Schedule - Part A - Prostheses List February 2014

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

01.01.01 - Aphakic

 01.01.01.01 - Rigid

 Alcon Laboratories (Aust.) Pty Ltd

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

 Bausch & Lomb (Australia) Pty Ltd

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

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

 Chamber Lens 30d. L122UV: 6.0mm optic,

 13.75mm length, power

 range; 5.0 to 30.0 Diopters

 Emagin Pty Ltd

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

 Intraocular Lens 8.5 in overall length

 ifc

 AMO Australia Pty Ltd

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

 overall length

 m

 AMO Australia Pty Ltd

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

 IOL 13.0mm in overall length

01.01.02 - Phakic

 01.01.02.01 - Rigid

 AMO Australia Pty Ltd

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

 Myopia.  Composition: PMMA overall length; 6mm Optic

 Diameter x 8.5 overall

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

 Hyperopia.  Composition: PMMA overall length

Prostheses List by Category, Groups and Sponsor Page 1 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Emagin Pty Ltd

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

 Hyperopic 8.5 in overall length;

 t1

 AMO Australia Pty Ltd

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

 7.5mm overall length

 Emagin Pty Ltd

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

 Intraocular Lens Composition: PMMA 7.5 in overall length

 t2

 AMO Australia Pty Ltd

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

 7.5mm overall length

 01.01.02.02 - Foldable

 Alcon Laboratories (Aust.) Pty Ltd

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

 single piece phakic lens  diopter increments

 AMO Australia Pty Ltd

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

 silicone intraocular lens increments.  Overall

 diameter 8.5mm. Optic

 6.0mm

 Emagin Pty Ltd

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

 Intraocular Lens Haptic: PMMA overall length

01.02.01 - Rigid

 Alcon Laboratories (Aust.) Pty Ltd

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

  D

Prostheses List by Category, Groups and Sponsor Page 2 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

01.02.02 - Foldable

 01.02.02.01 - Microincision

 at

 Carl Zeiss Pty Ltd

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

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

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

 capsular bag fixation 10.0 to 30.0D, 1.0D outside

  this range)

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

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

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

 capsular bag fixation 10.0 to 30.0D, 1.0D outside

  this range)

 at, pl

 Bausch & Lomb (Australia) Pty Ltd

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

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

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

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

 Carl Zeiss Pty Ltd

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

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

 edged single piece inraocular lens for  Overall length: 11.0mm

 capsular bag fixation.

CZ037 CT ASPHINA 509MP Preloaded, micro incision, aspheric  Diopter range: 0.0 to +  $374.00

 (aberration correcting), foldable  32.0D; Optic Size: 6.0mm;

 square-edged single-piece intraocular  Overall length: 11.0mm

 lens for capsular bag fixation

 at, pl, t1

 Carl Zeiss Pty Ltd

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

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

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

 capsular bag fixation length: 11.0mm

Prostheses List by Category, Groups and Sponsor Page 3 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 at, pl, t2

 Carl Zeiss Pty Ltd

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

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

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

 capsular bag fixation Length 11.0mm

 at, t1

 Carl Zeiss Pty Ltd

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

 ZEISS Micro Incision Aspheric  diameter. Diopter range:

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

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

 capsular bag fixation

 t2, at

 Carl Zeiss Pty Ltd

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

 Micro Incision Aspheric (aberration  diameter.  Diopter range:

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

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

 fixation

 01.02.02.02 - No edge modification

 Ellex Australia Pty Ltd

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

 lens: Model AQ 5010V diopters

 t1

 Ellex Australia Pty Ltd

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

 intraocular lens: Model AA4203TF;

  Model AA4203TL

 01.02.02.03 - Edge modification

 Alcon Laboratories (Aust.) Pty Ltd

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

 MA50BM, MA60AC

Prostheses List by Category, Groups and Sponsor Page 4 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 asymmetric optic/consistent edge

 AMO Australia Pty Ltd

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

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

 Foldable Acrylic IOL

 Carl Zeiss Pty Ltd

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

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

 hydrophobic surface properties)  length: 13.0mm

 intraocular lens for capsular bag or

 sulcus fixation.

 Device Technologies Australia Pty Ltd

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

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

 +35.0D (1.0D steps) and

 +15.5D to +26.5D (0.5D

 steps).

 Ellex Australia Pty Ltd

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

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

 Kevin Grundy (IBD) Pty Ltd

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

 copolymer, foldable with injector dia overall

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

 copolymer, foldable with injector dia overall

 at

 AMO Australia Pty Ltd

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

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

 chamber intraocular lenses,  dioptre in 0.5 increments

 Silicone/Acrylic

AO024 Tecnis™ One Piece (ZCB00) One piece intraocular lens with edge  +5 diopters to +34 diopters  $364.00

 modification and 360 degree square  in 0.5d increments

 edge

Prostheses List by Category, Groups and Sponsor Page 5 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Bausch & Lomb (Australia) Pty Ltd

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

 IOL with anterior optic-haptic square

 edge, posteriof optic-haptic square

 edge, 360-degree optic square edge

 and asperic optic for aberration control

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

 IOL, with anterior optic-haptic square

  edge, posterior optic-haptic square

 edge, 360 degree optic square edge

 and aspheric optic for aberration

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

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

 hydrophobic acrylic one-piece  in dioptric powers ranging

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

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

 posterior edge, modified C haptics and increments

  available in dioptric powers ranging  11.0D to 30.0D in 0.5

 from +0.0 to +34.0D. Diopter increments

 31.0D to 34.0D in 1

 Diopter increments

 Carl Zeiss Pty Ltd

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

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

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

 acrylic (with hydrophobic surface

 properties) intraocular lens for

 capsular bag fixation. (Monofocal lens

  for powers outside standard 409MP

 MICS range).

 Device Technologies Australia Pty Ltd

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

 C Loop IOL Length 12.00mm. Central

 Thickness 1.02mm

 (+22.0D). Available

 Diopters: -10.0D to35.0D

 (1.0D steps). +10.5D to

Prostheses List by Category, Groups and Sponsor Page 6 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 plate haptic  IOL Length 11.00mm. Available

 Diopters: +-0.0D to 35.0D

 (1.0D steps). +10.5D to

 29.5D (0.5D steps)

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

  IOL. Length 13.00mm. +-0.0D to

 +35.0D (1.0D) + 15.5D to

 +26.5D (0.5D). Minus range

  on demand.

