06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LK

 Smith & Nephew Surgical Pty Ltd

SM180 Peri-Loc Proximal Femur Plates < 6 holes $1,470.00

SN972 Peri-Loc Distal Femur Plates  6 holes $2,214.00

 Synthes Australia Pty Ltd

SY711 AO/ASIF Plates Anatomic Locking Femur Plates 6 holes $1,470.00

 Zimmer Pty Ltd

ZI844 Zimmer Periarticular Locking Plates 5.5mm Periarticular Locking Plates -  2 - 6 holes Left & Right $1,470.00

 Femur

 VAL

 Synthes Australia Pty Ltd

SY712 AO/ASIF Plates Antomic Locking Femur Plates 6 holes $1,800.00

 Zimmer Pty Ltd

ZI746 NCB Polyaxial Locking Plate System NCB Variable Angle Locking Plate -  5 holes Left & Right $1,800.00

 Femur - Ti Alloy

 06.03.03.33 - Periarticular anatomic - Femur 7 to 15 holes

 Device Technologies Australia Pty Ltd

DE078 Osteotomy Plates Osteotomy, Femoral - Stainless Steel 7.5mm - 17.5 mm $1,200.00

 Stryker Australia Pty Ltd

HW307 Dall Miles Cable Grip System -  Stainless Steel Plate:9 hole -   10 inches $1,200.00

 Stainless Steel Stainless Steel

HW308 Dall Miles Cable Grip System -  Stainless Steel Plate:11 hole -   12 inches $1,200.00

 Stainless Steel Stainless Steel

SK557 Stryker Plating System Femur Anatomical Locking Plates 12-14 hole $1,200.00

 Synthes Australia Pty Ltd

SY671 AO/ASIF Plates Distal Femoral 7-15 holes $1,854.00

 Zimmer Pty Ltd

ZI821 Periarticular Plates Periarticular Femoral Condylar Plates  7 - 15 holes $1,200.00

 - Stainless Steel

Prostheses List by Category, Groups and Sponsor Page 361 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LK

 Smith & Nephew Surgical Pty Ltd

SM181 Peri-Loc Proximal Femur Plates >7 - <15 holes $1,470.00

SN973 Peri-Loc Distal Femur Plates 7 to  15 holes $1,470.00

 Synthes Australia Pty Ltd

SY709 AO/ASIF Plates Anatomic Locking Femur Plates 7-15 holes $1,470.00

 Zimmer Pty Ltd

ZI749 NCB Polyaxial Locking Plate System NCB Variable Angle Locking Plate -  9 holes - 13 holes Left &  $1,470.00

 Femur - Ti Alloy Right

ZI845 Zimmer Periarticular Locking Plates 5.5mm Periarticular Plates - Femur 7 - 15 Holes Left & Right $1,470.00

ZI846 Zimmer Periarticular Locking Plates 5.5mm Periarticular Locking Plates -  18 - 20 holes Left & Right $1,470.00

 Femur

 VAL

 Biomet Australia Pty Ltd

BH311 Polyax Plating System Distal Femoral Locking Plate, Titanium 7-15 holes $1,800.00

 Synthes Australia Pty Ltd

SY710 AO/ASIF Plates Anatomic Locking Femur Plates 7-15 Holes $1,800.00

 Zimmer Pty Ltd

ZI747 NCB Polyaxial Locking Plate System NCB Periprosthetic Variable Angle  7 holes - 15 holes Left &  $1,800.00

 Locking Plate - Femur - Ti Alloy Right

 06.03.03.34 - Periarticular anatomic - Femur 16 holes

 Synthes Australia Pty Ltd

SY672 AO/ASIF Plates Anatomic Non Locking Femur Plates  16 Holes $1,854.00

 Zimmer Pty Ltd

ZI822 Periarticular Plates Periarticular Femoral Condylar Plates  Over 16 holes Left and Right $1,854.00

 - Stainless Steel

 LK

 Smith & Nephew Surgical Pty Ltd

SM182 Peri-Loc Proximal Femur Plates >16 holes $2,124.00

SN974 Peri-Loc Distal Femur Plates  16 holes $2,124.00

Prostheses List by Category, Groups and Sponsor Page 362 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Stryker Australia Pty Ltd

SK558 Stryker Plating System Femur Anatomical Locking Plates 16-24 hole $2,124.00

 Synthes Australia Pty Ltd

SY768 AO/ASIF Plates Anatomic Locking Femur Plates 16 Holes $2,124.00

 VAL

 Biomet Australia Pty Ltd

BH312 Polyax Plating System Distal Femoral Locking Plate, Titanium 16-25 holes $2,454.00

 Synthes Australia Pty Ltd

SY769 AO/ASIF Plates Anatomic Locking Femur Plates 16 Holes $2,454.00

 Zimmer Pty Ltd

ZI748 NCB Polyaxial Locking Plate System NCB Periprosthetic Variable Angle  Over 16 holes Left & Right $2,454.00

 Locking Plate - Femur - Ti Alloy

 06.03.03.35 - Periarticular anatomic - Fibula 6 holes

 LMT Surgical Pty Ltd

LM135 TriMed Hook Plate TriMed Hook Plate 4 and 6 hole $1,130.00

 Zimmer Pty Ltd

ZI762 Zimmer Periarticular Plates 3.5mm Periarticular Plates - Fibula 2 - 6 holes Left & Right $1,130.00

 LK

 Synthes Australia Pty Ltd

SY686 AO/ASIF Plates Anatomic Locking Fibula  6 holes $1,400.00

 Zimmer Pty Ltd

ZI847 Zimmer Periarticular Locking Plates 2.7mm Periarticular Locking Plates -  2 - 6 Holes Left & Right $1,400.00

 Fibula

 VAL

 Stryker Australia Pty Ltd

SK580 Stryker Locked Plate system Periarticular variable angle locking  5-6 Holes $1,730.00

 plate - fibula

 Wright Medical Australia

WR240 Ortholoc Fracture System - Plates Syndesmosis 4 Holes, Right and Left $1,730.00

Prostheses List by Category, Groups and Sponsor Page 363 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.03.36 - Periarticular anatomic - Fibula 7 to 15 holes

 LMT Surgical Pty Ltd

LM136 TriMed Hook Plate TriMed Hook Plate 8 hole $1,130.00

 Zimmer Pty Ltd

ZI763 Zimmer Periarticular Plates 3.5mm Periarticular Plates - Fibula 7 - 15 holes Left & Right $1,130.00

 LK

 Device Technologies Australia Pty Ltd

DE421 Locking distal Fibula plate Locking Distal Fibula Plate For  4-6 Holes ( Left and Right  $1,400.00

 Fracture Fixation Specific)

DE422 Locking Distal Fibula Plate Locking Distal Fibula Plate for  8 Hole ( Left and Right  $1,400.00

 Fracture Fixation Specific)

 LMT Surgical Pty Ltd

LM054 Argo Malleolar Plate  Titanium 7-10 Hole $1,400.00

 Synthes Australia Pty Ltd

SY760 AO/ASIF Plates LCP Distal Fibula; lateral,  7 to 15 Holes $1,400.00

 Posterolateral

 Tornier Pty Ltd

TO101 MaxLock Extreme System - Distal  Distal Fibula variable angle locking  Long, Medium, Short, Right $1,400.00

 Fibula Plate plate, Titanium  and Left

 Zimmer Pty Ltd

ZI848 Zimmer Periarticular Locking Plates 2.7 mm Periarticular Locking Plates -  8 - 14 Holes Left & Right $1,400.00

 Fibula

 VAL

 Stryker Australia Pty Ltd

SK581 Stryker Locked Plate System Periartiicular variable angle locking  7-15 holes $1,730.00

 plate - fibula

 Synthes Australia Pty Ltd

SY761 AO/ASIF Plates LCP Lateral Distal Fibula 7 to 15 Holes $1,730.00

 Wright Medical Australia

WR239 Ortholoc Fracture System - Plates Lateral Fibula, Posterior Fibula 8-15 Holes, Right and Left $1,730.00

Prostheses List by Category, Groups and Sponsor Page 364 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.03.37 - Periarticular anatomic - Fibula 16 holes

 Zimmer Pty Ltd

ZI764 Zimmer Periarticular Plates 3.5mm Periarticular Plates - Fibula 16 - 18 holes $1,130.00

 06.03.03.38 - Periarticular anatomic - Tibia 6 holes

 Advanced Surgical Design & Manufacture Ltd

AE036 Opening Wedge Tibial Ostectomy  Titanium 6mm - 20mm $1,219.00

 Plate

 Biomet Australia Pty Ltd

BH197 Periarticular Plating System Meta Plate - Titanium Sm - Lge  3 to 6 Holes $1,219.00

 Lifehealthcare Pty Ltd

LH445 Hinge Pediatric Plating System -  Articulated growth-correction  12mm, 16mm, 20mm  $1,219.00

 Hinge Plate fixation plate (distance between

 anchoring points)

LH458 I.T.S. Pilon Plate Locking Pilon Plates 4.6 and 8-holes (Screw  $1,219.00

 diameter: Cancellous

 4.2mm; Cortical 4.5mm)

 Smith & Nephew Surgical Pty Ltd

SN570 TC 100 Plate Cloverleaf Plate 3-4 hole $1,219.00

SN581 TC-100 Tibia Plates, L:/E 6 Holes  6 holes $1,219.00

 Stryker Australia Pty Ltd

SK530 Stryker Plating System. T-Plate, pre-shaped 5-6 hole $1,219.00

 Synthes Australia Pty Ltd

SY729 AO/ASIF Plates Anatomic Tibial Plates  6 holes $1,219.00

 Zimmer Pty Ltd

ZI398 High Tibia Osteotomy High Tibia Osteotomy - Ti alloy L shaped steel alloy plate;   $1,219.00

 Standard & Long

ZI765 Zimmer Periarticular Plates 3.5 & 4.5mm Periarticular Plates -  2 - 6 holes Left & Right $1,219.00

ZI823 Periarticular Plates Periarticular Tibial Plateau Plates -  2 holes - 6 holes Left and  $1,219.00

 Stainless Steel Right

Prostheses List by Category, Groups and Sponsor Page 365 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LK

 Synthes Australia Pty Ltd

SY732 AO/ASIF Plates Anatomic Locking Tibial Plates  6 Holes $1,489.00

 Zimmer Pty Ltd

ZI850 Zimmer Periarticular Locking Plates 3.5mm Periarticular Locking Plates -  2 - 6 holes Left & Right $1,489.00

 Tibia

 VAL

 Smith & Nephew Surgical Pty Ltd

SN975 Peri-Loc Tibia Plates   6 holes $1,819.00

 Wright Medical Australia

WR233 Ortholoc Ankle Plating Anterior, Posterior, Lateral or Medial 4-6 holes, Right ad Left, 93- $1,819.00

 155mm Length

 Zimmer Pty Ltd

ZI750 NCB Polyaxial Locking Plate System NCB Variable Angle Locking Plate -  5 holes Left & Right $1,819.00

 Tibia - Ti Alloy

 06.03.03.39 - Periarticular anatomic - Tibia 7 to 15 holes

 Smith & Nephew Surgical Pty Ltd

SN582 TC-100 Tibia Plates 7 to 15 holes $974.00

 Stryker Australia Pty Ltd

SK531 Stryker Plating System T-Plate, pre-shaped 7-13 hole $974.00

 Synthes Australia Pty Ltd

SY730 AO/ASIF Plates Anatomic Tibial Plates 7 - 15 Holes $974.00

 Zimmer Pty Ltd

ZI766 Zimmer Periarticular Plates 3.5 & 4.5mm Periarticular Plates -  7 - 15 holes Left & Right $974.00

ZI824 Periarticular Plates Periarticular Tibial Plateau Plates -  7 holes - 15 holes, Left and  $974.00

 Stainless Steel Right

 LK

 Smith & Nephew Surgical Pty Ltd

SN985 Peri-Loc Tibia Plates >7 to <15 holes $1,244.00

 Stryker Australia Pty Ltd

SK559 Stryker Plating System Distal Tibia Anatomical Locking  10-15 hole $1,244.00

Prostheses List by Category, Groups and Sponsor Page 366 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

SK561 Stryker Plating System Tibial Anatomical Locking Plates 10-14 hole $1,244.00

 Synthes Australia Pty Ltd

SY758 AO/ASIF Plates Anatomic Locking Tibial Plates 7 to 15 Holes $1,224.00

 Tornier Pty Ltd

TO100 MaxLock Extreme System - Medial  Medial distal tibia variable angle  Short, Medium, Long, Left  $1,244.00

 Distal Tibia Plate locking plate, Titanium and Right

 Zimmer Pty Ltd

ZI851 Zimmer Periarticular Locking Plates 3.5mm Periarticular Locking Plates -  8 - 14 holes Left & Right $1,244.00

 Tibia

 VAL

 Biomet Australia Pty Ltd

BH287 ALPS Anatomic Locked plating  Distal and Proximal Tibial Plates,  7 to 15 holes $1,574.00

 system Titanium

BH309 Polyax Plating System Proximal Tibial Locking Plate,  7 to 15 holes $1,574.00

 Titanium

 Smith & Nephew Surgical Pty Ltd

SN986 Peri-Loc Tibia Plates >7 to <15 holes $1,574.00

 Synthes Australia Pty Ltd

SY759 AO/ASIF Plates Anatomic Variable Angle Locking  7 to 15 Holes $1,574.00

 Tibial Plates

SY770 AO/ASIF Plates Anatomic Variable Angle Locking  7 - 15 holes $1,574.00

 Tibial Plates

 Wright Medical Australia

WR234 Ortholoc Fracture System - Plates Anterolateral Tibia, Medial Tibia  9, 12 or 13 holes, Right and  $1,574.00

 Plates or 1/3 Tubular Left

 Zimmer Pty Ltd

ZI751 NCB Polyaxial Locking Plate System NCB Variable Angle Locking Plate -  9 holes - 13 holes Left &  $1,574.00

 Tibia - Ti Alloy Right

 06.03.03.40 - Periarticular anatomic - Tibia 16 holes

 Synthes Australia Pty Ltd

SY731 AO/ASIF Plates Anatomic Tibial Plates 16 holes $1,219.00

Prostheses List by Category, Groups and Sponsor Page 367 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Zimmer Pty Ltd

ZI767 Zimmer Periarticular Plates 3.5 & 4.5mm Periarticular Plates -  16 - 20 holes $1,219.00

ZI825 Periarticular Plates Periarticular Tibial Plateau Plates -  Over 16 holes Left and Right $1,219.00

 Stainless Steel

 LK

 Smith & Nephew Surgical Pty Ltd

SN976 Peri-Loc Tibia Plates  16 Holes $1,489.00

 Stryker Australia Pty Ltd

SK562 Stryker Plating System Tibial Anatomical Locking Plates 16-30 hole $1,489.00

 Synthes Australia Pty Ltd

SY756 AO/ASIF Plates Anatomic Locking Tibial Plates 16 Holes $1,489.00

 VAL

 Biomet Australia Pty Ltd

BH288 ALPS-Anatomic Locked Plating  Distal and Proximal Tibial Plates,  16 - 25 holes $1,819.00

 system Titanium

BH310 Polyax Plating System Proximal Tibial Locking Plate,  16 to 20 holes $1,819.00

 Titanium

 Stryker Australia Pty Ltd

SK560 Stryker Plating System Distal Tibia Anatomical Locking  16-23 hole $1,819.00

 Synthes Australia Pty Ltd

SY757 AO/ASIF Plates Anatomic Variable Locking Tibial  16 Holes $1,819.00

 Plates

SY771 AO/ASIF Anatomic Variable Angle Locking  > 16 holes $1,819.00

 Tibial Plates

 06.03.03.41 - Periarticular anatomic - Calcaneal 6 holes

 LK

 Medical & Optical Instruments Australia Pty Ltd

MO405 Acumed Locking Calcaneal Plates Locking Calcaneal Plates <6 Hole LK $1,209.00

 06.03.03.42 - Periarticular anatomic - Calcaneal 7 to 15 holes

 Biomet Australia Pty Ltd

BH194 Periarticular Plating System Plate Calcaneal  - Titanium Small - Large $939.00

Prostheses List by Category, Groups and Sponsor Page 368 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Integra Neurosciences Pty Ltd

IG097 Calcenea Fracture Plate 14 hole titanium plate Small, Medium, Large $939.00

 Lima Orthopaedics Australia Pty Ltd

LC110 MTP Calcaneal Plate MTP Calcaneal Plpate 12 Hole 12 Hole - S/M/L - Left &  $939.00

 Right

 Smith & Nephew Surgical Pty Ltd

SN569 TC-100  Calcaneal Plates   7 to 15 holes $939.00

 Stryker Australia Pty Ltd

SK094 Stryker Plating System Small  Calcaneal Plate 70-80mm $939.00

 Fragment Set

 Synthes Australia Pty Ltd

SY017 AO/ASIF Plates Calcaneal Plates 7 - 15 holes $939.00

 Zimmer Pty Ltd

ZI857 Zimmer Periarticular Plating System 3.5mm Periarticular Plate - Calcaneal 7 holes $939.00

  VAL

 Wright Medical Australia

WR231 Calcaneus Plate Titanium locking plate, Tab &  14 holes $1,539.00

 Perimeter

 LK

 Medical & Optical Instruments Australia Pty Ltd

MO404 Acumed Locking Calcaneal Plates Locking Calcaneal Plates >7 to >15 holes LK $1,209.00

 Ortho Solutions Pty Ltd

OU017 Ti Calaneal Locking Plate Ti Calaneal Locking Plate 3.5 Ti Calaneal Locking Plate  $1,209.00

 3.5, large

 Ti Calaneal Locking Plate

 3.5, medium

 Ti Calaneal Locking Plate

 3.5, small

 Smith & Nephew Surgical Pty Ltd

SN983 Peri-Loc Calcaneal Plates >7 to <15 holes $1,209.00

 Synthes Australia Pty Ltd

SY188 AO/ASIF Plates Calcaneal, Locking 7 - 15 holes $1,209.00

Prostheses List by Category, Groups and Sponsor Page 369 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Tornier Pty Ltd

TO096 MaxLock Extreme System -  Calcaneal variable angle locking  Standard, Large, Extra  $1,209.00

 CalcLock Extreme Plate plate, Titanium Large, Right and Left

TO148 WAVE Calcaneal Fracture System  The WAVE Calcaneal Fracture System Plates: $1,209.00

 PLATE  is a low profile, anatomical plate and  Large Plates (Left or Right):

 screw system designed for the   Length = 71mm Width =

 minimally invasive fixation of  10-11mm

 calcaneal fractures. The plate and  Medium Plates (Left or

 associated locking and non-locking  Right): Length =  67mm

 screws facilitate the reconstruction of  Width = 10-11mm

 the height and width of the calcaneus,  Small Plates: (Left or

 and the remodelling of the lateral  Right): Length = 63mm

 calcaneal wall. The WAVE calcaneal  Width = 10-11mm

 Fracture System Plate has 7 screw

 holes (6 are threaded) and the plates

 are 2 - 3mm thick and are available in

 3 sizes. The WAVE Calcaneal Fracture

  System Plate also has two bending

 zones for a customised anatomical fit

 VAL

 Biomet Australia Pty Ltd

BH243 ALPS Foot System Calcaneal foot plate small to large $1,539.00

 Medartis

EO056 Aptus Foot Calcaneus Plates Left and right plates, small,  $1,539.00

 medium and large

 Smith & Nephew Surgical Pty Ltd

SN984 Peri-Loc Calcaneal Plates >7 to <15 holes $1,539.00

 Stryker Australia Pty Ltd

SR092 Stryker Locking Plate System Calcaneus Locking Plates 12 Hole $1,539.00

 06.03.03.43 - Periarticular anatomic - Calcaneal 16 holes

 VAL

 Stryker Australia Pty Ltd

SR093 Stryker Locking Plate System Calcaneus Locking Plates 16 Hole $1,539.00

 Wright Medical Australia

WR232 Calcaneus Plate Titanium locking plate, Tab &  16 & 17 holes $1,539.00

 Perimeter

Prostheses List by Category, Groups and Sponsor Page 370 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.03.44 - Periarticular anatomic - Foot

 Integra Neurosciences Pty Ltd

IG081 Hallu-Fix Plates Hallu-C and Hallu-S titanium plates  Length: 40 - 55mm 3 sizes:  $450.00

 for first MTP arthrodesis  1, 2, 3 for left or right

 Medical & Optical Instruments Australia Pty Ltd

MO379 Acumed Congruent Plate System Foot and Ankle Plate itianium  6 hole $450.00

 LK

 Medical & Optical Instruments Australia Pty Ltd

MO380 Acumed Congruent Plate System Foot and Ankle Plate Titanium  6 hole $730.00

MO381 Acumed Congruent Plate system Foort and Ankle Plate titanium  7 to 15 hole $730.00

 Wright Medical Australia

WR052 Charlotte MTP Fusion System MTP plate, stainless steel, SLIM  Left & right $730.00

WR065 Rearfoot Plate - RPS Unique extended plate geometry for  6 hole - 37mm, 8 hole -  $730.00

 plating complex rearfoot  50mm, 14 hole - 66mm

 reconstructions, uses 3.5mm locked

 screws for optimal bone purchase.

 VAL

 Stryker Australia Pty Ltd

HW459 Memometal Anchorage Bone Plates Osteosynthesis Bone Plate System Length 41mm, 51.5mm,  $1,060.00

 53mm Thickness 1.3mm,

 1.5mm

 Synthes Australia Pty Ltd

SY715 AO/ASIF Plates Anatomic Variable Angle Locking  2-20 Holes $1,060.00

 Foot Plate

 Wright Medical Australia

WR082 Orloloc Fracture System - Plates Akin, MTP Plates Akin - 3 Hole, 17mm; MTP - $1,060.00

  4 Hole, 23mm

WR244 Charlotte Claw Locking Plate Straight, U, T Plates - 2, 3, & 4 Hole 15, 20, 25, 30mm, Sm, Med,  $1,060.00

 Lge

Prostheses List by Category, Groups and Sponsor Page 371 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.03.45 - Periarticular anatomic - Cable plate (hook/grip) 6 holes

 Biomet Australia Pty Ltd

BI258 BMP Cable System Dynamic Compression Plate, 3 hole,  One size only $670.00

 Stainless Steel

BI259 BMP Cable System Dynamic Compression Plate, 5 hole,  One size only $670.00

 Stainless Steel

 Synthes Australia Pty Ltd

SY378 Trochanteric Reattachment Device Titanium alloy reattachment device  Standard and Long $670.00

 with cables

 Zimmer Pty Ltd

ZI167 Zimmer Internal Fixation Systems:  Cable-Ready 6 Hole Plate - Stainless  187mm long $670.00

 Cable System Steel

 06.03.03.46 - Periarticular anatomic - Cable plate (hook/grip) 7 to 15 holes

 Biomet Australia Pty Ltd

BI260 BMP Cable System Dynamic Compression Plate, 7 hole,  One size only $790.00

 stainless steel

BI261 BMP Cable System Dynamic Compression Plate, 9 hole,  One size only $790.00

 Stainless Steel

 Zimmer Pty Ltd

ZI169 Zimmer Internal Fixation Systems:  Cable-Ready 10 Hole Plate - Stainless 305mm long $790.00

 Cable System  Steel

 06.03.03.48 - Periarticular anatomic - Cable plate with integrated cables - 2 or less, 6 holes

 Stryker Australia Pty Ltd

SK403 Trochanteric Grip Trochanteric Grip Plate with 2 cables Large, 110 - 210mm, 2 -6  $1,736.00

 holes

 Tornier Pty Ltd

TO099 MaxLock Extreme System - Medial  Medial malleolous variable angle  5 holes $1,736.00

 Malleolous Plate locking plate, Titanium

 Zimmer Pty Ltd

ZI290 Cable Ready Cable Grip System Titanium - comes with two cables (Co  23 x 53mm, 1.8 x 635mm $1,736.00

 Cr), Integral Crimps

Prostheses List by Category, Groups and Sponsor Page 372 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.03.49 - Periarticular anatomic - Cable plate with integrated cables - > 2, 6 holes

 Smith & Nephew Surgical Pty Ltd

SN730 Accord Orthopaedic Cable System, Titanium  150-250mm $2,600.00

 Plate

 Stryker Australia Pty Ltd

HW306 Dall Miles Cable Grip System -  Stainless Steel Plate:7 hole -   8 inches $2,600.00

 Stainless Steel Stainless Steel

SK402 Trochanteric Grip Trochanteric Grip Plate with 2 cables Medium 100 - 200mm, 2 -6  $2,600.00

 Holes

 Zimmer Pty Ltd

ZI297 Cable Ready Cable Grip System Titanium 5 hole GTR with 4 cables $2,600.00

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 $2,600.00

 LK

 Global Orthopaedic Technology

GO197 SuperCable Trochanteric Grips and  Trochanteric Grips - Titanium Short 50mm, 2 Hole Plate  $2,870.00

 Cable Plate System 135mm, 4 Hole Plate

 190mm, 6 Hole Plate

 Straight, Right, Left 245mm

06.03.04 - Screws

 06.03.04.01 - Standard ( 4.5mm)

 Austofix

AX051 Tectona Hip Plate - Cortical Screw Cortical Screw, self tapping 4.5mm, lengths 28-46mm $72.00

AX052 Tectona Hip Plate - Compression  Comprssion screw, sterile packed Length 36mm. For  $72.00

 Screw compression with Tectona

 Lag Screw

 B Braun Australia Pty Ltd

BB052 BRAUN AUST Intramedullary  Compression Screw 4.5mmx64mm-4.5mmx102mm $72.00

BB056 BRAUN AUST Intramedullary  Fixation Screws Dia 4.5mm-6mm,Length  $72.00

 20mm-96mm

Prostheses List by Category, Groups and Sponsor Page 373 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BB057 BRAUN AUST Intramedullary  Closure Screws Length 8mm-10mm $72.00

BB059 BRAUN AUST Intramedullary  Huckstep Fine Thread Screw 4.5mmx19mm-4.5mmx57mm $72.00

BB271 Aesculap Schanz Screw Stainless steel All sizes $72.00

 Biomet Australia Pty Ltd

BH167 Comprehensive Shoulder Screws Screw, Non-Locking (4.75 or 6.5)mm x 15-50mm $72.00

BH200 Small / Large Fragment Set  Bone Screw 4.5-6.5mm diameter $72.00

BH271 Polyax Plating System Non-Locking Screw, Titanium 40-100mm $72.00

BH283 ALPS Plating System Non-locking bone screws 4.5 - 6.5mm diameter $72.00

BH317 Affixus Hip Fracture Nail System Distal screw 20-80mm $72.00

BH331 Small / Large  Fragment Set Bone Screw Titanium 4.5 to 6.5mm diameter $72.00

BH348 Comprehensive Segmental Revision  Comprehensive SRS Non-Locking  One size $72.00

 System (SRS) Screw

BI220 Bio-Modular Shoulder System Glenoid Screw 5mm x (15-40mm) $72.00

BI262 EBI XFIX Dynafix System Bone Screw, Cortical, tapered,  2.4mm to 6.00mm diameter $110.00

 Cancellous, Stainless Steel

BI829 EBI XFIX Vision System Screw, Transfixing, Stainless steel 4 - 6mm diameter $72.00

BI834 EBI XFIX DynaFix System Screw, VS Osteotomy System, Ti 6mm x (30mm-110mm) $72.00

 Device Technologies Australia Pty Ltd

DE367 Cancellous Bone Screws Cancellous Bone Screws 25-50mm x 6.5mm $72.00

DE423 PEEKPower HTO Plate Medial High Tibial Osteotomy  4.5mm Titanium  $72.00

 Implant Device System compression Screws

 DJO Australasia Pty Ltd

DD054 Replacement retaining screw for  Replacement retaining screw for  6.5mm x 30mm $72.00

 glenoid head glenoid head

 Emergo Asia Pacific Pty Ltd

ER097 DeRoyal Internal Fixation Systems - Screws, Stainless Steel 316L,  Standard size >=4.5mm $72.00

  Bone Screws manufactured in USA

 Euros Orthopaedics Australia Pty Ltd

EU027 SCULTRA II Reverse Glenoid base  Shoulder titanium glenoid base screw Diameters: 4.5 and 6.5 mm;  $72.00

 screw Lengths: 15, 20, 25, 30, 35,

 40 and 45 mm

Prostheses List by Category, Groups and Sponsor Page 374 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Exactech Australia

EX046 Equinoxe Compression Screw The compression screw compresses  4.5x18mm white, 4.5x22mm  $72.00

 the glenoid plate to the bone while  black, 4.5x26mm orange,

 providing 30 degrees of angular  4.5x30mm blue, 4.5x34mm

 variability red, 4.5x38mm green,

 4.5x42mm yellow,

 4.5x46mm purple

EX063 Equinoxe Reverse Shoulder, fracture Locking screw for tray adapter. One size. $72.00

  humeral adapter tray locking screw.

 Global Manufacturing Technology Pty Ltd

GM050 Contile Fin II Bone Screw 20 to 50mm $72.00

 Global Orthopaedic Technology

GO199 SuperCable Trochanteric Grips and  Compression Screws Titanium 4.5mm Diameter 10mm to 50  $72.00

 Cable Plate System mm length

 Integra Neurosciences Pty Ltd

IG113 Bone Screws Titanium screws (2) for use with the  4.5mm x (15, 20, 25, 30,  $72.00

 Universal2 Total Wrist System only 35mm)

 KH NXGEN (AUS) Pty Limited

KH013 NeoGen Locking Screw Locking Screw 4.5 to 5.0mm diamter, 25 to  $72.00

 110mm length

 Lifehealthcare Pty Ltd

LH444 Hinge Pediatric Plating System -  2 screws for articulated growth- 4.5 x 35mm, 4.5 x 30mm, 4.5  $72.00

 Screws correction fixation plate x 25mm

 Lima Orthopaedics Australia Pty Ltd

LC106 Supernail / Uninail - Self Tapping  Supernail / Uninail - Self Tapping  Diameter 4.5 / 6mm x Length $72.00

 Bone Screw Bone Screw  24 - 100mm

LC128 MCD Non Locking Bone Screw -  MCD Non Locking Bone Screw -  4.5 / 6.5mm Dia x 20 - $72.00

 Standard Standard 120mm Length Full thread

 Mathys Orthopaedics Pty Ltd

MA539 Affinis Inverse Lag Screw Metaglene Lag screw 18x4.5mm to 38 x 4.5 mm $72.00

 Medical & Optical Instruments Australia Pty Ltd

MO005 HBS Bone screw Compression - standard, high Length 10 - 30mm $72.00

MO413 Acumed Screws Screws >4.5mm $72.00

Prostheses List by Category, Groups and Sponsor Page 375 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Oceania Orthopaedics

OO136 MUTARS Cancellous Screws MUTARS Cancellous Screws 20-40mm $72.00

 Ortho Solutions Pty Ltd

OU027 Cortical Screw (Ti6AI4V) Cortical Screw 5.0mm x 20mm up to 5.0mm x $72.00

  40mm

OU037 Self Tapping Cortical Screw Self Tapping Cortical Screw 4.5mm self tapping cortical  $72.00

 screw 14mm to 95mm

 4.5mm cortical screw 14mm

 to 140mm

 4.5mm malleloar screw

 25mm to 70mm

 6.5 cancellous screw 16mm

 thread 30mm to 150mm

 6.5mm cancellous screw

 fully threaded 20mm to

 110mm

 Smith & Nephew Surgical Pty Ltd

SL013 TC-100 Cortical & Cancellous Screws  4.5mm $72.00

SL014 Peri-Loc & Peri-Loc VLP Cortical & Osteopenia Screws  4.5mm $72.00

 Stryker Australia Pty Ltd

HW337 Stryker Plating System Screws Ti or StST 4.5-6.5mm, L12-140mm $72.00

ST004 Stryker Plating System Screws -  Titanium or Stainless Steel 10-20mm $72.00

 Cortical 4.5mm

ST005 Stryker Plating System Screws -  6.5mm Stainless Steel or Titanium 20-50mm $72.00

 Cancellous

Prostheses List by Category, Groups and Sponsor Page 376 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Surgical Specialties

SQ084 PediNail - Captured Locking  4.5x16 Cort Screw 4.5mm Cort screws: 4.5mm x  $72.00

 screws - standard 4.5x18 Cort Screw 16-50mm, in 2mm

 4.5x20 Cort Screw increments 4.5mmx50mm-

 4.5x22 Cort Screw 85mm, in 5mm increments

 4.5x24 Cort Screw 4.5mm Cort Recon Screws:

 4.5x26 Cort Screw 4.5mmx45-100mm, in 5mm

 4.5x28 Cort Screw increments

 4.5x30 Cort Screw

 4.5x32 Cort Screw

 4.5x34 Cort Screw

 4.5x36 Cort Screw

 4.5x38 Cort Screw

 4.5x40 Cort Screw

 4.5x42 Cort Screw

 4.5x44 Cort Screw

 4.5x46 Cort Screw

 4.5x48 Cort Screw

 4.5x50 Cort Screw

 4.5x55 Cort Screw

 4.5x60 Cort Screw

 4.5x65 Cort Screw

 4.5x70 Cort Screw

 4.5x75 Cort Screw

 4.5x80 Cort Screw

 4.5x85 Cort Screw

 4.5x45 Cort Recon Screw

 4.5x50 Cort Recon Screw

 4.5x55 Cort Recon Screw

 4.5x60 Cort Recon Screw

 4.5x65 Cort Recon Screw

 4.5x70 Cort Recon Screw

 4.5x75 Cort Recon Screw

 4.5x80 Cort Recon Screw

 4.5x85 Cort Recon Screw

 4.5x90 Cort Recon Screw

 4.5x95 Cort Recon Screw

 4.5x100 Cort Recon Screw

SQ088 PediLoc - 4.5mm Self Tapping   10mm-60mm, in 2 mm  $72.00

 Cortical Screws 4.5 mm non locking full thread screw increments

 60mm-90mm, in 5mm

 increments

Prostheses List by Category, Groups and Sponsor Page 377 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Synthes Australia Pty Ltd

SY596 AO/ASIF Screws Cortex,Cancellous, Compression   4.5mm $72.00

 Screws

 Tornier Pty Ltd

TO047 Fixation Screw for Articular Implant Titanium D. 4.5mm, L 18 to 45mm $72.00

 Wright Medical Australia

WR036 Charlotte Carolina Jones Fracture  Low profile, solid-core, surgical grade 4.5mm, 4.5mm, 6.5mm,  $72.00

 System  stainless steel screw, partially  40mm-70mm overall screw

 threatded with thread length varying  lengths

 anthropometrically relative to overall

 screw length, utilising specialised

 instruments for IM placement in the

 5th metatarsal

WR209 Non-Locking Screws Titanium or Stailess Steel Alloy Non- 20-100mm, 4.5-5.5mm  $72.00

 Locking Screws Diameter

 Zimmer Pty Ltd

ZI133 NexGen Knee High Tibial  Screw - Ti 4.5 - 10 - 80 mm, 6.5 - 10 -  $72.00

 Osteotomy System 80 mm

ZI149 Periarticular Plates Periarticular 6.5mm Cancellous  16mm Thread - 35-90mm  $72.00

 Screws - Stainless Steel Long, 32mm Thread - 45-

 90mm Long, Fully Threaded

  - 25-90mm Long

ZI151 Periarticular Plates Periarticular 4.5mm Self Tapping  26 - 90mm $72.00

 Screws - Stainless Steel

ZI204 Zimmer ECT Screws 4.5mm Cortical Screws 14 - 120mm $72.00

ZI205 Zimmer ECT Screws 4.5mm Self tapping Cortical Screws 14 - 70mm $72.00

ZI206 Zimmer ECT Screws 4.5 Malleo Screw 25 - 70mm $72.00

ZI207 Zimmer ECT Screws 6.5mm Cancellous Screws 25 - 110mm $72.00

ZI400 Cortical Screws Screws- Cortical - Ti alloy 4.5/30 to 60mm $72.00

ZI596 NCB System NCB Screw Self Tapping 5.00mm x 14-85; 4.00mm x  $72.00

 14-48,

ZI598 NCB System NCB Cancellous Screws 4.5mm x 30-65, 5.0mm x 32- $72.00

 90, 4.5mm x 30-65 C/FT

ZI600 NCB System NCB Cannulated Screws 14mm to 65mm $72.00

ZI601 NCBSystem NCB Cannulated Cancellous Screws 4.5mm x 30-90mm $72.00

Prostheses List by Category, Groups and Sponsor Page 378 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

ZI831 NCB Polyaxial Locking System Variable Angle Locking Screw Cap -  8mm $72.00

 Ti Alloy

ZI834 NCB Polyaxial Locking System NCB Variable Angle Locking Spacer  1 - 3mm $72.00

 Pegs

ZI891 NCB System NCB Screws 14- 100mm $72.00

 CN

 Biomet Australia Pty Ltd

BH139 Peanut Growth Control Plating  Cannulated growth contol screws,  4.5mm Diameter, Length 16,  $212.00

 System - Screws titanium alloy 24, 30 and 40mm

BH184 Small / Large  Fragment Set Cannulated Bone Screw Titanium 4.5 - 8mm $212.00

BH333 Small / Large Fragment Set Cannulated Bone Screw 4.5 to 8.0mm diameter $212.00

 Device Technologies Australia Pty Ltd

DE371 Cannulated Titanium Low Profile  Cannulated titanium Low Profile  4.5-6.7mm $212.00

 Screws, Large Screws, Large

 Emergo Asia Pacific Pty Ltd

ER085 DeRoyal Internal Fixation System -  Cannulated Screws Stainless Steel  Standard size >=4.5mm $212.00

