 200 cm2 area $1,480.00 $1,800.00
7.1.1.15 CMF, 0.2 to 0.49mm thick, >200cm2 area
Biomet Australia Pty Ltd
BH018 W Lorenz Osteosynthesis System Sheet 1.5mm System. Titanium (203-206)mm x (123-127)mm $1,500.00 $1,750.00
x (0.2-0.3)mm
Prostheses List by Category, Groups and Sponsor Page 724 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
JJ441 Titanium Mesh Titanium Mesh Sterile 0.2mm thickness, 15cm x 15cm $1,500.00
Medtronic Australasia Pty Ltd
MC387 TiMesh Rigid Fixation Bone Grafting and Titanium, Square Grid Mesh Large $1,500.00 $2,000.00
Plating System
Surgiplas Medical
SP106 OsteoMed Plating & Fixation System Plates 111 x 191mm Mesh Plate, $1,500.00
Mesh > 200cm2 area.
Synthes Australia Pty Ltd
SY314 AO/ASIF Plate Titanium Mesh for reconstruction of cranial 200 x 200mm square, 0.4mm - $1,500.00
defects, Low Profile Neuro Mesh 0.6mm thick, Contourable
SY480 Mesh Plate Titanium malleable mesh plates 0.4mm > 200cm2 205x205 $1,500.00
7.1.1.18 CMF, 0.5 to 0.8mm thick, 1 to 10 cm2 area
Medical & Optical Instruments Australia Pty Ltd
MO129 Titan Mesh Mesh Plates Titanium 1 x 2 holes 1, 1.5, 2mm $315.00
MO289 Martin Level One Fixation Mesh Titanium 0.5 to 0.8mm thick, 1 to 10cm2 $315.00
area
Medtronic Australasia Pty Ltd
MC389 TiMesh Rigid Fixation Bone Grafting and Titanium, Square Grid Mesh Small $315.00
Plating System
MC898 Macropore Orbital Floor Liner 1 to 10 cm2 area; 1.0mm thick $650.00
Stryker Australia Pty Ltd
ST245 Leibinger Titanium Implant System Leibinger Mesh Implants Titanium 75 x 12 x 0.5mm $315.00
Resorbable
Biomet Australia Pty Ltd
BI417 Lactosorb Resorbable Cover, Solid or Holed, PGA/PLA (0.5 or 0.8mm) x 25 x 25mm $600.00
Craniomaxillofacial Fixation System
Medical & Optical Instruments Australia Pty Ltd
MO300 Martin Level One Fixation Resorb x & Mesh, PDLLA (resorbable) 0.50 to 0.80mm thick, 1 to $600.00
SonicWeld Rx 10cm² area
Prostheses List by Category, Groups and Sponsor Page 725 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC630 Macropore FRP (fast resorbing Polylactide and Polyglycolide polymer 25mm x 25mm x 0.75mm $600.00
polymer)
MC895 Macropore Protective Sheets 1 to 10 cm2 area; 0.5mm thick $600.00
Resorbable, Complex - Orbital
Medtronic Australasia Pty Ltd
MC897 Macropore Orbital Floor Liner 1 to 10 cm2 area; 0.5mm or $650.00
0.75mm thick
Resorbable, Orbital
Medical & Optical Instruments Australia Pty Ltd
MO301 Martin Level One Fixation Resorb x & Mesh, PDLLA (resorbable) 0.50 to 0.80mm thick, 1 to $650.00
SonicWeld Rx 10cm² area
7.1.1.19 CMF, 0.5 to 0.8mm thick, 11 to 25 cm2 area
Biomet Australia Pty Ltd
BH030 W Lorenzo Osteosynthesis Mesh 1.5mm system, precontoured, titanium 40 x 40 x 0.6mm profile $945.00 $1,000.00
Johnson & Johnson Medical Pty Ltd
JJ733 Bioplate - Biomesh 3MC 3MC (0.6mm) thick titanium malleable 36 x 52mm $510.00
mesh
JJ796 BIOPLATE Biomesh Titanium mesh for cranial fixation system 1.5mm diam; 0.45mm $700.00
thickness, 32 x 48mm
Medical & Optical Instruments Australia Pty Ltd
MO309 Titan Mesh Mesh Plates Titanium Box plate 50x30 profile 0.6mm $510.00
Medtronic Australasia Pty Ltd
MC893 Macropore Protective Sheets 11 to 25 cm2 area, 0.5mm $945.00
thick
Stryker Australia Pty Ltd
HW443 E-POR Biomaterial/ Panel - Porous Panel - Porous Polyethylene Titanium 0.5mm - 0.8mm thick, 38mm x $900.00
Polyethlene Titanium Mesh Composite Mesh Composite 50mm
ST246 Leibinger Titanium Implant System Leibinger Mesh Implants Titanium 75 x 18 x 0.5mm $510.00
Prostheses List by Category, Groups and Sponsor Page 726 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST247 Leibinger Titanium Implant System Leibinger Mesh Implants Titanium .75 x 27 x 0.5mm $510.00
Surgiplas Medical
SP108 OsteoMed Plating & Fixation System Plates 40 x 40mm Osteoform Mesh, $510.00 $1,250.00
Mesh 11 to 25cm2 area.
Orbital
Medical & Optical Instruments Australia Pty Ltd
MO310 Martin Level One Fixation Mesh, Titanium 0.50 to 0.80mm thick, 11 to $800.00
25cm² area
Resorbable
Biomet Australia Pty Ltd
BI418 Lactosorb Resorbable Panel, Lactosorb. 1.5mm System. 25 x 50mm (5 x 10 hole) $945.00 $1,200.00
Craniomaxillofacial Fixation System PGA/PLA
BI419 Lactosorb Resorbable Cover, Solid or Holed, PGA/PLA (0.5 or 0.8)mm x 50x50mm $945.00 $1,400.00
Craniomaxillofacial Fixation System
Medtronic Australasia Pty Ltd
MC629 Macropore FRP (fast resorbing Polylactide and Polyglycolide polymer 50mm x 50mm 0.75mm $945.00
polymer)
Synthes Australia Pty Ltd
SY544 PolyMax Rapid-Resorbable Fixation Mesh Plate Mesh for bone fixation, CMF, $945.00
System 0.5-0.8mm thick, 11-25cm2
7.1.1.2 CMF, <0.2mm thick, 1 to 10 cm2 area
Medical & Optical Instruments Australia Pty Ltd
MO291 Martin Level One Fixation Mesh, Titanium <0.2mm thick, 1 to 10cm² area $165.00 $361.00
Resorbable
Medtronic Australasia Pty Ltd
MC551 Macropore Protective Disc 25mm $165.00
MC554 Macropore CraniDisk 23 - 28mm $165.00
MC568 Macropore Bur Hole Cover 25mm $165.00
Prostheses List by Category, Groups and Sponsor Page 727 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.1.1.20 CMF, 0.5 to 0.8mm thick, 26 to 50 cm2 area
Biomet Australia Pty Ltd
BH023 W Lorenz Osteosynthesis System Panel, Regular or Small Grid. Titanium (80,85) x 53mm x 0.6mm $1,230.00 $1,315.00
BI644 W Lorenz Osteosynthesis System Mesh panel, 1.5mm System. Titanium 83 x 51mm x 0.6mm $980.00 $1,165.00
Johnson & Johnson Medical Pty Ltd
JJ258 BIOPLATE Biomesh Titanium cranial biomesh, packaged non- 0.6mm thickness, 65 x 65mm, $980.00
sterile 90 x 92mm
Medical & Optical Instruments Australia Pty Ltd
MO306 Martin Level One Fixation Mesh, Titanium 0.50 to 0.80mm thick, 26 to $980.00 $1,620.00
50cm² area
Medtronic Australasia Pty Ltd
MC915 TiMesh Titanium Rigid Fixation Bone FlexMesh 1.5mm System. Composition: 26 to 50 cm2 area; 0.6mm $980.00
Grafting and Plating System Titanium thick
Stryker Australia Pty Ltd
HW440 E-POR Biomaterial/ Panel - Porous Panel - Porous Polyethlene Titanium Mesh >0.8mm thick, 38mm x 50mm $975.00
Polyethlene Titanium Mesh Composite Composite
HW444 E-POR Biomaterial/ Panel - Porous Panel - Porous Polyethylene Titanium 0.5mm-0.8mm thick, 76mm x $1,050.00
Polyethlene Titanium Mesh Composite Mesh Composite 50mm
Surgiplas Medical
SP093 OsteoMed Plating & Fixation System Plates - Reconstruction Mesh Malleable/Ridgid, 74 x $980.00 $1,100.00
50mm, Mesh, 0.5 to 0.8mm
thick, 26 to 50cm3 area
Resorbable
Medical & Optical Instruments Australia Pty Ltd
MO305 Martin Level One Fixation Resorb x & Mesh, PDLLA (resorbable) 0.50 to 0.80mm thick, 26 to $1,230.00 $1,600.00
SonicWeld Rx 50cm² area
Medtronic Australasia Pty Ltd
MC560 Macropore Protective Sheets 60 x 80 x 0.5mm - 60 x 80 x $1,230.00
1.0mm
MC628 Macropore FRP (fast resorbing Polylactide and Polyglycolide polymer 60mm x 80mm x 0.75mm $1,230.00
polymer)
Prostheses List by Category, Groups and Sponsor Page 728 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.1.1.21 CMF, 0.5 to 0.8mm thick, 51 to 100 cm2 area
Aus Systems Pty Ltd
AU057 Titanium Surgical Mesh Titanium Surgical Mesh Mesh to suit 2mm screw $1,175.00
AU058 Titanium Surgical Mesh Titanium Surgical Mesh Mesh to suit 1.5mm screw $1,175.00
B Braun Australia Pty Ltd
BB315 Aesculap CranioPlate System/Plate Cranial fixation system, internal fracture, Plate Neuro, 65 x 90 mm, $1,175.00
Neuro, 65 x 90mm, 0.6mm mesh non biodegradable. Consists of screws, 0.6mm Mesh
plates.
Medtronic Australasia Pty Ltd
MC623 TiMesh Titanium Rigid Fixation Bone FlexMesh 2.2mm System. Composition: 114mm x 82mm, 0.6mm $1,175.00 $1,450.00
Grafting and Plating System Titanium.
MC877 TiMesh Rigid Fixation Bone Grafting and Titanium, Mesh 51 to 100 cm2 area, 0.6mm $1,175.00 $1,450.00
Plating System thickness
MC913 TiMesh Titanium Rigid Fixation Bone FlexMesh 1.0mm system. Composition: 51 to 100 cm2 area; 0.6mm $1,175.00 $1,450.00
Grafting and Plating System Titanium thick
MC917 TiMesh Titanium Rigid Fixation Bone FlexMesh 1.5mm System. Compostition: 51 to 100 cm2 area; 0.6mm $1,175.00 $1,450.00
Grafting and Plating System Titanium thick
Stryker Australia Pty Ltd
ST250 Leibinger Titanium Implant System Mesh: Micro, Dumbach, Dynamic Diameter 1.0mm - 2.3mm; Up $1,175.00
to 90 x 90mm
Surgiplas Medical
SP110 OsteoMed Plating & Fixation System Plates 90 x 90mm Osteoform Mesh, $1,175.00 $1,250.00
Mesh 51 to 100cm2 area.
Synthes Australia Pty Ltd
SY489 Mesh Plate Titanium Contourable mesh plate 0.5 to 0.8mm 51 to 100cm2 $1,175.00 $1,600.00
3D
Medical & Optical Instruments Australia Pty Ltd
MO251 Martin Level One Fixation Mesh, Titanium 0.50 to 0.80mm thick, 51 to $1,155.00 $2,600.00
100cm² area
Resorbable
Biomet Australia Pty Ltd
BI999 Lactosorb Resorbable Panel or Sheet, Solid or Holed, PGA/PLA (0.5 or 0.8)mm 100x100mm $1,480.00 $2,150.00
Craniomaxillofacial Fixation System
Prostheses List by Category, Groups and Sponsor Page 729 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC627 Macropore FRP (fast resorbing Polylactide and Polyglycolide polymer 100mm x 100mm x 0.75mm $1,480.00 $1,940.00
polymer)
MC899 Macropore Protective Sheets 51 to 100 cm2 area; 0.5mm $1,480.00 $1,940.00
thick
Synthes Australia Pty Ltd
SY547 PolyMax Rapid-Resorbable Fixation Mesh Plate Mesh for bone fixation, CMF, $1,450.00
System >0.8mm thick, 51-100cm2
area
7.1.1.22 CMF, 0.5 to 0.8mm thick, 101 to 200 cm2 area
Biomet Australia Pty Ltd
BH025 W.Lorenz Osteosynthesis System Pre-contoured Neuro Mesh titanium 163 x 115 x 0.6mm $2,100.00 $2,370.00
Johnson & Johnson Medical Pty Ltd
JJ799 BIOPLATE Biomesh Titanium cranial biomesh, packaged non 127 x 131mm, 0.6mm $1,255.00 $1,933.00
sterile thickness
Medtronic Australasia Pty Ltd
MC878 TiMesh Rigid Fixation Bone Grafting and Titanium, Mesh 101 to 200 cm2 area; 0.5 or $1,255.00 $1,750.00
Plating System 0.6mm thickness
Synthes Australia Pty Ltd
SY482 Mesh Plate Titanium rigid mesh plates 0.6mm < 200cm2 $1,255.00
Resorbable
Medical & Optical Instruments Australia Pty Ltd
MO204 Martin Level One Fixation Resorb x & Mesh, PDLLA (resorbable) 0.50 to 0.80mm thick, 101 to $2,100.00 $5,000.00
SonicWeld Rx 200cm² area
7.1.1.23 CMF, 0.5 to 0.8mm thick, >200cm2 area
Biomet Australia Pty Ltd
BH019 W Lorenz Osteosynthesis System Sheet 1.5mm System. Titanium 206 x 123 x 0.6mm $1,750.00 $2,370.00
Johnson & Johnson Medical Pty Ltd
JJ260 BIOPLATE Biomesh Titanium cranial biomesh 3ME, packaged 20 x 20cm $1,750.00 $3,455.00
non-sterile
Prostheses List by Category, Groups and Sponsor Page 730 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC620 TiMesh Titanium Rigid Fixation Bone FlexMesh 1.5mm System 148mm x 148mm, 0.6mm $1,750.00 $2,243.00
Grafting and Plating System
MC624 TiMesh Titanium Rigid Fixation Bone FlexMesh 2.2mm System. Composition: 154mm x 154mm, 0.6mm $1,750.00 $2,243.00
Grafting and Plating System Titanium.
Surgiplas Medical
SP112 OsteoMed Plating & Fixation System Plates 125 x 180mm Mesh Plate, 150 $1,750.00 $2,975.00
x 300mm Mesh Plate, Mesh
>200cm2 area..
Synthes Australia Pty Ltd
SY483 Mesh Plate Titanium rigid mesh plates 0.6mm > 200cm2 $1,750.00
7.1.1.24 CMF, 0.5 to 0.8mm thick, unspecified
Synthes Australia Pty Ltd
SY484 Mesh Plate Titanium rigid mesh plates - complex shape 0.6mm $1,690.00
7.1.1.26 CMF, >0.8mm thick, 1 to 10 cm2 area
Resorbable
Medtronic Australasia Pty Ltd
MC896 Macropore Protective Sheets 1 to 10 cm2 area; 1.0mm thick $470.00
7.1.1.27 CMF, >0.8mm thick, 11 to 25 cm2 area
Medtronic Australasia Pty Ltd
MC894 Marcropore Protective Sheets 11 to 25 cm2 area, 1.0mm $950.00
thick
Resorbable
Biomet Australia Pty Ltd
BI427 Lactosorb Resorbable Mesh, Mandibular Lactosorb 2.5mm 1.42mm x 42x42mm $950.00 $1,367.00
Craniomaxillofacial Fixation System System. PGA/PLA
Medical & Optical Instruments Australia Pty Ltd
MO231 Martin Level One Fixation Resorb x & Mesh, PDLLA (resorbable) >0.80mm thick, 11 to 25cm² $950.00
SonicWeld Rx area
Prostheses List by Category, Groups and Sponsor Page 731 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Synthes Australia Pty Ltd
SY545 PolyMax Rapid-Resorbable Fixation Mesh Plate Mesh for bone fixation, CMF, $950.00
System >0.8mm thick,11-25cm2
7.1.1.28 CMF, >0.8mm thick, 26 to 50 cm3 area
Stryker Australia Pty Ltd
HW441 E-POR Biomaterial/ Panel - Porous Panel - Porous Polyethylene Titanium >0.8mm thick, 76mm x 50mm $1,150.00
Polyethylene Titanium Mesh Composite Mesh Composite
Resorbable
Stryker Australia Pty Ltd
ST516 Stryker Leibinger Resorbable Fixation Resorbable plate: blank panel Tripolymer 55x55mm $1,020.00
System
ST526 Stryker Leibinger Resorbable Fixation Resorbable Mesh Tripolymer 55x55mm $1,020.00
System
7.1.1.29 CMF, >0.8mm thick, 51 to 100 cm2 area
Medtronic Australasia Pty Ltd
MC900 Macropore Protective Sheets 51 to 100 cm2 area; 1.0mm $1,430.00
thick
Resorbable
Synthes Australia Pty Ltd
SY546 PolyMax Rapid-Resorbable Fixation Mesh Plate Mesh for bone fixation, CMF, $1,175.00
System 0.5-0.8mm thick, 51-100cm2
area
Prostheses List by Category, Groups and Sponsor Page 732 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.1.1.3 CMF, <0.2mm thick, 11 to 25 cm2 area
Resorbable, Complex - Orbital
Johnson & Johnson Medical Pty Ltd
JJ687 PDS Plates Absorbable synthetic (poly-p-dioxanone) 0.25mm x 30mm x 40mm $515.00
plate/foil 0.5mm
x 30mm x 40mm
0.25mm x
40mm x 50mm
0.5mm x 40mm x
50mm
7.1.1.5 CMF, <0.2mm thick, 51 to 100 cm2 area
Medical & Optical Instruments Australia Pty Ltd
MO290 Martin Level One Fixation Mesh, Titanium <0.2mm, 51 to 100cm² area $380.00 $1,512.00
MO292 Martin Level One Fixation Mesh, Titanium <0.2mm thick, 51 to 100cm² $700.00 $1,564.00
area
7.1.2 Clamps, Pins, Tacks, Washers, Other Ancillary Components
7.1.2.10 Pin
Synthes Australia Pty Ltd
SY345 Titanium Sternal Fixation System Titanium Emergency Release Pin One Size only $95.00 $110.00
7.1.2.11 Tack
Resorbable
Medtronic Australasia Pty Ltd
MC570 Macropore Tacks 1.5 x 4mm - 2.0 x 6mm $52.00
Surgical Specialties
SQ050 Inion GTR Biodegradable System PLGA/TMC Copolymer: membrane & 6 tack kit $52.00
tacks
Prostheses List by Category, Groups and Sponsor Page 733 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.1.2.12 Washer
Stryker Australia Pty Ltd
SK146 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible Bi-concave $30.00
Universal Mandible Biconcave Washer of mandibular fractures and tumour Washer
resection
7.1.2.13 Wedges and Spacers
Polymer
Stryker Australia Pty Ltd
HW435 E-POR Biomaterial/ Craniotomy Gap Craniotomy Gap Wedge Porous One Size - V and T shape $385.00
Wedge Porous Polyethylene Polyethylene
HW439 E-POR Biomaterial/ Burr Hole Cover, Burr Hole Cover, Porous Polyethylene 15mm x 3mm x 5mm; 29mm x $385.00
Porous Polyethylene 7mm x 14mm
7.1.2.14 Other Ancillary
Cook Medical Australia Pty Ltd
WC264 SYSTEM- Doppler Blood Flow The Cook-Swartz Implantable Doppler Universal [one size] $180.00 $390.00
Monitoring System. COMPONENT - Flow Probe is an implantable 20MHz
Cook-Swartz Implantable Doppler Flow Probe with epoxy-coated Crystal and
Probe patented Silicone Cuff which provides
continuous direct vessel monitoring of
microvascular anastomoses. A 30cm wire
with external Retention Tabs is attached to
the 1mm diamter Crystal.
Surgiplas Medical
SP095 OsteoMed Plating & Fixation System Screws Locking Screw Inserts, Other $33.00 $140.00
ancillary
Resorbable
Medtronic Australasia Pty Ltd
MC580 Macropore Locks 2 - 20mm $250.00 $700.00
Prostheses List by Category, Groups and Sponsor Page 734 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.1.2.4 Anchor, Bone
Surgiplas Medical
SP096 OsteoMed Plating & Fixation System Screws MMF / Anchorage Screws $57.00 $140.00
1.2/1.6/2.0mm Anchor, Bone
7.1.2.5 Clamps
B Braun Australia Pty Ltd
BB072 Craniofix Titanium Clamps Titanium 11mm $95.00
BB073 Craniofix Titanium Clamps Titanium 16mm $95.00
BB168 Craniofix Titanium skull fixation clamp 20mm $95.00
Biomet Australia Pty Ltd
BI714 RapidFlap Cranial Clamp Clamp, Burr Hole or Craniotomy Line, 12, 16, 20mm $95.00 $108.00
Titanium
Cantley Medical Services
CF005 Cranial Loop Cranial Loop is a smart system for fixing One size - is suitable for 1.5mm $95.00 $100.00
Bone Flaps resulting from craniotomies. Its up to 24mm bone thickness as
instrument free, made from Peek - it is adjustable
Optima, allows the surgeon complete
control not artifacts seen on MRI/CT, its
fast and easy and takes less than a minute
for the bone to be fixed in place
Johnson & Johnson Medical Pty Ltd
JJ290 Burr hole button Sterile, 10 per package, silicone rubber Button length 35mm, cover $95.00
diameter 29mm, stem thickness
4.1mm
JJ291 Burr hole cover Burr hole cover, sterile, 10 per package, Seat diameter 10mm, seat $95.00
silicone rubber depth 6mm
JJ489 Bioplate ZIP Titanium Alloy Implant 11 - 12mm $95.00
JJ490 Bioplate ZIP Titanium Alloy Implant 15 - 16mm $95.00
JJ491 Bioplate ZIP Titanium Alloy Implant 18 - 20mm $95.00
Medtronic Australasia Pty Ltd
MC581 Invisx Locks Invisx polymer cranial fixation system Single pack $95.00 $175.00
Prostheses List by Category, Groups and Sponsor Page 735 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC582 Invisx Locks Invisx polymer cranial fixation system 2 pack $95.00 $175.00
Resorbable
B Braun Australia Pty Ltd
BB289 CranioFix Absorbable Double sided Cranial clamp, absorbable 11mm $95.00
polyester
7.1.3 Plate, General CMF and Small Fragments
7.1.3.1 CMF fracture or reconstruction plate, <0.5mm thick, <4 holes
Johnson & Johnson Medical Pty Ltd
JJ535 BIOPLATE Low Profile Low Profile 2-hole Straight Plate 11mm - 14mm length $65.00
Surgiplas Medical
SP076 Plates Micro, Midface & Mini Straight Plate - 2 Hole, Plate < $65.00 $120.00
4 holes.
Synthes Australia Pty Ltd
SY561 Matrix Micro Y Plate 3 hole $65.00
3D
Stryker Australia Pty Ltd
SK370 Universal Neuro NeuroClip 1.5mm $85.00
Pack
Biomet Australia Pty Ltd
BI949 Neurological Packs Plate & screws: Neuro pack - single plate 1.5mm or 2mm system $342.00 $360.00
or thinflip 2 hole plate set
7.1.3.10 CMF fracture or reconstruction plate, 0.5-0.99mm thick, >32 holes
Johnson & Johnson Medical Pty Ltd
JJ255 BIOPLATE Biomesh Titanium, lattice, 48 hole, packaged non- 32 x 44mm $300.00 $670.00
sterile
Surgiplas Medical
SP081 Plates Micro, Mini 40 Hole Straight Plate, Mesh $300.00 $506.00
18 row, Plate >32 holes.
Synthes Australia Pty Ltd
SY466 CMF fracture or reconstruction plate Titanium adaption plates 0.5 to 0.99mm > 32 holes $300.00
Prostheses List by Category, Groups and Sponsor Page 736 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Resorbable
Biomet Australia Pty Ltd
BH004 Lactosorb Resorbable Lactosorb Plates, 2mm System, All shapes >32 hole $380.00 $450.00
Craniomaxillofacial Fixation System PGA/PLA
BI993 Lactosorb Resorbable CMF System Lactosorb Plates, 1.5mm System 32+ holes- $380.00 $450.00
Synthes Australia Pty Ltd
SY514 CMF Rapid Resorbable fracture or Sterile Rapid resorbable reconstruction 0.5 to 0.99mm thick,> 32 holes $380.00
reconstruction Plate plate
7.1.3.11 CMF fracture or reconstruction plate, 1.0 to 1.99mm thick, <4 holes.
Medical & Optical Instruments Australia Pty Ltd
MO054 Martin Level One Fixation Plate, titanium 1 to 1.99mm thick, <4 holes $115.00
Stryker Australia Pty Ltd
ST497 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction 2 holes $115.00
Plating System: straight bridging plate
Titanium
ST498 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction 3 holes $115.00
Plating System: straight bridging plate
Titanium
Synthes Australia Pty Ltd
SY317 AO/ASIF Plate Titanium Plate - straight 1.6mm Profile, 2-4 holes $115.00
Resorbable
Synthes Australia Pty Ltd
SY506 CMF Rapid Resorbable fracture or Sterile Rapid resorbable reconstruction 1.0 to 1.99mm thick, <4 holes $220.00
reconstruction Plate plate
7.1.3.12 CMF fracture or reconstruction plate, 1.0 to 1.99mm thick, 4-7 holes.
Aus Systems Pty Ltd
AU002 Aus Systems Titanium Miniplates (Bone Low profile 2 & 4 hole Short, medium, long $165.00
Plates)
AU007 Aus Systems Titanium Miniplates (Bone Low profile pre-shaped - Square, T, L, Y, Short, medium, Long, 4 & 5 hole $165.00
Plates) Y Double & X
AU018 Aus Systems Titanium Miniplates (Bone Strip plates, Titanium (M10 series) 1mm profile, 4 holes $165.00
Plates)
Prostheses List by Category, Groups and Sponsor Page 737 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AU022 Aus Systems Titanium Miniplates (Bone Pre-shaped - L Small, Medium, Long $165.00
Plates)
AU055 Aus Systems Titanium Miniplates (Bone Pre-shaped - T, T Double, Y Small, Medium, Long, 4 & 5 $165.00
Plates) hole
AU056 Aus Systems Titanium Miniplates (Bone Pre-shaped - Y Double Small, Medium, Long $165.00
Plates)
Biomet Australia Pty Ltd
BH008 W Lorenz Osteosynthesis System 2.3mm Small Fragment System` Plate, all 2.3mm Small Fragment System` $165.00 $248.00
shapes, Titanium Plate, all shapes, Titanium
BH026 Mandibular Fracture System Plates, Angled or Curved, 2.0 Mandibular 4 - 7 hole $165.00 $200.00
System, Titanium
BH028 Manibular Fracture System Plates, matrix shape, 2.0 mandibular 4 or 6 hole $165.00 $207.00
system. Titanium
BI385 W Lorenz Osteosynthesis System Plate 2mm System 4-7 hole $165.00 $629.00
BI755 Mandibular Fracture System Plates, Y Shapek, 2.0 Mandibular 5 hole long, 5 hole medium, 5 $165.00 $210.00
Fracture System, Titanium hole regular
BI761 Mandibular Fracture System Plates, V Shape, 2.0 Mandibular Fracture 6 hole $165.00 $200.00
System, Titanium
BI764 Mandibular Fracture System Plates, 2.0 / 2.4 Mandibular Fracture 4-7 hole $165.00 $373.00
System, Titanium
Medical & Optical Instruments Australia Pty Ltd
MO282 Martin Level One Fixation Plate, titanium 1.0 to 1.99mm thick, 4 to 7 $165.00
holes
Medtronic Australasia Pty Ltd
MC514 TiMesh Mandibular Angle, Left/Right One size only $165.00 $1,010.00
MC517 TiMesh Mandibular "J" Plate One size only $165.00 $400.00
Stryker Australia Pty Ltd
SK134 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible Mini Plate, $165.00
Universal Mandible Mini Plate of mandibular fractures and tumour 4-6 holes with/without Bar
resection.
ST446 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate: 4 hole x 35mm $165.00
straight Titanium
ST447 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate: 45 4 holes, 40mm $165.00
deg plate Titanium
Prostheses List by Category, Groups and Sponsor Page 738 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST448 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate: 45 4 holes, 50mm $165.00
deg Titanium
ST452 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate: 6 holes $165.00
angled, 60 deg Titanium
ST481 Wurzburg Bone Plates Wurzburg Bone plate: double-T-shape, 4, 6 holes $165.00
with/without bar, 90 deg, regular/short
Titanium
ST482 Wurzburg Bone Plates Wurzburg Bone plate: double-Y-shape , 6, 8 holes $165.00
with/without bar, short/long/long extended
Titanium
ST483 Wurzburg Bone Plates Wurzburg Bone plate: double-Y-shape, no 7 holes $165.00
bridge Titanium
ST484 Wurzburg Bone Plates L-shape, right/left, Titanium 4 - 5 holes $165.00
ST486 Wurzburg Bone Plates Wurzburg Bone plate: T-shape, 5, 6 holes $165.00
with/without bar, 90 deg, regular/long
Titanium
ST487 Wurzburg Bone Plates Wurzburg Bone plate: T-shape, long, 80 5 holes $165.00
deg, long, right/left Titanium
ST488 Wurzburg Bone Plates Wurzburg Bone plate: Y-shape plate, 5 holes $165.00
regular/long Titanium
ST489 Wurzburg Bone Plates Wurzburg Bone plate: Z-shape plate, 4 holes $165.00
100/110 deg, right/left Titanium
ST491 Wurzburg Bone Plates Leibinger 3D Plating System: square 2x2 holes $165.00
Titanium
ST492 Wurzburg Bone Plates Leibinger 3D Plating System: rectangular 2x2 holes, 1mm thick $165.00
Titanium
ST493 Wurzburg Bone Plates Leibinger 3D Plating System: square 3x2 holes, 1mm thick $165.00
Titanium
ST500 Wurzburg Bone Plates Wurburg Mandibular Reconstruction 5 holes $165.00
Plating System: straight bridging plate
Titanium
ST501 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction 6 holes $165.00
Plating System: straight bridging plate
Titanium
ST502 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction 7 holes $165.00
Plating System: straight Titanium
Prostheses List by Category, Groups and Sponsor Page 739 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3D
Surgiplas Medical
SP073 Plates Micro, Midface, Mini, BSSO, TR BSSO 2 x 3 Hole Quad Plate, Plate 4 $185.00
to 7 holes.
Chin
Medical & Optical Instruments Australia Pty Ltd
MO224 Martin Level One Fixation Plate, titanium 1.0 to 1.99mm thick, 4 to 7 $350.00
holes
Complex
Stryker Australia Pty Ltd
SK131 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible Fracture $350.00
Universal Mandible Fracture Plate of mandibular fractures and tumour Plate, C-shaped, 4 holes
resection.
SK132 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible Fracture $350.00
Universal Mandible Fracture Plate of mandibular fractures and tumour Plate, Angled Shaped, 6 holes,
resection. 115-140 deg
Complex - Chin
Surgiplas Medical
SP018 Plates Micro, Midface, Mini & Maxi Chin Plate 2, 3, 4, 6, 8, 10 & $350.00
12mm, Plates 4 to 7 holes.
Complex - Condylar
Stryker Australia Pty Ltd
SK389 Universal System Condylar Prosthesis Left/Right $990.00
Compression
Biomet Australia Pty Ltd
BI754 Mandibular Fracture System Plates, Compression, 2.0 Mandibular 4 hole $295.00 $350.00
Fracture System, Titanium
BI756 Mandibular Fracture System Plates, Compression, 2.0 Mandibular 4-6 hole $295.00 $320.00
Fracture System, Titanium
Stryker Australia Pty Ltd
SK129 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible $295.00
Universal Mandible Compression Plate of mandibular fractures and tumour Compression Plate, 4-6 Holes
resection.
Prostheses List by Category, Groups and Sponsor Page 740 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Surgiplas Medical
SP028 OsteoMed Plating & Fixation System Plates - Fracture 4 hole Fracture Plate 32 - $295.00
37mm; EDC Plate 32mm &
34mm, 4 to 7 hole compression
plate.
SP034 OsteoMed Plating & Fixation System Compression Plates - Maxi Maxi: 4, 5 & 6 Hole Straight $295.00
Plate
Synthes Australia Pty Ltd
SY498 CMF fracture or reconstruction plate Mandible Plate, non-locking 1.0 to 1.99mm thick, 4 to 7 $295.00 $720.00
holes
Locking
Stryker Australia Pty Ltd
SK133 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible Fracture $470.00
Universal Mandible Fracture Plate of mandibular fractures and tumour Plate, 4-6 holes with/without Bar
resection.
SK144 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible 3D Plate, 4 $470.00
Universal Mandible 3D Plate of mandibular fractures and tumour x 2 Hole Square
resection
SK145 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible 3D Plate, 3 $470.00
Universal Mandible 3D Plate of mandibular fractures and tumour x 2 Hole Rectangle
resection
Surgiplas Medical
SP027 OsteoMed Plating & Fixation System Plates - Fracture 8 Hole Fracture Plate, 4 & 6 $470.00
hole locking fracture plate, 4 to
7 hole locking plate.
Synthes Australia Pty Ltd
SY486 CMF fracture or reconstruction plate Titanium mandible locking plate - complex 1.0 to 1.99mm 4 to 7 holes $470.00 $540.00
SY491 CMF fracture or reconstruction plate Titanium Mandibular locking 1.0 to 1.99 4 to 7 holes $470.00 $1,030.00
reconstruction plates - complex shape
Resorbable
Medical & Optical Instruments Australia Pty Ltd
MO185 Martin Level One Fixation Resorb x & Mesh, PDLLA (resorbable) 1.0 to 1.99mm thick, 4 to 7 $260.00 $360.00
SonicWeld Rx holes
Prostheses List by Category, Groups and Sponsor Page 741 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
ST519 Stryker Leibinger Resorbable Fixation Resorbable plate: L-shape plate, 110 deg, 7 holes $260.00
System right/left Tripoymer
Synthes Australia Pty Ltd
SY507 CMF Rapid Resorbable fracture or Sterile Rapid resorbable reconstruction 1.0 to 1.99mm thick, 4 to 7 $260.00
reconstruction Plate plate holes
Resorbable, Complex
Medtronic Australasia Pty Ltd
MC567 Macropore Clover Leaf Plates 4 hole $260.00 $450.00
7.1.3.13 CMF fracture or reconstruction plate, 1.0 to 1.99mm thick, 8-15 holes.
Biomet Australia Pty Ltd
BH009 W Lorenz Osteosynthesis System 2.3mm Small Fragment System, Plate, All 8-15 hole $450.00 $600.00
shapes Titanium
BH027 Mandibular Fracture System Plates, Angled or Curved, 2.0 Mandibular 8 hole $450.00 $600.00
System, Titanium
BH029 Mandibular Fracture System Plates, matrix shape, 2.0 mandibular 8 to 16 hole $450.00 $600.00
system. Titanium
BI767 Mandibular Fracture System Plates, Straight, 2.0 Mandibular Fracture 8-15 hole $450.00 $600.00
System, Titanium
Medical & Optical Instruments Australia Pty Ltd
MO313 Martin Level One Fixation Plate, titanium 1.0 to 1.99mm thick, 8 to 15 $450.00
holes
Medtronic Australasia Pty Ltd
MC522 TiMesh Curved Plate: Standard, Rigid, Left, Right 1mm x 12 holes $450.00
Stryker Australia Pty Ltd
ST449 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate: 8 holes, 60mm $450.00
straight Titanium
ST450 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate: 8 holes, 70mm $450.00
straight Titanium
ST494 Wurzburg Bone Plates Leibinger 3D Plating System: square, 4x2 holes, 1mm thick $450.00
rectangular Titanium
Prostheses List by Category, Groups and Sponsor Page 742 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST507 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction 9 holes $450.00
Plating System: total mandible bridging
plate Titanium
Surgiplas Medical
SP086 Plates Mini & Maxi 12 Hole Straight Plate 1.0 mm $450.00
thick, 8 Hole Straight Plate 1.0
mm thick, Plates 8 to 15 holes
LeFort
Medical & Optical Instruments Australia Pty Ltd
MO023 Martin Level One Fixation Plate, titanium 1.0 to 1.99mm thick, 8 to 15 $420.00
holes
Locking
Stryker Australia Pty Ltd
SK130 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible Fracture $645.00
Universal Mandible Fracture Plate of mandibular fractures and tumour Plate, 14 Holes
resection.
SK139 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible 3D Plate, $645.00
Universal Mandible 3D Plate of mandibular fractures and tumour (Full), 6 x 2 Hole, Curved,
resection. Square
Surgiplas Medical
SP117 OsteoMed Plating & Fixation System Mandible Locking plates 8-15 Hole Plates, 1.0-1.99 mm $645.00 $740.00
thick
Synthes Australia Pty Ltd
SY487 CMF fracture or reconstruction plate Titanium mandible locking plate 1.0 to 1.99mm 8 to 15 holes $645.00
SY492 CMF fracture or reconstruction plate Titanium Mandibular locking 1.0 to 1.99mm 8 to 15 holes $645.00 $1,200.00
reconstruction plates - complex shape
Resorbable
Medical & Optical Instruments Australia Pty Ltd
MO314 Martin Level One Fixation Resorb x & Plate, PDLLA (resorbable) 1.0 to 1.99mm thick, 8 to 15 $320.00 $480.00
SonicWeld Rx holes
Medtronic Australasia Pty Ltd
MC566 Macropore C Plates 8 hole $320.00 $550.00
Prostheses List by Category, Groups and Sponsor Page 743 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Synthes Australia Pty Ltd
SY508 CMF Rapid Resorbable fracture or Sterile Rapid resorbable reconstruction 1.0 to 1.99mm thick, 8 to 15 $320.00
reconstruction Plate plate holes
Resorbable, Complex - Orbital
Medical & Optical Instruments Australia Pty Ltd
MO186 Martin Level One Fixation Resorb x & Plate PDLLA (resorbable) 1.0 to 1.99mm thick,8 to 15 $420.00
SonicWeld holes
7.1.3.14 CMF fracture or reconstruction plate, 1.0 to 1.99mm thick, 16-32 holes.
Biomet Australia Pty Ltd
BI762 Mandibular Fracture System Plates, 2.4 Mandibular Fracture System, 16 - 24 Hole $770.00 $1,000.00
Titanium
Medical & Optical Instruments Australia Pty Ltd
MO295 Martin Level One Fixation Plate Titanium 1.0 to 1.99mm thick, 16 to 32 $770.00
holes
Stryker Australia Pty Ltd
ST451 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate: 16 holes, 120mm $770.00
straight Titanium
ST495 Wurzburg Bone Plates Leibinger 3D Plating System: rectangular 4x4 holes, 1mm thick $770.00
Titanium
ST496 Wurzburg Bone Plates Leibinger 3D Plating System: square, 6x4 holes, 1mm thick $770.00
rectangular Titanium
Surgiplas Medical
SP067 Plates Micro, Mini, Maxi 16 Hole Straight Plate, 1.0mm $770.00
thick, Plate 15 to 32 holes
Synthes Australia Pty Ltd
SY493 CMF fracture or reconstruction plate Titanium Mandibular locking 1.0 to 1.99 15 to 32 holes $818.00 $1,400.00
reconstruction plates - complex shape
3D
Medical & Optical Instruments Australia Pty Ltd
MO294 Martin Level One Fixation Plate, titanium 1.0 to 1.99mm thick, 16 to 32 $818.00 $992.00
holes
Prostheses List by Category, Groups and Sponsor Page 744 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Locking
Stryker Australia Pty Ltd
SK135 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible Mini Plate, $818.00
Universal Mandible Mini Plate of mandibular fractures and tumour 16 holes
resection.
SK136 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible Primary $818.00
Universal Mandible Primary of mandibular fractures and tumour Reconstruction Plate, (Hemi)
Reconstruction Plate resection. Left and Right 5+17 holes, with
template
SK137 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible Primary $818.00
Universal Mandible Primary of mandibular fractures and tumour Reconstruction Plate, 11-17
Reconstruction Plate resection. holes, with template
SK143 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible $818.00
Universal Mandible Reconstruction Plate of mandibular fractures and tumour Reconstruction Plate, (Full), 6 +
resection 15 + 6 holes, with template
SK296 Leibinger Titanium Implant System - Mandible Plates 4 hole 2.3mm Compression $818.00
Universal CMF Plate Plate; 6 Hole 2.3mm
Compression Plate
SK298 Leibinger Titanium Implant System - Mandible Plates 4-6 Hole, Straight Plate, $818.00
Universal CMF Plate with/without bar, locking
Surgiplas Medical
SP118 OsteoMed Plating & Fixation System Mandible Locking Plates 16-32 Hole Plates, 1.0-1.99 $818.00 $940.00
mm thick
Resorbable
Medical & Optical Instruments Australia Pty Ltd
MO293 Martin Level One Fixation Resorb x & Plate, PDLLA (resorbable) 1.0 to 1.99mm thick, 16 to 32 $345.00 $770.00
SonicWeld Rx holes
Synthes Australia Pty Ltd
SY509 CMF Rapid Resorbable fracture or Sterile Rapid resorbable reconstruction 1.0 to 1.99mm thick, 15 to 32 $345.00
reconstruction Plate plate holes
SY510 CMF Rapid Resorbable fracture or Sterile Rapid resorbable reconstruction 1.0 to 1.99mm thick,15 to 32 $345.00
reconstruction Plate plate holes
Prostheses List by Category, Groups and Sponsor Page 745 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.1.3.15 CMF fracture or reconstruction plate, 1.0 to 1.99mm thick, >32 holes
Resorbable
Synthes Australia Pty Ltd
SY511 CMF Rapid Resorbable fracture or Sterile Rapid resorbable reconstruction 1.0 to 1.99mm thick,> 32 holes $420.00
reconstruction Plate plate
7.1.3.17 CMF fracture or reconstruction plate, 2.0 to 2.99mm thick, 4- 7 holes
Compression
Synthes Australia Pty Ltd
SY499 CMF fracture or reconstruction plate Mandible Plate, non-locking 2.0 to 2.99mm thick, 4 to 7 $720.00
holes
Locking
Surgiplas Medical
SP120 OsteoMed Plating & Fixation System Mandible locking plates 4-7 Holes, 2.0-2.99 mm thick $620.00 $820.00
Resorbable
Biomet Australia Pty Ltd
BH005 Lorenz 2.4mm Locking Reconstruction Plate, Straight, 2.4mm System, Locking. 4-7 hole $620.00 $900.00
System Titanium
7.1.3.18 CMF fracture or reconstruction plate, 2.0 to 2.99mm thick, 8- 15 holes
Biomet Australia Pty Ltd
BI987 Lorenz 2.4mm Locking Reconstruction Plates Plate, Angled 2.4mm System, Ti 5 x 11 hole $1,100.00 $1,300.00
System
Compression
Synthes Australia Pty Ltd
SY497 CMF fracture or reconstruction plate Mandible Plate, non-locking 2.0 to 2.99mm thick, 8 to 15 $780.00
holes
Locking
Biomet Australia Pty Ltd
BI447 Lorenz 2.4mm Locking Reconstruction Plate, Curved, Std Thickness, 2.4mm 8 or 15 hole $490.00 $950.00
System System, Titanium
Prostheses List by Category, Groups and Sponsor Page 746 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
SK140 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible $490.00
Universal Mandible Reconstruction Plate of mandibular fractures and tumour Reconstruction Plate, 11 - 17
resection. holes, straight with template
Resorbable
Biomet Australia Pty Ltd
BH006 Lorenz 2.4mm Locking Reconstruction Plate, Straight, 2.4mm System, Locking. 8 - 15 hole $490.00 $950.00
System Titanium
7.1.3.19 CMF fracture or reconstruction plate, 2.0 to 2.99mm thick, 16- 32 holes
Biomet Australia Pty Ltd
BI986 Lorenz 2.4mm Locking Reconstruction Plates Plate, Angled 2.4mm System Ti 5 x (22 -24) hole $1,100.00 $1,600.00
System
Compression
Synthes Australia Pty Ltd
SY500 CMF fracture or reconstruction plate Mandible Plate, non-locking 2.0 to 2.99mm thick, 15 to 32 $900.00
holes
Locking
Biomet Australia Pty Ltd
BI448 Lorenz 2.4mm Locking Reconstruction Plate, curved, std or low profile, 2.4mm 16-32 hole $1,100.00 $1,500.00
System system, titanium
BI452 Lorenz 2.4mm Locking Reconstruction Plate, curved. Std or low profile, 2.4mm 16 hole $1,100.00 $1,300.00
System System, Titanium
BI455 Lorenz 2.4mm Locking Reconstruction Plate, Double Angled, 2.0 or 2.4mm 5 x (22 or 24) x 5 hole $1,100.00 $1,600.00
System System, Titanium
Stryker Australia Pty Ltd
SK138 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible $1,100.00
Universal Mandible Reconstruction Plate of mandibular fractures and tumour Reconstruction Plate, (Full), 6 +
resection. 13 + 6 holes, with template
SK141 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible $1,100.00
Universal Mandible Reconstruction Plate of mandibular fractures and tumour Reconstruction Plate, (Hemi),
resection Right and Left, 6 + 17 holes
with template
Prostheses List by Category, Groups and Sponsor Page 747 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK142 Leibinger Titanium Implant System - Items used for reconstruction and fixation Universal Mandible $1,100.00
Universal Mandible Reconstruction Plate of mandibular fractures and tumour Reconstruction Plate, (Full), 6 +
resection 17 + 6 holes, with template
Surgiplas Medical
SP026 OsteoMed Plating & Fixation System Plates - Fracture Rigid Comminuted Fracture $1,100.00
Plate
Synthes Australia Pty Ltd
SY471 CMF fracture or reconstruction plate Titanium mandibular locking reconstruction 2.0 to 2.99mm 15 to 32 holes $1,100.00
plates
Resorbable
Biomet Australia Pty Ltd
BH007 Lorenz 2.4mm Locking Reconstruction Plate, Straight, 2.4mm System, Locking. 16-32 hole $1,100.00 $1,500.00
System Titanium
7.1.3.2 CMF fracture or reconstruction plate, <0.5mm thick, 4- 7 holes
Johnson & Johnson Medical Pty Ltd
JJ537 BIOPLATE Low Profile Low Profile 4-hole Straight Plate 19mm length $140.00
JJ538 BIOPLATE Low Profile Low Profile 5-hole Y Plate 18mm length $140.00 $156.00
JJ539 BIOPLATE Low Profile Low Profile 6-hole X Plate 17mm length $140.00 $255.00
JJ540 BIOPLATE Low Profile Low Profile 5-hole T Plate 15mm length $140.00 $170.00
JJ541 BIOPLATE Low Profile Low Profile 4-hole Boxcar Plate 10 x 10mm $140.00 $195.00
JJ542 BIOPLATE Low Profile Low Profile 6-hole Narrow Boxcar Plate 8 x 17mm $140.00 $231.00
Synthes Australia Pty Ltd
SY562 Matrix Micro X, Frame plates 4 Hole $140.00
Burr
Medical & Optical Instruments Australia Pty Ltd
MO121 Martin Level One Fixation Plate, titanium <0.5mm thick, 4 to 7 holes $190.00 $330.00
Complex - Burr
Johnson & Johnson Medical Pty Ltd
JJ544 BIOPLATE Low Profile Low Profile Flex Contoured Burr Hole Low profile 0.3mm, 1.5mm $190.00
Cover diam hole, 12 - 18mm diam plate
Prostheses List by Category, Groups and Sponsor Page 748 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Pack
Johnson & Johnson Medical Pty Ltd
JJ638 BIOPLATE Neurosurgery Fixation Five Hole T-Plate with Screws - Titanium 1.5mm $355.00 $395.00
System - BIOPLATE Low Profile Plate
and Screw Sterile Packs
7.1.3.20 CMF fracture or reconstruction plate, 2.0 to 2.99mm thick, >32 holes
Locking
Synthes Australia Pty Ltd
SY472 CMF fracture or reconstruction plate Titanium mandibular locking reconstruction 2.0 to 2.99mm > 32 holes $1,450.00
plates
7.1.3.22 CMF fracture or reconstruction plate, =>3mm thick, 4 to 7 holes
Complex, Locking
Synthes Australia Pty Ltd
SY550 Titanium Sternal Fixation System Locking Plate - Star Star: 6 holes $820.00 $1,480.00
7.1.3.23 CMF fracture or reconstruction plate, =>3mm thick, 8 to 15 holes
Complex, Locking
Synthes Australia Pty Ltd
SY551 Titanium Sternal Fixation System Locking Plate - Straight , H or Star Straight: 12holes, H: small & $1,480.00
large, Star: 12 holes
Locking
Medical & Optical Instruments Australia Pty Ltd
MO002 Martin Level One Fixation Plate, titanium =>3mm thick, 8 to 15 holes $630.00
7.1.3.24 CMF fracture or reconstruction plate, =>3mm thick, 16 to 32 holes
Complex, Locking
Synthes Australia Pty Ltd
SY347 Titanium Sternal Fixation System Locking Plate - straight 20 or 30 holes $1,670.00 $1,800.00
Compression
Synthes Australia Pty Ltd
SY501 CMF fracture or reconstruction plate Mandible Plate, non-locking >3mm thick, 15 to 32 holes $1,350.00
Locking
Medical & Optical Instruments Australia Pty Ltd
MO004 Martin Level One Fixation Plate, titanium =>3mm thick, 16 to 32 holes $1,420.00
Prostheses List by Category, Groups and Sponsor Page 749 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.1.3.3 CMF fracture or reconstruction plate, <0.5mm thick, 8- 15 holes.