 IQ Medical

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

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

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

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

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

 aberration technology +29.5; 0.25D steps: +18.0

 to +25.0

IQ013 PreciSAL 302AC Acrylic, single piece, foldable  Available in dioptric  $364.00

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

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

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

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

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

 Kevin Grundy (IBD) Pty Ltd

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

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

 square edge, Anti-vaulting Haptics  to +22D

 at, pl

 AMO Australia Pty Ltd

AO034 TECNIS® 1-Piece Pre-Loaded IOL 1-piece IOL Posterior Chamber  +5.0 to +34.0 diopter  $374.00

 Intraocular lens, incorporates a  powers in 0.5 diopter

 proprietary wavefront-designed  increments.  Overall

 aspheric optic with a squared  diameter 13mm, Optic size

 posterior optic edge designed to

 provide a 360 degree barrier. The edge

  of the optic has a frosted design to

 reduce potential edge glare effects.

 Supplied pre-loaded in a screw style

 disposable injector.

Prostheses List by Category, Groups and Sponsor Page 7 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Ellex Australia Pty Ltd

XE004 Preloaded Aspheric Intraocular  Silicone intraocular lens 6.0mm $374.00

 IQ Medical

IQ014 PreciSAL P302AC Preloaded Acrylic, single piece,  Available in dioptric  $374.00

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

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

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

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

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

 at, pl, t1

 Bausch & Lomb (Australia) Pty Ltd

BL032 enVista Toric The enVista toric (Model MX60T) is a  Overall diameter is 12.5mm  $760.00

 one-piece glistening-free  for the entire lens power

 hydrophobic foldable IOL. The  range, with spherical

 enVista Toric, model MX60T IOL has  equivalent powers from +6.0

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

 posterior edge and modified C haptics, Diopter steps and cylinder

  an overall diameter of 12.5mm and an  powers from +1D to 6D 

 optic body of 6.0mm.  It is available in Diopters (at the IOL plane).

  multiple spherical and cylindrical

 powers.

 IQ Medical

IQ017 PreciSAL Toric T302AC Acrylic single piece, foldable  Available in spherical  $760.00

 intraocular lens with anterior and  dioptric powers from 0.0 to

 posterior optic-haptic square edge,  +30.0. 1D steps: 0.0 to

 360 degree optic square edge design,  +10.0; 0.5D steps: +10.5 to

 precision power calculation,  +17.5 and +28.5 to +30.0;

 aberration technology, toric  0.25D steps: +18.0 to

 correction on anterior surface with  +28.0; Cylinder powers

 cylinder marks to indicate flat  from 1.0D to 6.0D

 meridian plus the cylinder axis to

 allow alignment for astigmatic

 correction, and UV filter.

Prostheses List by Category, Groups and Sponsor Page 8 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

IQ018 PreciSAL Toric PT302AC Pre-loaded acrylic single piece,  Available in spherical  $760.00

 foldable intraocular lens with anterior dioptric powers from 0.0 to

  and posterior optic-haptic square  +30.0. 1D steps: 0.0 to

 edge, 360 degree optic square edge  +10.0; 0.5D steps: +10.5 to

 design, precision power calculation,  +17.5 and +28.5 to +30.0;

 aberration technology, toric  0.25D steps: +18.0 to

 correction on anterior surface with  +28.0; Cylinder powers

 cylinder marks to indicate flat  from 1.0D to 6.0D

 meridian plus the cylinder axis to

 allow alignment for astigmatic

 correction, and UV filter.

 at, pl, t1, vblf

 Design for Vision Pty Ltd

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

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

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

 hydophobic. 2.25D (351T4), 3.00D

 (351T5), 3.75D (351T6),

 4.50D (351T7), 5.25D

 (351T8), 6.00D (351T9)

 at, pl, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

 with Blue light protection and

 aspheric correction, in cartridge.

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

 foldable, acrylic, single piece lens

 with blue light protection and

 aspheric correction, in cartridge

 Design for Vision Pty Ltd

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

  blocker, Foldable, Single-Piece,

 Hydrophobic Acrylic

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

 incision, Aspheric, Blue-Blocker,

 Single Piece, Hydrophobic

Prostheses List by Category, Groups and Sponsor Page 9 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 IQ Medical

IQ016 PreciSAL P302A Preloaded Acrylic, single piece,  Available in dioptric  $405.00

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

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

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

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

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

 at, t1

 AMO Australia Pty Ltd

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

 Intraocular lens, incorporates a  powers in 0.5 diopter

 proprietary wavefront designed toric  increments.  Cylinder

 aspheric optic with a squared  power: 1.00 diopter, 1.50

 posterior optic edge designed to  diopter, 2.25 diopter, 3.00

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

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

 reduce potential edge glare effects. Overall diameter 13mm,

 Optic size 6mm.

 Device Technologies Australia Pty Ltd

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

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

  to +35.0D (in 0.01D

 increments) Cyl +0.25 to

 +6.99D cyl (in 0.01D

 increments)

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

 T1-T6 acrylic IOL. Length 11.00mm. Available

 diopters: +10.0D to +30.0D

  (0.5D). Cyl: (T1 +1.5D) (T2

  +2.25D) (T3 +3.0D) (T4

 +3.75D) (T5 +4.5D) (T6

 +5.25D)

Prostheses List by Category, Groups and Sponsor Page 10 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 at, t1, pl, vblf

 IQ Medical

IQ020 PreciSAL Toric PT302A Pre-loaded acrylic single piece,  Available in spherical  $800.00

 foldable intraocular lens with anterior dioptric powers from 0.0 to

  and posterior optic-haptic square  +30.0. 1D steps: 0.0 to

 edge, 360 degree optic square edge  +10.0; 0.5D steps: +10.5 to

 design, precision power calculation,  +17.5 and +28.5 to +30.0;

 aberration technology, toric  0.25D steps: +18.0 to

 correction on anterior surface with  +28.0; Cylinder powers

 cylinder marks to indicate flat  from 1.0D to 6.0D

 meridian plus the cylinder axis to

 allow alignment for astigmatic

 correction, and UV and blue light

 filters.