 Cannulated Bone Screws 316L manufactured in USA

 Johnson & Johnson Medical Pty Ltd

JJ557 DELTA Xtend Non Locking Canulated Metaglene  4.5mm $212.00

 Screw

 KH NXGEN (AUS) Pty Limited

KH016 KCS Cannulated Screw Cannulated Screw 4.5 to 7.3mm diameter, 20 to  $212.00

 120mm length

 Lima Orthopaedics Australia Pty Ltd

LC071 TNP® Cannulated Self drilling  TNP® Cannulated Self drilling Screw  Diameter 4.5, 6mm x 20- $212.00

 Screw with Ultra Flathead with Ultra Flathead 120mm Length

LC120 Superscrew - Standard Cannulated Cortical / Cancellous Lag  Dia. 4.5 / 5.0 / 6.5 / 7.2 mm x $212.00

 Screw Partial or Full Thread  25-140mm Length

LC131 MCD Cannulated Bone Screw -  MCD Cannulated Bone Screw Full or  4.5 to 6.5mm Dia x 16 -  $212.00

 Standard Partial Threaded - Standard 120mm Length

 LMT Surgical Pty Ltd

LM151 Fyxis plate screw Foot Plate Screw 9-55 mm $212.00

Prostheses List by Category, Groups and Sponsor Page 379 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Ortho Solutions Pty Ltd

OU034 Cannulated Screw Cannulated Screw cannulated screw 7.0 length $212.00

  45, thread length 32mm up

 to cannulated screw 7.0

 length 130, thread length

 32mm and cannulated screw

 7.0 length 35, thread length

 16mm up to cannulated

 screw 7.0 length 130, thread

  length 16mm

 5.0mm x 30mm up to 100mm

 titanium cannulated

 cancellous lag screw

 6.5mm x 20mm ( up to

 120mm) titanium cann.18mm

  thread

 8.0mm x 20mm titanuium

 cann (up to 120mm)18mm

 thread

 8.0mm x 20mm titanuium

 cann (up to 120mm)30mm

 thread

 8.0mm x 45mm titanuium

 cann (up to 120mm)45mm

 thread

 Smith & Nephew Surgical Pty Ltd

SL008 Cannulated Screw Partially & Fully Threaded Titanium 4.5mm $212.00

SL009 Cannulated screws Partially & Fully Threaded Stainless  4.5mm $212.00

 Steel

SN631 Cannulated Hip Pins Rush Nails, Round Bevil Point Hook  20.3mm - 254mm $212.00

 Pins

 Stryker Australia Pty Ltd

SK529 Stryker Cannulated Screw System Asnis III Cannulated screws 5.0-8.0mm $212.00

 Surgical Specialties

SQ058 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  4.5 x 90mm $212.00

 copolymer

SQ089 PediPlates - Cannulated Screws 4.5 mm Cannulated Screw 4.5mm x 16-36mm, in 4mm  $212.00

 increments

Prostheses List by Category, Groups and Sponsor Page 380 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

SQ090 Cannulated Screw System - Large:  7 mm partially threaded/fully threaded Fully Threaded: 30mm- $212.00

 7.0mm Stainless Steel  cannulated screw 120mm, in 5 mm increments

 

 32mm Threaded: 50-120 in

 5mm increments

 16mm Threaded: 30mm-

 Surgiplas Medical

SP029 OsteoMed Plating & Fixation System Plates - Fracture; Screws - Cannulated 6 Hole Fracture Plate 47 -  $212.00

  Lag 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

 Synthes Australia Pty Ltd

SY630 AO/ASIF Screws Cannulated Full, Partial Thread screw 4.50mm $212.00

 Tornier Pty Ltd

TO114 MaxTorque Cannulated Screw  Bone screws, Titanium, Cannulated,  Ø5.5mm Short Thread,  $212.00

 System - Standard screws Short or Long Thread Length 26-70mm

 Ø5.5mm Long Thread,

 Length 45-70mm

 Ø7.0mm Short thread,

 Length 40-130mm

 Ø7.0mm long Thread,

 Length 45-130mm

 Wright Medical Australia

WR248 Darco Headed Compression Screw  Cannulated titanium compression  4.5mm x 8-60mm; 6.5mm x  $212.00

 System 4.5, 6.5, 7.5 screws 35-120mm; 7.5mm x 35-

 120mm

 Zimmer Pty Ltd

ZI176 Zimmer Internal Fixation Systems:  Magna-FX - Stainless Steel 16 mm Thread - 30-30 mm;  $212.00

 Cannulated Screw 32 mm Thread - 40-120 mm;

 Fully Threaded - 30-130 mm

  Long

ZI448 Cannulated Screw Ti alloy One size only $212.00

ZI836 NCB Polyaxial Locking System 4.5mm Cannulated Variable Angle  14 - 100mm $212.00

 Locking Screws - Ti Alloy

Prostheses List by Category, Groups and Sponsor Page 381 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

ZI872 Zimmer Cannulated Screw System 7.0mm Cannulated Screw 32mm  7.0mm Cannulated Screw  $212.00

 Thread 32mm Thread. L=140

 7.0mm Cannulated Screw

 Full Thread. L=140

 7.0mm Cannulated Screw

 32mm Thread. L=145

 7.0mm Cannulated Screw

 Full Thread. L=145

 7.0mm Cannulated Screw

 32mm Thread. L=150

 7.0mm Cannulated Screw

 Full Thread. L=150

 7.0mm Cannulated Screw

 32mm Thread. L=155

 7.0mm Cannulated Screw

 Full Thread. L=155

 7.0mm Cannulated Screw

 32mm Thread. L=160

 7.0mm Cannulated Screw

 Full Thread. L=160

 7.0mm Cannulated Screw

 32mm Thread. L=165

 7.0mm Cannulated Screw

 Full Thread. L=165

 7.0mm Cannulated Screw

 32mm Thread. L=170

 7.0mm Cannulated Screw

 Full Thread. L=170

 7.0mm Cannulated Screw

 32mm Thread. L=175

 7.0mm Cannulated Screw

 Full Thread. L=175

 7.0mm Cannulated Screw

 32mm Thread. L=180

 7.0mm Cannulated Screw

 Full Thread. L=180

 CN, DT

 Lima Orthopaedics Australia Pty Ltd

LC068 DTS - DOUBLE THREADED  DTS - DOUBLE THREADED - SELF Diameter 4.5 and 6.5mm x  $402.00

 CANNULATED SCREW  TAPPING OR SELF DRILLING  Length 30 to 100mm

 CANNULATED SCREW

Prostheses List by Category, Groups and Sponsor Page 382 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

LC122 Versa Screw Self Drilling self tapping Cannulated  6.5 to 8mm Dia x 40 to  $402.00

 Compression Screw 120mm length

 LMT Surgical Pty Ltd

LM142 Extremity Medical Compression  Compression Screws 6.5mm $402.00

 Screw System

LM152 Unima Screw Foot Screw 7.2 7.2 x 50 - 120mm $402.00

LM153 Unima Screw Foot Screw 4.5 4.5 x 30 - 50mm $402.00

 Medical & Optical Instruments Australia Pty Ltd

MO357 Acutrak 2 Headless compression screw >4.5mm $402.00

MO383 Acumed Headless Compression Screw Acutrak 6/7 screw, Acutrak Plus >4.5mm $402.00

 Synthes Australia Pty Ltd

SY645 AO/ASIF Screws HCS Countersinkable Compression  4.5mm-6.5mm $402.00

 Screw

 Tornier Pty Ltd

TO123 NexFix 4.5MM Compression Screw The NexFix Compression Screw is a  4.5mm diameter x 14-40mm  $402.00

 stainless steel, cannulated, self  in 2mm increments, 40-

 tapping, and self drilling fixation  65mm in 5mm increments,

 device for osteotomies, fusions and  with short and long thread

 fracture fixation of small bones options

TO126 NexFix 6.5mm Compression Screw The NexFix Compression Screw is a  6.5mm diameter x 40-120mm  $402.00

 stainless steel, cannulated, self  in 5mm increments with

 tapping, and self drilling fixation  short and long thread

 device for osteotomies, fusions and  options

 fracture fixation of small bones

 Wright Medical Australia

WR033 Cannulated Screw Multi use compression screw,  6.5mm& 7.0mm dia, 40- $402.00

 cannulated, stainless steel or titanium 110mm lengths in 5mm

 increments

 Zimmer Pty Ltd

ZI180 Zimmer Large Herbert Bone Screw 4.5mm Cannulated Double Threaded  30 - 70mm $402.00

 Compression Bone Screw - Ti Alloy

ZI181 Zimmer Large Herbert Bone Screw 6.5mm Cannulated Double Threaded  25 mm - 100mm $402.00

 Compression Bone Screw - Ti Alloy

Prostheses List by Category, Groups and Sponsor Page 383 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 CN, LK

 Advanced Surgical Design & Manufacture Ltd

AE208  Total Wrist Implant System Carpal Screws 15, 18, 22, 26, 30mm $282.00

 Johnson & Johnson Medical Pty Ltd

JJ558 DELTA Xtend Locking Metaglene Screw Dia 4.5 4.5mm; 24, 30, 36, 42, 48 $282.00

 Smith & Nephew Surgical Pty Ltd

SN769 Peri-Loc Locking Cannulated Screws 4.5mm $282.00

 Stryker Australia Pty Ltd

SK564 Stryker Plating System SPS Locking Plate System Locking Screws - 5mm $282.00

 Tornier Pty Ltd

TO051 Aequalis Humeral Nail Screws Screws for Aequalis Humeral Head.  Proximal Screws length:  $282.00

 Cannulated Proximal screws: 5mm  From 36 to 60 every 4mm

 Diameter cannulated Ti, PE insert  Distal Screws length: From

 with thread inside. Distal screws  20 to 32 every 2mm

 4.5mm Diameter, Ti.

 CN, LK, DT

 Synthes Australia Pty Ltd

SY632 AO/ASIF Screws Cannulated Screws 4.50mm $472.00

 CN,DT

 Orthopaedic Solutions Pty Ltd

OE046 Merete - Cannulated HCS (headless  Bone screws, Titanium, Cannulated  Diameter + 6.5mm, length  $402.00

 Compression Screws) 6.5mm Compression 40-120mm (in 5mm

 increments)

 CN,LK

 Biomet Australia Pty Ltd

BH269 Polyax Plating system Cannulated Locking Screw, Titanium 4.5 to 8.0mm diameter $282.00

 Synthes Australia Pty Ltd

SY631 AO/ASIF Screws Cannulated Locking Screws 4.50mm $282.00

 DT

 Biomet Australia Pty Ltd

BH246 Rockwood Clavical Pin Clavical Pin with dual thread 4.5mm $262.00

Prostheses List by Category, Groups and Sponsor Page 384 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Lima Orthopaedics Australia Pty Ltd

LC075 F.T.S. BIOCOMPONENT  F.T.S. BIOCOMPONENT  Screw Dia 4.5 / 6mm x L 30- $262.00

 Compression Screw and Washer Compression Screw and/or Washer 120mm / Washer Dia 13-

 19mm

 Tornier Pty Ltd

TO143 611 Ankle Fusion Nail -Component The 611 ankle arthrodesis nail, self  5mm x100mm, 5mmx95mm,  $262.00

  : LOCKING SCREWS locking screws are made out of  5mmx90mm, 5mmx85mm,

 titanium alloy (Ti6AI4V) and  5mmx80mm, 5mmx75mm,

 incorporate a unique anti-backout  5mmx70mm, 5mmx65mm,

 design feature to ensure optimal  5mmx60mm, 5mmx55mm,

 5mmx50mm, 5mmx45mm,

 5mmx40mm, 5mmx35mm,

 5mmx32mm, 5mmx29mm,

 5mmx26mm, 5mmx23mm,

 5mmx20mm

 DT, CN

 Advanced Surgical Design & Manufacture Ltd

AE250 FusiFIX™ Triple thread, compression,  6mm $402.00

 cannulated screw system

 Synthes Australia Pty Ltd

SY691 Midfoot Fusion Bolt Solid intramedullary arthodesis  6.5mm diameter; 50-160mm  $402.00

 Length

 DT, LK

 Johnson & Johnson Medical Pty Ltd

DY572 Delta Shoulder system Metaglene Screw Stainless Steel 4.5mm $332.00

 LK

 Austofix

AX053 Tectona Hip Plate - Locking Screw Locking screw, self tapping 5.0mm, lengths 28-46mm $142.00

 B Braun Australia Pty Ltd

BB303 Position HTO Implant System -  Titanium cancellous and cortical  30mm-78mm x 4.5mm &  $142.00

 Locking Screws screw, locking head for solid plate  6.0mm diameter.

 Biomet Australia Pty Ltd

BH166 Comprehensive Shoulder Screws Screw, Locking, Ti 4.75 dia x (15-30)mm $142.00

BH268 Polyax Plating System Titanium Locking Screw 4.5-5.5mm $142.00

BH284 ALPS Plating System Locking screws 4.5 to 6.5mm diameter $142.00

Prostheses List by Category, Groups and Sponsor Page 385 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BH347 Comprehensive Segmental Revision  Comprehensive SRS Locking Screw One size $142.00

 System (SRS)

 Device Technologies Australia Pty Ltd

DE343 PEEKPower HTO Plate Medial High Tibial Osteotomy  5.0mm $142.00

 Implant Device System

DE344 iBalance HTO System PEEK Screws for iBalance HTO  4.5mm Cortical and 6.5mm  $142.00

 Implant Cancellous

DE369 Titanium Locking Cortical and  Titanium Locking Cortical and  4.5-6.5mm $142.00

 Cancellous Screws, Large Cancellous Screws, Large

 DJO Australasia Pty Ltd

DD056 Glenoid Baseplate Locking Bone  Glenoid Baseplate Locking Bone  5.0mm diameter, length 14- $142.00

 Screws Screws 38mm in 4mm increments

 Emergo Asia Pacific Pty Ltd

ER096 DeRoyal Implants-Internal Fixation  Stainless Steel 316L locking screws  Standard size >=4.5mm $142.00

 -  Screws manufactured in USA

 Exactech Australia

EX047 Equinoxe Glenosphere Locking  The Locking Screw locks  one size $142.00

 compression screws to the glenoid

 plate at a variable angle

 Global Orthopaedic Technology

GO198 SuperCable Trochanteric Grips and  Locking Screw Titanium 5.0mm diameter 10mm to  $142.00

 Cable Plate System 50mm length

 KH NXGEN (AUS) Pty Limited

KH015 MonoLoc Locking Screw Locking Screw 3.5mm diameter, 10 to 80mm  $142.00

 length

 Mathys Orthopaedics Pty Ltd

MA530 Affinis Inverse locking screw Locking Metaglene screw 24x4.0mm to 48x4.0mm $142.00

 Medical & Optical Instruments Australia Pty Ltd

MO414 Acumed Screws Locking Screws >4.5mm $142.00

 PurePlay Orthopaedics

PJ003 FlexiSystem, Flexit Cortical and  Cortical and Cancellous locking Duel 30,35,40,45,50,55,60,6,70,7 $142.00

 Cancellous locking screws and duel  threaded screws 5mm

  threaded screws

Prostheses List by Category, Groups and Sponsor Page 386 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Smith & Nephew Surgical Pty Ltd

SN768 Peri-Loc Fixation Device, Internal, Locking,  4.5mm -5.0mm $142.00

 Stainless Steel, Cortical & Cancellous

  Screw

SN890 PROMOS Reverse Modular  Glenoid Bone Screw 6/20mm 6/25mm, 6/30mm,   $142.00

 Shoulder System 6/35mm,  6/40mm

 Stryker Australia Pty Ltd

HW531 Stryker Plating System Locking Screw 5.0mm $142.00

 Surgical Specialties

SQ091 PediLoc - 4.5 Self-tapping, Locking 4.5 mm locking full thread screw 10mm-60mm, in 2mm  $142.00

  Cortical Screws increments

 60mm-90m, in 5mm

 increments

 Synthes Australia Pty Ltd

SY653 AO/ASIF Screws Locking Screws  4.5mm $142.00

SY693 Dynamic Locking Screw Pin-sleeve locking screw 5.0mm $142.00

 Tornier Pty Ltd

TO046 Aequalis Reversed Shoulder -  Titanium D45mm, L20 to 50mm $142.00

 Fixation Screw for Articular Implant

 Wright Medical Australia

WR074 Locking Screws Stainless Steel or Titanium Locking  4.5-5.5mm diameter, 8 -  $142.00

 Screws 100m length

 Zimmer Pty Ltd

ZI534 Zimmer Trabecular Metal Reverse  Inverse/Reverse Screw 4.5mm 18mm, 24mm, 27mm, 30mm,  $142.00

 Shoulder System 33mm, 36mm, 42mm, 48mm

ZI548 Zimmer Universal Locking System 2.7mm Universal Locking Screw Length:8mm; 10mm; 12mm;  $142.00

 14mm; 16mm; 18mm; 20mm;

 22mm; 24mm; 26mm; 28mm;

 30mm; 32mm; 34mm; 36mm;

 38mm; 40mm; 42mm; 44mm;

 46mm; 48mm; 50mm; 55mm;

 60mm

Prostheses List by Category, Groups and Sponsor Page 387 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LK, DT, CN

 LMT Surgical Pty Ltd

LM134 TriMed Compression Screws Compression Screws 4.5-7.5mm $472.00

 06.03.04.02 - Small (2.71mm 4.49mm)

 Advanced Surgical Design & Manufacture Ltd

AE154 ASDM Clavicle Plating System -  Fixation Device, Internal, Non- 3.5mm Low-profile Cortex  $91.00

 Screws locking, Stainless Steel, Cortical  Screws, 10-30mm (2mm

 Screw Size: 3.5mm & Cancellous  increments)

 Screw sizes 4.0mm 4.0mm Low-profile Cortex

 Screws, 10-30mm (2mm

 increments)

AE235 Stability Sigmoid Notch Total  The Sigmoid Notch Radial Screw is a  The Sigmoid Notch screw is $91.00

 DRUJ System / Sigmoid Notch  low profile self tapping cortical screw   available in 2mm

 made of implantable CoCr.  It is  increments from 18mm -

 designed to be placed bi cortical in  32mm and has a diameter of

 the radius and is introduced into the

 Radial stem thru a hole.  It is placed

 into the stem and tightened down

AE247 Sbi Non-Locking Screws Titanium Cortical Non-Locking Self  2.7mm Cortical, Non  $91.00

 tapping screws Locking, Self-tapping 10 -

 30mm

 2.7mm Lag, Non Locking,

 self tapping 10 -30mm

 3.5mm Cortical, Non

 Locking,Self tapping 8 -

 20mm

 Austofix

AX042 VRP Distal Radius Fixation System, 3.5mm Cortical Screw, Titanium 3.5mm diameter, 10mm- $91.00

  3.5mm Cortical Screw, Titanium 20mm lengths

AX087 Austofix Proximal Humeral Plating  Cortical Screw, Titanium 3.5mm, 20-40mm $91.00

 System - Austofix Cortical Screw

AX090 Austofix Proximal Humeral Plating  Cancellous Screw, Titanium 4mm 20-40mm $91.00

 System - Austofix PHP Cancellous

 Screw

 Biomet Australia Pty Ltd

BH142 OptiLock Upper Extremity Plating  Non-Locking Screws, Stainless Steel 3.5mm diameter, 10-60mm  $91.00

 System - Non-Locking Screws length (2mm increments)

Prostheses List by Category, Groups and Sponsor Page 388 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BH185 Small / Large  Fragment Set Bone Screw, Titanium 3.5 - 4.0mm diameter $91.00

BH257 Distal Radius Fracture Repair  Non-locking bone screw 3.5mm diameter $91.00

BH260 HI S3 Shoulder Fixation System Peg, Standard Stainless Steel 4mm $91.00

BH262 HI S3 Shoulder Fixation System Bone screw 3.8 to 4.0mm $91.00

BH275 ALPS Plating System Non locking Bone Screws 3.0-4.0mm $91.00

 Device Technologies Australia Pty Ltd

DE366 Low Profile Cancellous Bone Screws Low Profile Cancellous Bone Screws 4mm $91.00

DE407 Non-Locking Cortical and  Non-Locking Cortical and  3-3.5mm $91.00

 Cancellous Screws, Small Cancellous Screws, Small

 DJO Australasia Pty Ltd

DD055 Glenoid Baseplate Non Locking  Glenoid Baseplate Non Locking  3.5mm diameter, length 14- $91.00

 Bone Screw Bone Screw 34mm in 2mm increments

 Emergo Asia Pacific Pty Ltd

ER098 DeRoyal Internal Fixation System -  Screws, Stainless Steel 316L,  Small(2.71 - 4.49mm) $91.00

 screws manufactured in USA

 Global Manufacturing Technology Pty Ltd

GM109 OsteoBridge OsteoBridge Interlocking Screw 18m to 56mm $91.00

 Integra Neurosciences Pty Ltd

IG063 Tibiaxys Distal tibia system Titanium screw for use with Tibiaxys  4mm diameter with 6mm  $91.00

 distal tibia system head; 40mm - 100mm length

IG066 Integra Total Wrist Fusion System Cortical Screw for use with the Integra 3.5mm diameter: 10-32mm  $91.00

  Total Wrist Fusion Plates length

IG080 Hintegra Total Ankle Prosthesis Cortical fixation screw, Composition - Length 12 - 42mm $91.00

  Stainless Steel

IG099 Calcanea Variable Angle Screw Cortical Screw, Titanium Diameter 3.5mm, Length  $91.00

 20mm to 45mm

IG124 VIPER with VALT - cortical screws Cortical screw for fixation Diameter 3.5mm, length 10- $91.00

 18mm

IG130 Spider Limited Wrist Fusion System Stainless steel screws for Spider Plate Diameter 2.8mm, length 10- $91.00

  - 2.8mm bone screws 18mm

 Lifehealthcare Pty Ltd

LH323 ITS Cancellous Screws Cancellous Screws D=3.5mm & 4.2mm,  Length  $91.00

 = 14mm - 60mm (with

 incremental of 2)

Prostheses List by Category, Groups and Sponsor Page 389 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

LH324 ITS Cortical Screws Cortical Screws D=3.5mm & 4.2, 4.5mm,  $91.00

 Length =14mm - 60 mm

 (with incremental of 2)

 Lima Orthopaedics Australia Pty Ltd

LC052 Bone Screw Bone Screw self tapping cortical Diameter 3.5mm length 20- $91.00

 100mm

LC091 Diphos Plate - Spherical Head  Spherical Head Screw - Small Diameter 3.5mm x 8-26mm  $91.00

 Screw - Small length

LC101 Osteosynthesis Bone Screws  Osteosynthesis Bone Screws  Dia 3.5mm x 10-120mm  $91.00

 Cancellous - Small Cancellous - Mini length

LC102 Osteosynthesis Bone Screw  Osteosynthesis Bone Screw Cortical - Dia 3.5mm x 10-120mm  $91.00

 Cortical - Small  Small length

LC127 MCD non Locking Bone screw -  MCD NON Locking Bone Screw  3 to 4mm Dia x 08 - 60mm  $91.00

 Small Length partial or Full

 LMT Surgical Pty Ltd

LM075 Surgicraft Bone Screws Surgicraft Bone Screws 2-4mm diameter/10-40mm  $91.00

 length

LM116 Newclip Bone Screws NewClip Non - Locking Bone screws 2.8 - 4.5mm diameter to 10- $91.00

 60mm in length

LM146 TriMed Bone Screws Non-Locking Cortical Bone Screw 3.2/3.8/4.0 x 10-60mm $91.00

LM170 Screws - Standard Standard Screws 10 - 70mm $91.00

 Medartis

EO077 APTUS Screws Cortical Screws 2.8mm - 3.5mm Diameter $91.00

 Medical & Optical Instruments Australia Pty Ltd

MO321 Acumed Hexalobe Non Locking  Acumed Hexalobe Non Locking  Small (2.71mm-4.49mm) $91.00

 Screws

MO378 Acu-Loc Distal Radius Plate  Cortical Screw Locking 3.5mm $91.00

 Ortho Solutions Pty Ltd

OU028 fps non-LOCKING SCREW FPS 2.7mm non locking screw 8-30mm (FPS 2.7mm non  $91.00

 FPS GENII 2.7mm non-locking screw locking)

  10-50mm (FPS 3.5mm non-

 FPS 3.5mm non-locking screw locking)

Prostheses List by Category, Groups and Sponsor Page 390 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

OU032 CORTICAL SCREW CORTICAL SCREW 3.5MM CORTICAL  $91.00

 SELF TAPPING CORTICAL  SCREW 8MM

 3.5MM CORTICAL

 SCREW 10MM

 3.5MM CORTICAL

 SCREW 12MM

 3.5MM CORTICAL

 SCREW 14MM

 3.5MM CORTICAL

 SCREW 16MM

 3.5MM CORTICAL

 SCREW 18MM

 3.5MM CORTICAL

 SCREW 20MM

 3.5MM CORTICAL

 SCREW 22MM

 3.5MM CORTICAL

 SCREW 24MM

 3.5MM CORTICAL

 SCREW 26MM

 3.5MM CORTICAL

 SCREW 28MM

 3.5MM CORTICAL

 SCREW 30MM

 3.5MM CORTICAL

 SCREW 32MM

 3.5MM CORTICAL

 SCREW 34MM

 3.5MM CORTICAL

 SCREW 36MM

 3.5MM CORTICAL

 SCREW 38MM

 3.5MM CORTICAL

 SCREW 40MM

 3.5MM CORTICAL

 SCREW 42MM

 3.5MM CORTICAL

 SCREW 44MM

 3.5MM CORTICAL

 SCREW 45MM

 3.5MM CORTICAL

 SCREW 50MM

 3.5MM CORTICAL

 SCREW 55MM

 3.5MM CORTICAL

 SCREW 60mm

Prostheses List by Category, Groups and Sponsor Page 391 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 SCREW 3.5MM CORTICAL

 SCREW 65mm

 3.5MM CORTICAL

 SCREW 70mm

 3.5MM CORTICAL

 SCREW 75mm

 3.5MM CORTICAL

 SCREW 80mm

 3.5MM CORTICAL

 SCREW 85mm

 3.5MM CORTICAL

 SCREW 90mm

 3.5MM CORTICAL

 SCREW 95mm

 3.5MM CORTICAL

 SCREW 100mm

 3.5MM CORTICAL

 SCREW 105mm

 3.5MM CORTICAL

 SCREW 110mm

 3.5MM SELF TAPPING

 CORTICAL SCREW 10MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 12MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 14MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 16MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 18MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 20MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 22MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 24MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 26MM

Prostheses List by Category, Groups and Sponsor Page 392 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 28MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 30MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 32MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 34MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 36MM

 

 3.5MM SELF TAPPING

 CORTICAL SCREW 38MM

 

OU036 Cancellous Screw Cancellous Screw 4.0mm cancellous screw  $91.00

 fully threaded 10mm to

 60mm

 4.0mm cancellous screw

 partially threaded 10mm to

 60mm

 Orthotech Pty Ltd

OH454 OsteoMed FPS Bone screws 3.5/4mm x 10-60mm $91.00

 Smith & Nephew Surgical Pty Ltd

SL011 TC-100 Cortical and Cancellous Screws 2.71mm-4.49mm $91.00

SL012 Peri-Loc and Peri-Loc VLP Cortical and Osteopenia Screws 2.71mm-4.49mm $91.00

 Stryker Australia Pty Ltd

HW461 Memometal Anchorage Bone Screws Anchorage Locking Bone Screws 3.0 - 3.5mm diameter to 10 -  $91.00

 40mm in length

SK229 Omega Plus Compression Hip  Cephalic Implants Hansson Twin Hook  $91.00

 Screw System Compression Screw 25mm

SK452 Stryker Plating System Cortical  Screws 2.7mm - 4.5mm Diameter $91.00

 8mm - 150mm Length

ST006 Stryker Plating System Cancelleous screws 2.7-4.0mm $91.00

Prostheses List by Category, Groups and Sponsor Page 393 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Surgical Specialties

SQ085 PediNail-Captured locking screws- 4.0 x 15 Cort Screw (7mm Distal  4mmx15mm-60mm in 5 mm  $91.00

 small Lock) increments

 4.0 x 20 Cort Screw (7mm Distal

 Lock)

 4.0 x 25 Cort Screw (7mm Distal

 Lock)

 4.0 x 55 Cort Screw (7mm Distal

 Lock)

 4.0 x 60 Cort Screw (7mm Distal

 Lock)

 4.0 x 30Cort Screw (7mm Distal Lock)

SQ092 PediLoc Small Screws 3.5-4.0mm non-locking screws 10-70mm $91.00

 Surgiplas Medical

SP032 OsteoMed Plating & Fixation System Lag Screws - Maxi, MMF, 3.0mm 2.4mm x (8 - 42)mm; 2.4 x  $91.00

 (12 - 18)mm; 3.0mm x (12 -

 36)mm;

 Synthes Australia Pty Ltd

SY068 AO/ASIF Screws Cortex, Conical, Cancellous,  5mm - 160mm $91.00

 Compression Screws

 Tornier Pty Ltd

TO108 MaxLock Extreme System - 3.5/4mm  Bone screws, Titanium, non locking Ø 3.5mm, length 8-50mm $91.00

 Non Locking Screws Ø 4mm, length 8-60mm

TO145 WAVE Calcaneal Fracture System -  The WAVE Calcaneal Fracture System Screws Diameter = 4.0mm;  $91.00

 Fully Threaded Screw  is a low profile, anatomical plate and  Length = 26-50mm in 2mm

 screws system designed for the  increments & 55-90mm in

 fixation of calcaneal fractures. The  5mm

 plate and associated locking and non-

  locking screws facilitate the

 reconstrution of the height and width

 of the calcaneus, and possible

 remodelling of the lateral calcaneal

 wall. The WAVE calcaneal Fracture

 System is provided non-sterile. The

 Fully Threaded Screw is used with the

  WAVE Calcaneal Plate

 Wright Medical Australia

WR219 Evolve Ortholoc EPS System 3.5  Stainless Steel, Cortical & Cancellous 3.5mm diameter 10-60mm $91.00

 NL Screws  Screws

WR241 Stainless Steel Screw Stainless steel plate screw, non  2.7 & 3.2 dia. 8-50mm  $91.00

 length in 2mm increments

Prostheses List by Category, Groups and Sponsor Page 394 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Zimmer Pty Ltd

ZI150 Periarticular Plates Periarticular 4.0mm Cancellous  Part thread - 30-60 mm, Full  $91.00

 Screws - Stainless Steel thread 30-110 mm

ZI152 Periarticular Plates Periarticular 3.5mm Self Tapping  10 - 80mm $91.00

 Screws - Stainless Steel

ZI202 Zimmer ECT Screws 3.5mm Cortical Screws 10 - 130 mm $91.00

ZI203 Zimmer ECT Screws 4.0mm Cancellous Screws 10 - 60 mm $91.00

ZI892 NCB System NCB Screws 4mm x 14-90mm $91.00

 Break off

 Device Technologies Australia Pty Ltd

DE365 QuickFix Screw, Small Titanium Snapp-off Small Bone Screw,  3.0mm Diameter x 13-19mm  $336.00

 small Lengths

 Breakoff

 Integra Neurosciences Pty Ltd

IG134 Snap-Off screws Titanium break-off barrel screws for  Diameter 3.0mm, Length 10  $336.00

 Hallu-Fix - 18mm

 Stryker Australia Pty Ltd

HW450 Fixos Screws, Snap-off, 2.7mm Bone Fixation Screws, Snap-off, 2.7mm 2.7mm diameter, 14 to 22mm  $336.00

 (each 2mm)

 Breakoff, DT

 Perios Pty Ltd

PF002 BePOD Self-Compressive Screw Lengths 10mm - 34mm $526.00

PF008 Forefoot Snap off Screws Titanium Alloy Screws with Snap-off  Arthrodesis large diameter  $526.00

 Grip / Cannulated L28 - L40

 CD, DT

 Lima Orthopaedics Australia Pty Ltd

LC132 MCD Cannulated Double Threaded  MCD Cannulated Double Threaded  3.0/4.0mm Dia x 14 to 34mm $421.00

 Bone Scre - Small Bone Screw - Small  Length

 CN

 Biomet Australia Pty Ltd

BH186 Small / Large  Fragment Set Cannulated Titanium Bone Screw 3.0mm - 4.0mm $231.00

BH277 ALPS Plating System Cannulated  Bone Screws 3.0 to 4.0mm diameter $231.00

Prostheses List by Category, Groups and Sponsor Page 395 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Device Technologies Australia Pty Ltd

DE370 Cannulated Low Profile Screws,  Cannulated Low Profile Screws, Small 3-4mm $231.00

 Small

 Emergo Asia Pacific Pty Ltd

ER088 DeRoyal Internal Fixation Systems - Cannulated Screws, Stainless Steel  Small (2.71 - 4.49mm) $231.00

  cannulated screws 316L, manufactured in USA

 KH NXGEN (AUS) Pty Limited

KH017 KCS Cannulated Screws Cannulated Screw 4.0mm diameter, 25 to 70mm  $231.00

 length

 Lima Orthopaedics Australia Pty Ltd

LC119 Superscrew - small Cannulated Cotical / Cancellous Lag  Dia. 3.5 / 4.0 mm x 10-70mm  $231.00

 Screw Partial or Full Thread length

LC130 MCD Cannulated Bone Screw - Small MCD Canulated Bone Screw - Partial  3.0 to 4.0 mm Dia x 08- $231.00

 or Full Thread - Small 60mm Length

 LMT Surgical Pty Ltd

LM154 EOS Footset-Antares Footscrew 12-34mm $231.00

 Ortho Solutions Pty Ltd

OU030 Cannulated Screw Self Drill/Tap bone screws and washers are  3.5mm x 22mm, 3.5mm x  $231.00

 indicated for use in fixation of various  24mm, 3.5mm x 26mm, 3.5mm

 fractured bones. Mini plates and   x 28mm, 3.5mm x 30mm,

 screws 3.5mm or smaller are intended  3.5mm x 32mm, 3.5mm x

 fro use in small bones in the hand or  34mm, 3.5mm x  36mm,

 foot and include metacarpal, metatarsal 3.5mm x 40mm, 3.5mm x

  and phalange bones. Small and large  42mm, 3.5mm x 44mm, 3.5mm

 plates and screws 4.0mm and larger are  x 45mm, 3.5mm x 46mm,

  intended for use in large and long  3.5mm x 48mm, 3.5mm x

 bones which can include the clavicle,  50mm, 3.5mm x 55mm, 3.5mm

 scaplua, pelvis, calcaneus, talus ans   x 60mm

 long bones (humerus, ulna, radius,

 femur, tibia and fibula)

OU033 Titianium Cannulated Cancellous  Titianium Cannulated Cancellous lag  4.0mm x 10mm Titianium  $231.00

 lag Screw Screw Cannulated Cancellous lag

 Screw up to (4.0mm x 28mm)

 Smith & Nephew Surgical Pty Ltd

SN971 Cannulated Screw Stainless Steel 2.71mm - 4.49mm $231.00

 Stryker Australia Pty Ltd

SK528 'Stryker Cannulated Screw System Asnis III Cannulated screws 4.0mm $231.00

Prostheses List by Category, Groups and Sponsor Page 396 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

SR094 Stryker Cannulated Screw System Asnis Micro Cannulated screw 2.71mm-3.0mm, Diameters,  $231.00

 8mm-40mm lengths

 Surgiplas Medical

SP037 OsteoMed Plating & Fixation System Screws - Cannulated Lag 3.0mm x (10 x 28)mm; 4.0mm $231.00

  x (12 - 30)mm

SP038 OsteoMed Plating & Fixation System Screws - Cannulated Lag 3.0mm x (30 x 40)mm; 4.0mm $231.00

  x (32 - 52)mm

 Synthes Australia Pty Ltd

SY071 AO/ASIF Screws Cannulated screws >2.7mm-4.49mm $231.00

 Tornier Pty Ltd

TO113 MaxTorque Cannulated Screw  Bone screws, Titanium, Cannulated,  Ø3.2mm Short Thread,  $231.00

 System - Small Screws Short or Long Thread Length 12-30mm

 Ø3.2mm Long Thread,

 Length 12-38mm

 Ø3.8mm Short

 Thread,Length 16-50mm

 Ø4.0mm Long Thread,

 Length 14-50mm

 Ø4.0mm Long Thread,

 Length 24-50mm

TO121 CoverLoc Screws CoverLoc Screws, stainless steel, (lag  2.7mm & 3.3mm x 10mm- $231.00

 & cortical) & Pegs (threaded &  26mm in 2mm increments

 unthreaded)

TO146 WAVE Calcaneal Fracture System -  The WAVE Calcaneal Fracture System Screws: Diameter: 4mm;  $231.00

 Cannulated Lag Screw  is a low profile, anatomical plate and  Length = 26mm - 90mm (for

 screws system designed for the  lag screws) in 2mm

 fixation of calcaneal fractures. The  increments up to 50mm and

 plate and associated locking and non- 5mm increments up to 90mm

 locking screws facilitate the

 reconstruction of the height and

 width of the calcaneus, and possible

 remodelling of the lateral calcaneal

 wall. The WAVE Calcaneal Fracture

 System is provided non-sterile. The

 Cannulated Lag Screw is used with

 the WAVE Calcaneal Fracture Plate or

  with the washer for optional off plate

 use.