Johnson & Johnson Medical Pty Ltd
JJ543 BIOPLATE Low Profile Low Profile 8-hole Boxcar Plate 10 x 24mm $281.00
Orbital
Synthes Australia Pty Ltd
SY563 Matrix Micor Orbital curved plate 12 hole $320.00
7.1.3.4 CMF fracture or reconstruction plate, <0.5mm thick, 16- 32 holes.
Synthes Australia Pty Ltd
SY558 Matrix Micro Adaption, Strut Plates 18-20 hole $380.00
7.1.3.6 CMF fracture or reconstruction plate, 0.5-0.99mm thick, < 4 holes.
Australian Surgical Innovations Pty Ltd
AI004 ASI Plates and Screws Plate Straight, Left, Right, X, T and $95.00
Y shaped
B Braun Australia Pty Ltd
BB304 Aesculap CranioPlate System/ Plate Cranial fixation system, internal fracture, Plate Neuro, 2 hole 11 & $95.00
Neuro, 2 hole straight non biodegradable. Consists of screws, 16mm straight
plates
Biomet Australia Pty Ltd
BI677 W Lorenz Osteosynthesis System Plate, Neuro Straight, 1.5mm System, 2 hole (medium or long) $95.00 $110.00
Titanium
BI718 W Lorenz Osteosynthesis System Neuro Gap Plate, Titanium 6 hole 25mm length $95.00 $140.00
Johnson & Johnson Medical Pty Ltd
JJ204 Bioplate Bone Plate Titanium cranial fixation system - straight 1.5mm diam, 11mm length; $95.00
plate, 2 hole pack of 5
JJ216 Bioplate Bio-100 Plate Titanium cranial fixation system, 2 hole 1.9mm diam; 15mm length $95.00
pack of 5
JJ270 BIOPLATE Bone plate Titanium straight plate, 2 hole, 5 per pack, 12mm in length $95.00
packaged non-sterile
JJ281 BIOPLATE Bone plate Titanium BIO100, 2 hole plate, 5 per 1.5mm - 1.9mm Diam, 14mm $95.00
pack, packaged non-sterile length
Prostheses List by Category, Groups and Sponsor Page 750 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medical & Optical Instruments Australia Pty Ltd
MO250 Martin Level One Fixation Plate, titanium 0.5 to 0.99mm thick, <4 holes $95.00 $226.00
MO283 Martin Micro Plate Osteosynthesis System 1.5mm system Straight Plate Titanium 2 hole, 0.6mm profile $95.00
Medtronic Australasia Pty Ltd
MC872 TiMesh Rigid Fixation Bone Grafting and Titanium, Straight Plate < 4 holes $95.00 $150.00
Plating System
MC908 Timesh Rigid Straight Plates < 4 holes $95.00 $805.00
Stryker Australia Pty Ltd
SK356 Universal Neuro Titanium Low Profile Titanium Low Profile plates used for the 2-hole plate, 12mm bar, 16mm $95.00
Plate fixation of cranial bone plates bar
ST143 Leibinger Titanium Implant System Leibinger 3D plate Titanium 1.2x7-10mm, 0.55mm height $95.00
ST204 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: 2 holes, 0.55mm height $95.00
straight Titanium
ST343 Leibinger Titanium Implant System Leibinger 3D Plating System: micro 3 holes $95.00
triangular plate Titanium
Surgiplas Medical
SP075 Plates Micro, Midface & Mini Straight Plate - 2 Hole, Plate < $95.00 $120.00
4 holes.
SP101 Bioresorbable Fixation System Plates Neuro Fixation Set $95.00
Complex - Burr
Medtronic Australasia Pty Ltd
MC867 TiMesh Rigid Fixation Bone Grafting and Titanium, Plate Ohata Tristar 8.4 10mm, < 4 $140.00 $335.00
Plating System hole
Stryker Australia Pty Ltd
SK267 Leibinger Titanium Implant System Burr Hole Cover 1.0mm - 2.3mm Diameter 7, 10, 14 & 20mm $140.00
Compression
Johnson & Johnson Medical Pty Ltd
JJ275 BIOPLATE Bone plate Titanium cranial straight plate, 2 hole, 1.5mm - 1.9mm diam, 14 - $140.00
packaged non-sterile 15mm length
Synthes Australia Pty Ltd
SY475 CMF fracture or reconstruction plate Titanium adaption plates 0.5 to 0.99mm < 4 holes $140.00 $200.00
Prostheses List by Category, Groups and Sponsor Page 751 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Compression, Complex - Burr
Synthes Australia Pty Ltd
SY478 CMF fracture or reconstruction plate Titanium adaption plates 0.5 to 0.99mm < 4 holes $140.00 $280.00
Compression, Pack
Johnson & Johnson Medical Pty Ltd
JJ501 BIOPLATE Sterile Packs 813582, 2-Hole compression plate and 1 kit $399.00
screws - 1.9mm
JJ502 BIOPLATE Sterile Packs 813583, 2-Hole compression plate and 1 kit $140.00
screws - 1.9mm
Locking
Stryker Australia Pty Ltd
ST358 Leibinger Screws Leibinger - Salzburg Lag Screw System: 2 holes $86.00
locking plate, Titanium, with biconcave
washers
Pack
Johnson & Johnson Medical Pty Ltd
JJ492 BIOPLATE Sterile Packs 813573, 2-Hole straight plate and screws 1 kit $453.00
- 1.5mm
JJ493 BIOPLATE Sterile Packs 813574, 2-Hole compression plate and 1 kit $453.00
screws - 1.5mm
JJ494 BIOPLATE Sterile Plates 813575, 2-Hole straight plate and screws 1 kit $400.00
- 1.5mm
JJ500 BIOPLATE Sterile Packs 813581, 2-Hole straight plate and screws 1 kit $340.00
- 1.9mm
JJ734 Bioplate - Two hole straight plate with 2 Sterile low profile kit -2 hole plate w/ 2 11-19mm plates and 3-5mm $151.00 $159.00
self drilling screws sterile kit self drill scews self-drilling screws
JJ735 Bioplate - 2 x two hole straight plate with Sterilised low profile kit containing 2 x 2 11 - 19mm plates and 3-5mm $302.00 $318.00
4 self-drilling screws sterile kit hole compression plates and 4 x self- self drilling screws
drilling screws
Stryker Australia Pty Ltd
SR040 Universal Quick Flap System Sterile pack containing 3 x Titanium 2 hole . $543.00
plates (SK356), 6 x Viper self drilling 1.5
x 4mm screws (SK301)
Prostheses List by Category, Groups and Sponsor Page 752 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SR041 Universal Quik Flap System Sterile pack containing, 3 x Titanium 2 hole . $543.00
Plates (SK356), 6 x self-tapping screws
1.5 x 4mm
Resorbable
Synthes Australia Pty Ltd
SY512 CMF Rapid Resorbable fracture or Sterile Rapid resorbable reconstruction 0.5 to 0.99mm thick,<4 holes $180.00
reconstruction Plate plate
7.1.3.7 CMF fracture or reconstruction plate, 0.5-0.99mm thick, 4 - 7holes
B Braun Australia Pty Ltd
BB305 Aesculap CranioPlate System/Plate Cranial fixation system, internal fracture, Plate Neuro, 6 hole 10 x 17 $170.00
Neuro, 6 hole rectangular non biodegradable. Consists of screws, mm rectangular
plates.
BB306 Aesculap CranioPlate System/ Plate Cranial fixation system, internal fracture, Plate Neuro, 4 hole 10mm $170.00
Neuro, 4 hole square non biodegradable. Consists of screws, square
plates.
BB307 Aesculap CranioPlate System/ Plate Cranial fixation system, internal fracture, Plate Neuro, 4 hole 17 & 20 $170.00
Neuro, 4 hole straight non biodegradable. Consists of screws, mm straight
plates.
BB308 Aesculap CranioPlate System/ Plate Cranial fixation system, internal fracture, Plate Neuro, 6 hole 15 & $170.00
Neuro, 6 hole double Y non biodegradable. Consists of screws, 17mm, double Y shape
plates.
BB309 Aesculap CranioPlate System/ Plate Cranial fixation system, internal fracture, Plate Neuro, 5 hole 17mm, Y $170.00
neuro, 5 hole Y non biodegradable. Consists of screws, shape
plates
BB313 Aesculap CranioPlate System/ Plate Cranial fixation system, internal fracture, Plate Neuro, 6 hole x 16 & $170.00
Neuro, Burr hole cover 12 & 16mm non biodegradable. Consists of screws, 20mm Burr hole cover
plates.
Biomet Australia Pty Ltd
BH010 W Lorenz Osteosynthesis System 1.2, 1.7mm Small Fragment System` Plate, 4-7 hole $170.00 $248.00
all shapes, Titanium
BI348 W Lorenz Osteosynthesis System L-Plate, 2mm System, Left or Right. 2 x 2 hole, Mini or Low Profile $170.00 $220.00
Titanium
BI351 W Lorenz Osteosynthesis System L-Plate, 2mm System, Left or Right. 2 x 2 hole, long $170.00 $220.00
Titanium
Prostheses List by Category, Groups and Sponsor Page 753 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BI605 W Lorenz Osteosynthesis System Plate, Matrix, 1.0 or 1.5mm System, 6 hole $170.00 $220.00
Titanium
BI617 W Lorenz Osteosynthesis System Plate, Straight, 1mm System. Titanium 4 hole $170.00 $220.00
BI620 W Lorenz Osteosynthesis System Plate, Straight, low profile, 2.0mm System, 4 - 8 hole $170.00 $220.00
Titanium
BI621 W Lorenz Osteosynthesis System Plate, L , 2.5mm or 2m system, Titanium 2 x2 or 3x3 hole $170.00 $220.00
BI622 W Lorenz Osteosynthesis System Z-Shape Plate, Left or Right, 1.5mm or 2 x 2 hole $170.00 $220.00
2mm System. Titanium
BI623 W Lorenz Osteosynthesis System T-Plate, Left or Right, 1.5mm System. 3x3 hole, 7x7 hole $170.00 $220.00
Titanium
BI624 W Lorenz Osteosynthesis System T-Plate 90 degrees, Left or Right, 2mm 2x5hole, 3x3hole, 2x3hole $170.00 $220.00
System. Titanium
BI625 W Lorenz Osteosynthesis System Plate, Y, Double Y, X, 1.5mm System or One size only $170.00 $220.00
2.0mm System, Titanium
BI627 W Lorenz Osteosynthesis System Plate, Straight, 1.5mm System, Titanium 4 or 6 hole $170.00 $220.00
BI635 W Lorenz Osteosynthesis System Plate, DoubleT, Double Y; 1mm, 2mm 6,7,11 hole $170.00 $220.00
system, Titanium
BI638 W Lorenz Osteosynthesis System Plate, Orbital. 1mm System, Titanium One size only $170.00 $220.00
BI639 W Lorenz Osteosynthesis System Plate, Square. 1mm System. Titanium 4 hole $170.00 $220.00
BI640 W Lorenz Osteosynthesis System Plate, Matrix, 1.0 or 1.5mm System, 6 hole $170.00 $220.00
Titanium
BI656 W Lorenz Osteosynthesis System Plate, Orbital, 1.5mm, 2.0mm System, 6 hole $170.00 $200.00
Titanium
BI717 W Lorenz Osteosynthesis System Neuro Gap Plate, Titanium 6 hole, 45mm length $170.00 $220.00
BI720 W.Lorenz Osteosynthesis System Neuro Gap Plate; titanium 6 hole, 35mm length $170.00 $220.00
BI728 W.Lorenz Osteosynthesis System Neuro Square or Rectangular Plate, titanium 1.5mm system, 4 hole $170.00 $220.00
BI988 W Lorenz Osteosynthesis System Plate Straight 2mm System 4 - 7 hole $170.00 $220.00
Johnson & Johnson Medical Pty Ltd
JJ205 Bioplate Bone Plate Titanium cranial fixation system - straight 1.5mm - 1.9mm diam, 19mm $170.00
plate, 4 hole length
JJ206 Bioplate Bone Plate Titanium cranial fixation system - Y plate, 1.5mm diam, 17mm length $170.00
5 hole
Prostheses List by Category, Groups and Sponsor Page 754 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ207 Bioplate Bone Plate Titanium cranial fixation system - X plate, 1.5mm -1.9 diam, 17 - 18mm $170.00
6 hole length
JJ208 Bioplate Bone Plate Titanium cranial fixation system - T plate, 5 1.5mm diam, 15mm length $170.00
hole
JJ211 Bioplate Bone Plate Titanium cranial fixation system - box car, 1.5mm - 1.9mm diam, 10 x $170.00
4 hole 10mm
JJ212 Bioplate Bone Plate Titanium cranial fixation system - box car 6 1.5mm diam, 8 x 17mm $170.00
hole
JJ271 BIOPLATE Bone plate Titanium Y plate, 5 hole, packaged non- 1.9mm diam, 19mm length $170.00
sterile
JJ272 BIOPLATE Bone plate Titanium T-plate, 5 hole, packaged non- 1.9mm diam, 16mm length $170.00
sterile
JJ273 BIOPLATE Bone plate Titanium boxcar plate, 6 hole, packaged 1.9mm diam, 9 x 18mm $170.00
non-sterile
JJ280 BIOPLATE Bone plate Titanium large boxcar plate, 4 hole, 1.5mm diam, 14 x 14mm length $170.00
packaged non-sterile
Medical & Optical Instruments Australia Pty Ltd
MO285 Martin LevelOne Fixation Plate Titanium 0.5 to 0.99mm thick, 4 to 7 $198.00 $355.00
holes
MO296 Martin Level One Fixation Plate, titanium 0.5 to 0.99mm thick, 4 to 7 $170.00
holes
Medtronic Australasia Pty Ltd
MC393 TiMesh Rigid Fixation Bone Grafting and Titanium, Z Plate Left and Right 4 hole - 5mm, 9.5mm $170.00 $250.00
Plating System
MC519 TiMesh Squareplate 4 holes x 1mm - 4 holes x 2.2mm $170.00 $250.00
MC520 TiMesh X Plate 4 holes x 1mm - 4 holes x 2.2mm $170.00 $250.00
MC576 Timesh Double Y Plates 3 Hole - 2.5mm - 7mm $170.00 $900.00
MC870 TiMesh Rigid Fixation Bone Grafting and Titanium, Y Plate Double and Single 4 - 7 hole $170.00 $250.00
Plating System
MC875 TiMesh Rigid Fixation Bone Grafting and Titanium, T Plate 4 - 7 hole $170.00 $250.00
Plating System
MC883 TiMesh Rigid Fixation Bone Grafting and Titanium, L Plate (Left and right 4 to 7 holes $170.00 $250.00
Plating System configurations)
Prostheses List by Category, Groups and Sponsor Page 755 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC885 TiMesh Rigid Fixation Bone Grafting and Titanium, H Plate 4 - 7 hole $170.00 $250.00
Plating System
MC891 Macropore Oblique Plates 4 to 7 holes $200.00
MC909 Timesh Rigid Straight Plates 4 - 7 holes $170.00 $805.00
Stryker Australia Pty Ltd
SK259 Leibinger Titanium Implant System - Upperface Fixation Plates 7 Hole Double Y Plate $170.00
Universal CMF Plate Upperface, malleable; 7 Hole
Double Y Plate, Upperface
SK260 Leibinger Titanium Implant System - Upperface Fixation Plates 2x2 Hole 3-D Plate Upperface, $170.00
Universal CMF Plate malleable; 2x2 Hole 3-D Plate,
Upperface
SK261 Leibinger Titanium Implant System - Upperface Fixation Plates 6x2 Hole 3-D Plate Upperface, $170.00
Universal CMF Plate malleable; 6x2 Hole 3-D Plate,
Upperface
SK263 Leibinger Titanium Implant System - Upperface Fixation Plates 7 Hole T Plate, Upperface $170.00
Universal CMF Plate
SK264 Leibinger Titanium Implant System - Upperface Fixation Plates 4 Hole Orbita Plate, Upperface $170.00
Universal CMF Plate
SK270 Leibinger Titanium Implant System - Midface Fixation Plates 4 Hole Straight Plate with Bar, $170.00
Universal CMF Plate Midface; 4 Hole Curved Plate
with Bar, Midface
SK272 Leibinger Titanium Implant System - Midface Fixation Plates 5 Hole T Plate, Midface $170.00
Universal CMF Plate
SK273 Leibinger Titanium Implant System - Midface Fixation Plates 5 Hole Y Plate with 4mm Bar, $170.00
Universal CMF Plate Midface
SK274 Leibinger Titanium Implant System - Midface Fixation Plates 7 Hole Double Y Plate, $170.00
Universal CMF Plate Midface
SK280 Leibinger Titanium Implant System - L Plates 100 Degree, Advancement 2 - 5 - 6 Hole $170.00
Universal CMF Plate 10mm
SK282 Leibinger Titanium Implant System - L Plate 100 Degree Advancement 12mm 5 - 6 Holes $170.00
Universal CMF Plate
SK283 Leibinger Titanium Implant System - Graduated Stability L Plates 5 Hole L Plate 2mm $170.00
Universal CMF Plate Advancement 100 Degree Left,
Midface, GSP; 5 Hole L Plate
2mm Advancement 100 Degree
Right, Midface, GSP
Prostheses List by Category, Groups and Sponsor Page 756 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK340 Leibinger Titanium Implant System - Z Plate, Right/Left 4 holes $170.00
Universal CMF Plate
SK349 Leibinger Titanium Implant System - Titanium plates used for reconstruction and Universal CMF 4 hole Z plate, $170.00
Universal CMF Plate fixation of craniomaxillofacial fractures or Small, Orthognathic, locking.
osteotomy performed for correction of Universal CMF 4 hole Z plate,
facial deformity Large, Orthognathic, locking.
SK363 Universal Neuro Titanium Low Profile Titanium Low Profile plates used for the 8 hole plate without bar, 2 x 2 $170.00
Plate fixation of cranial bone flaps box plate, double Y 6 hole
8mm
ST123 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight 4 holes $170.00
Titanium
ST125 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight 6 holes $170.00
Titanium
ST130 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: straight, 5 holes $170.00
L-shape, right/left Titanium
ST132 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: T-shape, 5 holes $170.00
90 deg Titanium
ST133 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: T-shape, 7 holes $170.00
90 deg Titanium
ST137 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Y-shape 6 holes $170.00
Titanium
ST138 Leibinger Titanium Implant System Micro Plus Bone plate: double-Y-shape 6 - 7 Holes $170.00
ST139 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: double- 7holes $170.00
Y-shape Titanium
ST142 Leibinger Titanium Implant System Leibinger 3D plate Titanium 1.2x2-6mm, 0.55mm height $170.00
ST144 Leibinger Titanium Implant System Leibinger 3D plate Titanium 1.2x11-12mm, 0.55mm height $170.00
ST151 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: 4 holes, 0.55mm height $170.00
regular Titanium
ST154 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: 6 holes, 0.55mm height $170.00
regular Titanium
ST160 Leibinger Titanium Implant System Bone plate L-shape, 90 deg, right/left 4 Holes $170.00
ST162 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: L- 4 holes, 8mm bar, 0.55mm $170.00
shape, 90 deg, with bar, right/left Titanium height
Prostheses List by Category, Groups and Sponsor Page 757 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST164 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: L- 4 holes, 10mm bar, 0.55mm $170.00
shape, 90 deg, with bar, right/left Titanium height
ST165 Leibinger Titanium Implant System L-shape, right/left, with Bar 5 - 7 Hole $170.00
ST170 Leibinger Titanium Implant System Bone plate T-shape with or without bar 4 HOLES $170.00
ST172 Leibinger Titanium Implant System Mini Wurzburg Bone plate, T-shape 5 - 6 holes $170.00
ST180 Leibinger Titanium Implant System Bone plate Y-shape, 5 HOLES $170.00
ST181 Leibinger Titanium Implant System Mini Wurzburg Bone plate: T- Shape, Y- 5 - 6 holes $170.00
Shape & Double -T- Shape
ST183 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: 6 holes, 0.55mm height $170.00
double-Y-shape, regular Titanium
ST184 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: 6 holes, 8mm bar, 0.55mm $170.00
double-Y-shape, with bar Titanium height
ST185 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: 7 holes, 0.55mm height $170.00
double-Y-shape, regular Titanium
ST188 Leibinger Titanium Implant System Leibinger Mini Wurzburg Orbita Bone 4 holes, 6mm bar, 0.55mm $170.00
plate: curved, with bar Titanium height
ST189 Leibinger Titanium Implant System Leibinger Mini Wurzburg Orbita Bone 6 holes, 8mm bar, 0.55mm $170.00
plate: curved, with bar Titanium height
ST190 Leibinger Titanium Implant System LeibingerSteinhauser Orbita Bone plate: 6 holes, 0.55mm height $170.00
curved Titanium
ST195 Leibinger Titanium Implant System Bone plate, L-shape, 110 deg, right/left 4 holes $170.00
Titanium
ST197 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: L- 4 & 5 holes, with 12mm bar, $170.00
shape, 110 deg, regular, with bar, right/left 0.55mm height
Titanium
ST198 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Bone plate: 2x2 holes, 0.55mm height $170.00
square, rectangular Titanium
ST199 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Bone plate: 3x2 holes, 0.55mm height $170.00
square, rectangular Titanium
ST231 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: L- 4 holes $170.00
shape, 110 deg, regular Titanium
ST232 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: L- 4 holes, with 6mm, 8mm, $170.00
shape, 110 deg, right/left Titanium 10mm bar
Prostheses List by Category, Groups and Sponsor Page 758 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST233 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: L- 5 holes, with 12mm bar $170.00
shape, 110 deg, right/left Titanium
ST311 Leibinger Titanium Implant System Plate - Leibinger Low Profile 4 holes $170.00
Osteosynthesis System: mini, non-
compression / compression, straight,
regular / extended, medium / long Titanium
ST314 Leibinger Titanium Implant System Leibinger Low Profile Osteosynthesis 4 holes $170.00
System: L-shape, right/left, regular,
medium, long Titanium
ST315 Leibinger Titanium Implant System Leibinger Low Profile Osteosynthesis 5 holes $170.00
System: L-shape, right/left, long, extended
Titanium
ST326 Leibinger Titanium Implant System Leibinger Micro 3D Plating System: 2x2 holes, 0.55mm profile $170.00
square, rectangular Titanium
ST327 Leibinger Titanium Implant System Leibinger Micro 3D Plating System: 2x3 holes, 0.55mm profile $170.00
square, rectangular Titanium
ST331 Leibinger Titanium Implant System Leibinger Micro Bone plate Titanium 4 holes, 0.55mm profile $170.00
ST332 Leibinger Titanium Implant System Leibinger Micro Bone plate Titanium 6 holes, 0.55mm profile $170.00
ST333 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: straight 6 holes, 0.55mm profile $170.00
titanium
ST337 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: L- 5 holes, 0.55mm profile $170.00
shape, right/left Titanium
ST339 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: T- 5, 7, 9 holes, 0.55mm profile $170.00
shape, double-T-shape, right/left, 90 deg
Titanium
ST340 Leibinger Titanium Implant System Leibinger Steinhauser Bone Plate: X-shape 4, 8, 9 holes, 0.55mm profile $170.00
Titanium
ST341 Leibinger Titanium Implant System Leibinger Micro Bone Plate: Y-shape, 6 holes, 0.55mm profile $170.00
double-Y-shape Titanium
ST392 Luhr Fixation System Luhr Micro Fixation System: micro 6 holes, 6x7mm $170.00
double-T-shape plate Vitallium
ST393 Luhr Fixation System Luhr Micro Fixation System: micro 7 holes, 10x10mm $170.00
double-T-shape plate Vitallium
ST402 Luhr Fixation System Luhr Micro Fixation System: micro T- 6 holes, 14mm, 8 holes, 22mm $170.00
shape plate Vitallium
Prostheses List by Category, Groups and Sponsor Page 759 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST412 Luhr Fixation System Luhr Pan Fixation System: condensed, 4 holes x 12mm, 6 holes x $170.00
straight plate Vitallium 18mm, 12 holes x 36mm
ST415 Luhr Fixation System Luhr Pan Fixation System: L-shape plate, 4 holes, 16 x 9mm, 22 x 9mm $170.00
90 deg Vitallium
ST416 Luhr Fixation System Luhr Pan Fixation System: L-shape plate, 4 holes, 16 x 9mm, 22 x 9mm $170.00
110 deg Vitallium
ST417 Luhr Fixation System Luhr Pan Fixation System: straight plate 4 holes, 21mm $170.00
Vitallium
ST477 Wurzburg Bone Plates Wurzburg Mini Bone plate: straight, 6 holes $170.00
regular/long, with/without bar Titanium
Surgiplas Medical
SP074 Plates Micro, Midface, Mini, BSSO, TR BSSO 4 Hole BSSO Plate Short, $165.00
Medium, Long; TR BSSO
Plate, Short, Long; 4 & 6 Hole
Straight Plate 1.0mm thick,
Plate 4 to 7 holes.
SP084 Plates Mini & Maxi 4 & 5 Hole compression Plates $185.00 $204.00
4 to 7 Holes
SP087 Plates Mini & Maxi Zygomatic Plates, Pyriform $170.00 $204.00
Plates, Orthognathic, Y Plates,
Y Plate, H Plate, 5 Hole
straight plate, 13mm & 16mm L
Plate - Left & Right, 19mm T
Plate, X Plate; 10mm Square
Plate; 13mm, 15mm & 22mm L
Plate - Left & Right, 9mm &
11mm ZED Plate - Left &
Right
Synthes Australia Pty Ltd
SY252 AO/ASIF Facio-Maxillary Plates Flapfix - Plates for fixation of cranial bone 10 - 20mm $170.00
flaps
SY319 CMF fracture or reconstruction plate Titanium adaption plates - Low profile 0.5 to 0.99mm 4 -7 holes $170.00
neurosurgical plates
SY468 CMF fracture or reconstruction plate Titanium adaption plates 0.5 to 0.99mm 4 to 7 holes $170.00
SY494 CMF fracture or reconstruction plate Titanium adaption plates - Low profile 0.5 to 0.99 4 - 7 holes $170.00
neurosurgical plates
Prostheses List by Category, Groups and Sponsor Page 760 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Burr
Surgiplas Medical
SP072 Plates Micro, Mini, Maxi Burr Hole Plates, Calvarium $198.00 $280.00
Plate - Small & Large -
Calvarium Plate, Plates 4 to 7
Holes
Chin
Medical & Optical Instruments Australia Pty Ltd
MO286 Martin Level One Fixation Plate, titanium 0.5 to 0.99mm thick, 4 to 7 $246.00
holes
Complex
Synthes Australia Pty Ltd
SY470 CMF fracture or reconstruction plate Titanium adaption plates 0.5 to 0.99mm 4 to 7 holes $185.00
Complex - Burr
Aus Systems Pty Ltd
AU014 Aus Systems Titanium Miniplates (Bone Low profile burr hole cover 10mm, 14mm, 18mm, 22mm $198.00
Plates)
Biomet Australia Pty Ltd
BI353 W Lorenz Osteosynthesis System Plate, Burr Hole, 1mm, 1.5mm, 2mm system 13mm, 17mm, 18.5mm $198.00 $250.00
BI721 W Lorenz Osteosynthesis System Plate, Burr Hole, 1.5mm System, Titanium 22mm, 25mm $198.00 $250.00
Johnson & Johnson Medical Pty Ltd
JJ209 Bioplate Burr Hole Cover Titanium cranial fixation system - burr hole, 1.5mm - 1.9 diam, screw 12 - $198.00
6 hole 18mm diam plate
JJ210 Bioplate Burr Hole Cover Titanium cranial fixation system - burr hole, 1.5mm diam, 18mm plate $198.00
6 hole
JJ284 BIOPLATE Burr hole cover 1.9mm, titanium, flexible contoured burr 1.5 - 1.9mm diam hole, 12- $198.00
hole cover, packaged non-sterile 18mm diam plate
Medtronic Australasia Pty Ltd
MC868 TiMesh Rigid Fixation Bone Grafting and Titanium, Plate Fan Blade 11-18mm, Mesh $198.00 $335.00
Plating System 11-25mm, 4 - 7 hole
Prostheses List by Category, Groups and Sponsor Page 761 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
ST141 Leibinger Titanium Implant System Leibinger Burr Hole Cover: curved Titanium 7, 10, 14mm $198.00
Complex - Burr, Pack
Johnson & Johnson Medical Pty Ltd
JJ499 BIOPLATE Sterile Packs 813580, 6-Hole Burr Hole cover and 1 kit $438.00 $494.00
screws - 1.5mm
JJ507 BIOPLATE Sterile Packs 813588, 6-Hole Burr Hole Cover and 1 kit $434.00
Screws - 1.9mm
Complex - Chin
Biomet Australia Pty Ltd
BI591 W Lorenz Osteosynthesis System Chin Plates, Paulus, 2mm System, Titanium 4 - 12mm $246.00 $275.00
BI774 W Lorenz Osteosynthesis System Lefort plate, 1.5mm system, 0.6mm Flat, 2-11mm $246.00 $360.00
thickness, titanium
Stryker Australia Pty Ltd
SK348 Leibinger Titanium Implant System - Titanium plates used for reconstruction and Universal CMF 4 hole chin $246.00
Universal CMF Plate fixation of craniomaxillofacial fractures or plate, 4mm. Universal CMF 4
osteotomy performed for correction of hole chin plate, 6mm. Universal
facial deformity CMF 4 hole chin plate, 8mm.
Universal CMF 4 hole chin
plate, 10mm. Universal CMF 4
hole chin plate, 12mm.
ST356 Leibinger Titanium Implant System Paulus Chin plate Titanium 2, 4, 6, 8, 10, 12, 14mm bar, $246.00
0.6mm
Complex - Cranium
Surgiplas Medical
SP070 Plates Micro, Mini, Maxi Gap Plates, Plates 4 to 7 holes $280.00
Complex - Orbital
Biomet Australia Pty Ltd
BI738 W.Lorenz Osteosynthesis System Orbital Floor Plate; Titanium 1.5mm system, Large $890.00 $1,080.00
BI740 W.Lorenz Osteosynthesis System Orbital Floor Plate (Small) or NOE plate, Small or NOE plate $890.00 $950.00
1.5mm System, Titanium
Prostheses List by Category, Groups and Sponsor Page 762 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Compression
Biomet Australia Pty Ltd
BI349 W Lorenz Osteosynthesis System Plate, Compression Straight, 2mm System. 4 hole $185.00 $220.00
Titanium
Stryker Australia Pty Ltd
ST234 Leibinger Titanium Implant System Leibinger Mini Wurzburg Compression 4 holes, with 6 x 1mm bar $185.00
Bone plate: L-shape, C-shape Titanium
ST235 Leibinger Titanium Implant System Leibinger Mini Wurzburg Compression 6 holes, with 8 x 1mm bar $185.00
Bone plate: L-shape, C-shape Titanium
Surgiplas Medical
SP033 OsteoMed Plating & Fixation System Compression Plates - Micro, Mini & Maxi Micro: 2 x 3 Hole Compression $185.00
T Plate, Oblique Left & Right
Compression T Plate, 4 Hole
Straight Compression Plate; 5
Hole Straight Plate, 13mm Left
& Right L Plate, 19mm T Plate,
2 x 3 Hole Quad Plate; Mini: 4
Hole Left & Right L Plate, 4
Hole Left & Rig
Synthes Australia Pty Ltd
SY473 CMF fracture or reconstruction plate Titanium adaption plates 0.5 to 0.99mm 4 to 7 holes $185.00
Locking
Stryker Australia Pty Ltd
SK289 Leibinger Titanium Implant System - Mid-Face Fixation Plates, Locking 2x2 Hole 3-D Plate, Midface, $195.00
Universal CMF Plate Locking
SK291 Leibinger Titanium Implant System - Mid-Face Fixation Plates, Locking 5 Hole Y Plate with 4mm Bar, $195.00
Universal CMF Plate Midface, Locking; 5 Hole Y
Plate with 8mm Bar, Midface,
locking
SK292 Leibinger Titanium Implant System - Mid-Face Fixation Plates, Locking 7 Hole Double Y Plate, $195.00
Universal CMF Plate Midface, locking
Prostheses List by Category, Groups and Sponsor Page 763 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK294 Leibinger Titanium Implant System - Mid-Face Fixation Plates, Locking 5 Hole L Plate 2mm $195.00
Universal CMF Plate Advancement, Midface,
locking; 5 Hole L Plate 5mm
Advancement, Midface, locking
SK295 Leibinger Titanium Implant System - Mid-Face Fixation Plates, Locking 6 Hole L Plate 8mm $195.00
Universal CMF Plate Advancement, Midface,
locking; 6 Hole L-Plate 12mm
Advancement, Midface, locking
Orbital
Medical & Optical Instruments Australia Pty Ltd
MO297 Martin Level One Fixation Plate, titanium 0.5 to 0.99mm thick, 4 to 7 $170.00
holes
Pack
Biomet Australia Pty Ltd
BI870 Neurological Packs Plate & screws: Neuro pack Burr cover or 1.5mm or 2mm system $543.00 $720.00
multi plate set. Thinflap 4 hole plus plate
sets
Johnson & Johnson Medical Pty Ltd
JJ497 BIOPLATE Sterile Packs 813578, X-plate and screws - 1.5mm 1 kit $376.00 $494.00
JJ498 BIOPLATE Sterile Packs 813579, 4-Hole plate and screws - 1 kit $330.00 $400.00
1.5mm
JJ505 BIOPLATE Sterile Packs 813586, X-plate and Screws - 1.9mm 1 kit $410.00 $512.00
JJ506 BIOPLATE Sterile Packs 813587, Boxcar plate and screws - 1 kit $330.00 $364.00
1.9mm
Resorbable
Biomet Australia Pty Ltd
BH001 Lactosorb Resorbable Lactosorb Plates, 2mm System, All shapes 4 - 7 hole $200.00 $304.00
Craniomaxillofacial Fixation System PGA/PLA
BI990 Lactosorb Resorbable CMF System Lactosorb Plates, 1.5mm System 4 - 7 hole $200.00 $360.00
Medtronic Australasia Pty Ltd
MC550 Macropore Rectangle Plates 4-8 hole $200.00
MC553 Macropore Oblong Plates 6 - 8 hole $200.00
MC562 Macropore Y Plates 7 hole $200.00
Prostheses List by Category, Groups and Sponsor Page 764 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC563 Macropore Straight Plates 4 hole $200.00
Stryker Australia Pty Ltd
ST517 Stryker Leibinger Resorbable Fixation Resorbable plate: box shape Tripolymer 2x2 holes $200.00
System
ST524 Stryker Leibinger Resorbable Fixation Resorbable plate: Y-shape Tripolymer 6 holes $200.00
System
Synthes Australia Pty Ltd
SY504 CMF Rapid Resorbable fracture or Sterile Rapid resorbable reconstruction 0.5 to 0.99mm thick, 4 to 7 $200.00
reconstruction Plate plate holes
Resorbable, Complex - Orbital
Biomet Australia Pty Ltd
BI924 Lactosorb Resorbable Orbital Floor Plate, 1.5mm System, Left or right $615.00 $750.00
Craniomaxillofacial Fixation System PGA/PLA
Synthes Australia Pty Ltd
SY391 PolyMax Resorbable Fixation System 1.5/2.0 Orbital Floor Plate S, M, L $615.00
7.1.3.8 CMF fracture or reconstruction plate, 0.5-0.99mm thick, 8 - 15 holes
Aus Systems Pty Ltd
AU005 Aus Systems Titanium Miniplates (Bone Low profile condensed 8 hole $200.00
Plates)
B Braun Australia Pty Ltd
BB310 Aesculap CranioPlate System/ Plate Cranial fixation system, internal fracture, Plate Neuro, 8 hole 10 x 24 $200.00
Neuro, 8 hole rectangular non biodegradable. Consists of screws, mm rectangular
plates.
Biomet Australia Pty Ltd
BH011 W Lorenz Osteosynthesis System 1.2, 1.7mm Small Fragment System, Plate, 1.2, 1.7mm Small Fragment $200.00 $248.00
All shapes Titanium System, Plate, All shapes
Titanium
BI641 W Lorenz Osteosynthesis System Plate, Matrix. 1mm System, 1.5mm 2 x 4 hole $200.00 $250.00
System. Titanium
BI658 W Lorenz Osteosynthesis System Plate, Orbital. 1.5mm System, 2mm 8-10 hole $200.00 $248.00
System. Titanium
BI719 W Lorenz Osteosynthesis System Neuro Sub-Temporal Plate, Titanium medium $200.00 $410.00
Prostheses List by Category, Groups and Sponsor Page 765 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BI773 W Lorenz Osteosynthesis System Neuro sub-temporal plate, 1.5 system, Small $200.00 $283.00
titanium
BI989 W Lorenz Osteosynthesis System Plate Straight, 2mm System 8 - 15 hole $170.00 $220.00
Johnson & Johnson Medical Pty Ltd
JJ213 Bioplate Bone Plate Titanium cranial fixation system - box car, 1.5mm diam, 10 x 24mm $200.00
8 hole
JJ274 BIOPLATE Bone plate Titanium boxcar plate, 8 hole, packaged 1.9mm diam, 11 x 25mm $200.00 $287.00
non-sterile
JJ276 BIOPLATE Bone plate Titanium curved plate, 8 hole, packaged 1.5mm, 30mm length $200.00
non-sterile
Medical & Optical Instruments Australia Pty Ltd
MO317 Martin Level One Fixation Plate, titanium 0.5 to 0.99mm thick, 8 to 15 $200.00 $235.00
holes
Medtronic Australasia Pty Ltd
MC678 TiMesh Rigid Fixation Bone Grafting and Titanium, Universal Plate 12h $200.00 $350.00
Plating System
MC871 TiMesh Rigid Fixation Bone Grafting and Titanium, Straight Plate 8-15 holes $200.00 $350.00
Plating System
MC873 TiMesh Rigid Fixation Bone Grafting and Titanium, Straight Plate 8 - 15 hole $200.00 $350.00
Plating System
MC876 TiMesh Rigid Fixation Bone Grafting and Titanium, T Plate 8 - 15 hole $200.00 $350.00
Plating System
MC884 TiMesh Rigid Fixation Bone Grafting and Titanium, L Plate (Left and right 8 - 15 hole $200.00 $350.00
Plating System configurations)
MC886 TiMesh Rigid Fixation Bone Grafting and Titanium, H Plate 8-15 hole $200.00 $350.00
Plating System
MC892 Macropore Oblique Plates 8 to 15 holes $215.00 $420.00
MC910 Timesh Rigid Straight Plates 8-15 holes $200.00 $805.00
Stryker Australia Pty Ltd
SK258 Leibinger Titanium Implant System - Upperface Fixation Plates 10 Hole Curved Plate $200.00
Universal CMF Plate Upperface, malleable
condensed; 10 hole Curved
plate, Upperface
Prostheses List by Category, Groups and Sponsor Page 766 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK262 Leibinger Titanium Implant System - Uppeface Fixation Plates 8 Hole L Plate 90 Degree Left, $200.00
Universal CMF Plate Upperface; 8 Hole L Plate 90
Degree Right, Upperface
SK265 Leibinger Titanium Implant System - Upperface Fixation Plates 6x6 Hole 3-D Plate, $200.00
Universal CMF Plate Upperface; 6x6 Hole 3-D Plate
Upperface, malleable
SK271 Leibinger Titanium Implant System - Midface Fixation Plates 10 Hole Curved Plate, Midface $200.00
Universal CMF Plate
ST092 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System: 2.3x8 holes $200.00
straight plate Titanium
ST126 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight 8 holes $200.00
Titanium
ST127 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight 12 holes $200.00
Titanium
ST131 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: straight, 8 holes $200.00
L-shape, right/left Titanium
ST135 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: double- 9 holes $200.00
T-shape Titanium
ST136 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: double- 14 holes $200.00
T-shape Titanium
ST140 Leibinger Titanium Implant System Leibinger Micro, Micro Plus and Low 8 holes $200.00
Profile Bone plate: orbital plate, curved
Titanium
ST156 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: 8 holes, 0.55mm height $200.00
regular Titanium
ST167 Leibinger Titanium Implant System Leibinger Steinhauser plate: L-shape, 9 holes, 12mm bar, 0.55mm $200.00
right/left, with bar Titanium height
ST171 Leibinger Titanium Implant System Leibinger Steinhauser plate: T-shape, with 8 holes, 12mm bar, 0.55mm $200.00
bar Titanium height
ST191 Leibinger Titanium Implant System Leibinger Mini Wurzburg Orbita Bone 8 holes, 0.55mm height $200.00
plate: curved Titanium
ST194 Leibinger Titanium Implant System Leibinger Steinhauser Orbita Bone plate: 10 holes, 0.55mm height $200.00
curved Titanium
ST200 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Bone plate: 4x2 holes, 0.55mm height $200.00
square, rectangular Titanium
Prostheses List by Category, Groups and Sponsor Page 767 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST203 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Zygoma 4x2 holes, 0.55mm height $200.00
Bone plate: rectangular Titanium
ST312 Leibinger Titanium Implant System Plate - Leibinger Low Profile 8 holes $200.00
Osteosynthesis System: mini, non-
compression, compression, straight,
regular / extended, medium / long Titanium
ST328 Leibinger Titanium Implant System Leibinger Micro 3D Plating System: 2x4 holes, 0.55mm profile $200.00
square, rectangular Titanium
ST334 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: straight 8 holes, 0.55mm profile $200.00
titanium
ST338 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: L- 8 holes, 0.55mm profile $200.00
shape, right/left Titanium
ST342 Leibinger Titanium Implant System Leibinger Steinhauser Bone Plate: Y-shape 8 holes, 0.55mm profile $200.00
Titanium
ST344 Leibinger Titanium Implant System Leibinger 3D Plating System: micro 8 holes $200.00
circular plate Titanium
ST414 Luhr Fixation System Luhr Pan Fixation System: ladder plate 10 holes, 39 x 9mm $200.00
Vitallium
ST419 Luhr Fixation System Luhr Pan Fixation System: straight plate 8 holes, 45mm $200.00
Vitallium
ST478 Wurzburg Bone Plates Wurzburg Mini Bone plate: straight, long 8 holes $200.00
Titanium
ST480 Wurzburg Bone Plates Wurzburg Mini Bone plate: H and Y- 10, 12 holes $200.00
shape nasal plate Titanium
ST518 Stryker Leibinger Resorbable Fixation Resorbable plate: curved plate Trypolymer 8 holes $200.00
System
Surgiplas Medical
SP077 Plates Micro, Midface & Mini Quad Plate, Quad Plate - $210.00
Short, Plate 8 to 15 holes.
SP082 Plates Micro, Mini Sub - Temporal Plates, Plates 8 $287.00 $506.00
to 15 Holes
Prostheses List by Category, Groups and Sponsor Page 768 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SP085 Plates Mini & Maxi Curved Plate, 8 Hole Straight $200.00 $204.00
Plate; Mini : 10 Hole Straight
Plate, Extended Y Plate, Rigid
10 Hole Straight Plate, 12 Hole
Straight Plate, Y Plate - 13
Hole, 12 Hole Curved Plate, 10
Hole Straight Plate; 10 Hole
Curved Plate, Straight Plate 10
Hole, Y P
Synthes Australia Pty Ltd
SY467 CMF fracture or reconstruction plate Titanium adaption plates 0.5 to 0.99mm 8 to 15 holes $200.00
SY496 CMF fracture or reconstruction plate Titanium adaption plates - Low profile 0.5 to 0.99mm 8 - 15 holes $200.00
neurosurgical plates
3D
Surgiplas Medical
SP071 Plates Micro, Mini, Maxi Quad Plates, Medium 2 x 4 $210.00 $280.00
Hole Quad Plate, Plates 8 to 15
holes
Complex
Synthes Australia Pty Ltd
SY469 CMF fracture or reconstruction plate Titanium adaption plates 0.5 to 0.99mm 8 to 15 holes $210.00
SY477 CMF fracture or reconstruction plate Titanium adaption plates 0.5 to 0.99mm 8 to 15 holes $280.00 $580.00
Complex - LeFort
Stryker Australia Pty Ltd
SK345 Leibinger Titanium Implant System - Le Fort 1 Plate, Right/Left 11hole, Advancement 2 - $287.00
Universal CMF Plate 10mm
Compression
Synthes Australia Pty Ltd
SY474 CMF fracture or reconstruction plate Titanium adaption plates 0.5 to 0.99mm 8 to 15 holes $200.00 $500.00
Locking
Stryker Australia Pty Ltd
SK288 Leibinger Titanium Implant System - Mid-Face Fixation Plates, Locking 8 Hole Curved Plate, Midface, $210.00
Universal CMF Plate locking
Prostheses List by Category, Groups and Sponsor Page 769 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK290 Leibinger Titanium Implant System - Mid-Face Fixation Plates, Locking 2x6 Hole 3-D Plate, Midface, $210.00
Universal CMF Plate Locking
SK293 Leibinger Titanium Implant System - Mid-Face Fixation Plates, Locking 8 Hole Y Plate, Midface, locking $210.00
Universal CMF Plate
Orbital
Medical & Optical Instruments Australia Pty Ltd
MO318 Martin Level One Fixation Plate, titanium 0.5 to 0.99mm thick, 8 to 15 $235.00
holes
Resorbable
Biomet Australia Pty Ltd
BH002 Lactosorb Resorbable Lactosorb Plates, 2mm System, All shapes 8 - 15 hole $215.00 $360.00
Craniomaxillofacial Fixation System PGA/PLA
BI991 Lactosorb Resorbable CMF System Lactosorb Plates, 1.5mm System 8 - 15 hole $215.00 $360.00
Medtronic Australasia Pty Ltd
MC547 Macropore Z Plates 10 hole $215.00 $420.00
MC559 Macropore L Plates 8 hole, Left & Right $215.00 $420.00
MC564 Macropore Straight Plates 8 hole $215.00 $420.00
Stryker Australia Pty Ltd
ST520 Stryker Leibinger Resorbable Fixation Resorbable plate: ladder shape plate 2x5 holes $215.00
System Tripolymer
ST521 Stryker Leibinger Resorbable Fixation Resorbable plate: straight Tripolymer 14 holes $215.00
System
ST525 Stryker Leibinger Resorbable Fixation Resorbable plate: Y-shape Tripolymer 8 holes $215.00
System
Synthes Australia Pty Ltd
SY397 PolyMax Resorbable Fixation System 1.5 Burr Hole Cover 8 Hole $215.00 $600.00
SY505 CMF Rapid Resorbable fracture or Sterile Rapid resorbable reconstruction 0.5 to 0.99mm thick, 8 to 15 $215.00
reconstruction Plate plate holes
7.1.3.9 CMF fracture or reconstruction plate, 0.5-0.99mm thick, 16 - 32 holes
Aus Systems Pty Ltd
AU006 Aus Systems Titanium Miniplates (Bone Low profile 19 hole $204.00
Plates)
Prostheses List by Category, Groups and Sponsor Page 770 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AU019 Aus Systems Titanium Miniplates (Bone 16 & 19 hole 0.7mm & 1mm profile $204.00
Plates)
B Braun Australia Pty Ltd
BB317 Aesculap CranioPlate System/ Plate Cranial fixation system, internal fracture, Plate Neuro, 16 hole 63mm $204.00
Neuro, 16 hole straight non biodegradable. Consists of screws, straight
plates.