 at, t1, vblf

 Device Technologies Australia Pty Ltd

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

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

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

 increments) Cyl +0.25D to

 +6.99D cyl (in 0.01D

 increments)

 IQ Medical

IQ019 PreciSAL Toric T302A Acrylic single piece, foldable  Available in spherical  $780.00

 intraocular lens with anterior and  dioptric powers from 0.0 to

 posterior optic-haptic square edge,  +30.0. 1D steps: 0.0 to

 360 degree optic square edge design,  +10.0; 0.5D steps: +10.5 to

 precision power calculation,  +17.5 and +28.5 to +30.0;

 aberration technology, toric  0.25D steps: +18.0 to

 correction on anterior surface with  +28.0; Cylinder powers

 cylinder marks to indicate flat  from 1.0D to 6.0D

 meridian plus the cylinder axis to

 allow alignment for astigmatic

 correction, and UV and blue light

 filters.

Prostheses List by Category, Groups and Sponsor Page 11 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 at, t2

 Device Technologies Australia Pty Ltd

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

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

 0.0D to +35.0D (in 0.01D

 increments) Cyl +6.99D to

 +12.0D cyl (in 0.01D

 increments)

 at, t2, vblf

 Device Technologies Australia Pty Ltd

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

 monofocal toric acrylic IOL. Violet  length 11.00mm. Available

 Light Filter. diopters: Cyl +7.00D to

 +12.0D inclusive in 0.01D

 increments.

 at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

 with Blue Light Protection and

 Aspheric Correction

 Bausch & Lomb (Australia) Pty Ltd

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

 Violet Shield silicone, anterior & posterior edge  lengthModified  C 5

 modification intraocular lens with  degree angulation 0-30D,

 aberration technology, a violet light 0.5D steps

 Design for Vision Pty Ltd

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

 blocker, Single-piece, Hydrophobic

 Device Technologies Australia Pty Ltd

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

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

 Diopters: +-0.0D to 35.0D

 (1.0D steps) +15.5D to

 26.5D (0.5D steps).

Prostheses List by Category, Groups and Sponsor Page 12 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

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

 Diopters: +-0.0D to 35.0D

 (1.0D steps). +15.5D to

 26.5D (0.5D steps).

 IQ Medical

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

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

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

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

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

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

  +25.0

IQ015 PreciSAL 302A Acrylic, single piece, foldable  Available in dioptric  $385.00

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

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

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

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

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

 pl

 Ellex Australia Pty Ltd

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

 Intraocular Lens and posterior edge modification overall length 12.5mm,

 diopter range +10 to +28.0

 t1

 Kevin Grundy (IBD) Pty Ltd

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

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

 6.0D in 2D increments

 t1, at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

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

 lens with blue light protection and

 aspheric correction

Prostheses List by Category, Groups and Sponsor Page 13 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Design for Vision Pty Ltd

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

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

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

 2.25D (311T4), 3.00D

 (311T5)

 t1, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

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

 lens with blue light protection

 t2

 Kevin Grundy (IBD) Pty Ltd

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

 with injector dia overall, cyls 1.5D to

 11.0D in 0.5D increments

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

  to 11.00D Cylinder in 0.25

 steps                                           

                +31.00D to +35.00

 Spit: 1D to 11.00D

 Cylinder in 0.25steps

 vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

 SN60AT asymmetric optic/consistent edge,

 with blue light protection

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

 MN60MA, MN60AC with Blue light Protection

Prostheses List by Category, Groups and Sponsor Page 14 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 01.02.02.04 - Multifocal or bifocal

 at

 AMO Australia Pty Ltd

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

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

 with a diffractive posterior optic and a

  modified anterior surface technology

 with edge modification and 360

 degree square edge.

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

 Models ZMB00, ZKB00, ZLB00 with UV-blocking, foldable acrylic, 1- 13.0mm in overall length. 

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

  and a modified anterior surface  Diopter in 0.5 Diopter

 technology with edge modification  increments. ZCB00 +4.00

 and a 360 degree square edge. Diopter add, ZKB00 +2.75

 add, ZLB00 +3.25 add

 Carl Zeiss Pty Ltd

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

 multifocal IOL.  Diffractive bifocal  Diopter range 0.0D to

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

 distribution (65% distance / 35%

 near), 3.75D addition for near focus.

 Device Technologies Australia Pty Ltd

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

 haptic acrylic IOL. Optic Size 6.0mm Available

 diopters +-0.0D to +36.0D

 (0.05D steps)

 IQ Medical

IQ021 Lenstec SBL-3 Acrylic single piece, foldable  Available in dioptric  $822.00

 intraocular lens with anterior and  powers from 10.0 to +36.0.

 posterior optic-haptic square edge,  1D steps: 30.0 to +36.0;

 360 degree optic square edge design,  0.5D steps: +10.0 to +15.0

 precision power calculation,  and +25.0 to +29.5; 0.25D

 aberration technology, segmented bi- steps: +15.25 to +24.75

 focal optic with +3.0 D of near power,

 and UV filter.

Prostheses List by Category, Groups and Sponsor Page 15 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Kevin Grundy (IBD) Pty Ltd

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

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

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

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

 +8.5D to +23.5D in 0.5D

 at, pl

 Carl Zeiss Pty Ltd

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

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

 IOL for capsular bag fixation. The  length: 11.0mm

 anterior aspheric bifocal surface has an

  asymmetric light distribution 65/35

 for distance/near vision, and 3.75D

 add for the near focus.