Prostheses List by Category, Groups and Sponsor Page 397 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Wright Medical Australia

WR068 Cannulated Screw Titanium cannulated screw intended  3.5mm diameter x 34, 36 &  $231.00

 for use in conjunction with a plate for  38mm

 fixation of midfoot fusion

WR247 Darco Headed Compression Screw  Cannulated titanium compression  3.0-4.0mm x 16-50mm $231.00

 System screws

 Zimmer Pty Ltd

ZI177 Zimmer Internal Fixation Systems:  Mini Magna-FX - Stainless Steel 4 & 5mm diameters $231.00

 Cannulated Screw

ZI835 NCB Polyaxial Locking System 4.0mm Cannulated Variable Angle  14 - 65mm $231.00

 Locking Screws - Ti Alloy

 CN, DT

 Biomet Australia Pty Ltd

BH190 Barouk Screw System Metatarsal screw 3.0mm $421.00

 Integra Neurosciences Pty Ltd

IG057 Kompressor Titanium compression screw 10-34mm $421.00

IG069 Bold Compression Screw Cannulated titanium 3mm diam 10-34mm length $421.00

IG070 ICOS Screw: Ideal Compression  Cannulated titanium 4.0mm diam 26-60mm  $421.00

 Screw length, 6.5mm diam 40-

 150mm length

IG109 Qwix Screw Self drilling, self tapping, cannulated,  Diameter 3.0mm-7.5mm,  $421.00

 titanium screws. length 10mm-120mm

 Lima Orthopaedics Australia Pty Ltd

LC067 DTS - Double threaded cannulated  DTS - Double threaded cannulated  Diameter 3, 3.5, x Length 12 $421.00

 screw with guidewire screw with guidewire  to 40mm

LC109 WG - Mica Forefoot Surgey - Bone  self-threading, double threaded  3mm Dia x 10-40mm Length $421.00

 Screw - Small cannulated 3mm screws

LC124 TwinLock Screw - Small TwinLock Screw - Small 3.5/3.6mm to 4.0/4.1mm Dia  $421.00

 x 16 to 34 mm length

LC125 Twinlock Screw - Standard Twinlock Screw - Standard 5.2/5.5mm to 6.0/7.0mm Dia  $421.00

 x 25 to 120 mm Length

 LMT Surgical Pty Ltd

LM052 Ascension Compression Screw Titanium Compression Screw 2-5mm diameter ; 12 - 40mm  $421.00

 length

Prostheses List by Category, Groups and Sponsor Page 398 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

LM143 Extremity Medical Compression  Compression Screws 3.0-4.5mm $421.00

 Screw System

LM179 Compression Screw - Small 3.9mm diameter cannulated  Length: 14 - 22mm $421.00

 compression screw

LM186 Foot Motion - self-drilling  Self-drilling auto-compressive  3.0mm diameter, length  $421.00

 cannulated compression screws cannulated screw 8mm-40mm

 Medical & Optical Instruments Australia Pty Ltd

MO355 Acutrak 2 Headless compression screw 2.71mm - 4.49mm $421.00

MO368 Acumed Fixation Screw Acutrak Compression Screw Titanium 2.71mm - 4.49mm $421.00

MO382 Acutrak Headless Compression Screw Acutrak 4/5 screw 2.71mm - 4.49mm $421.00

Prostheses List by Category, Groups and Sponsor Page 399 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Ortho Solutions Pty Ltd

Prostheses List by Category, Groups and Sponsor Page 400 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

OU031 Compression Screw Compression Screw 3.0MM META SCREW -  $421.00

 LONG THREAD 10MM

 3.0MM META SCREW -

 LONG THREAD 12MM

 3.0MM META SCREW -

 LONG THREAD 14MM

 3.0MM META SCREW -

 LONG THREAD 16MM

 3.0MM META SCREW -

 LONG THREAD 18MM

 3.0MM META SCREW -

 LONG THREAD 20MM

 3.0MM META SCREW -

 LONG THREAD 22MM

 3.0MM META SCREW -

 LONG THREAD 24MM

 3.0MM META SCREW -

 LONG THREAD 26MM

 3.0MM META SCREW -

 LONG THREAD 28MM

 3.0MM META SCREW -

 LONG THREAD 30MM

 3.0MM META SCREW -

 LONG THREAD 32MM

 3.0MM META SCREW -

 LONG THREAD 34MM

 3.0MM META SCREW -

 SHORT THREAD 12MM

 3.0MM META SCREW -

 SHORT THREAD 14MM

 3.0MM META SCREW -

 SHORT THREAD 16MM

 3.0MM META SCREW -

 SHORT THREAD 18MM

 3.0MM META SCREW -

 SHORT THREAD 20MM

 3.0MM META SCREW -

 SHORT THREAD 22MM

 3.0MM META SCREW -

 SHORT THREAD 24MM

 3.0MM META SCREW -

 SHORT THREAD 26MM

 3.0MM META SCREW -

 SHORT THREAD 28MM

 3.0MM META SCREW -

 SHORT THREAD 30MM

Prostheses List by Category, Groups and Sponsor Page 401 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 3.0MM META SCREW -

 SHORT THREAD 32MM

 3.0MM META SCREW -

 SHORT THREAD 34MM

 3.0MM META SCREW -

 SHORT THREAD 36MM

 3.0MM META SCREW -

 SHORT THREAD 40MM

 3.0MM META SCREW -

 SHORT THREAD 44MM

 COMPRESSION SCREW

 10MM

 COMPRESSION SCREW

 12MM

 COMPRESSION SCREW

 14MM

 COMPRESSION SCREW

 16MM

 COMPRESSION SCREW

 18MM

 COMPRESSION SCREW

 20MM

 COMPRESSION SCREW

 22MM

 COMPRESSION SCREW

 24MM

 COMPRESSION SCREW

 26MM

 COMPRESSION SCREW

 28MM

 COMPRESSION SCREW

 30MM

 COMPRESSION SCREW

 32MM

 COMPRESSION SCREW

 34MM

 SCARF SCREW 10MM

 SCARF SCREW 12MM

 SCARF SCREW 14MM

 SCARF SCREW 16MM

 SCARF SCREW 16MM

 SCARF SCREW 18MM

 SCARF SCREW 20MM

 SCARF SCREW 22MM

 SCARF SCREW 24MM

 SCARF SCREW 26MM

Prostheses List by Category, Groups and Sponsor Page 402 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 SCARF SCREW 28MM

 SCARF SCREW 30MM

 SCARF SCREW 32MM

 SCARF SCREW 34MM

 Orthotech Pty Ltd

OH446 ExtremiFix Screws Headless Cannulated Compression  Diameter 3.0mm, 4.0mm.  $421.00

 Screw Length 10mm to 52mm;

 Diameter 2.71mm - 4.49mm.

 Smith & Nephew Surgical Pty Ltd

SM173 Peri-Loc Headless Cannulated Screw 2.71mm-4.49mm Headless  $421.00

 Cannulated Screw 8mm -

 40mm

 Stryker Australia Pty Ltd

HW451 Fixos Screws, Snap-off,AO fitting  Bone Fixation Screws, Snap-off, AO  3.0mm diameter, 10 to 22mm  $421.00

 3.0mm fitting 3.0mm (each 2mm)

HW452 Fixos Screws Bone Fixation Srews, Cannulated,  3.0mm-4.0mm diamter, 10 to  $421.00

 Double Threaded 60mm (each 2mm)

SK256 TwinFix Cannulated Compression  0 Diameter 3.2mm, lengths 14- $421.00

 Screw System 34mm

 Surgiplas Medical

SP122 ExtremiFix Screws Headless Cannulated Compression  Diameter 3.0mm, 4.0mm.  $421.00

 Screw Length 10mm to 52mm;

 Diameter 2.71mm - 4.49mm.

 Synthes Australia Pty Ltd

SY644 AO/ASIF Screws HCS Countersinkable Compression  3.0 $421.00

 Screw

 Tornier Pty Ltd

TO124 NexFix 3.0mm Compression Screw The NexFix Compression Screw is a  3.0mm diameter x 10 - 34mm  $421.00

 stainless steel, cannulated, self  length in 2mm increments

 tapping, and self drilling fixation

 device for osteotomies, fusions and

 fracture fixation of small bones

Prostheses List by Category, Groups and Sponsor Page 403 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Wright Medical Australia

WR034 Charlotte Foot & Ankle System Multi use compression screw,  3.0 & 4.3mm dia. 10-60mm  $421.00

 cannulated, stainless steel in 2mm increments

 CN, LK

 Integra Neurosciences Pty Ltd

IG093 Newdeal Screws/Lock Screws Screws - Cancellous, Cancellous  Cancellous/Cancellous  $301.00

 cannulated, cortical, cortical  cannulated - Diameter

 cannulated plus Lock screws 6.5mm, 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  Diameter 3.5mm, Length 10- $301.00

 for the fixation of specific Newdeal  50mm; Diameter 4.5mm,

 bone plates length 14-65mm; Diameter

 6.5, length 20-100mm

 Johnson & Johnson Medical Pty Ltd

MN040 Bristow-Latarjet Instability  Cannulated titanium locking screw 28mm to 48mm $301.00

 Shoulder Set - Screw

 CN,DT

 Device Technologies Australia Pty Ltd

DE427 Headless Compression Screw Headless Compression Screw for bone 3mm x 10-32mm $421.00

  fixation

 Orthopaedic Solutions Pty Ltd

OE048 Merete - Cannulated HCS  Bone Screws, Titanium, Cannulated  Diameter = 3.0mm, Length =  $421.00

 (Compression Screws 3.0mm x  Compression 12-32mm in2mm increments

 4.3mm) & 35mm, 40mm

 Diameter = 4.3mm, Length

 =20-40mm in 2mm increments

 Orthotech Pty Ltd

OH474 DynafitSystem Self-compressive screws 3.2 x 12-26mm $421.00

Prostheses List by Category, Groups and Sponsor Page 404 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

OH477 DynafitSystem Self-compressive screws 3.2 x 12-26mm $421.00

OH480 HBS 2 midi Self-compressive screws 3.0mm x 10-40mm $421.00

 Perios Pty Ltd

PF001 BePOD Canulated Self-Compressive Screws lengths 10mm to 34mm $421.00

 Wright Medical Australia

WR264 MICA Compression Screw Compression Screw for Minimally  Sizes 3mm 32mm - 44mm $421.00

 Invasive Surgery

 CN,LK

 Synthes Australia Pty Ltd

SY797 AO/ASIF Screws Philos Cannulated locking screw 3.5mm $301.00

 Zimmer Pty Ltd

ZI853 Zimmer Periarticular Plating System 5.5mm Cannulated Periarticular  30 - 150mm $301.00

 Locking Screws

ZI855 Zimmer Periarticular Locking  3.5mm Cannulated Periarticular  30 - 90mm $301.00

 Locking Screws

 DT

 Biomet Australia Pty Ltd

BH247 Rockwood Clavical Pin Clavical Pin with dual thread 3.0-3.8mm $281.00

 Device Technologies Australia Pty Ltd

DE272 Bio-Compression Screw System Fixation Device 16mm, 18mm, 20mm, 22mm,  $281.00

 24mm, 26mm

 LMT Surgical Pty Ltd

LM182 Chevron Screw Non-Cannulated Self Tapping Screws Diameter: 2.8mm $281.00

 Length: 16- 28mm

 Medical & Optical Instruments Australia Pty Ltd

MO374 Acutrak Fusion Screws Fusion Screws Titanium 2.71mm - 4.49mm $281.00

 DT CN

 Wright Medical Australia

WR062 Headless Compression screws Compression screw cannulated,  2.5-3.2mm diameter x 10- $421.00

 titanium, self tapping, self drilling. 32mm

Prostheses List by Category, Groups and Sponsor Page 405 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 DT, CN

 Advanced Surgical Design & Manufacture Ltd

AE249 FusiFIX™ Triple thread, cannulated,  4mm $421.00

 compression screw system

 Integra Neurosciences Pty Ltd

IG107 Bold Compression Screw Cannulated Titanium Diameter 3.0-3.70mm,  $421.00

 length 10-34mm

 LMT Surgical Pty Ltd

LM109 NewClip Compression Screws Compression Screw 3.5mm x 10-18mm $421.00

 Medartis

EO058 Aptus 3.0 Cannulated Headless  Aptus 3.0 Cannulated Headless  3.0 diameter.  Short and  $421.00

 Compression Screw Compression Screw long threaded 10mm to

 RQSolutions Medical Devices Distribution Support

RQ003 Orthomed Metallic Compression  The compression screw is indicated  10 sizes $421.00

 Screw for fixation of bone fragments for  Head diameter: 3.8mm

 forefoot surgery. Proximal diameter: 3mm

 The compression screws are self- Internal diameter: 1.10mm

 tapping cannulated screws, which  Different length from 10mm

 present two types of thread diameter  to 34mm by pitch of 2mm

 (one on the screw head and a body  between each reference

 part of the screw). They are

 particularly intended to repair the 1st

 metatarsal in the foot.

 The pitch difference between the

 proximal and the distal part allows

 creating a compression are between

 the upper and lower bone fragment of

 1st metatarsal improving the healing

 process.

 DT, LK

 Medartis

EO074 APTUS Screws Aptus Locking Screws 2.8mm - 3.5mm Diameter $351.00

 DT,LK

 Johnson & Johnson Medical Pty Ltd

DY573 Delta Shoulder System Metaglene Screw Stainless Steel 3.5mm $351.00

Prostheses List by Category, Groups and Sponsor Page 406 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LK

 Advanced Surgical Design & Manufacture Ltd

AE155 ASDM Clavicle Plating System -  Fixation Device, Internal, Locking,  3.5mm Locking Screws, 10- $161.00

 Screws Stainless Steel, Cortical Screw Size:  30mm (2mm increments)

 3.5mm

AE246 SBi Locking Screws Titanium Cortical Locking Self- 2.7mm Cortical Locking,  $161.00

 tapping screws Self-tapping 10 - 30mm

 3.5mm Cortical, Locking,

 Self tapping 8 -20mm

 Austofix

AX003 Austofix Intramedullary Screws Humeral Head Screw, stainless steel 4.3mm $161.00

AX086 Austofix Proximal Humeral Plating  Locking Screw Titanium 3.5mm, 20-100mm $161.00

 System - Austofix PHP Locking

 Screw

AX089 Austofix Proximal Humeral Plating  Variable Angle Locking Screw,  3.5mm 20-100mm $161.00

 System - Austofix VA Locking  Cobalt Chrome

 Biomet Australia Pty Ltd

BH141 OptiLock Upper Extremity Plating  Locking Screws, Stainless Steel 3.5mm Diameter, 10-60mm  $161.00

 System - Locking Screws length (2mm increments)

BH261 HI S3 Shoulder Fixation System Locking Peg 4mm diameter $161.00

BH272 Polyax Plating System Locking Bone screws 4.0mm diameter $161.00

BH276 ALPS Plating System Cancellous titanium Locking Bone  10-100mm $161.00

 Screws

BH289 ALPS System Polyaxial locking screws 3-4.0mm diameter $161.00

 Device Technologies Australia Pty Ltd

DE368 Locking Cortical land Cancellous  Locking Cortical and Cancellous  3-3.5mm $161.00

 Screws, Small Screws, Small

 Emergo Asia Pacific Pty Ltd

ER086 DeRoyal Internal Fixation Systems - Locking Screws, Stainless Steel  Small (2.71-4.49mm) $161.00

  Locking Screws 316L, manufactured in USA

 Integra Neurosciences Pty Ltd

IG067 Surfix screw plus Surfix Lock-Screw Locking screws with an independent  2.7mm: 10-32mm $161.00

 lock-screw head

Prostheses List by Category, Groups and Sponsor Page 407 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

IG068 Surfix Screw plus Surfix Lock-Screw Locking screws with an independent  3.5mm: 10-28mm $161.00

 lock-screw head that screw into

 fixation plates. This combination

 effects dynamic compression.

IG092 Newdeal Lock Screws For use with Newdeal bone screws  Diameter 2.7mm - 6.5mm $161.00

 and plates

IG098 Calcanea Locking Screw Cortical Screw, Titanium Diameter 3.5mm, Length  $161.00

 20mm to 45mm

IG120 Surfix Locking Screws Locking screws with an independent  3mm; 10-24mm length $161.00

 lock-screw head

 Lima Orthopaedics Australia Pty Ltd

LC053 Threaded Head Bone Screw Threaded Head Bone Screw Cancellous Diameter 3.5, 4mm, length  $161.00

 10-60mm

LC095 Diphos Plate - Threaded Head  Threaded Head Screw - Small Diameter 3.5mm x Length 8- $161.00

 Screw - Small 40mm

LC113 MCD Locking Bone Screw - smal MCD Locking Bone Screw Small 3.5/40 mm Dia x 08-60mm  $161.00

 Length Parital or Full Thread

 LMT Surgical Pty Ltd

LM069 Normed Foot screws Titanium locking bone screws 2.7-4.0mm $161.00

LM115 Newclip Bone Screws Newclip Locking Bone Screws 2.8 - 4.5mm diameter to 10- $161.00

 60mm in length.

LM145 TriMed Bone Screw Locking Cortical Bone Screw 3.2mm x 10-40mm $161.00

LM147 TriMed Bone Screw Locking Compression Bone Screw 4mm x 35-60mm $161.00

LM171 Screws -Locking Locking Screw 10 - 70mm $161.00

 Medical & Optical Instruments Australia Pty Ltd

MO322 Acumed Hexalobe Locking Screws Acumed Hexalobe Locking Screws Small (2.71mm-4.49mm) $161.00

MO370 Acumed Tap-Loc Tap screws, Tap-Loc Screws 3.6mm -60 mm Length $161.00

MO377 Acu-Loc Distal Radius Plate  Cortical Screw 3.5mm $161.00

MO415 Acumed Screws Screws 2.71mm - 4.49mm $161.00

 Ortho Solutions Pty Ltd

OU024 Locking screw FPS 3.5mm locking screw FPS 3.5mm x 14mm locking  $161.00

 FPS GENII 3.5mm locking screw screw up to 35mm

 FPS 2.7mm locking screw

 FPS GENII 2.7mm locking screw

Prostheses List by Category, Groups and Sponsor Page 408 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Orthopaedic Solutions Pty Ltd

OE047 Merete - MetaFix LS - Locking   Bone screws, Titanium, Locking Diameter = 3.0, length = 12- $161.00

 Screws 3.0 & 3.5mm 28mm in 2mm increments

 Diameter = 3.5mm, length

 12-48mm in 2mm increments

 Orthotech Pty Ltd

OH455 OsteoMed FPS Bone screws 3.5/4mm x 10-60mm $161.00

 Smith & Nephew Surgical Pty Ltd

SN944 Peri-Loc Locking Screws 2.71mm - 4.49mm $161.00

 Stryker Australia Pty Ltd

HW460 Memometal Anchorage Bone Screws Anchorage Bone Screws 3.0-3.5mm diameter to 10 -  $161.00

 40mm in length

SK563 Stryker Plating System SPS Locking Plate System Locking screws 3-4mm $161.00

SR073 Stryker Locking Plate System Locking Screws Diameter 2.7 to 3.5mm,  $161.00

 Length 10mm to 70mm

 Surgical Specialties

SQ093 PediLoc - 3.5mm self-tapping,  3.5 mm self tapping/locking cortical  Self tapping cortical screw  $161.00

 Locking Cortical Screws screw (threaded/T15 hexalobe) with T 15 Hexalobe: 10mm-

 60mm, in 2mm increments

 60-70mm, in 5mm

 increments

 Locking cortical full thread:

  10mm-60mm, in 2mm

 increments, 60mm-70mm, in

 5mm increments

 Locking CorticalScrew

 with T15 Hexalobe:

 10mm-56mm, in 2mm

 increments

 Synthes Australia Pty Ltd

SY652 AO/ASIF Screws Locking Head Screws >2.7mm - <4.5mm $161.00

SY692 Dynamic Locking Screw Pin-sleeve locking screw 3.7mm $161.00

Prostheses List by Category, Groups and Sponsor Page 409 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Tornier Pty Ltd

TO032 Aequalis Humeral Plate Screws Proximal humeral plate screws  Proximal locking screws:  $161.00

 (Cancellous self-tapping locking  4mm, cortical self tapping

 screws, Cortical self-tapping locking  locking screws: 20 to 60mm

 screws or Cortical Self-tapping   length; proxmial inferior

 compression screws) locking screws: 3.5mm,

 cortical self tapping locking

  screws: 10 to 40mm length;

  distal compression screws:

 3.5mm, cortical self-tapping

 compression

TO109 MaxLock Extreme System - 3.5mm  Bone screws, titanium, fixed or  Ø 3.5mm Fixed angle,  $161.00

 locking screws variable angle locking Length 8-45mm

 Ø 3.5mm Variable angle,

 Length 10-50mm

TO118 Nexfix MTP Fusion System Unique low profile stainless steel  3.2mm x 12mm, 14mm, 16mm, $161.00

 locking screw for use with NexFix   18mm, 20mm

 MTP Fusion plates,  indicated for use

 in osteoporotic bone

TO147 WAVE Calcaneal Fracture System -  The WAVE Calcaneal Fracture System Screws: Diameter = 4.0mm,  $161.00

 Locking Screw  is a low profile, anatomical plate and  Length - 14-44 in 2mm

 screw system designed for the  increments

 minimally invasive fixation of the

 calcaneal fractures. The plate and

 associated locking and non-locking

 screws facilitate the reconstruction of

 the height and width of the calcaneus,

 and remodelling of the lateral

 calcaneal wall. The WAVE calcaneal

 System is provided non-sterile. The

 Locking Screw is used with the

 WAVE Calcaneal Fracture Plate

 Wright Medical Australia

WR072 Ortholoc Fracture System Screws Titanium, variable angle locking  3.5 & 4.0mm diameter, 8- $161.00

 100mm length

WR078 Charlotte Lisfranc Recontruction  Solid core stainless steel screw. 3.7mm diameter, 8-100mm  $161.00

 System - Screw. length.

WR218 Evolve Ortholoc EPS System 3.5  Stainless Steel, Variable Angle  3.5mm Diameter, 10-60mm $161.00

 locking Locking, Cortical & Cancellous

Prostheses List by Category, Groups and Sponsor Page 410 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

WR228 Titanium Screw Locking, non-locking or cannulated,  8-40mm, 3.5mm $161.00

 for use only with Darco titanium

 plates, self-tapping

WR242 Stainless Steel Screw Stainless steel plate screw, locking 2.7 & 3.2 dia. 8-50mm  $161.00

 length in 2mm increments

WR245 Charlotte Claw Locking Screws 3.5mm stainless steel locking screws  3.5mm: 12-40mm $161.00

 for use with Claw Plate

 Zimmer Pty Ltd

ZI852 Zimmer Periarticular Plating System 4.5mm Periarticular Locking Screws 12 - 110mm $161.00

ZI854 Zimmer Universal Locking System 3.5mm Universal Locking Screws 12 - 90mm $161.00

ZI856 Zimmer Universal Locking System 3.5mm Universal Locking Screws - Ti  12 - 60mm $161.00

 Alloy

 LK, CN, DT

 LMT Surgical Pty Ltd

LM133 TriMed Compression Screws 'Compression Screws 3.0-4.5mm $491.00

 06.03.04.03 - Mini (2.01 2.7 mm)

 Advanced Surgical Design & Manufacture Ltd

AE080 Carpal Fusion System Screw 316L Stainless Steel, Low Profile  2 - 7 mm Diameter 12 - 24mm $93.00

 Custom Thread Screw  Length

AE149 ASDM Clavicle Plating System -  Fixation Device, Internal, Non- 2.7mm Low-profile cortex  $93.00

 Screws locking, Stainless Steel, Cortical  screws, 10-30mm (2mm

 Screw Size: 2.7mm increments)

AE214 Carpal Screw Titanium 2.5mm diameter in sizes  $93.00

 12mm - 20mm length

AE234 Percufix Titanium Diameter: 2-2.5mm, Length  $93.00

 22-40mm

 Biomet Australia Pty Ltd

BH278 ALPS Plating System Non-locking bone screw 2.5 to 2.7mm $93.00

BH302 ALPS Hand Fracture System Bone screws 2.5mm $93.00

BI768 Mandibular Fracture System Screw, IMF 2./2.4 Mandibular  2.0 x(5 - 13)mm $93.00

 Fracture, Titanium

 Device Technologies Australia Pty Ltd

DE214 Cortical Screw Titanium 10-24mm x 2.3mm $93.00

Prostheses List by Category, Groups and Sponsor Page 411 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Emergo Asia Pacific Pty Ltd

ER089 DeRoyal Internal Fixation Systems - Screws, Stainless Steel 316L,  Mini (2.01 - 2.7mm) $93.00

  screws Manufactured in USA

 Integra Neurosciences Pty Ltd

IG065  Integra Total Wrist Fusion System - Cortical screw for use with the integra 2.7mm diameter: 10-32mm  $93.00

  Cortical Screw  Total Wrist Fusion Plates length

IG129 Spider Limited Wrist Fusion System Stainless steel screws for Spider plate Diameter 2.4mm, length 8- $93.00

  - 2.4mm bone screws 14mm

 Lima Orthopaedics Australia Pty Ltd

LC100 Osteosynthesis Bone Screws - Mini Osteosynthesis Bone Screws - Mini Dia 2.7mm x 6-40mm length $93.00

LC134 MCD Bone Screw - Mini MCD Non Locking bone Screw -  2.3 / 2.7 Dia x 06-30mm  $93.00

 Length

 LMT Surgical Pty Ltd

LM111 Ascension Radial Head Plate  Ascension radial Head Plate Non- 2.7mm x 10-26mm $93.00

 Locking Screws

LM144 TriMed Bone Screw Non-Locking Cortical Bone Screws 2.3mm x 32mm, 2.7 x 10 -  $93.00

 24mm

LM174 Screws - Standard - Mini 2.7mm diameter standard screw 8 - 30mm $93.00

 Medartis

EO076 APTUS Screws Cortical Screws 2.3mm - 2.5mm Diameter $93.00

 Medical & Optical Instruments Australia Pty Ltd

MO323 Acumed Hexalobe Non Locking  Acumed Hexalobe Non Locking  Mini (2.01mm-2.7mm) $93.00

 Screws

MO375 Acu-Loc Distal Radius Plate  Threaded, non-threaded,locking, non- 2.3 mm $93.00

 locking screw peg, titanium

MO394 RibLoc rib fracture plating system  RibLoc Screws Mini 2.01-2.7mm $93.00

 screws

Prostheses List by Category, Groups and Sponsor Page 412 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Ortho Solutions Pty Ltd

OU026 Cortex screws Cortex screws 2.4mm x 10mm up to 28mm $93.00

 2.0mm x 8mm up to 26mm

 2.0mm cortical screw 6mm

 up to 38mm

 2.0mm self tapping S/S

 cortical screw 8mm up to

 24mm

 2.7mm cortical screw 6mm

 up to 38mm

 Orthotech Pty Ltd

OH452 OsteoMed FPS Bone screw - std 2/2.7mm x 8-22mm $93.00

OH464 OsteoMed HPS Bone screws - threaded/lag 2.4mm x 4-36mm $93.00

OH469 IXOS Radius Plating System Std Screw 2.5 x 8-30mm $93.00

 Smith & Nephew Surgical Pty Ltd

SN082 TC 100  Cortical Screws 2.01mm - 2.7mm $93.00

SN833 Peri-Loc & Peri-Loc VLP Cortical Screws 2.01-2.7mm $93.00

 Stryker Australia Pty Ltd

SK103 Stryker Plating System Cortical bone screws 2.7mm diameter, 22 - 80mm   $93.00

 lengths

 Synthes Australia Pty Ltd

SY352 A/ASIF Screw Cortex, Cancellous, Compression  5mm - 60mm $93.00

 Screws

 Tornier Pty Ltd

TO107 MaxLock Extreme System -  Bone screws, Titanium, Non locking Ø 2.4/2.7mm, length 6- $93.00

 2.4/2.7mm Non locking screws

TO120 Nexfix MTP Fusion System Unique low profile stainless steel  2.7mm x 12mm, 14mm, 16mm, $93.00

 locking screw for use with NexFix   18mm, 20mm, 24mm, 28mm

 MTP Fusion plates, indicated for use

 in normal bone

Prostheses List by Category, Groups and Sponsor Page 413 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

TO130 Activa Screw The Activa Screw is a bioresorbable  2.7mm x 10, 12 , 14 , 16, 20  $93.00

 device that maintains accurate  & 24mm

 alignment of bone fractures,

 osteotomies, arthrodeses, bone grafts

 and osteochondral fractures after

 surgical procedure. The Activa Screw

 possess' rigidity similar to bone

 which decreases

 Wright Medical Australia

WR031 Micronail intramedullary radial  2.7mm Titanium Screw 10mm - 20mm $93.00

 fixation

WR255 Evolve EPS System Non-Locking Stainless Steel Cortical Screws 2.5 - 2.7mm Diameter, 10- $93.00

 50mm

 Zimmer Pty Ltd

ZI201 Zimmer ECT Screws 2.7mm Cortical Screws 6 - 50mm $93.00

ZI551 Zimmer Universal Locking System 2.7 mm Locking T & L Plate Sterile  2 hole head 3 hole shaft  $93.00

 and Non-Sterile 39mm 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

 Breakoff

 Integra Neurosciences Pty Ltd

IG105 Hallu Break-off screw Titanium with break-off barrel Diameter 2.7mm, Length 11- $338.00

 14mm

IG133 Snap-Off screws Titanium break-off barrel screws for  Diameter 2.7mm; length 10- $338.00

 Hallu-Fix 34mm

 Lima Orthopaedics Australia Pty Ltd

LC056 Self Breaking Screw - Mini Self Breaking Screw Mini Diameter 2.7 mm x length  $338.00

 11-22 mm

 LMT Surgical Pty Ltd

LM155 EOS Footset - Entos Footscrew 11-14mm $338.00

Prostheses List by Category, Groups and Sponsor Page 414 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Ortho Solutions Pty Ltd

OU029 TWIST-OFF SCREW 11 mm TWIST-OFF SCREW2.5MM  10-18mm (1.5mm shank) 10- $338.00

 Cancellous thread 18mm, 11-17mm (cancellous

 12 mm TWIST-OFF SCREW2.5MM   thread)

 Cancellous thread

 13 mm TWIST-OFF SCREW2.5MM

 Cancellous thread

 14 mm TWIST-OFF SCREW2.5MM

 Cancellous thread

 15 mm TWIST-OFF SCREW2.5MM

 Cancellous thread

 17 mm TWIST-OFF SCREW2.5MM

 Cancellous thread

 SCREW-OFF screw10mm (1.5mm

 Shank)

 SCREW-OFF screw11mm (1.5mm

 Shank)

 SCREW-OFF screw12mm (1.5mm

 Shank)

 SCREW-OFF screw13mm (1.5mm

 Shank)

 SCREW-OFF screw14mm (1.5mm

 Shank)

 SCREW-OFF screw15mm (1.5mm

 Shank)

 SCREW-OFF screw16mm (1.5mm

 Shank)

 SCREW-OFF screw17mm (1.5mm

 Shank)

 SCREW-OFF screw18mm (1.5mm

 Shank)

 SCREW-OFF screw10mm

 SCREW-OFF screw11mm

 SCREW-OFF screw12mm

 SCREW-OFF screw13mm

 SCREW-OFF screw14mm

 SCREW-OFF screw15mm

 SCREW-OFF screw16mm

 SCREW-OFF screw17mm

 SCREW-OFF screw18mm

Prostheses List by Category, Groups and Sponsor Page 415 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Perios Pty Ltd

PF007 Forefoot Snap off Screws Titanium Alloy Screws with Snap-off  Weil self tapping L9 - L15 $338.00

 Grip

 Stryker Australia Pty Ltd

HW453 Fixos Screws Bone Fixation Screws, Double  2.2mm diameter, 11 to 16mm  $338.00

 Threaded (each 1mm)

 Tornier Pty Ltd

TO133 NexFix Snap-Off Screw The NexFix Snap-Off Screw System is  2.0mm x 11mm, 2.0mm x  $338.00

 a self-drilling and self-tapping screw  12mm, 2.0mm x 13mm, 2.7mm

 system for fixation of fractures, fusions   x 13mm, 2.7mm x 15mm,

 and osteotomies. The design allows  2.7mm x 17 mm

 the holding device to break off once

 the screw head is in contact with the

 distal cortex.

 Wright Medical Australia

WR035 Charlotte Foot & Ankle System Snap-off screws, titanium alloy 2.0 dia 11, 12, 14mm. 2.7 dia $338.00

  13, 15, 17mm

WR230 Twist-off Screw Unique feature of two thread diameters 2.5mm diameter x 11-15mm $338.00

  to suit variable bone quality,

 specifically designed for Weil-

 osteotomy, titanium, self drilling and

 self tapping, twist-off connector.