Biomet Australia Pty Ltd
BH012 W Lorenz Osteosynthesis System 1.2, 1.7mm Small Fragment System, Plate, 1.2, 1.7mm Small Fragment $204.00 $350.00
All shapes Titanium System, Plate, All shapes
Titanium
BI985 W Lorenz Osteosynthesis System Plates Straight, 1.5, 2.0 or 1.0mm System 15 - 32 holes $204.00 $350.00
Johnson & Johnson Medical Pty Ltd
JJ278 BIOPLATE Bone plate Titanium cranial straight plate, 16 hole, 1.5mm and 1.9mm diam, 63 - $204.00
packaged non-sterile 86 length
Medical & Optical Instruments Australia Pty Ltd
MO284 Martin Level One Fixation Plate, titanium 0.5 to 0.99mm thick, 16 to 32 $204.00 $320.00
holes
Medtronic Australasia Pty Ltd
MC874 TiMesh Rigid Fixation Bone Grafting and Titanium, Straight Plate 16-32 hole $204.00 $450.00
Plating System
MC911 Timesh Rigid Straight Plates 16-32 holes $204.00 $805.00
Stryker Australia Pty Ltd
SK255 Leibinger Titanium Implant System - Upperface Fixation Plates 24 Hole Straight Plate $204.00
Universal CMF Plate Upperface, malleable
condensed; 24 Hole Straight
Plate Upperface
SK257 Leibinger Titanium Implant System - Upperface Fixation Plates 18 Hole Straight, Upperface, $204.00
Universal CMF Plate Malleable
SK266 Leibinger Titanium Implant System - Upperface Fixation Plates 10x10 Hole 3-D plate $204.00
Universal CMF Plate Upperface, malleable; 10x10
Hole 3-D plate, Upperface
SK269 Leibinger Titanium Implant System - Midface Fixation Plates 24 Hole Straight Plate Midface, $204.00
Universal CMF Plate malleable condensed; 20 Hole
Straight Plate Midface,
malleable; 24 Hole Straight
Plate Midface
Prostheses List by Category, Groups and Sponsor Page 771 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ST102 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System: 2.7mm, 17 holes $204.00
bridging, plate, straight Titanium
ST128 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight 16 holes $204.00
Titanium
ST129 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight 24 holes $204.00
Titanium
ST157 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: 16 holes, 0.55mm height $204.00
regular Titanium
ST158 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: 30 holes, 6mm bar, 0.55mm $204.00
regular Titanium height
ST159 Leibinger Titanium Implant System LeibingerSteinhauser plate: regular Titanium 30 holes, 6mm bar, 0.55mm $204.00
height
ST201 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Bone plate: 4x4 holes, 0.55mm, 0.55mm $204.00
square, rectangular Titanium height
ST202 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Bone plate: 6x4 holes, 0.55mm height $204.00
square, rectangular Titanium
ST329 Leibinger Titanium Implant System Leibinger Micro 3D Plating System: 4x4 holes, 0.55mm profile $204.00
square, rectangular Titanium
ST330 Leibinger Titanium Implant System Leibinger Micro 3D Plating System: 4x6 holes, 0.55mm profile $204.00
square, rectangular Titanium
ST335 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: straight 16 holes, 0.55mm profile $204.00
titanium
ST336 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: straight 24 holes, 0.55mm profile $204.00
titanium
ST401 Luhr Fixation System Luhr Micro Fixation System: micro straight 22 holes, 90mm $204.00
plate Vitallium
ST420 Luhr Fixation System Luhr Pan Fixation System: straight plate 16 holes, 93mm $204.00
Vitallium
ST479 Wurzburg Bone Plates Wurzburg Mini Bone plate: straight, 16 holes $204.00
regular Titanium
Surgiplas Medical
SP083 Plates Mini & Maxi 16 & 18 Hole Straight Plate, 18 $204.00
Hole Straight Plate, Plates 15
to 32 Holes
Prostheses List by Category, Groups and Sponsor Page 772 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Synthes Australia Pty Ltd
SY495 CMF fracture or reconstruction plate Titanium adaption plates - Low profile 0.5 to 0.99mm 16 - 32 holes $204.00
neurosurgical plates
Complex - Burr
Medtronic Australasia Pty Ltd
MC869 TiMesh Rigid Fixation Bone Grafting and Titanium, Plate Ohata Kerf Cover, 5 - 32 hole $430.00
Plating System
Stryker Australia Pty Ltd
SK355 Universal Neuro Titanium Low Profile Titanium Low Profile plates used for the Small, large, 20mm burr hole, $430.00
Plate fixation of cranial bone flaps 16 hole without bar
Compression
Synthes Australia Pty Ltd
SY476 CMF fracture or reconstruction plate Titanium adaption plates 0.5 to 0.99mm 15 to 32 holes $312.00 $620.00
Locking
Stryker Australia Pty Ltd
SK287 Leibinger Titanium Implant System - Mid-Face Fixation Plates, Locking 16 Hole Straight Plate, $312.00
Universal CMF Plate Midface, locking
Resorbable
Biomet Australia Pty Ltd
BH003 Lactosorb Resorbable Lactosorb Plates, 2mm System, All shapes 16-32 hole $220.00 $380.00
Craniomaxillofacial Fixation System PGA/PLA
BI992 Lactosorb Resorbable CMF System Lactosorb Plates, 1.5mm System 16 - 32 holes- $220.00 $380.00
Medtronic Australasia Pty Ltd
MC565 Macropore Straight Plates 20 hole $220.00 $450.00
Synthes Australia Pty Ltd
SY513 CMF Rapid Resorbable fracture or Sterile Rapid resorbable reconstruction 0.5 to 0.99mm thick,15 to 32 $220.00
reconstruction Plate plate holes
7.1.4 Screw, CMF and Small Fragment
7.1.4.1 Diameter <1.24mm
Advanced Surgical Design & Manufacture Ltd
AE007 MF-Cortex Screw Titanium 1.0 - 2.7mm dia, length 2 - $70.00
40mm
Prostheses List by Category, Groups and Sponsor Page 773 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Biomet Australia Pty Ltd
BH013 W Lorenz Osteosynthesis System Small Fragment Titanium System, Titanium Screw, 1.2mm diameter, $70.00 $80.00
1.4mm diameter
Medical & Optical Instruments Australia Pty Ltd
MO287 Martin Level One Fixation Screw Titanium diameter <1.24mm $70.00 $75.00
Medtronic Australasia Pty Ltd
MC574 Timesh X-Drive Screws 2 - 15mm $70.00 $76.00
MC879 TiMesh Rigid Fixation Bone Grafting and Titanium, Screw - Cruciate Head, 12 point Diameter <1.24mm $70.00 $76.00
Plating System Flat Head
Stryker Australia Pty Ltd
SK299 Leibinger Screw (Various) - Universal 1.2mm Diameter, 3-12mm $70.00
CMF Screws Length; 1.4mm Diameter 3-
9mm Length
SK300 Leibinger Screw (Various) - Universal Self Drilling, 1.2mm Diameter, $70.00
CMF Screws 3-4mm Length
ST110 Stryker Leibinger Plating System Micro Self Tapping Screws 1.0 - 1.4mm Diameter, 2 - $70.00
12mm Lengths
ST408 Luhr Fixation System Luhr Micro Fixation System: emergency 1.0x2-6mm $70.00
screws Vitallium
ST444 Luhr Fixation System Luhr Mini/ Pan Fixation System: 3-20mm. Pack of 6 $70.00
emergency and standard screws Vitallium
Surgiplas Medical
SP088 Screws Micro, Maxi & Self Drilling "Size1.2mm self-drilling $70.00
screws, 1.2mm x (2 - 14)mm,
Screws diameter < 1.24mm"
Synthes Australia Pty Ltd
SY559 AO/ASIF Screw CMF screw; cortex, cortical, emergency, 1.0mm-1.20mm various lengths $70.00
self-tapping,self-drilling
Compression
Surgiplas Medical
SP031 OsteoMed Plating & Fixation System Lag Screws - Micro, Mini 1.2mm x (6 - 16)mm; 1.6mm x $80.00
(10-12)mm; 2.0mm x (8 -
22)mm;
Prostheses List by Category, Groups and Sponsor Page 774 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Fixation Device, Internal, Screw
Australian Surgical Innovations Pty Ltd
AI007 ASI Plates and Screws Screw Width 1.0 - 3.0mm. Length 3.0 $70.00
- 25mm
7.1.4.2 Diameter 1.25 - 1.74mm (1.5mm)
Aus Systems Pty Ltd
AU043 Aus Systems Titanium Bone Screws Screws 1.5mm & 1.8mm diameter 3mm - 11mm length $43.00
B Braun Australia Pty Ltd
BB316 Aesculap CranioPlate System/Screws Cranial fixation system, internal fracture, screws neuro, self drilling, $43.00
Neuro, self-drilling, 1.5 x 3, 4 & 5mm non biodegradable. Consists of screws, magazine of 8, 1.5mm x 3, 4 &
plates. 5 mm lengths
Biomet Australia Pty Ltd
BH014 W Lorenz Osteosynthesis System Small Fragment Titanium System. Titanium Screw, 1.7mm diameter $43.00
BH020 W Lorenz Osteosynthesis System Bone Screw, Cross Drive or Centre Drive. 1.5mm dia x (3.5 - 17)mm $43.00
Titanium
BI733 W.Lorenz Osteosynthesis System Bone Screw, Self Drilling, Cross Drive, 1.5 mm (dia) x 6.0, 7.0mm $43.00
Titanium [lengths]
BI734 W.Lorenz Osteosynthesis System Bone Screw, Self Drilling, Cross Drive, 1.5 mm (dia) x 3.5, 4.0, $43.00
Titanium 5.0mm, [lengths]
Johnson & Johnson Medical Pty Ltd
JJ201 Bioplate Bone Screw Titanium cranial fixation system 1.5mm diam, 3-10 6mm length; $43.00
pack of 5
JJ248 BIOPLATE Bone screw Titanium alloy self-drilling screw, 5 per Dia 1.5mm, length 3 - 5mm $43.00
pack, packaged non-sterile
JJ252 BIOPLATE Bone screw Titanium alloy long screw, 1 per pack, Dia 1.5mm, length 3, 4, 5, 6, 8, $43.00
packaged non-sterile 10mm
JJ534 BIOPLATE Low Profile Low Profile Titanium Screw 1.5mm diam, 3-5mm length $43.00
Medical & Optical Instruments Australia Pty Ltd
MO288 Martin Level One Fixation Screw Titanium diameter 1.25 to 1.74mm $43.00 $78.00
Medtronic Australasia Pty Ltd
MC880 TiMesh Rigid Fixation Bone Grafting and Titanium, Screw - Cruciate Head, 12 point Diameter 1.25 - 1.74mm $43.00 $90.00
Plating System Flat Head
Prostheses List by Category, Groups and Sponsor Page 775 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC904 Timesh Internal Drive Screws Diameter 1.5mm $43.00 $90.00
Stryker Australia Pty Ltd
SK301 Leibinger Screw (Various) - Universal 1.7mm Diameter, 3-12mm $43.00
CMF Screws Length; 1.9mm Diameter, 3-
9mm Length
SK302 Leibinger Screw (Various) - Universal Self Drilling, 1.7mm Diam; 3- $43.00
CMF Screws 6mm Length
SK362 Universal Neuro Screws Titanium screws used for the fixation of Diameter 1.5mm, length 4- $43.00
cranial bone flaps 6mm. Emergency Screws:
Diameter 1.7mm, length 4mm.
SK457 Maxillo-Mandibular Fixation Screw MMF Screw, Self Drilling, Stainless Steel Dia 1.7mm/2.0mm, Length $43.00
2mm to 20mm
ST111 Leibinger Screws Leibinger Mini Wurzburg Bone Screws: 1.7x3-12mm $43.00
square fit, self-tapping Titanium
ST148 Leibinger Screws Leibinger Micro Plus Screws: cross-slot, 1.4x3mm, 1.4x5mm $43.00
self-tapping Titanium
ST149 Leibinger Screws Leibinger Micro Plus Screws: cross-slot, 1.4x7mm, 1.4x9mm $43.00
self-tapping Titanium
ST150 Leibinger Screws Leibinger Micro Plus Screws: cross-slot, 1.4x11mm $43.00
self-tapping Titanium
ST236 Leibinger Titanium Screws Bone Screw, cross-fit, self-tapping Diameter 1.7mm, Length 3mm $43.00
- 38mm
Surgiplas Medical
SP089 Screws Micro, Maxi & Self Drilling "Size1.6mm x (4-8)mm self- $43.00 $49.00
drilling screws,1.5mm Safety
,Screws diameter 1.25-
1.75mm"
Synthes Australia Pty Ltd
SY556 AO/ASIF screw CMF screw; cortex, cortical, emergency, 1.3-1.7mm, various lengths $43.00
self-tapping, self-drilling; low profile
Prostheses List by Category, Groups and Sponsor Page 776 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Locking
Stryker Australia Pty Ltd
SK303 Leibinger Screw (Various) - Universal Locking, 1.7mm Diameter, 4- $48.00
CMF Screws 6mm Length; Locking 1.9mm
Diameter, 5mm Length
Resorbable
Biomet Australia Pty Ltd
BI994 Lactosorb Resorbable Bone Screw Lactosorb, single screw 1.5mm dia $121.00 $160.00
Craniomaxillofacial Fixation System (multiple screws per pack) PGA/PLA
Medical & Optical Instruments Australia Pty Ltd
MO308 Martin Level One Fixation Resorb x & SonicPin PDLLA (resorbable) diameter 1.25-1.74mm $121.00 $200.00
SonicWeld
Stryker Australia Pty Ltd
ST527 Stryker Leibinger Resorbable Fixation Resorbable Screws Trypolymer 1.7x4-5mm Pack of 10 $121.00
System
ST528 Stryker Leibinger Resorbable Fixation Resorbable Screws Trypolymer 1.7x3-6mm Pack of 2 $121.00
System
ST529 Stryker Leibinger Resorbable Fixation Resorbable Screws Trypolymer 1.7x3-6mm Pack of 4 $121.00
System
Synthes Australia Pty Ltd
SY502 PolyMax Resorbable Fixation System Polyactide Resorbable Screw/Tack 1.5mm dia $121.00
7.1.4.3 Diameter 1.75 - 2.24mm (2.0mm)
Aus Systems Pty Ltd
AU035 Aus Systems Titanium Bone Screws Screws 2mm & 2.3mm diameter 4mm - 15mm length $40.00
B Braun Australia Pty Ltd
BB314 Aesculap CranioPlate System/ Screws Cranial fixation system, internal fracture, Screws Neuro, Emergency, self $40.00
Neuro Emergency, self tapping, 1.8mm x non biodegradable. Consists of screws, tapping, magazine of 8, 1.8mm
3 & 5mm plates. x 3 & 5mm lengths
Biomet Australia Pty Ltd
BH016 TMJ System Screw, Cross Drive, Fossa. Titanium 2.0mm dia x (5 - 13)mm $40.00 $75.00
BH021 W Lorenz Osteosynthesis System Bone Screw, Cross Drive or Centre Drive. 1.8mm dia x (3.5 - 17)mm $40.00 $50.00
Titanium
Prostheses List by Category, Groups and Sponsor Page 777 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BI360 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive, Std 2.0mm x (4 - 7) mm $40.00 $50.00
or Self Drilling; Titanium
BI365 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive; 2.0mm x (9 - 19) mm $40.00 $50.00
Titanium
BI744 Mandibular Fracture System Screw, High Torque 2.0/2.4 Mandibular 2.0 x (9-17)mm $40.00 $50.00
Fracture, Titanium
BI747 Mandibular Fracture System Screw, High Torque (HT), Lag, 2.0/2.4 Dia 2.0 x 19, 21.0, 23, 25, 27, $40.00 $60.00
Mandibular Fracture System, Titanium 29mm Lengths
Johnson & Johnson Medical Pty Ltd
JJ215 Bioplate Bio-100 Screw Titanium cranial fixation system 1.9 mm diam; 15mm length $40.00
pack of 5
JJ244 BIOPLATE Bone screw Titanium alloy self-drilling screws, 5 per Dia 1.9mm, length 3 - 5mm $40.00
pack, packaged non-sterile
JJ245 BIOPLATE Bone screw Titanium alloy self-drilling screws, 5 per Dia 1.9mm, length 4mm $40.00
pack, packaged non-sterile
JJ251 BIOPLATE Bone screw Titanium alloy long screws, 5 per pack, Dia 1.9mm, length 3, 4, 5, 6, 8, $40.00
packaged non-sterile 10mm
JJ253 BIOPLATE Bone screw Titanium alloy emergency screws, 5 per Dia 1.8, length 6mm; Dia $40.00
pack, packaged non-sterile 2.3mm, length 5mm
Medartis
EO007 Aptus Hand Titanium cortex screws 1.2-2,5mm diameter, 4mm- $67.00
34mm
Medical & Optical Instruments Australia Pty Ltd
MO134 Martin Osteosynthesis System Screw Fami Anchor Titanium 1.5 - 2.0mm Diameter 8 - 15mm $40.00 $164.00
MO315 Martin Level One Fixation Screw, titanium Diameter 1.75 - 2.24mm $40.00 $65.00
Medtronic Australasia Pty Ltd
MC881 TiMesh Rigid Fixation Bone Grafting and Titanium, Screw - Cruciate Head, 12 point Diameter 1.75 - 2.24mm $40.00 $110.00
Plating System Flat Head
MC905 Timesh Internal Drive Screws Diameter 1.8mm $40.00 $110.00
MC906 Timesh Rescue Screws Diameter 1.8mm $40.00 $110.00
Prostheses List by Category, Groups and Sponsor Page 778 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Stryker Australia Pty Ltd
SK151 Leibinger Screw - Universal Mandibular Items used for reconstruction and fixation Universal Mandible Screws, $40.00
Screws of mandibular fractures and tumour 2.0mm Diameter, 16mm-20mm
resection Length; Universal Mandible
Screws, 2.3mm Diameter,
16mm-20mm Length
SK153 Leibinger Screw - Universal Mandibular Items used for reconstruction and fixation Universal Mandible Smartlock $40.00
Screws of mandibular fractures and tumour Screws, 2.0mm Diameter,
resection 4mm-14mm Length; Universal
Mandible Smartlock Screws,
2.3mm Diameter, 4mm-16mm
Length
SK385 Universal System Condyle Fastening Screws One size only $40.00
ST082 Leibinger Screws Leibinger IMF: cross-slot screws Titanium 2.0x8mm, 2.0x14mm, 2.0x20mm $40.00
ST083 Leibinger Screws Leibinger Steinhauser Screw System: 2.0x4-12mm $40.00
cross-slot screws Titanium
ST084 Leibinger Screws Leibinger Steinhauser Screw System: 2.0x13-22mm $40.00
cross-slot screws Titanium
ST113 Leibinger Screws Leibinger Mini Wurzburg Bone Screws: 1.9x5mm, 1.9x7mm $40.00
square fit, self-tapping Titanium
ST114 Leibinger Screws Leibinger Mini Wurzburg Bone Screws: 2.0x4-19mm $40.00
square fit, self-tapping Titanium
ST240 Leibinger Screws Leibinger Mini Wurzburg Emergency 1.9 x 5mm $40.00
Screws Titanium
ST490 Wurzburg Bone Plates Wurzburg Bone Screws: self-tapping 2x4-19mm, 2.3x7-9mm. Pack $40.00
Titanium of 10
Surgiplas Medical
SP090 Screws Micro, Maxi & Self Drilling "Size2.0mm x (4-8)mm self- $40.00 $55.00
drilling screws,1.9mm Safety
,Screws diameter 1.75-
2.24mm"
Synthes Australia Pty Ltd
SY560 AO/ASIF Screw. CMF screw; cortex, cortical, emergency, 1.8-2.0mm, various lengths. $40.00
self-tapping, self-drilling.
Prostheses List by Category, Groups and Sponsor Page 779 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Compression
Stryker Australia Pty Ltd
SK152 Leibinger Screw - Universal Mandibular Items used for reconstruction and fixation Universal Mandible Lag $155.00
Screws of mandibular fractures and tumour Screws, 2.0mm Diameter,
resection 24mm-42mm Length
Distractor
Synthes Australia Pty Ltd
SY400 External Midface Distractor System Fixation Screws 40-50mm $85.00
SY403 External Midface Distractor System Set Screw One size only $85.00
SY405 External Midface Distractor System Titanium Wire Fixation Screw 15-27mm $85.00
Locking
Medical & Optical Instruments Australia Pty Ltd
MO316 Martin Level One Fixation Screw, titanium Diameter 1.75 - 2.24mm $90.00
Stryker Australia Pty Ltd
SK149 Leibinger Screw - Universal Mandibular Items used for reconstruction and fixation Universal Mandible Screws, $90.00
Screws of mandibular fractures and tumour 2.0mm Dia, 4-14mm Length;
resection Universal Mandible Screws,
2.3mm Dia, 4-14mm Length
SK150 Leibinger Screw - Universal Mandibular Items used for reconstruction and fixation Universal Mandible Smartlock $90.00
Screws of mandibular fractures and tumour Screws, 2.0mm Diameter,
resection 16mm-20mm Length; Universal
Mandible Smartlock Screws,
2.3mm Diameter, 18mm-20mm
Length
Surgiplas Medical
SP116 OsteoMed Plating & Fixation System Locking Screws Diameter 2.0mm, length 4-18mm $90.00 $120.00
Synthes Australia Pty Ltd
SY557 AO/ASIF Screw CMF screw; cortex, cortical, emergency, 2.0-2.4mm, various lengths $90.00
self-tapping, locking
Resorbable
Biomet Australia Pty Ltd
BI415 Lactosorb Resorbable Bone Screw, 2 Pack, Endobrow, 2 x 5mm $141.00 $160.00
Craniomaxillofacial Fixation System Lactosorb. PGA/PLA
Prostheses List by Category, Groups and Sponsor Page 780 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BI995 Lactosorb Resorbable Bone Screw Lactosorb, single screw 2.0mm dia $141.00 $160.00
Craniomaxillofacial Fixation System (multiple screws per pack) PGA/PLA
Danex Medical Pty Ltd
XD013 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Screws 2 x 9-19mm, 2.5 x 10- $141.00
copolymer 23mm and 2.8 x 10 - 23mm
Medical & Optical Instruments Australia Pty Ltd
MO307 Martin Level One Fixation Resorb x & SonicPin, PDLLA (resorbable) Diameter 1.75 - 2.24mm $141.00 $200.00
SonicWeld Rx
Medtronic Australasia Pty Ltd
MC626 Macropore FRP (fast resorbing Polylactide and Polyglycolide polymer 1.8mm x 3-8mm $141.00
polymer)
MC631 Macropore FRP (fast resorbing Polylactide and Polyglycolide polymer 2.1mm x 3-8mm $141.00
polymer) screw
MC901 Macropore Screws Diameter 1.75 - 2.24mm $141.00
Surgical Specialties
SQ060 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Screws 2 x 9-19mm, 2.5 x 10- $141.00
copolymer 23mm and 2.8 x 10 - 23mm
Synthes Australia Pty Ltd
SY503 PolyMax Resorbable Fixation System Polyactide Resorbable Screw/Tack 2.0/2.5mm dia $141.00
7.1.4.4 Diameter 2.25 - 2.74mm (2.5mm)
Biomet Australia Pty Ltd
BH015 W Lorenz Osteosynthesis System Small Fragment Titanium System. Titanium Screw 2.3mm diameter, 2.5mm $45.00
diameter
BH017 TMJ System Screw, Cross Drive, Fossa. Titanium 2.3mm Dia x (5 - 13)mm $45.00 $75.00
BI723 Mandibular Fracture System Screw, High Torque 2.0/2.4 Mandibular 2.7 x (6-20)mm $45.00 $55.00
Fracture, Titanium
BI726 Mandibular Fracture System Screw, High Torque (HT), Emergency, Dia 2.3mm x 4.0, 5.0, 7.0, 9.0, $45.00
2.0/2.4 Mandibular Fracture System, 11.0, 13.0, 15.0mm Lengths
Titanium
BI735 W.Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive; 2.3mm x (5 - 9) mm $45.00
Titanium
BI748 Mandibular Fracture System Screw, High Torque (HT), 2.0/2.4 Dia 2.4 x 6.0mm, 8.0, 10.0, $45.00 $55.00
Mandibular Fracture System, Titanium 12.0, 14.0, 16.0, 18.0mm
Lengths
Prostheses List by Category, Groups and Sponsor Page 781 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BI751 Mandibular Fracture System Screw, High Torque (HT), Lag, 2.0/2.4 2.4mm Dia, 24, 28, 32, 36, $45.00 $55.00
Mandibular Fracture, Titanium 40mm Lengths
Johnson & Johnson Medical Pty Ltd
JJ254 BIOPLATE Bone screw Titanium alloy emergency screw, 1 per Dia 1.8, length 6mm; Dia $45.00
pack, packaged non-sterile 2.3mm, length 5mm
Medical & Optical Instruments Australia Pty Ltd
MO311 Martin Level One Fixation Screw, Titanium Diameter 2.25 - 2.74mm $45.00 $75.00
Medtronic Australasia Pty Ltd
MC882 TiMesh Rigid Fixation Bone Grafting and Titanium, Screw - Crucuate Head, 12 Diameter 2.25 - 2.74mm $45.00 $130.00
Plating System point Flat Head
MC902 Macropore Screws Diameter 2.25 - 2.74mm $141.00 $160.00
MC907 Timesh Rescue Screws Diameter 2.4mm $45.00 $130.00
Stryker Australia Pty Ltd
SK148 Leibinger Screw - Universal Mandibular Items used for reconstruction and fixation Universal Mandible Screws, $45.00
Screws of mandibular fractures and tumour Emergency, 2.7mm Diameter,
resection 8-20mm Length
ST098 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System: 2.3x6-22mm $45.00
screws Titanium
ST115 Leibinger Screws Leibinger Mini Wurzburg Bone Screws: 2.3x6-9mm $45.00
square fit, self-tapping Titanium
Surgiplas Medical
SP091 Screws Micro, Maxi & Self Drilling 2.4mm x (4-22)mm self-drilling $45.00
screws, 2.7mm x (8-20)mm;
2.7mm Safety Screws, diameter
2.25-2.74mm
SP094 OsteoMed Plating & Fixation System Screws 2.4mm x (6-22)mm Locking $75.00 $140.00
Screws, Screws 2.25-2.74mm
Synthes Australia Pty Ltd
SY553 AO/ASIF Screw CMF screw: cortex, cortical, emergency, 2.4-2.7mm, various lengths $45.00
self-tapping, self-drilliing
Prostheses List by Category, Groups and Sponsor Page 782 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Locking
Biomet Australia Pty Ltd
BI457 Lorenz 2.4mm Locking Reconstruction Screw, Locking Reconstruction Modular. 2.4 x (6-18)mm $75.00 $95.00
System Titanium
BI786 Lorenz 2.4mm Locking Reconstruction Screw, bending inserts, titanium One size only $75.00
System
Medical & Optical Instruments Australia Pty Ltd
MO312 Martin Level One Fixation Screw, titanium Diameter 2.25 - 2.74mm $75.00
Stryker Australia Pty Ltd
SK147 Leibinger Screw - Universal Mandibular Items used for reconstruction and fixation Universal Mandible Smartlock $75.00
Screws of mandibular fractures and tumour Emergency Screws, 2.7mm
resection Diameter, 8mm - 20mm length
Synthes Australia Pty Ltd
SY552 AO/ASIF Screw. CMF Screw; cortex, cortical, emergency, 2.4mm, various lengths. $75.00
self-tapping, locking.
Resorbable
Biomet Australia Pty Ltd
BI996 Lactosorb Resorbable Bone Screw Lactosorb,single screw 2.5mm dia $141.00 $160.00
Craniomaxillofacial Fixation System (multiple screws per pack) PGA/PLA
Danex Medical Pty Ltd
XD009 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Screws 2.8 x 6-23mm, 3.1 x 6- $141.00
copolymer 8mm
XD014 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Screws 1.5 - 2.5mm dia x 5- $121.00
copolymer 8mm long
Surgical Specialties
SQ051 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Screws 1.5 - 2.5mm dia x 5- $121.00
copolymer 8mm long
SQ056 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Screws 2.8 x 6-23mm, 3.1 x 6- $141.00
copolymer 8mm
Prostheses List by Category, Groups and Sponsor Page 783 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.1.4.5 Diameter 2.75 - 3.24mm (3.0mm)
Biomet Australia Pty Ltd
BI742 TMJ System Screw, Cross Drive Mandibular (2.7 - 3.2mm) x (8 - 12mm) $54.00
Component, Titanium
Medtronic Australasia Pty Ltd
MC571 Timesh 12 Point Screws 3 - 20mm $54.00 $150.00
MC903 Macropore Screws Diameter 2.75 - 3.24mm $155.00 $170.00
Synthes Australia Pty Ltd
SY554 AO/ASIF Screw CMF screw: cortex, emergency, self- 2.7-3.2mm, various lengths $54.00
tapping
Locking
Synthes Australia Pty Ltd
SY555 AO/ASIF Screw. CMF screw; cortex, emergency, self- 2.7-3.2mm, various lengths. $90.00
tapping.
Resorbable
Biomet Australia Pty Ltd
BI997 Lactosorb Resorbable Bone Screw Lactosorb, single screw 2.8mm dia $155.00 $160.00
Craniomaxillofacial Fixation System (multiple screws per pack) PGA/PLA
Danex Medical Pty Ltd
XD010 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Screws 3.1 x 6 - 30mm and $155.00
copolymer 2.5 x 30mm
Surgical Specialties
SQ057 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Screws 3.1 x 6 - 30mm and $155.00
copolymer 2.5 x 30mm
7.1.4.7 Diameter >4mm
Resorbable
Danex Medical Pty Ltd
XD012 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Screws 4.5 x 20-55mm, 3.1 x $310.00
copolymer 40mm
Surgical Specialties
SQ059 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC Screws 4.5 x 20-55mm, 3.1 x $310.00
copolymer 40mm
Prostheses List by Category, Groups and Sponsor Page 784 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.1.5 Reconstruction Material Sheet, Non-mesh
7.1.5.1 Small, <50cm2
Stryker Australia Pty Ltd
SK515 Nasal Sheet (Strut). Nasal Sheet (Strut). Model 9536 Nasal Sheet (Strut): 40 x 9 x $220.00
1.1mm
Polymer
Stryker Australia Pty Ltd
HW416 Micro Thin Sheet Model/s 8438, 83020, 83022, 83029 8438: 30 x 50 x 0.4mm, $443.00
83020: 38 x 50 x 0.25mm,
83022: 38 x 50 x 0.35mm,
83029: 38 x 50 x 0.45mm
HW417 Sheet Porus Polyethylene. Models 6330, 6331, Sheets 6330: 38 x 50 x 1.5mm, $443.00
8662, 9562. Micro single channel sheet, 6331: 50 x 76 x 1.5mm, 8662:
model 9528. Barrier microplate single 76 x 127 x 1.5mm, 9862: 38 x
channel sheet, model 9527 Medpor Titan 50 x 3mm. Microplate single
Implant Sheets Plain, Barrier & Double channel Sheet 9528: 38 x 50 x
Barrier, and Medpor Titan Orbital floor 0.85mm. Barrier microplate
and wall sheets 8102 single channel Sheet 9527: 38 x
50 x 0.85mm. Titan implant
sheets 81020: 76 x 50 x
HW418 Barrier Sheet: Barrier Sheet - Orbital Porus Polyethylene. Barrier sheet - Barrier sheet - Rectangle: 50 x $443.00
Floor Rectangle, models 8312 and 9312. Orbital 76 x 1mm, 50 x 76 x 1.6mm:
floor implants, models 8305 and 9305 50 x 76 x 1mm, 50 x 76 x
1.6mm. Orbital Floor: 38 x 50
x 1mm, 38 x 50 x 1.6mm
HW428 Sheet - Multi Channel, Barrier Channel. Porus Polyethylene. Miniplate channel Miniplate channel: 40 x 52 x $443.00
sheet, model 9529. Microplate channel 2.3mm. Mircoplate channel: 40
sheet, model 9530. Barrier Miniplate and x 52 x 2.3mm. Barier Miniplate
Microplate Channel Sheets, Models 9531 and Microplate Channel Sheets:
and 9532. 40 x 52 x 2.3mm, 40 x 52 x
2.3mm
HW442 E-POR Biomaterial/ Sheet - Porous Sheet - Porous Polyethylene 30mm - 50mm x 0.4mm - 3mm $443.00
Polyethylene
SK513 Ultra Thin Sheet Porus Polyethylene. Models 7210 38 x 50 x 0.85mm $443.00
Prostheses List by Category, Groups and Sponsor Page 785 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK516 Ultra Thin Sheet Porus Polyethylene. Model 7212 50 x 76 x 0.85mm $443.00
SK517 Sheet - Barrier Single Channel Sheet. Porus Polyethylene. Barrier Single Channel Barrier Single Channel: 38 x 50 $443.00
Sheet, Model 9527. x 0.85mm
Resorbable
Biomet 3i Australia Pty Ltd
NW005 OsseoGuard Resorbable Collagen Dental Resorbable Collagen Membrane 15mm x 20mm, 20mm x $345.00
Membrane 30mm, 30mm x 40mm
Henry Schein-Halas Pty Ltd
HD010 Bio-Gide Bio-Gide & Bio-Gide Perio are collagen 30mm x 40mm $345.00
membranes containing porcine collagen in
a bilayer structure. They are used for
guided bone regeneration and peridontal
tissue regeneration in oral and maxillofacial
surgery.
HD011 Bio-Gide Bio-Gide & Bio-Gide Perio are collagen 25mm x 25mm $345.00
membranes containing porcine collagen in
a bilayer structure. They are used for
guided bone regeneration and peridontal
tissue regeneration in oral and maxillofacial
surgery.
HD012 Bio-Gide Bio-Gide & Bio-Gide Perio are collagen 13 x 25mm $345.00
membranes containing porcine collagen in
a bilayer structure. They are used for
guided bone regeneration and peridontal
tissue regeneration in oral and maxillofacial
surgery.
HD013 Bio-Gide Perio Bio-Gide & Bio-Gide Perio are collagen Bio-Gide perio - 16mm x $345.00
membranes containing porcine collagen in 22mm
a bilayer structure. They are used for
guided bone regeneration and peridontal
tissue regeneration in oral and maxillofacial
surgery.
Medical & Optical Instruments Australia Pty Ltd
MO302 Martin Level One Fixation Resorb x & Reconstruction sheet not mesh PDLLA 25x25mm-0.1mm $345.00 $550.00
SonicWeld (resorbable)
Prostheses List by Category, Groups and Sponsor Page 786 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.1.5.2 Medium, 50-145cm2
Polymer
Stryker Australia Pty Ltd
HW426 Ultra Thin Sheet Porus Polyethylene. Model 7214 76 x 127 x 0.85mm $950.00
7.1.5.3 Large, >145cm2
Polymer
Stryker Australia Pty Ltd
HW427 Ultra Thin Sheet Porus Polyethylene. Model 7216 127 x 178 x 0.85mm $1,550.00
7.1.5.4 Unspecified or various
Stryker Australia Pty Ltd
SK520 Medpor Porous Polyethylene Porous Polyethylene Biomaterial Custom Custom designed and made $8,500.00
Biomaterial Custom Made Implant Made Product for ear, nose, face and from CT scan image
Orbit reconstruction
Block
Stryker Australia Pty Ltd
HW419 Block Models 6332 - 6340 & 6359 6332: 13 x 38 x 3mm, 6333: $825.00
13 x 38 x 6mm, 6334: 13 x 38
x 9.5mm, 6335: 25 x 50 x 3
mm, 6336: 25 x 50 x 6mm,
6337: 25 x 50 x 9.5mm, 6338:
38 x 63 x 3mm, 6339: 38 x 63
x 6mm, 6340: 38 x 63 x 9.5mm
6359: 150 x 201mm
HW429 Flexblock TF Porus Polyethylene. Flexblock TF implant, Flexblock TF: small 70 x 70 x $850.00
models 9521 - 9522. 10mm, medium 88 x 86 x
15mm,
HW430 Flexblock TF Porus Polyethylene. Flexblock TF implant, Flexblock TF: large 98 x 95 x $1,000.00
model 9523. 18mm.
HW431 Flexblock, Cranial Grid Porus Polyethylene.Flexblock cranial grid Flexblock cranial grid: 97 x 107 $1,600.00
implant, model 9524. x 6mm.
Prostheses List by Category, Groups and Sponsor Page 787 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK514 Flexblock TF2 Flexblock TF2 implant, left and right, Flexblock TF2: small left & $950.00
models 9857 - 9860, 9861 - 9862 right 61 x 78 x 18mm, Medium
left & right 74 x 93 x 20mm,
large left & right 82 x 105 x
20mm
SK518 Flexblock TF2 Porus Polyethylene. Flexblock TF2 Flexblock TF2: large 82 x 105 $825.00
implant, left and right, models 9861 - 9862 x 20mm.
SK519 Flexblock Porus Polyethylene. Flexblock, model Flexblock: 56 x 91 x 4mm. $860.00
6314.
Block, Polymer
Anatomics Pty Ltd
AT072 E-POR Biomaterial Block Preform - various 3D 13mm - $825.00
63mm
7.1.5 Screw, craniomaxillofacial and small fragment
7.1.5.5 Screw, craniomaxillofacial and small fragment, diameter 2.25 - 2.74mm (2.5mm)
Locking
Medartis
EO006 Aptus Hand Aptus Hand-locking screws 2.0mm-2.5mm diameter, 6mm- $130.00
34mm length
7.2.1 Chin
Stryker Australia Pty Ltd
HW412 Chins Extended chin implants: Round RZ Extended chin Implants design $286.00 $400.00
(Models 8313 - 8315) and extended RZ round small: 45 x 47 x
square RZ (Models 8316, 8318). Two 3mm, medium 45 x 47 x 5mm,
piece chin design (Models 8320 - 8322). large 45 x 47 x 7mm; Extneded
Single piece chin design, contoured Chin Implants square small 45
(Models 7520 - 7522). Additional chin x 47 x3mm; Medium 45 x 47 x
shapes (Models 6341 - 6344) Contoured 5mm; Large 45 x 47 x 7mm;
t Two piece design small 46 x 33
x 5mm; Medium 56 x 36 x 7mm
Prostheses List by Category, Groups and Sponsor Page 788 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Surgiplas Medical
SP004 Facial Prosthesis Silicone elastomer Small / Medium / Large / X- $286.00
Large
7.2.2 Cranium
Surgiplas Medical
SP113 OsteoMed Plating & Fixation System Plates 90 x 90mm, 95 x 165mm, & $2,600.00 $2,975.00
Large Pre-formed Osteoform
Mesh, Cranium.
Coated
Anatomics Pty Ltd
AT064 E-POR Biomaterial/ Cranial Temporal, Cranial Temporal, Porous Polyethylene Left, Right, 130mm x 130mm $2,600.00
Porous Polyethylene Titanium Mesh Titanium Mesh Composite
Composite
Complex - Custom
Australian Surgical Innovations Pty Ltd
AI006 ASI Plates and Screws Custom Mesh . $6,700.00
Complex - Custom, Biomodelled
Medtronic Australasia Pty Ltd
MC526 TiMesh Surgical Mesh: Anterior, Posterior, One size only $6,700.00 $9,930.00
Modified
MC527 TiMesh Lateral Mesh: Left, Right One size only $6,700.00 $9,930.00
MC528 TiMesh Cranial Custom Mesh 121mm x 72mm - 152 x 152mm $6,700.00 $9,930.00
MC625 Modified Dual TiMesh TiMesh Surgical Mesh Modified, includes 121mm x 77mm - 152mm x $10,500.00 $12,250.00
two cranial plates. Composition: Titanium 152mm.
Complex - Custom, Polymer
Anatomics Pty Ltd
AT063 E-POR Biomaterial/ Patient Specific Patient Specific Cranial Implant, Porous Cranial Shape - Customised $9,930.00
Cranial Implant, Porous Polyethylene Polyethylene
Prostheses List by Category, Groups and Sponsor Page 789 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Polymer
Anatomics Pty Ltd
AT061 E-POR Biomaterial/ Contour Porous Contour Porous Polyethylene One Size 56mm x 91mm $1,300.00
Polyethylene
Stryker Australia Pty Ltd
HW437 E-POR Biomaterial/ Mastoid, Pterional, Mastoid, Pterional, Contourable Porous Left, Right, 43mm - 57mm x $1,300.00
Contourable Porous Polyethylene Polyethylene 0.6mm, 1.5mm
Resorbable
Medtronic Australasia Pty Ltd
MC548 Macropore Cranial Recon 29 - 165mm $481.00
7.2.3 Ear, other than hearing appliance
7.2.3.2 Ear Base
Stryker Australia Pty Ltd
HW432 Ear Reconstruction Porus Polyethylene. Ear base left and right, Ear base: 29 x 55 x 13mm, 32 $600.00
models 7542 and 7525 - 7527. Ear base x 65 x 16mm. Ear base
extended left and right, models 8330 and extended: 30 x 60mm.
8331.
7.2.3.3 Helical Rim
Stryker Australia Pty Ltd
HW420 Ear Reconstruction Porus Polyethylene. Helical rim, models Helical rim: 37 x 62mm $420.00
8328 and 8329
7.2.4 Malar Implant
Stryker Australia Pty Ltd
HW413 Genioplasty Wedge Porus Polyethylene. Genioplasty wedges, Small 60 x 25 x 5mm, medium $420.00
models 8340 - 8343 60 x 25 x 7.5mm, large 60 x 25
x 10mm
HW414 Prejowl Shape Porus Polyethylene. Model 8319 45 x 41 x 4mm $420.00
Prostheses List by Category, Groups and Sponsor Page 790 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SK512 Malar Shape Porus Polyethylene. Design RZ malar Design RZ malar shapes: super $420.00
shapes, super petite and petite, left and petite left and right 50 x 19 x
right (Models 9501 - 9504). Design M 3mm, Design RZ malar shapes
malar shapes, left and right (Models 9507 petite left and right 50 x 19 x
- 9512). Additional malar shapes, 5mm. Design malar shapes:
extended contoured left and right (Models small left and right 64 x 19 x
9513 - 9518) Contoured 3mm, left and right medium 64
x 19 x 4.5mm, Left and right
large 64 x 19 x
Complex, Polymer
Stryker Australia Pty Ltd
HW434 E-POR Biomaterial/ Midface Contour Midface Contour Porous Polyethylene One size $1,150.00
Porous Polyethylene
HW438 E-POR Biomaterial/ Temporal Fossa Temporal Fossa Implant Porous 61mm - 105mm x 18mm - 20mm $1,150.00
Implant Porous Polyethylene Polyethylene
7.2.5 Mandible, Maxilla and Temperomandibular Joint (TMJ)
7.2.5.1 Mandible, Full
Medtronic Australasia Pty Ltd
MC513 TiMesh Full Mandible One size only $1,520.00 $1,920.00
Surgiplas Medical
SP092 Osteo Plating & Fixation System Plates - Reconstruction 5 x 20 x 5 Hole Full Mandible $1,520.00
Plate; 5 x 16 x 5 Hole Full
Mandible Plate; Mandible, Full
7.2.5.12 Maxilla
Medtronic Australasia Pty Ltd
MC512 TiMesh Maxillary Prosthesis One size only $2,124.00
7.2.5.2 Hemimandible
Medtronic Australasia Pty Ltd
MC515 TiMesh Hemimandible, Left/Right One size only $645.00
Prostheses List by Category, Groups and Sponsor Page 791 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Surgiplas Medical
SP024 OsteoMed Plating & Fixation System Plates - Reconstruction 5 x 16 Hole plate Right & Left $645.00 $840.00
7.2.5.3 Mandibular Angle
Compression
Surgiplas Medical
SP069 Plates Micro, Mini, Maxi Angled EDC Plate, Angled $375.00
Long EDC Plate, 40mm 6 Hole
Fracture Plate, 6 Hole Curved
EDC Plate, 33mm & 38mm 4
Hole EDC Plate, 48mm 6 Hole
EDC Plate, Mandible,
Mandible/Reduction, Mandible
Angle
Polymer
Anatomics Pty Ltd
AT073 E-POR Biomaterial Contoured Mandible Shape Various Dimensional Angles $1,485.00
Stryker Australia Pty Ltd
HW422 Mandibular angle Porus Polyethylene. RZ mandibular angles RZ mandibular angles: 65 x 35 $1,485.00
left and right (Models 9955 - 9960); Porus x 3 x 6.5 x 3 x 3mm, 65 x 35 x
Polyethylene. Contoured mandibular 7 x 6.5 x 3 x 3mm, 65 x 35 x
angles left and right (Models 88037 - 11 x 6.5 x 3 x 3mm. Contoured
88038) mandibular angles left and
right:59 x 29 x 7 x 11mm.
7.2.5.4 Symphysis
Medtronic Australasia Pty Ltd
MC516 TiMesh Mandibular Symphysis One size only $1,294.00
7.2.5.5 Mandibular Component
Biomet Australia Pty Ltd
BI559 TMJ System Mandibular Component, Left or Right, (40 - 60mm), 5-13 hole $6,875.00
Titanium
Prostheses List by Category, Groups and Sponsor Page 792 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BI792 Lorenz 2.4mm Locking Reconstruction Condyle left or right, chrome cobalt (CoCr) One size only $1,545.00 $1,600.00
System
Medical & Optical Instruments Australia Pty Ltd
MO024 Martin Level One Fixation Temporary condylar impant, titanium 5cm $1,545.00
Stryker Australia Pty Ltd
SK218 Leibinger Titanium Implant System - Items used for reconstruction following Universal Mandible Condylar $1,545.00
Universal Mandible Condylar Device trauma or tumor resection of the mandible. Device Left and Right
Included are 2x cross pin fixation screw.
7.2.5.6 Fossa Component
Biomet Australia Pty Ltd
BI569 TMJ System Fossa Component, Left or Right; Titanium, Small, Medium Large $5,850.00
UHMWPE
7.2.6 Nose and Zygoma
7.2.6.1 Nasal Dorsum
Device Technologies Australia Pty Ltd
DE319 Facial Implant Nasal Nasal dorsum Small, large $279.00
DE322 Facial Implant Nasal Zygomatic Right, left $279.00
Stryker Australia Pty Ltd
HW423 Nasal Shape. Petite Nasal Dorsum. Porus Polyethylene. Petite Nasal Dorsum ( Petite Nasal Dorsum: 4 x 4 x $279.00
Models 84000 - 84004). 45mm, 4 x 4 x 55mm, 5 x 5 x
45mm, 5 x 5 x 55mm, 6 x 9 x
55mm.