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

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

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

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

  optic provides two diffractive focal

 points (+3.33D near focus and +1.66D

  intermediate focus) with asymmetric

 light distribution 50% distance / 20%

  intermediate / 30% near vision.

 at, pl, t1

 Carl Zeiss Pty Ltd

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

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

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

 posterior surface with asymmetric  (all 0.5D steps)

 light distribution (65% distance/ 35%

  near), and 3.75D addition for near

Prostheses List by Category, Groups and Sponsor Page 16 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

CZ036 AT LISA tri Toric 939MP Trifocal (aspheric), bitoric, micro  Diopter range -10.00 to  $1,218.00

 incision, single-piece IOL for  +28.0 and +1 to +4.0 DC

 capsular bag fixation, implantable  Optic size: 6..00mml;

 with preloaded injector system. The  Overall length: 11.mm

 trifocal (anterior) optic provides two

 diffractive focal points (+3.33D near

 focus and + 1.66D intermediate focus)

 with asymmetric light distribution

 50% distance / 20% intermediate /

 30% near vision,

 at, t1

 AMO Australia Pty Ltd

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

 Diopters in 0.5 Diopter

 increments.  Cylinder

 powers 1.50D, 2.25D,

 3.00D and 4.00D

 Carl Zeiss Pty Ltd

CZ038 AT LISA tri toric 939M low cylinder Trifocal (aspheric), bitoric, micro  Diopter range: -10.00 to +  $1,198.00

 incision, single-piece IOL for  32.0 DS and +1 to +6.5DC

 capsular bag fixation.  The trifocal  Optic Size: 6.0mm. Overall

 (anterior) optic provides two  Length: 11.0mm

 diffractive focal points (+3.33D near

 focus and +1.66D intermediate focus)

 with asymmetric light distribution

 50% distance / 20% intermediate /

 30% near vision.

 Device Technologies Australia Pty Ltd

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

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

 +36.0D inclusive in 0.01D

 increments. Cyl +0.25 to

 +6.99D inclusive in 0.01D

 increments

Prostheses List by Category, Groups and Sponsor Page 17 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 at, t1, vblf

 Device Technologies Australia Pty Ltd

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

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

  +36.0D inclusive in 0.01D

 increments. Cyl +0.25D to

 +6.99D inclusive in 0.01D

 increments.

 at, t2

 Carl Zeiss Pty Ltd

CZ039 AT LISA tri toric 939M high  Trifocal (aspheric), bitoric, micro  Diopter range: -10.00 to +  $1,500.00

 powered cylinder incision, single-piece IOL for  32.0 DS and +7 to +12 DC

 capsular bag fixation. The trifocal  Optic Size: 6.0mm. Overall

 (anterior) optic provides two  Length: 11.0mm

 diffractive focal points (+3.33D near

 focus and +1.66D intermediate focus)

 with asymmetric light distribution

 50% distance / 20% intermediate /

 30% near vision.

 Device Technologies Australia Pty Ltd

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

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

 +36.0D inclusive in 0.01D

 increments. Cyl +6.99D to

 +12.0D inclusive in 0.01D

 increments

 at, t2, vblf

 Device Technologies Australia Pty Ltd

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

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

 Light Filter 0.0D to +36.0D inclusive in

  0.01D increments.  Cyl

 +7.00D to +12.0D inclusive

  in 0.01D increments.

Prostheses List by Category, Groups and Sponsor Page 18 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

 foldable, acrylic, single piece lens

 with apodised diffractive optic and

 blue light protection

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

 SV25T0 and MN6AD1 foldable, acrylic, single piece lens

 with apodised diffractive optic and

 blue light protection

 Bausch & Lomb (Australia) Pty Ltd

BL033 FineVision POD F Posterior chamber, UV absorbing,  An overall diameter of  $864.00

 foldable, aspheric, acrylic, single  11.40mm and optic diameter

 piece lens with apodised diffractive,  of 6.00mm. From 0 to +35

 trifocal optic and blue light  diopters with 0.5 diopters

 with 0.5 diopter increments.

BL034 FineVision Micro F Posterior chamber, UV absorbing,  An overall diameter of  $864.00

 foldable, aspheric, acrylic, single  10.75mm and optic diameter

 piece lens with apodised diffractive ,  of 6.15mm. From 0 to +35

 trifocal optic and blue light  dopters with 0.5 diopter

 increments.

 Design for Vision Pty Ltd

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

 Aspheric, Blue-blocker, Single Piece,

 Hydrophobic

 t1, at

 Carl Zeiss Pty Ltd

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

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

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

 bifocal posterior surface with   (all 0.5D steps)

 asymmetric light distribution (65%

 distance / 35% near), 3.75D addition

 for near focus.

Prostheses List by Category, Groups and Sponsor Page 19 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Kevin Grundy (IBD) Pty Ltd

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

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

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

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

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

 Cylinder. NEAR: +14.0D to

  27.0D in 0.5 STEPS:

 +2.00D +3.00D  +4.00D

 Cylinder

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

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

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

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

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

 Increments Cylinder: 1.0D

 to 1.5D and 2.5D to 6.00D

 in 0.5 increments

 t1, at, vblf

 Alcon Laboratories (Aust.) Pty Ltd

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

  IOL (SND1T2-5; SV25T2-6) foldable, acrylic, aspheric, toric single  to 3.00 D cylinder

  piece lens with apodised diffractive

 optic and blue light protection.

 t2, at

 Carl Zeiss Pty Ltd

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

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

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

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

 light distribution (65% distance /

 35% near), 3.75D addition for near

Prostheses List by Category, Groups and Sponsor Page 20 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 01.02.02.05 - Accommodative

 at, pa, pl

 AMO Australia Pty Ltd

AO035 Synchrony Vu Accommodating IOL Synchrony Vu Dual Optic  5.50mm Anterior Optic,  $822.00

 Accommodating Posterior Chamber  6.00mm Interior Optic,

 IOL 9.80mm Overall Length,

 Diopter Range: +16.00 to

 +28.00 in 0.5D Increments

 at, pa, t1

 Bausch & Lomb (Australia) Pty Ltd

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

 BL1AT/BL2AT and BL1UT/BL2UT  (BL1AT,BL1UT,AT50T) or

 is an accommodating IOL  12.0mm (BL2AT/BL2UT)

 incorporating a toroidal posterior  for the entire lens power

 surface. The foldable IOL has a square  range. Spherical equivalent

 posterior edge with polyimide  powers range from +5.0 to

 footplates and is available in multiple  +33.0 Diopters in 0.5

 spherical and cylindrical powers. Diopter steps and cylinder

 powers of +1.25, +2.00 and

 +2.75 Diopters (at the IOL

 plane).

 pa

 Bausch & Lomb (Australia) Pty Ltd

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

 Dioptres of accommodation with dual  Dioptre steps

 mechanism of action: (1) forward axial

 movement of lens and (2)

 accommodative arching of optic. 