 Breakoff, CN

 Stryker Australia Pty Ltd

HW457 Fixos Screws Bone Fixation Screws 2mm diam. X11mm lenth to  $478.00

 2mm x 16mm

 CN

 Emergo Asia Pacific Pty Ltd

ER092 DeRoyal Internal Fixation Systems - DeRoyal Internal Fixation Systems -  Mini (2.01 - 2.7mm) $233.00

  cannulated screws cannualted screws Stainless Steel

 316L Manufactured in USA

 Lima Orthopaedics Australia Pty Ltd

LC118 Superscrew - Mini Cannulated Cortical Partial or Full  Dia. 2.7mm x 10-30mm length $233.00

 Thread

LC129 MCD Cannulated Bone Screw -  MCD Cannulated Bone Screw - Mini 2.0 to 2.3mm Dia x 08 -  $233.00

 24mm Length

Prostheses List by Category, Groups and Sponsor Page 416 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LMT Surgical Pty Ltd

LM156 EOS Footset-Pyxis Footscrew 11-28mm $233.00

LM180 Compression Screw - Mini 2.7mm diameter cannulated  Length:14 - 24mm $233.00

 compression screw

 Smith & Nephew Surgical Pty Ltd

SN970 Cannulated Screw Stainless Steel 2.01mm - 2.1mm $233.00

 Stryker Australia Pty Ltd

SR095 Stryker Cannulated Screw System Asnis Micro Cannulated Screw 2.01mm-2.7mm, Diameters,  $233.00

 8mm-40mm lengths

 Surgiplas Medical

SP035 OsteoMed Plating & Fixation System Screws - Cannulated Lag 2.0mm x (6 - 16)mm; 2.4mm x $233.00

  (6 - 20)mm

SP036 OsteoMed Plating & Fixation System Screws - Cannulated Lag 2.0mm x (18 - 42)mm; 2.4mm  $233.00

 x (22 - 50)mm

 Synthes Australia Pty Ltd

SY321 AO/ASIF Screw Cannulated screw 2.4mm $233.00

 Tornier Pty Ltd

TO112 MaxTorque Cannulated Screw  Bone screws, Titanium, Cannulated,  Ø2.5mm Short Thread,  $233.00

 System - Mini Cannulated Screws Short or Long Thread Length 18-30mm

 Ø2.5mm Long Thread,

 Length 10-30mm

 Wright Medical Australia

WR246 Headed Compression Screw System Cannulated compression screws -  2.0-2.7mm x 10-50mm $233.00

 titanium or stainless steel

 CN, DT

 Advanced Surgical Design & Manufacture Ltd

AE236 AutoFIX The SBi AutoFIX Twin Pitch  2.0mm and 2.5mm  $423.00

 Cannulated Compression Screw  Cannulated Compression

 System implants are indicated in the  Screw

 treatment of fractures, nonunions,

 pseudarthrosis and degenerative

 changes, as well as corrective

 osteotomies geared towards a

 functionally stable osteosynthesis

Prostheses List by Category, Groups and Sponsor Page 417 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Lima Orthopaedics Australia Pty Ltd

LC062 HVS BONE SCREW Self drilling, self threading double  Length 10-34mm $423.00

 threaded cannulated screw

LC123 TwinLock Screw - Mini TwinLock Screw - Mini 2.5/2.8mm Dia x 8 to 20 mm  $423.00

 length

 Orthotech Pty Ltd

OH447 ExtremiFix Screws Headless Cannulated Compression  Diameter 2.0mm, 2.4mm.  $423.00

 Screw Length 10mm to 52mm;

 Diameter 2.01mm - 2.7mm

 Stryker Australia Pty Ltd

HW454 Fixos Screws, Cannulated, Double  Done Fixation Screws, Cannulated  2.5mm  diameter, 10 to 30  $423.00

 Threaded, 2.5mm Threaded, 2.5mm (each 2mm)

 Surgiplas Medical

SP121 ExtremiFix Screws Headless Cannulated Compression  Diameter 2.0mm, 2.4mm.  $423.00

 Screw Length 10mm to 52mm;

 Diameter 2.01mm - 2.7mm

 Synthes Australia Pty Ltd

SY646 AO/ASIF Screws HCS Countersinkable Compression  2.4 $423.00

 Screw

 Tornier Pty Ltd

TO125 NexFix 2.5mm Compression Screw The NexFix Compression Screw is a  2.5mm diameter x 10 - 34mm  $423.00

 stainless steel, cannulated, self  length in 2mm increments

 tapping, and self drilling fixation

 device for osteotomies, fusions and

 fracture fixation of small bones

 CN,DT

 LMT Surgical Pty Ltd

LM181 Cannulated Self Tapping  Cannulated Self Tapping Compression Diameter 2.25 -2.6mm,  $423.00

 Compression Screws  Screws Length: 10 -34mm

 Medical & Optical Instruments Australia Pty Ltd

MO356 Acutrak 2 Headless compression screw 2.5mm $423.00

 Orthotech Pty Ltd

OH462 OsteoMed HPS Bone screws - cannulated headless 2.4mm x 10-36mm $423.00

OH475 DynafitSystem Self-compressive screws 12-26mm $423.00

OH481 HBS 2 mini Self-compressive screws 2.5mm x10-40mm $423.00

Prostheses List by Category, Groups and Sponsor Page 418 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 DT

 Biomet Australia Pty Ltd

BH245 Rockwood Clavicle Pin Clavicle Pin with dual thread 2.5mm $257.00

 Lima Orthopaedics Australia Pty Ltd

LC137 MCD Double Threaded Bone Screw  MCD Double Threaded Bone Screw -  2.3/3.0 mm Dia x 08 - 26mm  $283.00

 - Mini Mini Length

 Medical & Optical Instruments Australia Pty Ltd

MO373 Acutrak fusion Screws Fusion Screws Titanium 2.01mm - 2.7mm $283.00

 Orthotech Pty Ltd

OH476 DynafitSystem Self-compressive screws 2/2.6 x 12-26mm $283.00

 Zimmer Pty Ltd

ZI178 Zimmer Herbert Bone Screw Double Threaded Compression Bone  Scaphoid - 12 - 30mm  $283.00

 Screw

ZI179 Zimmer Herbert/Whipple Bone  Cannulated Double Threaded  12 mm - 30 mm $283.00

 Compression Bone Screw

 DT CN

 Ortho Solutions Pty Ltd

OU025 2.5 mm Meta Screw Meta Screw 2.5mm length 10 up to  $423.00

 2.5mm length 26mm

 DT, CN

 Biomet Australia Pty Ltd

BH241 Hand and Foot Fracture Systems FRS Screw 10mm to 34mm L x 2.5mm  $423.00

 Diameter

 Integra Neurosciences Pty Ltd

IG121 BOLD 2.5mm Compression Screw Cannulated, double threaded  Diameter 2.5mm, length 10- $423.00

 compression screw 30mm

 Medartis

EO057 Aptus 2.2 Cannulated Headless  APTUS® Cannulated Compression  2.2 diameter.  Short and  $423.00

 Compression Screws Screws long threaded 10mm to

 DT, LK

 Medartis

EO073 APTUS Screws Aptus Locking Screws 2.5mm Diameter $423.00

Prostheses List by Category, Groups and Sponsor Page 419 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LK

 Austofix

AX043 VRP Distal Radius Fixation System, Threaded, non-threaded, partially  2.0, 2.5, 2.6mm diameter,  $163.00

  Threaded, mpm-threaded, partially  threaded locking, non-locking screw,  14mm-30mm lengths

 threaded locking, non-locking  peg, titanium

 screw, peg, Titanium

AX083 VRP Distal Radius Fixation System  Variable Angle Locking Screw,  2.5mm, 10-30mm $163.00

 - VRP VA locking Screw Cobalt Chrome

 Biomet Australia Pty Ltd

BH294 Distal Radius Fracture Repair  Locking titanium bone screws 2-2.5mm $163.00

BH295 Distal Radius Fracture Repair  'Multidirectional locking bone  2-2.5mm $163.00

BH296 Distal Radius Fracture Repair  Locking titanium bone screws with  2.0 - 2.5mm $163.00

 dual thread

BH301 ALPS Hand Fracture System Multidirectional locking bone screws 2.5mm $163.00

BH303 ALPS Hand Fracture System Locking Bone Screws 2.5mm $163.00

BI929 Sternalock Screws Ti 2.4-2.7mm x 8-12mm $163.00

 Device Technologies Australia Pty Ltd

DE412 Low Profile Locking Screws Locking screws for Arthrex Fracture  2.7mm x (8-30mm) $163.00

 Plate Fixation

 Emergo Asia Pacific Pty Ltd

ER087 DeRoyal Internal Fixation Systems - Locking Screw, Stainless Steel 316L,  Mini (2.01 - 2.7mm) $163.00

  Locking screws manufactured in USA

 Integra Neurosciences Pty Ltd

IG123 VIPER with VALT - variable angle  Variable angle locking screws Diameter 12.7mm, length  $163.00

 locking screws 10-30mm

IG126 Surfix Locking Screws Locking screws with an independent  2.7mm, 10 - 24mm length $163.00

 lock-screw head

 Lima Orthopaedics Australia Pty Ltd

LC092 Diphos Plate - Threaded Head  Threaded Head Screw - Mini Diameter 2.3/2.7mm x  $163.00

 Screw - Mini Length 10-40mm

LC093 Diphos Plate - Threaded Pin with  threaded Pin with Screw head Diameter 2.3mm x Length  $163.00

 Screw Head 30-40mm

LC136 MCD Locking Bone Screw - Mini MCD Locking Bone Screw - Mini 2.3 / 2.7mm Dia x 06 - 30mm  $163.00

 Length

Prostheses List by Category, Groups and Sponsor Page 420 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LMT Surgical Pty Ltd

LM061 Xpode Screws Xpode screws 2.4mm  $163.00

LM112 Ascension Radial Head Plate  Ascension Radial Head Plate  2.7mm x 10mm - 40mm $163.00

 Locking Screws

LM175 Screws -Locking -mini 2.7mm diameter locking screw 8 - 30mm $163.00

LM185 Trimed Locking Cortical Screws Locking cortical screw 2.7mm x 10 -20mm $163.00

 Medical & Optical Instruments Australia Pty Ltd

MO320 Acumed Hexalobe Locking Screws Acumed Hexalobe Locking Screws Mini (2.01mm-2.7mm) $163.00

MO369 Acumed Tap-Loc Tap screws, Tap-Loc Screws 2.7mm 36mm-60mm length $163.00

MO376 Acu-Loc Distal Radius Plate  Locking screws 2.01-2.7mm $163.00

 Orthotech Pty Ltd

OH453 OsteoMed FPS Bone Screws - Locking 2/2.7m x 8-22mm $163.00

OH463 OsteoMed HPS Bone screws - angled locking 2.4mm x 6-36mm $163.00

OH468 IXOS Radius Plpating System Locking Screw 2.5 x 8-30mm $163.00

 Smith & Nephew Surgical Pty Ltd

SL028 D-RAD SMART PACK Cortical screws 2.01 mm - 2.7 mm $163.00

SL030 D-RAD SMART PACK VAL Locking screws 2.01mm - 2.7mm 2.01mm - 2.7mm $163.00

SN968 Peri-Loc Locking screws 2.01mm - 2.7mm $163.00

SN969 Peri-Loc VLP VAL Locking Screws 2.01mm - 2.7mm 2.01mm - 2.7mm $163.00

 Stryker Australia Pty Ltd

SK527 Stryker Locking Plate System Locking Screws 2.3-2.7mm $163.00

 Synthes Australia Pty Ltd

SY651 AO/ASIF Cortex Screws Locking Head Screws 2.4mm-2.7mm $163.00

 Tornier Pty Ltd

TO104 Mini MaxLock Extreme System -  Bone screws, Titanium, fixed or  Ø2.4/2.7mm Fixed angle  $163.00

 2.4/2.7mm Locking Screws variable angle locking locking, Length 6-40mm

 Ø2.4mm Variable angle

 locking, Length 6-30mm

 Wright Medical Australia

WR032 Micronail Intramedullary Radial  2.5mm titanium buttress screw 16 - 28mm $163.00

 Fixation

Prostheses List by Category, Groups and Sponsor Page 421 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

WR081 Ortholoc Fracture System Titanium, variable angle locking  2.4, 2.7mm diameter, 8- $163.00

 100mm length

WR227 Titanium Screw Locking, non-locking or cannulated,  8-40mm, 2.7mm $163.00

 for use only with Darco titanium

 plates, self-tapping

WR243 Charlotte Claw Locking Screws 2.7mm stainless steel locking screws  2.7mm, 12-36mm $163.00

 for use with Claw Plate

WR257 Evolve EPS System 2.7 Locking Stainless Steel Variable Angle  2.7mm Diameter, 10-50mm $163.00

 Locking Screws

 Zimmer Pty Ltd

ZI858 Zimmer Periarticular Locking  2.4 & 2.7mm Periarticular Locking  8-40mm $163.00

 Screws

 LK, DT, CN

 LMT Surgical Pty Ltd

LM132 TriMed Compression Screws Compression Screws 2.0mm 2.5mm $493.00

 06.03.04.04 - Micro ( 2.0mm)

 Biomet Australia Pty Ltd

BH299 ALPS Hand Fracture System Bone Screws 1.0 - 2.0mm $67.00

 Emergo Asia Pacific Pty Ltd

ER090 DeRoyal Internal Fixation Systems - Screws, Stainless steel 316L,  Micro (<=2.0mm) $67.00

  screws manufactured in the USA

 Lima Orthopaedics Australia Pty Ltd

LC099 Osteosynthesis Bone Screws -  Osteosynthesis Bone Screws - Micro Dia 1.5/1.8/2.0mm x 4-40mm $67.00

  length

LC133 MCD Non Locking Bone Screw -  MCD Non Locking Bone Screw -  2.0mm Dia x 06-26mm Length $67.00

 Micro Micro

 LMT Surgical Pty Ltd

LM173 Screws - Standard - Micro 2mm diameter standard screw 5 - 19mm $67.00

 Medartis

EO075 APTUS Screws Cortical Screws 1.5mm - 2.0mm Diameter $67.00

 Orthotech Pty Ltd

OH459 OsteoMed HPS Bone Screws - threaded/lag 1.2/1.6/2.0mm x 4-36mm $67.00

Prostheses List by Category, Groups and Sponsor Page 422 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Smith & Nephew Surgical Pty Ltd

SL006 TC-100 Cortical Screws 2.0mm $67.00

 Synthes Australia Pty Ltd

SY065 AO/ASIF Screws Cortex Screw 2.0mm $67.00

 Wright Medical Australia

WR256 Evolve EPS System Non-Locking Stainless Steel Cortical Screws 1.5 - 2.0mm Diameter, 10- $67.00

 40mm

 Zimmer Pty Ltd

ZI742 Zimmer ECT Screws 1.5mm Cortical Screws 6 - 18mm $67.00

 Break off

 Device Technologies Australia Pty Ltd

DE364 QuickFix Screw Micro Titanium Snap-off Small Bone Screw 2.0mm Diameter x 10-14mm  $312.00

 lengths

 RQSolutions Medical Devices Distribution Support

RQ001 Orthomed Metallic Snap-off screw The Snap-off screw is indicated for  Thread diameter:  $312.00

 fixation of bone fragments. Snap off  2mm/cortical thread

 screws are breakable self tapping  Core diameter: 1mm

 screws, which present a breakable  Overall length: depending

 cartridge necessary to the screw  on reference

 setting. They are particularly intended Threaded length: depending

  to repair the 2nd, 3rd, 4th and 5th   on reference

 metatarsal of the foot. 2 opposite slots at the tip

 (self drilling and self

 tappering profile)

 4 slots in the screw head for

 screwdriver grip

 Breakoff

 Biomet Australia Pty Ltd

BH193 Twistoff Screw TwistOff Screw Titanium 11-14mm Long $312.00

 Integra Neurosciences Pty Ltd

IG135 Spin screw: Snap-off screws Titanium break-off barrel screws Diameter 2.0 mm, Length 11  $312.00

 -14mm

 Lima Orthopaedics Australia Pty Ltd

LC077 Self Breaking Screw - Micro Self Breaking Screw - Micro Dia 2.0 mm x Length 7-24 mm $312.00

Prostheses List by Category, Groups and Sponsor Page 423 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Smith & Nephew Surgical Pty Ltd

SM172 Peri-Loc 2.0mm Twist-Off Screw 2.0mm Twist-Off Screw 8mm, $312.00

  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

 Wright Medical Australia

WR229 Twist-off Screw Unique feature of two thread diameters 2.0mm diameter x 11-15mm $312.00

  to suit variable bone quality,

 specifically designed for Weil-

 osteotomy, titanium, self drilling and

 self tapping, twist-off connector.

 CN, DT

 LMT Surgical Pty Ltd

LM187 Foot Motion - weil screws Weil screw is a titanium self tapping,  2.0mm diameter, length 8mm  $397.00

 self-cutting screw - 15mm

 Synthes Australia Pty Ltd

SY647 AO/ASIF Screws HCS Countersinkable Compression  1.5 $397.00

 Screw

 CN,DT

 Orthotech Pty Ltd

OH461 OsteoMed HPS Bone screws - cannulated headless 2.0mm x 10-36mm $397.00

 DT

 Tornier Pty Ltd

TO128 NexFix Compression Pin The NexFix Compression Pin is a  2.0mm x 10mm, 2.0mm x  $257.00

 tapered stainless steel compression  12mm, 2.0mm x 14mm, 2.0mm

 pin for use in maintaining alignment   x 16mm, 2.7mm x 20mm,

 and providing interfragmentary  2.7mm x 24mm, 3.5mm x

 compression of small bones in  25mm, 3.5mm x 30mm

 osteotomies, fusions and fractures

 until a stable bony union occurs. It is

 self drilling

Prostheses List by Category, Groups and Sponsor Page 424 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 DT, Break off

 Medical & Optical Instruments Australia Pty Ltd

MO367 Acumed Fixation Screw Acutrak Compression Screw Titanium 2mm $502.00

 DT, LK

 Medartis

EO072 APTUS Screws Aptus Locking Screws 1.5mm - 2.0mm Diameter $297.00

 LK

 Biomet Australia Pty Ltd

BH300 ALPS Hand Fracture System Locking Bone Screws 1.0 - 2.0mm $137.00

 Emergo Asia Pacific Pty Ltd

ER100 DeRoyal Internal Fixation Systems - Locking Screws, Stainless Steel  Micro (<= 2.0mm) $137.00

  Locking Screws 316L, manufactured

 Lima Orthopaedics Australia Pty Ltd

LC135 MCD Locking Bone Screw - Micro MCD Locking Bone Screw - Mini 2mm Dia x 08 - 26mm  $137.00

 Length

 LMT Surgical Pty Ltd

LM110 NewClip Distal Radius Screws Cortical Bone Screw 2.0mm x 14-28mm $137.00

 Orthotech Pty Ltd

OH460 OsteoMed HPS Bone screws - angled locking 1.6/2mm x 6-36mm $137.00

 Stryker Australia Pty Ltd

SK526 Stryker Locking Plate System Locking Screws 1.2-2.0mm diameter $137.00

 Synthes Australia Pty Ltd

SY650 AO/ASIF Cortex Screws Locking head screws 1.5-2.0mm $137.00

 Wright Medical Australia

WR030 Evolve Locking Cancellous Bone  The Evolve stainless steel locking  2.0mm x 14 - 28mm $137.00

 Screws

WR073 Ortholoc Fracture System Titanium, variable angle locking  2.0mm diameter, 8 - 100mm  $137.00

 length

WR258 Evolve EPS System 2.0 Locking Stainless Steel Variable Angle  2.0mm Diameter, 10-50mm $137.00

 Locking Screws

Prostheses List by Category, Groups and Sponsor Page 425 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LK, DT, CN

 LMT Surgical Pty Ltd

LM131 TriMed Compression Screws Compression screws 1.7mm $467.00

 06.03.04.05 - Dynamic

 Advanced Surgical Design & Manufacture Ltd

AE068 ASDM Clavicle Compression  Clavicle Compression PinTitanium  3.2 & 4.0 mm x 50mm - 130mm $247.00

 Screw, Double Threaded

 Austofix

AX054 Tectona Hip Plate - Standard Lag  Hip Lag Screw, sterile packed 12.5mm, 14.5mm $247.00

 Screw

AX055 Tectona Hip Plate - Lag Screw HA  Hip Lag Screw HA coated, sterile  12.5mm - lengths 50-145mm $247.00

 coated packed

 Ortho Solutions Pty Ltd

OU035 CHS/SCS Lag Screw Lag Screrw CHS/SCS Lag Screw 50mm  $247.00

 to145mm

 Smith & Nephew Surgical Pty Ltd

SN489 Intermediate Osteotomy System Lag 35 mm - 85mm, 1 1/2" - 3-3/4" $247.00

SN492 Paediatric Osteotomy System Lag Screw 22mm- 40mm $247.00

 Stryker Australia Pty Ltd

HW333 Omega Plus Compression Hip  Lag Screw - Standard -  Stainless Steel 50-130mm length  $247.00

 Screw System

HW334 Omega Plus Compression Hip  Lag Screw - Super -  Stainless Steel 50-130mm length  $247.00

 Screw System

SK228 Omega Plus Compression Hip  Cephalic Implants Hansson Twin Hook 50- $274.00

 Screw System 140mm

 Synthes Australia Pty Ltd

SY054 AO/ASIF Screws DHS/DCS lag screw 50-145mm L $247.00

SY690 MultiLoc Screw Conical, Locking "Screw-in-Screw" 4.5mm; 20mm - 60mm  $247.00

 Length

 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

Prostheses List by Category, Groups and Sponsor Page 426 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.04.06 - Screw Washers

 Austofix

AX027 Austofix Femoral & Tibial Nailing  Washer for screws; s-s Dia 11mm & 13mm $103.00

 System

 Biomet Australia Pty Ltd

BH169 Washerloc Tibial Fixation Device Interference Anchor Plate (4.75 or 6.5)mm dia x 15- $103.00

 50mm

BH189 Small / Large Fragment Set S/S Washer Spiked, Standard, Cancellous, One size only $103.00

  Cortical & Fastening Wire

BH280 ALPS SFS Flat and cupped Titanium washers Flat and cupped $103.00

BH286 ALPS LFS Flat and cupped Titanium washers 4.5-6.5mm $103.00

BH332 Small / Large  Fragment Set Washer Titanium -  One size only $103.00

 Flat/Cup/Countersink

 Device Technologies Australia Pty Ltd

DE071 Washer Screw Washer 7 - 15mm $103.00

DE163 Bio-Post & Washers PLLA composition Implant 35mm - 50mm,  $103.00

 Washers 16mm

 Emergo Asia Pacific Pty Ltd

ER093 DeRoyal Internal Fixation Systems - Washers, threaded and unthreaded,  3.0mm - 13.0mm $103.00

  Washers Stainless Steel 316L, manufactured in

 USA

 Johnson & Johnson Medical Pty Ltd

JJ824 Bristow-Latarjet Instability  Cannulated titanium top hat screw One size only $103.00

 Shoulder Set - Top Hat Screw

 Lima Orthopaedics Australia Pty Ltd

LC087 TNP® Bone Washer Ti TNP® Bone Washer Ti 13mm to 19mm $103.00

LC121 Versa Screw Washer Versa Screw Washer One Size $103.00

 LMT Surgical Pty Ltd

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 $103.00

Prostheses List by Category, Groups and Sponsor Page 427 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Orthotech Pty Ltd

OH458 OsteoMed FPS Screw Washers 2/2.7/3.5/4.0mm $103.00

 Smith & Nephew Surgical Pty Ltd

SL007 Universal Washers Screw Washers All sizes $103.00

SN424 ACL/PCL Reconstructions Acufex Spiked Washer One size only $103.00

 Stryker Australia Pty Ltd

HW298 Asnis Guided Screw System Washer, Stainless Steel One size only $103.00

HW299 Asnis Guided Screw System Washer -  Titanium 4, 5, 6.5,8mm $103.00

SK201 Stryker Trauma Locking Nail  Proximal Humeral Nail Proximal Humerous Washer  $103.00

 round/square

SK565 Stryker Plating System Washers 7-13mm $103.00

 Synthes Australia Pty Ltd

SY092 AO/ASIF Washers Washers 1.0mm - 16mm D $103.00

 Tornier Pty Ltd

TO115 MaxTorque Cannulated Screw  Screw washer, Titanium, Contoured or Ø4.0 to 7.0mm $103.00

 System- Washers  Flat

TO127 NexFix Washer The NexFix Washer is a threaded  9mm, 11mm, 13mm $103.00

 circular 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

 Wright Medical Australia

WR060 Ring washer Screw Washers 2.7/3.7/4.0/4.5 $103.00

 Zimmer Pty Ltd

ZI210 Zimmer Large-Frag System Washer/Spiked washer Small & Large $103.00

 Ti

 Smith & Nephew Surgical Pty Ltd

SN982 Double-spiked plate Low-profile washer for tibial fixation  10-25mm $85.00

 system

Prostheses List by Category, Groups and Sponsor Page 428 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.04.07 - Screw post/peg

 ConMed Linvatec Australia Pty Ltd

LV022 EndoPearl Bio-Absorbable Implant  ACL Fixation - PLLA 7mm - 9mm $140.00

 - ACL Fixation

 LMT Surgical Pty Ltd

LM041 Trimed Bearing Plate, Fixation Pegs Bearing plate fixation pegs 2.3mm $140.00

 Medartis

EO088 Aptus Shoulder (Spiral Blades ) Spiral Blades Proximal Humerus 3.5mm System $140.00

 Smith & Nephew Surgical Pty Ltd

SL029 D-RAD SMART PACK Variable angle locking screw or peg 1.0 - 2.0mm $140.00

SN422 Fixation Post Tibial fixation device 25 -55mm $140.00

 Stryker Australia Pty Ltd

SK154 Stryker Cross-Screw HA/PLLA screw for ligament/tendon  Dia 6mm: Length 40-60mm $140.00

 fixation

SK155 Wedge Interference screw Threaded PLLA screw with cross pin  Dia 7-12mm, Length 20- $140.00

 for ligament/tendon fixation 40mm; pin length standard

 Synthes Australia Pty Ltd

SY110 AO/ASIF Screws Buttress Pin Various lengths $140.00

SY435 Epoca Custom Offset Shoulder  Epoca Glenoid Screw 8-30mm $140.00

 Prosthesis

SY649 AO/ASIF Screws Self Drilling, self tapping, conical   3.5mm $140.00

 screws

 Tornier Pty Ltd

TO098 MaxLock Extreme System - DRLock  Locking Peg, Titanium Ø2.0mm, Length 10-30mm $140.00

 Extreme Locking Peg

 06.03.04.08 - Screw Accessories - Nuts

 Stryker Australia Pty Ltd

SK566 Stryker Plating System Nuts 4.5-5.0mm $40.00

 Zimmer Pty Ltd

ZI209 Zimmer Large-Frag System Cortical Nut for 4.5mm screw Small & Large $40.00

Prostheses List by Category, Groups and Sponsor Page 429 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.04.09 - Screw Accessories - Locking Nuts

 Stryker Australia Pty Ltd

HW274 Stryker Plating System Locking Insert/Plug Assembly 5mm $280.00

 Zimmer Pty Ltd

ZI859 Zimmer Periarticualr Locking  1.8mm Periaticular Locking Pegs 18-30mm $280.00

 06.03.04.10 - Screw Accessories - Caps

 Smith & Nephew Surgical Pty Ltd

SN945 Peri-Loc Screw Accessories, Hole Filler 4.5mm $130.00

 Stryker Australia Pty Ltd

HW335 Omega Plus Compression Hip  Compression Screw -  Stainless Steel 25mm length $130.00

 Screw System

 Synthes Australia Pty Ltd

SY195 Orthopaedic External Fixator  Protective caps for rods, protection  One size only $10.00

 Tornier Pty Ltd

TO110 MaxLock Extreme System  - PEEK  Locking Ring, PEEK,Pre - assembled  Ø 2.4/3.5mm $130.00

 ring on inserter

 Zimmer Pty Ltd

ZI597 NCB Plating System NCB Spacers & Screw Caps 1, 2 and 3 $130.00

06.03.05 - Surgical Accessories

 06.03.05.01 - Wires

 Advanced Surgical Design & Manufacture Ltd

AE052 ASDM K-wire Stainless steel - sterile Dia 0.7 - 2.5mm, length 100  $12.00

 - 230mm

 Biomet Australia Pty Ltd

BH201 Ace External Fixator Olive wire bayonet point - stainless  1.5 or 1.8mm $12.00

 steel, packet of 3

BH202 Ace External Fixator Wire bayonet point - stainless steel 1.8mm $12.00

BH335 Small / Large Fragment Set S/S K/Wire Stainless Steel  0.8 to 3.0 mm x 6-9" or 150- $12.00

 500mm

Prostheses List by Category, Groups and Sponsor Page 430 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Emergo Asia Pacific Pty Ltd

ER054 Nile CoCr Wire System CoCr wire 1.0mm $12.00

 Johnson & Johnson Medical Pty Ltd

DP045 Isola System (Stainless Steel) Double Wire One size only $12.00

 Lima Orthopaedics Australia Pty Ltd

LC088 Clavical Fracture Wire Threaded Clavical Fracture Wire Diameter 2 - 2.5 - 3 - 3.5 - 4 - $12.00

  4.5 - 5mm x Length 280mm

 Link Orthopaedics  Australia

LO147 Bone Cerclage Wire Cerclage Wire Length 470mm, Diameter  $12.00

 sizes of 0.4mm, 0.5mm,

 0.6mm, 0.7mm, 0.8mm.

 Packet size of 10

 Medtronic Australasia Pty Ltd

MC506 Orfil Double Pearl-Tipped Wires 1 - 350mm $12.00

 Orthotech Pty Ltd

OH260 Hartshill Wire (packet 10) stainless steel 1.2mm diam & 0.9mm dia $12.00

 Smith & Nephew Surgical Pty Ltd

SN440 Ilizarov Wires 300-370 length x 1-1.8mm  $12.00

 diameter

SN459 Wire Suture 18Ga - 28Ga $12.00

SN460 Wire Cerclage 0.6mmx175mm -  $12.00

 0.8mmx200mm

 Wright Medical Australia

WR063 K Wire Titanium or stainless steel, single or  0.9 - 2.0mm $12.00

 double trocar

 Zimmer Pty Ltd

ZI293 Zimmer Wires Stainless Steel Length 23cm, Thickness  $12.00

 2mm, 0-4mm, 8mm

ZI294 Zimmer Wires Stainless Steel Length 7, 6cm - 23cm,  $12.00

 Thickness 0mm, 7mm - 2mm,

 0mm

Prostheses List by Category, Groups and Sponsor Page 431 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 OL

 Johnson & Johnson Medical Pty Ltd

DY528 Expedium Spinal System - Cobalt  CoCr wire single with/without  1.0mm $166.00

 Chrome Single Wire

 Ortho Solutions Pty Ltd

OU002 RFS OLIVE WIRE RFS OLIVE WIRE 1.8MM X 400MM $166.00

 1.5MM X 300MM

 Smith & Nephew Surgical Pty Ltd

SN441 Ilizarov Wires with stopper 300-370 length x 1-1.8mm  $166.00

 diameter

 06.03.05.02 - Pins

 Advanced Surgical Design & Manufacture Ltd

AE070 ASDM Steinmann Pin Steinmann Pin 2.8-5.0mm diameter $30.00

AE238 SBi K-Wire K-Wire 1.6mm $30.00

 Biomet Australia Pty Ltd

BI232 Moore Pins Scan Pin, Stainless Steel 16mm x 51-152mm $30.00

BI271 EBI XFIX Dynafix System Wire Straight or Olive with Washer,  160 or 200mm x (1.6 or  $30.00

 Chrome Cobalt 2.0mm)

BI304 Rush Intramedullary Pins Stainless Steel 3.2mm x (100-250mm) $30.00

BI306 Rush Intramedullary Pins Stainless Steel (6 - 6.4mm) x (280 - 440mm) $30.00

BI857 Kirschner Wires Stainless Steel wire (1-3.2mm) diameter x (100 to $30.00

  310mm) length

 CK Surgitech Pty Ltd

AK004 Kirschner Wires Kirschner Wire 0.6mm to 3.0mm diameter /  $10.00

 various lengths

 Emergo Asia Pacific Pty Ltd

ER147 DeRoyal Internal Fixation  Systems  Wires, threaded and unthreaded,  1.0mm - 2.8mm Threaded and $30.00

 - Wires Stainless Steel 316L, manufactured in   Unthreaded

 USA

 Integra Neurosciences Pty Ltd

IG073 K-Wire (Kirschner) Stainless steel 70mm, 100mm, 200mm  $30.00

 length

Prostheses List by Category, Groups and Sponsor Page 432 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

IG074 Tac-Pin (Threaded) Compression pin-titanium 1.7mm diam 15-25mm length $30.00

 Johnson & Johnson Medical Pty Ltd

DP809 Small / Large Fragment Set S/S K-wire standard 0.2-3.5mm $30.00

 Lima Orthopaedics Australia Pty Ltd

LC076 Steinmann Pin Steinmann Diameter 2 - 5mm x Length  $30.00

 150 - 250mm

LC089 Kirschner Wire Kirschner Wire - Various Diameter 1 to 3mm x 80 to  $30.00

 310mm Length

LC145 MCD K-Wire Threaded Threaded Stainless Steel (<2mm) 0.6 to 2.0mm Dia x 150 to  $30.00

 200mm Length

LC146 MCD K Wire Non-Threaded Non-Threaded Stainless Steel (>2mm) 2.8mm Dia x 200 to 450mm  $30.00

 Length

LC147 MCD K Wire Non-Threaded Non-Threaded Stainless Steel K Wire  0.6 to 2.0mm Dia x 150 to  $30.00

 (<2mm) 200mm Length

LC148 MCD K Wire Threaded Threaded Stainless Steel (>2mm) 208mm Dia x 200 to 450mm  $30.00

 Length

 LMT Surgical Pty Ltd

LM014 Trimed Marked K-Wire Stainless Steel Diameter 0.9 - 1.1mm $30.00

 Medartis

EO089 Aptus K-wires K-wires 0.8mm-1.8mm Diameter,  $30.00

 100mm - 150mm in length

 Medical & Optical Instruments Australia Pty Ltd

MO177 Acutrak Fixation Screw Wire Kirschner Stainless Steel 0.70mm to 1.6mm diameter, 4 $30.00

  to 9in (10.16 to 22.86mm)

 length

MO209 Acumed Congruent Plate System Threaded K-Wire - Titanium WT-1606STT: Length 15cm $30.00

  x Diameter 0.62"; WT-

 0906STT: Length 15cm x

 Diameter 0.35"; WS-

 2408STT length 20.32cm x

 Diameter 0.24cm

Prostheses List by Category, Groups and Sponsor Page 433 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Ortho Solutions Pty Ltd

OU001 RFS STRAIGHT WIRE RFS STRAIGHT WIRE RFS STRAIGHT WIRE  $11.00

 1.8MM X 370MM

 RFS DT STRAIGHT WIRE

 1.8MM X 370MM

 RFS STRAIGHT WIRE

 1.5MM X 300MM

 RFS TITANIUM

 STRAIGHT WIRE 1.8MM

 X 370MM

OU003 K-WIRE DOUBLE TROCAR K-WIRE DOUBLE TROCAR 1.1mm x 150mm $30.00

 1.6mm x 125mm

 2.0mm x 150mm

 Smith & Nephew Surgical Pty Ltd

SN451 Wire Kirschner Various 1.3 - 304.8mm $30.00

 Stryker Australia Pty Ltd

HW368 Osteo Kirschner Wire K wire -  Stainless Steel Diameter 1.0 - 2.0mm $30.00

SK213 Hoffmann II External Fixation  Hoffmann II Micro K-wire $30.00

ST007 Stryker Plating System - K Wires Stainless Steel or Titanium 150mm length in 1.25, 1.6,  $30.00

 2.0mm diameter

ST890 Steinmann Pins Stainless Steel 7,9" $30.00

 Surgical Specialties

SQ076 K wires k wire threaded 1.6mm $30.00

 Synthes Australia Pty Ltd

SY249 AO/ASIF K Wires, Pins  Hybrid Pins - Spade point  1.5, 3.2mm Diameter $30.00

 wires/reduction wires

SY787 AO/ASIF K-Wires K-Wires 0.25 - 400mm $30.00

 Trewavis Surgical Instruments Pty Ltd

TS001 Trewavis Surgical Kirschner Wires Composition: Stainless Steel, Model  Dia 0.7-2.8mm, Length 100- $30.00

 No: 200-000-A to 200-930-K 230mm

TS002 Trewavis Surgical Steinmann Pins Composition:  Stainless Steel, Model  Dia 3.0 - 5.0mm $30.00

 Nos: 200 - 950-L to 200-970-Q

 Zimmer Pty Ltd

ZI323 Zimmer Wires Stainless Steel Rushpins Diameter 2.4 - 6.4mm;  $30.00

 Length 2.5 - 52.7cm

Prostheses List by Category, Groups and Sponsor Page 434 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 AB

 B Braun Australia Pty Ltd

BB060 BRAUN AUST Intramedullary  Isosorb Resorbable Fixation Pin 2mmx60mm-3.5mmx80mm $294.00

 Biomet Australia Pty Ltd

BH319 Orthosorb Absorbable Pin Orthosorb - Polydiaxanone Fixation  40 x 1.3mm $294.00

 Pins 3 pins per pkt

BH320 Orthosorb Absorbable Pin Orthosorb - Polydiaxanone 3 pins per 40mm x 2mm $294.00

  pkt

BH321 Orthosorb Absorbable Pin Orthosorb Pkt 1 - Polydiaxanone 1mm x 40mm x 1.3mm $294.00

BH322 Orthosorb Absorbable Pin Orthosorb Pkt 1 - Polydiaxanone 40 x 2.0mm $294.00

BH324 Orthosorb Absorbable Pin Orthosorb -Polydiameterxanone 50 x 1.3mm $294.00

BH325 Orthosorb Absorbable Pin Orthosorb - Polydiaxanone 2 pins per 40mm x 2.0mm $294.00

  pkt

BH326 Orthosorb Absorbable Pin Orthosorb Arthroscopic Fix-Set -  40 x 1.3mm $294.00

 Polydiaxanone 5 pins per pkt

 ConMed Linvatec Australia Pty Ltd

LV050 Bionx Implants - Rods  PGA, PLA or PLLA 1.5mm x 10-70mm $294.00

LV051 Bionx Implants - Rods  PGA, PLA or PLLA 2.0mm $294.00

LV063 SmartNail Self-Reinforced 96L/4D PLA Bone  1.5mm O.D x 16, 20 & 25mm $294.00

 Fixation Nail  L

LV084 SmartNail Self-reinforced 96L / 4D PLA Bone  2.4mm O.D x 16, 25, 35 &  $294.00

 Fixation Nail 45mm L

LV088 SmartPin Resorbable Bone Fixation  Self-Reinforced PLLA 10, 20, 30 & 40mm $294.00

 Pin, 1.1mm

 Device Technologies Australia Pty Ltd

DE273 Trim-IT Spin Pin Trim-IT  Pin Fixation 1.5 - 2.0mm x 100mm $294.00

 Surgical Specialties

SQ063 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Pin 1.5 & 2 mm dia x 20-50  $294.00

 copolymer mm long

Prostheses List by Category, Groups and Sponsor Page 435 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Tornier Pty Ltd

TO129 Activa Pin The Activa pin is a bioreabsorbable  1.5mm x 50mm, 2.0mm x 50mm $294.00

 grooved pin device for fixation of

 bone 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.

 COM

 Stryker Australia Pty Ltd

SK230 Hansson Pin Cephalic Implants Hansson Pin 70-140mm $358.00

 OL

 Johnson & Johnson Medical Pty Ltd

DP480 DePuy Spinal Wire Wire with Button or Beaded Wire 18 - 24 gauge wire $134.00

DY527 Expedium Spinal System - Cobalt  CoCr wire double with/without button 1.0mm $134.00

 Chrome Double Wire

 Medical & Optical Instruments Australia Pty Ltd

MO162 Tension Band Pin Stainless Steel 50 to 90mm $134.00

 Stryker Australia Pty Ltd

SK117 Stryker Kirschner Wires Olive Wires 1.0- 2.0mm Diameter $134.00

 TH

 Advanced Surgical Design & Manufacture Ltd

AE069 Threaded wires & pins Threaded wires & pins 1.0-5.0mm diameters $30.00

 various threaded lengths

 06.03.05.03 - Cables

 Biomet Australia Pty Ltd

BI253 BMP Cable System Cable Chrome Cobalt 1.6mm or 2.0mm $379.00

BI256 BMP Cable System Cable, Stainless Steel 1.6mm or 2.0mm $379.00

 Medical & Optical Instruments Australia Pty Ltd

MO166 Osteo Clage Cable System CoCr, Stainless Steel Cable 850mm $379.00

Prostheses List by Category, Groups and Sponsor Page 436 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Perios Pty Ltd

PF014 TLS- Tendon  Suspension tape for anchoring tendon One size - 6mm $379.00

 Anchoring/Suspension Tape  for ACL/PCL reconstruction

 Stryker Australia Pty Ltd

HW309 Dall Miles Cable Grip System -  Vitallium: Cable -  Vitallium 1.6 and 2mm $379.00

 Vitallium

 Synthes Australia Pty Ltd

SY276 Spine Cable System Single Lead One size only $379.00

 Zimmer Pty Ltd

ZI161 Zimmer Internal Fixation Systems:  Cable-Ready Stainless Steel 1.3 mm $379.00

 Cable System

ZI163 Zimmer Internal Fixation Systems:  Cable-Ready Plate Cable Stainless  610 mm long $379.00

 Cable System

 06.03.05.04 - Cables - with in-built locking device

 Advanced Surgical Design & Manufacture Ltd

AE171 Blackstone - Posterior Cervical  Double  Loop Cable w/Four Crimps -  One size only $539.00

 System Titanium

AE172 Blackstone - Posterior Cervical  Single Loop Cable w/Two Crimps -  One size only $539.00

 System Titanium

 Global Orthopaedic Technology

GO092 C-Fix Cable Fixation System Titanium Leader Cable Assembly 1-1.3mm $539.00

GO168 Iso-Elastic™ Cerclage System Iso-Elastic™ Cerclage Cable  One Size Only $539.00

 Johnson & Johnson Medical Pty Ltd

DP364 Control Cable with Sleeve Control Cable with sleeve  One size only $539.00

 Lifehealthcare Pty Ltd

LH496 Jazz Posterior Fixation System -  A multi-purpose Ti alloy connector  3.5mm to 6.0mm, all sizes in  $539.00

 Multipurpose Connector which is clipped onto 5.5 diameter  between.