Prostheses List by Category, Groups and Sponsor Page 793 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.2.6.2 Nasal Arch
Stryker Australia Pty Ltd
HW415 Nasal Shape or Rhinoplasty Shape Porus Polyethylene. Nasal Arch shapes, Nasal arch shapes: small 70 x $350.00
nasal arch and nasal sheet (Models 9533 - 13 x 2mm, medium 70 x 15 x
9536). Nasal dorsum shapes, design A 2mm, large 70 x 15 x 2mm,
and design B (Models 7516 - 7518). sheet 40 x 9 x 1.1mm. Nasal
Nasal valve support, lateral nasal valve dorsum shapes: design A small
support and ext. 53 x 5mm, design A large 66 x
8mm, design B 67 x 6.5mm.
Nasal valve support: lateral
nasal valve 13 x 0.85 x 3.5mm
7.2.6.3 Nasal Shell Shape
Stryker Australia Pty Ltd
HW425 Nasal Shell Shapes. Nasal Shell Shapes, Regular and Large Regular: 38 x 21 x 17mm, $490.00
with Inserts Small and Large (included). Insert Small 30 x 4 x 9mm,
Models 9553 - 9554. Thin Nasal Shell Insert Large 38 x 2.5 x 9mm.
84006 Large: 40 x 20 x 18mm, Insert
Small 32 x 4 x 9mm, Insert
Large 41 x 3 x 9mm. Thin
Nasal Dorsal Shell 42.7mm x
16.4mm x 21.8mm
7.2.6.4 Nasal Valve Support
Device Technologies Australia Pty Ltd
DE315 Facial Implant Nasal "L" Shaped White, pink 1.9 x 4.1 x 2.8cm, 1.8 x 4 x $227.00
2.9cm
Stryker Australia Pty Ltd
HW424 Nasal Valve Support. Lateral Nasal Valve, Model 7545. Lateral Nasal Valve:13 x 3.5 x $350.00
External Nasal Valve Batten, Model 7546. 0.85mm, External Nasal Valve
External Nasal Valve Batten - Thin, Batten: 25 x 11 x 0.85mm,
Model 7167 External Nasal Valve Batten -
Thin: 24 x 11.5 x 0.6mm.
Prostheses List by Category, Groups and Sponsor Page 794 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.2.6.5 Naso-orbital Ethmoid Implant
Complex
Medtronic Australasia Pty Ltd
MC521 TiMesh Naso-Orbital-Ethmoid 1mm - 2.2mm; Complex 1, $541.00
Complex 2, Complex 3
7.2.7 Orbit
7.2.7.1 Complete Orbital Shape
Stryker Australia Pty Ltd
HW411 Complete Orbital Shape Porus Polyethylene. Complete and 2 / 3 Inferior: 83 x 78mm $1,940.00
orbit shapes. Inferior 2 / 3 left and right.
Models 9567, 9568
HW421 Complete Orbital Shape Complete left and right. Models 9569, Complete 61 x 76mm $1,940.00
9570
7.2.7.2 Orbital Floor
Surgiplas Medical
SP079 Plates Micro, Mini Orbital Plate, Orbital Plate Large $890.00
Coated
Anatomics Pty Ltd
AT055 E-POR Biomaterial/ Orbital Wall and Orbital Wall and Floor Porous 41 x 42 x 0.6-1.0mm $985.00
Floor Porous Polyethylene Titanium Polyethylene Titanium Mesh Composite
Mesh Composite (large)
Stryker Australia Pty Ltd
HW433 E-POR Biomaterial/ Orbital Wall and Orbital Wall and Floor Porous 41 x 42 x 0.6-1.0mm $985.00
Floor Porous Polyethylene Titanium Polyethylene Titanium Mesh Composite
Mesh Composite (large)
Prostheses List by Category, Groups and Sponsor Page 795 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.2.7.4 Opthalmic Rim
Stryker Australia Pty Ltd
SK511 Orbital Rim Orbital rims, left and right extended. Left & right extended models $395.00
Models 9539, 9540 Orbital Rim Onlay 47 x 40mm Oribtal Rim Onlay
Implants 81001, 81002 Implants left & right 40 x 40mm
7.2.7.6 Wedge for Orbit
Stryker Australia Pty Ltd
HW410 Enophthalmos Wedge Regular left and right. Large left and right. Regular: 22 x 31 x 7mm. Large: $460.00
(Models 9541 - 9544) 28 x 40 x 7.5mm
7.2.8 External Prostheses, Bone Attachments
7.2.8.1 Endosseous Implant
Fixture
Cochlear Limited
CO042 Vistafix™ Fixture ST Titanium self-tapping fixtures for the 3mm and 4mm $635.00
retention of midface and orbital prostheses.
7.2.8.2 Abutment, Permanent
Cochlear Limited
CO036 Standard Abutments Abutment Complete - Titanium 3.0mm - 90780, 4.0mm - $412.00
90778, 5.5mm - 90776,
7.0mm - 90774
Offset/Angled
Cochlear Limited
CO037 Face to Face Console Abutment Unigrip - Titanium 30, 60, 90, 110 Degrees $895.00
7.2.8.3 Abutment, Temporary or Healing
Cochlear Limited
CO038 Face to Face Healing Abutment Unigrip - Titanium 7mm $285.00
Prostheses List by Category, Groups and Sponsor Page 796 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.2.8.4 Abutment Fixtures
Cover Screw
Cochlear Limited
CO035 Face to Face Cover Screw with Internal Hexagon One Size Only $142.00
7.3.1 Abutment, permanent
AstraTech Pty Ltd
AZ009 AstraTech Profile BI Abutment . $175.00
Biomet 3i Australia Pty Ltd
NW001 3i Abutment Complete Titanium 3.25 - 6mm diameter $175.00
Neoss Australia Pty Ltd
NJ003 Neoss Titanium Abutment Neoss Abutment Titanium Universal $175.00
NJ004 Neoss Gold Abutment Neoss Abutment Gold Universal $175.00
Nobel Biocare Australia Pty Ltd
NR001 Nobel Biocare Abutments Abutment, complete Np, RP, WP 6.0mm $175.00
7.3.2 Abutment, temporary or healing
AstraTech Pty Ltd
AZ001 Astra Tech Cover Screws Cover Screw Diameter 3.0mm, 3.5mm, $52.00
4.0mm, 4.5/5.0mm Short, 4.5/
5.0mm Long
AZ003 Astra Tech Healing Abutments Healing Abutments, Healing Abutments Healing Abutments 3.0, Zebra $70.00
Zebra 1.5, 3.0, 4.5, 6.0mm; Healing
Abutment 5.5mm Ultra, Short,
Long; 7.0mm Short, Long; ST
Short, Long; ST 5.5mm Short,
Long; ST 7.0mm Short, Long;
Temporary Abutment 3.5, 4.0
4.0/5.0mm
AZ004 Astra Tech Abutments Temporary Abutment Diam 3.0 - 5.0mm $96.00
Prostheses List by Category, Groups and Sponsor Page 797 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Neoss Australia Pty Ltd
NJ009 Neoss Implant Healing Abutment with Screw universal $70.00
Nobel Biocare Australia Pty Ltd
NR002 Nobel Biocare Cover Screws Cover screw NP, RP, WP, 6.0mm $52.00
NR004 Nobel Biocare Abutments Abutment, temporary or healing, complete NP, RP, WP, 6.0mm $70.00
Straumann Pty Ltd
SB002 Straumann Pty Ltd Straumann Healing Cap NNI/RN/WNI Height 1.5 - 4.5 mm $52.00
SB004 Straumann Bone Level Implant Healing Straumann Healing Abutment NC/RC Height 0 - 6 mm $70.00 $84.00
Abutment
7.3.3 Other endosseous implant
AstraTech Pty Ltd
AZ002 Astra Tech MicroThread Fixtures and Titanium fixture with microthreaded Diameter 3.0 - 5.0mm, Length $467.00
MicroThread Osseospeed Fixtures cervical neck 8-19mm
Biomet 3i Australia Pty Ltd
NW002 3i Self Tapping Threaded Implants and Osseotite/Ice 3.25 - 6mm diameter $467.00 $545.00
3i Coverscrew
NW004 Endobon Xenograft Granules Hydroxyapatite granules 0.5-1mm diameter; 0.5ml, $300.00
1.0ml, 2.0ml
Henry Schein-Halas Pty Ltd
HD006 Dental Implants Titanium type 4 and 5 3.25 to 6.0mm diameter, 6.0 to $96.00
52.5mm length
Neoss Australia Pty Ltd
NJ001 NEOSS IMPLANT SYSTEM TITANIUM DENTAL IMPLANT DIAMETERS 3.25, 3.5, 4.0, $350.00
4.5, 5.0, 5.5mm in Lengths: 7,
9, 11, 13, 15, 17mm
Nobel Biocare Australia Pty Ltd
NR003 Branemark Fixtures Titanium Fixture 3, 4, 5mm $467.00
NR006 Branemark Novum System Titanium - Kit Fixture System One size only $350.00
NR009 NobelDirect Implant Dental Implant Endosseous incorporating 10mm, 13mm, 16mm $467.00 $617.00
abutment, Titanium
Prostheses List by Category, Groups and Sponsor Page 798 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
NR010 Replace Implant Dental Implant Endosseous, Titanium 10mm, 13mm, 16mm $467.00
NR011 NobelPerfect Implant Dental Implant Edosseous, Titanium 10mm, 13mm, 16mm $467.00
NR012 Groovy Implants (NobelReplace Straight Dental Implants, endosseous Diameter 3.5 - 6.0mm; Length $467.00
Groovy, NobelReplace Tapered 8.0 - 18.0mm
Groovy, NobelSpeedy Replace,
Branemark System Mk III Groovy,
NobelSpeedy Groovy)
NR013 NobelActive implants Dental implants, endosseous Diameter 3.5 - 5.0mm; Length $467.00
8.5 - 18.0mm
Straumann Pty Ltd
SB001 Straumann Pty Ltd Straumann Dental Implant NNI/RN/WNI Diameter 3.3 - 4.8mm Length 6 $360.00
- 16mm
SB003 Straumann Bone Level Implants NC/RC Straumann Bone Level Implants NC/RC Diameter 3.3 - 4.8 mm Length $467.00 $526.00
8-14 mm
SB005 Straumann Bone Ceramic 070.203 Straumann Bone Ceramic 400 - 070.203 Straumann Bone $98.00
700 Ceramic 400 -700, Granule
size 400 - 700 microns, Unit
size 0.25 g, Volume: approx
0.3 ml
SB006 Straumann Bone Ceramic 070.204 Straumann Bone Ceramic 500 - 070.204 Straumann Bone $168.00
1000 Ceramic 500 -1000, Granule
size: 500 -1000 microns, Unit
size: 0.5 g, Volume: approx
0.95 ml
SB007 Straumann Bone Ceramic 070.205 Straumann Bone Ceramic 500 - 070.205 Straumann Bone $301.00
1000 Ceramic 500 -1000, Granule
size: 500 -1000 microns, Unit
Size 1g, Volume approx 1.9 ml
Young Sun Global Pty Ltd TA Implantium
YS001 OSTEON, Bone grafting material: 0.5cc OSTEON is a synthetic osteoconductive Particle size: 0.5-1.0mm, 1.0- $125.00
bone graft substitute composed of 2.0mm
hydroxyapatite (HA) and beta-tricalcuim Volume: 0.5cc
phosphate (β-TCP).
Prostheses List by Category, Groups and Sponsor Page 799 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.3.3.1 Zygomatic Bone Implants
Nobel Biocare Australia Pty Ltd
NR007 Branemark Titanium Fixture Zygomaticus Fixture 30, 35, 42.5, 40, 45, 47.5, 50, $600.00 $800.00
52.5mm Length
7.3.4 Orthodontic skeletal anchor plate
Biomet Australia Pty Ltd
BH042 Metamorfix Plate, Y, T, straight, hook left, straight or long, standard hook $260.00
right.
Stryker Australia Pty Ltd
SK420 Orthodontic Skeletal Anchor Plate Orthodontic Skeletal Anchor Plate, 1.7mm $260.00
Standard
Locking
Stryker Australia Pty Ltd
SK421 Orthodontic Skeletal Anchor Plate Orthodontic Skeletal Anchor Plate Locking 1.7mm $320.00
Screw
Stryker Australia Pty Ltd
SK422 Orthodontic Skeletal Anchor Screw Anchor Screw for Mandibular Maxillary 1.7mm $110.00
Fixation Screw, Self-Drilling
SK423 Orthodontic Skeletal Anchor Screw Anchor Screw for Mandibular Maxillary 2.0mm $110.00
Fixation Screw, Self-Drilling
7.4.1 Complete
7.4.1.1 External, Midface
Multivector
Medical & Optical Instruments Australia Pty Ltd
MO236 Martin Distraction Osteogenesis Rigid Distractor System, Complete, External, one size only $8,791.00
External Distraction (Polley RED II) Midface, Aluminium, Carbon Fibre
Prostheses List by Category, Groups and Sponsor Page 800 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.4.1.2 External, Mandible
Multivector
Stryker Australia Pty Ltd
SK183 Leibinger Intraoral Distractor (Multiguide Manufactured from stainless steel, allows Frame 20mm - 35mm, 2.0mm $4,150.00
II) gradual, independent, and simultaneous diameter, 50 - 90 mm length
distraction of the mandible in 3 planes. Auto - Pilot Pins
Synthes Australia Pty Ltd
SY349 Multi Vector Distractor Set Titanium Multi Vector Distractor MVD Arms:15mm-85mm. Pin $1,955.00
holding clamps-
ramus,body,universal,limited
bone stock ramus and body.
Assembly left & right 35mm. K
wires 2.0mm 150mm length.
Connecting bar 4.0mm
100mm-200mm length
SY401 External Midface Distractor System Head Frame Assembly, Carbon Fibre Rods One size only $8,100.00
7.4.1.3 Other
Single Vector
Medical & Optical Instruments Australia Pty Ltd
MO233 Martin Distraction Osteogenesis Distractor System, Complete, other, titanium 1.5mm $7,100.00
7.4.1.4 Internal/Intraoral
Multivector
Medical & Optical Instruments Australia Pty Ltd
MO239 Martin Distraction Osteogenesis Distractor System, Complete, other, titanium 15-60 mm distraction length $3,100.00
Surgiplas Medical
SP045 Logic Distraction System Distractor, spacers & activation set Straight, Curved 18-52mm $3,150.00
Single Vector
Biomet Australia Pty Ltd
BI823 Alveolar Ridge Distraction System - distraction device, single tooth 10-20mm $1,955.00
titanium
Prostheses List by Category, Groups and Sponsor Page 801 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BI824 Alveolar Ridge Distraction System - distraction device, multi tooth 10-20mm $1,955.00
titanium
Medical & Optical Instruments Australia Pty Ltd
MO135 Martin Distraction Osteogenesis Distractor System, Complete, 10 to 20 mm $1,955.00 $2,700.00
internal/intraoral, titanium
Synthes Australia Pty Ltd
SY399 Alveolar Distractor Vertical mandibular, maxilla alveolar ridge 8-16mm $1,955.00
distractor
SY408 Mandible External Fixator Three Quarter Mandible One size $1,460.00
SY409 Mandible External Fixator Full Mandible One size only $1,460.00
SY410 Mandible External Fixator Full Mandible Ramus One size $1,460.00
SY411 Mandible External Fixator Hemi Mandible One size $1,460.00
Single Vector, Resorbable
Biomet Australia Pty Ltd
BI934 Lactosorb Distraction System Plate, drive screw and distractor, Small, Medium, Large $3,500.00
PGA/PLLA, Ti
7.4.2 Component
7.4.2.2 Distractor Body
Synthes Australia Pty Ltd
SY515 Midface Distractor System Distractor System, Distractor Body 10-40mm distraction length $1,955.00 $2,200.00
7.4.2.3 Footplate
Medical & Optical Instruments Australia Pty Ltd
MO242 Martin Distraction Osteogenesis Rigid Distractor System, Component, Footplate, 1.5mm $156.00
External Distraction (Polley RED II) titanium
Stryker Australia Pty Ltd
SK455 Leibinger Endosseous Alveolar Ridge Dual plate with threaded transport rod, Single Tooth $1,312.00
Distraction System titianium
Synthes Australia Pty Ltd
SY404 External Midface Distractor System Maxillary Footplate Assembly 80mm-110mm $480.00
Prostheses List by Category, Groups and Sponsor Page 802 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SY406 External Midface Distractor System Titanium Zygomatic, Maxxilary Footplate 3 holes, 40mm $156.00
SY516 Midface Distractor System Distractor System, Assembly,Footplate 6-25mm $480.00 $800.00
7.4.2.4 Rod
Synthes Australia Pty Ltd
SY402 External Midface Distractor System Horizontal Rod Assembly One size only $990.00
7.4.2.5 Cross Bar
Medical & Optical Instruments Australia Pty Ltd
MO246 Martin Distraction Osteogenesis Rigid Distractor System, Component, Cross one size only $990.00 $1,560.00
External Distraction (Polley RED II) Bar, aluminium.carbon fibre
7.4.2.6 Screws/Pins (other than bone screws)
Medical & Optical Instruments Australia Pty Ltd
MO234 Martin Distraction Osteogenesis Rigid Distractor System, Component, 45-55mm $148.00 $217.00
External Distraction (Polley RED II) Screws/Pins (other than bone screws),
titanium
Synthes Australia Pty Ltd
SY517 Midface Distractor System Distractor System, Screw 4-10mm $75.00
7.4.2.9 Other
Biomet Australia Pty Ltd
BI825 Alveolar Ridge Distraction System - Shim plate, titanium 1-3mm $100.00
titanium
Medical & Optical Instruments Australia Pty Ltd
MO240 Martin Distraction Osteogenesis Rigid Distractor System, Component, Other, 1.5-1.58mm $1,461.00 $1,696.00
External Distraction (Polley RED II) titanium, aluminium
Synthes Australia Pty Ltd
SY518 Midface Distractor System Distractor System , Body extentions 20-40mm $500.00
Prostheses List by Category, Groups and Sponsor Page 803 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.5.1 General or unspecified
LMT Surgical Pty Ltd
LM030 Synovis Coupler High Density polyethylene (ring); Stainless Diameter 1-3mm $620.00 $625.00
Steel (pins)
7.5.2 Muscular
7.5.2.1 Calf implant
Device Technologies Australia Pty Ltd
DE316 Calf Implants Asymmetrical shape, silicone gel smooth 85-180cc $517.00
surface
DE318 Calf Implant Silicone elastomer - smooth surface, 70-175cc $517.00
asymmetrical shape,
DE323 Calf Implant Silicone elastomer - smooth surface, 15-105cc $517.00
symmetrical shape
DE325 Calf Implants Symmetrical shape, silicone gel 12-140cc $517.00
7.5.2.2 Gluteal
Device Technologies Australia Pty Ltd
DE326 Gluteal Implants filled with Gel Oval Shape, Silicone Gel, Smooth 100-300cc $620.00
DE327 Gluteal Implants filled with Gel Oval Shape, Silicone Gel, Textured Surface 200-400cc $620.00
DE328 Gluteal Implants filled with Gel Round Shape, Silicone Gel, Smooth 200-300cc $620.00
Surface
DE329 Gluteal Implants filled with Elastomer Oval Shape, Silicone Elastomer, Smooth 95-260cc $620.00
Surface
DE330 Gluteal Implants filled with Elastomer Oval Shape, Silicone Elastomer, Textured 225-420cc $620.00
Surface
DE331 Gluteal Implants filled with Elastomer Round Shape, Silicone Elastomer, Smooth 250-340cc $620.00
Surface
Prostheses List by Category, Groups and Sponsor Page 804 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.5.3 Facial
Surgiplas Medical
SP048 Gel Filled Mammary Prosthesis Models Smooth Round 80 to 800ml $610.00
RGI-D, RGI-DH and RGI-DEH
7.5.3.1 Other unspecified
Device Technologies Australia Pty Ltd
DE320 Facial Implant Chin Anotomical chin Small, medium, large/left, right $275.00
DE321 Facial Implant Chin Chin Small, medium, large/left, right $258.00
DE332 Facial Implant - Ear One size only $496.00
7.5.3.2 Malar
Device Technologies Australia Pty Ltd
DE317 Facial Implant Malar Malar Small, medium, large/left or right $330.00
DE333 Facial Implant Malar Malar Anatomical Small, medium, large/left or right $330.00
Polymer
Stryker Australia Pty Ltd
HW436 E-POR Biomaterial/ Transsphenoidal Transphenoidal Sellar Contourable Porous 2.5mm x 20mm - 40mm $500.00
Sellar Contourable Porous Polyethylene Polyethylene
7.5.4 Mammary Implants
Johnson & Johnson Medical Pty Ltd
MN028 Spectra Adjustable Gel Breast Implant Adjustable Gel Breast Implant (Smooth) 190cc-760cc $1,050.00 $1,350.00
(Smooth)
Prostheses List by Category, Groups and Sponsor Page 805 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MN029 Spectra Adjustable Gel Breast Implant Adjustable Breats Implant 190cc to 760cc $1,125.00 $1,400.00
Formed, Pre-shaped, Textured
Allergan Australia Pty Limited
AW004 Style 510 Dual Gel Breast Prosthesis Anatomical textured implant with dual gel LX sizes from 130-575 grams, $1,200.00 $1,500.00
for projection of nipple/areola complex, MX sizes from 145-600 grams,
concave base and tapered edges for FX sizes from 165-630 grams
minimisation of edge/thoracic wall
palpability.
High profile
Johnson & Johnson Medical Pty Ltd
MN016 Mentor Siltex Low Bleed Gel-Filled . 75, 200, 225, 250, 275, 300, $685.00
(High Profile) Mammary Prostheses 325, 350, 400, 450, 500, 550cc
Breast, Permanently Implantable
Surgiplas Medical
SP011 Nagosil SFS-LP-Saline Filled Low Smooth surface 100 to 600cc $640.00
Profile Smooth Surface Breast
Prostheses, Nagosil SFS-HP-Saline
Filled High Profile Smooth Surface
Breast Prostheses
High profile, Textured
Surgiplas Medical
SP012 Nagotex SFX-LP-Saline Filled Low Textured surface 100 to 600cc $715.00
Profile Textured Surface, Nagotex SFX-
HP-Saline Filled High Profile Textured
Surface Breast Prostheseses
Textured
Surgiplas Medical
SP047 Gel Filled Mammary Prosthesis Models Textured Round 80 to 800ml $760.00
GFX-LP, GFX and GFX-EHP
Textured, Formed, Pre-shaped, Silicone shell
Allergan Australia Pty Limited
AW007 McGhan Style 410 & 410 Soft Touch Full, moderate or low height, Extra Full, 125 - 775 grams $1,200.00
Biodimensional Biocell Textured Full, moderate or low projection
Cohesive Gel-filled Mammary Implant
Prostheses List by Category, Groups and Sponsor Page 806 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.5.4.1 Saline filled <500cc
Medium profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN050 Mentor Saline-filled Anterior Diaphragm Mammary Prostheses - Smooth 125cc - 475cc $640.00
Mammary Prostheses
Silicone shell, Valved
Johnson & Johnson Medical Pty Ltd
MN045 Mentor Spectrum Saline Tissue Expander Saline Mammary Prostheses - Smooth 125 - 475cc $950.00 $1,125.00
Textured, High profile, Silicone shell, Pre-shaped
Johnson & Johnson Medical Pty Ltd
MN054 Mentor Saline Siltex Anterior Diaphragm Mammary Prostheses - Textured 275 - 450cc $685.00
Valve Mammary
Textured, Medium profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN053 Mentor Saline Siltex Anterior Diaphragm Mammary Prostheses - Textured 125 - 475cc $685.00
Valve Mammary
Textured, Silicone shell, Pre-shaped, Valved
Johnson & Johnson Medical Pty Ltd
MN047 Mentor Siltex Spectrum Saline Tissue Saline Mammary Prostheses - textured 275 - 450cc $950.00 $1,125.00
Expander
Textured, Silicone shell, Valved
Johnson & Johnson Medical Pty Ltd
MN049 Mentor Siltex Spectrum Saline Tissue Saline Mammary Prostheses - textured 125 - 475cc $950.00 $1,125.00
Expander
Textured,Medium profile,Silicone shell,Pre-shaped
Johnson & Johnson Medical Pty Ltd
MN056 Mentor Saline Siltex Anterior Diaphragm Mammary Prostheses - Textured 175 - 475cc $685.00
Valve Mammary
Prostheses List by Category, Groups and Sponsor Page 807 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.5.4.10 Gel filled, unspecified volume or various
Device Technologies Australia Pty Ltd
DE338 Silimed Anatomical Textured Mammary Anatomical shape, textured surface, 115cc to 600cc $790.00 $1,050.00
Implant silicone gel filled mammary implant
Formed, Textured
Surgiplas Medical
SP114 Nagor Breast Implants Silicone Firm and Stable Gel Breast 150 - 620cc $760.00 $790.00
Implants
Silicone shell, High profile
Allergan Australia Pty Limited
AW008 Allergan Type SLD, SHD, SRL, SRM, Low, Medium, High or Extra High Profile 100 - 800 grams $685.00
SRF, SRX Smooth Silicone Gel-filled
Mammary Implant
Silicone shell, High profile, Textured
Allergan Australia Pty Limited
AW009 Allergan styles CML, CMH, TSL, TSM, Silicone Cohesive Gel-Filled Breast Implant 80 - 800 grams $790.00
TSF, TSX
7.5.4.11 Pectoral implant
Device Technologies Australia Pty Ltd
DE334 Pectoral Implants Gel - Smooth surface 190cc - 300cc $950.00
7.5.4.2 Saline filled, 500cc to 650cc
High profile
Johnson & Johnson Medical Pty Ltd
MN023 Smooth Round High Profile Saline-Filled Model 350-3170; Model 350-3190; 170cc, 190cc, 210cc, 230cc, $715.00
Mammary Prosthesis Model 350-3210; Model 350-3230; 250cc, 270cc, 290cc, 310cc,
Model 350-3250; Model 350-3270; 330cc, 380cc, 420cc, 460cc,
Model 350-3290; Model 350-3310; 500cc, 560cc, 630cc
Model 350-3330; Model 350-3380;
Model 350-3420; Model 350-3460;
Model 350-3500; Model 350-3560;
Model 350-3630
Prostheses List by Category, Groups and Sponsor Page 808 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medium profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN051 Mentor Saline-filled Anterior Diaphragm Mammary Prostheses - Smooth 500cc - 650cc $640.00
Mammary Prostheses
Silicone shell, Valved
Johnson & Johnson Medical Pty Ltd
MN046 Mentor Spectrum Saline Tissue Expander Saline Mammary Prostheses - Smooth 525 - 575cc $950.00 $1,125.00
Textured, High profile, Silicone shell, Pre-shaped
Johnson & Johnson Medical Pty Ltd
MN055 Mentor Saline Siltex Anterior Diaphragm Mammary Prostheses - Textured 500 - 650cc $685.00
Valve Mammary
Textured, Silicone shell, Pre-shaped, Valved
Johnson & Johnson Medical Pty Ltd
MN048 Mentor Siltex Spectrum Saline Tissue Saline Mammary Prostheses - textured 550 - 650cc $950.00 $1,125.00
Expander
Textured,Medium profile,Silicone shell,Pre-shaped
Johnson & Johnson Medical Pty Ltd
MN057 Mentor Saline Siltex Anterior Diaphragm Mammary Prostheses - Textured 525cc $685.00
Valve Mammary
7.5.4.3 Saline filled, 651-850cc
Medium profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN052 Mentor Saline-filled Anterior Diaphragm Mammary Prostheses - Smooth 700cc to 800cc $640.00
Mammary Prostheses
7.5.4.6 Gel filled, <500cc
Medical Vision Australia Pty Ltd
MF059 Cereform Silicone Breast Implant, Silicone Gel-Filled Breast Implant 100cc to 500cc $1,000.00
Anatomical, Textured Surface
MF062 Cereform Silicone Gel-filled Breast Silicone Gel-filled Breast Implant 100cc to 500cc $700.00
Implant, Round, Smooth and Textured
Surface
Prostheses List by Category, Groups and Sponsor Page 809 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MF065 Cereform "Aptima" Silicone Gel Filled Silicone gel-filled breast implant with very 100cc to 500cc $750.00
Breast Implant high profile and filled with "Aptima" high
cohesive gel
High prof,Silicone shell,PreShaped,Textured,Formed
Johnson & Johnson Medical Pty Ltd
MN069 Mentor Medical Systems Contour Mammary Prostheses - Textured - High <500cc $1,000.00 $1,200.00
Profile Gel filled Mammary Prostheses, Profile
Breast Permanently Implantable
High profile, Silcone shell, Textured
Allergan Australia Pty Limited
AW005 Allergan Type MLP, MHP, TRL, TRM, Low, Medium, High & Extra High profile, 80 - 800 grams $760.00
TRF, TRX Low, Medium, High & Extra textured surface
High Profile Gel-Filled Mammary Implant
High profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN072 Smooth High Profile Gel-filled Mammary Mammary Prostheses 125 - 480cc $685.00
Prostheses
High profile, Silicone Shell, Textured
Johnson & Johnson Medical Pty Ltd
MN078 Perthese Sensitive Gel Breast Implants Perthese Sensitive ultra high profile 95cc - 485cc $760.00 $950.00
MN102 Round Cohesive Gel-Filled Mammary Mammary Prostheses - textured <500cc $715.00 $760.00
Prosthesis
Low profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN061 Mentor Medical Systems Smooth Low Mammary Prostheses - Smooth - Low 100 - 450cc $685.00 $715.00
Bleed Gel-Filled, Mammary Prostheses proflie
Breast, Permanently Implantable
Prostheses List by Category, Groups and Sponsor Page 810 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Med prof,Silicone shell,Pre-shaped,Textured,Formed
Johnson & Johnson Medical Pty Ltd
MN066 Mentor Medical Systems Contour Mammary Prostheses - Textured <500cc $1,000.00 $1,200.00
Profile Gel filled Mammary Prostheses,
Breast Permanently Implantable
Medium profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN058 Mentor Medical Systems Smooth Low Mammary Prostheses Smooth - Medium 100 - 450cc $685.00 $715.00
Bleed Gel-Filled, Mammary Prostheses profile
Breast, Permanently Implantable
Medium profile, Silicone shell, Textured
Johnson & Johnson Medical Pty Ltd
MN105 Round Cohesive Gel-Filled Mammary Mammary Prostheses - textured <500cc $715.00 $760.00
Prosthesis
Preshaped
Surgical Supplies Australia Pty Ltd
ZW003 Eurosilicone Breast Implants Anatomical Cohesive Gel Breast Implants 100cc to 500cc $1,000.00 $1,150.00
for Plastic and Reconstrive Surgery
Silicone shell, High profile
Allergan Australia Pty Limited
AW010 Allergan Style 40, 45, SSL, SSM, SSF, Round: low, medium, high & extra high 110 - 800 grams $685.00
SSX Intrashiel Gel-Filled Round profile
Mammary Implant
Textured, High Profile, Silicone Shell
Johnson & Johnson Medical Pty Ltd
MN075 Siltex High Profile Gel-filled Mammary Mammary Prostheses - Textured <500cc $715.00
Prostheses
MN090 Perthese Sensitive Gel Breast Implants Perthese Sensitive high profile 90cc - 455cc $760.00 $950.00
Prostheses List by Category, Groups and Sponsor Page 811 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Textured, Medium profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN063 Mentor Siltex Low Bleed Gel-Filled, Mammary Prostheses - Textured 100 - 450cc $715.00
(Moderate Profile) Mammary Prostheses
breast, Permanently Implantable
MN081 Perthese Sensitive Gel Breast Implants Perthese Sensitive moderate profile 100cc - 450cc $760.00 $950.00
MN087 Perthese Sensitive Gel Breast Implants Perthese Sensitive moderate plus profile 115cc - 475cc $760.00 $950.00
7.5.4.7 Gel filled, 500cc-650cc
Medical Vision Australia Pty Ltd
MF060 Cereform Silicone Breast Implant, Silicone Gel-Filled Breast Implant 500cc to 650cc $1,000.00 $1,250.00
Anatomical, Textured Surface
MF063 Cereform Silicone Gel-filled Breast Silicone Gel-filled Breast Implant 500cc to 650cc $750.00
Implant, Round, Smooth and Textured
Surface
MF066 Cereform "Aptima" Silicone Gel Filled Silicone gel-filled breast implant with very 500cc to 650cc $760.00 $850.00
Breast Implant high profile and filled with "Aptima" high
cohesive gel
Formed, Pre-shaped
Surgiplas Medical
SP049 Gel Filled Mammary Prosthesis Models CoGel High Cohesive 100 to 790gm $1,000.00
CoGel-XR, CoGel-XRH, CoGel-XL,
CoGel- XM and CoGel XF
High prof,Silicone shell,PreShaped,Textured,Formed
Johnson & Johnson Medical Pty Ltd
MN070 Mentor Medical Systems Contour Mammary Prostheses - Textured - High 500-650cc $1,000.00 $1,200.00
Profile Gel filled Mammary Prostheses, Profile
Breast Permanently Implantable
High profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN073 Smooth High Profile Gel-filled Mammary Mammary Prostheses 500 - 650cc $685.00
Prostheses
Prostheses List by Category, Groups and Sponsor Page 812 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
High profile, Silicone Shell, Textured
Johnson & Johnson Medical Pty Ltd
MN079 Perthese Sensitive Gel Breast Implants Perthese Sensitive ultra high profile 530cc - 630cc $760.00 $950.00
MN103 Round Cohesive Gel-Filled Mammary Mammary Prostheses - textured 500 - 650cc $715.00 $760.00
Prosthesis
Low profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN062 Mentor Medical Systems Smooth Low Mammary Prostheses Smooth - Low profile 500 - 600cc $685.00 $715.00
Bleed Gel-Filled, Mammary Prostheses
Breast, Permanently Implantable
Med prof,Silicone shell,Pre-shaped,Textured,Formed
Johnson & Johnson Medical Pty Ltd
MN067 Mentor Medical Systems Contour Mammary Prostheses - Textured - 500 - 650cc $1,000.00 $1,200.00
Profile Gel filled Mammary Prostheses, Medium Proflie
Breast Permanently Implantable
Medium profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN059 Mentor Medical Systems Smooth Low Mammary Prostheses - Smooth - Medium 500 -600cc $685.00 $715.00
Bleed Gel-Filled, Mammary Prostheses Profile
Breast, Permanently Implantable
Medium profile, Silicone shell, Textured
Johnson & Johnson Medical Pty Ltd
MN106 Round Cohesive Gel-Filled Mammary Mammary Prostheses - textured 500 - 650cc $715.00 $760.00
Prosthesis
Silicone shell, High profile, Textured
Allergan Australia Pty Limited
AW011 McGhan Style 110 & 120 Biocell Round: Moderate or high profile 90 - 650 grams $760.00
Textured, Intrasheild barrier Gel-Filled
Mammary Implant
Prostheses List by Category, Groups and Sponsor Page 813 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Textured
Device Technologies Australia Pty Ltd
DE341 Silimed Anatomical Polyurethane Breast Polyurethane coated silicone gel breast 115cc to 640cc $790.00 $1,100.00
Implant implant
Textured, High Profile Silicone Shell
Johnson & Johnson Medical Pty Ltd
MN076 Siltex High Profile Gel-filled Mammary Mammary Prostheses - Textured 500 - 650cc $715.00
Prostheses
Textured, high profile, silicone shell
Johnson & Johnson Medical Pty Ltd
MN088 Perthese Sensitive Gel Breast Implants Perthese Sensitive high profile 520cc - 650cc $760.00 $950.00
Textured, Medium profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN064 Mentor Siltex Low Bleed Gel-Filled, Mammary Prostheses - Textured 500 - 600cc $715.00
(Moderate Profile) Mammary Prostheses
breast, Permanently Implantable
MN082 Perthese Sensitive Gel Breast Implants Perthese Sensitive moderate profile 500cc - 650cc $760.00 $950.00
MN084 Perthese Sensitive Gel Breast Implants Perthese Sensitive moderate plus profile 510cc - 635cc $760.00 $950.00
7.5.4.8 Gel filled, 651-850cc
Medical Vision Australia Pty Ltd
MF061 Cereform Silicone Breast Implant, Silicone Gel-Filled Breast Implant 650 cc to 850cc $1,000.00 $1,500.00
Anatomical, Textured Surface
MF064 Cereform Silicone Gel-filled Breast Silicone Gel-filled Breast Implant 650cc to 850cc $760.00 $850.00
Implant, Round, Smooth and Textured
Surface
MF067 Cereform "Aptima" Silicone Gel Filled Silicone gel-filled breast implant with very 650cc to 850cc $760.00 $1,000.00
Breast Implant high profile and filled with "Aptima" high
cohesive gel
Prostheses List by Category, Groups and Sponsor Page 814 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
High prof,Silicone shell,PreShaped,Textured,Formed
Johnson & Johnson Medical Pty Ltd
MN071 Mentor Medical Systems Contour Mammary Prostheses - Textured - High 651-850cc $1,000.00 $1,200.00
Profile Gel filled Mammary Prostheses, Profile
Breast Permanently Implantable
High profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN074 Smooth High Profile Gel-filled Mammary Mammary Prostheses 700 - 800cc $685.00
Prostheses
High profile, Silicone Shell, Textured
Johnson & Johnson Medical Pty Ltd
MN080 Perthese Sensitive Gel Breast Implants Perthese Sensitive ultra high profile 705cc $760.00 $950.00
MN104 Round Cohesive Gel-Filled Mammary Mammary Prostheses - textured 651 - 850cc $715.00 $760.00
Prosthesis
Med prof,Silicone shell,Pre-shaped,Textured,Formed
Johnson & Johnson Medical Pty Ltd
MN068 Mentor Medical Systems Contour Mammary Prostheses - Textured - 651-850cc $1,000.00 $1,200.00
Profile Gel filled Mammary Prostheses, Medium Profile
Breast Permanently Implantable
Medium profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN060 Mentor Medical Systems Smooth Low Mammary Prostheses Smooth - Medium 700 - 800cc $685.00 $715.00
Bleed Gel-Filled, Mammary Prostheses Profile
Breast, Permanently Implantable
Medium profile, Silicone shell, Textured
Johnson & Johnson Medical Pty Ltd
MN107 Round Cohesive Gel-Filled Mammary Mammary Prostheses - textured 651 - 800cc $715.00 $760.00
Prosthesis
Textured
Device Technologies Australia Pty Ltd
DE340 Silimed Polyurethane Breast Implant Polyurethane coated silicone gel breast 40cc to 695cc $760.00 $780.00
implant
Prostheses List by Category, Groups and Sponsor Page 815 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Textured, High Profile Silicone Shell
Johnson & Johnson Medical Pty Ltd
MN077 Siltex High Profile Gel-filled Mammary Mammary Prostheses - Textured 651-850cc $715.00
Prostheses
Textured, high profile, silicone shell
Johnson & Johnson Medical Pty Ltd
MN089 Perthese Sensitive Gel Breast Implants Perthese Sensitive high profile 850cc $760.00 $950.00
Textured, Medium profile, Silicone shell
Johnson & Johnson Medical Pty Ltd
MN065 Mentor Siltex Low Bleed Gel-Filled, Mammary Prostheses - Textured 700cc - 800cc $715.00
(Moderate Profile) Mammary Prostheses
breast, Permanently Implantable
MN083 Perthese Sensitive Gel Breast Implants Perthese Sensitive moderate profile 700cc - 800cc $760.00 $950.00
MN086 Perthese Sensitive Gel Breast Implants Perthese Sensitive moderate plus profile 685cc - 800cc $760.00 $950.00
7.5.4.9 Gel filled >850cc
Textured, medium profile, silicone shell
Johnson & Johnson Medical Pty Ltd
MN085 Perthese Sensitive Gel Breast Implants Perthese Sensitive moderate plus profile 910cc $760.00 $950.00
7.5.5 Skin, artificial
7.5.5.1 Small, <50cm2
Integra Neurosciences Pty Ltd
IG034 Integra Artificial Skin (IDRT) Terminally INTEGRA Dermal Regeneration 5cm x 5cm $900.00
Sterile Template is a bilayer membrane system for
skin replacement made of a porous matrix
of fibers of cross-linked bovine tendon
collagen and glycosaminoglycan and
polysiloxane layer.
Prostheses List by Category, Groups and Sponsor Page 816 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.5.5.2 Medium, 50cm2 to 149cm2
Integra Neurosciences Pty Ltd
IG035 Integra Artificial Skin (IDRT) Terminally INTEGRA Dermal Regeneration 10cm x 12.5cm $1,140.00
Sterile Template is a bilayer membrane system for
skin replacement made of a porous matrix
of fibers of cross-linked bovine tendon
collagen and glycosaminoglycan and
polysiloxane layer.
7.5.5.3 Large, 150cm2 to 400cm2
Integra Neurosciences Pty Ltd
IG036 Integra Artificial Skin (IDRT) Terminally INTEGRA Dermal Regeneration 10cm x 25cm $1,740.00
Sterile Template is a bilayer membrane system for
skin replacement made of a porous matrix
of fibers of cross-linked bovine tendon
collagen and glycosaminoglycan and
polysiloxane layer.
7.5.5.4 Extra large, >400cm2
Integra Neurosciences Pty Ltd
IG037 Integra Artificial Skin (IDRT) Terminally INTEGRA Dermal Regeneration 20cm x 25cm $3,380.00
Sterile Template is a bilayer membrane system for
skin replacement made of a porous matrix
of fibers of cross-linked bovine tendon
collagen and glycosaminoglycan and
polysiloxane layer.
7.5.6 Tissue expanders
Formed, Pre-shaped, Dual chamber, Valved
Allergan Australia Pty Limited
AW012 McGhan Style 150 Biodimensional Full height, Short Height, t 9.6 -16cm width x 8 - 17cm $2,040.00 $2,420.00
Biocell Textured Expand Gel/Saline height x 4.2 - 7.1cm projection
Filled Mammary Implant, Low Pole
Prostheses List by Category, Groups and Sponsor Page 817 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.5.6.1 Skin or mammary, up to 850cc
Device Technologies Australia Pty Ltd
DE337 Silimed Tissue Expander Anatomical superior-pole/inferior-pole 200ml-840ml $1,100.00
shape, textured, magnetic
Johnson & Johnson Medical Pty Ltd
MN002 Expanders, skin - Volume 250cc - 850cc $1,050.00
Self Expanding
Spectrum Surgical
SO042 Osmed Tissue Expanders Self inflating, Hydrogel 0.24ml-650ml $1,250.00
Two stage, Valved
Device Technologies Australia Pty Ltd
DE335 Silimed Tissue Expander Double chamber, textured, magnetic, with 470mm-780mm $1,050.00
suture tabs. Catalogue number: 20799
Valved, Textured
Johnson & Johnson Medical Pty Ltd
MN042 Siltex Contour Breast Tissue Expander Mentor Siltex Contour Breast Tissue 250-850cc $1,250.00
Expander
7.5.6.10 Orbital
Self Expanding
Spectrum Surgical
SO041 Osmed Sphere / Hemisphere tissue Self inflating, Hydrogel 6mm, 8mm, 9mm, 10mm $865.00 See rule 5B for effect of Condition.
expander
7.5.6.2 Skin or mammary, 850cc to 1250cc
Johnson & Johnson Medical Pty Ltd
MN001 Mentor Radovan Tissue Expander - Volume 25cc - 1000cc $670.00
Valved, Textured, 1000cc
Allergan Australia Pty Limited
AW013 Allergan Biospan Tissue Expander Silicone Elastomer. Saline filled. 150-950 cm3 $1,250.00
Prostheses List by Category, Groups and Sponsor Page 818 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
7.5.6.3 Skin or mammary, greater than 1251cc
Two stage, Valved
Surgiplas Medical
SP010 Nagor Tissue Expander Two Stage, Valved 10 to 2000cc $890.00
7.5.6.4 Skin or mammary, custom
Two stage, Valved
Johnson & Johnson Medical Pty Ltd
MN013 Mentor Siltex Becker . 145 to 800cc $2,040.00
Expander/Mammary Prostheses
Bone Matrix Implants, Artificial
Biomet Australia Pty Ltd
BI487 Mimix Calcium Phosphate Bone Void Calcium Phosphate 5 grams $1,004.00
Filler
BI488 Mimix Calcium Phosphate Bone Void Calcium Phosphate 10 grams $1,900.00
Filler
BI489 Mimix Calcium Phosphate Bone Void Calcium Phosphate 20 grams $2,300.00
Filler
Cristalline Paragel Very Cohesive Gel Implant
Surgical Supplies Australia Pty Ltd
ZW001 Eurosilicone Breast Implants Textured Cohesive Gel Breast Implants for 100cc to 900cc $725.00
Plastic and Reconstructive Surgery
Orthopaedic Internal Fixation Systems, Fracture
Stryker Australia Pty Ltd
ST369 Luhr Fixation System Luhr Mandibular Compression System: Curved: 30,38, 45mm, Straight: $152.00
curved, straight, metacarpal plate Vitallium 30, 40, 50, 60, 80mm,
metacarpal: 41, 45mm
Prostheses List by Category, Groups and Sponsor Page 819 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Orthopaedic Internal Fixation Systems, Other
Biomet Australia Pty Ltd
BI472 Lorenz Pectus Bar Pectus Bar, Stainless Steel 178-432mm $1,256.00
BI483 Lorenz Pectus Bar Stabilizer, Triangular or Elongated, One size only $505.00
Stainless Steel
Surgien Pty Ltd
BR001 OPRA System Central screw - titanium One size only $1,860.00
BR002 OPRA System Healing cylinder - titanium One size only $3,150.00
BR003 OPRA System Healing screw - titanium One size only $2,460.00
BR004 OPRA System Fixture - titanium 16 - 20mm $36,900.00
BR005 OPRA System Abutment - titanium Length 47 - 77mm $19,250.00
BR006 OPRA System Abutment screw - titanium Length 57 - 87mm $5,775.00
Surgiplas Medical
SP032 OsteoMed Plating & Fixation System Lag Screws - Maxi, MMF, 3.0mm 2.4mm x (8 - 42)mm; 2.4 x (12 $80.00
- 18)mm; 3.0mm x (12 -
36)mm;
Paragel Cohesive Gel Implant
Surgical Supplies Australia Pty Ltd
ZW002 Eurosilicone Breast Implants Round Cohesive Gel Breast Implants for 100cc to 900cc $685.00
Pastic and Reconstructive Surgery
Skin expander
Device Technologies Australia Pty Ltd
DE336 Silimed Tissue Expander various shapes, textured, magnetic port 150ml-1000ml $890.00 $900.00
Medical Vision Australia Pty Ltd
MF053 PMT Integra tissue expander Tissue/skin Expander 5cc to 1400cc $1,250.00
Prostheses List by Category, Groups and Sponsor Page 820 of 911
PLASTIC AND RECONSTRUCTIVE
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Tissue Reconstructive Materials
Device Technologies Australia Pty Ltd
DE339 Silimed Textured Mammary Implant Textured surface silicone gel mammary 40cc to 695cc $650.00
implant
Prostheses List by Category, Groups and Sponsor Page 821 of 911
POCE-NEURO
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.2.2 Repair, Graft, Medium (11–50cm2)
Lifehealthcare Pty Ltd
LH467 HydroFix Spine Shield medium The HydroFix Spine Shield is indicated for 5cmx6cmx1.0mm $472.00 $707.00
use in specific locations as a cover of the 5cmx6cmx0.6mm
spine to provide a plane of dissection
during revision surgery.