 Posterior chamber, polyspheric

 optics, 3-piece, plate haptic, foldable

 UV light filtering, bic

 IQ Medical

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

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

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

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

 and +25.0 to +30.0; 0.2D

 steps; +18.0 to +25.0

Prostheses List by Category, Groups and Sponsor Page 21 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 pa, at

 Bausch & Lomb (Australia) Pty Ltd

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

 provide > 3 Diopters of  Diopter steps.  10.0 - 16.5

 accommodation with dual mechanism  Diopters (12mm length) and

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

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

  of optic.  Posterior chamber, aspheric,

 aberration free optics, 3-piece, plate

 haptic, fol

01.02.03 - Pseudo-phakic, piggy-back

 01.02.03.01 - Monofocal

 Design for Vision Pty Ltd

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

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

 to 10.00D in 0.5D

 at

 Kevin Grundy (IBD) Pty Ltd

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

 I.O.L.

 t1, at

 Kevin Grundy (IBD) Pty Ltd

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

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

 Standard Sulcus fixated with undulating

 Haptics and Posterior Haptic

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

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

 (Premium)  fixated with undulating Haptics and  0.5D steps

 Posterior Haptic Angulation

Prostheses List by Category, Groups and Sponsor Page 22 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 01.02.03.02 - Multi-focal

 at

 Kevin Grundy (IBD) Pty Ltd

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

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

 Sulcus-Fixated with Undulating  + 3.00 Addition

 Haptics and Posterior Haptic

 at, t1

 Design for Vision Pty Ltd

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

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

 4D, 5D, 6D Addition 3.5D

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

 Multifocal Toric Supplementary IOL Supplementary IOL Equivalent) Cylinders 2D

 and 3D Addition 3.5D

01.03.01 - Viscoelastic

 Alcon Laboratories (Aust.) Pty Ltd

AL006 PROVISC VISCOELASTIC  PROVISC contains sodium  0.85mL pack $80.00

 SOLUTION

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

 hyaluronate

AL015 Cellugel viscoelastic fluid Hypromellose 2% . $80.00

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

 Viscosurgical Device chondroitin sulfate 40mg/mL

 AMO Australia Pty Ltd

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

 0.85ml

AO032 Healon Endocoat Viscoelastic 0.85ml $80.00

 Bausch & Lomb (Australia) Pty Ltd

BL008 Ocucoat Intraocular Fluid 20mg/mL hydroxypropylmethyl  1ml and 2ml Sterile $80.00

 cellulose for intraocular use

Prostheses List by Category, Groups and Sponsor Page 23 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 intraocular use

 Carl Zeiss Pty Ltd

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

 sodium hyaluronate 10mg/ml. 

 (previously called Ophthalin)

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

 sodium hyaluronate 15mg/ml. 

 (previously called Opthalin Plus)

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

 contains sodium hyaluronate (NaHA,  ampoules

 1.5%) and lidocaine hydrochloride

 (1%). Also contains two topical

 ampoules with NaHA (0.3%) and

 lidocaine (2%)

 IQ Medical

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

 Hydroxypropylmethylcellulose cellulose for intraocular use. Pre-

 loaded in a sterile syringe with one

 cannula for injection, in a sterile

 Tyvek pouch

 hmw

 AMO Australia Pty Ltd

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

 Fluid 23mg/ml .

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

 Fluid

 01.03.01.01 - Dual Fluids

 Alcon Laboratories (Aust.) Pty Ltd

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

 hyaluronate, VISCOAT contains

 chondroitin sulfate and sodium

 hyaluronate

Prostheses List by Category, Groups and Sponsor Page 24 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Carl Zeiss Pty Ltd

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

 dispersive viscoelastic in one

 syringe, separated by a valve. 

 Dispersive: sodium hyaluronate

 (2.2%).  Cohesive: sodium

01.03.02 - Non Viscous

 Design for Vision Pty Ltd

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

 applications

01.04.01 - Simple

 Alcon Laboratories (Aust.) Pty Ltd

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

 12.3 - 14.5 uncompressed

 AMO Australia Pty Ltd

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

 Implant

 Carl Zeiss Pty Ltd

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

 Design for Vision Pty Ltd

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

 Emagin Pty Ltd

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

 pl

 Design for Vision Pty Ltd

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

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

Prostheses List by Category, Groups and Sponsor Page 25 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Insight Surgical Pty Ltd

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

 (acrylic)

01.04.02 - Complex

 Design for Vision Pty Ltd

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

01.05.01 - Long Tube

 AMO Australia Pty Ltd

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

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

 Implant BG 103-425, Baerveldt  tumble-polished finish

 Glaucoma Implant BG 103-250

 Design for Vision Pty Ltd

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

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

 Plate/Single Plate-Dual

 Chamber/Double Plate

 v

 Design for Vision Pty Ltd

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

 of silicon *175mm square

01.05.02 - Short Tube

 01.05.02.01 - Cannulated

 Alcon Laboratories (Aust.) Pty Ltd

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

Prostheses List by Category, Groups and Sponsor Page 26 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

01.05.03 - Ab Interno Glaucoma Drainage Device

 RQSolutions Medical Devices Distribution Support

RQ072 iStent Trabecular Micro-Bypass  The iStent GTS100R and GTS100L  1.0mm in length, 0.33mm in  $800.00

 are micro-invasive glaucoma surgical  height with a snorkel

 devices which are implanted in an "ab  length of 0.25mm

 interno" procedure into the trabecular

 meshwork to create a bypass through

 the trabecular meshwok to Schlemm's

 Canal to improve aqueous outflow

 through the natural physiologic

 pathway.