 Medtronic Australasia Pty Ltd

MI146 Atlas Cable System Single One size only $539.00

 Smith & Nephew Surgical Pty Ltd

SN732 Accord Orthopaedic Cable System, SS Cable  2.0mm $539.00

 w/clamp

Prostheses List by Category, Groups and Sponsor Page 437 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Stryker Australia Pty Ltd

HW524 Dall Miles Cable Grip System Cable and sleeve 1.6mm and 2.0mm $539.00

 Synthes Australia Pty Ltd

SY377 Orthopaedic Cable System Cable with Crimp 1.0mm - 1.7mm, 750mm $539.00

 Zimmer Pty Ltd

ZI164 Zimmer Internal Fixation Systems:  Cable-Ready GTR Distal end Cable -  635 mm long $539.00

 Cable System Cobalt Chrome

ZI170 Zimmer Internal Fixation Systems:  Cable-Ready Pin - Stainless Steel 35, 40, 45, 65mm long $539.00

 Cable System

ZI173 Zimmer Internal Fixation Systems:  Cable-Ready GTR Cable - Proximal  635mm long $539.00

 Cable System

ZI174 Zimmer Internal Fixation Systems:  Cable-Ready Stainless Steel Cable 1.8mm $539.00

 Cable System

 06.03.05.05 - Cables - with >1 locking device

 Johnson & Johnson Medical Pty Ltd

JJ923 Songer Cable System Double loop Cable with 2 crimps One size only $539.00

 Lima Orthopaedics Australia Pty Ltd

LC049 DCD Cerclage Cable The DCD cerclage cable is used to  Single size only. $539.00

 treat 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.

 Medigroup Australia

MZ007 Pioneer Cable System Pioneer Titanium Sternal Orthopaedic One diameter size (1.10mm)  $470.00

  Cable and Crimp - Single Reverse cutting needle

MZ008 Pioneer Cable System Pioneer Stainless Steel Sternal  One diameter size (1.10mm)  $470.00

 Orthopaedic cable and crimp - Single There are 4 needle types on

 the cables. Cutting Edge,

 Blunt Tip, Tapered Tip,

 Reverse Cutting.

Prostheses List by Category, Groups and Sponsor Page 438 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

MZ009 Pioneer Cable System Pioneer Stainless Steel Sternal  One diameter size (1.10mm) $470.00

 Orthopeadic Cable and Crimp - 4 Pack 

 There are four needle types

 on the cables. Cutting edge,

 Blunt Tip, Tapered Tip,

MZ012 Tritium SCP (Sternal Cable Plate) Periarticular Titanium Sternal Double  One Size $539.00

 Double Cable Plate (6 Holes, 2  Cable Plate, 6 Holes, 2 Integrated

 Integrated Cables) Cables, Locking Plate

MZ013 Tritium SCP (Sternal Cable Plate) BOX Plate (4 Holes, 1 Integrated  One Size $539.00

 Cable)

MZ014 Tritium SCP (Sternal Cable Plate) Periarticular Titanium Sternal X Plate, One Size $539.00

  8 holes, 1 Integrated Cable, Locking

 Screws

MZ015 Tritum SCP (Sternal Cable Plate),  Cannullous Locking Rescue Screw for Diameter: 3.0mm $539.00

 Rescue Screw  use with Pioneer Tritium SCP  Lengths: 8mm, 10mm, 12mm,

 (Sternal Cable Plate), 3.0mm  14mm, 16mm,18mm,20mm

MZ016 Tritium SCP (Sternal Cable Plate) V Shaped Titanium Sternal Plate, 4  one size $539.00

 Holes, Locking Screw/Plate, Complex

  Shape

MZ017 Tritium SCP (Sternao Cable Plate),  Cannullous Locking Screw for use  "Diamter: 2.7mm $539.00

 Standard Screw with Pioneer Tritium SCP (Sternal  Lengths: 8mm, 10mm, 12mm,

 Cable Plate), 2.7mm  14mm, 16mm, 18mm, 20mm"

 Medtronic Australasia Pty Ltd

MI147 Atlas Cable System Double w/2 crimps One size only $539.00

 Orthotech Pty Ltd

OH258 Songer cable system Double loop titanium spinal cable  One size only $539.00

 plus crimps

 Stryker Australia Pty Ltd

SK401 Trochanteric Grip Dall-Miles Trochanteric Grip with 2  Small, Medium and Large $539.00

 Chrome Cobalt Cables

 06.03.05.06 - Wire forms (including washers/screws) - all sizes

 LMT Surgical Pty Ltd

LM001 TriMed Wrist Fixation System Washer . $123.00

Prostheses List by Category, Groups and Sponsor Page 439 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Synthes Australia Pty Ltd

SY257 A/O/ASIF K-wires Cerclage Wire - coils with and  0.4-2.5mm $123.00

 without eye

 06.03.05.07 - Cerclage bands

 Lifehealthcare Pty Ltd

LH497 Jazz Posterior Fixation System -  Polyester braid with buckle and  4mm width $497.00

 Open Braid stainless steel tip

 LMT Surgical Pty Ltd

LM005 TriMed Fixation Systems Multiple stainless steel wire forms various sizes $497.00

 Mathys Orthopaedics Pty Ltd

MA540 Reconstruction Cerclage Band Cerlage Band,Titanium 260x6x0.5 mm $497.00

 Oceania Orthopaedics

OO044 IC Cerclage System IC Bone Cerclage System, pure titanium 8mm wide $497.00

 Smith & Nephew Surgical Pty Ltd

SM010 PLUS Endoprothetik Cerclage  CCG Band - Pure Titanium Length 27cm $497.00

 Systems

SM011 PLUS Endoprothetik Cerclage  CCG-GF Band with fixation spikes -  Length 27cm $497.00

 Systems Pure Titanium

SM033 PLUS Endoprothetik Cerclage  CCG Stabilizer with Band XS - L $497.00

 06.03.05.08 - Locking device for wires/cables

 Advanced Surgical Design & Manufacture Ltd

AE170 Blackstone - Posterior Cervical  Crimp Two Pack - Titanium One size only $116.00

 System

 Biomet Australia Pty Ltd

BI254 BMP Cable System Cable Sleeve, Chrome Cobalt,  One Size only $116.00

 Stainless Steel

 Johnson & Johnson Medical Pty Ltd

DP363 Control Cable Control Cable sleeve  One size only $116.00

JJ924 Songer Cable System Flanged crimp/flat bar or 2 hole bar One size only $116.00

JJ925 Songer Cable System Cable and Crimp One size only $116.00

Prostheses List by Category, Groups and Sponsor Page 440 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Lifehealthcare Pty Ltd

LH498 Jazz Posterior Fixation System -  Connector/Grip Titanium Alloy 5.5mm $116.00

 Connector

 Medical & Optical Instruments Australia Pty Ltd

MO165 Osteo Clage Cable System CoCr, Stainless Steel Cable Sleeve 2mm $116.00

 Medtronic Australasia Pty Ltd

MI148 Atlas Cable System Crimp One size only $116.00

 Orthotech Pty Ltd

OH259 Songer Cable System - 2 Crimps Titanium One size only $116.00

 Smith & Nephew Surgical Pty Ltd

SN733 Accord Orthopaedic Cable System, SS Button  One Size Only $116.00

 Plate Adapter

 Stryker Australia Pty Ltd

HW310 Dall Miles Cable Grip System -  Vitallium: Sleeve -  Vitallium 1.6 and 2mm $116.00

 Vitallium

 Synthes Australia Pty Ltd

SY057 AO/ASIF K-Wires, Pins, Washers  Wire mount & spacer 2mm - 6mm $116.00

 06.03.05.09 - Hook/Grip for wires/cables

 Biomet Australia Pty Ltd

BI255 BMP Cable System Trochanteric Grip, Chrome Cobalt 1.6mm or 2.0mm $582.00

 Stryker Australia Pty Ltd

HW302 Dall Miles Cable Grip System -  Stainless Steel: Trochanter Grip -   Small, Medium, Large $582.00

 Stainless Steel Stainless Steel

HW311 Dall Miles Cable Grip System -  Vitallium: Trochanter Grip -   Small, Medium and Large $582.00

 Vitallium

SR072 Dall miles Trochanteric grip with  stainless steel dall miles trochanteric  small, medium, large  43- $582.00

 divergent hooks grip with diverging proximal hooks 53mm

Prostheses List by Category, Groups and Sponsor Page 441 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.05.10 - Grooved Button for wires/cables

 Advanced Surgical Design & Manufacture Ltd

AE202 Parcus MiTi Suture Anchor The Parcus MiTi Suture Anchor is a  2.0mm, 2.5mm & 3.5mm  $240.00

 threaded, tapered fastener for use in  diameter

 attachment of soft tissue to bone. The

 device is made from a Titanium alloy,

 Ti-6A1-4V. MiTi Suture Anchors are

 presented as sterile items.

 Stryker Australia Pty Ltd

HW313 Dall Miles Cable Grip System -  Vitallium: Grooved Button -   One size only $195.00

 Vitallium

 Zimmer Pty Ltd

ZI234 Cable System  Cable Ready, Cable Button 2,5mm - 5,0mm $195.00

 06.03.05.11 - Wedges

 Device Technologies Australia Pty Ltd

DE345 iBalance HTO System Medial High Tibial Osteotomy  Small (6mm, 7mm, 8mm, 9mm, $1,681.00

 Implant Device System  10mm, 11mm, 12mm, 13mm,

 14mm, 15mm)

 Medium (5mm, 6mm, 7mm,

 8mm, 9mm, 10mm, 11mm,

 12mm, 13mm, 14mm, 15mm)

 

 Large (5mm, 6mm, 7mm,

 8mm, 9mm, 10mm, 11mm,

 12mm, 13mm, 14mm, 15mm)

Prostheses List by Category, Groups and Sponsor Page 442 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

06.03.06 - Staples

 06.03.06.01 - Staples

 Advanced Surgical Design & Manufacture Ltd

AE237 StaFIX The StaFIX Staples are retained  6x6, 6x12,8x8, 8x16, 10x10,  $134.00

 implants and removable used  10x20, 12x24

 primarily for the 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.

 Biomet Australia Pty Ltd

BH191 Barouk System Staples Varisation Staple  Stainless Steel 26-90Deg x 8-10mm $134.00

BH327 Barouk System Staples TIFLEX Staple  / Pin -  Titanium 1.6 - 2.5 Dia 7-24mm width  $134.00

 13/15-36/50mm Length

 ConMed Linvatec Australia Pty Ltd

LV025 Staplizer Bone Staple Cartridge 5 Titanium staples per cartridge 7 x 7mm, 7 x 10mm, 10 x  $134.00

 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

 Corin Australia Pty Ltd

CR118 LARS Ligament Staple CoCr synthetic ligament anchor Width 8mm & length 20mm $134.00

 Device Technologies Australia Pty Ltd

DE062 Ligament Staples Cobalt Chromium Molybdenium  6mm - 16mm $134.00

DE292 QuickFix Staple System Compression Staple for Fusion 8mm 10mm $134.00

 Integra Neurosciences Pty Ltd

IG075 Solustaple Standard Staple Stainless steel 90 deg & 26 degree 8 & 10mm length $134.00

Prostheses List by Category, Groups and Sponsor Page 443 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

IG076 Uni-Clip Compression Staple Stainless steel Width 11mm - 20mm,  $134.00

 Length 13mm - 32mm;

 Notched - Width 11mm -

 20mm, Length 13mm -

 32mm;

IG103 Uni-Clip Compression Staple  Stainless Steel, Notched and Non- Width 11-30mm, Length  $134.00

 Notched 13-32mm

 Lima Orthopaedics Australia Pty Ltd

LC072 Ligament Fixation Staple - Small Ligament Fixation Staple - Small 6 - 11 mm width $134.00

LC073 Straight Staples - Small Straight Staples - Small 7.5 to 10 mm width $134.00

LC074 Osteotomy Offset Staple - Small Osteotomy Offset Staple - Small 5 - 11 mm $134.00

LC083 Ligament Fixation Staple - Medium Ligament Fixation Staple - Medium 11 - 16 mm width $134.00

LC084 Straight Staples - Medium Straight Staples - Medium 12.5 mm $134.00

LC085 Osteotomy Offset Staple - Medium Osteotomy Offset Staple - Medium 11 - 20 mm $134.00

LC086 Osteotomy Offset Staple - Large Osteotomy Offset Staple - Large 26 - 36 mm $134.00

 LMT Surgical Pty Ltd

LM157 EOS Footset - Varisation staple Foot staple 8-10mm $134.00

LM158 Pareous staple Foot staple 1.5mm 6-14 and 2.5mm 14- $134.00

 30

 Ortho Solutions Pty Ltd

OU005 VARISATION STAPLE VARISATION STAPLE 90° 10MM VARISATION STAPLE  $134.00

 VARISATION STAPLE 26° 10MM 90° 10MM WIDE

 VARISATION STAPLE 90° 8MM VARISATION STAPLE

 VARISATION STAPLE 26° 8MM 26° 10MM WIDE

 VARISATION STAPLE

 90° 8MM WIDE

 VARISATION STAPLE

 26° 8MM WIDE

 RQSolutions Medical Devices Distribution Support

RQ012 Orthomed Osteotomy & Ligament  Osteotomy Staple.  Cast Chromium- 10*8, 10*10 $134.00

 Staples cobalt non-absorbable. Stainless Steel

  non-absorbable.

RQ014 Orthomed Osteotomy & Ligament  Ligament Staple.  Cast Chromium- 6.6*20, 6.6*15 $134.00

 Staples cobalt staples, non-absorbable.

RQ016 Orthomed Osteotomy & Ligament  Ligament Staple.  Cast Chromium- 10*25, 5*25 $134.00

 Staples cobalt staples, non-absorbable.

Prostheses List by Category, Groups and Sponsor Page 444 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

RQ017 Orthomed Osteotomy & Ligament  Ligament Staple.  Cast Chromium- 16*12.5 $134.00

 Staples cobalt staples, non-absorbable

RQ062 Orthomed Osteotomy & Ligament  Osteotomy Staple.  Cast Chromium- 20*25, 26*25, 36*25,  $134.00

 Staples cobalt non-absorbable. Stainless Steel 26*34, 34*34, 24*36,

  non-absorbable. Non-sterile 57-73

RQ063 Orthomed Osteotomy & Ligament  Osteotomy Staple.  Cast Chromium- 20*25 $134.00

 Staple cobalt staples, non-absorbable

RQ064 Orthomed Osteotomy & Ligament  Osteotomy Staple.  Cast Chromium- 26*25, 36*25, 26*34,  $134.00

 Staple cobalt non-absorbable. 34*34, 24*36,24*40,24*44

RQ065 Orthomed Osteotomy & Ligament  Osteotomy Staple.  Cast Chromium- 16*25, 18*25, 20*25,  $134.00

 Staples cobalt non-absorbable. Stainless Steel 22*25, 26*25, 32*25, 36*25

  non-absorbable.  Non-sterile 57-75

RQ066 Orthomed Osteotomy & Ligament  Osteotomy Staple.  Cast Chromium- 16*25, 18*25, 20*25 $134.00

 Staple cobalt non-absorbable.

RQ067 Orthomed Osteotomy & Ligament  Osteotomy Staple.  Cast Chromium- 22*25, 26*25, 32*25, 36*25 $134.00

 Staple cobalt non-absorbable.

RQ068 Orthomed Osteotomy & Ligament  Ligament Staple.  Cast Chromium- 6*15, 6*20, 8*15, 8*20 $134.00

 Staples cobalt staples, non-absorbable

RQ069 Orthomed Osteotomy & Ligament  Ligament Staple.  Cast Chromium- 11*15, 11*20, 16*20, 16*15 $134.00

 Staples cobalt staples, non-absorbable.

 Smith & Nephew Surgical Pty Ltd

SN463 Bone Staple Fixation - Osteotomy Fixation Staple 5mm- 14mm.  $134.00

  McConnel HTO PF 15mm

 0-S

SN464 Bone Staple Fixation - Short Leg Xsmall - large $134.00

SN465 Bone Staple Fixation - Table Small -Medium  13mm -  $134.00

 16mm.

SN466 Bone Staple Krackow HTO 12,14,16mm $134.00

 Stryker Australia Pty Ltd

HW317 Rutherford Staple Ellison Arched Staple, Vitallium 9,12,15mm x 23mm $134.00

HW318 Rutherford Staple Ellison Flat Staple, Vitallium 8,11,14 x 23mm $134.00

HW319 Rutherford Staple Ellison Soft Tissue Retainer,   8,11,14mm  $134.00

Prostheses List by Category, Groups and Sponsor Page 445 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Surgical Specialties

SQ071 Mini Staple For fixation of osteotomies of first   and 63°, 8-10mm x 10mm $134.00

 phalanx (e.g. Akin), 1mm diameter,

 straight & angled design

 Tornier Pty Ltd

TO131 NexFix Compression Staples The NexFix Compression Staple is  10 mm in width, leg length  $134.00

 made of stailess steel and is 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 depending

 on the type of osteotomy and on the

 patients bone quality

TO132 NexFix Closing Wedge Osteotomy  The NexFix Closing wedge osteotomy 8mm x 90 deg, 8mm x 64 deg $134.00

 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

 Wright Medical Australia

WR037 Charlotte Foot & Ankle System Compression Staple, Stainless Steel 13, 15, 20, 25mm interaxis,  $134.00

 leg lengths 11, 13, 15, 17,

 20 & 25mm, 10 Sizes in Total

WR038 Charlotte Foot & Ankle System Quick Staple, Stainless Steel One Size Only $134.00

 COMP

 Device Technologies Australia Pty Ltd

DE295 Compression Staple Compression staple for fusion 10x10mm 10x15mm  $417.00

 15x10mm 15x15mm 20x20mm

 MM

 Advanced Surgical Design & Manufacture Ltd

AE230 M-Fix Nitinol 10-19mm $534.00

 Biomet Australia Pty Ltd

BH192 Barouk System Staples Memory Staple - Titanium Alloy 12-20mm Long $534.00

Prostheses List by Category, Groups and Sponsor Page 446 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Lima Orthopaedics Australia Pty Ltd

LC064 Hot Memory Staple 4 leg - Medium Hot Memory Staple 4 leg - Medium Width 11-20 mm $534.00

LC065 ADS INTERPHALANX COLD  INTERPHALANX Cold Memory  0-35 Degree $534.00

 MEMORY STAPLE Staple

LC079 Mono-Cortical Hot Memory Staple - Mono-Cortical Hot Memory Staple - 2 Width 20-30 mm $534.00

  2 leg large  leg large

LC080 Mono-cortical Hot Memory Staple -  Mono-cortical Hot Memory Staple - 2  Width 11-20 mm $534.00

 2 leg Medium leg Medium

LC081 Mono-cortical Hot Memory Staple -  Mono-cortical Hot Memory Staple - 2  Width 8-11 mm $534.00

 2 leg Small leg Small

LC082 Asymmetric Hot Memory Staple -  Asymmetric Hot Memory Staple - 2  Width 11-12mm $534.00

 Medium leg - Medium

 LMT Surgical Pty Ltd

LM159 Eleos staple Foot staple 4-34/38mm $534.00

Prostheses List by Category, Groups and Sponsor Page 447 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Ortho Solutions Pty Ltd

Prostheses List by Category, Groups and Sponsor Page 448 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

OU004 MEMO STAPLE 12mm memo staple /16mm memo  12MM MEMO STAPLE  $534.00

 staple/ 20mm memo staple (13MM)

 12MM MEMO STAPLE

 (14MM)

 12MM MEMO STAPLE

 (15MM)

 12MM MEMO STAPLE

 (16MM)

 12MM MEMO STAPLE

 (17MM)

 12MM MEMO STAPLE

 (13MM X 15MM)

 12MM MEMO STAPLE

 (14MM X 16MM)

 12MM MEMO STAPLE

 (15MM X 17MM)

 12MM MEMO STAPLE

 (16MM X 18MM)

 12MM MEMO STAPLE

 (17MM X 19MM)

 20MM MEMO STAPLE

 (13MM)

 20MM MEMO STAPLE

 (15MM)

 20MM MEMO STAPLE

 (17MM)

 20MM MEMO STAPLE

 (19MM)

 20MM MEMO STAPLE

 (21MM)

 20MM MEMO STAPLE

 (23MM)

 20MM MEMO STAPLE

 (25MM)

 20MM MEMO STAPLE

 (12MM X 15MM)

 20MM MEMO STAPLE

 (14MM X 17MM)

 20MM MEMO STAPLE

 (16MM X 19MM)

 20MM MEMO STAPLE

 (18MM X 21MM)

 20MM MEMO STAPLE

 (20MM X 23MM)

 12mm Memo Staple (13mm)

 

Prostheses List by Category, Groups and Sponsor Page 449 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 12mm Memo Staple (14mm)

 

 12mm Memo Staple (15mm)

 

 12mm Memo Staple (16mm)

 

 12mm Memo Staple (17mm)

 

 16mm Memo staple (14mm x

 16mm)

 16mm Memo staple (16mm x

 18mm)

 16mm Memo staple (18mm x

 20mm)

 Stryker Australia Pty Ltd

HW462 Memometal Memory Staples Memory Metal Implants 10 mm to 25 mm $534.00

 Surgical Specialties

SQ044 BME Nitininol Osteosynthesis  Dynamic Compression Implants OSS  Large wire 2.0-3.0 - Sizes  $534.00

 Staple - Biocompatible Nitonol 20x20x20, 22x25x22,

 30x30x30, 12x15x12

SQ045 BME Nitinol Osteosynthesis staple Dynamic Compression Implants OSS  Small Wires $534.00

 Staple - Biocompatible Nitono

SQ046 OSSStaple Osteosynthesis Staple Dynamic Compression Implants OSS  Asymmetric - 11x15x13,  $534.00

 Staple - Asymmetric Staples -  11x17x15, 11x17x19 &

 Biocompatible Nitonol Construction 18x18x15

SQ048 Step/Barb OSStaple Dynamic Compression Implant,  2mm, 4mm, 6mm 9mm &  $534.00

 Calcaneal Step OSStaple, Nitinol  12mm offsets

 Memory Alloy

SQ068 Hammerlock Nitinol Intramedullary Fixation  16, 19 and 22mm $534.00

 System - Straight and Angled

 06.03.06.04 - Plate staple

 Surgical Specialties

SQ047 BME Nitinol Osteosynthesis Staple Dynamic Compression Implants OSS  Plate Staple - 15x6, 15x8,  $577.00

 Plate Staple - Biocompatible Nitonol  15x10

 Construction

Prostheses List by Category, Groups and Sponsor Page 450 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

06.03.07 - Soft Tissue Fixation Devices

 06.03.07.01 - No suture (including arrows)

 ConMed Linvatec Australia Pty Ltd

LV028 Pre-loaded BioStinger Bio- Violet, PLLA 10, 13, 16mm $246.00

 Absorbable Meniscal Repair

LV071 Contour Meniscus Arrow 80L/20D, LPLA & PLLA 1.1mm x 10, 13,16mm $246.00

 Smith & Nephew Surgical Pty Ltd

SN413 Shoulder Reconstruction 3.7mm TAG & Wedge Suture Wedge 3.7mm $246.00

SN414 Shoulder Reconstruction Suretac Absorbable Staple 6-8 x 16mm $246.00

SN415 Shoulder Reconstruction TAG Bioabsorbable Anchor Wedge 3.7mm $246.00

 Stryker Australia Pty Ltd

HW374 Howmedica Mainstay Soft Tissue  Without suture - Titanium 4.5, 3.5 and 2.7 anchor $246.00

 Anchor

HW375 Howmedica Mainstay Soft Tissue  Zip anchor - Titanium Sip 4.5 anchor with #5  $246.00

 Anchor suture and #2 suture 2

 strands, zip 3.5 anchor with

 #2 suture and #0 suture 2

 strands, zip 2.7 anchor with

 #0 suture

SK048 Stryker Cuff Anchor Titanium anchor kit for soft tissue  Length 5-8mm $246.00

 reattachment

 Tornier Pty Ltd

TO095 ArthroTunneler TunnelPro System Lateral button, PEEK 10mm $246.00

 Zimmer Pty Ltd

ZI182 Zimmer Internal Fixation Systems:  Statak/Mini-Statak - Suture, Stainless  2, 5 mm - 5, 0mm $246.00

 Soft Tissue Re-attachment Device Steel

 AB

 Device Technologies Australia Pty Ltd

DE059 Arthrex Meniscal Dart PLA 10mm - 14mm $309.00

DE126 Chondral Dart Polylactide Compositition Length 18mm $309.00

Prostheses List by Category, Groups and Sponsor Page 451 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.07.02 - Suture, Small anchors (2.3mm)

 Arthrocare Australasia Pty Ltd

AF039 Q-Fix All Suture Anchor Soft suture anchor 1.8mm $310.00

 Biomet Australia Pty Ltd

BH171 JuggerKnot Soft Anchor Suture Anchor , Polyester, PE 1.0mm, 1.4mm, 1.5mm $310.00

BI969 MaxFire Meniscal Repair Device one size $310.00

BI979 Hitch suture anchor Suture anchor with maxbraid sutures,  2.4mm $310.00

 PEEK

 ConMed Linvatec Australia Pty Ltd

LV005 Ultrafix MiniMite StitchPak Suture  Soft Tissue Re-attachment - Stainless  2.3mm predeployed diameter $310.00

 Anchor Steel

LV024 Ultrafix MicroMite Small Joint  Suture Anchoring Device - Titanium 1.5mm predeployed diameter $310.00

 Anchor

LV119 Y-Knot Suture Anchor Y-Knot Suture Anchor 1.3mm and  1.3mm and 1.8mm $310.00

 1.8mm

LV124 PressFT PEEK Suture Anchor  The ConMed Linvatec PressFT Suture 2.1mm $335.00

  Anchors are manufactured from PEEK

  and are provided, preloaded on a

 single use driver and pre-threaded

 with either one or two Hi-Fi Sutures.

 Danex Medical Pty Ltd

XD016 Nanotack Suture Anchor 1.4mm High Strength PEEK suture  1.4mm $310.00

 anchor pre-loaded with suture and

 inserter for arthrosopic hip labral

 reattachment

 Device Technologies Australia Pty Ltd

DE430 Corkscrew Suture Anchor Titanium alloy with Fibrewire suture 2.2mm $310.00

 Johnson & Johnson Medical Pty Ltd

JJ087 Mitek Tacit Quick Anchor  Titanium Suture Anchor 2.0 x 3.6mm $310.00

JJ091 Mini Quick Anchor with Suture Anchor with Suture Anchor with Suture and  $310.00

 Multiple size needles

JJ100 Micro Quick Anchor  Titanium Suture Anchor 1.3 x 3.7mm $310.00

Prostheses List by Category, Groups and Sponsor Page 452 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LMT Surgical Pty Ltd

LM160 AIM-TEC AVRE SF Anchor System  Titanium screw type anchor system Diameter : 1.7 and 22mm $335.00

 - Small

 RQSolutions Medical Devices Distribution Support

RQ010 Orthomed Metallic Suture Screwed  Metallic screwed anchors are made of a A total of 1 size $310.00

 Anchors  titanium, with one or two sutures of  2mm

 braided ultra-high molecular weight

 polyethylene (UHMWPE) with or

 without needles. This anchor is

 placed on a single use insertion

 device.

 The ORTHOMED single-use

 insertion device is composed of a

 stainless steel axis and a polymer

 Smith & Nephew Surgical Pty Ltd

SL025 Suturefix Ultra All suture anchor 1.7-2.3 $310.00

SM162 SPYROMITE A non-absorbable polymer (PEEK)  2mm in diameter $310.00

 anchor for use in ligament/tendon

 reconstruction in small joint

 applications

SM163 DYNOMITE A non-absorbable polymer (PEEK)  2mm in diameter $310.00

 anchor for use in ligament/tendon

 reconstruction in small joint

 applications

SN417 T-Bar Suture Retention System T-Fix RCG  1.8mm $310.00

SN418 T-Bar Suture Retention System T-Fix Single & Double T-Fix Suture Bar, Straight  $310.00

 Needle, Double Suture

SN442 Mini TAG Suture Anchor 2.0mm 2.0mm $310.00

 Stryker Australia Pty Ltd

HW526 Memometal Anchor Fixation System Anchors 1-2mm $310.00

 Synthes Australia Pty Ltd

SY417 Titanium Wire, Barb and Needle Titanium wire surture and needle with One size only $310.00

  titanium alloy barb fixation

 Wright Medical Australia

WR212 G Force Anchorlok Soft Tissue  Titanium suture anchor 1.9mm $310.00

 Anchors

Prostheses List by Category, Groups and Sponsor Page 453 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 AB

 ConMed Linvatec Australia Pty Ltd

LV125 GENESYS PressFT Suture Anchor  The ConMed Linvatec GENESYS  2.1mm $529.00

 2.1mm PressFT (biocomposite) Suture

 Anchors are manufactured from

 polylactide copolymer (96L/4D PLA

 co-polymer) and beta-tricalcium

 phosphate (B-TCp), and are provided

 sterile, preloaded on a single-use

 driver and pre-threaded with either

 one or two Hi-Fi Sutures

 Johnson & Johnson Medical Pty Ltd

JJ421 MicroFix Anchor with Suture Anchor with suture Anchor with Suture and  $529.00

 Multiple size needles

JJ926 MiniLok Anchor System Suture Anchor 2.3mm $529.00

 MI

 ConMed Linvatec Australia Pty Ltd

LV115 Sequent Meniscal Repair Device The Sequent Meniscal Repair Device  7 (5.1mm x 1.3mm Implants) $795.00

 is pre-loaded with

 polyetheretherketone (PEEK)

 implants threaded onto one size #0

 (3.5 metric) HiFi® suture.  The device

 sequentially deplos the implants and

 suture that are tightened down to

 create multiple stitches to create

 fixation points along a soft tissue tear

Prostheses List by Category, Groups and Sponsor Page 454 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.07.03 - Suture, Medium anchors (2.4 3.9mm)

 Advanced Surgical Design & Manufacture Ltd

AE150 Parcus Series 3 Peek CF Suture  10323T, 3.5mm w/Suture Push-In  3.5mm diameter $465.00

 Anchor Anchor w/two #2 Parcus Braid TM

 Sutures (green, white/green).

 10313, 3.5mm Knotless Push-In

 Anchor provided with a Suture Passer

  (MUST BE USED IN

 CONJUNCTION WITH #10344

 Sterile Driver).

 10344, 3.5mm Sterile Driver for 35

 Knotless Anchor (used with 35

 knotless anchor #10313)

 Arthrocare Australasia Pty Ltd

AF005 ArthRoCare Anchor System Anchor fixating soft tissue to bone 2.8 - 3.4mm $465.00

AF036 Speedfix PEEK Suture Implant Soft tissue to bone suture anchor 3.4mm x 12.5mm $465.00

AF037 Speedlock HIP Knotless Fixation  PEEK knotless suture anchor implant 3.4mm $465.00

 Implant  for fixation of soft tissue to bone in

 the hip

AF038 Magnum M Suture Implant Anchor fixating soft tissue to bone 2.8mm $465.00

AF040 Q-Fix All Suture Anchor Soft suture anchor 2.8mm $465.00

 Biomet Australia Pty Ltd

BI320 Arthrotek Harpoon System Suture Anchor, Stainless Steel, Ti 1 to 5 $465.00

BI968 ToggleLoc Femoral Fixation Device 15mm-60mm $465.00

 ConMed Linvatec Australia Pty Ltd

LV010 Mini-Revo Screw Soft Tissue Re-attachment - Titanium 2.7mm diameter $465.00

LV027 Pre-Loaded Ultrafix RC Anchor Surgical Grade Stainless Steel,  Dia 2.9mm, length 6.5mm $465.00

 preloaded with 2 #2 sutures

LV108 Bio Mini-Revo Suture Anchor Bioabsorbable Suture Anchor with  3.1mm O.D $465.00

 Two #2 Hi-Fi Sutures

LV123 Press FT PEEK Suture Anchor Press FT PEEK Suture Anchor -  2.6mm $465.00

 preloaded on a single driver

Prostheses List by Category, Groups and Sponsor Page 455 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Danex Medical Pty Ltd

XD020 Pivot Anatomic Labrum Restoration High Strength PEEK anchor pre- 12mm x 2.4-2.8mm, 1.4- $465.00

  Anchors laoded with suture and inserter for  2.0mm, 2.8-3.5mm

 arthroscopic hip labral reattachment

 Device Technologies Australia Pty Ltd

DE198 Fastak Suture Anchor (Small Bone) With Fibrewire Suture Dia. 2.4mm x Length 7.5mm $465.00

DE225 Fastak Anchor Titanium with fibrewire suture 2.8mm x 11.7mm $465.00

DE428 Corkscrew Suture Anchor Titanium alloy with Fibrewire suture 3.5mm $465.00

DE433 Pushlock Suture Anchor Knotless Suture Anchor 2.5 - 3.5mm $465.00

DE461 SutureTak Suture Anchor Suture Anchor with Fiberwire 2.4mm - 3mm $465.00

 Johnson & Johnson Medical Pty Ltd

DY576 Healix Anchor System Titanium anchor with suture 2.9 - 3.9mm $465.00

JJ076 Mitek Ethibond Knotless Suture  Titanium anchor 2.7 x 10.8 mm $465.00

 Anchor

JJ089 Mitek GII QuickAnchor Plus  Titanium Anchor, with various  2.4 x 8.8mm $465.00

JJ093 Mitek Rotator Cuff Quick Anchor  Titanium  Anchor, with various  2.8 x 11mm $465.00

 Plus

JJ095 Mitek Super Quick Anchor Plus  Titanium  Anchor, with various  2.8 x 11.4mm $465.00

JJ946 GRYPHON PEEK Instability  Suture Anchor 2.4-3.0mm $465.00

JJ948 Healix Anchor System PEEK anchor with Orthocord suture 2.9 - 3.9mm anchor diameter $465.00

 LMT Surgical Pty Ltd

LM161 AIM-TEC AVRE SF Anchor System  Titanium screw type anchor system Diameter : 3mm $400.00

 - Medium

LM163 AIM-TEC AVRP SF (PEEK)  PEEK screw type anchor system Diameter: 3mm $465.00

 Anchor System -Medium

 RQSolutions Medical Devices Distribution Support

RQ009 Orthomed Metallic Suture Screwed  Metallic screwed anchors are made of a A total of 1 size $465.00

 Anchors  titanium, with one or two sutures of  3mm

 braided ultra-high molecular weight

 polyethylene (UHMWPE) with or

 without needles. This anchor is

 placed on a single use insertion

 device.

 The ORTHOMED single-use

 insertion device is composed of a

 stainless steel axis and a polymer

Prostheses List by Category, Groups and Sponsor Page 456 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Smith & Nephew Surgical Pty Ltd

SM146 Bioraptor 2.3 PK PEEK optima suture anchor 2.3mm $465.00

SM177 RAPTORMITE 3.0 PK An non-absorbable polymer (PEEK)  3mm $465.00

 suture anchor for use in

 ligament/tendon reconstruction

SN141 T-Bar Suture Retention System Fastfix One size only $465.00

SN846 KINSA Suture Anchor, Polmer With  2.9mm $465.00

 Polyester Suture Material

SN854 Fast-Fix Ultra Meniscal suture anchor One Size $465.00

SN902 FAST-FIX 360 This is a double anchor, self tying  One size $465.00

 device for all-inside meniscal repair

SN903 Minitac This is a titanium suture anchor with  2.0mm $465.00

 needles for repair and reattachment of

 the ligaments in small joint

SN907 TWINFIX Ti This is a titanium suture anchor for  2.8mm $465.00

 repair and reattachment of ligaments to

  bone in joint arthroscopy

SN909 BIORAPTOR Knotless This is a knotless suture anchor for  2.9mm. $465.00

 repair and reattachment of the labrum

 in shoulder and hip arthroscopy.