Medtronic Australasia Pty Ltd
MC990 Obex Neurofilm Synthetic Self-Adhesive Barrier and 50mm x 100mm $755.00
Sealant for Cerebrospinal Fluid Leaks
MC991 Obex Neurofilm Synthetic Self-Adhesive Barrier and 50mm X 50mm $550.00
Sealant for Cerebrospinal Fluid Leaks
MC992 Obex Neurofilm Synthetic Self-Adhesive Barrier and 50mm x 25mm $380.00
Sealant for Cerebrospinal Fluid Leaks
4.2.3 Repair, Graft, Large (51–100cm2)
Lifehealthcare Pty Ltd
LH466 Hydrofix Spine Shield Large The Hydro Fix Spine shield is indicated for 6cmX10cmX1.0mm $785.00 $1,335.00
use in specific locations as a cover of the 6cmX10cmX0.6mm
spine to provide a plane of dissection
during revision surgery
4.2.5 Repair, Liquid Sealant
6 to 9.99ml
MD Solutions Pty Ltd
MB007 ADHERUS Dural Sealant Dural sealant 6ml $835.00
Prostheses List by Category, Groups and Sponsor Page 822 of 911
POCE-NEURO
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.3.1 Valves
4.3.1.1 Valve, Externally Adjustable
Distal catheter, Reservoir/Priming function
Medtronic Australasia Pty Ltd
MI020 Strata Snap Shunt Assembly Adjustable CSF Valve with five symmetric 35-47mm, 120cm catheter $2,406.00 $3,635.00
performance level steps, includes integral
peritoneal catheter
Reservior/Priming Function
Medtronic Australasia Pty Ltd
MC949 Strata NSC Burr Hole Valve Adjustable cerebrospinal fluid (CSF) flow One size only $2,221.00 $2,700.00
valve. Polypropylene and acetal plastic
base. Silicone elastomer dome.
Reservior/Priming Function, Proximal/Distal cathet
Medtronic Australasia Pty Ltd
MC961 Strata NSC LP Shunt kit Strata NSC LP Shunt kit with Closed Tip One size only $2,856.00 $3,385.00
Lumbar Catheter and Peritoneal Catheter,
small lumen
MC965 Strata NSC LP Shunt kit Strata NSC LP Shunt kit with closed Tip One Size only $2,856.00 $3,385.00
Lumbar Catheter and Integral Peritoneal
Catheter, Small Lumen
MC971 Strata NSC LP Shunt kit Strata NSC LP Shunt kit with Open Tip One Size only $2,856.00 $3,385.00
Lumbar Catheter and Peritoneal Catheter,
small lumen
Reservoir/Priming function
Medtronic Australasia Pty Ltd
MI021 Strata Valve Adjustable CSF Valve with five symmetric 13-16mm x 35-47mm $2,406.00 $3,250.00
performance level steps
Reservoir/Priming function, Antisyphon function
Medtronic Australasia Pty Ltd
MC970 Strata Burr Hole Valve Adjustable cerebrospinal fluid (CSF) flow One size only. $3,250.00
valve with anti-siphon device.
Polypropylene and acetal plastic base.
Silicone elastomer dome.
Prostheses List by Category, Groups and Sponsor Page 823 of 911
POCE-NEURO
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Reservoir/Priming function, Coating
Medtronic Australasia Pty Ltd
MI019 Strata Valve with Bioglide Adjustable CSF Valve with five symmetric 13-16mm x 35-47mm $2,406.00 $3,450.00
performance level steps, surface of valve
bonded with hydrogel
Reservoir/Priming function, Distal catheter
Medtronic Australasia Pty Ltd
MC963 Strata NSC Burr Hole Shunt Assembly Adjustable cerebrospinal fluid (CSF) flow One size only $2,406.00 $2,885.00
valve. Polypropylene and acetal plastic
base. Silicone elastomer dome. With
integral catheter.
Reservoir/Priming/Antisyphon function.Distal cathe
Medtronic Australasia Pty Ltd
MC972 Strata Burr Hole Shunt Assembly Shunt Assembly: Adjustable cerebrospinal One size only. $3,435.00
fluid (CSF) flow valve with anti-siphon
device. Polypropylene and acetal plastic
base. Silicone elastomer dome with integral
catheter.
4.3.1.2 Valve, Non-externally adjustable
Reser/Prim function Prox/Distal Cathet Antibiotic
Johnson & Johnson Medical Pty Ltd
JJ822 Codman Hakim Precision Fixed Fixed Pressure Valve with Siphonguard Standard and Micro $2,100.00
Pressure Valve with Siphonguard device and Bactiseal ventricular and
unitised with Bactiseal impregnated peritoneal catheters: Opening pressures:
ventricular and peritoineal catheters 10-130mmH2O
4.3.3 Catheter
Proximal
Medtronic Australasia Pty Ltd
MI023 Shunt Component Catheter Ventricular Catheter, CSF Catheter 1.3 - 35cm $149.00 $220.00
Prostheses List by Category, Groups and Sponsor Page 824 of 911
POCE-NEURO
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.3.5 Reservoir/Priming Device
Medtronic Australasia Pty Ltd
MI018 Reservoir CSF Reservoir, Port, Neonatal, Snap Various $375.00 $750.00
assembly
4.3.6 Shunt Attachment
4.3.6.1 Connector
Medtronic Australasia Pty Ltd
MI022 Shunt Component Connector Connectors, fixation tabs Various $38.00 $155.00
4.4.2 External Components
4.4.2.1 Programmer
Medtronic Australasia Pty Ltd
MC837 Medtronic Activa Patient Programmer Medtronic Activa Patient Programmer One size only $1,400.00 $1,600.00
(Model 37642)
4.4.3 Leads
4.4.3.2 Lead Extension
St Jude Medical Australia Pty Ltd
SJ234 Pocket Adaptor IS-1 Pocket Adaptor 25cm and 50cm $1,510.00 $2,000.00
4.4.5 Accessories
Medtronic Australasia Pty Ltd
MI003 Medtronic DBS Tunneling Tool DBS Tunneling Tool Accessory Kit One size only $150.00 $175.00
Accessory Kit
Prostheses List by Category, Groups and Sponsor Page 825 of 911
POCE-NEURO
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.5.1 Pulse Generators
4.5.1.2 Rechargeable Pulse Generator
>8 electrodes
Emergo Asia Pacific Pty Ltd
ER005 Nevro Spinal Cord Stimulation System The Implantable Pulse Generator (IPG) is N/A $19,150.00 $28,000.00
(SCSS) - IPG Kit a rechargeable implantable device. It is
capable of stimulating the spinal cord
nerves through the electrodes of the leads
connected to any combination of the
output terminals, using one programmable
current source.
Dual channel; >8 electrodes
Medtronic Australasia Pty Ltd
MI004 Medtronic RestoreSensor Implantable 16 Electrode Rechargeable implantable 22cm3 $19,150.00 $24,000.00
Neurostimulator neurostimulator for pain management with
AdaptiveStim
4.5.2 External Components
4.5.2.1 Patient Programmer
Medtronic Australasia Pty Ltd
MI005 Medtronic myStim Patient Programmer Patient programmer for implantable One size only $1,350.00 $1,500.00
(Model 37744) neurostimulator
4.5.2.2 On/Off switching device
Emergo Asia Pacific Pty Ltd
ER009 Nevro Spinal Cord Stimulation System The patient remote control is a handheld, N/A $1,350.00
(SCSS) - Patient Remote Kit battery operated unit able to communicate
via radiofrequency (RF) with the
Implantable Pulse Generator and trial
stimulator
Prostheses List by Category, Groups and Sponsor Page 826 of 911
POCE-NEURO
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.5.2.3 Recharger
Emergo Asia Pacific Pty Ltd
ER008 Nevro Spinal Cord Stimulation System The Charger is a battery powered N/A $1,000.00 $3,000.00
(SCSS) - Charger Kit rechargable device intended to recharge
the Implantable Pulse Generator (IPG)
battery transcutaneously
Medtronic Australasia Pty Ltd
MI006 Medtronic External Patient Recharger Patient recharger system for implantable One size only $1,000.00 $3,000.00
System Model 37754 neurostimulator
4.5.3 Leads
4.5.3.1 Permanent Lead
Emergo Asia Pacific Pty Ltd
ER006 Nevro Spinal Cord Stimulation System The percutaneous lead is intended to be Spacing: 1-9mm spacing, 1- $4,164.00 $4,250.00
(SCSS) - Lead Kit single use and interfaces with the 9mm in 1mm increments;
Implantable Pulse Generator, lead Length: 30-90cm in 5cm
extender OR cable, and lead accessories. increments
> 8 Electrodes
St Jude Medical Australia Pty Ltd
SJ231 Penta Leads Paddle leads (Penta Leads have a curved 2-3mm, 30cm-110cm $8,000.00 $8,400.00
paddle instead of a conventional flat
paddle)
4.5.4 Lead Extension
Boston Scientific Australia Pty Ltd
BS169 Precision SCS Splitter 2 x 4 Lead extension for connection of multiple 2 configurations $1,510.00
leads
Emergo Asia Pacific Pty Ltd
ER007 Nevro Spinal Cord Stimulation System The lead extender is intended to be used Length: 15cm-60cm, in $1,510.00
(SCSS) - Lead Extension Kit when the implant site for the Implantable increments of 5cm
Pulse Generator is too far from the
stimulation site to directly connect the
stimulation lead.
Prostheses List by Category, Groups and Sponsor Page 827 of 911
POCE-NEURO
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.5.5 Accessories
Medtronic Australasia Pty Ltd
MC951 Multi-Lead Trialing Cable Connector for implanted lead to External One size only $300.00
Neurostimulator
Other Accessories
Medtronic Australasia Pty Ltd
MC824 Medtronic Neurostimulation Accessory Screening Cable (3550-03), Synergy IPG Various $168.00
Kits Connector Plug (3550-09), Tunnelling
Tools (3555, 3550-06, 3555-60), EZ
Anchor (3550-16), Boot and Anchor Kit
(3550-24)
4.8.1 Stent
4.8.1.1 Open cell stent
ev3 Australia Pty Ltd
EE026 Solitaire Solitaire Neurovascular Remodelling Diameter: 3-6mm $7,500.00 $10,000.00
Device is a self-expanding, fully retrievable Length: 15-40mm
device which can be delivered and
deployed by a single operator.
Self Expandable
Boston Scientific Australia Pty Ltd
BS190 Neuroform EZ Stent System Self expanding Nitinol stent with delivery 2.5-4.5mm $7,500.00
system
4.8.2 Coils
Boston Scientific Australia Pty Ltd
BS177 Target Detachable Coils Detachable GDC coils 2mm-15mm diameter 1cm to $1,640.00
40cm length
Prostheses List by Category, Groups and Sponsor Page 828 of 911
POCE-NEURO
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
JJ485 Orbit detachable coil Helical Fill 2mm - 12mm, 1.5cm - 30cm $1,400.00
JJ486 Orbit detachable coil Complex Standard 6mm - 20mm, 10cm - 30cm $1,505.00
JJ487 Orbit detachable coil Complex 1.5mm - 14mm $1,505.00
Penumbra Neuro Australia Pty Ltd
PN003 Penumbra Coil System / Penumbra Frame configuration coil, three-dimensional Diameters: 3-24mm $1,250.00 $2,800.00
Complex Standard Coil 400 complex shape, stiffest coil within the Lengths: 6-57cm
system, first coil to be placed, frames area
of embolisation and holds subsequent coils
within this zone.
PN004 Penumbra Coil System / Penumbra Fill configuration coil is used to fill empty Diameters: 3-24mm $1,250.00 $3,000.00
Complex Soft Coil 400 space within the frame coil. The stiffness Lengths: 6-57cm
allows for a traumatic interaction with the
aneurysm wall and primary packing of the
occlusion site (aneurysm).
PN005 Penumbra Coil System / Penumbra J Finish Coil Implant (J Soft) fills small Lengths: 1-15cm $1,250.00 $2,800.00
Soft Coil 400 empty pockets remaining within the
occlusion site. The J shaped tip and
stiffness allows the coils to manoeuvre and
fill the remaining pockets after use of the
primary Fill Coils.
PN006 Penumbra Coil System / Penumbra The Soft Finish Coil Implant (Curve Extra Diameters: 2-4mm $1,250.00 $2,800.00
Curve Extra Soft 400 Soft) is used for final packing of the Lengths: 1-20cm
aneurysm. The serpentine shape and the
lowest stiffness allow the coils to
manoeuvre and fill any remaining pockets
after use of the other coil types.
PN008 Penumbra Coil System / Penumbra Coil A single detachment handle which is One size only $350.00
Detachment Handle compatible with all Penumbra Coil
configurations and can be used to detach
all coils needed for a single patient.
Prostheses List by Category, Groups and Sponsor Page 829 of 911
POCE-NEURO
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
4.8.4 Assist Devices
N Stenning & Co Pty Ltd
NG056 SONIC Microcatheter Micro catheter DMSO compatible Dia: 1.2fr or 1.5fr $700.00 $1,417.00
Length: 165cm or 190cm
Balloons
ev3 Australia Pty Ltd
EE030 ev3 Occlusion Balloon Catheters Single lumen balloon catheter to 3-7mm diameter; 7-30mm length $4,000.00
temporarily occlude the central lumen
allowing inflation of the balloon during
neurosurgical and vascular procedures.
Catheter
ev3 Australia Pty Ltd
EE029 Marksman Microcatheters The MARKSMAN Microcatheter is a Outer Diameter: 2.8F Inner $700.00 $1,295.00
variable stiffness, single lumen catheter Diameter: 0.027" Length: 105-
designed to access small, tortuous vascular 150cm
areas. The outer surface of the catheter's
distal segment is coated with a hydrophilic
material to provide lubricity during use.
The catheter also incorporates a PTFE
liner to facilitate movement of delivery
devices passed through its lumen and has a
radiopaque marker at the distal tip to
facilitate fluoroscopic visualization. The
distal tip of the catheter is shapeable.
Johnson & Johnson Medical Pty Ltd
JJ488 Prowler Infusion Catheters Braid/coil catheter Size: 50cm - 170cm. $719.00
Catheters
Boston Scientific Australia Pty Ltd
BS191 Neuro Renegade Hi-Flo Microcatheter Microcatheter for deployment of 2.5-4.5mm $700.00
neuroform stent system
Prostheses List by Category, Groups and Sponsor Page 830 of 911
POCE-NEURO
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Penumbra Neuro Australia Pty Ltd
PN007 Penumbra Coil System / Penumbra PX A variable stiffness catheter reinforced with Length: 150cm $700.00 $1,000.00
400 Microcatheter nitinol provides access to target site,
reinforcing conduit for other intravascular
devices. Includes rotating hemeostasis
valve, tip shaping mandrel, introducer
sheath.
Coil detachment device
Boston Scientific Australia Pty Ltd
BS172 InZone Detachment System InZone Detachment System is specifically One size $400.00
designed for use with the Target
Detachable Coils
Coil detachment devices
Johnson & Johnson Medical Pty Ltd
DY533 Trufill Coil system - Trufill DCS Syringe Trufill syringe barrel with a pressure gauge, One sterile unit. $350.00 $400.00
a threaded plunger assembly.
Prostheses List by Category, Groups and Sponsor Page 831 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 1 - Urogenital - Incontinence Prostheses
sys
Endotherapeutics Pty Ltd
ET057 Flow Secure Artificial Urinary Sphincter Artificial Urinary Sphincter with conditional One Size $10,000.00
occlusion, inflatable hydraulic device
Group 1a - Incontinence: inflatable
American Medical Systems
AM002 Acticon Artificial Bowel Sphincter Cuff Occlusive Cuff 9, 10, 11, 12, 13, 14cm $3,574.00
(available in both 2.0cm &
2.9cm widths)
AM032 Acticon Artificial Bowel Sphincter Pump Control Pump One Size $6,432.00
AM033 Acticon Artificial Bowel Sphincter Pressure Regulating Balloon 81-90cm, 91-100cm, 101- $3,500.00
Pressure Regulating Balloon 110cm, 111-120cm
AM034 Acticon Artificial Bowel Sphincter Accessory Kit One Size $689.00
Accessory Kit
ak
American Medical Systems
AM030 AMS 800 Artificial Urinary Sphincter Accessory Kit One Size $689.00
Accessory Kit
con
Device Technologies Australia Pty Ltd
DE313 Inflatable Periurethral Constrictor Consists of a membrane, filler product and One size only $1,225.00
silicone tube
oc
American Medical Systems
AM001 AMS 800 Artificial Urinary Sphincter Occlusive Cuff 13 Cuff sizes from 3.5 to 11.0 $2,614.00
Cuff cm: Size: 3.5, 4, 4.5, 5, 5.5, 6,
6.5, 7, 7.5, 8, 9, 10, 11cm
Prostheses List by Category, Groups and Sponsor Page 832 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AM021 AMS 800 Artificial Urinary Sphincter Silicone cuff for artificial urinary sphincter. 13 Cuff sizes from 3.5 to 11.0 $2,614.00
Cuff For the implantation of the second cuff for cm: Size: 3.5, 4, 4.5, 5, 5.5, 6,
the AMS 800 6.5, 7, 7.5, 8, 9, 10, 11cm
AM051 AMS 800 Urinary Control System with Occlusive Cuff with InhibiZone Antibiotic 13 Cuff sizes from 3.5 to 11.0 cm $2,850.00
InhibiZone - cuff Surface Treatment
pu
American Medical Systems
AM029 AMS 800 Artificial Urinary Sphincter Control Pump One size $4,947.00
Pump
AM050 Urinary Control System Pump Pump with InhiboZone Antibiotic Surface One size only. $5,150.00 $5,343.00
Treatment
rb
American Medical Systems
AM028 AMS 800 Artificial urninary sphincter Pressure Regulating Balloon 51 - 60cm, 61 -70cm, 71 - 80cm $2,057.00
Pressure Regulating Balloon
Group 1b - Incontinence: permanently adjustable
MD Solutions Pty Ltd
MB003 Adjustable Continence Therapy for ACT Device: Prosthesis designed for the 6 - 14cm $4,145.00
Women treatment of female SUI comprising of a
single silicone balloon attached via a
conduit to titanium and rubber ports
allowing for post operative adjustment.
MB004 Adjustable Continence Therapy device ACT Device: prosthesis designed for the 6 - 14cm $8,290.00
for women treatment of female SUI comprising of
silicone balloons x 2 attached via a conduit
to titanium and rubber ports allowing for
post operative adjustment.
MB005 Adjustable Continence Therapy for Men ProACT Device: prosthesis designed for 6 - 14cm $8,290.00
the treatment of male SUI comprising of
silicone balloons x2 attached via a conduit
to titanium and rubber ports allowing for
post operative adjustment.
Prostheses List by Category, Groups and Sponsor Page 833 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MB006 Adjustable Continence Therapy for Men ProACT Device: Prosthesis designed for 6 - 14cm $4,145.00
the treatment of male SUI comprising of a
single silicone balloon attached via a
conduit to titanium and rubber ports
allowing for post operative adjustment.
d
Uromedica Asia-Pacific Pty Ltd
UO002 Adjustable Continence Therapy device ACT Device: prosthesis designed for the 6 - 14cm $8,290.00
for women treatment of female SUI comprising of
silicone balloons x 2 attached via a conduit
to titanium and rubber ports allowing for
post operative adjustment.
UO003 Adjustable Continence Therapy for Men ProACT Device: prosthesis designed for 6 - 14cm $8,290.00
the treatment of male SUI comprising of
silicone balloons x2 attached via a conduit
to titanium and rubber ports allowing for
post operative adjustment.
s
Uromedica Asia-Pacific Pty Ltd
UO001 Adjustable Continence Therapy for ACT Device: Prosthesis designed for the 6 - 14cm $4,145.00
Women treatment of female SUI comprising of a
single silicone balloon attached via a
conduit to titanium and rubber ports
allowing for post operative adjustment.
UO004 Adjustable Continence Therapy for Men ProACT Device: Prosthesis designed for 6 - 14cm $4,145.00
the treatment of male SUI comprising of a
single silicone balloon attached via a
conduit to titanium and rubber ports
allowing for post operative adjustment.
Group 1c - Incontinence: sling, male, synthetic
American Medical Systems
AM017 InVance Male Sling System Kit includes inserter with shaft, 6 bone One Size $5,718.00
screws with suture and silicone-coated
sling surgical mesh
Prostheses List by Category, Groups and Sponsor Page 834 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AM048 AMS AdVance XP Male Sling System Sub-urethral sling implant for treatment of Arm width: 1.2cm, Centre $5,718.00
male stress urinary incontinence. Made width: 3.55cm, Total Length:
from polypropylene monofilament mesh 35.5cm, 43.5cm
Endotherapeutics Pty Ltd
ET050 ARGUS Adjustable Male Sling made of silicone One size only $5,616.00
adjustable self fixating columns and urethral
cushion
Medical Specialties Australia Pty Ltd
MS055 TiLOOP Male Tension-free mesh made out of titanized 65 g/m2 (strong) $2,500.00
polypropylene for restoration of male
urinary continence.
Group 1e - Incontinence: sling, female, synthetic
Allied Medical Limited
AH003 GMD Universal Incontinence Sling Kit A sterile single use device for treatment of Mesh = 500mm x 15mm and $865.00
female stress urinary incontinence. An Trocars = 250 mm x 15mm
implantable device for use in women as a approx
suburethral sling for treatment of SUI
resulting from urethral hypermobility and/or
intrinsic sphincter deficiency.
American Medical Systems
AM014 Sparc Sling System Polypropylene mesh sling, two needles One size only $860.00
with rotating handles, two cystoscopy aids
AM019 MONARC Sling System Product includes - mesh and two needles One Size Only $865.00 $990.00
with handles attached
Prostheses List by Category, Groups and Sponsor Page 835 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
AM049 Mini ArcTM Single-Incision Sling System The MiniArcTM Single Incision Sling 8.5cm $865.00
System is intended for the placement of a
suburethral sling for the treatment of female
stress urinary incontinence (SUI) resulting
from urethral hypermobility and/or intrinsic
sphincter deficiency.
The MiniArc sling kit is comprised of an
8.5 cm monofilament macroporous Type I
polupropylene mesh with a small integrated
self-fixating tips that are made of
polypropylene, and a curved needle that
inserts into the self-fixating tip for
advancement and placement of the sling.
AM055 MiniArc Precise Single-Incision Sling The MiniArc Precise Single-Incision Sling Short Centre-Length Sling $865.00 $950.00
System System (MiniArc Precise System) is Total: 8.5cm
intended for the placement of a suburethral Centre (mid section): 2.0cm
sling for the treatment of female stress Long Centre-Length Sling
urinary incontinence (SUI) resulting from Total: 8.5cm
urethral hypermobility and/or intrinsic Centre (mid section): 5.5cm
sphincter deficiency.
The MiniArc Precise sling kit is comprised
of two configurations. The configurations
are identified by their mesh sling option:
Short center-length mesh (short mesh) and
Long centre-length mesh (long mesh).
Each configuration contains a delivery tool
(identical tool for both configurations) and
either one short or long 8.5 cm Type I
monofilament polypropylene mesh sling
with polypropylene designed self-fixating
tips, and a curved needle housing with
barb guards that inserts into the self-
fixating tip for advancement and placement
of the sling.
Boston Scientific Australia Pty Ltd
BS078 Advantage Transvaginal Mid-Urethral Polypropylene mesh sling One size only $817.00
Sling System
Prostheses List by Category, Groups and Sponsor Page 836 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BS096 Lynx Suprapubic Mid-Urethral Sling Polypropylene mesh Sling One size only $817.00
System
BS097 Obtryx Transoburator Mid-Urethral Polypropylene mesh sling One size only $817.00
Sling System
BS140 Advantage Fit Transvaginal Mid-Urethral Polypropylene mesh sling One size only $817.00
Sling System
BS154 Solyx SIS System Polypropylene mesh sling One size only $865.00
Coloplast Pty Ltd
CT013 Aris Transobturator Sling System Sling System for female stress urinary One Size $865.00
incontinence
Covidien Pty Ltd
AS120 IVS Tunneller-Intravaginal Tunneller IVS Tunneller System Trans Obuturator 50 cm (mesh) $860.00
System with two stylets and polypropylene mesh
Device Technologies Australia Pty Ltd
DE283 Desara Urogenital Sling Sling for Female Stress Urinary 1.1cm x 4.5cm $699.00
Incontinence and Vaginal Vault Prolapse
Endotherapeutics Pty Ltd
ET043 Safyre Autofixation System Urinary incontenence sling made of One size only $860.00 $1,000.00
polydimethysiloxane and polyproplene
ET059 TOA/TVA SLING, TRANSVAGINAL SLING FOR THE TREATMENT OF ONE SIZE $865.00 $950.00
TRANS-OBTURATOR APPROACH FEMALE STRESS URINARY
INCONTINENCE WITH INTRA AND
POST-OPERATIV ADJUSTABILITY
ET060 Ophira Minisling System Mini sling system made from monofilament One size. $865.00 $985.00
mesh, held between self anchoring
polypropylene columns in a fishbone
design. Supplied with a retractable
insertion guide for sling placement. Ophira
sling has a blue loosening suture inserted in
the base of one of the fixation arms,
allowing intraoperative adjustment.
Gytech Pty Ltd
GP001 Cousin Biotech Intramesh L.I.F.T Polypropylene Mesh One size only $551.00
Prostheses List by Category, Groups and Sponsor Page 837 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
JJ070 TVT (Tension-Free Vaginal Tape) Single Undyed Prolene (polypropylene) 11 x 450mm $865.00
use device nonabsorbable tape
JJ442 Gynecare TVT-O Items included are: Gynecare TVT 1.1x45 cm $865.00
Obturator device, Two Gynecare TVT
Helical Passers and a Gynecare TVT
Atraumatic Winged Guide. The device
component of the system consists of
undyed or blue Prolene Polypropylene
Mesh
JJ775 GYNECARE TVT SECUR The GYNECAGE TVT SECUR System Mesh measures 1.1cm x 8cm in $865.00
consists of a device, 2 Inserters (with length
finger pads and a release wire), 1
Protective cover, and 1 plastic delivery tray
MN039 Gynecare TVT ABBREVO™ Implant assembly consisting of mesh sling 1.1cm x 12cm $865.00
Continence System and sterile, single-patient use helical passer
sheaths.
Medical Specialties Australia Pty Ltd
MS060 TiLOOP Tape Tension-free non-absorbable titanised tape light / extralight $865.00 $1,300.00
TFS Manufacturing Pty Ltd
TF001 TFS Tissue Fixation System TFS Tissue Fixation System One Size Only $850.00
Group 1g - Incontinence: injectable, synthetic
Australasian Medical & Scientific Ltd
AN007 Coaptite Calcium hydroxylapatite spheres 1 ml syringe $520.00
suspended in an aqueous gel carrier,
Coaptite is an injectable synthetic tissue
reconstructive material
Endotherapeutics Pty Ltd
ET011 Macroplastique Sterile, textured, highly cross linked 1.3 ml $690.00 $1,008.00
polydimethylsiloxane elastomer implants
suspended in a bio-excretable carrier gel.
Prostheses List by Category, Groups and Sponsor Page 838 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ET053 Macroplastique Sterile, textured, highly cross linked 2.5ml Implants $1,328.00 $1,800.00
polydimethylsiloxane elastomer implants
suspended in a bio-excretable carrier gel.
Johnson & Johnson Medical Pty Ltd
JJ802 BULKAMID Urethral Bulking System Transparent polyacrylamide gel for female 2 x 1ml syringes, 2 x $1,175.00
urinary incontinence. Kit comprises 2 BULKAMID 23G needles, 1 x
syringe, 2 needles, 1 applicator disposable sheath
Lifehealthcare Pty Ltd
LH376 Durasphere SUI Injectable Bulking agent for Stress Urinary 1ml $531.00
Incontinence
LH379 Durasphere SUI Injectable Bulking agent for Stress Urinary 3ml $1,593.00
Incontinence
Group 1h - Incontinence: injectable, biological
Bard Australia Pty Ltd
BA041 Contigen Cross Linked Collagen Contigen Bard Collagen Implant for Stress 2.5cc per syringe $669.00 $674.00
Urinary Incontinence
Group 2 - Urogenital - Ureteric Stents
Applied Medical Australia Pty Ltd
MH010 Silhouette Ureteral Stent The Silhouette Ureteric Stent is Multiple French Sizes & Lengths $140.00
manufactured with a soft material that
provides superior comfort. It has superior
column strength through a coil-reinforced
body providing effortless placement. The
tight coils prevent migration. The smaller
outside diameter of 4F with inner diameter
comparable to 6F standard stents provides
exceptional drainage. SL-6 hydrophilic
coating further facilitates placement.
Prostheses List by Category, Groups and Sponsor Page 839 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 2a - Ureteric stents: fixed length, polyurethane
Cook Medical Australia Pty Ltd
WC027 Polyurethane Double Pigtail Stent Set Multiple French Sizes and $180.00
Lengths
WC281 Universa Soft Ureteral Stent Set Universa Soft Ureteral Stent Set, with or 5, 6, 7 and 8FR in fixed lengths $180.00
without the TFE WireGuide, fixed length (18 - 30CM)
P
Cook Medical Australia Pty Ltd
WC022 C-Flex Double Pigtail Ureteric Stent Set Set includes: Stent, Wire, Positioner Multiple French Sizes, Multi- $180.00
length
SP
Cook Medical Australia Pty Ltd
WC018 C-Flex Endoureteratomy Stent Set 6.0/10.0 Fr, & 7.0/14.0 Fr, $241.00
Multiple Length
WC236 Paterson-Forrester Subcutaneous Subcutaneous Urinary Diversion Stent Stent 8.5 French, 65cm long $286.00
Urinary Diversion Stent
T
Cook Medical Australia Pty Ltd
WC214 Cook Ureteral Stents Amplatz Ureteral Stent Set, Ultrathane RB 8.5Fr - 12,20,22,24,26,28cm $243.00
Design Radioplaque Band and AQ and 10.2Fr - 22,24,26,28cm
Hydrophilic Coating Set includes one stent
positioner with flexible stent introducer
catheter
N Stenning & Co Pty Ltd
NG030 Paediatric Ureteric Valve Stent Set Open end with introducer and guidewire, 12 - 22cm $197.00
Polyurethane
NG031 Paediatric Ureteric Integral Stent Set Open end with introducer and guide wire, 12 - 22cm Per pack of 5 $197.00
Polyurethane
NG032 DD Ureteric Stent Set Open end with introducer and guide wire 22 - 30cm Per pack of 2 $238.00
NG046 Paediatric Ureteric Valve Stent Set Fixed length wirthan stent 12 - 22cm $197.00
Prostheses List by Category, Groups and Sponsor Page 840 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Pyramed Pty Limited
PY012 Ex-Stent Tumour Ureteral Stent Set Open end stent with guide wire and pusher 6-8Fr., length 26-32cm $197.00 $243.00
Group 2b - Ureteric stents: fixed length, other synthetic
Applied Medical Australia Pty Ltd
MH012 Silhouette System Ureteral Stent Set Coil reinforced body. SL-6 hydrophilic Mulitple French Sizes & Lengths $198.00
coating. UroWire 0.035" 3-in-1 guidewire
with kink resistant nitinol core. Design
divided into 3 sections: silver section (front
end) floppy SL - 6 hydrophilic coating;
Blue section (mid) super stiff PTFE (not
hydrophicaly coated); and Green section
(back) flexible
Boston Scientific Australia Pty Ltd
BS038 Polaris Ureteral Stents Dual durometer ureteral stent with attached Diameters up to 14Fr & lengths $214.00
suture up to 40cm
BS086 Polaris Ultra Ureteral Stent Dual durometer ureteral stent with attached Diameters up to 14Fr & lengths $214.00
suture up to 40cm
BS091 Percuflex; Percuflex Plus; Percuflex Tail; Ureteral stent with attached suture Diameters up to 14Fr & lengths $214.00
Percuflex Tail Plus Ureteral Stents; up to 40cm
Ureteral Stent System Kit
BS093 Retromax Plus Ureteral Stent Ureteral stent Diameters up to 14Fr & lengths $214.00
up to 40cm
BS116 Polaris Loop Ureteral Stent Dual durometer ureteral stent with attached Diameters up to 14Fr & lengths $214.00
suture up to 40cm
BS192 Percuflex® Helical Ureteral Stent with Hydro Plus™ Coating 6fr to 8fr and 10cm to 30cm $214.00
Cook Medical Australia Pty Ltd
WC273 Ureteric Stent Set Set includes soft Aqueous Coated (AQ) Multiple French Sizes and $198.00
ureteric stent, positioner, with or without Lengths
wire guide
Olympus Australia
OL078 Ureteral Stents Diversion Stent, silicone 7 - 8.5 F x 90cm $177.00
Prostheses List by Category, Groups and Sponsor Page 841 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
P
Applied Medical Australia Pty Ltd
MH013 Paediatric Silhouette System Set Coil reinforced body. SL-6 hydrophilic 4F, 8 - 12cm $245.00
coating. UroWire 0.035" 3-in-1 guidewire
with kink resistant nitinol core. Design
divided into 3 sections: silver section (front
end) floppy SL - 6 hydrophilic coating;
Blue section (mid) super stiff PTFE (not
hydrophicaly coated); and Green section
(back) flexible
SP
Applied Medical Australia Pty Ltd
MH003 Acucise RP35 Procedural Pack Composition: Polypropylene & Titanium One size only $2,860.00
MH007 Acucise RP35 Procedural Starter Pack Polypropylene and Titanium One Size Only $3,328.00
Cook Medical Australia Pty Ltd
WC024 Ultrathane Endoureteratomy Stent Set 6/9.5 Fr & 7/14.0Fr , Multiple $234.00
Length
T
Boston Scientific Australia Pty Ltd
BS092 Contour Ureteral Stent Ureteral stent with attached suture Diameters up to 14Fr & lengths $214.00
up to 40cm
N Stenning & Co Pty Ltd
NG028 DD Ureteric Tumor Stent Set Open/Closed end with introducer and 20 - 28cm $123.00
guide wire, Polyurethane
NG029 DD Ureteric Valve Stent Set Open end with introducer and guide wire, 22 - 30cm $142.00
Polyurethane
Group 2c - Ureteric stents: fixed length, other synthetic thermosensitive
Cook Medical Australia Pty Ltd
WC130 Ureteric Stent Set Set includes Aqueous Coated (AQ) firm Multiple French Sizes, and $261.00
fixed length ureteric stent, positioner, with Lengths
or without wire guide
Prostheses List by Category, Groups and Sponsor Page 842 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
WC131 Endo-sof double pigtail stent Set with Multiple French Sizes and $261.00
AQ Hydrophilic Coating and Sideholes Lengths
WC170 Universa Firm Universa Firm Double Pigtail Stent and Multiple French Sizes and $184.00
Positioner only Lengths
WC172 Universa Firm Universa Firm Double Pigtail Stent Set Multiple French Sizes and $204.00
Lengths
Group 2d - Ureteric stents: fixed length, metal
T
Cook Medical Australia Pty Ltd
WC226 RESONANCE Metallic Ureteral Stent Metallic Double Pigtail Stent 6 Fr, Multiple Lengths $1,720.00
Set
Group 2e - Ureteric stents: fixed length metal thermosensitive
Endotherapeutics Pty Ltd
ET055 Memokath Ureteric Stent Memokath Model 051CW. 30mm - 200mm $3,778.00
Group 2f - Ureteric stents: multilength polyurethane
Bard Australia Pty Ltd
BA044 Ureteral Stent Bard Inlay Hydrophilic coated Pigtail (Inlay) 4.7Fr 14, 20, 22, 24, $199.00
Ureteric stent without guidewire; Bard 26, 28cm. 6Fr- 14, 20, 22,
Flouro 4 Silicone Multilength ureteric stent 24, 26, 28cm 7Fr 14, 20, 22,
with guidewire; Urinary Diversion Stent All 24, 26, 28cm 8Fr- 14, 20, 22,
Silicone 24, 26, 28cm. (Flouro)
Multilength 4,6,7,and 8fr.
(Diversion) 7Fr x 90cm &
8Fr x 90cm.
Cook Medical Australia Pty Ltd
WC020 Towers Peripheral Ureteral Stent Set Multiple French Sizes Multi- $214.00
length
WC282 Universa Soft Ureteral Stent Set Universa Soft Ureteral Stent Set, with or 5, 6, 7 and 8FR in multi-length $199.00
without the TFE WireGuide, multi-length (21-31CM)
Prostheses List by Category, Groups and Sponsor Page 843 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
P
Cook Medical Australia Pty Ltd
WC218 C-Flex Multilength Ureteric Stent Set Set includes: Paediatric Stent, Wire, 3.7 Fr, Multiple Lengths $254.00
Positioner
WC219 C-Flex Double Pigtail Ureteric Stent Set Set includes: Paediatric Stent, Wire and 3.7 Fr, Multilple Lengths $254.00
Positioner
SP
Cook Medical Australia Pty Ltd
WC237 Radiance Ureteric Stent Set Synthetic Thermosensitive Ureteral Stent Multiple French Sizes and $261.00 $312.00
Set with Heparin Coating Lengths
Group 2g - Ureteric: multilength other synthetic
Boston Scientific Australia Pty Ltd
BS094 Contour VL; Stretch VL Flexima; Ureteral stent with attached suture Diameters up to 14Fr & lengths $212.00
Ureteral Stents up to 40cm
Cook Medical Australia Pty Ltd
WC002 Sof-Flex Multi-length Ureteric Stent Set Set includes Stent, Wire, Positioner Multiple French Sizes, Multi- $198.00
length
WC003 Sof-Flex Multi-length Ureteric Stent Set Stent and Positioner only Multiple French Sizes, Multi- $198.00
length
WC104 Cook Ureteral Stent - Sof-Flex Double Radiopaque Sof-Flex Stent, Stainless Steel Multiple French Sizes and $228.00
Pigtail Stent Set - Special Wire Guide, Radiopaque Polyurethane Lengths
Catheter and Radiolucent Vinyl Positioner
WC140 Filiform Multi-Length Silicone Stent Set Stent, Wire, Positioner Multiple French Sizes and $265.00
Lengths
WC147 Kwart Retro-Inject Stent Set Stent, Wire, Inserter, Release Sleeve Multiple French Sizes and $198.00
Lengths
WC149 Sof-Flex Double Pigtail Ureteric Stent Stent and Positioner only Multiple French Sizes and $198.00
Set Lengths
WC150 Sof-Flex Double Pigtail Ureteric Stent Set includes: Stent, Wire, Positioner Multiple French Sizes and $198.00
Set Lengths
WC272 Ureteric Stent Set Set includes soft Aqueous Coated (AQ) Multiple French Sizes, multi- $198.00
ureteric stent, positioner, with or without length
wire guide
Prostheses List by Category, Groups and Sponsor Page 844 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Olympus Australia
OL076 Ureteral Stents Single J Ureteric Stent, silicone 7 - 8.5 F x 90cm $177.00
OL077 Ureteral Stents Double J Ureteric Stent, silicone 6-8.5 F, 12 - 24 cm $196.00
OL080 Quadra-Coil Multi Length Ureteral Stent Tecoflex polymer, hydrophilic 4.5F-8.5F x length 22 - 28cm $139.00 $178.00
coating/PTFE coating
P
Cook Medical Australia Pty Ltd
WC217 Sof-Flex Multilength Ureteric Stent Set Set includes: Paediatric Stent, Wire, 3 Fr, Multiple Lengths $259.00
Positioner
WC220 Sof-Flex Double Pigtail Ureteric Stent Set includes: Paediatric Stent, Wire, 3 Fr, Multiple Lengths $259.00
Set Positioner
SP
Cook Medical Australia Pty Ltd
WC023 Greene Renal Transplant Stent Set Transplant stent set Multiple French Sizes, Multi- $243.00
length
T
Cook Medical Australia Pty Ltd
WC138 Filiform Double Pugtail Silicone Stent Set Stent, Wire, Positioner Multiple French Sizes and $265.00
Lengths
Group 2h - Ureteric: multilength other synthetic thermosensitive
Cook Medical Australia Pty Ltd
WC035 Ureteric Stent Set Set includes Aqueous Coated (AQ) firm Multiple French Sizes, Multi- $261.00
multilength ureteric stent, positioner, with Length
or without wire guide
WC169 Universa Firm Universa Firm Multi-length stent set Multiple French Sizes and $204.00
Lengths
WC171 Universa Firm Universa Firm Multi-length Stent and Multiple French Sizes and $184.00
Positioner only Lengths
Group 2j - Ureteric: urinary diversion
Boston Scientific Australia Pty Ltd
BS095 Urinary Diversion Stents Percuflex urinary diversion stent Diameters up to 14Fr & lengths $212.00
up to 95cm
Prostheses List by Category, Groups and Sponsor Page 845 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Cook Medical Australia Pty Ltd
WC031 Bander Ureteral Diversion Stent Set Left or right stent Multiple French Sizes and $132.00
Lengths
WC128 Bander Ureteral Diversion Stent Set Left and Right Stents Multiple French Sizes and $212.00
Lengths
Pyramed Pty Limited
PY001 Optimed Ureteric Stents Soft-Polyurethane. Ureteral. Paediatric Ureteral 4.5 x 28,30,32 cm; 6 x $212.00
Ureteral. Renal Transplantation. Urinary 26,28,30,32 cm; 7 x
Diversion. 26,28,30,32 cm. Paediatric
Ureteral 8 x 28,30,32 cm.
Renal Transplantation 4 x
10,12,14,16 cm; 6 x 12,14,16
cm; 7 x 12,14,16 cm. Urinary
Diversion 8 x 12,14,16 cm.
PY011 Opti-J Ureteral Stent System Steerable ureteral stent/ureteral stent with 4.5-8 Fr., length 26-32cm $212.00
pusher
Group 3 - Urogenital - Urethral Stents
Group 3a - Urethral stents : Metal, expandable
American Medical Systems
AM003 Urolume Plus TM Endo Urethral Endourethral wall stent for urethral Range: 1.5 - 4.0cm $2,475.00
prostheses strictures, DESD and BPH
Bard Australia Pty Ltd
BA042 Memotherm Prostatic Stents Memotherm Prostatic Urethral wall Stent 36Fr, 20mm to 60mm in 5mm $2,475.00
increments; 42Fr, 20mm to
60mm in 5mm increments
Group 3b - Urethral: metal, thermosensitive
Endotherapeutics Pty Ltd
ET054 Memokath Prostatic - Urethral Stents Memokath Models: 028S, 028SW, 028T, 5mm - 90mm $2,475.00
028TW, 044T, 044TW, 045T, 045TW,
045TTW
Prostheses List by Category, Groups and Sponsor Page 846 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 3c - Urethral: paediatric
Cook Medical Australia Pty Ltd
WC126 Firlit-Kluge Uretheral Stent Firlit-Kluge uretheral stent Multiple French Sizes, Length $58.00
30cm
WC136 Kaontz Urethral Stent Kaontz Urethral Stent Multiple French Sizes, Length $49.00
12cm
WC137 Pediatric Urethral C-Stent Pediatric Urethral C-Stent Multiple French Sizes, Length $49.00
15cm
WC162 Tarkington Urethral Stent Set Stent, Wire 8 Fr $81.00
Group 4 - Urogenital - Reconstructive Material
Group 4a - Reconstructive Material : synthetic
American Medical Systems
AM023 IntePro Large Pore Polypropylene Y- Large pore polypropylene mesh One size $677.00
Sling
AM026 Perigee Transobturator Anterior 4 helical shaped needles with handles, 4 One size $1,353.00
Prolapse Repair System synthetic graft arms enclosed in plastic with
a centre "cape" mesh.
Boston Scientific Australia Pty Ltd
BS127 Polyform Synthetic Mesh Synthetic Polypropylene mesh Width Up to 15cm & lengths $390.00
up to 20cm
Coloplast Pty Ltd
CT014 NovaSilk Polypropylene Mesh knitted monofilament polypropylene mesh 15cm x 15cm - One Size $310.00
Endotherapeutics Pty Ltd
ET063 Vantris Bulking agent for the treatment of 1ml Syringe $1,000.00 $1,300.00
Vesicoureteric Reflux
Johnson & Johnson Medical Pty Ltd
JJ679 GYNECARE PROLIFT + M Anterior Pre-cut GYNECARE GYNEMESH M* One size only $1,333.00
Pelvic Floor Repair System Partially Absorbable mesh and single use
instruments for mesh placements
JJ789 GYNECARE GYNEMESH Pelvic floor reconstructive material, 25 x 25 cm $677.00
lightweight mesh
Prostheses List by Category, Groups and Sponsor Page 847 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ790 GYNECARE GYNEMESH PS Pelvic floor reconstructive material, 10 x 15 cm $310.00
lightweight mesh
Medical Specialties Australia Pty Ltd
MS061 TiLOOP Two Tension-free non-absorbable titanised light, extralight, small, medium $310.00 $1,322.00
polypropylene mesh for posterior pelvic
floor repairs
MS062 TiLOOP Four Tension-free non-absorbable titanised light, extralight, small, medium $310.00 $1,333.00
polypropylene mesh for anterior pelvic
floor repairs
Q-Med (Sweden) Australia Pty Ltd
QM001 Deflux Deflux is a sterile, highly viscous gel of 1ml in syringe $1,000.00
dextranomer microspheres and non-animal
stabilised hyaluronic acid constituting a
biocompatible and biodegradable implant
for the treatment of vesicoureteral reflux.
The stabilised hyaluronic acid acts mainly
as a carrier, leaving the dextranomer
microspheres at the implant site. They are
gradually surrounded by host connective
tissue.
QM002 Deflux and Metal needle kit Deflux is a sterile, highly viscous gel of 1 ml syringe and needle size $1,130.00
dextranomer microspheres and non-animal 3.7FR x 23G x 350mm
stabilised hyaluronic acid constituting a
biocompatible and biodegradable implant
for the treatment of vesicoureteral reflux.
The stabilised hyaluronic acid acts mainly
as a carrier, leaving the dextranomer
microspheres at the implant site. They are
gradually surrounded by host connective
tissue. 3.7FR x 23G x 350mm Metal
Needle.
ap, k
Boston Scientific Australia Pty Ltd
BS157 Pinnacle Duet PFR Kit Synthetic polypropylene mesh assemblies Two configurations $2,540.00
and fixation device
Johnson & Johnson Medical Pty Ltd
JJ476 Gynecare Prolift Pelvic Floor Repair Pre-cut gynemesh PS and single use PFRT01 $2,540.00
System instruments for mesh placement
Prostheses List by Category, Groups and Sponsor Page 848 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ745 GYNECARE PROSIMA Combined Pre-cut gynemesh PS and single use 2 x Pieces of GYNECARE $2,540.00
Pelvic Floor Repair System instruments for mesh placement GYNEMESH PS* Mesh
(approximately 80mm x
60mm). 1 x Vaginal Support
Device, 1 x Syringe, 1 x
Anterior Inserter, 1 x Posterior
Inserter
JJ747 GYNECARE PROLIFT+M combined Pre-cut GYNECARE GYNEMESH M* One Size Only $2,540.00
Pelvic Floor Repair System Partially Absorbable mesh and single use
instuments for mesh placement
k
American Medical Systems
AM027 Apogee Vault Suspension System 2 stainless steel curved needles with One size $1,322.00
handles, a large pore polypropylene mesh
attached in the centre of a polypropylene
mesh enclosed in plastic sheaths and two
dilating conectors.
AM052 Elevate Anterior & Apical Prolapse IntePro Lite Mesh and single use One size only. $1,333.00
Repair System instuments for mesh placement.
AM053 Elevate Apical & Posterior Prolapse IntePro Lite mesh and single use one size only $1,322.00
Repair System instruments for mesh placement
Boston Scientific Australia Pty Ltd
BS131 Pinnacle PFR Kit Synthetic Polypropylene mesh assembly One configuration $2,540.00
and fixation device
BS155 Uphold Vaginal Support System Synthetic polypropylene mesh assembly One configuration $1,333.00
and fixation device
BS156 Pinnacle PFR Kit Posterior Synthetic polypropylene mesh assembly One configuration $1,322.00
and fixation device
BS193 PFR Kit - Pinnacle™ LITE Synthetic polypropylene mesh assemblies One configuration $1,322.00 $2,540.00
Anterior/Apical and fixation device
BS194 Pinnacle™ Lite - PFR Kit Posterior Synthetic polypropylene mesh assemblies One configuration $1,322.00 $1,333.00
and fixation device
BS195 Pinnacle™ LITE Duet Synthetic polypropylene mesh assemblies Two configurations $1,322.00 $2,540.00
and fixation device
BS198 Uphold™ LITE Vaginal Support System” Synthetic polypropylene mesh assemblies One Configuration $1,322.00 $1,333.00
and fixation device
Prostheses List by Category, Groups and Sponsor Page 849 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Device Technologies Australia Pty Ltd
DE300 Ascend Pelvic Floor Repair System Ascend AC: Anterior Compartment Mesh Width: 5.7 - 8.7 cm, Length 10 $1,322.00
for Vaginal Vault Prolapse. Ascend PC: - 13 cm.