01.06.01 - Spacers

 Spectrum Surgical

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

 x 0.35mm thick

01.06.02 - Weights

 01.06.02.01 - Gold <1.8 grams

 Design for Vision Pty Ltd

DV260 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for  Gold Thin 0.6, 0.8, 1.0, 1.2,  $425.00

 patients with facial palsy 1.4, 1.6g

 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

 Spectrum Surgical

SO047 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for  Gold Thin 0.6, 0.8, 1.0, 1.2,  $425.00

 patients with facial palsy 1.4, 1.6g

Prostheses List by Category, Groups and Sponsor Page 27 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 01.06.02.02 - Gold ≥1.8 grams

 Design for Vision Pty Ltd

DV259 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for  Contour Gold 0.6, 0.8, 1.0,  $800.00

 patients with facial palsy. 1.2, 1.4, 1.6, 1.8g

 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

 Spectrum Surgical

SO046 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for  Contour Gold 0.6, 0.8, 1.0,  $800.00

 patients with facial palsy. 1.2, 1.4, 1.6, 1.8g

 01.06.02.03 - 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

 Design for Vision Pty Ltd

DV261 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for  Platinum Thin 0.6, 0.8, 1.0,  $1,300.00

  Platinum patients with facial palsy 1.2, 1.4, 1.6g

 Contour Platinum 0.6, 0.8,

 1.0, 1.2, 1.4, 1.6, 1.8g

 Spectrum Surgical

SO048 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for  Platinum Thin 0.6, 0.8, 1.0,  $1,300.00

  Platinum patients with facial palsy 1.2, 1.4, 1.6g

 Contour Platinum 0.6, 0.8,

 1.0, 1.2, 1.4, 1.6, 1.8g

01.07.01 - Intracanalicular

 Design for Vision Pty Ltd

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

 Bodkin lacrimal intubation set

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

 Intubation Sets

Prostheses List by Category, Groups and Sponsor Page 28 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

DV256 LIS 052 "StenTube" Large Diameter Lachrymal Intubation  1.32mm Tube diameter $135.00

 Set

 Device Technologies Australia Pty Ltd

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

 .051 x 33cm

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

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

 packaged sterile Probes 0.40mm x 11cm,

 tubing 35cm x 0.64mm.

 Probes 0.60mm x 11mm,

 tubing 35cm x 0.30mm.

 Spectrum Surgical

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

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

 Probes/Polypropylene Thread PVP Differential Bika: 0.64

 & 1.18mm O.D. Tube/40 x

 1.2mm probes, PVP Bika for

 DCR: 0.94mm O.D. Tube/50

  x 0.8mm probes, PVP Infant

 Bika 0.64mm O.D. Tube/55

 x 0.7mm probes, PVP Infant

 Bika II: 0.64mm O.D. Tube/

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

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

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

 to 400mm.  PEEK Thread:

 0.2mm to 0.4mm x 500mm.

 mc

 Spectrum Surgical

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

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

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

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

 0.2mm to 0.4mm x 500mm. 

 Plug Collar: 2mm to 4mm.

Prostheses List by Category, Groups and Sponsor Page 29 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

01.07.02 - Extracanalicular

 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

01.07.03 - Balloon Dilatation Catheters

 Design for Vision Pty Ltd

DV258 Lacricath Lachrymal Duct Balloon  Unilateral Lachrymal Duct Balloon  2mm, 3mm & 5mm $485.00

 Catheter Catheter system including inflation

 device

 bilateral

 Design for Vision Pty Ltd

DV257 Lacricath Lachrymal Duct Balloon  Bilateral Lachrymal Duct Balloon  2mm, 3mm and 5mm $879.00

 Catheter Catheter System including inflation

 device.

01.08.01 - 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  Bioceramic diameter, 12, 14,  $1,200.00

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

 (Synthetic) Synthetic Diameter, 10, 12,

 14, 16, 18, 20, 22mm

Prostheses List by Category, Groups and Sponsor Page 30 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

01.08.02 - Extrascleral

 01.08.02.01 - Complex and permeable

 Stryker Australia Pty Ltd

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

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

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

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

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

 9868 & 80022 COI Implants 7222: Approx

  4ml, 7223: Approx 5ml,

 80026: Approx 6ml, MCOI

 7207: Approx 3ml, 7208:

 Approx 4.2ml,  7209:

 Approx 5.6ml, QUAD

 Motility Small 16ml,

 Medium: 18ml, Large: 20ml,

  Extra Large: 22ml.

 ha

 Spectrum Surgical

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

 wrapped bioceramic (aluminium   20, 22mm; Synthetic

 oxide), mesh wrapped hydroxyapatite  Hydroxyapatite diameter:

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

 acid)

 vp

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

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

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

  interconnecting pore structure that

 supports tissue ingrowth. The device

 is available in sizes to meet the

 patient's specific needs.  Used for

 orbital reconstruction following

 enucleation and evisceration

 procedure.

Prostheses List by Category, Groups and Sponsor Page 31 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 01.08.02.02 - Multi-component

 Spectrum Surgical

SO019 FCI Orbital Implants Peg & Sleeve Standard Large $863.00

01.08.03 - Fascial - solid and permeable

 Device Technologies Australia Pty Ltd

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

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

 packaged sterile 2mm

 Spectrum Surgical

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

 with silicone tubing. probes, 280mm 0.64mm

 tubing.

01.09.01 - Buckles, bands, tyres and sponges

 Austmed Pty Limited

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

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

 Implant used in Scleral Buckling  Mira Symmetrical Oval Tire

 (Dimethylmethylvinyl Siloxane  7mm, Mira 287WG Murray

 Copolymer) wide (3.5mm) grooved

 symmetrical tire, 10mm

 wide, Mira 288 ross

 symmetrical grooved tire,

 low profile 10mm wide by

 2.5mm, Mira 289

 Symmetrical oval tire 10m

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

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

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

 Copolymer)  1.57mm I.D., Mira 270

 Sleeve 0.76mm I.D.

Prostheses List by Category, Groups and Sponsor Page 32 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 Retinal Implant used in Scleral  Band 2mm, Mira 240

 Buckling (Dimethylmethylvinyl  Circling Band 2.5mm.