 Stryker Australia Pty Ltd

HW527 Memometal Anchor Fixation System Anchors 3.6mm $465.00

SK177 Stryker Cuff Anchor Glenoid Titanium anchor kit for soft  Dia 2 - 3mm $465.00

 tissue reattachment

SK451 XCEL Anchor Bio-absorbable Suture Anchor 2mm-10mm $465.00

 Tornier Pty Ltd

TO052 Piton Knotless Fixation Implant  System includes Piton Knotless  Anchor: one size. Suture:  $465.00

 System anchors (single) NiTi and two Force  size 2 in the system,

 Fiber sutures size #2 UHMWPE options: blue/white or

 Wright Medical Australia

WR210 G Force Anchorlok Soft Tissue  Peek suture anchor 3.5mm $465.00

 Anchors

WR214 G Force Anchorlok Soft Tissue  Titanium Suture Anchor 2.5 & 3.5mm $465.00

 Anchors

Prostheses List by Category, Groups and Sponsor Page 457 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 AB

 ConMed Linvatec Australia Pty Ltd

LV126 GENESYS PressFT Suture Anchor  The ConMed Linvatec GENESYS  2.6mm $527.00

 2.6mm PressFT (biocomposite) Suture

 Anchors are manufactured from

 polylactide copolymer (96L/4D PLA

 co-polymer) and beta-tricalcium

 phosphate (B-TCp), and are provided

 sterile, preloaded on a single-use

 driver and pre-threaded with either

 one or two Hi-Fi Sutures

 Device Technologies Australia Pty Ltd

DE197 Bio - Fastak with Fibrewire suture 3mm x 11mm $527.00

DE304 BioComposite SutureTak Suture  Absorbable suture anchor with a  3mm $527.00

 Anchor molded-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

DE431 Corkscrew FT Suture Anchor with Fiberwire 2.4mm - 3.9mm $527.00

DE435 BioComposite PushLock BioComposite Pushlock Knotless  2.4 - 3.5 mm $527.00

 Suture Anchor

DE460 Bio Suturetak Suture Anchor Absorbable Suture Anchor with  2.4mm - 3mm $527.00

 Fiberwire

 Johnson & Johnson Medical Pty Ltd

JJ927 Panalok RC Anchor System Suture Anchor 2.9mm $527.00

JJ928 Bioknotless Anchor System Suture Anchor 3.9mm $527.00

JJ945 GRYPHON BR Instability Anchor Suture Anchor 2.4-3.0mm $527.00

JJ950 HEALIX BR Anchor Biocryl Rapide anchor with suture 3.4 to 3.9mm $527.00

MN171 Lupine Anchor System Suture Anchor 3.9mm $527.00

 Smith & Nephew Surgical Pty Ltd

SM178 RAPTORMITE 3.7 This is a absorbable suture anchor for  3.7mm $527.00

 repair and reattachment of ligaments in

  arthroscopic surgery

Prostheses List by Category, Groups and Sponsor Page 458 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

SN906 OSTEORAPTOR This is an hydroxyapatite  2.9mm $527.00

 incorporated absorbable suture

 anchor for repair and reattachment of

 the labrum in shoulder and hip

SN908 OSTEORAPTOR This is an hydroxyapatite  2.9mm $527.00

 incorporated absorbable suture

 anchor for repair and reattachment of

 the labrum in shoulder and hip

 06.03.07.04 - Suture, Large anchors (4mm)

 Advanced Surgical Design & Manufacture Ltd

AE128 V-Lox PEEK CF Suture Anchors Titanium Fully Threaded Suture  4.5mm; 5.5mm; 6.5mm,  $465.00

 double loaded and triple

 loaded suture anchors

AE129 V-Lox PEEK CF Suture Anchors PEEK CF Fully Threaded Suture  4.5m; 5.5mm; 6.5mm, $465.00

 Anchor

 Arthrocare Australasia Pty Ltd

AF004 ArthroCare Anchor System Anchor fixating soft tissue to bone 4.5,5.5mm & 6.5mm $465.00

AF034 Titan Ti Suture Anchor System Tendon to bone Anchor 5.5mm and 6.55mm x 16.5mm $465.00

AF035 Spartan PEEK Suture Implant Spartan PEEK Suture Implant 5.5mm, 6.5mm $465.00

 Biomet Australia Pty Ltd

BH056 Lactosorb Suture Anchor Threaded with 1 suture, PGA/PLA,  (3.5, 5.5, 6.8)mm dia anchor $465.00

 polyethylene

BH057 Lactosorb Suture Anchor Threaded with 2 suture, PGA/PLA,  (3.5, 5.5, 6.8)mm dia anchor $465.00

 polyethylene

BH117 Allthread Knotless Suture Anchor Knotless peek suture anchor, polymer 4.5, 5.5 & 6.8mm $465.00

BH118 Allthread Titanium Suture Anchor Suture anchor, titanium with  5.0 & 6.5mm $465.00

 Maxbraid suture with and without

BH119 Allthread Peek Suture Anchor Suture anchor, peek polymer, with  5.5 &6.8mm $465.00

 maxbraid suture and without needles

 ConMed Linvatec Australia Pty Ltd

LV009 Revo Cancellous Screw Soft Tissue Re-attachment - Titanium 4mm diameter $465.00

LV090 Super Revo Suture Anchor with Hi- Titanium Suture Anchor 5.0mm O.D x 14.2mm L $465.00

 Fi Suture

Prostheses List by Category, Groups and Sponsor Page 459 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

LV091 ThRevo Suture Anchor Titanium screw-in suture anchor 5.0mm OD x 14.2mm L $465.00

LV112 CrossFT Suture Anchor PEEK Optima Suture Anchor with  4.5mm, 5.5mm & 6.5mm  $465.00

 multiple sutures with or without  diameters

LV113 PopLok Suture Anchor PEEK Optima Suture Anchor with or  2.8mm, 3.3mm, 3.5mm &  $465.00

 without sutures 4.5mm diameters

LV114 Super Revo-FT,ThRevo-FT Fully Threaded Suture Anchor pre- 5mm $465.00

 threaded with two or three sutures

 with or without needles

LV116 Sequent Meniscal Repair Device The Sequent Meniscal Repair Device  4 (5.1mm  x 1.3mm Implants $465.00

 is pre-loaded with

 polyetheretherketone (PEEK)

 implants threaded onto one size #0

 (3.5 metric) HiFi® suture.  The device

 sequentially deplos the implants and

 suture that are tightened down to

 create multiple stitches to create

 fixation points along a soft tissue tear

LV117 CrossFT Suture Anchor Polyester PEEK Optima Suture Anchor with  4.5mm, 5.5mm and 6.5mm $465.00

 Multiple Polyester Sutures

LV122 Sequent Meniscal Repair Device - 3  The Sequential Meniscal Repair  5.1mm x 1.3mm $465.00

 Implant Device is pre-loaded with

 polyetheretheketone (PEEK)

 implants threaded onto one size #0

 Danex Medical Pty Ltd

XD017 Quattro Link Knotless Anchor Knotless Anchor manufactured from  2.9mm,4.5mm and 5.5mm $465.00

 PEEK-OPTIMA polymer pre-

 assembled to stainless steel inserter.

 Provided as a single-use sterile

XD018 Quattro X Suture Anchor Suture Anchor with sutures,  5.5mm and 6.5mm $465.00

 manufactured from PEEK-OPTIMA

 polymer pre assembled to stainless

 stell inserter. Provided as a single-use

  sterile device.

 Device Technologies Australia Pty Ltd

DE298 Tightrope Syndesmosis Buttress  For Syndesmosis and Fracture Repair Universal one size only $465.00

DE429 Corkscrew Suture Anchor Titanium alloy with Fibrewire suture 4.5mm - 6.5mm $465.00

DE434 Pushlock Suture Anchor Knotless Suture Anchor 4.5mm $465.00

DE458 Swivelock Twist-in knotless suture anchor 4mm $465.00

Prostheses List by Category, Groups and Sponsor Page 460 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Johnson & Johnson Medical Pty Ltd

DY577 Healix Anchor System Titanium anchor with suture 4.5 - 6.5mm $465.00

JJ096 Mitek Fastin Anchor  Titanium Suture Anchor 3 x 8.4mm, 4 x 9.7mm, 5.2 x  $465.00

 11.5mm

JJ097 Fastin Anchor System Suture Anchor 4 & 6.5mm $465.00

JJ678 Versalok Bone Anchor System Suture anchor 4.9-6.3mm $465.00

JJ909 OmniSpan Peek backstops with suture 0 to 27 degrees $465.00

JJ947 Healix  Anchor System PEEK anchor system 4.5 - 6.5mm anchor diameter $465.00

MN101 OmniSpan Meniscal Repair System Pre-loaded Peek backstops and  0 to 27 degrees $465.00

 ORTHOCORD suture

 LMT Surgical Pty Ltd

LM162 AIM-TEC AVRE SF Anchor System  Titanium screw type anchor system Diameter : 5 and 6mm $400.00

 - Large

LM164 AIM-TEC AVRP SF (PEEK)  PEEK screw type anchor system Diameter: 5 and 6.5mm $465.00

 Anchor System - Large

 Medical & Optical Instruments Australia Pty Ltd

MO408 Acu-Sinch Repair System This is a suture-and-anchor soft tissue Titanium Anchor: D=5.5mm, $465.00

  repair system designed to complement  L=12mm

  the Acumed Clavicle Plating system  Titanium Suture Retainer:

 by treating coracoclavicular ligament  L=5.3mm, W=4mm

 repair injuries associated with

 clavicle fractures and is used in

 conjuction midshaft or distal clavicle

 plate. All Acu-Sinch kits come in a

 sterile procedure pack.

 RQSolutions Medical Devices Distribution Support

RQ004 Orthomed Metallic Suture Screwed  Metallic screwed anchors are made of a A total of 4 sizes $465.00

 Anchors  titanium, with one or two sutures of  4mm

 braided ultra-high molecular weight  5mm

 polyethylene (UHMWPE) with or  5.5mm with needles

 without needles. This anchor is  5.5mm without needles

 placed on a single use insertion

 device.

 The ORTHOMED single-use

 insertion device is composed of a

 stainless steel axis and a polymer

Prostheses List by Category, Groups and Sponsor Page 461 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

RQ008 Orthomed Absorbable Screwed  Absorbable screwed anchors are made  Two sizes: $465.00

 Anchors - two sutures of a lactic-acid copolymer: poly (L,DL 5.5mm absorbable screwed

  - lactide) anchor, with two non  anchor with 2 sutures #2

 absorbable sutures of braided ultra- with needles

 high molecular weight polyethylene  5.5mm absorbable screwed

 (UHMWPE) with and without  anchor with 2 sutures #2

 needles. This anchor is placed on a  without needles

 single use insertion device.

 Signature Orthopaedics

SF003 Signature ST Shoulder Anchor PEEK fully threaded suture anchor 4.5mm, 5.5mm &6.5mm $465.00

 Smith & Nephew Surgical Pty Ltd

SL015 Healicoil suture anchor 4.5mm and 5.5mm $465.00

SM147 Twinfix PK PEEK Optima fully threaded suture  4.5mm 5.5mm and 6.5mm $465.00

 anchor

SM148 Footprint Non-knot tying suture anchor 4.5mm, 5.5mm, 6.5mm $465.00

SM179 TWINFIX Ti This is a titanium suture anchor for  4.5mm, 5.5mm, 6.5mm $465.00

 repair and reattachment of ligaments to

  bone in joint arthroscopy

SN008 Rotorloc Absorbable PLA Suture  - One size only $465.00

 Anchor System

SN416 Shoulder Reconstruction  Fastentor Suture Anchor One size only $465.00

SN651 OBL Anchor System Preloaded Soft Tissue Anchor System  Anchor sizes - Titanium:  $465.00

 Material: Titanium Alloy or  2.8, 3.5, 4.0 5.0, 6.5mm

 Polyacetal Polymer. Comes with  Anchor size - Polymer: 5.0mm

 Insertion device and 2 Braided

SN652 OBL Anchor System  Soft Tissue Anchor System Non- 4.0 and 6.5mm $465.00

 preloaded Material:  Titanium Alloy

SN714 TwinFix Quick-T 2.8 - 6.5mm $465.00

 Stryker Australia Pty Ltd

HW373 Howmedica Mainstay Soft Tissue  With suture - Titanium 4.5 anchor with #2 and #5  $465.00

 Anchor suture, 2.7 anchor with #0

 suture

SK176 Stryker Cuff Anchor Bio Zip PLLA anchor for soft tissue  Dia 3 - 8mm $465.00

 ligament/tendon fixation

Prostheses List by Category, Groups and Sponsor Page 462 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Tornier Pty Ltd

TO090 Insite FT anchors Bone anchors Ti or PEEK, preloaded  4.5mm, 5.5mm or 6.5mm $465.00

 with suture

 Wright Medical Australia

WR211 G Force Ancholok Soft Tissue  Peek suture anchor 5.0mm $465.00

 Anchors

WR213 G Force Anchorlok Soft Tissue  Titanium suture anchor 5.0mm $465.00

 Anchors

 AB

 Arthrocare Australasia Pty Ltd

AF033 Doubleplay Suture Implant Doubleplay Implant (TCP/PLLA) -  5.0mm and 6.5mm $527.00

 Tricalcium phosphate and poly-L-

 lactide

 ConMed Linvatec Australia Pty Ltd

LV118 Genesys CrossFT Micro TCP Soft Tissue Suture Anchor  4.5mm, 5.5mm, 6.5mm  $527.00

 with multiple sutures with or without diameters

  needles

 Device Technologies Australia Pty Ltd

DE302 BioComposite Corkscrew Suture  The threaded design over the entire  4.5mm - 5.5mm $527.00

 Anchor length 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.

DE306 BioComposite SwiveLock The SwiveLock is a 4.75 or 5.5mm  4.75mm - 5.5mm $527.00

 twist-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

DE432 Corkscrew FT Suture Anchor with Fiberwire 4mm - 6.5mm $527.00

Prostheses List by Category, Groups and Sponsor Page 463 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

DE436 BioComposite PushLock Knotless Suture Anchor 4.5mm $527.00

DE459 Bio Swivelock Twist-in knotless suture anchor 4mm $527.00

 Johnson & Johnson Medical Pty Ltd

JJ099 Panalok Anchor System Polylactic acid absorbable anchor  4.1 x 6.0mm $527.00

 with absorbable and non-absorbable

JJ929 BioKnotless RC Anchor System Suture Anchor One size only $527.00

JJ930 RapidLoc Anchor System Suture top Hat Straight 12 degree and 27  $527.00

 degree

JJ931 Spiralok Anchor System Suture Anchor 5-6.5mm $527.00

JJ949 HEALIX Anchor System Biocryl Rapide anchor with suture 4.5-6.5mm $527.00

 Smith & Nephew Surgical Pty Ltd

SN703 Absorbable Suture Anchor Preloaded PLLA Suture Anchor 5.0mm & 6.5mm $527.00

 06.03.07.05 - Button/thread/tape or Button/thread/button

 Advanced Surgical Design & Manufacture Ltd

AE130 Parcus - GFS Parcus - GFS Fixation for knee  GFS Standard with 10mm,  $394.00

 ligament 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  One Size $394.00

 steel, titanium, PE suture with or

 without disposable instruments

BI005 Re-Unite Orthopaedic System Rotator Cuff Butress, Lactosorb;  One size only $394.00

 PGA/PLA

BI920 EZLoc Femoral fixation Device Ligament Anchor, Ti, PE 7-8; 9-10mm x Short, std or  $394.00

 long.

 ConMed Linvatec Australia Pty Ltd

LV109 XO Button with Continuous Loop Titanium suspensor, fixation device  4.5mm x 13.5mm with  $394.00

 for femoral fixation in ACT and PCL  Continuous Loop lengths

 repairs 15-60mm

Prostheses List by Category, Groups and Sponsor Page 464 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Device Technologies Australia Pty Ltd

DE252 Tightrope Syndesmosis Repair Kit Titanium or stainless steel, with non  One size only $394.00

 absorbable Fiberwire suture material

DE271 RetroButton Femoral Fixation Device 12mm Button with 15-60mm $394.00

  loops, 15mm Button with

 15-60mm loops

DE299 Meniscal Cinch Meniscal Repair Device Universal One size only $394.00

 Emergo Asia Pacific Pty Ltd

ER129 BOTAO - ACL Button with  BOTAO Titanium button with  15mm - 40mm loop length $394.00

 Continuous Loop - ligament  polyester Continuous Loop and

 fixation device Polyester Traction Threads

 Johnson & Johnson Medical Pty Ltd

JJ951 RigidLoop Cortical Fixation Loop 15-60mm, Xlarge, adjustable $394.00

 RQSolutions Medical Devices Distribution Support

RQ005 Orthomed ACF Femoral Cortical  The ACF Femoral Cortical Anchor is  10 sizes: $394.00

 Anchors used for ACL reconstruction, in  15mm to 60mm in 5mm

 accordance with the hamstring tendon increments

  method to fasten the graft on the

 femoral cortex.

 Smith & Nephew Surgical Pty Ltd

SL016 Endobutton Twinbridge A button/thread/button device for  6mm $394.00

 ligament reconstruction

SN429 ACL/PCL Reconstructions EndoButton Tape One size only $394.00

SN853 Endobutton Fixation for ACL/PCL reconstruction 5-9mm, 15-60mm $394.00

 06.03.07.06 - Button

 Device Technologies Australia Pty Ltd

DE301 Suture Button Multiple hole button for fixation of  2.6mm - 7.5mm $394.00

 bone to 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

 Smith & Nephew Surgical Pty Ltd

SN426 ACL/PCL Reconstructions EndoButton 4 x 12mm, 4mm x 18mm $394.00

Prostheses List by Category, Groups and Sponsor Page 465 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

SN427 ACL/PCL Reconstructions Fixation Button 12-17mm $394.00

SN428 ACL/PCL Reconstructions EndoButton CL 20-50mm $394.00

 06.03.07.07 - Interference Screw (± sleeve)

 Advanced Surgical Design & Manufacture Ltd

AE094 ACL Fixation Screws Tapered Flat Head, Tappered, Titanium 9 - 11mm Diameter 30mm  $190.00

 Length

AE095 ASDM Standard ACL Fixation  Standard Flat Head Screw 7 - 11mm Diameter 20mm -  $190.00

 50mm Length

AE127 Parcus PEEK CF Interface Screw PEEK CF Interface Screw 7,8,9mm x 20-35mm  $190.00

 10,11,12mm x 25-35mm

 Biomet Australia Pty Ltd

BH145 TunneLoc Tibial Fixation Device with  7 to 10mm diameter $190.00

 Tensioner, PEEK

BH168 Washerloc Tibial Fixation Device Screw - Ti 24 - 60mm x 5.8mm diameter $190.00

BI239 Arthrotek Ligament Fixation System Interference Screw, Titanium 15-30mm $190.00

BI241 Gentle Threads Ligament Fixation  Screw, Graft Interference, PGA/PLA 7mm, 8mm, 9mm, 10mm $190.00

 Screws

 ConMed Linvatec Australia Pty Ltd

LV016 Propel Interference Screws ACL Fixation - Titanium Diameter 7.0 - 9.0mm,  $190.00

 Length 20 - 30mm

LV017 Guardsman Femoral Interference  ACL Fixation - Titanium Diameter 7.0 - 9.0mm,  $190.00

 Screws Length 20 - 30mm

LV018 Cannulated Interference Screws ACL Fixation - Titanium Diameter 7.0 - 9.0mm,  $190.00

 Length 20 - 40mm

 Corin Australia Pty Ltd

CR031 LARS Interference Screw Titanium Interference screw 5.2 - 10mm diameter, 15 -  $190.00

 30mm

 Device Technologies Australia Pty Ltd

DE374 GraftBolt Interference Screw and Sheath 7mm, 8mm, 9mm and 10mm $190.00

DE439 Peek Delta Screws Interference screw for soft tissue  6-12mm Diameter x (23mm- $190.00

 Fixation 35m) Length

DE440 Interference Screws Interference screw for Soft Tissue  7-10mm x (15-35mm) $190.00

 Fixation

Prostheses List by Category, Groups and Sponsor Page 466 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Johnson & Johnson Medical Pty Ltd

JJ588 Femoral Intrafix System Screw and Sheath Fixation System for  7 to 10mm $190.00

 the Femur in ACL repairs

JJ912 Intrafix Interference System Non absorbable screw/sheath 6 to 10mm $190.00

JJ922 Kuroska Fixation Screw System Interference screw 7 to 9mm $190.00

 Perios Pty Ltd

PF015 TLS - Tendon Anchoring System -  Titanium screw for suspensory  10 x 20mm, 10 x 25mm, 12 x  $190.00

 Titanium fixation of tendon 20mm

PF016 TLS - Tendon Anchoring Screw -  PEEK screw for suspensory fixation  10 x 20mm 10 x 25mm $190.00

 PEEK of tendon

 RQSolutions Medical Devices Distribution Support

RQ002 Orthomed Interference Screws with  The screws are intended to fix an  9 sizes $190.00

 Atraumatic Thread autogenous transplant (hamstring  Diameter: 7,8 and 9mm

 tendons) or a synthetic graft in the  Length: 18, 23 and 28mm

 femur and tibia during an Anterior

 Cruciate Ligament (ACL)

 reconstruction.

Prostheses List by Category, Groups and Sponsor Page 467 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

RQ006 Orthomed MISBIO Bioresorbable  The Orthomed Misbio Bioresorbable  Diameter 6-10mm, length  $190.00

 Interference Screws interference screws are intended to set  23mm

 an autogenous transplant (hamstring  Diameter 7-10mm, length

 tendons or patellar tendon) in the  30mm

 femur and tibia during an Anterior  Diameter 9-11mm, length

 Cruciate Ligament (ACL)  35mm

 Details:

 MISBIO 6.23: 6mm

 diameter, 23mm length

 MISBIO 7.23: 7mm

 diameter, 23mm length

 MISBIO 8.23: 8mm

 diameter, 23mm length

 MISBIO 9.23: 9mm

 diameter, 23mm length

 MISBIO 10.23: 10mm

 diameter, 23mm length

 MISBIO 7.30: 7mm

 diameter, 30mm length

 MISBIO 8.30: 8mm

 diameter, 30mm length

 MISBIO 9.30: 9mm

 diameter, 30mm length

 MISBIO 10.30: 10mm

 diameter, 30mm length

 MISBIO 9.35: 9 mm

 diameter, 35mm length

 MISBIO 10.35: 10mm

 diameter, 35mm length

 MISBIO 11.35: 11mm

 diameter, 35mm length

RQ007 Orthomed Interference Screw Bone  The screws are intended to set an  9 sizes: $190.00

 to Bone autogenous transplant (hamstring  Diameter: 7, 8 & 9mm

 tendons or patellar tendons) in femur  Lengths: 18, 23 & 28mm

 and tibia during an Anterior Cruciate

 Signature Orthopaedics

SF001 Tissue Loc Tenodesis Screw Cannulated Interference Screw -  4x10mm, 5x10mm, 4x15mm,  $190.00

 5x15mm, 6x15mm, 6x20mm,

 7x25mm, 8x25mm, 8x30mm,

 9x25mm, 9x30mm

SF035 Signature ST Shoulder Anchor PEEK fully threaded suture anchor 2.3mm $190.00

Prostheses List by Category, Groups and Sponsor Page 468 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Smith & Nephew Surgical Pty Ltd

SL017 Biosure Healicoil interference screw 6-10mm diameter $190.00

SL024 RCI PK Interference screw 5x22, 5x22L, 6x22, 6x22L,  $190.00

 6x27, 6x27L, 7x22,  7x22L,

 7x27, 7x27L, 7x32, 7x32L,

 8x22, 8x22L, 8x27, 8x27L,

 8x32, 9x27, 9x27L, 9x32,

 9x37, 10x32, 10x37, 11x32

 11x37, 12x32, 12x37

SM164 BIOSURE A non-absorbable polymer (PEEK)  6-12mm in diameter $190.00

 interference screw for use in

 ligament/tendon reconstruction

SN420 ACL/PCL Reconstruction RCI Screws Titanium 7-11mm diameter, 25-40mm  $190.00

 length

SN423 ACL/PCL Reconstructions Acufex Tibial Fixation Anchor One size only $190.00

SN425 ACL/PCL Reconstructions Cannuflex Silk & Soft Silk Interference 5.5 x 20mm - 9x30mm $190.00

  Screw

SN432 ACL/PCL Reconstructions Tibial Post Screw Small, Standard $190.00

SN981 BIOSURE SYNC Soft tissue intra-tunnel tibial fixation  6-12mm $190.00

 device which includes Interference

 screw and sheath

 Stryker Australia Pty Ltd

SK023 ACL Wedge Interference Screw Threaded titanium screw for  Dia 7 - 12mm, length 20 -  $190.00

 ligament/tendon fixation 40mm

SK047 Stryker Wedge Interference Screw Threaded biosteon screw for  Dia 7 - 12mm, length 20 -  $190.00

 ligment/tendon fixation 40mm

ST830 Stryker Wedge Interference Screw Small threaded titanium screw for  Diameter 7 - 9mm, Length  $190.00

 ligament/tendon fixation 20 - 25mm

 Synthes Australia Pty Ltd

SY292 Facet Interference Screw Cannulated Screw 7.5mm $190.00

 Wright Medical Australia

WR080 G-Force Tenodesis System Cannulated Interference Screw -  4-8mm diameter, 10-25mm  $190.00

 PEEK Optima width

Prostheses List by Category, Groups and Sponsor Page 469 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 AB

 ConMed Linvatec Australia Pty Ltd

LV019 BioScrew Bioabsorbable  ACL Fixation - PLLA Diameter 7.0 - 9.0mm,  $481.00

 Interference Screw Length 20 - 30mm

LV077 BioScrew XtraLok Tibial Fixation  ACL Fixation - PLLA Diameter 8, 9, 10, 11mm;  $481.00

 Device Length 35 & 40mm

LV103 Matryx Interference Screw Matryx (SR-96L/4D PLA with ß- 7.3 x 20mm; 7.3 x 25mm; 7.3  $481.00

 TCP) Inteference Screw x 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

LV120 GENESYS Matryx Interference  GENESYS Matryx Interference Screw  7.0x20mm,7.0x25mm,7.0x30 $481.00

 Screw, diameter 7 - 11mm  - cannulated bioabsorbable mm,8.0x20mm,8.0x25mm,8.0

 x30mm,8.0x35mm,9.0x20mm,

 9.025mm,9.0x30mm,9.0x35m

 m,10x20mm,10x25mm,10x30

 mm,10x35mm,11x20mm,11x

 25mm,11x25mm,11x25mm,1

 1x25mm,11x30mm,11x35mm

 ,11x40mm

LV121 GENESYS Matrix Interference  GENESYS Matrix Interference Screw - 5.0mm diameter  $481.00

 Screw, diameter 5-6.5mm.  Cannulated,bioabsorbable x15,20,25,30mm lengths

 5.5mm diameter

 x15,20,25,30mm lengths

 6.0mm diameter

 x15,20,25,30mm lengths

 6.5mm diameter

 x15,20,25,30mm lengths

 Device Technologies Australia Pty Ltd

DE068 Interference Screws ARTHREX Non-sheathed 7 x 28mm - 12 x 28mm $481.00

DE069 Interference Screws Bio-Cortical - PLA 8 x 17 - 11 x 17mm and 8 x  $481.00

 20 - 10 x 20mm

DE072 Bio-Interference Screw PLA 7mm - 9mm $481.00

DE166 Bio-Tenodesis Screw Composition PLLA Dia 5.5-9mm $481.00

Prostheses List by Category, Groups and Sponsor Page 470 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

DE167 Bio-Interference Screw Composition - PLLA, delta tapered Dia6.5 - 10.5mm to 8 - 12mm $481.00

  x 28 - 35mm length

DE224 Retro Screw Composition PLLA 8-10mm x 20mm $481.00

 Johnson & Johnson Medical Pty Ltd

JJ127 Absolute Absorbable Interference  Polylactic acid screw 7 to11mm x (23 to 30mm) $481.00

 Screw

 Smith & Nephew Surgical Pty Ltd

SN004 Bioabsorbable screw BioRCI-HA Screw, Medial, Portal,  7 x 20mm - 12 x 35mm $481.00

 Reverse thread, Tibial specific, Trans-

 tibial

SN421 ACL/PCL Reconstructions Absorbable PLLA Screw 7-12mm diameter, 25-35mm  $481.00

 length

SN430 ACL/PCL Reconstructions EndoFix Bioabsorbable Screw 7 x 20mm - 9mm x30mm $481.00

 Surgical Specialties

SQ067 CPS Screw Hexalon Biodegradable  Biodegradable ACL/PCL Recon  6 x 20, 6 x 25, 6 x 30, 7 x 20,  $481.00

 ACL/PCL Reconstruction Screw 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, HA

 Device Technologies Australia Pty Ltd

DE297 BioComposite Interference Screw Soft Tissue Fixation Device 7mm - 35mm $481.00

 Johnson & Johnson Medical Pty Ltd

DY477 BioIntrafix Tibial Soft Tissue  Compostion - Tricalcium Phosphate & 30mm $481.00

 Fastener (Sheath)  Polylactic Acid

JJ337 Biocryl - TCP/PLA Interference Screw Composition - Tricalcium Phosphate  7x23mm; 7x30mm; 8x23mm;  $481.00

 & Polylactic Acid 8x30mm, 9x23mm; 9x30mm;

 10x23mm; 10x30mm;

 11x30mm

JJ473 BioIntrafix Tibial Soft Tissue  Compostion - Tricalcium Phosphate & 6 to 10mm $481.00

  Polylactic Acid

JJ484 MILAGRO Interference Screw TCP/PLGA Interference ACL Screw  5-12mm $481.00

 System

Prostheses List by Category, Groups and Sponsor Page 471 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Signature Orthopaedics

SF057 Bio-Composite Interference Screw HA infused Ploymer Interference  5-12mm $481.00

 Screws

 Smith & Nephew Surgical Pty Ltd

SM176 Biosure HA An absorbable polymer interference  6-12mm $481.00

 screw for use in ligament/tendon

 reconstruction

 06.03.07.08 - Screw/Pin/Post

 Advanced Surgical Design & Manufacture Ltd

AE097 Tibial Post Screw Titanium 5 - 6mm $475.00

 Biomet Australia Pty Ltd

BI246 Arthrotek Ligament Fixation System Bone Mulch Screws, Titanium 10.5mm x (20-35mm) $475.00

 Device Technologies Australia Pty Ltd

DE070 TransFix Implant Screw System -  Titanium alloy 40mm & 50 mm $475.00

 Arthrex

 Stryker Australia Pty Ltd

SK024 Stryker Cross-screw Threaded titanium screw for  8mm x 40-60mm $475.00

 ligament/tendon fixation

 AB

 Device Technologies Australia Pty Ltd

DE127 Bio-Transfix Composition Poly (L-lactide) Diameter 5mm, length 50mm $486.00

 Johnson & Johnson Medical Pty Ltd

JJ078 Rigidfix ACL Cross Pin Polylactic acid pin 2.7 & 3.3mm x 42mm $486.00

JJ815 RIGIDFIX BIOCRYL Cross Pin Cross pin composed of Biocryl  2.7mm & 3.3mm $486.00

 (bioabsorbable TCP/PLA)

06.03.08 - Soft Tissue Substitute

 06.03.08.01 - Biological (human or animal tissue derived)

 Johnson & Johnson Medical Pty Ltd

DY136 Restore Orthobiologic Soft Tissue  Restore Patch One size only $6,339.00

 Implant

Prostheses List by Category, Groups and Sponsor Page 472 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.08.02 - Non-biological

 Corin Australia Pty Ltd

CR032 Lars Ligamanet Augmentation  Woven polyester prosthetic ligaments 60,80,100,120,160 & Y  $4,439.00

 reconstruction system shaped fibres

CR201 Ligament Augmentation &  Woven polyester prosthesic ligament 30 fibres $4,439.00 That an Artificial Ligament should

 Reconstruction System (LARS)   only be funded for intra-articular

 AC30RA cases where no non-synthetic graft

  sources (allografts and autografts)

  are available.

CR202 Ligament Augmentation &  Woven polyester prosthetic ligament 20 fibres $4,439.00 That an Artificial Ligament should

 Reconstruction System (LARS)   only be funded for intra-articular

 LAC 20 cases where no non-synthetic graft

  sources (allografts and autografts)

  are available.

CR203 Ligament Augmentation &  Woven polyester prosthetic ligament 30 fibres $4,439.00 That an Artificial Ligament should

 Reconstruction System (LARS)   only be funded for intra-articular

 LAC 30 cases where no non-synthetic graft

  sources (allografts and autografts)

  are available.

CR204 Ligament Augmentation &  Woven polyester prosthetic ligament 32 fibres $4,439.00 That an Artificial Ligament should

 Reconstruction System (LARS)   only be funded for intra-articular

 MCL 32 cases where no non-synthetic graft

  sources (allografts and autografts)

  are available.

CR205 Ligament Augmentation &  Woven polyester prosthetic ligament 40 fibres $4,439.00 That an Artificial Ligament should

 Reconstruction System (LARS) -   only be funded for intra-articular

 Rotator Cuff CR 25 cases where no non-synthetic graft

  sources (allografts and autografts)

  are available.

CR206 Ligament Augmentation &  Woven polyester prosthetic ligament 48 fibres $4,439.00 That an Artificial Ligament should

 Reconstruction System (LARS) -   only be funded for intra-articular

 Rotary Cuff CR 30 cases where no non-synthetic graft

  sources (allografts and autografts)

  are available.

CR214 LARS Reinforcer Ligament Woven polyester prosthetic ligaments 8 fibres $4,439.00

Prostheses List by Category, Groups and Sponsor Page 473 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LMT Surgical Pty Ltd

LM070 Surgicraft Ligament Augmentation  Woven Polyester Prosthetic  Various $4,439.00

 Reconstruction System

 NeoSurgical Pty Ltd

NY001 Poly-Tape Open weave high strength polyester  Width 3mm-50mm $4,439.00

 tape Length 400-800mm

Prostheses List by Category, Groups and Sponsor Page 474 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 RQSolutions Medical Devices Distribution Support

RQ070 LIGASTIC reinforcement ligament The LIGASTIC reinforcement artificial 7 sizes: $4,439.00 That an Artificial Ligament should

  ligament is to constitute a  LCA60NEF: 30 threads,   only be funded for intra-articular

 reinforcement or support during  length 300mm, diameter  cases where no non-synthetic graft

 healing & repair of the Patellar  6mm  sources (allografts and autografts)

 tendon, achilles tendon, antero lateral  LT60:30 threads, length   are available.

 laxity of ankle, medial collateral  290mm, width 6 or 8.8mm

 ligament and posterior cruciate  RTF22: 11 threads, length

 ligament. 360mm, width 8mm

 There are different products for the  RTF18: 9 threads, length

 reinforcement of the collateral  360mm, width 7mm

 ligaments, anterior cruciate ligament,  LCP88NE: 22 threads,

 achilles tendon, shoulder, patella  length 550mm, width 5.5mm

 tendon, popliteal tendon, ankle  

 anterior-lateral laxity and acromial- LLI30: 15 threads, length

 clavicular dislocation. 350mm, width 22.5mm

 The product consists of warp-knitted   L30: 15 threads, length

 fibres of PET. It is knitted in bands of  360mm, diameter 4.5mm

 8, 15, 18, 22, 36 or 72 warp threads.  LT60: 30 threads, length

 The basic structure of LIGASTIC is

 always identical. However, the

 presentation varies depending on the

 actual joint affected. The ligaments

 presented are:

 - cylindrical string, with variable

 length & diameter. Diameter varies

 according to fiber content & required

 resistance. Both ends of the ligament

 are soft, formed as a reinforced loop,

 allowing an easy passage through the

 bone tunnels. These ends have a

 temporary function & are able to be

 cut off after the tunnel passage.

 - band, for reinforcement of a flat

 anatomical structure such as the

 medial collateral ligament in the knee

 

 - reinforcement ligament (uncoated

 LIGASTIC) - for support and healing

 of intra-articular or extra-articular

 natural ligaments

Prostheses List by Category, Groups and Sponsor Page 475 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

06.03.09 - 6.3.9 - Soft Tissue Fixation Devices

 06.03.09.05 - Button/thread/tape or Button/thread/button

 Signature Orthopaedics

SF019 EZ Flip ACL/PCL Fixation system Fixation for ACL/PCL fixation 15-60mm length $369.00

06.03.11 - External Fixateurs

 06.03.11.01 - Halo-thoracic device

 Australian Orthotic Technologies

ZT001 Ossur Halo Thoracic Orthosis Spinal, Halo thoracic orthosis;  Small, medium (standard)  $3,035.00

 inclusive of crown, skull pins and vest and large.