Posterior Compartment Mesh for Vaginal
Vault Prolapse
Johnson & Johnson Medical Pty Ltd
JJ477 Gynecare Prolift Pelvic Floor Repair Pre-cut gynemesh PS and single use PFRA01 $1,333.00
System instruments for mesh placement
JJ478 Gynecare Prolift Pelvic Floor Repair Pre-cut gynemesh PS and single use PFRP01 $1,322.00
System instruments for mesh placement
JJ676 GYNECARE PROSIMA Anterior Precut gynaemesh PS and single use 1 x Pieces of GYNECARE $1,322.00 $1,333.00
Pelvic Floor Repair System instruments for mesh placement. Includes GYNEMESH PS* Mesh
vaginal support device (approximately 80mm x
60mm). 1 x Vaginal Support
Device, 1 x Syringe, 1 x
Posterior Inserter
JJ746 GYNECARE PROSIMA Posterior Pre - Cut gynemesh PS and single use 1 x Pieces of GYNECARE $1,333.00
Pelvic Floor Repair System instruments for mesh placement GYNEMESH PS* Mesh
(approximately 80mm x
60mm). 1 x Vaginal Support
Device, 1 x Syringe, 1 x
Posterior Inserter
JJ748 GYNECARE PROLIFT+M Posterior Pre-cut GYNECARE GYNEMESH M* Once Size Only $1,322.00
Pelvic Floor Repair System Partially Absorbable mes and single use
instruments for mesh placement
Group 4b - Reconstructive Material : biological
Boston Scientific Australia Pty Ltd
BS185 Xenform Soft Tissue Repair Matrix 2x7cm Graft derived from fetal dermal bovine 2x7cm $786.00
tissues
BS186 Xenform Soft Tissue Repair Matrix 4x7cm Graft derived from fetal dermal bovine 4x7cm $786.00
tissues
BS187 Xenform Soft Tissue Repair Matrix Graft derived from fetal dermal bovine 6x10cm $786.00 $1,120.00
6x10cm tissues
BS188 Xenform Soft Tissue Repair Matrix Graft derived from fetal dermal bovine 8x12cm $786.00 $1,890.00
8x12cm tissues
Prostheses List by Category, Groups and Sponsor Page 850 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Cook Medical Australia Pty Ltd
WC253 Surgisis Biodesign 4-layer Tissue Graft Surgisis Biodesign Posterior Pelvic Floor 14cm x 16cm Site Specific $1,200.00
Graft Shape
WC254 Surgisis Biodesign 4-layer Tissue Graft Surgisis Biodesign Anterior Pelvic Floor 9cm x 12cm Trapezoide Shape $850.00
Graft
Group 4c - Reconstructive Material : bone and ligament fixation
American Medical Systems
AM010 Influence Bone Screw Bone screw with pre-attached 5.5 x 1.7 mm $700.00
polypropylene monofilament suture. For
incinsionless tranvaginal sling procedure.
Loop Screw Bone Screw
Group 5 - Urogenital - Penile Prostheses
Group 5a - Penile : malleable
American Medical Systems
AM054 AMS Spectra Concealable Penile AMS Spectra Concealable Penile 9.5 mm x 12cm AMS Spectra $3,375.00 $5,411.00
Prosthesis Prosthesis
9.5 mm x 16cm AMS Spectra
9.5 mm x 20cm AMS Spectra
12 mm x 12cm AMS Spectra
12 mm x 16cm AMS Spectra
12 mm x 20cm AMS Spectra
14 mm x 12cm AMS Spectra
14 mm x 16cm AMS Spectra
14 mm x 20cm AMS Spectra
9.5mm Spectra Rear Tip
Extender Kit (0.5-3cm)
9.5mm Spectra Rear Tip
Extender Kit (4-6cm)
0.5 cm Rear Tip Extender
1 cm Rear Tip Extender
2 cm Rear Tip Extender
3 cm Rear Tip Extender
4 cm Rear Tip Extender
Prostheses List by Category, Groups and Sponsor Page 851 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Coloplast Pty Ltd
CT002 Acu-form Penile Prosthesis Malleable penile prosthesis Dia: 9ml (14 - 23cm length), dia $2,100.00
: 11mm (16 - 25cm length),
Dia: 13mm (18 - 27cm length)
Device Technologies Australia Pty Ltd
DE314 Malleable Penile Implant Consists of a membrane, filler product and 14-23cm $817.00
silicone tube
A
Coloplast Pty Ltd
CT007 Genesis Penile Prosthesis (Resist Coated) Malleable Penile Prosthesis (Resist Coated) Dia 9mm (14 - 23cm lengths), $2,500.00 $3,700.00
Dia: 11mm (16 - 25cm lengths),
Dia: 13mm (18 - 27cm lengths)
Group 5b - Penile : inflatable, two component
A
American Medical Systems
AM041 AMS Ambicor AMS Ambicor Inflatable Penile Prostheses AMS Ambicor Inflatable Penile $10,414.00
Prostheses 12.5mm in 14, 16
& 18cm length, 14mm in 16, 18
& 20cm length, 15.5mm in 18,
20 & 22cm length
Coloplast Pty Ltd
CT001 Excel Inflatable Penile Prosthesis (Resist Two-piece inflatable penile prosthesis Cylinder lengths $10,200.00
Coated) (Resist Coated) 10,12,14,16,18,20,22cm & six
rear-tip extenders (two each 1,
2 & 3cm)
Group 5c - Penile : inflatable, three component
A, ak
Coloplast Pty Ltd
CT005 Titan Inflatable Penile Prosthesis (Resist Assembly kit for three component penile Standard & Narrow -base $680.00
Coated) - Assembly Kit prosthesis (Resist Coated)
Prostheses List by Category, Groups and Sponsor Page 852 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
A, cyl
American Medical Systems
AM004 AMS 700 Series Inflatable Penile 700 Series with InhibiZone 12, 14, 15, 16, 18, 21cm $3,830.00
Prostheses with Inhibizone Cylinders
Coloplast Pty Ltd
CT008 Titan Inflatable Penile Prosthesis (Resist Cylinders for three component penile 10, 12, 14, 16, 18, 20, 22cm $3,830.00
Coated) - Cylinders prosthesis (Resist Coated)
A, ds
American Medical Systems
AM040 AMS 700 Series Inflatable Penile 700 Series with InhibiZone One Size $135.00
Prostheses with InhibiZone Deactivation
Package
Coloplast Pty Ltd
CT012 Titan Inflatable Penile Prosthesis (Resist True Lock Plug for deactivation of three One Size $135.00
Coated) - True-lock Plug component penile prosthesis (Resist
Coated)
A, pc
American Medical Systems
AM037 AMS 700 Series Inflatable Penile 700 Series with InhibiZone 12, 14, 15, 16, 18, 21cm $8,495.00
Prostheses with InhibiZone Pump &
Cylinders Preconnected
Coloplast Pty Ltd
CT009 Titan Inflatable Penile Prosthesis (Resist Preconnected Cylinders & pump for three 10, 12, 14, 16, 18, 20, 22cm $8,495.00
Coated) - Cylinders & Pump component penile prosthesis (Resist (in both infrapubic & scrotal
Preconnected Coated) models)
A, pu
American Medical Systems
AM036 AMS 700 Series Inflatable Penile 700 Series with InhibiZone One Size $4,665.00
Prostheses with InhibiZone Pump
Coloplast Pty Ltd
CT011 Titan Inflatable Penile Prosthesis (Resist Pump for three component penile One Size $4,665.00
Coated) - Pump prosthesis (Resist Coated)
Prostheses List by Category, Groups and Sponsor Page 853 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
A, res
American Medical Systems
AM038 AMS 700 Series Inflatable Penile 700 Series InhibiZone 50, 65, 100ml $1,980.00
Prostheses InhibiZone Reservoir
Coloplast Pty Ltd
CT010 Titan Inflatable Penile Prosthesis (Resist Reservoir for three component penile 60, 75, 100ml $1,980.00 $2,020.00
Coated) - Lock-out Valve Reservoir prosthesis (Resist Coated)
A, sys
Coloplast Pty Ltd
CT006 Titan Inflatable Penile Prosthesis (Resist Three-piece inflatable Penile Prosthesis 10cm, 12cm, 14cm, 16cm, $10,475.00
Coated) (Resist Coated) 18cm, 20cm Cylinder Lengths
ak
American Medical Systems
AM045 AMS 700 Series Inflatable Penile 700 Series (Non InhibiZone) One Size $689.00
Prostheses Accessory Kit
cyl
American Medical Systems
AM022 AMS 700 Series Inflatable Penile 700 Series (Non InhibiZone) 12, 14, 15, 16, 18, 21cm $3,520.00
Prostheses Cylinders
ds
American Medical Systems
AM046 AMS 700 Series Inflatable Penile 700 Series (Non InhibiZone) One Size $135.00
Prostheses Deactivation Package
pc
American Medical Systems
AM043 AMS 700 Series Inflatable Penile 700 Series (Non InhibiZone) 12, 14, 15, 16, 18, 21cm $7,810.00
Prostheses Pump & Cylinders
Preconnected
pu
American Medical Systems
AM042 AMS 700 Series Inflatable Penile 700 Series (Non InhibiZone) One Size $4,290.00
Prostheses Pump
Prostheses List by Category, Groups and Sponsor Page 854 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
res
American Medical Systems
AM044 AMS 700 Series Inflatable Penile 700 Series (Non InhibiZone) 50, 65, 100ml $1,795.00
Prostheses Reservoir non Inhibizone
Group 6 - Urogenital - Testicular
American Medical Systems
AM015 AMS Testicular Prostheses Solid silicone elastomer with suture hole Small, Medium, Large $653.00
Coloplast Pty Ltd
CT003 Saline Filled Testicular Prosthesis Testicular Prosthesis Extra Small, Small, Medium, $653.00
Large
CT004 Soft Solid Testicular Prosthesis Gel filled Testicular Prosthesis Small, Medium, Large & Extra $653.00 $780.00
Large
Device Technologies Australia Pty Ltd
DE324 Testicular Implant Silicone with holes for fixation 3230 5-38cc $653.00
Endotherapeutics Pty Ltd
ET028 Promedon Testicular Prosthesis Silicone Elastomer Small - 31 x 23 mm, Medium - $653.00
37 x 28 mm, Large - 42 x 32
mm, Xlarge
Surgiplas Medical
SP002 Testicular Implant Silicone Elastomer Small / Medium / Large $653.00
Group 7 - Urogenital - Sacral Neuromodulation
Medtronic Australasia Pty Ltd
MC180 Sacral Nerve Stimulation Unilateral Interstim stimulation lead Models 3080 & 28 cm $3,400.00
3886. Platinum / Iridium, polyurethane.
MC185 Sacral Nerve Stimulation Unilateral Interstim Temporary test stimulation lead. One size only $393.00
Model 3065U. This model is temporary
for patient trial. Platinum / Iridium,
polyurethane.
Prostheses List by Category, Groups and Sponsor Page 855 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC186 Sacral Nerve Stimulation Accessories Model 041827-002 Auxiliary screener One size only; 9-12.5cm $130.00
cable kit. Polypropylene. OR Model
041828-002 Foramen Needle (box of 6).
Sterile individual units. Stainless steel.
MC291 Sacral Nerve Stimulation Lead Model 4 electrode tined lead - platinum iridium, 28 - 41cm $4,420.00
3093 TINED LEAD electrodes 0, 2, 3 are 3mm,electrode 1 is
10mm and coiled, spacing is 1.5mm
MC719 InterStim Neurostimulator Model 3023 Titanium 42g $9,550.00
MC755 InterStim II Neurostimulator Titanium Weight 22g $9,550.00
MC756 InterStim iCON Patient Programmer Hand held device Model 3037 to be used One size only $1,400.00
with implantable neurostimulation devices
MC757 Tined Lead model 3889 4 electrode tined lead - platinum, iridium 28, 33 and 41cm $4,420.00
MC775 Interstim Lead Introducer Kit Lead Introducer Kit for Sacral Nerve One size only $393.00 $541.00
Stimulation
MC777 Interstim Extension Lead Quadripolar Extension Kit 10, 25, 51cm $1,510.00
Group 8 - Urogenital - Tubal Obstruction Devices
Gytech Pty Ltd
GP004 Essure System (ESS305) Stainless steel, polyester fibre One size only, 2 per pack $1,290.00 $1,344.00
Group 8a - Tubal obstruction : extraluminal
Femcare Australia Pty Ltd
FE001 Filshie Clip Titanium One size only $155.00
FE003 Filshie Clips - Sterishot With Disposable Applicator One Size $410.00
Olympus Australia
OL079 Falope-Ring Bands Fallopian Tube Clip (each) 5mm - 12mm $39.00
Prostheses List by Category, Groups and Sponsor Page 856 of 911
UROGENITAL
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 8b - Tubal obstruction : intraluminal
Hologic (Australia) Pty Ltd
YC001 Adiana Permanent Contraceptive System The Adiana Permanent Contraceptive The Adiana Delivery Catheter $645.00 $800.00
System provides permanent female and handle is approx. 58 cm in
sterilisation by occlusion of the fallopian length, with an attached
tubes via a hysteroscopic transuterine connector cable that is 49 cm in
approach. The Adiana Permanent length. The shaft has a
Contraceptive System consists of the maximum shaft OD of 0.060
Adiana Radiofrequency Generator and an inches (+0.005in). The distal
Adiana Delivery catheter with detachable tip of the device up to the depth
Adiana Matrix. To provide patients with make, which enters the
an alternative, highly safe, effective, fallopian tube, has a maximum
accessible, and widely acceptable female OD of 0.053 inches (1.27mm).
sterilisation option, the Adiana System was The matrix is a cylindrical
develpoed as the next generation shape of approx. 1.60 mm in
trancervical device. The intention was to diameter of approx. 0.44mm is
further improve the safety profile of the created within the centre of the
trancervical device. The Adiana System matrix.
can be placed in the day procedure setting
without the use of general or regional
anesthesia.
Group 9 - Urogenital - Nephrostomy Catheter
Pyramed Pty Limited
PY013 Optimed nephrostomy catheter set Soft polyurethane drainage sets 7-14Fr., length 25cm - 30cm $120.00 $240.00
PY014 Optimed nephrostomy catheter Soft polyurethane drainage catheter 7-14Fr., length 25cm - 30cm $120.00
Prostheses List by Category, Groups and Sponsor Page 857 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 1: Bare Metal Stents
Group 1a: Balloon Expandable, pre mounted
Abbott Australasia Pty Ltd
AY022 Cobalt Chromium Balloon Expandable Cobalt Chromium Diameter 4-10mm, Length 12- $1,800.00
Peripheral Stent 58mm
co
B Braun Australia Pty Ltd
BB244 Coroflex Blue Cobalt Chromium Alloy L605 2-4mm diameter, 8-25mm length $1,100.00
Johnson & Johnson Medical Pty Ltd
JJ567 PALMAZ® BLUE™ .018 Peripheral L605 Cobalt Chromium Alloy Balloon 12, 15, 18, 24mm length 4, 5, $1,800.00
Stent System Expandable Stent 6, 7mm diameter
Medtronic Australasia Pty Ltd
MC328 Racer Renal Stent System Cobalt Alloy Diameter: 4-7mm; Lengths: 12 $1,800.00
&18mm
MC773 Assurant Cobalt Stent Iliac balloon expandable stent system Diameter: 6 - 10mm , Length: $1,800.00
20 - 80mm
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
co,re
Johnson & Johnson Medical Pty Ltd
JJ688 Palmaz Blue .014 Renal Stent System CoCr balloon expandable stent 12, 15, 18, 24mm Lengths $1,800.00
(on Aviator Plus) 40, 50,
60, 70mm diameters
80, 142cm shaft
lengths
o, ca
Medical Vision Australia Pty Ltd
MF015 CP Stent CP Stent Uncovered 16, 22, 28, 24, 39 & 45mm $2,500.00
length
MF017 CP Stent CP Stent Uncovered, mounted on BIB 16, 22, 28, 24, 39 & 45mm $3,600.00
balloon length
Prostheses List by Category, Groups and Sponsor Page 858 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
re, s
Medtronic Australasia Pty Ltd
MC959 Hippocampus Renal Stent System Hippocampus Renal Rapid Exchange Diameter 4.0mm - 7.00mm $1,800.00
Stainless Steel Stent system, 5F sheath, Length: 10mm - 24mm
0.014" guide wire compatible
s
Abbott Australasia Pty Ltd
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
Bard Australia Pty Ltd
BA190 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items Stent Length 15mm - 18mm, $1,800.00
included in delivery system: nylon balloon, 0.035 compatible
stent and deployment system
BA191 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items Stent Length 19mm - 27mm, $1,800.00
included in delivery system: nylon balloon, 0.035 compatible
stent and deployment system
BA192 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items Stent Length 28mm - 37mm, $1,800.00
included in delivery system: nylon balloon, 0.035 compatible
stent and deployment system
BA193 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items Stent Length 38mm - 56mm, $1,800.00
included in delivery system: nylon balloon, 0.035 compatible
stent and deployment system
BA194 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items Stent Length 15mm - 18mm, $1,800.00
included in delivery system: nylon balloon, 0.018 compatible
stent and deployment system
BA195 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items Stent Length 19mm - 27mm, $1,800.00
included in delivery system: nylon balloon, 0.018 compatible
stent and deployment system
Prostheses List by Category, Groups and Sponsor Page 861 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BA196 Lifestent - Peripheral Stent Stent: Stainless Steel Composition. Items Stent Length 28mm - 37mm, $1,800.00
included in delivery system: nylon balloon, 0.018 compatible
stent and deployment system
BA197 Lifestent - Peripheral Stent Stent: Stainless Steel Composition. Items Stent Length 38mm - 56mm, $1,800.00
included in delivery system: nylon balloon, 0.018 compatible
stent and deployment system
Biotronik Australia Pty Ltd
BT094 Dynamic PTA Balloon Expandable Stent 5-10mm diameter / 15, 25, 38, $1,800.00 $1,950.00
56mm lengths
Johnson & Johnson Medical Pty Ltd
JJ057 Palmaz Balloon Expandable Stent Stainless steel stent Diameter 4-12mm, length 20- $1,600.00
30mm
JJ058 Palmaz Balloon Expandable Stent Stainless steel stent Extra-large $1,800.00
JJ304 Palmaz Genesis Peripheral Stent and Stainless steel balloon expandable stent Diameter 3-8mm, length 12- $1,800.00
Delivery System on Slalom mounted on a slalom balloon 39mm
JJ305 Palmaz Genesis Peripheral Stent and Stainless steel balloon expandable stent Diameter 4-8mm, length 12- $1,800.00
Delivery System on Opta Pro mounted on an Opta Pro Balloon 39mm
JJ306 Palmaz Genesis Peripheral Stent Stainless steel peripheral stent Diameter 4-12mm, length 11- $1,780.00
79mm
Medical Specialties Australia Pty Ltd
MS059 Thalis Inert Stent Implantation System Balloon-Expandable Peripheral Stent Diameter: 5-12mm; Length: 18- $1,800.00
Implantation System 58mm
s,re
Boston Scientific Australia Pty Ltd
BS059 Express Vascular LD Stent; Express Stainless Steel, Balloon Expanding Stent Stent Diameters up to 10mm $1,800.00
Vascular SD Stent and lengths up to 60mm
Cook Medical Australia Pty Ltd
WC234 Formula 414 Rx Renal Stent System Balloon Expandable Vasc/Biliary Stent Rapid exchange 014/018, 80- $1,800.00
135cm delivery system.
Diameters 4-10mm, lengths 0.8
- 4cm
Prostheses List by Category, Groups and Sponsor Page 860 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
JJ479 PALMAZ GENESIS on CORDIS Peripheral balloon expandable stent and Lengths: 12, 15, 18, 24mm. $1,800.00
AMIIA RX .014 Delivery System rapid exchange delivery system Diameter: 4, 4.5, 5, 5.5, 6, 6.5,
7mm
Group 1c: Self expandable
Boston Scientific Australia Pty Ltd
BS167 Placehit Wallstent Biomedical cobalt-based alloy, self Stent diameters up to 19mm $1,800.00
expanding stent and lengths up to 100mm
n
Abbott Australasia Pty Ltd
AY021 Nitinol Self Expanding Peripheral Stent Nitinol Diameter 3-10mm $2,100.00
AY031 Xpert Xpert is a laser cut nitinol self expanding 3 - 8mm in diameter, 20 - $1,800.00
stent, used to treat peripheral vessel 80mm in length
disease, Xpert is a low profile system
designed for small vessels and is 4 french.
Bard Australia Pty Ltd
BA178 Luminex Vascular Stent Luminex nitinol self-expanding stent 4mm - 20mm diameters, 2cm - $1,800.00
12cm lengths
BA185 Lifestent Laser cut nitinol self expanding stent, used Diameter: 6-10mm, Length: $2,100.00
to treat peripheral disease 20-100mm
BA198 Lifestent Peripheral Stent Stent: Nitinol composition with tanilum 6-8mm Diameter, length 20- $2,100.00
markers, Items included in the delivery 90mm
system: Stent, deployment system
BA199 Lifestent Laser cut nitinol self expanding stent, used Diameter: 6-8mm, Length: $1,800.00 $2,100.00
to treat peripheral disease 120mm
Biotronik Australia Pty Ltd
BT072 Astron Peripheral self expanding nitinol, coated Dia: 6 - 12mm, Len: 30 - 100mm $1,800.00
stent
BT103 ASTRON PULSAR The Astron Pulsar is a nitinol self 4-12.0mm by 20-200mm $1,800.00 $2,400.00
expanding stent, used to treat peripheral
vessel disease. Is 4Fr compatible and a
rapid exhange delivery system
Prostheses List by Category, Groups and Sponsor Page 861 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Boston Scientific Australia Pty Ltd
BS077 Sentinol Nitinol Vascular Stent System Nitinol Stent with Uniflex Delivery System Diameter: 5 to 10mm. Length: $1,800.00
20 to 120mm
BS137 EPIC Nitinol Stent Nitinol self expanding stent Stent diameters up to 14mm $1,800.00
and lengths up to 120mm
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
WC287 Zilver® Flex 35™ Vascular Stent The Zilver® Flew 35™ Stent (ZFV) is a The Zilver® Flex 35™ Stent is $1,800.00
self-expandable stent made of nitinol. The available in the following sizes:
special laser-cut pattern of the nitinol tube stent outer diameters of 5 -
provides a construction with a strong radial 10mm and stent lengths of 20 -
force and high flexibility. The stent has 140mm.
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.
Endotherapeutics Pty Ltd
ET037 SX-Ella Endovascular Stent Uncovered, self-expanding nitinol stent Dia 6-16mm, length 22-77mm $1,800.00 $2,200.00
ev3 Australia Pty Ltd
EE024 Protégé EverFlex Peripheral Stent Protégé EverFlex is a self expanding Diameter 5-8, Length 20-100mm $2,100.00 $2,400.00
Nitinol stent premounted on an OTW
delivery system.
Johnson & Johnson Medical Pty Ltd
JJ068 SMART .018" Peripheral Stent System Nitinol carotid stent and delivery system 6 - 10 mm $1,800.00
JJ235 SMART Peripheral stent system Laser cut nitinol tube. Available in long Dia 6 - 8mm, length 120mm $1,800.00
stents to treat large vessel lesions.
JJ419 SMART Control Peripheral Stent SMART Control is a laser cut nitinol self Dia 6 – 14mm; Length 20 – $2,100.00
System expanding stent, used to treat peripheral 100mm
vessel disease.
Prostheses List by Category, Groups and Sponsor Page 862 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
JJ592 SMART Nitinol Stent System Long 120mm Stent, 6F compatible 6-8mm diameter, 120mm stent $2,100.00
length, 120cm delivery system
Medtronic Australasia Pty Ltd
MC743 Complete SE Stent Nitinol 20mm - 80mm $1,800.00 $2,100.00
MC744 Complete SE Stent Nitinol 100mm - 120mm $1,800.00 $2,100.00
MI010 Maris Plus Peripheral Self-Expanding Nitinol, self expanding, peripheral stent Diameter: 6.0-12.0mm; Length: $1,800.00 $2,100.00
Stent System system 30-120mm
Pyramed Pty Limited
PY006 Optimed Femoral Sinus Stent Sinus-wave nitinol Stent 3 - 10mm x 20-130mm $1,800.00
PY015 Optimed Iliac Sinus Stent Sinus-wave nitinol stent 6 - 14mm x 30 -120mm $1,800.00
'n'
Boston Scientific Australia Pty Ltd
BS196 Innova Self-Expanding Stent Nitinol, self expanding stent Diameters up to 8mm, lengths $1,800.00
less than 150mm
n, ds
Abbott Australasia Pty Ltd
AY035 Absolute Pro (Long Length) Laser cut nitinol self expanding stent Diameter 5mm to 10mm; length $2,100.00
<150mm 120mm
n, l
Abbott Australasia Pty Ltd
AY036 Absolute Pro (Long Length) Laser cut nitinol self expanding stent <150 Diameter 5mm to 10mm; length $2,970.00
150mm, 170mm, 200mm
Prostheses List by Category, Groups and Sponsor Page 863 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Biotronik Australia Pty Ltd
BT122 Pulsar 18 Peripheral self-expanding Pulsar 18 self expanding Nitinol Stent Stent Diameter (mm) / Length $2,970.00
Nitinol stent system System (mm) / Catheter length (cm)
4/100/90 4/120/90 4/150/90
4/170/90 4/200/90 5/100/90
5/120/90 5/150/90 5/170/90
5/200/90 6/100/90 6/120/90
6/150/90 6/170/90 6/200/90
7/100/90 7/120/90 7/150/90
7/170/90 7/200/90 4/100/135
4/120/135 4/150/135
4/170/135 4/200/135
5/100/135 5/120/135
5/150/135 5/170/135
5/200/135 6/100/135
6/120/135 6/150/135
6/170/135 6/200/135
7/100/135 7/120/135
7/150/135 7/170/135 7/200/135
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. The Length:170mm and 200mm
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.
Medtronic Australasia Pty Ltd
MI011 Maris Plus Peripheral Self-Expanding Nitinol, self expanding, peripheral stent Diameter: 6.0-12.0mm; Length: $2,970.00
Stent System system 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
n, L,
Boston Scientific Australia Pty Ltd
BS197 Innova Self-Expanding Stent Nitinol, self expanding stent Diameters up to 8mm, Lengths $2,970.00
greater than 150mm
Prostheses List by Category, Groups and Sponsor Page 864 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
n, re
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
AY032 ACCULINK Peripheral Stent System Nickel-Titanium Intra-vascular stent 4-10mm diameter, 13-56mm $1,800.00
length
Boston Scientific Australia Pty Ltd
BS189 Adapt Monorail Carotid Stent System Nitinol self expanding stent 21-40mm length, 4-9mm $1,800.00
diameter
Cook Medical Australia Pty Ltd
WC278 Zilver Vascular Stent with Rapid Zilver Stent Vascular Design, self- Delivery System 5Fr, 125cm. $1,800.00
Exchange Delivery System expandable nitinol stent. Preloaded in a 5.0 Stent diameter 4mm-10mm.
French Rapid Exchange delivery catheter. Stent length 2cm-8cm.
ev3 Australia Pty Ltd
EE006 Protégé GPS Peripheral Stent Protégé RX Peripheral Stent Diameter 6-10mm Length 20- $1,800.00
60mm
Johnson & Johnson Medical Pty Ltd
JJ463 PRECISE RX Nitinol Stent System Nitinol self expandable stent and repid Stent Lengths 20, 30, 40mm; $2,100.00
exchange delivery system Stent Diameter: 5, 6, 7, 8, 9,
10mm
JJ646 Precise Pro Rx Nitinol Stent System Nitinol self expanding stent Diameter: 5, 6, 7, 8, 9, 10mm; $2,100.00
Length: 20, 30, 40mm
Medtronic Australasia Pty Ltd
MC978 Cristallo Ideale Carotid Self Expanding Cristallo Ideale Nitinol, Carotid Self Cylinder Diameter: 7.0mm - $1,800.00 $3,280.00
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.
n,l
Bard Australia Pty Ltd
BA200 Lifestent Laser cut nitinol self expanding stent, used Diameter: 6-8mm, Length: $2,970.00
to treat peripheral disease 150mm
Prostheses List by Category, Groups and Sponsor Page 865 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BA201 Lifestent Laser cut nitinol self expanding stent, used Diameter: 6-8mm, Length:170mm $2,970.00
to treat peripheral disease
ev3 Australia Pty Ltd
EE025 Protégé EverFlex Peripheral Stent Protégé EverFlex is a self expanding Diameter 5-8mm, Length 150- $2,970.00
Nitinol stent premounted on an OTW 200mm
delivery system.
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
o
Boston Scientific Australia Pty Ltd
BS035 Expandable Endoprosthesis Biomedical superalloy, self expanding stent Stent Diameters up to 30mm $1,800.00
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
o, cw
Boston Scientific Australia Pty Ltd
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
Group 10: Peritoneal Dialysis - Long Term Implantable Catheters
Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA001 Tenckhoff Peritoneal Dialysis Catheter Adult 2 cuff, Adult 1 cuff, Adult 0 Cuff 42cm to 47cm length. All $170.00 $175.00
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 866 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
KA002 Tenckhoff Peritoneal Dialysis Catheter Paediatric 2 cuff, Paediatric 1 cuff, 31cm to 37 cm length. All $170.00 $185.00
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 Catheter Swan Neck, 2 cuff Int.diam: 3.2mm; ext diam $200.00 $255.00
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 $240.00 $300.00
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-left, 20 to 25cm external segment or $200.00 $235.00
Peritoneal Dialysis Catheter Adult, 2 cuff-right 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 Catheter, Adult, 2 cuffs 57 to 62cm length. All $199.00
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 867 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 2: Stent Grafts
Group 2a1: Tube (Thoracic Aorta)
n, e
W L Gore & Associates
GT260 Conformable GORE TAG Thoracic Conformable GORE TAG Diameters (mm): 28, 31, 34, $11,027.00 $15,095.00
Endoprosthesis 37, 40, 45
Length (cm) 15
n, e , l
W L Gore & Associates
GT023 Excluder Endovascular Prostheses Thoracic Stent Graft Nitinol & ePTFE 34, 37 & 40mm Diameter x $14,500.00
20cm Lengths
n, e, l
W L Gore & Associates
GT261 Conformable GORE TAG Thoracic Conformable GORE TAG Diameters (mm): 34, 37, 40, 45 $14,500.00 $15,660.00
Endoprosthesis
Length (cm): 20
n, e, ttg
W L Gore & Associates
GT259 Conformable GORE TAG Thoracic Conformable GORE TAG Straight Stent Grafts: $11,027.00 $14,526.00
Endoprosthesis Diameters (mm): 21, 26, 28,
31, 34, 37, 40, 45
Length (cm): 10
Tapered Stent Grafts:
Diameters (mm): 26x21; 31x26
Lengths (cm): 10
n, p
Medical Specialties Australia Pty Ltd
MS052 Relay Thoracic Stent Graft Duralloy Nitinol Surgical Graft Material Diameter 22 - 46mm, Length $11,027.00 $13,500.00
Braided Polyester PFTE impregnated 103 - 179mm
Suture Dual Sheath Delivery System
Medtronic Australasia Pty Ltd
MC206 Talent Thoracic Stent Graft Talent Endoluminal Stent Graft - Thoracic 22 - 46mm x 130mm $11,027.00
Stent Graft System
Prostheses List by Category, Groups and Sponsor Page 868 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
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 Delivery 22-46mm diameter, 150mm $11,027.00
System length
n, p, l
Medical Specialties Australia Pty Ltd
MS053 Relay Thoracic Stent Graft Duralloy Nitinol Surgical Graft Material Diamter 22 - 46mm, Length $14,500.00 $18,400.00
Braided Polyester PFTE impregnated 180 - 271mm
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
MC958 Valiant Captivia Valiant Stent Graft with Captivia Delivery 24-46mm diameter, 200mm $14,500.00
System length
n,e
W L Gore & Associates
GT191 Excluder Endovascular Prostheses Thoracic Stent Graft Nitinol & ePTFE Diameter 26-40mm x 10cm $11,027.00 $13,400.00
Length
n,p
Medtronic Australasia Pty Ltd
MC960 Valiant Captivia Valiant Stent Graft with captivia delivery 22 - 46 mm diameter: 100mm $11,027.00
system length
o, e, ca
Medical Vision Australia Pty Ltd
MF016 CP Stent CP Stent Covered 16, 22, 28, 24, 39 & 45mm $3,000.00
length
MF018 CP Stent CP Stent Covered, mounted on BIB 16, 22, 28, 24, 39 & 45mm $4,300.00
balloon length
Prostheses List by Category, Groups and Sponsor Page 869 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
s, p
Cook Medical Australia Pty Ltd
WC238 Zenith Thoracic Endovascular Graft Thoracic Proximal Grft 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 Graft Short Thoracic Proximal Graft Diameter 22mm - 42mm. $11,027.00
with Pro_Form and the Z-Trak Plus Length 115mm - 162mm
Introduction System - Short Proximal
Component
s, p, l
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 Graft Long Thoracic Proximal Endovascular Diameter 28mm-42mm Length $14,500.00
with Pro-Form and the Z-Trak Plus Graft 197mm-216mm
Introduction System - Long Proximal
Component
Group 2a2: Tube (Abdominal Aorta)
n, p
Medtronic Australasia Pty Ltd
MC850 Endurant AAA Abdominal Tube Endurant Endoluminal Stent Graft System - 23 - 36mm X 85mm $4,850.00
Abdominal Tube
s, p
Cook Medical Australia Pty Ltd
WC232 Zenith Renu AAA Ancillary Graft - Main Stent graft indicated for the repair of in situ Proximal diameter 22 - 36mm, $4,850.00
Body Extension AAA stent grafts Length (covered section) 43 -
62mm
Group 2a3: Tube (Aorto-uni-iliac)
n, p
Medtronic Australasia Pty Ltd
MC153 Talent AAA Aorto Uni lliac Stent Graft Talent Endoluminal Stent Graft System - 22 - 36mm x 75 - 310mm $10,200.00
AUI Tapered System.
Prostheses List by Category, Groups and Sponsor Page 870 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
MC847 Endurant Aorto-Uni-Iliac (AUI) Endurant Endoluminal Stent Graft System - 23 - 36mm X 120mm $10,200.00
AUI
s, p
Cook Medical Australia Pty Ltd
WC235 Zenith Renu AAA Ancillary Graft - Stent graft indicated for the repair of in situ Proximal diameter 22-36mm, $10,200.00
Converter AAA stent grafts distal diameter 12mm, lengths
108-125mm
Group 2b: Bifurcated
n, e
W L Gore & Associates
GT263 GORE EXCLUDER AAA The GORE EXCLUDER AAA Proximal Diameters (mm): 23, $8,555.00
Endoprosthesis featuring C3 Delivery Endoprosthesis is for the endovascular 26, 28.5
System treatment of infrarenal AAAs. The GORE Distal Diameters (mm): 12,
EXCLUDER AAA Endoprosthesis 14.5
featuring C3 Delivery System allows the Length (cm): 12, 14, 16, 18
trunk-ipsilateral component to be Proximal Diameter (mm): 31
respositioned during deployment Distal Diameter (mm): 14.5
Lengths (cm): 13, 15, 17
n, p
Medtronic Australasia Pty Ltd
MC845 Endurant AAA Stent Graft Bifurcation Endurant Endoluminal Stent Graft System - 23 - 36mm x 13 - 20mm x 135 $8,955.00
Bifurcated Graft -185mm
Terumo Corporation Australia
TU002 Anaconda Endovascular Graft System Bifurcated Aortic System, Ultrathin woven 18 - 34mm $12,405.00
polyester, nitinol ring stents, tantalum
markers
n,e
W L Gore & Associates
GT024 Excluder AAA Endovascular Prostheses AAA Abdominal Stent Graft Nitinol & 23-28.5mm Diameter, 14- $7,440.00
ePTFE - two piece system (1/2) Trunk - 18cm Length
Ipsilateral Limb
s, p
Cook Medical Australia Pty Ltd
WC133 Zenith Flex AAA Endovascular Graft - Stainless steel Dia 22 - 32mm, length 82 - $5,794.00
body only 140mm
Prostheses List by Category, Groups and Sponsor Page 871 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
WC261 Zenith Fenestrated AAA Endovascular Distal Bifurcated Body with Flexor sheath Diameter 12 - 24mm, 1st length $5,689.00
Graft with Flexor 28 - 62mm, 2nd length 76 -
121mm
WC277 Zenith Flex AAA Endovascular Graft Zenith Flex with Z-trak main body - AAA Diameter - 22mm - 36mm. $5,794.00
with the Z-Trak Introduction System - endovascular graft Length 82mm - 149mm.
main body
Group 2c: Branched
Cook Medical Australia Pty Ltd
WC233 Zenith Branch Endovascular Graft - Iliac Bifurcated branch vessel stent graft with Common iliac lengths 45 or $7,500.00
Bifurcation openings to connect the common iliac, 61mm, external iliac lengths 41
sidebranch, and external iliac segments. or 58mm and distal cuff
Made of stainless steel and nitinol z-stents diameters 10 or 12mm
and woven polyester, mounted on H&LB
one shot delivery system
Group 2d: Fenestrated
Cook Medical Australia Pty Ltd
WC263 Zenith Fenestrated AAA Endovascular Proximal Fenestrated body with Flexor 1 or 2 internal stents, 24 - $8,561.00
Graft with Flexor sheath 36mm Diameter, 73 - 129mm
Length
Group 2e: Accessory components (aortic)
Cook Medical Australia Pty Ltd
WC045 Zenith Endovascular Graft Converter Diameter 20 through 36 $2,555.00
Length 80-85
WC048 Zenith Endovascular Graft Body Extensions Diameter 22 through 36 $2,555.00
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
Prostheses List by Category, Groups and Sponsor Page 872 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
WC288 Zenith Dissection Endovascular Stent The Zenith Dissection Endovascular Stent Diameter: 46mm (designed for $6,300.00
with the H&L-B One-Shot Introduction vessel diameters 24-38mm).
System is indicated for the endovascular Length: 82, 123, 164mm
treatment of patients with aortic dissection
distal to the left subclavian artery.