 Siloxane Copolymer) Strips-Mira 41 Strip 3.5mm,

 Mira 42 Strip 4mm, Mira 20

 Strip 4mm, Mira 219 Strip

 4.5mm, Mira 31 Strip 4.5mm,

  Mira 32 Strip 5mm, Mira

 225 Oval Strip 5mm, Mira

 220 Strip 6mm. Boats-Mira

 60 Boat

 Device Technologies Australia Pty Ltd

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

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

 2.5 x 125mm, 0.75 x 2.5 x

 125mm

 Spectrum Surgical

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

 40, 3.5 x 0.75mm Type 41,

 4.0 x 1.25mm Type 42, 2.5 x

 0.6mm Type 240, Morin 3.5

 x 0.6mmStrip - 5.7mm Type

  20, 7.2mm Type 31, 9.2mm

 Type 32, 6mm Type 219,

 7.5mm Type 220, 8mm Type

 225

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

 Groove, 7 to 9mm wide),

 Biconvex: (2.5mm Groove, 7

  to 10mm wide),

 Asymetrical: (2.5mm

 Groove, 7 to 10mm wide)

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

 Morin Strip: 7mm wide x

 100mm long, Caputo Zip

 Strip: 7 to 9mm wide x

 120mm long, Korobelnik

 Oval Strip: 2 x 5mm

Prostheses List by Category, Groups and Sponsor Page 33 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 01.09.01.01 - Sponges

 Austmed Pty Limited

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

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

 Elastomer Sponge) 2.5mm, Mira 503 Cylinder

 3mm, Mira 504 Cylinder

 4mm, Mira 505 Cylinder

 5mm, Mira 505G Grooved

 cylinder 5mm, Mira 505T

 Packer tunnel cylinder 5mm,

  Mira 510 Half cylinder

 5mm, Mira 515 Brucker two-

 thirds cyl

 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

Prostheses List by Category, Groups and Sponsor Page 34 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

01.09.02 - Clips and tacks

 Device Technologies Australia Pty Ltd

DE201 Labtician Tantalum Clips Tantalum 2, 2.5mm $50.00

01.09.03 - Sleeves

 Device Technologies Australia Pty Ltd

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

 Spectrum Surgical

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

 Length 30mm

01.09.04 - Intraocular Gases

 Alcon Laboratories (Aust.) Pty Ltd

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

 Constellation® Vision System C3F8 and SF6  single dose syringe

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

 C3F8 and SF6 in single dose syringe

 Device Technologies Australia Pty Ltd

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

 retinal surgery

 IQ Medical

IQ012 EasyGas Endotamponade Gases for Retinal  60ml dispensed in a single  $75.00

 Surgery, EasyGas SF6, C2F6 or C3F8, dose, sterile syringe

  each supplied in a 60ml syringe,

Prostheses List by Category, Groups and Sponsor Page 35 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

01.09.05 - Intraocular Heavy Liquids

 Alcon Laboratories (Aust.) Pty Ltd

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

 surgery additive

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

 surgery additive

 Bausch & Lomb (Australia) Pty Ltd

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

 retinal surgery additive

BL018 DK Line 100% purified  Perfluorodecalin 7ml $240.00

 perfluorodecalin

 Design for Vision Pty Ltd

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

 Device Technologies Australia Pty Ltd

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

 surgery, operative device for retinal

 surgery, in particular retinal

 detachment (RD), RD with giant tear

 etc.

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

 retinal surgery, pre-operative device

 for retinal surgery, in particular retinal

  detachment (RD), RD with giant tear,

 RD with proliferative vitreal

 retinopathy (PVR) etc.

 IQ Medical

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

 Postoperative

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

 medium, intraoperative

 Spectrum Surgical

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

 perfluorodecalin, FCI - OCTA:

 Purified perfluoro-N-octane

Prostheses List by Category, Groups and Sponsor Page 36 of 1059

01 - OPHTHALMIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 perfluorodecalin, FCI - OCTA:

 Purified perfluoro-N-Octane

01.09.06 - Intraocular Silicone Oils

 Bausch & Lomb (Australia) Pty Ltd

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

 Oil

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

 Design for Vision Pty Ltd

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

 Device Technologies Australia Pty Ltd

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

 vitreoretinal surgery

 IQ Medical

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

 Spectrum Surgical

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

 Free)  free purified silicone oil

Prostheses List by Category, Groups and Sponsor Page 37 of 1059

02 - EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

02.01.01 - Cochlear Implants

 Advanced Bionics Australia Pty Ltd

BD006 Harmony ™ HiResolution® Bionic  The HiRes 90K with HiFocus 1j  Straight array (1j).  56.0mm  $13,570.00

 Ear System - HiRes 90K Implant  Electrode is the implanted component  (L) x 28.0mm (W) x 3.0mm

 Cochlear Stimulator with HiFocus  of the HiResolution Bionic Ear  (D)

 1j Electrode 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  The HiRes 90K with HiFocus Helix  Helix (coiled) electrode  $13,570.00

 Ear - HiRes 90K Implant Cochlear  Electrode is the implanted component  array - 56.0mm (L) x 28.0mm

 Stimulator with HiFocus Helix  of the HiResoulution Bionic Ear  (W) x 3.0mm (D)

 Electrode System. It 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

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

 featuring a special 16mm, 22 contact

 point electrode array

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

 Cochlear Implants with Contour   implant with perimodiloar electrode

 Advance 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 38 of 1059

02 - EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Med-El Implant Systems Australasia Pty Ltd

US008 Mi1000 CONCERTO/ Mi1000  Ultra small minimally invasive  Stimulator Housing: L 17.3  $13,570.00

 Concerto PIN titanium cochlear implant with six  mm, W 25.4 mm, Thin 4.5 mm

 atraumatic electrode options.    (Weight 7.6g)

 Includes sequential and parallel  Electrode: Standard (26.4

 stimulation, comprehensive  mm), FLEXsoft (26.4 mm),

 diagnostic toolkit and safety features  Medium (20.9mm), FLEX24

 such as unique implant ID and output  (20.9mm), Compressed

 capacitors for each channel (12.1mm), FLEX28

 (23.1mm)

 Cochlear Limited

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

 Contour Advance Electrode Cochlear implant with perimodiolar

 electrode array.  Titanium casing,

 removable magnet, 22 half-banded

 platinum electrodes, moulded in a

 durable silicone seal

CO024 Nucleus Freedom Implant with  Speech processor and accessories -  One size only $13,570.00

 Straight Electrode Initial

CO057 Cochlear™ Nucleus® CI422  Model CI422, 4th generation cochlear One size $13,570.00

 cochlear implant with Straight   implant with straight array.  Titanium

 casing, removable magnet.  22 half

 banded platinum intracochlear

 electrodes moulded with a silicone

 elastomer carrier and spaced over a

 20mm active array.  The electrode

 diameter is 0.6mm at the badal end,

 tapering to 0.3mm at the apical

 electrode band.