 Standard

 Johnson & Johnson Medical Pty Ltd

DY294 Bremer Halo Crown System Aluminium Crown & Vest Standard & 3D $3,035.00

 06.03.11.02 - Frame Complete - Monoplanar & Modular Frames

 Mini

 Advanced Surgical Design & Manufacture Ltd

AE228 MiniFix Finger Mini Fixator System One size $2,055.00

AE233 MicroFix Finger Mini Fixator System one size $2,055.00

 Akva Surgical Pty Ltd

VK006 Orthopaedic External Fixation  Complete System Sterile One size only $2,055.00

 System - Radiolucent Wrist Fixator

VK010 Orthopaedic External Fixation  Articulated Ankle Fixator One size only $2,055.00

 System - Xcaliber External Fixator

 Biomet Australia Pty Ltd

BH240 Hoffman Wrist Kit Hoffman Sterile Wrist Kit One size only $2,055.00

BI775 EBI XFIX DynaFix System Distal radius fixator, wristfix, sterile,  One size only $2,055.00

 complete

BI777 EBI XFIX DynaFix System Mini fixator/lengthener with  Small, Medium, Long,  $2,055.00

 100mm, 150mm

Prostheses List by Category, Groups and Sponsor Page 476 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Wright Medical Australia

WR205 Sidekick Rearfoot Fixator Pre-assembled external fixator for  n/a $2,055.00

 specific indications of triple

 arthrodesis, subtalar arthrodesis and

 ankle arthrodesis

 Small

 Advanced Surgical Design & Manufacture Ltd

AE229 RadioFix Radio Fixator System One size $2,150.00

AE231 Poing Fix Wrist Fixator System One size $2,150.00

AE232 Wrist Fixator PFII Wrist Fixator System One size $2,150.00

 Akva Surgical Pty Ltd

VK002 Orthofix External Fixation System  Anodised aluminium and stainless  One size only $2,150.00

 Pennig Wrist Fixator

VK013 Orthofix External Fixation Systems MiniRail System Short, Standard, Long and  $2,150.00

 Articulated Horizontal and

 Vertical Axis

 Biomet Australia Pty Ltd

BH154 EBI XFIX Dynafix System Fixator Complete, small Small, Extra small $2,150.00

BH158 EBI XFIX Dynafix System Distal Radius Fixator, Wristfix,  One Size Only $2,150.00

 Stainless Steel, Aluminium

 Smith & Nephew Surgical Pty Ltd

SN965 Smith & Nephew External Fixation  Complete Frame, 3 Dimensional &  Small $2,150.00

 (Llizarov, Taylor Spatial Frame, Jet- Compression/Distraction Device

 X, Compass)

 Stryker Australia Pty Ltd

SK396 Hoffmann II Compact Wrist Sterile  Bridging & Non-bridging Sterile Wrist Kit $2,150.00

 Pre-Packs, RL

 Small, CDD

 Stryker Australia Pty Ltd

ST945 Monotube External Fixation System Anodized metal alloy, dynamic tube  15mm $2,900.00

 assembly yellow

Prostheses List by Category, Groups and Sponsor Page 477 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Standard

 Akva Surgical Pty Ltd

VK001 Orthofix External Fixation System  Anodised aluminium and stainless  One size only $6,500.00

 Ankle Fixator

VK009 Orthopaedic External Fixation  Metadiaphyseal Fixator One size $6,500.00

 System - Xcaliber External Fixator

VK012 Orthofix Limb Reconstruction System Orthofix Limb Reconstruction System Adult and paediatric -  $6,500.00

 Short, Standard and Long

 Biomet Australia Pty Ltd

BH150 EBI XFIX Dynafix System Standard Straight Fixator Complete Stndard 5 or 8 cm arms $6,500.00

BI850 EBI XFIX DynaFix System Hip Distractor Aluminium, Stainless  One Size Only $6,500.00

 Steel, Titanium

 Smith & Nephew Surgical Pty Ltd

SN946 Smith & Nephew External Fixation  Complete Frames, 3 Dimensional &  Standard $6,500.00

 (Llizarov,Taylor Spatial Frame, Jet- Compression/Distraction

 X, Compass

 Stryker Australia Pty Ltd

SK365 Hoffman II External Fixation System Hoffmann II Ankle Sterile Pre-Pack  Standard Large Ankle Kit   $6,500.00

 kit, RL

 Standard, CDD

 Biomet Australia Pty Ltd

BH353 TEMPFIX External Fixation System  Sterile pack for external fixation of  Sterile transfixing pin lower $9,925.00

 -transfixing pin sterile kit lower extremity periarticular fractures  leg frame kits

BH354 TEMPFIX External Fixation System  Sterile pack for external fixation of  Sterile half pin lower leg  $9,925.00

 - half pin sterile kit lower extremity periarticular fractures frame kits

 Stryker Australia Pty Ltd

SK364 Hoffman II External Fixation System Hoffman II Sterile Pre-pack kit, RL Standard Tibia $9,925.00

SK378 Hoffman II External Fixation System Hoffman Pre-pack Pelvic kit Sterile Pelvic Kit $9,925.00

ST946 Monotube External Fixation System Anodized metal alloy, dynamic tube  20mm $9,925.00

 assembly blue

ST947 Monotube External Fixation System Anodized metal alloy, dynamic tube  25mm $9,925.00

 assembly rod

Prostheses List by Category, Groups and Sponsor Page 478 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.11.03 - Frame Component - Monoplanar, Clamp

 3D

 Stryker Australia Pty Ltd

HW517 HOFFMANN3 EXTERNAL  MULTIPLANAR CLAMP  STANDARD $1,662.00

 FIXATION SYSTEM PIN/ROD-ROD

 Mini

 Synthes Australia Pty Ltd

SY664 Orthopaedic External Fixator  Mini Frame Holding Clamp 3.0-4.0mm $328.00

SY727 Orthopaedic External Fixator  External fixator clamps, connecting  1-3mm $328.00

 clamp

 Small

 Akva Surgical Pty Ltd

VK014 Orthofix External Fixation Systems Pennig Minifixator Short, Standard, Long $4,800.00

 Biomet Australia Pty Ltd

BH155 EBI XFIX Dynafix System Clamp straight body, Tee, or ankle Small or extra small $4,800.00

BH163 EBI XFIX Dynafix System Clamp: straight body, Tee or ankle Small, Extra Small $4,800.00

 Smith & Nephew Surgical Pty Ltd

SN966 Smith & Nephew External Fixation  Monoplanar Clamp, 3 Dimensional Small $4,800.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

 Synthes Australia Pty Ltd

SY728 Orthopaedic External Fixator  External fixator clamps, connecting  2.0 - 4.9mm $4,800.00

 clamp

 Standard

 Biomet Australia Pty Ltd

BH159 EBI XFIX Dynafix System Clamp: straight body, Tee or ankle 5 - 8 cm $1,662.00

BI851 EBI XFIX Dynafix System Rail Clamp (Rotational Serrated T- Ex Small, Small, Adult, 4-6mm $1,662.00

 clamp, Swivel, Translational,

 Uniplaner Adjustable)

 Synthes Australia Pty Ltd

SY199 Orthopaedic External Fixator  External fixator clamps, double clamp 8.0 - 11mm $1,662.00

SY203 Orthopaedic External Fixator  External fixator clamps, tube to  11mm Diameter $1,662.00

 tube/universal clamp

Prostheses List by Category, Groups and Sponsor Page 479 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

SY236 Orthopaedic External Fixator  External fixator clamp components,  1.25-6.0mm $1,662.00

 halo with visor

SY247 Orthopaedic External Fixator  External fixator clamp components,  1.25-6.0mm $1,662.00

 double joint

 Standard, 3D

 Smith & Nephew Surgical Pty Ltd

SN947 Smith & Nephew External Fixation  Monoplanar Clamp Standard $1,662.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

 Stryker Australia Pty Ltd

ST968 TenXor External Fixation System Anodized metal alloy, ring to  One size only $1,662.00

 monotube triax tube clamp

 Standard, 3D, CDD

 Biomet Australia Pty Ltd

BH149 EBI XFIX Dynafix System Distraction mechanism Male female $2,300.00

 Standard, CDD

 Biomet Australia Pty Ltd

BH151 EBI XFIX Dynafix System Clamp: Straight body, tee or ankle 5-8cm $1,662.00

BH152 EBI XFIX Dynafix System Compression / Distraction /  5-8cm $1,662.00

 dynamisation modules

 Smith & Nephew Surgical Pty Ltd

SL021 Modular Rail System Monoplanar Clamp 50mm - 100mm $1,662.00

 06.03.11.04 - Frame Component - Monoplanar, Body

 Small

 Biomet Australia Pty Ltd

BH164 EBI XFIX Dynafix System Fixator Body Small, Extra Small $2,485.00

 Small CDD

 Biomet Australia Pty Ltd

BH157 EBI XFIX Dynafix System CD Mechanism Small, Extra Small fixator $2,485.00

 Small, CDD

 Stryker Australia Pty Ltd

ST948 Monotube External Fixation System Anodized metal alloy, dynamic tube  15mm $2,485.00

 yellow

Prostheses List by Category, Groups and Sponsor Page 480 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Standard

 Biomet Australia Pty Ltd

BH153 EBI XFIX Dynafix System Body component Std $2,000.00

BH161 EBI XFIX Dynafix System Body Component Std $2,000.00

BI856 EBI XFIX Dynafix System Monoplanar Transport Rail,  100-420mm $2,000.00

 radiolucent (carbon fibre)

 Smith & Nephew Surgical Pty Ltd

SL018 Modular Rail System Rail Standard; small; small short $2,000.00

 standard CDD

 Stryker Australia Pty Ltd

SK568 Hoffmann II MRI System Anodized metal alloy, dynamic tube,  15/20mm $2,650.00

 MRI

 Standard, CDD

 Biomet Australia Pty Ltd

BI819 EBI XFIX Dynafix System Multi Axial Correction and  4-8cm, Xsmall - Adult $2,650.00

 Metaphyseal Arc Module complete

 with T-clamp

 Smith & Nephew Surgical Pty Ltd

SN950 Smith & Nephew External Fixation  Monoplanar Clamp, compression  Standard $2,650.00

 (Ilizarov, Taylor Spatial Frame, Jet- distraction device

 X, Compass)

 Stryker Australia Pty Ltd

SK567 Monotube External Fixation System Anodized metal alloy, dynamic tube  20mm $2,650.00

 blue

 06.03.11.05 - Frame Component - Monoplanar, Adaptor

 standard

 Smith & Nephew Surgical Pty Ltd

SN948 Smith & Nephew External Fixation  Monoplanar Clamp, 3 Dimensional Standard $2,000.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

SN949 Smith & Nephew External Fixation  Monoplanar clamp, Compresion  Standard $2,000.00

 (Llizarov, Taylor Spatial Frame, Jet- Distraction Device

 X, Compass)

Prostheses List by Category, Groups and Sponsor Page 481 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Stryker Australia Pty Ltd

ST943 Hoffman II External Fixation System Anodised metal alloy, adjustable  Long, short $2,000.00

 connecting rod

ST953 Monotube External Fixation System Anodized metal alloy, T-Adapter  15, 20, 25mm $2,000.00

 yellow, blue, red

 06.03.11.06 - Frame Component - Full Circular Ring

 Stryker Australia Pty Ltd

HW476 HOFFMANN LRF - FULL  FULL CURCULAR RING DIAMETER - 80 - 270MM $721.00

 CIRCULAR RING

 Standard

 Smith & Nephew Surgical Pty Ltd

SN952 Smith & Nephew External Fixation  Full Circular Ring standard $721.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

 Synthes Australia Pty Ltd

SY425 Distraction Osteogenesis Ring  Full Ring, MRI safe, Titanium 140mm-200mm Diameter $721.00

SY665 Orthopaedic External Fixator  Full Ring for Hybrid, RL MRI 115-205mm $721.00

 06.03.11.07 - Frame Component - Partial Circular Ring

 Akva Surgical Pty Ltd

VK011 Orthopaedic External Fixation  Hybrid Fixator One size only $1,105.00

 System - Xcaliber External Fixator

 Stryker Australia Pty Ltd

HW478 HOFFMANN LRF - PARTIAL  PARTIAL CIRCULAR RING DIAMETER - 100-240MM $1,105.00

 CIRCULAR RING

 Standard

 Biomet Australia Pty Ltd

BH147 EBI XFIX Dynafix System MAC Rings or Arcs, Rotational or  100-220mm $1,105.00

 Smith & Nephew Surgical Pty Ltd

SL019 Modular Rail System Rail Arc Various $1,105.00

Prostheses List by Category, Groups and Sponsor Page 482 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

SN953 Smith & Nephew External Fixation  Partial Circular Ring Standard $1,105.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

 Stryker Australia Pty Ltd

ST965 TenXor External Fixation System Anodized metal alloy, open ring 150, 180, 210, 250mm $1,105.00

 Synthes Australia Pty Ltd

SY422 Distraction Osteogenesis Ring  Partial Circular Ring, Arch Plate 80-240mm $1,105.00

SY666 Orthopaedic External Fixator  Partial Ring for Hybrid, RL MRI 1/4,  115-205mm $1,105.00

 3/4

 06.03.11.08 - Frame Component - Circular Coupling Device

 Stryker Australia Pty Ltd

HW474 HOFFMANN LRF Coupling SHORT , LONG $360.00

 Standard

 Smith & Nephew Surgical Pty Ltd

SN951 Smith & Nephew External Fixation  Monoplanar adaptor standard $360.00

 (Ilizarov, Taylor Spatial Frame, Jet-

 X, Compass)

SN954 Smith & Nephew External Fixation  Circular Coupling device standard $360.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

 Stryker Australia Pty Ltd

HW482 HOFFMANN LRF - WIRE BOLT  WIRE BOLT COUPLING SHORT, MEDIUM, LONG $360.00

 COUPLINGS

 Synthes Australia Pty Ltd

SY662 Orthopaedic External Fixator  Hybrid Ring Clamps; Combination,  11.0mm $360.00

 Rod, Rod/Wire, Adjustable,

 Tube/Tube RL MRI

 06.03.11.09 - Frame Component - Circular Frame Strut Device

 Stryker Australia Pty Ltd

HW481 HOFFMANN LRF - THREADED  THREADED TELESCOPIC ROD DIAMETER - 6MM  $1,000.00

 TELESCOPIC ROD LENGTHS  - 30-400MM

Prostheses List by Category, Groups and Sponsor Page 483 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 3D

 Synthes Australia Pty Ltd

SY793 Distraction Osteogenesis Ring  Circular Frame, 3 Dimensional  Extra short - Long $1,300.00

 Telescopic Struts

 Standard

 Biomet Australia Pty Ltd

BI828 EBI XFIX Vision System Clamp/Rod, stainless steel/aluminium 4mm/6mm, 3-5 hole, 50- $1,000.00

 150mm

 Smith & Nephew Surgical Pty Ltd

SN956 Smith & Nephew External Fixation  Circular Frame Strut Device,  standard $1,000.00

 (Llizarov, Taylor Spatial Frame, Jet- Compression Distraction Device

 X, Compass)

 Stryker Australia Pty Ltd

HW480 HOFFMANN LRF - STATIC  STATIC STRUT LENGTHS - 20 -60MM $1,000.00

SR096 HOFFMANN LRF - TELESCOPIC  TELESCOPIC STRUT LENGTHS - 100-277MM $1,000.00

 STRUT

 Standard, 3D

 Smith & Nephew Surgical Pty Ltd

SN955 Smith & Nephew External Fixation  Circular Frame Strut Device, 3  standard $1,000.00

 (Llizarov, Taylor Spatial Frame, Jet- Dimensional

 X, Compass)

 06.03.11.10 - Frame Component - Foot Plate

 Stryker Australia Pty Ltd

HW475 HOFFMAN LRF FOOT RING PLATE/ARCH DIAMETER - 100-210MM $3,000.00

 Standard

 Smith & Nephew Surgical Pty Ltd

SN957 Smith & Nephew External Fixation  Foot Plate Standard $3,000.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

 Synthes Australia Pty Ltd

SY427 Distraction Osteogenesis Ring  Foot Plates, Carbon Fibre RL MRI 100mm-180mm $3,000.00

Prostheses List by Category, Groups and Sponsor Page 484 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.11.11 - Frame Component - Circular Frame, Nuts & Spacers

 Stryker Australia Pty Ltd

HW477 HOFFMANNLRF - NUTS,  NUTS, WASHERS , SPACERS SHORT, LONG, M6,M8,1- $47.00

 WASHERS , SPACERS 7MM

 Standard

 Smith & Nephew Surgical Pty Ltd

SL023 Modular Rail System Rail Accessories Various $47.00

SN958 Smith & Nephew External Fixation  Circular Frame, Nuts & Spacer standard $47.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

 Synthes Australia Pty Ltd

SY228 Distraction Osteogenesis Ring  Connecting Plate / Spacer 1 - 5 holes $47.00

SY419 Distraction Osteogenesis Ring  Nuts, Washers & Spacers 1mm-50mm $47.00

 06.03.11.12 - Frame Component - Coupling Device

 Stryker Australia Pty Ltd

HW516 HOFFMANN3 EXTERNAL  ROD COUPLER 0-120 DEGREES $770.00

 FIXATION SYSTEM

 Synthes Australia Pty Ltd

SY091 AO/ASIF k-Wires, Pins, Washers etc Pinless pins/clips Asymetric small and large $770.00

 Mini

 Lima Orthopaedics Australia Pty Ltd

LC058 S.E.M. II 400 External Fixator - Clamp - Left / Right / Threaded / Non  One size $645.00

 Clamp Threaded

 Stryker Australia Pty Ltd

SK206 Hoffmann II External Fixation  Hoffmann II Micro - Couplings  Couplings, Rod to rod, Pin  $645.00

 to Rod and Multipin

 Small

 Stryker Australia Pty Ltd

ST935 Hoffman II External Fixation System Anodised metal alloy, rod to rod  8/8mm $655.00

 coupling

Prostheses List by Category, Groups and Sponsor Page 485 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

ST936 Hoffman II External Fixation System Anodised metal alloy, pin to rod  8/4, 5mm $655.00

 coupling

 Synthes Australia Pty Ltd

SY746 Orthopaedic External Fixator  Frame Coupling Device 2.0mm - 4.9mm $655.00

 Small, CCD

 Synthes Australia Pty Ltd

SY745 Orthopaedic External Fixator  Distractors and lengthening  1.0 - 2.5mm $655.00

 Standard

 Biomet Australia Pty Ltd

BH148 EBI XFIX Dynafix System MAC system couplig devices, Ring,  Male Female $770.00

 Angulating coupler, rotational adapter

BI827 EBI XFIX Vision System Rod connectors, stainless  Dia 9.5mm $770.00

 steel/aluminium

BI831 EBI XFIX Vision System Post, Bone Screw, Telescoping,  One size only $770.00

 stainless steel

BI854 EBI XFIX Dynafix System Rail Accessory (Adaptor, CD  Ex Small, Small, Adult, 4-6mm $770.00

 Support, Dynamization, Bridge)

 Smith & Nephew Surgical Pty Ltd

SL020 Modular Rail System Caps, clamps (upper, lower & stacked) Various $770.00

  & hinges, clamp connectors

SL022 Modular Rail System Angle Clamps Various $770.00

 Stryker Australia Pty Ltd

HW448 Hoffmann3 External Fixation system  Hoffmann3 posts straight, 30 deg, 90 deg $770.00

 - Posts

HW449 Hoffmann3 External Fixation System Rod & Pin-Rod couplings Coupling, 5/8/11mm rods -  $770.00

 4/5/6mm pins

SK375 Hoffman II External Fixation System Hoffman II MRI Coupling Pin to Rod, Rod to Rod,  $770.00

 Tube to Rod, Pin Clamp

 Assembly

SK485 Hoffmann Xpress - Universal Pin  Hoffmann Xpress External Fixation  One size to fit the Rod to Rod $770.00

 Clamp Device - Adapted to fit the needs of

 medically trained staff of such

 occupations as the Armed Forces

Prostheses List by Category, Groups and Sponsor Page 486 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

SK487 Hoffmann Xpress - 5 Pin Clamp Posts Hoffmann Xpress External Fixation  2 categories, a 1 post clamp  $770.00

 Device - adapted to fit needs of  and a 2 post clamp

 medically trained staff of such

 occupations as the Armed Forces

ST952 Monotube External Fixation System Anodized metal alloy, single pin  15, 20, 25mm $770.00

 clamp yellow, blue, red

ST954 Monotube External Fixation System Anodized metal alloy, tube to tube  15, 20, 25mm, 15/20mm,  $770.00

 clamp yellow, blue, red, yellow/blue,  20/25mm

 blue/red

ST966 TenXor External Fixation System Anodized metal alloy, ring clamp One size only $770.00

ST967 TenXor External Fixation System Anodized metal alloy, wire post, pin  One size only $770.00

 post

ST971 TenXor External Fixation System Anodized metal alloy, with sliding  One size only $770.00

 clamp

ST972 TenXor External Fixation System Anodized metal alloy,with sliding  One size only $770.00

 clamp and spacer

 Synthes Australia Pty Ltd

SY663 Orthopaedic External Fixator  Medium Frame; Rod, Threaded,  5-11.0mm $770.00

 Adjustable Clamps RL MRI

SY744 Orthopaedic External Fixator  Distractors and lengthening  20mm - 30mm $770.00

 Standard, 3D

 Smith & Nephew Surgical Pty Ltd

SN959 Smith & Nephew External Fixation  Coupling device, 3 dimensional Standard $770.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

SN964 Smith & Nephew External Fixation  Articulating Hinge, 3 Dimensional Standard $770.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

SN967 Smith & Nephew External Fixation  Articulating Hinge, 3 Dimensional &  Mini $770.00

 (Llizarov, Taylor Spatial Frame, Jet- Compression Distraction Device

 X, Compass)

 Stryker Australia Pty Ltd

ST951 Monotube External Fixation System Anodized metal alloy, pin clamp  15, 20, 25mm $770.00

 yellow, blue, red

Prostheses List by Category, Groups and Sponsor Page 487 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Standard, CCD

 Akva Surgical Pty Ltd

VK003 Orthofix External Fixation System  Anodised aluminium and stainless  One size only $770.00

 Elbow Fixator

 Standard, CDD

 Akva Surgical Pty Ltd

VK004 Orthofix External Fixation System  Anodised aluminium and stainless  One size only $770.00

 Hybrid Fixator

VK005 Orthofix External Fixation System  Anodised aluminium and stainless  One size only $770.00

 Knee Fixator

 Biomet Australia Pty Ltd

BI853 EBI XFIX Dynafix System CD Clicker Ex Small, Small, Adult, 5- $770.00

 20cm

 Stryker Australia Pty Ltd

SK390 Hoffman II External Fixation System Hoffman II MRI Compression/Dystraction  $770.00

 Tube, Dynamisation Tube

ST950 Monotube External Fixation System Anodized metal alloy, dynamic tube  25mm $770.00

 Synthes Australia Pty Ltd

SY237 Orthopaedic External Fixator  3 degree, 6 degree, 11 degree. Medium, 8.0 - 11.0mm $770.00

  Large

 06.03.11.13 - Frame Component - Rods

 Mini

 Stryker Australia Pty Ltd

SK211 Hoffmann II External Fixation  Hoffmann II Micro - Carbon Fibre  3mm (30-150mm) $52.00

 Rods, RL

SK212 Hoffmann II External Fixation  Hoffman II Micro - Stainless Steel Rods 3mm x (30-180mm) $52.00

 Small

 Stryker Australia Pty Ltd

ST962 Monotube External Fixation System Carbon tube yellow 015, RL 15mm $144.00

 Synthes Australia Pty Ltd

SY193 Orthopaedic External Fixator  Rod / Bar 2.0mm - 15mm $144.00

SY668 Orthopaedic External Fixator   Curved and straight rod, RL, MRI  4.0mm $144.00

 Carbon Fibre

Prostheses List by Category, Groups and Sponsor Page 488 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Standard

 Biomet Australia Pty Ltd

BH358 Ace External Fixator Threaded Rod, titanium 1/4" x 20cm $155.00

BI830 EBI XFIX Vision System Ring Connector Assembly, stainless  1 or 2 bolt model $155.00

 steel/aluminium

BI832 EBI XFIX Vision System Rods, Bars, stainless steel/aluminium/ Dia 9.5mm, 150-400mm  $155.00

  or carbon fibre (radiolucent) length

 Smith & Nephew Surgical Pty Ltd

SN960 Smith & Nephew External Fixation  Rods Standard $155.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

SN961 Smith & Nephew External Fixation  Rods, telescopic standard $155.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

 Stryker Australia Pty Ltd

HW446 Hoffmann3 External Fixation system  MRI curved and straight rod/coupler - Diameter - 11mm, lengths  $155.00

 - MRI Curved and straight   carbon fibre 100-650mm

 rod/coupler - carbon fibre

SK393 Hoffman II External Fixation System Hoffmann II MRI Connecting Rods,  8mm Connecting rod  $155.00

 RL  (100mm - 500mm), 5mm

 Connecting rod (100mm -

 500mm), Semi Circular

 Curve Rod

SK486 Hoffmann Xpress External Fixation  Hoffmann Xpress - Connnecting Tube,  15 mm diameter / 150 to 440 $155.00

 Device RL, MRI  mm in length

ST963 Monotube External Fixation System Carbon tube blue 015, RL 150, 200, 250, 300mm $155.00

ST964 Monotube External Fixation System Carbon tube red 015, RL 150, 200, 250, 300mm $155.00

 Synthes Australia Pty Ltd

SY196 Orthopaedic External Fixator  Rod/Bar 8 - 11 mm $155.00

SY238 Orthopaedic External Fixator  External fixator clamp components,  1.25-6.0mm $155.00

 connecting tube

SY421 Distraction Osteogenesis Ring  Threaded Rod, MRI Safe 250mm-350mm $155.00

SY667 Orthopaedic External Fixator  Curved and straight rod, RL, MRI  8.0-11.0mm $155.00

 Carbon Fibre

Prostheses List by Category, Groups and Sponsor Page 489 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.11.14 - Frame Component - Pins

 Akva Surgical Pty Ltd

VK007 Screw Frame Component - Pins Shaft Dia 3.0 - 6.0mm $149.00

 Thread Dia 6.0 - 2.00mm

 Total Length 40 - 260mm

 Thread Length 15 - 100mm

VK008 Osteotite screw HA coated screw used for fixation of  Shaft Dia 3.0 - 6.0mm,  $149.00

 an external frame Thread Dia 6.0 - 2.0mm,

 Total Length 40 - 260mm,

 Thread Length 15 - 90mm

Prostheses List by Category, Groups and Sponsor Page 490 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Ortho Solutions Pty Ltd

Prostheses List by Category, Groups and Sponsor Page 491 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

OU006 TITANIUM EX. FIX. PIN TITANIUM EX.FIX.PIN TITANIUM EX. FIX. PIN  $149.00

 4.0MM X 20MM,

 TITANIUM EX. FIX. PIN

 4.0MM X 25MM

 TITANIUM EX. FIX. PIN

 4.0MM X 30MM,

 TITANIUM EX. FIX. PIN

 4.0MM X 35MM

 TITANIUM EX. FIX. PIN

 4.0MM X 40MM,

 TITANIUM EX. FIX. PIN

 4.0MM X 45MM

 TITANIUM EX. FIX. PIN

 4.0MM X 50MM,

 TITANIUM EX. FIX. PIN

 4.0MM X 60MM

 TITANIUM EX. FIX. PIN

 5.0MM X 20MM,

 TITANIUM EX. FIX. PIN

 5.0MM X 25MM

 TITANIUM EX. FIX. PIN

 5.0MM X 30MM,

 TITANIUM EX. FIX. PIN

 5.0MM X 35MM

 TITANIUM EX. FIX. PIN

 5.0MM X 40MM,

 TITANIUM EX. FIX. PIN

 5.0MM X 45MM

 TITANIUM EX. FIX. PIN

 5.0MM X 50MM,

 TITANIUM EX. FIX. PIN

 5.0MM X 55MM

 TITANIUM EX. FIX. PIN

 5.0MM X 60MM,

 TITANIUM EX. FIX. PIN

 5.0MM X 65MM

 TITANIUM EX. FIX. PIN

 5.0MM X 70MM,

 TITANIUM EX. FIX. PIN

 5.0MM X 75MM

 TITANIUM EX. FIX. PIN

 5.0MM X 80MM,

 TITANIUM EX. FIX. PIN

 5.0MM X 85MM

 TITANIUM EX. FIX. PIN

 5.0MM X 90MM,

Prostheses List by Category, Groups and Sponsor Page 492 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 TITANIUM EX. FIX. PIN

 6.0MM X 20MM

 TITANIUM EX. FIX. PIN

 6.0MM X 25MM

 TITANIUM EX. FIX. PIN

 6.0MM X 30MM

 TITANIUM EX. FIX. PIN

 6.0MM X 35MM

 TITANIUM EX. FIX. PIN

 6.0MM X 40MM

 TITANIUM EX. FIX. PIN

 6.0MM X 45MM

 TITANIUM EX. FIX. PIN

 6.0MM X 50MM

 TITANIUM EX. FIX. PIN

 6.0MM X 55MM

 TITANIUM EX. FIX. PIN

 6.0MM X 60MM

 TITANIUM EX. FIX. PIN

 6.0MM X 65MM

 TITANIUM EX. FIX. PIN

 6.0MM X 70MM

 TITANIUM EX. FIX. PIN

 6.0MM X 75MM

 TITANIUM EX. FIX. PIN

 6.0MM X 80MM

 TITANIUM EX. FIX. PIN

 6.0MM X 85MM

 TITANIUM EX. FIX. PIN

 6.0MM X 90MM

 SST EX. FIX PIN 5MM X

 35MM X 175MM, SELF

 DRILL/TAP PIN 3.0MM

 L=60/10, SELF

 DRILL/TAP PIN 3.0MM

 L=60/15 SELF

 DRILL/TAP PIN 3.0MM

 L=80/20 SELF

 DRILL/TAP PIN 3.0MM

 L=110/22, SELF

 DRILL/TAP PIN 4.0MM

 L=90/40

 SELF DRILL/TAP PIN

 4.0MM L=120/45,

 SELF DRILL/TAP PIN

 4.0MM L=150/40,

Prostheses List by Category, Groups and Sponsor Page 493 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 SELF DRILL/TAP PIN

 4.0MM L=150/50,

 SELF DRILL/TAP PIN

 4.0MM L=180/50,

 SELF DRILL/TAP PIN

 4.0MM L=200/40,

 SELF DRILL/TAP PIN

 4.0MM L=250/50,

 SELF DRILL/TAP PIN

 4.0MM L=250/70,

 SELF DRILL/TAP PIN

 5.0MM L=120/35,

 SELF DRILL/TAP PIN

 5.0MM L=150/40,SELF

 DRILL/TAP PIN 5.0MM

 L=150/50,SELF

 DRILL/TAP PIN 5.0MM

 L=180/50,SELF

 DRILL/TAP PIN 5.0MM

 L=200/50,SELF

 DRILL/TAP PIN 5.0MM

 L=150/40,SELF

 DRILL/TAP PIN 5.0MM

 L=150/50,

 SELF DRILL/TAP PIN

 5.0MM L=180/50,SELF

 DRILL/TAP PIN 5.0MM

 L=200/50,SELF

 DRILL/TAP PIN 5.0MM

 L=200/60,SELF

 DRILL/TAP PIN 5.0MM

 L=250/50,SELF

 DRILL/TAP PIN 5.0MM

 L=250/70,

 Smith & Nephew Surgical Pty Ltd

SL010 Smith & Nephew Ex-Fix Frame Component - pins All sizes $149.00

 Stryker Australia Pty Ltd

SK483 HA Apex Pins HA coated bone screw 4-6mm diameters, various  $274.00

 lengths.

ST884 Apex Pins Stainless Steel Orthopaedic Pins 2 - 6mm $149.00

Prostheses List by Category, Groups and Sponsor Page 494 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Synthes Australia Pty Ltd

SY051 AO/ASIF Pins Seldrill 3mm - 6mm $149.00

 06.03.11.15 - Frame Component - Pin Clamp Assembly

 Small

 Stryker Australia Pty Ltd

ST892 Hoffmann II Compact External  Pin clamp assembly with no post One Size Only $695.00

 Fixation System

 Synthes Australia Pty Ltd

SY224 Orthopaedic External Fixator  External fixator clamp components,  1.0 - 3.0mm $695.00

 angled piece

 Standard

 Smith & Nephew Surgical Pty Ltd

SN962 Smith & Nephew External Fixation  Pin Clamp Assembly Standard $1,077.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

SN963 Smith & Nephew External Fixation  Pin Clamp Assembly, 3 Dimensional Standard $1,077.00

 (Llizarov, Taylor Spatial Frame, Jet-

 X, Compass)

 Stryker Australia Pty Ltd

HW447 Hoffmann3 External Fixation System Pin clamp Assembly 5 hole with/without posts $1,077.00

  - Pin Clamp

SK373 Hoffman II External Fixation system Hoffman II MRI, Pin Clamp Assembly,  Pelvic Clamp $1,077.00

 MRI

 Synthes Australia Pty Ltd

SY200 Orthopaedic External Fixator  External fixator clamps, transverse  1.25 - 6.0mm $1,077.00

 clamp

SY239 Orthopaedic External Fixator  External fixator clamp components,  1.25-8.0mm $1,077.00

 angled piece with nut

SY242 Orthopaedic External Fixator  External fixator clamp components, bar 1.25-6.0mm $1,077.00

  for upper jaw

SY418 Distraction Osteogenesis Ring  Bolt-connecting, clamp, eye, wire  One size $1,077.00

 offset, wire slotted, MRI safe.

Prostheses List by Category, Groups and Sponsor Page 495 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Standard, 3D

 Biomet Australia Pty Ltd

BI852 EBI XFIX Dynafix System Rail Clamp (Rotational Serrated T- Ex Small, Small, Adult, 4-6mm $3,348.00

 clamp, Swivel, Translational,

 Uniplaner, Adjustable)

 06.03.11.16 - Frame Component  - Pin Clamp Assembly Post

 Small

 Stryker Australia Pty Ltd

ST937 Hoffman II External Fixation System Anodised metal alloy, 30 deg angled  One size only $99.00

 post, stainless steel

ST938 Hoffman II External Fixation System Anodised metal alloy, straight post,  One size only $99.00

 stainless steel

 Standard

 Stryker Australia Pty Ltd

HW479 HOFFMANN LRF - POSTS POSTS LENGTHS - 44-88MM $111.00

SK374 Hoffman II External Fixation System Hoffman II MRI Posts 8mm and 5mm $111.00

 Synthes Australia Pty Ltd

SY420 Distraction Osteogenesis Ring  Wire Post MRI Safe Short, Long $111.00

 06.03.11.17 - Articulating Hinge

 Australian Orthotic Technologies

ZT002 Ossur Halo Thoracic Orthosis Spinal, Halo thoracic orthosis; skull  2 1/4" or 3". $451.00

 pin set

 Mini

 Wright Medical Australia

WR206 Sidekick Coretrak Articulating  Sterile kit, includes tube fixator,  Standard, long, articulating $2,460.00

 articulating fixator, half pin and pin

 covers, for external fixation of the foot

 of hand, Radiolucent

 Standard

 Biomet Australia Pty Ltd

BI849 EBI XFIX DynaFix System OptiROM Passive Distractor Module One Size Only $451.00

Prostheses List by Category, Groups and Sponsor Page 496 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Johnson & Johnson Medical Pty Ltd

DY295 Bremer Halo Crown System Titanium Skull Pins Standard & Hi-Fix $451.00

 Synthes Australia Pty Ltd

SY428 Distraction Osteogenesis Ring  Universal Hinge One Size $451.00

 System & Orthopaedic External

 Fixator Systems

 Standard, CDD

 Biomet Australia Pty Ltd

BI776 EBI XFIX DynaFix System OptiROM Articulating Fixator  Small and Large $4,070.00

 Complete

 Stryker Australia Pty Ltd

ST888 Howmedica Dynamic Joint  Complete Y Body Frame - Stainless  One size only $4,070.00

 Steel

 06.03.11.18 - Upper body kit

 Stryker Australia Pty Ltd

HW489 HOFFMANN3 external fixation  Sterile field kit Standard kit A $6,366.00

 system

 06.03.11.19 - Lower body kit

 Stryker Australia Pty Ltd

HW490 HOFFMANN3 external fixation  Sterile field kit Standard kit B $5,681.00

 system

06.03.14 - Bone Cement

 06.03.14.01 - Cement only

 CareFusion Australia 316 Pty Ltd

ZQ001 Ava-Tex Radiopaque Bone Cement  13.8g Barium-Polymer Powder & 6ml  12mL $174.00

 Kit 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

GM148 BonOs Inject Injectable acrylic vertebroplasty  40gm $174.00

Prostheses List by Category, Groups and Sponsor Page 497 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Heraeus Kulzer Australia Pty Ltd

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

DY097 Vetebrplastic Cement Vetebrplastic cement One size only $174.00

JJ609 Vertebroplasty System Vertobroplasty System 11cc $174.00

JJ932 SmartSet PMMA bone cement 20 to 40g $174.00

 Medtronic Australasia Pty Ltd

MC984 CD HORIZON Fenestrated Screw  Fenestrated screw cement - High  20g powder, 9g vial $174.00

 Cement viscosity, radiopaque, PMMA bone

 cement

 Orthotech Pty Ltd

OH126 Cemex bone cement 1 mix  1 mix 40g powder and 13.3g $174.00

 Methylmethacrylate/Polymethylmetha  liquid

 crylate

OH166 Mendec Spine Bone Cement 20g sterile powder / 9.4g  $174.00

 sterile liquid

 Scient'x Australia

SX051 OsseoFix+ System Radiopaque bone cement  10gm, 11gm, 13gm $174.00

 vertebroplasty 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  Polymethyl Methacrylate, Styrene  40 grams $174.00

 Bone 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 498 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.14.02 - 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

HK007 Palacos or Palamed Bone Cement  Single Mix PMMA with Gentamicin 20 grams $184.00

 with Gentamicin

HK008 Copal G+C High-viscosity, radiopaque bone  40g $184.00

 cement with gentamicin and

 clindamycin

HK009 Palacos or Palamed Bone Cement  Single Mix PMMA with Gentamicin 40g $184.00

 with Gentamicin

 Johnson & Johnson Medical Pty Ltd

DP108 CMW Antibiotic Bone Cement  CMW Bone Cement Various with  20, 40 grams $184.00

 Antibiotic

JJ933 SmartSet Bone cement with antibiotic 20 to 40g $184.00

 Orthotech Pty Ltd

OH127 Cemex-genta bone cement 1 mix Methylmethacrylate/  1 mix 40g powder and 13.3g $184.00

 Polymethylmethacrylate with   liquid

 gentamiacin

 Stryker Australia Pty Ltd

HW320 Antibiotic Simplex Bone Cement  Polymethyl Methacrylate, Styrene  40 grams $184.00

 with Tobramycin Copolymer, Barium Sulfate

 Zimmer Pty Ltd

ZI877 Cemex-genta bone cement 1 mix Methylmethacrylate/  1 mix 40g powder and 13.3g $184.00

 Polymethylmethacrylate with   liquid

 gentamiacin

Prostheses List by Category, Groups and Sponsor Page 499 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.14.03 - Cement with Complex Delivery System

 CareFusion Australia 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 CMW Bone Cement with vaccum mixing  40 to 100g $500.00

 system

JJ582 SmartMix Bone Cement with Vacuum Mixing  40 to 100g $500.00

 System

JJ736 Confidence Spinal cement system Spinal Bone Cement PMMA and  5-11cc $500.00

 Percutaneous Administration Kit

 Synthes Australia Pty Ltd

SY429 Vertebral Augmentation Vertecem, Traumacem Cement, and  21gm $500.00

 Viscosafe Mixing System

 CDS

 Orthotech Pty Ltd

OH171 Mendec Spine Bone Cement 20g powder / 9.4g sterile  $500.00

 liquid

 06.03.14.04 - Cement with Antibiotic and Complex Delivery System

 Biomet Australia Pty Ltd

BH112 Optipac Refobacin Plus, Prefilled Vaccum  40gm $500.00

 Mixing System, Gentamicin Sulphate,

 PMMA Cement

BH113 Optipac Refobacin Plus, Prefilled Vacuum  60-80gm $500.00

 mixing system, Gentamicin Sulphate,

 PMMA Cement

 Heraeus Kulzer Australia Pty Ltd

HK010 Palacos R+G Pro Single Mix PMMA with Gentamicin  55g, 75g $500.00

 and Complex Delivery System

 Johnson & Johnson Medical Pty Ltd

DP445 CMW Antibiotic Bone cement with vacuum  40 to 100g $500.00

 mixing system

Prostheses List by Category, Groups and Sponsor Page 500 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

JJ583 SmartMix Antibiotic Bone Cement with Vacuum 40 to 100g $500.00

  Mixing System

 Zimmer Pty Ltd

ZI873 Cemex® System Genta Bone Cement  with Gentamicin  40, 60, 70 and 80 grams $500.00

 packaged in a complex delivery

 06.03.14.05 - 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

06.03.15 - Bone Graft Substitute

 06.03.15.01 - Ceramic, 0-5cc

 Austofix

AX066 Graftys BCP - Preformed 5cc Biphasic Calcium Phosphate  0-5cc $760.00

AX073 Graftys Bone Cement - HBS Bone  Macroporous Calcium Phosphate  5cc $760.00

 Cement Cement

AX078 Graftys Bone Cement - Quickset  Macroporous Calcium Phosphate  5cc $760.00

 Bone Cement Cement

AX080 Graftys BCP - Granules 5cc Biphasic Calcium Phosphate  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  5cc $760.00

AJ010 KGBone Synthetic bone substitute, custom-fit  4mm-10mm $760.00

 for KAGE cervical interbody cage

Prostheses List by Category, Groups and Sponsor Page 501 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Baxter Healthcare Pty Ltd

BX296 ACTIFUSE SHAPE 1.6mLBONE  A silicate substituted synthetic bone  1.6mL $760.00

 MATRIX IMPLANT ARTIFICIAL graft

BX297 ACTIFUSE SHAPE 2.6mLBONE  A silicate substituted synthetic bone  2.6mL $760.00

 MATRIX IMPLANT ARTIFICIAL graft

BX305 ACTIFUSE  A silicate substituted synthetic bone  2.5mL $760.00

 MICROGRANULES2.5mLBONE  graft

 MATRIX IMPLANT ARTIFICIAL

BX306 ACTIFUSE MICROGRANULES  A silicate substituted synthetic bone  5mL $760.00

 5mLBONE MATRIX IMPLANT  graft

 ARTIFICIAL

 Biomimetic Therapeutics PTY Ltd

BM008 Augment Bone Graft - rhPDGF-BB  rhPDGF-BB solution (0.3mg/ml) 1.5cc (0.45mg) $760.00

 component

BM009 Augment Bone Graft - rhPDGF-BB  rhPDGF solution (0.3mg/ml) 3cc (0.90mg) $760.00

 component

BM010 Augment Bone Graft - β-TCP  β-TCP granules 1.5 cc, 3cc $760.00

 component

 Device Technologies Australia Pty Ltd

DE308 BonAlive Granules Bone Graft Substitute - Bioactive  13130 - 0.5-0.8mm small  $760.00

 Glass 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  0-5 cc $760.00

DE312 ENGlpore Granules (size 1,0-2, 5 mm) 5 cc Granules (size 1,0-2, 5 mm)  $760.00

 Granules (size 2, 5-4, 0 mm) 5 cc 5 cc

 Granules (size 2, 5-4, 0 mm)

 5 cc

Prostheses List by Category, Groups and Sponsor Page 502 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

DE346 Engipore Pre-formed Bone  Pre-formed Bone Substitute 0-5cc Catalogue number:  $760.00

 Substitute 0-5cc PFS015005-30-00 Size:

 4.7cc

 Catalogue number:

 PFS015006-19-00 Size:

 2.6cc

 Catalogue number:

 PFS015006-20-00 Size:

 3.6cc

 Catalogue number:

 PFS015006-25-00 Size:

 2.2cc

 Catalogue number:

 PFS015005-21-00 Size:

 1.2cc

 Emergo Asia Pacific Pty Ltd

ER002 Kryptonite Radiopaque 5cc sterile kit with syringe  $760.00

 with barium

ER004 Kryptonite Osteoconductive Adhesive 5cc sterile kit with syringe $760.00

ER104 GeneX GeneX paste 5cc $760.00

ER106 GeneX GeneX putty 5cc $760.00

ER107 GeneX GeneX putty 2.5cc $760.00

ER124 Stimulan Kit/Rapid Cure-5 cc Calcium Sulphate synthetic rapid cure 5cc $760.00

  bone void filler kit.