Medtronic Australasia Pty Ltd
MC158 Talent Aortic Extension Stent Graft Talent Endoluminal Stent Graft - Aortic 22 - 36mm x 26 - 30mm $2,555.00 $3,000.00
Extension
MC849 Endurant AAA Aortic Extension Endurant Endoluminal Stent Graft System - 23 - 36mm x 60mm $2,555.00 $3,300.00
Aortic Extension
W L Gore & Associates
GT189 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Diameter 23 - 28.5mm, Length $2,555.00 $3,100.00
Aortic Extender 3.3cm
n, p
Terumo Corporation Australia
TU003 Anaconda Endovascular Graft System Aortic Extension Cuff. Ultrathin woven 18 - 34mm $2,555.00
polyester, nitinol ring stents, tantalum
markers
s, p
Cook Medical Australia Pty Ltd
WC188 Zenith Thoracic Endovascular Graft Thoracic Body Extension 22mm to 42mm diameter; $6,300.00
77mm to 81mm length
WC274 Zenith TX2 TAA Endovascular Graft Thoracic Proximal Extension Diameter - 22mm - 42mm $6,300.00
with Pro-Form and the Z-Trak Plus Length - 77mm - 81mm
Introduction System (thoracic body
extension)
Group 2f: Accessory components (other including iliac limbs)
Cook Medical Australia Pty Ltd
WC047 Zenith Endovascular Graft Leg Extensions Diameter 18 through 24 Length $2,555.00
55
WC103 Zenith Iliac Plug Zenith AAA Endovascular Graft Diameter 14, 16, 18, 20, 22, $2,555.00
24mm
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
Prostheses List by Category, Groups and Sponsor Page 873 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Medtronic Australasia Pty Ltd
MC203 Talent Occluder System Nitinol stents attached to polyester graft Standard Sizes, 8 - 24mm x 31 $2,620.00
sealed both ends - 35mm
MC846 Endurant AAA Contralateral Iliac Limb Endurant Endoluminal Stent Graft System - 10 - 28mm X 80 - 120mm $3,450.00
Contralateral Iliac Limb
MC848 Endurant AAA Iliac Extension Endurant Endoluminal Stent Graft System - 10 - 28mm x 80mm $3,260.00
Iliac Extension
n, p
Terumo Corporation Australia
TU004 Anaconda Endovascular Graft System Iliac Extension Cuff. Ultrathin woven 8 - 18mm $3,450.00
polyester, nitinol ring stents, tantalum
markers
TU005 Anaconda Endovascular Graft System Iliac Leg, Ultrathin woven polyester, nitinol 8 - 18mm $3,450.00
ring stents, tantalum markers
TU041 Anaconda Endovascular Graft System Flared iliac limb. Ultrathin woven Diameter: proximal end 12- $3,450.00
polyester, nitinol ring stents, tantalum 17mm, distal end 15-23mm;
markers Length: 80-130mm
n,e
W L Gore & Associates
GT188 Excluder AAA Endovascular Prostheses AAA Stent Graft Nitinol & ePTFE Two Diameter 12 - 14.5mm x 10 x $3,522.00
piece system (2/2) Contralateral Limb 14cm Length
GT190 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Diameter 10 - 14.5mm, Length $3,522.00 $3,700.00
Iliac Extender 7cm
s, n
Cook Medical Australia Pty Ltd
WC286 Zenith® Spiral-Z AAA lliac Legs with Z- Zenith® Spiral-Z AAA lliac Leg Proximal Diameter - 13mm $3,308.00
Trak™ Introduction System Distal Diameter - 9mm to 24
mm
Working Length - 39 mm to
122 mm
Prostheses List by Category, Groups and Sponsor Page 874 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 2g: Tube
Atrium Australia - Pacific Rim Pty Limited
AC023 Advant PTFE V12 Stent Graft System Balloon Expandable PTFE Encapsulated 5mm - 12mm Diameter $4,185.00
Stainless Steel Peripheral Vascular Stent
AC027 Advanta V12 Stent Graft System Balloon Expandable PTFE Encapsulated 12 - 16 mm diameter 29mm $4,950.00
Stainless Steel Vascular Stent length. 80cm and 120cm
catheter lengths
AC028 Advanta V12 Stent Graft System Balloon Expandable PTFE Encapsulated 12 - 16 mm diameter 41mm $5,695.00
Stainless Steel Vascular Stent length. 80cm and 120cm
catheter lengths
AC029 Advanta V12 Stent Graft System Balloon Expandable PTFE Encapsulated 12 - 16 mm diameter 61mm $6,280.00
Stainless Steel Vascular Stent length. 80cm and 120cm
catheter lengths
Bard Australia Pty Ltd
BA004 Encapsulated Carbon Lined Stent Graft AV access PTFE covered nitinol self- 4mm - 10mm diameter, 3cm - $3,395.00
expanding stent 8cm length
BA005 Encapsulated Carbon Lined Stent Graft Iliac / SFA PTFE covered nitinol self- 4mm - 10mm diameter, 3cm - $3,395.00
expanding stent 12cm length
W L Gore & Associates
GT029 Gore Tips Endoprosthesis ePTFE 8-12mm Diameter 4-8cm $4,000.00
Graft-Lined Length 2cm
Unlined Length
Prostheses List by Category, Groups and Sponsor Page 875 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
h
W L Gore & Associates
GT225 Gore Viabahn ® endoprosthesis with Gore Viabahn ® endoprosthesis with 5mmx2.5cm 120cm 5mmx5cm $3,000.00
heparin bioactive surface heparin bioactive surface is a flexible, self 120cm 6mmx2.5cm 120cm
expanding endoluminal device consisting of 6mmx5cm 75cm 6mmx5cm
an ePTFE lining with external nitinol 120cm 7mmx2.5cm 120cm
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
GT226 Gore Viabahn ® endoprosthesis with Gore Viabahn ® endoprosthesis with 5mmx 15cm 120cm, 6mmx $4,025.00 $4,300.00
heparin bioactive surface heparin bioactive surface is a flexible, self 15cm 75cm 6mmx 15cm
expanding endoluminal device consisting of 120cm 7mmx 15cm 75cm
an ePTFE lining with external nitinol 7mmx 15cm 120cm 8mmx
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
Prostheses List by Category, Groups and Sponsor Page 876 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
GT227 Gore Viabahn ® endoprosthesis with Gore Viabahn ® endoprosthesis with 5mmx 10cm 120cm 6mmx $3,495.00
heparin bioactive surface heparin bioactive surface is a flexible, self 10cm 75cm 6mmx 10cm
expandinbg endoluminal device consisting 120cm 7mmx 10cm 75cm
of an ePTFE lining with external nitinol 7mmx 10cm 120cm 8mmx
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
h, l
W L Gore & Associates
GT262 GORE VIABAHN® Endoprosthesis GORE VIABAHN® Endoprosthesis with 5mm x 25cm x 120CATH $5,625.00
with Heparin Bioactive Surface Heparin Bioactive Surface is a flexible, self 6mm x 25cm x 120CATH
expanding endoluminal device consisting 7mm x 25cm x 120CATH
of an ePTFE lining with external nitinol 8mm x 25cm x 120CATH
support
n,e
W L Gore & Associates
GT020 Viabahn Endoprosthesis ePTFE & Nitinol Self Expanding Viabahn 2.5mm - 13mm $3,000.00
Endoluminal Graft System Diameter, 5cm Length;
Hemobahn 6 - 13mm Diameter,
5cm Length
GT021 Viabahn/Hemobahn Endoprosthesis ePTFE & Nitinol Self Expanding Viabahn 2.5mm - 13mm, 10cm $3,395.00
Endoluminal Graft System Length; Hemobahn 6 - 13mm
Diameter 10cm Length
GT022 Viabahn/Hemobahn Endoprosthesis ePTFE & Nitinol Self Expanding Viabahn 2.5mm - 13mm $4,025.00
Endoluminal Graft System Diameter, 15cm Length;
Hemobahn 6 - 11mm Diameter,
15cm Length
Prostheses List by Category, Groups and Sponsor Page 877 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 3: Grafts
Group 3a: Tube
Atrium Australia - Pacific Rim Pty Limited
AC002 Atrium PTFE Vascular Graft Straight PTFE Standard Wall 6mm x 10cm - 10mm x 90cm $860.00
AC013 Atrium PTFE Vascular Graft Straight PTFE Thin Wall 6mm x 10cm - 10mm x 90cm $860.00
AC018 Atrium Ultramax PET Grafts Straight Polyster Graft 6mm x 15cm - 24mm x 30cm $860.00
AC019 Atrium Ultramax PET Grafts Straight Polyster Graft 6mm x 40cm - 8mm x 100cm $860.00
B Braun Australia Pty Ltd
BB021 Vascular Uni - Graft Vascular graft 40cm $665.00
BB022 Vascular Uni - Graft Vascular graft 30cm $540.00
BB023 Vascular Uni - Graft Vascular graft 20cm $470.00
BB024 Vascular Uni - Graft Vascular graft 15cm $391.00
BB025 Vascular Uni - Graft Vascular graft 10cm $240.00
BB119 Vascugraft PTFE, Straight Standard Wall Dia 4 - 10mm, length 40 - $860.00
50cm
BB126 Vascugraft Thin Wall Straight Dia 3 - 8mm, length10 - 40cm $725.00
BB127 Vascugraft Thin Wall Straight Dia 3 - 8mm, length 10 - 40cm $725.00
BB142 Vascugraft Easy Glide - Standard Wall Straight Dia 6mm, length 40 - 60cm $860.00
BB144 Vascugraft Easy Glide - Thin Wall Straight Dia 6 - 8mm, length 40 - 70cm $860.00
Bard Australia Pty Ltd
BA020 Impra PTFE Vascular Grafts ePTFE graft - thin wall, 10 - 50cm long 3mm - 10mm diameter $860.00
BA025 Impra PTFE Vascular Grafts ePTFE graft - regular wall, 10-50cm long 3 - 19mm diameter $860.00
Lifehealthcare Pty Ltd
LH004 Thoratec, Vectra Vascular Graft - Vectra, Biocompatible Polyurethane Length 40cm $860.00
Synthetic Vascular Access Graft
LH006 Thoratec, Vectra Vascular Graft - Vectra, Biocompatible Polyurethane Length 20cm $860.00
Synthetic Vascular Access Graft
Prostheses List by Category, Groups and Sponsor Page 878 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
St Jude Medical Australia Pty Ltd
SJ107 InterGard HemaBridge Aortic Graft 20 x 10mm - 36 x 10mm $860.00 $1,075.00
diameter, 35 x 40cm length
SJ219 Intergard W – Woven straight Woven straight 6-8mm, 30cm $860.00 $1,022.00
SJ224 InterGard Knitted Ultrathin Straight 6-8mm X 40cm $860.00 $921.00
SJ226 Interflow UltraThin ePTFE vascular graft 6-8mm X 40cm $860.00 $940.00
Terumo Corporation Australia
TU008 Fluoropassiv Graft Straight Graft - Thin Wall, Crimped. 5 to10mm x 30 to 40cm $870.00
Fluoropolymer/polyester, Knitted
TU020 Gelsoft Plus Graft Straight, Polyester, Knitted 6 - 24mm x 12.5 - 30cm $870.00
TU022 Gelweave Graft Straight, Polyester, Woven 6-38mm x 10-40cm $870.00
TU025 SEALPTFE Graft Thin Wall, Straight, Sealed, PTFE 5 to 10mm x 10 to 40cm $870.00
TU027 SEALPTFE Graft Standard Wall, Straight, Sealed, PTFE 5 to 10mm x 10 to 40cm $870.00
W L Gore & Associates
GT009 Gore-Tex Vascular Grafts Vascular Grafts - Aorto -Pulmonary & 3.5-5mm Diameter x 15-20cm $327.00
Systemic-Pulmonary Shunts (ePTFE) Length
GT132 Gore-Tex Vascular Grafts Standard Wall Grafts (ePTFE) Diameter 4 - 8mm, Length $198.00
10cm
GT138 Gore-Tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 4 - 8mm, Length $195.00
10cm
GT139 Gore-Tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 20 $461.00
- 30cm
GT149 Gore-Tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 4 - 10mm, Length $245.00
10cm
GT150 Gore-Tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 6 - 10mm, Length $337.00
20cm
GT151 Gore-Tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 6 - 10mm, Length $526.00
30cm
GT152 Gore-Tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length $661.00
40cm
GT158 Gore-Tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 4 - 10mm, Length $255.00
10cm
GT159 Gore-Tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length $347.00
20cm
Prostheses List by Category, Groups and Sponsor Page 879 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
GT160 Gore-Tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length $551.00
30cm
GT161 Gore-Tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 6 - 10mm, Length $661.00
40cm
GT167 Gore-Tex Vascular Grafts Vascular Grafts - Aorto-Pulmonary & Diameter 3.5 - 5mm, Length 5cm $221.00
Systemic-Pulmonary Shunts (ePTFE)
Stretch & Non Stretch
GT168 Gore-Tex Vascular Grafts Vascular Grafts - Aorto-Pulmonary & Diameter 3.5 - 5mm, Length $262.00
Systemic-Pulmonary Shunts (ePTFE) 10cm
Stretch & Non Stretch
GT193 Gore-Tex Vascular Grafts Standard Wall Grafts (ePTFE) 6-10mm Diameter x 40cm $618.00
Length
GT195 Gore-Tex Vascular Graft Standard wall grafts (ePTFE) Diameter 6mm x 20cm length $321.00
GT200 Gore-Tex Vascular Graft Standard wall grafts stretch (ePTFE) Diameter 6-12mm x 20cm length $332.00
GT241 Gore-Tex Vascular Graft Stretch Standard Wall Graft (ePTFE) 6 & 8mm x 40cm $638.00
b
Bio Nova International Pty Ltd
BN004 Omniflow II Vascular Prosthesis - Biosynthetic vascular prosthesis for 3 - 4 mm x 20 cm $1,305.00 $1,775.00
Straight peripheral revascularisation and vascular
access
BN029 Omniflow II Vascular Prosthesis Biosynthetic vascular prosthesis for 5, 6, 7 and 8mm internal $1,720.00 $3,301.00
peripheral revascularisation and vascular diameter; 20 to 40cm length
access
b, Di
Bio Nova International Pty Ltd
BN026 Omniflow II Vascular Prosthesis Biosynthetic vascular prosthesis for 9 and 10mm internal diameter, $1,842.00 $3,301.00
peripheral revascularisation and vascular 20 to 40cm length
access
b, Di, L
Bio Nova International Pty Ltd
BN028 Omniflow II Vascular Prosthesis Biosynthetic vascular prosthesis for 9 and 10mm internal diameter; $2,150.00 $4,348.00
peripheral revascularisation and vascular 45 to 85cm length
access
Prostheses List by Category, Groups and Sponsor Page 880 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
b, L
Bio Nova International Pty Ltd
BN027 Omniflow II Vascular Prosthesis Biosynthetic vascular prosthesis for 5, 6, 7 and 8mm internal $1,940.00 $4,348.00
peripheral revascularisation and vascular diameter; 45 to 65cm length
access
Di
St Jude Medical Australia Pty Ltd
SJ220 Intergard W – Woven Straight Woven Straight 10-34mm, 15-30cm $967.00
SJ222 Intergard K Knitted Straight Knitted straight 20-40cm, 10-24mm $921.00
W L Gore & Associates
GT146 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 12 - 24mm, Length $551.00
20cm
GT147 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 12 - 24mm, Length $551.00
30cm
GT148 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 12 - 24mm, Length $551.00
40cm
GT240 Gore-Tex Vascular Graft Stretch Standard Wall Graft (ePTFE) 10mm x 40cm $638.00
h
W L Gore & Associates
GT221 Gor-Tex Propaten Stretch Thin Walled Stretch Thin Walled Graft (ePTFE) - 6-8mm diameter, non-Ringed $860.00
Vascular Graft Heparin Bonded 40cm length
id
Terumo Corporation Australia
TU039 Rapidax™ Rapid Access Haemodialysis Triple layered self sealing haemodialysis 6mm x 20-40cm $1,300.00
Graft Access Graft. ePTFE internal and external
layer with proprietary elastomer inner layer
- Straight and Pre-curved
id,L
Terumo Corporation Australia
TU040 Rapidax™ Rapid Access Haemodialysis Triple layered self sealing haemodialysis 6mm x 45-50cm $1,300.00
Graft Access Graft. ePTFE internal and external
layer with proprietary elastomer inner layer
- Straight and Per-curved
Prostheses List by Category, Groups and Sponsor Page 881 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
L
B Braun Australia Pty Ltd
BB018 Vascular Uni - Graft Vascular graft 100cm $770.00
BB019 Vascular Uni - Graft Vascular graft 60cm $665.00
BB020 Vascular Uni - Graft Vascular graft 50cm $625.00
BB123 Vascugraft PTFE - Straight Standard Wall Dia 5 - 10mm, length 80cm $970.00
BB124 Vascugraft PTFE - Straight Standard Wall Dia 5 - 8mm, length 90 - $970.00
100cm
BB125 Vascugraft Thin Wall Straight Dia 3 - 8mm, length 70 - $970.00
100cm
BB141 Vascugraft Easy Glide - Standard Wall Straight Dia 6mm, length 70 - 80cm $950.00
Bard Australia Pty Ltd
BA024 Impra PTFE Vascular Grafts ePTFE graft - thin wall, greater than 50cm 3 - 10 diameter $970.00
long
BA026 Impra PTFE Vascular Grafts ePTFE graft - regular wall, greater than 3 - 10mm diameter $970.00
50cm long
Lifehealthcare Pty Ltd
LH005 Thoratec, Vectra Vascular Graft - Vectra, Biocompatible Polyurethane Length 50cm $970.00
Synthetic Vascular Access graft
St Jude Medical Australia Pty Ltd
SJ225 InterGard Knitted Ultrathin Straight 6-8mm X 70cm $970.00
SJ227 Interflow UltraThin ePTFE vascular graft 6-8mm X 80cm $970.00
Terumo Corporation Australia
TU006 Twillweave Graft Straight, Polyester, Woven, Unsealed 6-24mm x 50-60cm $860.00
TU009 Fluoropassiv Graft Straight Graft - Thin Wall, Crimped. 5 to10mm x 50 to 70cm $970.00
Fluoropolymer/polyester, Knitted
TU021 Gelsoft Plus Graft Straight, Polyester, Knitted 6-24mm x 50-60cm $970.00
TU023 Gelweave Graft Straight, Polyester, Woven 6-38mm x 50-60cm $970.00
TU026 SEALPTFE Graft Thin Wall, Straight, Sealed, PTFE 5 to 10mm x 50 to 80cm $970.00 $1,159.00
TU028 SEALPTFE Graft Standard Wall, Straight, Sealed, PTFE 5 to 10mm x 50 to 80cm $970.00
W L Gore & Associates
GT136 Gore-tex Vascular Grafts Standard Wall Grafts (ePTFE) Diameter 4 - 10mm, Length $970.00 $1,070.00
80cm
Prostheses List by Category, Groups and Sponsor Page 882 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
GT143 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length $860.00
70cm
GT145 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 4 - 10mm, Length 90 $970.00 $1,070.00
- 100cm
GT157 Gore-Tex Stretch Thin Walled Vascular Thin Wall Grafts Stretch (ePTFE) Diameter 4 - 10mm, Length 90 $970.00 $1,070.00
Graft - 100cm
GT164 Gore-Tex Vascular Grafts Thin wall grafts (ePTFE) Dia 3 - 10mm, length 70cm $970.00
GT237 Gore-Tex Vascular Graft Standard Wal Grafts(ePTFE) 5mm-8mm diameter, 70-80cm $970.00
length
GT239 Gore-Tex Vascular Graft Standard Wall Grafts (ePTFE) 5-8mm diameter, 90-100cm $970.00 $1,070.00
length
GT243 Gore-Tex Stretch Standard Walled Stretch Standard Walled Graft (ePTFE) 6-8mm diameter, 80cm length $970.00 $1,070.00
Vascular Graft
GT245 Gore-Tex Stretch Thin Walled Vascular Thin Wall Graft Stretch (ePTFE) 6-8mm diameter, 70cm length $970.00
Graft
GT247 Gore-Tex Vascular Graft Thin Wall Graft Stretch (ePTFE) 6-8mm diameter, 80cm length $970.00 $1,070.00
GT249 Gore-Tex Vascular Graft Thin Wall Grafts (ePTFE) 4-8mm diameter, 80cm length $970.00 $1,070.00
GT251 4-8mm Thin Walled Vascular Graft Thin Walled Graft (ePTFE) 4-8mm x 90-100cm $970.00 $1,070.00
L, Di
St Jude Medical Australia Pty Ltd
SJ221 Intergard W – Woven Straight Woven Straight 10-32mm, 60-70cm $1,075.00
SJ223 Intergard K Knitted straight Knitted straight 10mm 70cm $970.00
W L Gore & Associates
GT236 Gore-Tex Vascular Graft Standard Wall Grafts (ePTFE) 10mm diameter, 70-80cm length $1,075.00
GT238 Gore-Tex Vascular Graft Standard Wal Grafts (ePTFE) 10mm diameter, 90-100cm $1,075.00
length
GT242 Gore-Tex Stretch Standard Walled Stretch Standard Wall Graft (ePTFE) 10mm diameter, 80cm length $1,075.00
Vascular Graft
GT244 Gore-Tex Stretch Thin Walled Vascular Thin Wall Graft Stretch (ePTFE) 10mm diameter, 70cm length $1,075.00
Graft
GT246 Gore-Tex Stretch Thin Walled Vascular Thin Wall Graft Stretch (ePTFE) 10mm diameter, 80cm length $1,075.00
Graft
GT248 Gore-Tex Vascular Graft Thin Wall Grafts (ePTFE) 10mm diameter, 80cm length $1,075.00
Prostheses List by Category, Groups and Sponsor Page 883 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
GT250 10mm Thin Walled Vascular Graft Thin Walled Graft (ePTFE) 10mm x 90-100cm $1,075.00
L, h
W L Gore & Associates
GT222 Gortex Stretch Thin Walled Propaten Stretch Thin Wall Graft (ePTFE)- Heparin 6-8mm diameter Non-Ringed $970.00 $1,200.00
Graft Bonded 80cm length
L, r
Atrium Australia - Pacific Rim Pty Limited
AC045 Advantra PTFE Vascular Graft Trilaminate PTFE Graft with Graft 4 - 8mm diameter 50cm - $1,630.00 $3,384.00
Deployment System 100cm lengths
B Braun Australia Pty Ltd
BB121 Vascugraft Straight Standard Wall with Helix Support Dia 6 - 10mm, length 60 - $990.00
80cm
BB122 Vascugraft Straight Standard Wall with Helix Support Dia 5 - 8mm, length 90cm $1,160.00
BB128 Vascugraft Straight Standard Wall with Helix Support Dia 6mm x length 100cm $1,260.00
BB129 Vascugraft Straight Standard Wall with Helix Support Dia 5 - 8mm, length 80 - 90cm $1,260.00
BB130 Vascugraft Straight Standard Wall with Helix Support Dia 4 - 6mm, length 50 - 70cm $1,055.00
BB134 Vascugraft Thin Wall Centre Helix Dia 4 - 8mm, length 70 - 80cm $1,045.00
BB137 Vascugraft Standard with Centred Helix Dia 4 - 8mm, length 70 - 90cm $1,019.00
Bard Australia Pty Ltd
BA021 Impra PTFE Vascular Grafts ePTFE graft - radially supported, thin wall. 4 - 8mm diameter, greater than $1,630.00
50cm long
BA023 Impra PTFE Vascular Grafts ePTFE graft - radially supported, regular 4 - 10mm diameter, greater $1,630.00
wall. than 50cm long
St Jude Medical Australia Pty Ltd
SJ112 InterGuard UltraThin Knitted Radially Supported Straight 6mm - 70cm to 8mm - 70cm $1,230.00
SJ229 Interflow Ultrathin Radially Supported ePTFE vascular graft with radial support 6-8mm X 80cm $1,159.00
Prostheses List by Category, Groups and Sponsor Page 884 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Terumo Corporation Australia
TU035 SEALPTFE Graft Thin Wall, Straight, Sealed externally 5 to 10mm x 50cm $1,630.00
Reinforced, Vascular Artificial
Arteries/Prostheses of PTFE, Sealed with
Gelatin
W L Gore & Associates
GT008 Gore-Tex Vascular Ring Graft Ringed Grafts removable thin wall - stretch 6-8mm Diameter x 80cm $1,630.00 $1,800.00
(ePTFE) Length - Ringed Section 70cm
Length
GT179 Gore-Tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 5 - 6mm x 70cm $1,630.00
(ePTFE) Length, Ringed Section 60cm
Length
GT180 Gore-Tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 5 - 6mm x 80cm $1,630.00 $1,800.00
(ePTFE) Length, Ringed Section 60cm
Length
GT182 Gore-Tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 6mm, Lengths 80 - $1,630.00 $1,800.00
(ePTFE) 90 cm, Ringed Section 60cm
Length
GT183 Gore-Tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 8mm, Lengths 80 - $1,630.00 $1,800.00
(ePTFE) 90 cm, Ringed Section 70cm
Length
GT186 Gore-tex Stretch Removable Ringed Stretch Thin Walled Removable Ringed Diameter 6mm x 70cm Length, $1,630.00
Vascular Graft (ePTFE) Graft Ringed Section 60cm
GT187 Gore-tex Stretch Removable Ringed Stretch Thin Walled Removable Ringed Diameter 6 - 8mm x 70cm $1,630.00
Vascular Graft (ePTFE) Graft Length, Ringed Section 60 -
70cm Length
GT212 Gore-Tex Stretch Intering Vascular Graft Stretch Thin Walled ePTFE graft with Dia 6-8mm, 60cm radial $1,630.00
Integrated Rings supported length x 60cm length
GT213 Gore-Tex Intering Vascular Graft ePTFE integrated rings in the wall of a Dia 6-8mm, 80cm radial $1,630.00 $1,800.00
stretch thin walled graft supported length x 80cm length
GT253 Gore-Tex Stretch Removable Ringed Stretch Removable Ringed Thin Walled 8mm diameter, 40cm length, $1,630.00
Vascular Graft Graft (ePTFE) 30cm removable ringed section
Prostheses List by Category, Groups and Sponsor Page 885 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
L, r, h
W L Gore & Associates
GT234 Gore-Tex Stretch Propaten with Stretch Thin Walled (ePTFE), Heparin 6mm diameter, 70cm length, $1,630.00 $1,834.00
Removable Rings Vascular Graft Bonded, Graft with Removable Rings 60cm ringed section
GT254 Gore-Tex Stretch Propaten Vascular Stretch Thin Walled Graft, Removable 6-8mm diameter, 80cm length, $1,630.00 $1,960.00
Graft Rings (ePTFE), Heparin Bonded 60-70cm Ringed Section
r
Atrium Australia - Pacific Rim Pty Limited
AC001 Atrium PTFE Vascular Graft Radially Supported (Ringed) PTFE 4mm x 10cm - 10mm x 100cm $1,520.00
Standard Wall
AC012 Atrium PTFE Vascular Graft Radially Supported (Ringed) PTFE Thin 4mm x 10cm - 10mm x 100cm $1,520.00
Wall
AC043 Advantra PTFE Vascular Graft Trilaminate PTFE Graft with Graft 4mm - 8mm diameter, 10cm - $1,520.00 $3,384.00
Deployment System 45cm length
B Braun Australia Pty Ltd
BB120 Vascugraft Straight Standard Wall with Helix Support Dia 6 - 10mm, length 10 - $850.00
50cm
BB132 Vascugraft Thin Wall Centre Helix Dia 6mm, length 45cm $725.00
BB133 Vascugraft Thin Wall Centre Helix Dia 5 - 6mm, length 45 - 50cm $935.00
BB146 Vascugraft Easy Glide - Thin Wall Straight with Helix Dia 6 - 8mm, length 40 - 80cm $970.00
Support
Bard Australia Pty Ltd
BA019 Impra PTFE Vascular Grafts ePTFE graft - radially supported, thin wall, 4mm - 8mm diameter $1,400.00
10 - 50cm long
BA022 Impra PTFE Vascular Grafts ePTFE graft - radially supported, regular 4 - 19mm diameter $1,400.00
wall, 10-50cm long
St Jude Medical Australia Pty Ltd
SJ046 Intergard K Knitted Radially Supported 6mm x 70cm - 8mm x 60cm $970.00 $1,230.00
SJ228 Interflow Ultrathin Radially Supported ePTFE vascular graft with radial support 6-8mm X 40cm $1,159.00
Terumo Corporation Australia
TU010 Fluoropassiv Graft Straight Graft, Thin Wall, Externally 5 to10mm x 30 to 40cm $1,520.00
Reinforced. Fluoropolymer/polyester,
Knitted
Prostheses List by Category, Groups and Sponsor Page 886 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
TU011 Fluoropassiv Graft Straight Graft, Thin Wall, Externally 5 to10mm x 50 to 70cm $1,520.00
Reinforced. Fluoropolymer/polyester,
Knitted
TU016 Gelsoft Plus Graft Polyester, Externally Reinforced, Knitted 6 to 10mm x 75m $1,520.00
TU017 Gelsoft Plus Graft Polyester, Externally Reinforced, Knitted 6 to 10mm x 100cm $1,520.00
TU019 Gelsoft Plus Graft Femoro-femoral, Polyester, Knitted, 6mmx30cm to 8mmx40cm $1,520.00
Externally reinforced
TU029 SEALPTFE Graft Standard Wall, Straight, Sealed, Externally 5 to 10mm x 10 to 40cm $970.00
Reinforcement, PTFE
TU030 SEALPTFE Graft Standard Wall, Straight, Sealed, Externally 5 to 10mm x 50 to 80cm $1,520.00
Reinforcement, PTFE
W L Gore & Associates
GT185 Gore-Tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 6mm x 80cm Length, $1,520.00 $1,800.00
Stretch (ePTFE) Ringed Section 30cm Length
GT211 Gore-Tex Intering Stretch Thin Walled ePTFE integrated rings in the wall of a Diameter 6-8mm, 40cm radial $1,520.00
Vascular Graft stretch thin walled graft supported length x 40cm length
GT218 Gortex Propaten Vascular Graft Stretch Thin Wall Graft (ePTFE) 6mm diameter 30cm $1,800.00
Removable Ring - 70cm length
GT252 Gore-Tex Stretch Removable Ringed Stretch Removable Ringed Thin Walled 8mm diameter, 40cm length, $1,520.00
Vascular Graft Graft (ePTFE) 30cm removable ringed section
r, Di
Atrium Australia - Pacific Rim Pty Limited
AC044 Advantra PTFE Vascular Graft Trilaminate PTFE Aortic Graft with 12mm - 24mm diameter 30cm $1,211.00 $3,384.00
hydrostatic membrane length
r, h
W L Gore & Associates
GT235 Gore-Tex Propaten Vascular Graft Stretch (ePTFE), Heparin Bonded, Graft 8mm diameter, 40cm length $1,520.00
GT255 Gore-Tex Stretch Propaten Vascular Stretch Thin Walled Graft, Removable 8mm diameter, 40-50cm length, $1,520.00 $1,700.00
Graft Rings (ePTFE), Heparin Bonded 30-40cm Ringed Section
Prostheses List by Category, Groups and Sponsor Page 887 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
r, id
Atrium Australia - Pacific Rim Pty Limited
AC048 Advantra PTFE Vascular Graft with Trilaminate PTFE. Vascular Access PTFE 4mm - 8mm diameter. 10cm - $1,720.00 $3,000.00
Graft Deployment System 40cm length
r, L
Terumo Corporation Australia
TU032 SEALPTFE Graft Thin Wall, Straight, Sealed, Externally 5 to 10mm x 60 to 80cm $1,630.00 $1,709.00
Reinforced, PTFE
Group 3b: Bifuicated
Atrium Australia - Pacific Rim Pty Limited
AC016 Atrium Ultramax PET Grafts Bifurcate Polyster Graft 12mm x 24mm - 6mm x 12mm $962.00
x 40cm
AC026 Advanta SST Bifurcated PTFE Graft 12mm - 24mm X 6mm - 12mm $975.00 $3,384.00
Length 40cm
B Braun Australia Pty Ltd
BB027 Vascular Uni - Graft - Bifurcated Vascular graft 12x7 to 12x12 $375.00
St Jude Medical Australia Pty Ltd
SJ042 Intergard W Woven Bifuicated 18mm x 9mm - 24mm x $975.00 $1,020.00
12mm
SJ045 Intergard K Knitted Bifuicated 12mm x 6mm - 24mm x 12mm $975.00 $1,020.00
Terumo Corporation Australia
TU007 Twillweave Graft Bifuicated, Polyester, Woven, Unsealed 12mm x 6mm x 45cm to 24mm $962.00
x 12mm x 45cm
TU013 Gelweave Graft Bifuicated, Polyester, Woven 12mmx 6mmx 45 cm to $975.00
24mmx12mm x 45cm
TU014 Gelsoft Plus Graft Bifuicated, Polyester, Knitted 12mmx6mmx45cm to $975.00
24mmx12mmx45cm
L
W L Gore & Associates
GT006 Gore-Tex Stretch Bifurcated Graft Stretch Bifurcated Graft with Thin Walled 12x6mm to 24x12mm 40- $962.00
Limbs (ePTFE) 50cm long
Prostheses List by Category, Groups and Sponsor Page 888 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 3c: Branched or Fenestrated (2 or more)
L
Atrium Australia - Pacific Rim Pty Limited
AC017 Atrium Ultramax PET Grafts Axillo-bifemoral Polyster Graft 8mm - 10mm 100 x 60cm $1,950.00
St Jude Medical Australia Pty Ltd
SJ043 Intergard W Woven Aortic Arch 24mm x 10mm x 8mm x 8mm x $1,950.00
50cm - 30mm x 10mm x 8mm
x 8mm
SJ047 Intergard K Knitted Axillobifemoral Diameter (mm) Length (cm) 8 x $1,950.00
8 100/60; 10 x 10 100/60; 8 x
6 x 6 85/55; 8 x 8 85/55; 8 x 8
100/55
L, r
Terumo Corporation Australia
TU018 Gelsoft Plus Graft Axillo-bifemoral, Polyester, Knitted, 8x8mm/100x60cm; $1,950.00
Externally reinforced 8x7mm/90x40cm;
10x8mm/90x40cm
W L Gore & Associates
GT216 Gore-Tex Axillobifemoral Vascular Graft Stretch vascular graft with removable rings Diameter 8mm x 90cm 40cm $1,950.00
(ePTFE)
Group 3d: Tapered or End-modified
Atrium Australia - Pacific Rim Pty Limited
AC003 Atrium PTFE Vascular Graft Tapered PTFE Standard Wall 4-6mm x 30cm - 6-8mm x 90cm $875.00
AC014 Atrium PTFE Vascular Graft Tapered PTFE Thin Wall 4-6mm x 30cm - 6-8mm x 90cm $875.00
B Braun Australia Pty Ltd
BB026 Vascular Uni - Graft - Tapered Vascular graft 12x6 to 24x12 $702.00
BB131 Vascugraft Thin Wall Tapered Dia 4 - 8mm, length 40 - 90cm $875.00
BB138 Vascugraft Standard with Short Taper Dia 4 - 8mm, length 30 - 70cm $875.00
BB155 Vascugraft Standard Tapered Dia 4 - 7mm, length 30 - 70cm $875.00
Prostheses List by Category, Groups and Sponsor Page 889 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BB157 Vascugraft Standard Wall Stepped Taper Dia 4 - 8mm, length 40 - 45cm $842.00
Bard Australia Pty Ltd
BA029 Impra PTFE Vascular Grafts Venaflo ePTFE graft with preformed cuff 4mm - 8mm diameter, 10cm - $842.00
50cm length
L
B Braun Australia Pty Ltd
BB136 Vascugraft Standard Tapered Dia 4 - 8mm, length 70 - 90cm $985.00
BB139 Vascugraft Standard with Short Taper Dia 4 - 8mm, length 80cm $985.00
Bard Australia Pty Ltd
BA171 Dynaflo AK Bypass Graft PTFE Graft 7 & 8mm diameter. 50, 60, 70, $985.00
80cm lengths
Terumo Corporation Australia
TU033 SEALPTFE Graft Standard Wall, Tapered, Sealed, PTFE 4 to 7mm Taper x 45 to 50cm $860.00
W L Gore & Associates
GT171 Gore-tex Vascular Grafts Standard Wall Grafts Stretch Tapered Diameter 4-6mm & 4-7 mm, $842.00
(ePTFE) Length 45 - 48cm
GT172 Gore-Tex Vascular Grafts Standard Wall Grafts Stretch Tapered Diameter 4-7 mm, Length $985.00
(ePTFE) 70cm
L, r
Atrium Australia - Pacific Rim Pty Limited
AC046 Advantra PTFE Vascular Graft Tapered Trilaminate PTFE Graft with 4mm - 8mm diameter 50cm - $875.00 $3,384.00
Graft Deployment System 80cm lengths
B Braun Australia Pty Ltd
BB145 Vascugraft Thin Wall Centred Helix Tapered Dia 4 - 7mm, length 70cm $875.00
Bard Australia Pty Ltd
BA028 Impra PTFE Vascular Grafts Distaflo ePTFE graft with preformed cuff 6-10mm diameter, 40 - 80cm $875.00
and flex support length
r
Atrium Australia - Pacific Rim Pty Limited
AC047 Advantra PTFE Vascular Graft Tapered Trilaminate PTFE Graft with 4mm - 8mm diameter, 10 - $875.00 $3,384.00
Graft Deployment System 40cm lengths
Prostheses List by Category, Groups and Sponsor Page 890 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
B Braun Australia Pty Ltd
BB143 Vascugraft Easy Glide - Standard Wall with Helix Dia 6 - 8mm, length 40 - 70cm $875.00
Short Taper
BB156 Vascugraft Standard Wall with Tapered Centre Helix Dia 4 - 8mm, length 40 - 45cm $842.00
W L Gore & Associates
GT175 Gore-tex Vascular Grafts Ringed Grafts Removable Standard Wall 4-7 mm x 70cm - Rings 30cm $875.00 $1,630.00
Tapered (ePTFE) Length
GT214 Gore-Tex Intering Vascular Graft Internally radially supported vascular graft 4-6 tapered diameter 38cm $842.00
(ePTFE) radial support length 45cm
length; 4-7 tapered diameter
38cm radial support length
45cm length; 6mm diameter
40cm radial support length
40cm length
r, L
Australasian Medical & Scientific Ltd
AN010 Tayflow TFT SLF Graft Spiral laminar flow graft 70cm length x 7mm diameter $875.00 $2,675.00
80cm length x 7mm diameter
70cm length x 8mm diameter
80cm length x 8mm diameter
r, L, id
Atrium Australia - Pacific Rim Pty Limited
AC049 Advantra PTFE Vascular Graft with Trilaminate PTFE. Vascular Access Graft 4mm - 8mm diameter. 50 - $1,720.00 $3,000.00
Graft Deployment System 80cm length
Group 4: Vascular Patches
Group 4a: Biological
1
Bio Nova International Pty Ltd
BN020 Omniflow II Vascular Prostheses - Vascular Patch 1.5cm x 5cm (less than 8 sq. $600.00 $672.00
Straight Cm)
2
Bio Nova International Pty Ltd
BN021 Omniflow II Vascular Prostheses - Vascular Patch 2.5cm x 10cm (more than 8 sq. $744.00 $875.00
Straight cm
Prostheses List by Category, Groups and Sponsor Page 891 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 4b: Synthetic
1
Atrium Australia - Pacific Rim Pty Limited
AC041 Atrium Ultramax Patches Knitted Double Velour Vascular Patch 6 sq cm $205.00 $270.00
B Braun Australia Pty Ltd
BB017 Vascular Patch Vascular patch 12x9 to 3x4 $205.00
Bard Australia Pty Ltd
BA039 Grafts Vascular Polyester pledgets Rectangle, Oval, Circle, Square $87.00
2.9mm-8mm x 6mm - 9.5mm
BA089 Impra PTFE Vascular Grafts ePTFE Cardiovascular Patch 0.4mm Oval 20 x 90mm $205.00
BA090 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, 100 x 150mm $764.00 $787.00
Circular
BA091 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, 50 x 75mm $372.00 $383.00
Rectangular
BA092 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, 50 x 150mm $372.00 $383.00
Rectangular
BA095 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, 25 x 150mm $313.00 $322.00
Rectangular
Terumo Corporation Australia
TU042 Fluoropassiv Patch Thin wall, Fluoropolymer/polyester, Koper 6-15mm x 5-7.5cm $205.00 $233.00
Knitted
2
Atrium Australia - Pacific Rim Pty Limited
AC042 Atrium Ultramax Patches Knitted Double Velour Vascular Patch 19 – 76 sq cm $250.00 $357.00
Bard Australia Pty Ltd
BA031 Grafts Vascular Polyester soft tissue patch 1mm thick 5cm x 10cm $153.00 $158.00
BA032 Grafts Vascular Polyester soft tissue patch 1mm thick 10cm x 15cm $286.00 $295.00
BA033 Grafts Vascular Polyester soft tissue patch 1mm thick 15cm x 20cm $388.00 $400.00
BA034 Grafts Vascular Polyester soft tissue patch 1mm thick 20cm x 30cm $459.00 $473.00
BA035 Grafts Vascular PTFE Felt 2mm thick 5cm x 10cm $153.00 $158.00
BA036 Grafts Vascular PTFE Felt 2mm thick 10cm x 15cm $286.00 $295.00
Prostheses List by Category, Groups and Sponsor Page 892 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
BA037 Grafts Vascular PTFE Felt 2mm thick 15cm x 20cm $388.00 $400.00
BA038 Grafts Vascular PTFE Felt 2mm thick 20cm x 30cm $459.00 $473.00
BA093 Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, 30 x 30mm, 10 x 90mm, 30 x $250.00
Rectangular, Patch 0.4 Oval, Rectangular 60mm
Terumo Corporation Australia
TU043 Fluoropassiv Patch Thin wall, Fluoropolymer/polyester, Koper 10-15mm x 7.5-10cm $250.00
Knitted
W L Gore & Associates
GT012 Soft Tissue Patch ePTFE 1mm Thickness 5 x 10cm $225.00
GT013 Soft Tissue Patch ePTFE 1mm Thickness 10 x 15cm $661.00
GT014 Soft Tissue Patch ePTFE 1mm Thickness 15 x 20cm $1,192.00
GT015 Soft Tissue Patch ePTFE 1mm Thickness 20 x 30cm $2,083.00
GT016 Soft Tissue Patch ePTFE 2mm Thickness 5 x 10cm $369.00
GT017 Soft Tissue Patch ePTFE 2mm Thickness 10 x 15cm $894.00
GT018 Soft Tissue Patch ePTFE 2mm Thickness 15 x 20cm $1,630.00
GT019 Soft Tissue Patch ePTFE 2mm Thickness 20 x 30cm $2,808.00
Group 5: Vessel Band
Group 5: Vessel band
AllVascular Pty Ltd
VA001 Venous Valve Ring Dacron/silicone variable diameter ring 52mmx15mmx0.09 mm $1,065.00
Group 6: Embolic Protection Devices
Group 6a: Venous
B Braun Australia Pty Ltd
BB106 Temporary Vena Cava System Phynox/ combination of various metals inc. One size, expands to Max $1,450.00
Nickel,Copper, Molubden,Steel length 38mm/Max diameter
30mm
BB169 Vena Cava Filter System PHYNOX Introducer system, 'J' Diameter 28 mm $1,900.00
Guidewire, Seldinger needle, disposable
scalpel
Prostheses List by Category, Groups and Sponsor Page 893 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Bard Australia Pty Ltd
BA010 Recovery G2 Nitinol self expanding vena cava filter 28mm Filter, 7Fr delivery System $2,348.00
Cook Medical Australia Pty Ltd
WC096 Cook Vena Cava Filter Universal Filter Diameter up to 40mm, Length $2,348.00
up to 60mm
WC283 Vena Cava Filter with NavAlign Delivery The filter consists of a non-magnetic filter Filter measures 30mm in $2,348.00
System (30mm diameter, 48mm long) preloaded diameter and 48mm long
on a femoral filter introducer and/or a
jugular filter introducer, an 8.5 French
coaxial introducer system (compatible with
a .035 inch wire guide) for introduction
and a hydrophilic coated dilator.
Imaxeon Pty Ltd
IX004 ALN Vena Cava Filter The ALN Vena Cava Filter is implanted One size, diameter up to 32mm $2,150.00
into the SVC via the femoral, brachial and
jugular vein to prevent pulmonary emboli
(PEs).
Johnson & Johnson Medical Pty Ltd
JJ423 OPTEASE retrievable vena cava filter OPTEASE is a laser cut nitinol vena cava Suitable for vessels up to 30mm $2,348.00
filter, used to treat patients at high risk of
pulmonary embolisation
Group 6c: Arterial
Abbott Australasia Pty Ltd
AY018 Emboshield Embolic Protection Device, including Large and small. Two wire $2,100.00
delivery system, device specific procedural lengths: 190cm for Monorail
wire, filter for capturing embolic matter system and 315cm for Over the
and retrieval system wire
AY030 Accunet Embolic Protection Device, including 4.5 - 7.5; 190cm, 300cm length $2,100.00
delivery system, device specific procedural catheter
wire, filter for capturing embolic matter
and retrieval system.
Prostheses List by Category, Groups and Sponsor Page 894 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Boston Scientific Australia Pty Ltd
BS085 Filterwire EZ Embolic Protection Device Vessel compatibility 3.5mm - $2,100.00
5.5mm and delivery system
lengths up to 300cm.
ev3 Australia Pty Ltd
EE022 Spider FX Embolic Protection Device The Spider FX is a rapid exchange device Filter: 3.0 - 7.0mm; Capture $2,100.00
percutaneously delivered distal embolic Wire: 190 and 320cm
protection device with components
designed to capture and remove debris
from vessels during interventional
procedures in the vasculature.
Johnson & Johnson Medical Pty Ltd
JJ445 ANGIOGUARD XP Emboli Capture Distal protection device and delivery system Length: 300cm, diameter: $2,100.00
Guidewire System 0.014, Basket sizes 4mm,
5mm, 6mm, 7mm, and 8mm
JJ480 Angioguard RX Emboli Capture Distal protection device and delivery system Length 180cm, Diameter $2,100.00
Guidewire System 0.014"; basket sizes 4mm,
5mm, 6mm, 7mm and 8mm
Medtronic Australasia Pty Ltd
MC954 Mo.Ma Proximal Cerebral Protection Mo.Ma Proximal Cerebral Protection Minimum sheath size = 8F or $2,100.00
Device Device. Protects the brain from 9F, Minimum diameter of inner
embolisation, blocking antigrade blood working channel =
flow from the common Carotid Artery and 0.069"/1.76mm (8F sheath) or
retrograde blood flow from the External 0.083"/2.12mm (9F sheath);
Carotid Artery. 0.035" guide wire compatible
Group 7: Arterial Closure Devices
Group 7: Arterial closure devices
Abbott Australasia Pty Ltd
AY017 Starclose 6 Fr Exchange Sheath, Dilator, Guidewire, 6 Fr $410.00
implantable nitinol clip pre-mounted on a
Clip Applier
AY033 Proglide Suture Mediated Closure Device 5 - 8 French $410.00
AY034 Prostar Suture Mediated Closure Device - Closure Up to 24 French $750.00
of Large holes
Prostheses List by Category, Groups and Sponsor Page 895 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Johnson & Johnson Medical Pty Ltd
JJ823 EXOSEAL (TM) Vascular Closure Vascular Closure Device 5 - 7F $410.00
Device
Medtel Australia Pty Ltd
ME107 Superstitch Suture Mediated Closure Device Sheath sizes: 6F and 8F $410.00
St Jude Medical Australia Pty Ltd
SJ014 Angio-Seal Vascular Closure Device - Angio-Seal Haemostatic Puncture Closure 6F $410.00
STS Platform and STS Plus Device, Models 6F-STS Platform and 6F
STS Plus
SJ015 Angio-Seal Vascular Closure Device - Angio-Seal Haemostatic Puncture Closure 8F $410.00
STS Platform and STS Plus Device, Models 8F-STS Platform and 8F
STS Plus
SJ094 Angio-Seal VIP Angio-Seal Haemostatic Puncture Closure 6F $410.00
Device Models 6F STS Platform, 6F STS
Plus and 7F VIP
SJ095 Angio-Seal VIP Angio-Seal Haemostatic Puncture Closure 8F $410.00
Device Models 8F STS Platform, 8F STS
Plus and 8F VIP
SJ155 Angio-Seal Evolution Haemostatic Puncture Closure Device 6F- 6F and 8F $410.00
8F
SJ218 FemoSeal Vascular Closure System Haemostatic Puncture Closure Device One Size $410.00
nb
Lifehealthcare Pty Ltd
LH460 Mynx Vascular Closure Device Water-soluble synthetic sealant made of a 5F, 6/7F $410.00
polyethylene glycol (PEG) The sealant is
resorbed by the body within 30 days
Group 8: Occlusion Devices
Group 8a: Particle
Boston Scientific Australia Pty Ltd
BS034 Contour PVA, Contour SE Polyvinyl Alcohol (PVA) embolization Up to 1200 micron, volume up $204.00
particles spherical-shaped PVA to 2ml.
Prostheses List by Category, Groups and Sponsor Page 896 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Cook Medical Australia Pty Ltd
WC044 PVA Embolisation particles Embolisation & Occlusion Particle Size Ranges (microns) $204.00
50-100, 100-200, 200-
300,300-500, 500-700, 700-
1000, 1000-1500, 1500-2000,
2000-2800
Device Technologies Australia Pty Ltd
DE294 Bead Block Plyvinyl Alcohol hydrogel microspheres in 2ml- (100 - 300, 300 - 500, $204.00 $419.00
pre-loaded syringe 500 - 700, 700 - 900, 900 -
1200 microns
Endotherapeutics Pty Ltd
ET052 Hepasphere Expanding microspheres designed for 50 - 200 microns $204.00 $1,650.00
chemic0-embolisation with
chemotherapeutic agents such as Ethiodil,
Cisplatin, Epirubicin, Mitomycin, etc.
Group 8b: Coil, Peripheral
Boston Scientific Australia Pty Ltd
BS021 Interlock IDC, VortX and Pushable Coil and microcatheter delivery system Coil diameters up to 30mm and $1,250.00
Coils, FasTracker, Renegade lengthes up to 100cm.
Delivery system lengths up to
200cm
BS026 VortX and Pushable Coils Pushable coils Diameters up to 30mm and $143.00
lengths up to 60mm
Cook Medical Australia Pty Ltd
WC037 Coil - Embolisation MWCE Standard Stainless Steel Diameters: .025, .035, .038 $143.00
and .052, Extended Lengths:
1cm to 20cm, Coil Taper
Diameters: 2mm to 10mm
WC190 Detachable Mreye Embolization Coils Standard Mreye Diameters: .035 and .038, $66.00
Extended Lengths: 1cm to
20cm, Coil Diameters: 3mm to
20mm
Prostheses List by Category, Groups and Sponsor Page 897 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ev3 Australia Pty Ltd
EE023 Axium Detachable Coil System Platinum alloy coils (including coils enlaced Diameter: 1.5 - 25mm; Length: $1,950.00
with PGLA filaments and Nylon Fibers) 1 - 50cm
attached to a composite implant delivery
pusher with a radiopaque positioning
marker. The proximal end of the pusher is
loaded into the Actuator which detaches
the coil.
Johnson & Johnson Medical Pty Ltd
JJ224 TruFill Pushable coil Platinum pushable coil of 1. Straight, 2. C, Size .014" outer diameter. Size $34.00
3. Flat spiral and 4. Complex shapes. 2 - 10mm and length 2 - 100mm
Embolic coil and delivery tube.
P
Cook Medical Australia Pty Ltd
WC039 Cook Embolization Coil Hilal Platinum Diameters: .018, Extended $143.00 $208.00
Lengths: .5cm to 6cm, Coil
Diameters: Straight to 10mm
Pyramed Pty Limited
PY008 Platinum Spirale and Cirrus embolisation Embolisation coils with or without fibers Spiral diameter 2mm - 16mm; $143.00
coils <100mm length 25mm - 80mm; coil
diameter 0.27mm - 0.82mm
P, L
Cook Medical Australia Pty Ltd
WC038 Coil - Embolisation Coils MWCE- Tornado Platinum Diameters: .018, .035 and $143.00 $218.00
TORNADO .038, Coil Taper Diameters:
2mm to 10mm
WC173 Cook Embolisation Coils Nester Platinum Diameters: .018 and .035, $143.00 $247.00
Extended Lengths: 14cm, Coil
Diameters: 3mm to 10mm
Pyramed Pty Limited
PY009 Platinum Spirale and Cirrus embolisation Embolisation coils with or without fibers Spiral diameter 4mm - 10mm; $143.00 $247.00
coils 100-150mm length 100mm - 150mm; coil
diameter 0.27mm - 0.82mm
Prostheses List by Category, Groups and Sponsor Page 988 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
PY010 Platinum Spirale and Cirrus embolisation Embolisation coils with and without fibers Spiral diameter 5mm - 16mm; $143.00 $380.00
coils 200-450mm length 200mm - 450mm; Coil
diameter 0.82mm.
Group 8d: Polymer
Endotherapeutics Pty Ltd
ET006 Embospheres - 2ml per implant $630.00
ET007 Embospheres - 1ml per implant $420.00
ET008 Embospheres - .5ml per implant $320.00
ids
Boston Scientific Australia Pty Ltd
BS028 GDC and PVA Delivery Catheters Microcatheter Delivery Systems Delivery system lengths up to $700.00
175cm
Group 8e: Detachable Balloon or Sphere
St Jude Medical Australia Pty Ltd
SJ265 Amplatzer Vascular Plug Self expandable nitinol wire mesh Diameter 4mm - 16mm, Length $1,900.00
7 & 8mm
SJ268 Amplatzer Vascular Plug III AVP III is a self-expanding, Nitinol mesh Size: (mm): 4, 6, 8, 10, 10, 12, $1,900.00
occlusion device. 12, 14, 14 Long Axis (mm): 4,
6, 8, 10, 10, 12, 12, 14, 14
Length (mm): 6.5
SJ269 AMPLATZER Vascular Plug 4 The AMPLATZER Vascular Plug 4 4mm 4 diameter 10.0 length $1,900.00
(AVP4) is a self-expanding, Nitinol mesh 5mm 5 diameter 10.5 length
occlusion device. The Device has a 6mm 6 diameter 11.0 length
radiopaque marker band at each end and a 7mm 7 diameter 12.5 length
micro screw attachment at one end for 8mm 8 diameter 13.5 length
attaching to the delivery wire. The AVP4
fits through a 0.038 guidewire compatible
diagnostic catheter allowing the use of the
same catheter throughout the procedure
rather than having to exchange the
diagnostic catheter for a second delivery
catheter to place a plug.