Prostheses List by Category, Groups and Sponsor Page 39 of 1059

02 - EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

02.01.02 - Speech Processors

 02.01.02.01 - Initial

 Advanced Bionics Australia Pty Ltd

BD008 Harmony™ HiResolution® Bionic  The Auria Harmony Processor is an  Sound Processor Size 54  $11,500.00

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

 Processor - Auria Harmony Sound  Bionic Ear System. This processor is  mm (w). Headpiece

 Processor (INITIAL Order) intended to deliver HiResolution  Diameter: 28.1 mm

 sound to a cochlear 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  The Platinum Sound Processor is a  PSP only one size; 2.69' x  $11,500.00

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

 processor - Platinum Series  Bionic Ear System. This processor is  Headpiece cable : options

 Processor (PSP) INITIAL Order intended to deliver HiResolution  18, 24, 32, 42 and 48 inches

 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

 consists of the sound processor,

 headpiece, connecting cables, and

 essential accessory kit.

BD014 Neptune Sound Processor and  The Neptune Processor is an external  One size only and varying  $11,500.00

 Headpiece (UHP) initial order  component of the HiRes Bionic Ear  cable lengths.

 includes Neptune Accessory Kit,  System. This processor is intended to

 these devices are the external part of  deliver HiResolution sound to a

 a cochlear implant system. cochlear implant.

 System Composed of: Processor and

 Universal Headpiece and Cable

 (UHP) with Neptune Accessory kit

 comprising : Neptune Connect ,

 Neptune Cover, Neptune cable for

 AquaMic, Thin magnet, Foam

 Spacer, Aquamic Color caps.

Prostheses List by Category, Groups and Sponsor Page 40 of 1059

02 - EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BD017 Naida CI Q70 Sound Processor The Naida CI sound processor is one  Measurements Size H x W x  $11,500.00

 part of a cochlear implant system that  D in mm:

 enables hearing. The other necessary  Processor Only 26 x 9 x19

 parts of the system are the Implantable  - with Off-the-Ear Adaptor

 Cochlear Stimulator (ICS), headpiece  40 x 9 x 19

 and headpiece cable. The sound  - with 110 mAh 49 x 9 x 19

 processor consists of two parts: the  

 sound processor and battery power  - with 170 mAh 55x 9 x 19

 source. There are five battery options,  - with 230 mAh 59 x 9 x 19

 including three sizes of Lithium Ion  

 rechargeable PowerCel™ batteries  - with Zn-Air Battery Pak

 and a Zn-Air Battery Pak

 Cochlear Limited

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

 - Initial accessories

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

 Sound Processor - INITIAL Nucleus 5 cochlear implant system

 with multiple wearing options and a

 remote control.

CO069 Cochlear ™ Nucleus® CP910  The Cochlear Nucleus CP910 Sound  There is only one size of the  $11,500.00

 Sound Processor (Initial) Processor is a behind-the-ear sound  processing unit and coil.

 processor two built-in directional  There are two sizes for

 microphones battery holder and cover.

CO071 Cochlear ™ Nucleus® CP920  The Cochlear Nucleus CP920 Sound  There is only one size of the  $11,500.00

 Sound Processor (Initial) Processor is a behind-the-ear sound  processing unit and coil.

 processor with two built-in  There are two sizes for

 directional micophones. battery holder and cover.

 Med-El Implant Systems Australasia Pty Ltd

US004 OPUS 2 Speech Processor Cochlear implant speech processor,  54.0mm x 35.1mm x 8.7mm $11,500.00

 fine structure speech processing,

 remote control, interface for assistive

 listening devices according to the

 international hearing aid standard

 (initial patient kit)

US009 RONDO Audio Processor Single Unit audio processor for the  One size - 44.1mm (l) x  $11,500.00

 MED-EL Cochlear Implant System,  37.2mm (w) x 11.8mm (h)

 integrating coil cable & electronics

 package worn off the ear it is held in

 place by magnetic attraction

Prostheses List by Category, Groups and Sponsor Page 41 of 1059

02 - EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 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.

CO064 Cochlear ™ Nucleus® CP910  The Cochlear Nucleus CP910 Sound  There is only one size of the  $12,950.00

 Sound Processor Hybrid™ Mode  processor in "Hybrid Mode" facilitates processing unit and coil.

  electroacoustic stimulation of the  There are two sizes for the

 cochlea battery holder and cover.

CO066 Cochlear™ Nucleous® CP920  The Cochlear Nucleous CP920 Sound There is only one size of the  $12,950.00

 Sound Processor - Hybrid™ Mode   Processor in "hybrid Mode"  processing unit and coil.

 facilitates electroacoustic stimulation  There are two sizes for

 of the cochlea battery holder and cover.

 Med-El Implant Systems Australasia Pty Ltd

US006 DUET 2 Audio Processor for Electric and  50.6mm x 8.5mm x 59.7mm $12,950.00

 Acoustic Stimulation (2nd

 Generation EAS)

 02.01.02.02 - Replacement

 Generation 3

 Cochlear Limited

CO019 ESPrit 3G Speech Processor -  Speech processor, Generation 3 Cable lengths: 6, 8, 10, 20,  $6,790.00

 Replacement 28cm

Prostheses List by Category, Groups and Sponsor Page 42 of 1059

02 - EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Generation 4

 Advanced Bionics Australia Pty Ltd

BD009 Harmony™ HiResolution® Bionic  The Auria Harmony Processor is an  Sound Processor - one size  $8,050.00

 Ear System -Behind The Ear Sound  external component of the HiRes  54 mm (H) x 13mm (TH) x 21

 Processor - Auria Harmony Sound  Bionic Ear System. This processor is   mm (W)

 Processor (REPLACEMENT Order) intended to 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  The Platinum Sound Processor is a  PSP: one size; 2.69' x 2.19"  $8,050.00

 Ear System - Body worn Platinum  body worn component of the HiRes  x 0.81"

 Sound Processor (PSP)  Bionic Ear System. This processor is

 REPLACEMENT Order intended to 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