Prostheses List by Category, Groups and Sponsor Page 989 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
ids
St Jude Medical Australia Pty Ltd
SJ266 AMPLATZER Vascular Plug - II The AMPLATZER Vascular Plug II is a 9-AVP2-003, 3mm Diameter, $2,100.00
self-expandable, multi-lobed cylindraical 6mm Plug Length, 9-AVP2-
device made from a nitinol wire mesh. 004, 4mm Diameter, 6mm Plug
Length, 9-AVP2-006, 6mm
Diameter, 6mm Plug Length, 9-
AVP2-008, 8mm Diameter,
7mm Plug Length, 9-AVP2-
010, 10mm Diameter, 7mm
Plug Length, 9-AVP2-012,
12mm Diameter, 9mm Plug
Length, 9-AVP2-014, 14mm
Diameter, 10mm Plug Length,
9-AVP2-016, 16mm Diameter,
12mm Plug Length, 9-AVP2-
018, 18mm Diameter, 14mm
Plug Length, 9-AVP2-020,
20mm Diameter, 16mm Plug
Length, 9-AVP2-022, 22mm
Diameter, 18mm Plug Length
Group 8f: Liquid
ids
ev3 Australia Pty Ltd
EE018 Onyx DSMO/Liquid Embolic Material 18, 20, 34 (formulations) $2,300.00
EE019 Onyx System DSMO Liquid Embolic Material 500 Formulation $4,950.00
Group 9: Long-term Vascular Access Devices
Group 9a: Percutaneous Catheters – single lumen
Cook Medical Australia Pty Ltd
WC111 Cook Central Venous Catheterisation Kit Single lumen peripherally inserted catheter 3 - 6 Fr, 40 - 80cm $135.00
set, which may include catheter, standard
or micropuncture introducer set
Prostheses List by Category, Groups and Sponsor Page 900 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
WC113 Cook Central Venous Catheterisation Kit Single lumen peripherally inserted catheter Fr 3, 4, 5 and Length 50 and $116.00
set, includes catheter, needle, J-wire, 60cm
MPIS wire and introducer
WC116 Cook Central Venous Long Term Cook TPN single lumen catheter Fr 3, length 55, 65cm; Fr 4, $119.00
Catheter length 65cm, Fr 6.5, 9.5, length
90cm
WC117 Cook Central Venous Long Term Cook TPN single lumen catheter set Fr 3, length 55; Fr 4, length $119.00
Catheter 65cm, Fr 6.5 length 65, 90cm,
Fr 9.5, length 90cm
WC201 Cook Central Venous Catherisation Kits Turbo-Flo Peripherally Inserted Central 4Fr - 60cm and 5Fr - 60cm $135.00
Venous Catheter Set, Single Lumen
Polyurethane with Micropuncture Peel-
Away Sheath Introducer and Wire Guide
WC202 Cook Central Venous Catheterisation Turbo-Flo Peripherally Inserted Central 5Fr - 60cm $124.00
Kits Venous Catheter Set, Single Lumen
Polyurethane with Peel Away Sheath
Introducer and Wire Guide
WC204 Cook Central Venous Catheterisation Turbo-Flo Over-The-Wire Peripherally 4Fr - 60cm and 5Fr -60cm $135.00
Kits Inserted Central Venous Catheter Set,
Single Lumen Polyurethane with
Micropuncture Peel-Away Sheath
Introducer and Wire Guide
WC206 Cook Central Venous Catheterisation PICC Peripherally Inserted Central 3Fr - 50cm and 4Fr and 5Fr - $244.00
Kits Venous Catheter Set, Single Lumen 60cm
Silicone with Micropuncture Peel-Away
Sheath Introducer and Nitinol Wire Guide
WC207 Cook Central Venous Catheterisation PICC Peripherally Inserted Central 3Fr - 50cm and 4Fr and 5Fr - $135.00
Kits Venous Catheter Set, Catheter without 60cm
Clamp, Single Lumen Silicone with
Micropuncture Peel-Away Sheath
Introducer and Wire Guide
Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA008 Single Lumen Right Atrial Catheter Central Venous Catheters constructed of 84cm, 1.3mm OD, 94cm $54.00
radiopaque silicone rubber 2.2mm OD, 94cm 3.2mm OD
Prostheses List by Category, Groups and Sponsor Page 901 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Mayo group
CM011 Arrow Peripherally Inserted Central Range of Polyurethane single lumen 3 Fr, range of lengths $119.00
Catheterisation Sets peripherally inserted central catheters with
or without stylet
CM012 Arrow Peripherally Inserted Central Range of Polyurethane single lumen 4 Fr, range of lengths $119.00
Catheterisation Sets peripherally inserted central catheters with
or without stylet
CM013 Arrow Peripherally Inserted Central Range of Polyurethane double lumen 4 and 5 Fr, range of lengths $119.00
Catheterisation Sets peripherally inserted central catheters with
or without stylet
cu
Bard Australia Pty Ltd
BA049 Broviac Catheters Without VitaCuff, silicone 2.4 - 6.6 French Catheter $180.00 $185.00
BA050 Hickman Catheters Single Without VitaCuff, silicone 7 - 14.4F French Catheter $252.00 $260.00
BA125 Groshong Central Venous Catheter Closed-Ended CVC, Single Lumen 5.5Fr - 9.5Fr $323.00 $333.00
BA129 Groshong Peripherally Inserted Central Closed-Ended PICC, Single Lumen 3Fr - 5Fr $175.00 $180.00
Catheter
i
Mayo group
CM016 ARROWg+ard Blue Single Lumen A polyurethane central venous catheter CS-24301 - 16g x 20cm, $80.00
Central Venous Catheters with Blue FlexTip (of various lengths, sizes Single Lumen, Adult
and lumen configurations) with CS-24306E-16g x 16cm,
antimicrobial impregnation (chlorhexidine Single Lumen Adult
and silver sulphadiazine) on the external CS-24701 - 14g 20 cm, Single
surface of the polyurethane catheter body. Lumen Adult
CS-24706E -14g x 16cm,
Single Lumen, Adult
pi
Bard Australia Pty Ltd
BA184 PowerPICC Single Lumen Power Injector Catheter 5F, 55cm length $165.00
Cook Medical Australia Pty Ltd
WC279 Turbo-Ject Peripherally Inserted Central 4/5 Fr Single Lumen Polyurethane PICC 4 and 5 French, 60 cm catheter $165.00
Catheter Set ( Single Lumen) with Micropuncture Peel-Away Sheath length, single lumen catheter
Introducer and Echogenic needle
Prostheses List by Category, Groups and Sponsor Page 902 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Mayo group
CM022 Arrow single lumen pressure injectable Single lumen pressure injectable 4 Fr x 50cm, Single lumen $165.00
peripherally inserted central catheter peripherally inserted central catheter
(PICC) set (PICC) set
Group 9b1: Percutaneous Catheters – Multiple lumen
Bard Australia Pty Ltd
BA130 Groshong Peripherally Inserted Central Closed-Ended PICC, Multiple Lumen 3Fr - 5Fr $211.00 $217.00
Catheter
Cook Medical Australia Pty Ltd
WC112 Cook Central Venous Catheterisation Kit Double or triple lumen peripherally inserted 3 - 8 Fr 40 - 80cm $204.00
catheter set, which may include catheter,
standard or micropuncture introducer set
WC114 Cook Central Venous Catheterisation Kit Double lumen peripherally inserted Fr 6, 7 and Length 58 and $148.00
catheter set, includes catheter, needle, J- 60cm
wire, MPIS wire and introducer
WC118 Cook Central Venous Long Term Cook TPN double lumen catheter Fr 5, length special; Fr 7, length $119.00 $183.00
Catheter 65cm, Fr 9 length 80, 90cm,
Fr 12, length special
WC119 Cook Central Venous Long Term Cook TPN double lumen catheter set Fr 7, length 65cm, Fr 9 length $164.00 $228.00
Catheter Set 90cm, Fr 12, 90, special
WC203 Cook Central Venous Catherisation Kits Turbo-Flo Peripherally Inserted Central 5Fr - 60cm $148.00
Venous Catheter Set, Dual Lumen
Polyurethane with Peel-Away Sheath
Introducer and Wire Guide
WC205 Cook Central Venous Catheterisation Turbo-Flo Over-The Wire Peripherally 5Fr - 60cm $159.00
Kits Inserted Central Venous Catheter Set,
Dual Lumen Polyurethane with
Micropuncture Peel-Away Sheath
Introducer and Wire Guide
Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA019 Mahurkar 12Fr Triple Lumen Catheter Mahurkar 12Fr Triple Lumen Catheter 12Fr - 13cm, 16cm, 19cm & $230.00
Curved Extension Kit 24cm lengths available
Prostheses List by Category, Groups and Sponsor Page 903 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
KA020 Mahurkar 13.5Fr Q-Plus Dual Lumen Mahurkar 13.5Fr Q-Plus Curved 13.5Fr - 13.5cm, 16cm, 19cm $127.00
Catheter Extension Double Lumen Catheter Kit & 24cm lengths available
cu
Bard Australia Pty Ltd
BA051 Hickman Catheters Dual Without VitaCuff, silicone 7 - 9 French Catheter $350.00 $361.00
BA052 Hickman Catheters Triple Without VitaCuff, silicone 13.5 French Catheter $415.00 $427.00
BA126 Groshong Central Venous Catheter Closed-Ended CVC, Multiple Lumen 5.5Fr - 9.5 Fr $376.00 $387.00
BA209 HemoStar Long Term Haemodialysis Dialysis Catheter, Multiple Lumen 14.5Fr - 16Fr $485.00
Catheter
Medical Specialties Australia Pty Ltd
MS009 Catheterisation kits(Horizon Medical) Central Venous Catheter - right atrial 2.7 -14F $417.00
catheter, silicone
cu, i
Gambro Pty Ltd
GA001 'GamCath Dolphin Protect HighFlow 'Haemodialysis catheter with a modified '109585 - 13Fr x 15cm double $190.00
Haemodialysis Catheter Kit anti-thrombogenic surface (polymer system lumen: 109584 - 13FRx 20cm
of polydimethysilxane blocks) and a non- double lumen, 109705 - 13Fr x
release anti-microbial coating (Bismith 25cm double lumen; 109706 -
copolymer film) on internal and external 13Fr x 15cm curved double
surfaces of catheter. lumen; 109707 - 13Fr x 20cm
curved double lumen.
i
Cook Medical Australia Pty Ltd
WC230 Cook Spectrum CVC Catheter 3 Lumen Triple lumen CVC line with antibiotic 5Fr, 7Fr, 9Fr $120.00
with antibiotic impregnation impregnation
WC231 Cook Spectrum 5 Lumen CVC Catheter 5 lumen CVC with antibiotic impregnation 10Fr $180.00
with antibiotic impregnation
Prostheses List by Category, Groups and Sponsor Page 904 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Mayo group
CM017 ARROWg+ard Four & Five Lumen A polyurethane central catheter with Blue CS-22854E - 8.5 Fr x 16cm, $170.00
Central Venous Catheters FlexTip (of various lengths, sizes and Quad Lumen
lumen configurations) with antimicrobial CS-25854E - 8.5Fr x 20cm,
impregnation (chlorhexidine and silver Quad Lumen
sulphadiazine) on the external surface of CS-22855 - 8.5 x 16cm, Five
the polyurethane catheter material Lumen
CS-25855 - 8.5Fr x 20cm,
Five Lumen
CM018 ARROWg+ard Blue Double & Triple A polyurethane central venous catheter CS-24402 - 4Fr x13cm, Dual $110.00
Lumen Central Venous Catheters with Blue FlexTip (of various lengths, sizes Lumen CS-22502 -5FR x 5cm,
and lumen configurations) with Dual Lumen CS-25402 - 4Fr
antimicrobial impregnation (chlorhexidine x 8cm, Dual Lumen CS-25502
and silver sulphadiazine) on the external - 5Fr x 12cm, Dual Lumen
surface of the polyurethane catheter CS-22702E - 7Fr x 16cm,
material Double Lumen CS-26702 -
7Fr x 20cm, Double Lumen
CS-27702E - 7Fr x 20cm,
Double Lumen CS-25553 -
5.5Fr x 8cm, Triple Lumen CS-
22703E - 7Fr x 16cm, Triple
Lumen CS-26553 -5.5Fr x
13cm, Triple Lumen CS-
24703E - 7Fr x 30cm, Triple
Lumen
CS-25703E - 7Fr x 20cm,
Triple Lumen
CM019 ARROWg+ard Blue Plus QUAD Lumen Central Venous Catheters (of Various CS-42854E - 8.5Fr x 16cm, $170.00
Central Venous Catheters lengths, sizes and lumen configurations with Quad Lumen CS-45854E -
antimicrobial impregnation on:1. The 8.5Fr x 20cm, Quad Lumen
external indwelling surface of catheter
material (chorhexidine and silver
sulphadiazine) 2. The entire internal fluid
pathway including catheter, extension-lines
and hubs (chlorhexidine acetate)
Prostheses List by Category, Groups and Sponsor Page 905 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
CM020 ARROWg+ard Blue Plus Double & Double & Triple Lumen Central Venous CS-45802E - 8 Fr x 20cm, $120.00
Triple Lumen Central Venous Catheters Catheters (of various lengths sizes and Dual Lumen CS-46702E - 7Fr
lumen configurations) with antimicrobial x 20cm, Dual Lumen CS-
impregnation on: 1. The external indwelling 47702E - 7Fr x 20cm, Dual
surface of catheter material (chlorhexidine Lumen CS-42703E - 7Fr x
and silver sulphadiazine) 2. The entire 16cm, Triple Lumen CS-
internal fluid pathway including catheter, 45703E - 7Fr x 20cm, Triple
extension-lines and hubs (chlorhexidine Lumen
acetate)
pi
Bard Australia Pty Ltd
BA182 PowerPICC Triple Lumen Power Injector Catheter 6F, 55cm length $230.00
BA183 PowerPICC Dual Lumen Power Injector Catheters 5F, 6F, 55cm Length $225.00
Cook Medical Australia Pty Ltd
WC280 Turbo-Ject Peripherally Inserted Central 4/5 Fr Double Lumen Polyurethane PICC 4 and 5 French, 60 cm $225.00
Catheter Set ( Double Lumen) with Micropuncture Peel-Away Sheath Catheter length, double lumen
Introducer and Echogenic needle catheter
Mayo group
CM021 Arrow double lumen pressure injectable Arrow double lumen pressure injectable 5Fr x 50cm, Double Lumen $225.00
peripherally inserted central catheter PICC (peripherally inserted central
(PICC) set catheter) set
CM024 Arrow Pressure Injectable Triple-Lumen Pressure injectable triple lumen PICC 6Fg x 50cm, triple lumen $230.00
PICC. (Peripherally Inserted Central Catheter) Set
Group 9b2: Percutaneous Catheters – Multiple lumen for haemodialysis
Bard Australia Pty Ltd
BA211 Haemodialysis Catheters Haemodialysis Catheters, multiple lumen 11Fr - 13.5Fr $130.00
Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA007 Mahurkar Subclavian Catheter Kit Chronic haemodialysis, long term vascular 36, 40cm $184.00
access for haemodialysis and apheresis.
Constructed of radiopaque silicone rubber.
Prostheses List by Category, Groups and Sponsor Page 906 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
KA012 Mahurkar Subclavian Catheter Kit Acute haemodialysus, short term vascular 11.5 Fr, 13.5cm Straight Exten, $130.00
access. Catheters constructed of 11.5 Fr, 16cm Straight Exten,
radiopaque polyurethane. Tips are made of 11.5 Fr 19.5cm Straight Exten,
polyvinyl chloride and are more 10 Fr 12cm Curved Exten, 10
radiopaque than the rest of the catheter. Fr 15cm Curved Exten, 11.5 Fr
16cm Curved Exten, 11.5 Fr
16cm Curved Exten, 11.5 Fr
19.5cm Curved Exten
KA014 Mahurkar Maxid Catheters Catheters constructed of radiopaque Size, 38, 43, 48, 53cm $305.00
polyurethans, high kink resistant. The
arterial lumen is shorter than the venous
lumen at the catheter's distal end in order
to reduce recirculation during haemodialysis
cu
Bard Australia Pty Ltd
BA040 VitaCuff, Hickman Catheter Dialysis/Apheresis catheter, dual lumen, 36-45cm overall length $349.00 $359.00
silicone
BA140 HemoGlide Long Term Haemodialysis Dialysis Catheter, Multiple Lumen 14.5 Fr $357.00 $368.00
Catheter
BA159 HemoSplit Long Term Haemodialysis HemoSplit is a carbothane long term dual Standard Kit (straight 15cm to $485.00 $500.00
catheter lumen catheter used to provide vascular 42cm and pre-curved 19cm to
access for haemodialysis. 31cm), Microintroducer Kits
(straight 19cm to 42cm & pre-
curved 19cm to 31cm)
Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA011 Permcath Dual Lumen Catheter Chronic Haemodialysis, long term vascular 36cm, 40cm $330.00
access for haemodialysis and aphaeresis.
Constructed of radiopaque silicone rubber.
KA013 Permcath Dual Lumen Catheter Chronic haemodialysis, long term vascular 28, 36, 40cm $290.00
access for haemodialysis and aphaeresis.
Constructed of radiopaque silicone rubber.
Prostheses List by Category, Groups and Sponsor Page 907 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
KA018 Palindrome Haemodialysis catheter 14.5Fr. 19, 23, 28, 33, 55cm $485.00 $600.00
Insertion Lengths, with 36, 40,
45, 50, 72cm Overall length,
with side slots, symmetric tip
Mayo group
CM023 Arrow Cannon II Plus Chronic Dual Lumen, Retrograde Tunneled, 15Fg x 24 - 55cm $450.00
Haemodialysis Catheter Set Cuffed, Tip First, Chronic Haemodialysis
Catheter Set
Tekmed Pty Ltd
TK005 Medcomp Long Term Catheter sets for ASH, TESIO-BioFlex with cuff 10, 14 French 24,28,32 & $450.00
Haemodialysis 36cm lengths
TK006 Medcomp Long Term Catheter sets for HemoFlow HFS-Carbothane with cuff 14.5 French 24,28,32 & $295.00
Haemodialysis 36cm lengths
i
Mayo group
CM015 ARROWg+ard Blue Haemodialysis Haemodialysis Catheters (of various CS-22122 - 12Fr 16cm, Dual $195.00
Catheters lengths, sizes and lumen confiurations) with Lumen CS-22123 – 12Fr
antimicrobial impregnation (chlorhexidine 16cm, Triple Lumen CS-25122
and silver sulphadiazine) on the external – 12Fr x 20cm, Dual Lumen
surface of the polyurethane catheter CS-22142CF – 14Fr x 15cm,
material. Dual Lumen, Curved, Firm CS-
22142F – 14Fr x 15cm, Dual
Lumen Firm CS-25122 – 12Fr
x 20cm, Double Lumen CS-
25123 – 12Fr x 20cm, Triple
Lumen CS- 25142CF – 14Fr x
20cm, Double Lumen, Curve,
Firm CS-25142F – 14Fr x
20cm, Double Lumen, Firm
CS-26142F – 14Fr x 25cm,
Double Lumen, Firm CU-
22122 – 12Fr x 16cm, Double
Lumen, Curved CU-23122 –
12Fr x 13cm, Double Lumen,
Curved CU-25122 – 12Fr x
20cm, Double Lumen, Curved
Prostheses List by Category, Groups and Sponsor Page 908 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 9c: Infuser Ports – single chamber
B Braun Australia Pty Ltd
BB170 Celsite Access Port for pain relief Composition - polysulphone. Kit includes Diameter of septum:11.7mm. $495.00
tunnelling rod, filter, connectors, needles, Height: 11.5mm. Dimension:
syringe, tuohy needle 25.8 x 37.8mm
Bard Australia Pty Ltd
BA056 Subcutaneous Ports Titanium or MRI Implantable Port, Open- 6FR - 9.6Fr $500.00
Ended Catheter Single Chamber
BA057 Groshong Subcutaneous Ports Titanium or MRI Implatable Port, Closed- 7Fr - 8 Fr $521.00
Ended Catheter, Single Chamber
BA060 Subcutaneous Ports Low-Profile Titanium or MRI Implantable 6 - 6.6 French Catheter $534.00 $653.00
Port, Open-Ended Catheter Single
Chamber
BMDi Tuta Healthcare Pty Ltd
TT001 Paragon Ambulatory Drug Infusion System The top of the Paragon infuser is made of Infuser - 100mL Administration $534.00
acetyl with stainless steel parts; the bottom Sets - 0.50mL, 1mL, 2mL,
is made of clear polycarbonate. Diam: 4mL, 10mL, 50mL, 100mL, or
10cm Height: 5.8cm. Administration Sets 200mL/hr
- made from PVC and acrylic
components.
Cook Medical Australia Pty Ltd
WC093 Cook Implantable Injection/Infusion Ports Petite or Standard, single or multiple 3 - 12 Fr pre-attached or $500.00
chamber Polysulfone Port which may detached catheter or valve system
include micropuncture or standard
introducer set
WC094 Cook Implantable Injection/Infusion Ports Mini or Petite or Standard, single or 3 - 12 Fr pre-attached or $534.00
multiple chamber titanium Port which may detached catheter or valve system
include micropuncture or standard
introducer set
WC115 Cook Implantable Injection/Infusion Port Mini, single or multiple chamber titanium 3 - 12 Fr pre-attached or $534.00 $652.00
Port which may include micropuncture detached catheter or valve
introducer set system
Prostheses List by Category, Groups and Sponsor Page 909 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Denward Dell Pty Ltd TA Surimex
DW003 Jet Port Plus Set - Vascular Access Port Implantable injection / infusion port system: Port: Diameter: 28.0mm, $375.00
port chamber with silicone membrane; Height: 12.3mm; Catheter: 6.6
connectable polyurethane catheter; and French, Length: 750mm
introducer kit.
DW004 Jet Port Plus Low Profile Peripheral Set Implantable injection / infusion port system: Port: Length: 24.0mm, Width: $420.00
- Vascular Access Port low profile port chamber with silicone 20.5mm, Height: 10.3mm
membrane; connectable polyurethane Catheter: 6.6 French, Length:
catheter; and introducer kit 750mm
Medical Specialties Australia Pty Ltd
MS014 Injection/Infusion Ports Sterile Plastic/titanium, single lumen 5-15F $771.00
MS016 Injection/Infusion Ports Sterile Plastic/titanium, paediatric 5, 6, 7,8, 9.6F $771.00
pi
Bard Australia Pty Ltd
BA181 PowerPort Sterile Titanium or MRI, subcutaneous One size, OF Catheter $630.00
implanted port with attachable radiopaque
open ended ChronoFlex polyurethane
catheter, intermediate kit
BA208 PowerPort with Groshong Catheter Titanium or MRI implantable Port, 8Fr $630.00 $750.00
Closed-Ended Catheter, Single Chamber
Denward Dell Pty Ltd TA Surimex
DW006 T-Port Contrast set - Vascular access Injection infusion port system: titanium port 6163653077: Port Base 27mm $630.00
port. chamber with silicone membrane: x 13mm, CD 1.3 x 2.2mm, CL
connectable polyurethane catheter; 75cm. 6163652087: PB
introducer kit. 27mm x 13mm, CD 1.6 x
2.6mm, CL 75cm.
6163663077: PB 23mm x
10mm, CD 1.3 x 2.2mm, CL
75cm.6163662087: PB 23mm
x 10mm, CD 1.6 x 2.6mm, CL
75cm.
DW007 pfm Contrast Port High pressure injection port system: plastic Port: length 32.1mm, width $630.00
or plastic/titanium port with silicone 23.6mm, height 13.2mm.
mebrane; connectable polyurethane Catheter: 6.6 or 8.4 French,
catheter; introducer kit length 750mm
Prostheses List by Category, Groups and Sponsor Page 910 of 911
VASCULAR CAG
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 9d: Infuser Ports – multiple chambers
Bard Australia Pty Ltd
BA059 Dual Lumen Subcutaneous Ports Silicone, Polyurethane or ChronoFlex 7 - 10 French Catheter $805.00
Open-ended Catheter
Cook Medical Australia Pty Ltd
WC164 Cook Implantable Injection/Infusion Ports Dual or Multiple Chamber Titanium Port 3 - 12 Fr pre-attached or $762.00
which may include micropuncture or detached catheter or valve system
standard introducer set
Medical Specialties Australia Pty Ltd
MS015 Injection/Infusion Ports Sterile Plastic/titanium, dual lumen 10, 10.5, 12F $786.00
Grand Total: 9306 Records
Prostheses List by Category, Groups and Sponsor Page 911 of 911
PART B - Human Tissue List August 2011
1 - OPHTHALMIC
Billing Code Facility Minimum Benefit Maximum Benefit
Amniotic Membrane
LEM03 Lions Eye Donation Service $770.00
Cornea
LEM01 Lions Eye Donation Service $2,000.00
LEN01 Lions NSW Eye Bank $1,633.00
LEW01 Lions Eye Bank of Western Australia $2,500.00
QEB01 Queensland Eye Bank $2,100.00
SAE01 The Eye Bank of South Australia $1,000.00
Cornea for Endothelial Lamellar Keratoplasty
LEM04 Lions Eye Donation Service $2,660.00
Cornea For Lamellar
LEN03 Lions NSW Eye Bank $980.00
Sclera
LEM02 Lions Eye Donation Service $150.00
LEN02 Lions NSW Eye Bank $245.00
LEW02 Lions Eye Bank of Western Australia $250.00
QEB02 Queensland Eye Bank $298.00
SAE02 The Eye Bank of South Australia $60.00
Conduit - Aortic
TBV56 Donor Tissue Bank of Victoria $1,013.00
Conduit - Aortic + Valve
QHV09 The Prince Charles Hospital - Queensland Heart Valve Bank $5,499.00
Conduit - Arterial
SHV03 Sydney Heart Valve Bank, St. Vincent's Hospital $987.00
Conduit - Pulmonary
TBV03 Donor Tissue Bank of Victoria $1,012.00
Conduit - Pulmonary + Valve
QHV08 The Prince Charles Hospital - Queensland Heart Valve Bank $5,499.00
Page 1 of 15
CARDIO-THORACIC
Billing Code Facility Minimum Benefit Maximum Benefit
Conduit - Pulmonary large
QHV07 The Prince Charles Hospital - Queensland Heart Valve Bank $1,448.00
Conduit - Pulmonary small
QHV06 The Prince Charles Hospital - Queensland Heart Valve Bank $1,448.00
Patch - Mitral
QHV03 The Prince Charles Hospital - Queensland Heart Valve Bank $1,448.00
Patch - Pericardium
QHV05 The Prince Charles Hospital - Queensland Heart Valve Bank $1,448.00
Patch - Tricuspid
QHV04 The Prince Charles Hospital - Queensland Heart Valve Bank $1,448.00
Pericardium
TBV50 Donor Tissue Bank of Victoria $490.00
Thoracic Aorta
QHV11 The Prince Charles Hospital - Queensland Heart Valve Bank $1,450.00
Valve - Aortic
QHV01 The Prince Charles Hospital - Queensland Heart Valve Bank $5,499.00
RPH01 Royal Perth Hospital T/A Heart Valve Bank $6,406.00
SHV01 Sydney Heart Valve Bank, St. Vincent's Hospital $5,350.00
TBV01 Donor Tissue Bank of Victoria $6,598.00
Valve - Mitral
QHV10 The Prince Charles Hospital - Queensland Heart Valve Bank $5,499.00
Valve - Pulmonary
QHV02 The Prince Charles Hospital - Queensland Heart Valve Bank $5,499.00
RPH02 Royal Perth Hospital T/A Heart Valve Bank $6,406.00
SHV02 Sydney Heart Valve Bank, St. Vincent's Hospital $5,350.00
TBV02 Donor Tissue Bank of Victoria $6,598.00
Autologous Chondrocyte Implant
MVS22 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $9,538.00
Autologous Chondrocytes Implant and Matrix
ORT01 Orthogen Australia Pty Ltd $11,400.00
VAP01 Verigen Australia Pty Ltd $11,400.00
Page 2 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
Autologous Skull Flap
MVS23 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $1,396.00
QBB60 The Queensland Bone Bank $1,568.00
RNB02 Hunter New England Bone Bank $1,470.00
Autologous Skull Flap - processed
QBB56 The Queensland Bone Bank $1,986.00
Bone - Cancellous Bone Matrix, Lyophilised 40cc
TBV52 Victorian Institute of Forensic Medicine $619.00
Bone - Cancellous Bone Matrix, Lyophilised 80cc
TBV53 Victorian Institute of Forensic Medicine $1,237.00
Bone - Cancellous Crunch 15cc
NBB62 New South Wales Bone Bank $903.00
Bone - Cancellous Crunch 30cc
NBB61 New South Wales Bone Bank $1,647.00
Bone - Cancellous Crunch 60cc
NBB60 New South Wales Bone Bank $2,498.00
Bone - Cancellous Cubes (6) Freeze Dried
QBB09 The Queensland Bone Bank $1,609.00
Bone - Cancellous Strips (2) Freeze Dried
QBB10 The Queensland Bone Bank $680.00
Bone - Chips/cubes 40cc
TBV09 Donor Tissue Bank of Victoria $973.00
Bone - Chips/cubes 80cc
TBV10 Donor Tissue Bank of Victoria $1,853.00
Bone - Cortico-Cancellous Crunch (40/60) 15cc
NBB65 New South Wales Bone Bank $903.00
Bone - Cortico-Cancellous Crunch (40/60) 30cc
NBB64 New South Wales Bone Bank $1,647.00
Bone - Cortico-Cancellous Crunch (40/60) 60cc
NBB63 New South Wales Bone Bank $2,498.00
Page 3 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
Bone – Cortico-Cancellous Crunch <20g Sterile
AUB08 Australian Biotechnologies $2,215.00
Bone – Cortico-Cancellous Crunch <30g
AUB04 Australian Biotechnologies $2,070.00
Bone - Demineralised Bone Matrix, Lyophilised 10g
TBV55 Donor Tissue Bank of Victoria $1,049.00
Bone - Demineralised Bone Matrix, Lyophilised 5g
TBV54 Donor Tissue Bank of Victoria $524.00
Bone - Milled <30g Freeze Dried
PBT37 Perth Bone and Tissue Bank $750.00
Bone - Milled <30gr (60cc equivalent)
PBT08 Perth Bone and Tissue Bank $2,134.00
Bone - Milled >50gr (100cc equivalent)
PBT10 Perth Bone and Tissue Bank $3,135.00
Bone - Milled 20g
QBB45 The Queensland Bone Bank $1,993.00
Bone - Milled 20g Freeze Dried
QBB03 The Queensland Bone Bank $2,524.00
Bone - Milled 30 - 50gr (60 - 100cc equivalent)
PBT09 Perth Bone and Tissue Bank $2,734.00
Bone - Milled 30-50g Freeze Dried
PBT38 Perth Bone and Tissue Bank $900.00
Bone - Milled 40cc
TBV11 Donor Tissue Bank of Victoria $1,165.00
Bone - Milled 80cc
TBV12 Donor Tissue Bank of Victoria $2,084.00
Bone - Milled Femoral Head
AUB02 Australian Biotechnologies $2,457.00
Bone - Ronguered Chips
QBB68 The Queensland Bone Bank $2,022.00
Page 4 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
Bone - Ronguered Chips Freeze Dried
QBB67 The Queensland Bone Bank $2,524.00
Bone Plug/Dowel - Cancellous
NBB05 New South Wales Bone Bank $1,224.00
PBT03 Perth Bone and Tissue Bank $500.00
TBV07 Donor Tissue Bank of Victoria $691.00
Bone Plug/Dowel - Tricortical
TBV08 Donor Tissue Bank of Victoria $750.00
Cartilage - costal segments
PBT11 Perth Bone and Tissue Bank $300.00
QBB12 The Queensland Bone Bank $210.00
TBV17 Donor Tissue Bank of Victoria $390.00
Cortical Strut
AUB05 Australian Biotechnologies $2,451.00
QBB52 The Queensland Bone Bank $441.00
TBV14 Donor Tissue Bank of Victoria $763.00
Cortical Strut >15 - 20cm
PBT07 Perth Bone and Tissue Bank $2,284.00
Cortical Strut >20cm
PBT48 Perth Bone and Tissue Bank $2,532.00
Cortical Struts 10-15cm
PBT06 Perth Bone and Tissue Bank $1,914.00
Disc - Freeze Dried
QBB04 The Queensland Bone Bank $713.00
Elbow - joint
QBB14 The Queensland Bone Bank $2,205.00
TBV18 Donor Tissue Bank of Victoria $5,247.00
Fascia Lata
NBB09 New South Wales Bone Bank $922.00
TBV21 Donor Tissue Bank of Victoria $806.00
Fascia Lata - Large (15cm x 10cm)
Page 5 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
PBT15 Perth Bone and Tissue Bank $1,590.00
Fascia Lata - per sq cm
QBB11 The Queensland Bone Bank $5.00
Fascia Lata - Small (10cm x 5cm)
PBT16 Perth Bone and Tissue Bank $825.00
Femoral Head
ACT01 ACT Bone Bank $2,432.00
APH01 The Avenue Private Hospital Bone Bank $1,131.00
AUB03 Australian Biotechnologies $2,354.00
CSA01 Rachel Forster Bone Bank $802.00
DHR01 Barwon Health Bone Bank $2,432.00
HBB01 The Hobart Private Hospital Bone Bank $2,113.00
LPH01 Lingard Private Hospital Bone Bank $1,103.00
MMH01 Mater Misericordiae Hospital Bone Bank Theatres $400.00
MVS05 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $1,595.00
NBB16 New South Wales Bone Bank $2,354.00
PBT22 Perth Bone and Tissue Bank $2,432.00
QBB27 The Queensland Bone Bank $2,163.00
RNB01 Hunter New England Bone Bank $2,050.00
SVN01 Mater Hospital $731.00
TBV26 Donor Tissue Bank of Victoria $2,354.00
Femoral Head - Autologous
QBB61 The Queensland Bone Bank $2,163.00
Femoral Head - Freeze Dried
QBB28 The Queensland Bone Bank $2,163.00
Femoral Hemi-condyle
NBB59 New South Wales Bone Bank $2,271.00
PBT21 Perth Bone and Tissue Bank $2,217.00
TBV46 Donor Tissue Bank of Victoria $1,206.00
Femoral Rings
NBB17 New South Wales Bone Bank $1,606.00
PBT24 Perth Bone and Tissue Bank $1,606.00
Page 6 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
QBB30 The Queensland Bone Bank $1,591.00
Femoral Rings - Freeze Dried
QBB31 The Queensland Bone Bank $670.00
Femoral Shaft
QBB23 The Queensland Bone Bank $2,247.00
Femoral Shaft - Freeze Dried
QBB66 The Queensland Bone Bank $2,811.00
Femoral Shaft - Half
NBB57 New South Wales Bone Bank $2,778.00
Femoral Shaft - Middle Third
NBB13 New South Wales Bone Bank $2,507.00
TBV24 Donor Tissue Bank of Victoria $2,137.00
Femoral Shaft - Segment
NBB56 New South Wales Bone Bank $1,687.00
Femoral Shaft - Third
NBB55 New South Wales Bone Bank $1,687.00
Femoral Shaft/Tibial Shaft - Middle third
PBT19 Perth Bone and Tissue Bank $2,791.00
Femur - Distal (Shaft & Condyles)
MVS02 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
PBT17 Perth Bone and Tissue Bank $3,354.00
TBV22 Donor Tissue Bank of Victoria $3,854.00
Femur - Distal Half
NBB10 New South Wales Bone Bank $2,778.00
QBB20 The Queensland Bone Bank $2,800.00
Femur - Distal third
NBB11 New South Wales Bone Bank $2,606.00
Femur - Entire
MVS03 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB12 New South Wales Bone Bank $6,200.00
QBB22 The Queensland Bone Bank $4,268.00
Page 7 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
TBV23 Donor Tissue Bank of Victoria $6,455.00
Femur - Entire head removed
PBT18 Perth Bone and Tissue Bank $5,683.00
Femur - Proximal (shaft, trochanter, neck)
MVS04 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
PBT20 Perth Bone and Tissue Bank $3,354.00
TBV25 Donor Tissue Bank of Victoria $3,826.00
Femur - Proximal half
NBB15 New South Wales Bone Bank $2,921.00
QBB25 The Queensland Bone Bank $3,020.00
Femur - Proximal third
NBB14 New South Wales Bone Bank $1,306.00
Femur - Proximal with femoral head
TBV51 Donor Tissue Bank of Victoria $3,713.00
Fibula - Entire
MVS07 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB18 New South Wales Bone Bank $6,041.00
PBT25 Perth Bone and Tissue Bank $2,577.00
QBB32 The Queensland Bone Bank $2,651.00
TBV27 Donor Tissue Bank of Victoria $6,222.00
Fibula - Segment
NBB54 New South Wales Bone Bank $2,359.00
PBT28 Perth Bone and Tissue Bank $1,422.00
Fibula - Segment (12cm)
MVS14 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
TBV29 Donor Tissue Bank of Victoria $1,055.00
Fibula - Segment (6cm)
MVS13 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
TBV28 Donor Tissue Bank of Victoria $691.00
Fibular Shaft
TBV30 Donor Tissue Bank of Victoria $2,193.00
Page 8 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
Hemipelvis - Acetabulum
NBB21 New South Wales Bone Bank $2,905.00
PBT29 Perth Bone and Tissue Bank $2,841.00
QBB33 The Queensland Bone Bank $2,762.00
TBV31 Donor Tissue Bank of Victoria $2,992.00
Hemipelvis - Complete
MVS08 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB24 New South Wales Bone Bank $6,500.00
PBT30 Perth Bone and Tissue Bank $5,228.00
QBB37 The Queensland Bone Bank $4,268.00
TBV32 Donor Tissue Bank of Victoria $6,788.00
Hemipelvis - iliac crest
NBB22 New South Wales Bone Bank $2,705.00
PBT31 Perth Bone and Tissue Bank $1,134.00
QBB34 The Queensland Bone Bank $2,478.00
TBV33 Donor Tissue Bank of Victoria $2,705.00
Hemipelvis - Tricortical iliac wedge
NBB23 New South Wales Bone Bank $1,195.00
PBT32 Perth Bone and Tissue Bank $1,031.00
QBB35 The Queensland Bone Bank $1,195.00
TBV34 Donor Tissue Bank of Victoria $1,042.00
Hemipelvis - Tricortical iliac wedge Freeze Dried
QBB36 The Queensland Bone Bank $735.00
Humeral Head
TBV37 Donor Tissue Bank of Victoria $1,653.00
Humeral Head Addition
NBB26 New South Wales Bone Bank $1,545.00
Humeral Shaft
NBB50 New South Wales Bone Bank $3,090.00
QBB39 The Queensland Bone Bank $1,612.00
Humeral Shaft - Half
Page 9 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
NBB51 New South Wales Bone Bank $1,671.00
Humerus - Distal
MVS19 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB25 New South Wales Bone Bank $2,359.00
TBV49 Donor Tissue Bank of Victoria $2,241.00
Humerus - Entire
MVS20 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB29 New South Wales Bone Bank $3,142.00
QBB43 The Queensland Bone Bank $3,035.00
Humerus - Entire with rotator cuff
NBB30 New South Wales Bone Bank $3,182.00
PBT33 Perth Bone and Tissue Bank $3,343.00
Humerus - Proximal
NBB27 New South Wales Bone Bank $2,769.00
PBT35 Perth Bone and Tissue Bank $1,134.00
TBV36 Donor Tissue Bank of Victoria $2,769.00
Humerus - Proximal half with rotator cuff
NBB28 New South Wales Bone Bank $2,778.00
Humerus - Proximal with rotator cuff
MVS09 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
PBT34 Perth Bone and Tissue Bank $2,788.00
TBV35 Donor Tissue Bank of Victoria $2,646.00
Humerus - Ring
NBB53 New South Wales Bone Bank $1,448.00
Ligament - Medial
NBB31 New South Wales Bone Bank $1,781.00
TBV38 Donor Tissue Bank of Victoria $1,781.00
Meniscal Graft
PBT47 Perth Bone and Tissue Bank $1,856.00
Meniscus
QBB05 The Queensland Bone Bank $1,400.00
Page 10 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
TBV40 Donor Tissue Bank of Victoria $1,184.00
Meniscus with Ligaments
TBV39 Donor Tissue Bank of Victoria $2,147.00
Osteotomy Wedge
PBT60 Perth Bone and Tissue Bank $1,031.00
Patella
QBB47 The Queensland Bone Bank $788.00
TBV41 Donor Tissue Bank of Victoria $1,020.00
Patellar unit whole with tibial block
PBT40 Perth Bone and Tissue Bank $2,564.00
Radius
MVS18 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB06 New South Wales Bone Bank $3,024.00
PBT13 Perth Bone and Tissue Bank $1,800.00
QBB15 The Queensland Bone Bank $2,258.00
TBV19 Donor Tissue Bank of Victoria $3,115.00
Radius - Ring
NBB49 New South Wales Bone Bank $1,854.00
Radius - Shaft
NBB47 New South Wales Bone Bank $2,975.00
Rib (5cm)
MVS21 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $382.00
PBT41 Perth Bone and Tissue Bank $300.00
TBV43 Donor Tissue Bank of Victoria $487.00
Spinal Ring
AUB07 Australian Biotechnologies $1,854.00
Tendon
AUB10 Australian Biotechnologies $2,184.00
Tendon - Achilles
NBB01 New South Wales Bone Bank $1,922.00
PBT61 Perth Bone and Tissue Bank $1,985.00
Page 11 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
QBB62 The Queensland Bone Bank $1,922.00
TBV05 Donor Tissue Bank of Victoria $1,024.00
Tendon - Achilles Hemi
QBB65 The Queensland Bone Bank $1,433.00
Tendon - Achilles with bone block
NBB02 New South Wales Bone Bank $2,228.00
PBT01 Perth Bone and Tissue Bank $2,301.00
QBB01 The Queensland Bone Bank $1,922.00
TBV06 Donor Tissue Bank of Victoria $2,085.00
Tendon - Achilles with bone plug
AUB09 Australian Biotechnologies $2,228.00
Tendon - Achilles with machined conical bone block
NBB69 New South Wales Bone Bank $2,728.00
Tendon - EHL
QBB69 The Queensland Bone Bank $1,922.00
Tendon - Gracilis
QBB59 The Queensland Bone Bank $1,922.00
Tendon - Patellar
QBB48 The Queensland Bone Bank $2,055.00
Tendon - Patellar Hemi
QBB63 The Queensland Bone Bank $1,570.00
Tendon - Patellar split with bone plugs
PBT02 Perth Bone and Tissue Bank $1,918.00
Tendon - Patellar with bone plugs
NBB33 New South Wales Bone Bank $2,147.00
TBV42 Donor Tissue Bank of Victoria $2,147.00
Tendon - Patellar with machined conical bone plug
NBB68 New South Wales Bone Bank $2,647.00
Tendon - Patellar with Quads
NBB72 New South Wales Bone Bank $2,184.00
Page 12 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
Tendon - Peroneus Longus
NBB73 New South Wales Bone Bank $2,184.00
Tendon - Semi tendinosis
NBB70 New South Wales Bone Bank $2,185.00
QBB70 The Queensland Bone Bank $1,922.00
Tendon - Single (ant and post tibilias, FDL, EDL, hamstring, gracilis)
PBT46 Perth Bone and Tissue Bank $2,124.00
Tendon - Tibialis Anterior
NBB67 New South Wales Bone Bank $2,184.00
QBB58 The Queensland Bone Bank $1,922.00
TBV57 Donor Tissue Bank of Victoria $2,085.00
Tendon - Tibialis Posterior
NBB71 New South Wales Bone Bank $2,184.00
QBB57 The Queensland Bone Bank $1,922.00
Tibia - Condyles only
TBV47 Donor Tissue Bank of Victoria $1,661.00
Tibia - Distal
MVS17 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
QBB51 The Queensland Bone Bank $1,892.00
TBV48 Donor Tissue Bank of Victoria $2,177.00
Tibia - Plateau (prox 1/3)
NBB35 New South Wales Bone Bank $2,518.00
Tibia - Proximal
NBB36 New South Wales Bone Bank $2,551.00
PBT45 Perth Bone and Tissue Bank $2,635.00
QBB54 The Queensland Bone Bank $2,365.00
Tibia - Proximal 16-25cm
TBV45 Donor Tissue Bank of Victoria $2,468.00
Tibia - Proximal 7-15cm
TBV44 Donor Tissue Bank of Victoria $2,562.00
Tibia - Proximal half
Page 13 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
MVS11 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
Tibia – Proximal third
AUB06 Australian Biotechnologies $2,562.00
Tibia - Proximal with Patella
QBB08 The Queensland Bone Bank $2,800.00
Tibia - Proximal with Patella & Tendon
PBT44 Perth Bone and Tissue Bank $3,979.00
Tibia - Proximal with Patellar Tendon
NBB46 New South Wales Bone Bank $3,986.00
Tibia - Ring
NBB45 New South Wales Bone Bank $1,448.00
Tibia - Whole
MVS16 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB37 New South Wales Bone Bank $4,065.00
QBB55 The Queensland Bone Bank $4,248.00
Tibia - Whole with Patella
QBB64 The Queensland Bone Bank $4,268.00
Tibia - Whole with Patellar Tendon
NBB44 New South Wales Bone Bank $5,455.00
Tibia Shaft
QBB53 The Queensland Bone Bank $992.00
Tibial Shaft
NBB41 New South Wales Bone Bank $3,747.00
Tibial Shaft - half
NBB43 New South Wales Bone Bank $2,450.00
Tibial Shaft - third
NBB42 New South Wales Bone Bank $2,645.00
Tibial Shaft Freeze Dried
QBB02 The Queensland Bone Bank $872.00
Tri Cortical Osteotomy
Page 14 of 15
ORTHOPAEDIC
Billing Code Facility Minimum Benefit Maximum Benefit
NBB66 New South Wales Bone Bank $1,208.00
Ulna
MVS15 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB07 New South Wales Bone Bank $2,787.00
PBT14 Perth Bone and Tissue Bank $1,500.00
QBB16 The Queensland Bone Bank $2,258.00
TBV20 Donor Tissue Bank of Victoria $2,871.00
Ulna - Ring
NBB40 New South Wales Bone Bank $1,854.00
Ulna - Shaft
NBB38 New South Wales Bone Bank $2,450.00
Grand Total: 276 Records
Page 15 of 15
Part C - Other Prostheses August 2011
CARDIO-THORACIC
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
Group 14: Implantable Cardiac Event Recorders
Medtronic Australasia Pty Ltd
MC763 Reveal XT Reveal XT Insertable Cardiac Monitor 61 x 19 x 8 mm with a volume $3,900.00
of 9cc
MC768 Reveal DX Insertable Cardiac Monitor 61 x 19 x 8 mm with a volume $3,900.00
of 9cc
St Jude Medical Australia Pty Ltd
SJ152 SJM Confirm Model DM2102 Implantable cardiac monitor with atrial 6.5cc, 12g $3,900.00
fibrillation monitoring.
SJ159 SJM Confirm Model DM2100 Implantable cardiac monitor 6.5cc, 12g $3,900.00
Page 1 of 3
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
3.2.3 External Infusion Pumps, Battery Powered
3.2.3.1 Insulin infusion pump, variable basal insulin rates, intermittent boluses
Roche Diagnostics Australia Pty Ltd
RO020 Accu-chek Spirit Insulin Pump Insulin infusion pump One size only $4,000.00 $5,000.00
3.2.3.2 Insulin infusion pump (as 3.2.3.1) with integral calculator to determine boluses and active
Managing Diabetes Pty Ltd
DF001 DANAIIS Insulin Pump Continuous insulin infusion pump 75mm x 45mm x 19mm $4,000.00
Roche Diagnostics Australia Pty Ltd
RO044 Accu-Chek Combo System Insulin delivery device capable of remotely The Accu-Chek Combo $8,000.00
receiving and acting on information about System is only available in one
blood glucose levels, performing bolus size.
calculation and bolus advice on additional
parameters than what is normally provided.
DE, SS
Managing Diabetes Pty Ltd
DF002 DANAR Insulin Pump The DANAR Insulin Pump is a small 75 x 45 x 19mm, 60grams $5,100.00
device about the size of a pager. It holds
up to 300 units of insulin, which is
delivered continuously through a small tube
to the patient. The DANAR Insulin Pump
also has an integrated blood glucose meter
and remote control via bluetooth
communication.
Medtronic Australasia Pty Ltd
MC353 Medtronic MiniMed Insulin Infusion Pump Paradigm Model MMT-722. 'Smart' Pump dimensions: 5.1 x 9.4 x $8,000.00 $8,950.00
Insulin Pump with REAL-Time continuous 2.0cm
glucose monitoring capability and with
remote control
MC354 Medtronic MiniMed Insulin Infusion Pump Paradigm Model MMT-522. 'Smart' Pump Dimensions: 5.1 x 7.6 x $8,000.00 $8,950.00
Insulin Pump with REAL-Time continuous 2.0cm
glucose monitoring capability and with
remote control
Page 2 of 3
GENERAL MISCELLANEOUS
Minimum Maximum
Billing Code Product Name Description Size Benefit Benefit Notations
SS
Australasian Medical & Scientific Ltd
AN005 Animas 2020 Insulin Pump. Ambulatory Insulin Infusion Pump 7.4cm x 5cm x 1.9cm $7,750.00
Medical Specialties Australia Pty Ltd
MS031 Medical Specialties "Deltec Cozmo Ambulatory Insulin Infusion Pump Deltec Cozmo Insulin Pump - $8,000.00 $9,360.00
Insulin Pump" each
Medtronic Australasia Pty Ltd
MC351 Medtronic MiniMed Insulin Infusion Pump Paradigm Model MMT - 715 Pump Dimensions: 5.1 x 9.4 x $8,000.00
2.0cm
MC352 Medtronic MiniMed Insulin Infusion Pump Paradigm Model MMT - 515 Pump Dimensions: 5.1 x 7.6 x $8,000.00
2.0cm
3.2.3.3 Device capable of automatically adjusting insulin delivery based on continuous glucose
DE, SS
Medtronic Australasia Pty Ltd
MC839 Medtronic MiniMed Insulin Infusion Pump Paradigm Veo Model MMT-554. 'Smart' 5.1 x 7.6 x 2.0cm $8,000.00 $9,500.00
Insulin Pump with REAL-Time continuous
glucose monitoring capability,
incorporating a low glucose suspend and
with remote control.
MC840 Medtronic MiniMed Insulin Infusion Pump Paradigm Veo Model MMT-754. 'Smart' 5.1 x 9.4 x 2.0cm $8,000.00 $9,500.00
Insulin Pump with REAL-Time continuous
glucose monitoring capability,
incorporating a low glucose suspend and
with remote control.
Grand Total: 16 Records
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