ER127 Stimulan kit -5cc Calcium Sulphate synthetic bone void 5cc $760.00

  filler kit

ER153 Kainos Granules 1 x 2cm3 $760.00

ER154 Kainos Granules 1 x 3cm3 $760.00

ER155 Kainos Granules 1x5cm3 $760.00

ER161 Kainos Blocks 4-8x13x14 $760.00

 Eupharma

EH001 OSIQ Nano HA Bone Paste - Bone  OSIQ is a ready to use Nano Bone  Pre loaded syringes  $760.00

 matrix implant artificial Graft Substitiute injectable bone  0.5cc,1.0cc,2.0cc,3.0cc &

 matrix paste. 5.0cc

EH002 ELIZ Bone Graft Substitute Synthetic HA / TCP Bone Graft  Granules (1.0 - 4.0mm) (0.8 - $760.00

 Substitute  1.5mm) (0.5 - 1.0mm)

 Volume / Vial (0.25cc to

 5.0cc)

Prostheses List by Category, Groups and Sponsor Page 503 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Johnson & Johnson Medical Pty Ltd

DP447 Biosel 2 BIOSEL II Dose 5G (Calcium  5g $760.00

 Phosphates)

DY362 Conduit Conduit Cylinder H8 - 20 x D10 - 20mm $760.00

DY363 Conduit Conduit Wedge H6-18 x D15 x L15 $760.00

DY427 Conduit TCP Bone matrix implant 5cc $760.00

 LMT Surgical Pty Ltd

LM067 Crossbone Bone substitute Wedges:6-15mm height $760.00

 Blocks: height 3 -10mm,

 Width 3-10mm,

 length10-20mm

 Granules: Granule size 0.5 -

  3.5mm, Volume 0.4 -5cc

 Medtronic Australasia Pty Ltd

MC415 BCP Biphasic Calcium Phosphate  1-3cc $760.00

 Reabsorbable Graft Supplement

MC594 Mastergraft Calcium Phosphate Ceramic Granules 5cc Vial $760.00

MC669 BCP Biphasic Calcium Phosphate  5cc $760.00

 Reabsorbable 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

 More Group Pty Ltd

MV001 BondBone Biphasic Calcium Sulfate 0.5cc, 1cc $760.00

MV003 4Bone Synthetic Bone Graft HA/βTCP synthetic bone graft 0.5cc, 1cc, 2cc $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)

Prostheses List by Category, Groups and Sponsor Page 504 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Prism Surgical Designs Pty Ltd

PZ004 In'Oss Synthetic Bone Graft Putty  0.5ml, 1ml, 2.5ml and 5ml  $760.00

 Hydroxyapatite/Beta Calcium  Putty

 Phosphate (HA/beta-TCP) and

 Hydroxpropylmethylcellulose

 hydrogel carrier (HPMC)

PZ005 ReproBone TCP/HA Synthetic Bone Graft  0.5-5cc $760.00

PZ009 ReproBone novo HA Synthetic Bone Graft Paste 0.5-5ml $760.00

 Scient'x Australia

SX019 Bonex Granules 2cc $760.00

SX073 Samarys RF - 3D bone substitute 3D hydroxapatite and tricalcic  4.5mm to 10 height (o.1cc to $760.00

 phosphate implant  1cc)

SX085 Bone'XTRUDABLE Biphasic Calcium Phosphate,  1ml, 2ml, 5ml $760.00

 Hydrated Biphasic Calcium

SX086 Alphatec Velossity Biphasic Calcium Phosphate with  1ml. 2.5ml, 5ml $760.00

 absorbable hydrogel (putty)

 Signature Orthopaedics

SF005 Osteoflo Biphasic Calcium Phosphate;  1ml, 2ml, 5ml $760.00

 Hydrated Biphasic Calcium

SF060 Osteoflo G Biphasic Calcium Phosphate 2cc, 5cc Granules $760.00

 Signature Spine

SV014 Tripore HA Granuels 5cc Biphasic Calcium Phosphate 2cc Granules, 5cc Granules $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  Beta-tricalcium phosphate 5cc morsels $760.00

 bone void filler

SK480 HydroSet Injectable Calcium  Injectable, rapid set, calcium  5cc $760.00

 Phosphate Cement phosphate bone substitute  kit

SR061 HydroSet Injectable Calcium  Injectable, rapid set, calcium  3cc $760.00

 Phosphate Cement phosphate bone substitute kit

 Synthes Australia Pty Ltd

SY003 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone  5g $760.00

 Graft Substitute

Prostheses List by Category, Groups and Sponsor Page 505 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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  Mini Bead Kit 5cc Standard/Fast Cure $760.00

 (STANDARD 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

WR224 Osteoset T Calcium Sulphate with Tobroamycin 5cc vial $760.00

 Zimmer Pty Ltd

ZI192 Bone Graft Substitute Triosite Granules (0.5 - 1.0 mm grain  1 g Tube $760.00

 sizes)- HATCP

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 -  6 - 12mm $760.00

Prostheses List by Category, Groups and Sponsor Page 506 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 CDS

 LMT Surgical Pty Ltd

LM091 FixEx Bone Cement Calcium Phosphate Bone Cement 5cc $1,250.00

 Medical & Optical Instruments Australia Pty Ltd

MO387 Callos Bone Void Filler Calcium Phosphate Bone Void Fille 3CC, 5CC $1,250.00

 Surgiplas Medical

SP064 Osteovation Calcium Phosphate Bone substitute  2-3cc $1,250.00

 kit, quick set, EX/Impact/Inject

SP065 Osteovation Calcium Phosphate Bone sbustitute  5cc $1,250.00

 kit; 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  4cc $1,250.00

WR017 Osteoset Bone Void Filler Calcium Sulphate 3mm Syringe 1.25cc $1,250.00

WR019 Osteoset MIIG X3 Injectable Calcium Sulphate Bone  5cc $1,250.00

 Void Filler, Includes Syringe

 06.03.15.02 - Ceramic, >5cc - 10cc

 Austofix

AX069 Graftys Bone Cement - Quickset  Macroporous Calcium Phosphate  8cc $1,200.00

 Bone Cement Cement

AX071 Graftys Bone Cement - HBS Bone  Macroporous Calcium Phosphate  8cc $1,200.00

 Cement Cement

Prostheses List by Category, Groups and Sponsor Page 507 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

AX079 Graftys BCP - Granules 10cc Biphasic Calcium Phosphate  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  10cc $1,200.00

 Baxter Healthcare Pty Ltd

BX299 ACTIFUSE SHAPE 8.0mL BONE  A silicate substituted synthetic bone  8.0mL $1,200.00

 MATRIX IMPLANT ARTIFICIAL graft

BX301 ACTIFUSE GRANULES  A silicate substituted synthetic bone  10mL $1,200.00

 10mLBONE MATRIX IMPLANT  graft

 ARTIFICIAL

BX304 ACTIFUSE EASY PREP BONE  A silicate substituted synthetic bone  10ml $1,200.00

 MATRIX IMPLANT ARTIFICIAL graft

BX307 ACTIFUSE MICROGRANULES  A silicate substituted synthetic bone  10mL $1,200.00

 BONE MATRIX IMPLANT  graft

 ARTIFICIAL

 Biomet Australia Pty Ltd

BI946 Calcibon Granules or paste, TCP 10cc $1,200.00

 Danex Medical Pty Ltd

XD019 Comp06 Bone Reinforcement  Bone Reinforced Comppsite  10cc $1,200.00

 Composite consisting of Flowable, curable

 polymeric matrix with bioceramic,

 supplied in a sterile ready-to-use

 double syringe cartridge with mixing

 tip allowing mixing of the two

 Device Technologies Australia Pty Ltd

DE307 BonAlive Granules Bone Graft Substitute - Bioactive  13140 - 0.5-0.8mm small  $1,200.00

 Glass Granules granules, 10cc syringe

 13340 - 1.0-2.0mm medium

 granules, 10cc syringe

 13440 - 2.0-3.15mm large

 granules, 10cc syringe

DE311 SINTlife Nanostructured Paste/putty in  10 cc $1,200.00

 syringe - 10 cc

Prostheses List by Category, Groups and Sponsor Page 508 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

DE347 Engipore Pre-formed Bone  Pre-formed Bone Substitute 5-10cc Catalogue No: PFS015005- $1,200.00

 Substitute 5-10cc 31-00  Size: 6.4cc

 Catalogue No: PFS015005-

 32-00  Size: 8.2cc

 Catalogue No: PFS015005-

 23-00  Size: 7.2cc

 Catalogue No: PFS015005-

 24-00  Size: 9.6cc

 Catalogue No: PFS015008-

 02-00  Size: 6.8cc

 Catalogue No: PFS015008-

 03-00  Size: 9.9cc

 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 $1,200.00

  with barium

ER103 GeneX GeneX paste 10cc $1,200.00

ER105 GeneX GeneX putty 10cc $1,200.00

ER125 Stimulan Kit/Rapid Cure-10cc Calcium Sulphate synthetic rapid cure 10 cc $1,200.00

  bone void filler kit

ER128 Stimulan kit-10cc Calcium Sulphate synthetic bone void 10cc $1,200.00

  filler kit

ER156 Kainos Granules 1x6cm3 $1,200.00

ER157 Kainos Granules 1x10cm3 $1,200.00

 Eupharma

EH003 ELIZ Bonr graft Substitute Synthetic HA /TCP Bone Graft  Granules (1.0 - 4.0mm) (0.8 - $1,200.00

 Substitute  1.5mm) (0.5 - 1.0mm)

 Volume / Vial 10.0cc

 Global Orthopaedic Technology

GO066 ApaPore Actifuse. Sterile, hydroxyapatite-  1-2ml to 10cc $1,200.00

 based bone matrix

 Johnson & Johnson Medical Pty Ltd

DY353 Conduit TCP Bone matrix implant 10cc $1,200.00

Prostheses List by Category, Groups and Sponsor Page 509 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LMT Surgical Pty Ltd

LM176 Cross Bone 5-10cc Bone substitute Blocks-Height:10mm,  $1,200.00

 Width:14-20mm,

 Length:30-40mm (Volume:

 5.6-6.0cc)

 Granules - Granule size 0.5-

 Medtronic Australasia Pty Ltd

MC595 Mastergraft Calcium Phosphate Ceramic Granules 10cc Vial $1,200.00

MC670 BCP Biphasic Calcium Phosphate  10cc $1,200.00

 Reabsorbable Graft Supplement

MC856 Nanostim Synthetic Bone Paste 10cc $1,200.00

 More Group Pty Ltd

MV002 4Bone Synthetic Bone Graft HA/βTCP synthetic bone graft 6cc $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)

 Prism Surgical Designs Pty Ltd

PZ006 ReproBone TCP/HA Synthetic Bone Graft  6-10cc $1,200.00

PZ010 ReproBone novo HA Synthetic Bone Graft Paste 6-10ml $1,200.00

 Scient'x Australia

SX018 Bonex Granules 10cc $1,200.00

SX087 Alphatec Velossity Biphasic Calcium Phosphate with  10ml $1,200.00

 absorbable hydrogel (putty)

 Signature Orthopaedics

SF061 Osteoflo G Biphasic Calcium Phosphate 6cc,10cc Granules $1,200.00

 Signature Spine

SV015 Tripore HA Granuels 10cc Biphasic Calcium Phosphate 10cc $1,200.00

 Stryker Australia Pty Ltd

SK188 VITOSS - Synthetic cancellous bone Beta-tricalcium phosphate 10cc morsels and 10cc  $1,200.00

  void filler dowels

SR054 HydroSet Injectable Calcium  Injectable, rapid set, calcium  10cc $1,200.00

 Phosphate phosphate bone substitute kit

Prostheses List by Category, Groups and Sponsor Page 510 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 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

 Medical & Optical Instruments Australia Pty Ltd

MO388 Callos Bone Void Filler Calcium Phosphate Bone Void Filler 10CC $1,525.00

 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  10cc $1,525.00

 kit; Quick Set; EX/Impact/Inject

 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  20x25x10-14mm; 25x35x7- $1,525.00

 Bone Graft Substitute - Wedge 13mm

 Wright Medical Australia

WR003 ProDense / Osteoset XR Composite Injectable Bone Void  10cc $1,525.00

WR039 Cellplex TCP Synthetic Cancellous  Alpha & Beta Tricalcium Phosphate 7cc $1,525.00

 Bone

Prostheses List by Category, Groups and Sponsor Page 511 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.15.03 - Ceramic, >10cc - 20cc

 Austspine Pty Ltd

AJ034 Jectos 20cc Injectible synthetic bone graft  20cc $1,500.00

 Baxter Healthcare Pty Ltd

BX298 ACTIFUSE GRANULES BONE  A silicate substituted synthetic bone  20mL $1,500.00

 MATRIX IMPLANT ARTIFICIAL graft

BX300 ACTIFUSE SHAPE15.8mL BONE A silicate substituted synthetic bone  15.8mL $1,500.00

  MATRIX IMPLANT ARTIFICIAL graft

BX302 ACTIFUSE GRANULES BONE  A silicate substituted synthetic bone  5mL $1,500.00

 MATRIX IMPLANT ARTIFICIAL graft

 Biomet Australia Pty Ltd

BI947 Calcibon Granules or paste, TCP 20ml $1,500.00

 Device Technologies Australia Pty Ltd

DE309 ENGlpore Granules (size 1,0-2,5 mm) 15 cc Granules (size 1,0-2,5 mm)  $1,500.00

 Granules (size 2,5-4,0 mm) 15 cc 15 cc

 Granules (size 2,5-4,0 mm)

 15 cc

 Emergo Asia Pacific Pty Ltd

ER126 Stimulan Kit/Rapid Cure-20cc Calcium Sulphate synthetic rapid cure 20cc $1,500.00

  bone void filler kit.

ER158 Kainos Granules 1x16cm3 $1,500.00

ER159 Kainos Granules 1x20cm3 $1,500.00

 Eupharma

EH004 ELIZ Bone Graft Substitute Synthetic HA / TCP Bone graft  Granules (1.0 - 4.0 mm) (0.8  $1,500.00

 Substitute - 1.5mm) (0.5 - 1.0mm)

 Volume / Vial ( 15.0 cc to

 20.0cc)

 Global Orthopaedic Technology

GO067 ApaPore Actifuse. Sterile, hydroxyapatite- 20cc $1,500.00

 based bone matrix

 Johnson & Johnson Medical Pty Ltd

DY354 Conduit TCP Bone matrix implant 15cc $1,500.00

Prostheses List by Category, Groups and Sponsor Page 512 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 LMT Surgical Pty Ltd

LM177 Cross Bone 10-20cc Bone Substitute Blocks - Height: 15mm,  $1,500.00

 Width: 30mm Length:35mm

  (Volume:15.75cc)

 Granyles - Granule size 0.5-

 3.5mm; Volume 20cc

 Medtronic Australasia Pty Ltd

MC596 Mastergraft Calcium Phosphate Ceramic Granules 15cc Vial $1,500.00

MC671 BCP Biphasic Calcium Phosphate  20cc $1,500.00

 Reabsorbable Graft Supplement

 Prism Surgical Designs Pty Ltd

PZ007 ReproBone TCP/HA Synthetic Bone Graft  11-20cc $1,500.00

PZ011 ReproBone novo HA Synthetic Bone Graft Paste 11-20ml $1,500.00

 Signature Spine

SV016 Tripore HA Granuels 20cc Biphasic Calcium Phosphate 12cc Granuels, 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  Injectable, rapid set, calcium  15cc $1,500.00

 Phosphate Cement phosphate bone substitute kit

 Synthes Australia Pty Ltd

SY001 chronOS™ β-TCP Porous β-Tricalcium Phosphate Bone  20g $1,500.00

 Graft Substitute

 Wright Medical Australia

WR007 ProDense / Osteoset XR Composite Bone Void Filler - Pellets 20cc $1,500.00

WR015 Osteoset Pellets - Bone Graft  Calcium Sulphate 4.8mm Pellets 20cc $1,500.00

 Substitute

 CDS

 Biomet Australia Pty Ltd

BI937 GPS Bone Biologics TCP Granules/GPS, TCP 20ml $2,150.00

 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

Prostheses List by Category, Groups and Sponsor Page 513 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Wright Medical Australia

WR004 ProDense/Osteoset XR Composite Injectable Bone Void  20cc $2,150.00

WR020 Osteoset MIIG X3 Injectable Calcium Sulphate Bone  15cc $2,150.00

 Void Filler, Includes Syringe

WR040 Cellplex TCP Synthetic Cancellous  Alpha & Beta Tricalcium Phosphate 15cc & 20cc $2,150.00

 Bone

WR215 Pro-Dense core Decompression Kit Composite Injectable Bone Void  15cc $2,150.00

 Filler plus instrumentation kit for core

  decompression

 06.03.15.04 - Ceramic, >20cc

 Baxter Healthcare Pty Ltd

BX303 ACTIFUSE GRANULES  A silicate substituted synthetic bone  40mL $1,560.00

 40mLBONE MATRIX IMPLANT  graft

 ARTIFICIAL

 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

 Emergo Asia Pacific Pty Ltd

ER160 Kainos Granules 1x30cm3 $1,560.00

 Eupharma

EH005 ELIZ Bone Graft Substitute Synthetic HA / TCP Bone Graft Granules (1.0 - 4.0mm) (0.8 - $1,560.00

  1.5mm)(0.5 - 1.0mm)

 Volume / Vial (25.0 cc to

 30.0 cc)

 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

 Medtronic Australasia Pty Ltd

MC597 Mastergraft Calcium Phosphate Ceramic Granules 30cc Vial $1,560.00

Prostheses List by Category, Groups and Sponsor Page 514 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Prism Surgical Designs Pty Ltd

PZ008 ReproBone TCP/HA Synthetic Bone Graft  21-30cc $1,560.00

 Scient'x Australia

SX017 Bonex Block L:5.5 - 50mm $1,560.00

 Signature Orthopaedics

SF062 Osteoflo G Biphasic Calcium Phosphate 30cc Granules $1,560.00

 Stryker Australia Pty Ltd

SK187 VITOSS - Synthetic cancellous bone Beta-tricalcium phosphate 30cc morsels and 30cc  $1,560.00

  void filler dowels

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,  25cc only $1,560.00

 mould, spatula and mixing bowl

WR013 Osteoset T Pellets Calcium sulphate with tobramycin 20cc $1,560.00

 06.03.15.05 - 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

 06.03.15.06 - 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  1 x 1x 2 approx. 1.6g $529.00

 Implant material, biological, animal

 source.

Prostheses List by Category, Groups and Sponsor Page 515 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medtronic Australasia Pty Ltd

MI096 Grafton Plus Demineralized Bone  Grafton Plus Demineralized Bone  1-5cc $529.00

 Matrix Matrix: Paste

MI098 Grafton Demineralized Bone Matrix Grafton Demineralized Bone Matrix:  5cc $529.00

 Orthoblend

MI101 Grafton Demineralized Bone Matrix Grafton Demineralized Bone Matrix:  1.5cm x 1.5cm x 0.25cm $529.00

 Flex

MI103 Grafton Demineralized Bone Matrix Grafton Demineralized Bone Matrix:  60mm diameter $529.00

 A-Flex

 06.03.15.07 - Demineralised Bone Matrix, >5cc - 10cc

 Henry Schein-Halas Pty Ltd

HD017 Bio-Oss Natural bone mineral derived from  1 to 2mm; 2.0g (6cc) $1,400.00

 bovine bone

 Lifehealthcare Pty Ltd

LH474 Orthoss - Bone implant material Orthoss Granules Spongiosa.  Bone  Granule Size 2-4mm, 3g  $1,400.00

 implant material, biological, animal  (approx. 8-10cc)

 source

LH475 Orthoss - Bone implant material Orthoss Spongiosa Block. Bone  2 x 2 x 1.3cm (approx. 3.6g) $1,400.00

 Implant material, biological, animal

 source.

 Medtronic Australasia Pty Ltd

MI097 Grafton Plus Demineralized Bone  Grafton Plus Demineralized Bone  10cc $1,400.00

 Matrix Matrix: Paste

MI099 Grafton Demineralized Bone Matrix Grafton Demineralized Bone Matrix:  10cc $1,400.00

 Orthoblend

MI102 Grafton Demineralized Bone Matrix Grafton Demineralized Bone Matrix:  2.5cm x 10cm x 0.25cm $1,400.00

 Flex

MI104 Grafton Demineralized Bone Matrix Grafton Demineralized Bone Matrix:  2.5cm x 5cm x 0.8cm (2) $1,400.00

 Matrix PLF

MI106 Grafton Demineralized Bone Matrix Grafton Demineralized Bone Matrix:  1cm x 10cm x 0.8cm (2) $1,400.00

 Matrix Strips

Prostheses List by Category, Groups and Sponsor Page 516 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.15.08 - 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  (approx.. 13-20cc)

 source

 Medtronic Australasia Pty Ltd

MI100 Grafton Demineralized Bone Matrix Grafton Demineralized Bone Matrix:  15cc $1,800.00

 Orthoblend

MI105 Grafton Demineralized Bone Matrix Grafton Demineralized Bone Matrix:  2.5cm x 10cm x 0.8cm (2) $1,800.00

 Matrix PLF

MI107 Grafton Demineralized Bone Matrix Grafton Demineralized Bone Matrix:  1cm x 20cm x 0.8cm (2) $1,800.00

 Matrix Strips

 06.03.15.09 - 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  1 preformed block of  $850.00

 granules, embedded in 10% porcine  cancellous-bone granulate

 collagen.  The collagen component is  and collagen, block sizes

 resorbed within a few weeks.  The  500mg

 properties of the Bio-Oss granules

 remain unchanged. Facilitates

 handling.

HD008 Bio-Oss Collagen The product consists of Bio-Oss  1 preformed block of  $850.00

 granules, embedded in 10% porcine  cancellous-bone granulate

 collagen.  The collagen component is  and collagen, block size

 resorbed within a few weeks.  The  250mg

 properties of the Bio-Oss granules

 remain unchanged. Facilitates

 handling.

HD014 Bio-Oss Collagen The product consists of Bio-Oss  1 preformed block of  $850.00

 granules, embedded in 10% porcine  cancellous-bone granulate

 collagen.  The collagen component is  and collagen, block size

 resorbed within a few weeks.  The  100mg

 properties of the Bio-Oss granules

 remain unchanged. Facilitates

 handling.

Prostheses List by Category, Groups and Sponsor Page 517 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medtronic Australasia Pty Ltd

MC660 Mastergraft Matrix 5cc $850.00

MI142 Mastergraft Mastergraft Putty >0cc-5cc $850.00

 Stryker Australia Pty Ltd

SK466 VITOSS Foam - Compression  Highly porous bone graft material  5cc Foam strip (25x50x4) $850.00

 Resistant Synthetic Cancellous  made from beta-tricalcium phosphate

 Boane Void Filler -TCP) and Type I bovine collagen.

SK476 VITOSS Foam - Compression  Highly porous bone graft material  1.2cc Foam Pack $850.00

 Resistant Synthetic Cancellous  made from beta-tricalcium phosphate

 Bone Void Filler. -TCP) and Type I bovine collagen

SK477 VITOSS Foam - Compression  Highly porous bone graft material  2.5cc Foam Pack $850.00

 Resistant Synthetic Cancellous  made from beta-tricalcium phosphate

 Bone Void Filler. -TCP) and Type I bovine collagen

SK478 VITOSS Foam - Compression  Highly porous bone graft material  5cc Foam Pack $850.00

 Resistant Synthetic Cancellous  made from beta-tricalcium phosphate

 Bone Void Filler. -TCP) and Type I bovine collagen.

 06.03.15.10 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), >5cc - 10cc

 Medtronic Australasia Pty Ltd

MC663 Mastergraft Matrix 10cc $1,988.00

MI143 Mastergraft Mastergraft Putty >5cc-10cc $1,988.00

 Stryker Australia Pty Ltd

SK467 VITOSS Foam - Compression  Highly porous bone graft material  10cc Foam strip (25x100x4) $1,988.00

 Resistant Synthetic Cancellous  made from beta-tricalcium phosphate

 Bone Void Filler -TCP) and Type I bovine collagen.

SK468 VITOSS Foam - Compression  Highly porous bone graft material  10cc Foam strip (25x50x8) $1,988.00

 Resistant Synthetic Cancellous  made from beta-tricalcium phosphate

 Bone Void Filler -TCP) and Type I bovine collagen.

SK470 VITOSS Foam - Compression  Highly porous bone graft material  Small Cup 52mm Diameter $1,988.00

 Resistant Synthetic Cancellous  made from beta-tricalcium phosphate

 Bone Void Filler -TCP) and Type I bovine collagen.

SK471 VITOSS Foam - Compression  Highly porous bone graft material  Large Cup 56mm Diameter $1,988.00

 Resistant Synthetic Cancellous  made from beta-tricalcium phosphate

 Bone Void Filler -TCP) and Type I bovine collagen.

Prostheses List by Category, Groups and Sponsor Page 518 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

SK479 VITOSS Foam - Compression  Highly porous bone graft material  10cc Foam Pack $1,988.00

 Resistant Synthetic Cancellous  made from beta-tricalcium phosphate

 Bone Void Filler. -TCP) and Type I bovine collagen

 06.03.15.11 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), >10cc - 20cc

 Medtronic Australasia Pty Ltd

MC662 Mastergraft Matrix 20cc $2,256.00

MI144 Mastergraft Mastergraft Strip >10cc-20cc $2,256.00

 Stryker Australia Pty Ltd

SK469 VITOSS Foam - Compression  Highly porous bone graft material  20cc Foam strip (25x100x8) $2,256.00

 Resistant Synthetic Cancellous  made from beta-tricalcium phosphate

 Bone Void Filler -TCP) and Type I bovine collagen.

 06.03.15.12 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), >20cc

 Medtronic Australasia Pty Ltd

MI145 Mastergraft Mastergraft Strip >20cc $3,000.00

 Stryker Australia Pty Ltd

SK475 VITOSS Foam - Compression  Highly porous bone graft material  Sheet (Wide Strip)  $3,000.00

 Resistant Synthetic Cancellous  made from beta-tricalcium phosphate  75x100x4mm

 Bone Void Filler. -TCP) and Type I bovine collagen.

 06.03.15.13 - Biologically Active Bone Inductor, 0 - 2.5mg

 Medtronic Australasia Pty Ltd

MC806 Infuse Bone Graft Recombinant human bone  Extra Small 2.1mg $1,500.00

 morphogenetic protein rhBMP-2

MC807 Infuse Bone Graft Recombinant human bone  Mini 1.05mg $1,500.00

 morphogenetic protein rhBMP-2

 06.03.15.14 - Biologically Active Bone Inductor, >2.5mg - 5mg

 Medtronic Australasia Pty Ltd

MC808 Infuse Bone Graft Recombinant human bone  Small 4.2mg $3,200.00

 morphogenetic protein rhBMP-2

Prostheses List by Category, Groups and Sponsor Page 519 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.15.15 - Biologically Active Bone Inductor, >5mg - 10mg

 Medtronic Australasia Pty Ltd

MC683 Infuse Bone Graft Recombinant human Bone  Medium 8.4mg $6,000.00

 Morphogenetic Protein rhBMP-2

 06.03.15.16 - Biologically Active Bone Inductor, >10mg

 Medtronic Australasia Pty Ltd

MC684 Infuse Bone Graft Recombinant human Bone  Large 12mg $6,400.00

 Morphogenetic Protein rhBMP-2

 Stryker Australia Pty Ltd

ST865 OP-1 Implant - Osteogenic Protein  Osteoinductive and osteoconductive  1 vial $6,400.00

 1, 3.5mg bone graft substitute

 06.03.15.17 - Metal Scaffold

 Biomet Australia Pty Ltd

BH359 OsseoTi Porous Metal Foot &  Porous Titanium Reconstructive  15mm x 15mm x 4mm to  $1,283.00

 Ankle Reconstructive Wedges Wedges 24mm x 20mm x 11mm

 Wright Medical Australia

WR071 BioFoam Bone Wedge Titanium metal scaffold for angular  Depth 14 - 44mm $1,283.00

 correction in ankle and foot Width 10 - 44mm

 Thickness

 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

 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

Prostheses List by Category, Groups and Sponsor Page 520 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 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

 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   x 25mm x 4mm

06.03.16 - Meshes

 06.03.16.01 - Metallic

 Johnson & Johnson Medical Pty Ltd

DP223 Thackray Mesh Stainless Steel Ortron 90 mesh 200x200mm $949.00

 Lima Orthopaedics Australia Pty Ltd

LC066 TNP® Calcaneus Bone Plate Ti TNP® Calcaneus Bone Plate Ti Plate has holes to  $949.00

 accommodate screw sizes

 from 2 to 6mm

LC069 TNP® SRT Net Plate Ti TNP® SRT Net Plate Ti One size $949.00

LC070 TNP® Net Plate Ti TNP net plate Ti 13x23mm $949.00

 Stryker Australia Pty Ltd

HW525 Exeter Hip X-Change Revision  X-Change Stainless steel Revision  Small, medium and large $949.00

 System Mesh - Medial Wall,Rim, Femoral. Flat

 Zimmer Pty Ltd

ZI329 CPT Impaction Grafting Mesh Titanium Femoral or acetabular mesh 6 sizes acetabular rim (small  $949.00

 and large), medial wall

 (small and large), flat and

 femoral meshes

 06.03.16.02 - Non Metallic

 Oceania Orthopaedics

OO101 Mutars Attachment Tube Mutars attachment tube 33/55mm $288.00

Prostheses List by Category, Groups and Sponsor Page 521 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Smith & Nephew Surgical Pty Ltd

SN777 GTS Sleeve Polypropylene non-absorbable  one size only $288.00

 woven mesh

06.03.17 - Tumour / Limb Deficiency

 06.03.17.02 - Spacer

 Oceania Orthopaedics

OO121 MUTARS - Arthodesisbody Arthodesis Body 120mm $6,571.00

 06.03.17.04 - Central Screw

 Surgien Pty Ltd

BR001 OPRA System Central screw - titanium One size only $1,860.00

 06.03.17.05 - Healing Cylinder

 RQSolutions Medical Devices Distribution Support

RQ051 Taper Sleeve Connector (as a  Orthodynamics The Integral Leg  1 size only $3,150.00

 component of the Orthodynamics  Prosthesis -Taper Sleeve Connector

 The Integral Leg Prosthesis)

 Surgien Pty Ltd

BR002 OPRA System Healing cylinder - titanium One size only $3,150.00

 06.03.17.06 - Healing Screw

 Surgien Pty Ltd

BR003 OPRA System Healing screw - titanium One size only $2,460.00

 06.03.17.07 - Fixture

 RQSolutions Medical Devices Distribution Support

RQ046 Orthodynamics The Integral Leg  Orthodynamics The Integral Leg  82 items with sizes ranging  $36,900.00

 Prosthesis - Modular Femoral Stem  Prosthesis-Modular Femoral Stem in stem length from 140mm

 (as a component of The Integral Leg  to 180mm

 Prosthesis)

Prostheses List by Category, Groups and Sponsor Page 522 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Surgien Pty Ltd

BR004 OPRA System Fixture - titanium 16 - 20mm $36,900.00

 06.03.17.08 - Abutment

 RQSolutions Medical Devices Distribution Support

RQ048 Orthodynamics The Integral Leg  Orthodynamics The Integral Leg  6 sizes $19,250.00

 Prostheses-Dual Cone Extension  Prosthesis-Dual Cone Extension

 (as a component of the

 Orthodynamics The Integral Leg

RQ049 Silicone cap (as a component of the  Orthodynamics The Integral Leg  1 size $19,250.00

 Orthodynamics The Integral Leg  Prosthesis-Silicone Cap

 Prosthesis

 Surgien Pty Ltd

BR005 OPRA System Abutment - titanium Length 47 - 77mm $19,250.00

 06.03.17.09 - Abutment Screw

 Surgien Pty Ltd

BR006 OPRA System Abutment screw - titanium Length 57 - 87mm $5,775.00

 06.03.17.10 - Oncology Humeral Stem

 Oceania Orthopaedics

OO133 MUTARS humeral stem MUTARS humeral stems 7-13mm 7mm length $5,775.00

 06.03.17.12 - Humerus Extension Piece

 Oceania Orthopaedics

OO129 MUTARS extension piece MUTARS humerus extension piece 20mm/40mm/60mm $4,393.00

OO130 MUTARS humerus reducer MUTARS humerus reducer 80mm $4,393.00

 06.03.17.14 - Humerus Connection Piece

 Oceania Orthopaedics

OO128 MUTARS Humerus connecting part MUTARS Humerus connecting part 80mm $4,580.00

Prostheses List by Category, Groups and Sponsor Page 523 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.17.17 - Humerus Connecting Screw

 Oceania Orthopaedics

OO131 MUTARS humerus screw MUTARS humerus screw 15mm,35mm,55mm,75mm $653.00

 06.03.17.22 - Humeral Head/Cap

 Oceania Orthopaedics

OO125 MUTARS Glenosphere MUTARS glenosphere 40mm $4,260.00

OO126 MUTARS Head MUTARS Head 50mm $4,260.00

OO127 MUTARS Humerus cap MUTARS Humerus cap Small, medium and large. +5  $4,260.00

 and +10mm offset

 06.03.17.23 - Distal Humerus Flange

 Biomet Australia Pty Ltd

BH346 Comprehesive Segmental Revision  Comprehensive SRS Flange Small, large $4,347.00

 System (SRS)

 06.03.17.30 - METS Humeral Shaft

 Oceania Orthopaedics

OO123 MUTARS Distal Humerus MUTARS Distal Humerus 50mm, 30mm $3,243.00

OO124 MUTARS Humerus diaphyseal  MUTARS Humerus diaphyseal  8-9 mm diameter, 100mm  $3,243.00

 implant length

 06.03.17.35 - METS Bayley Walker Glenoid Component

 Oceania Orthopaedics

OO135 MUTARS Glenoid MUTARS Glenoid 1 size $7,485.00

 06.03.17.37 - Femoral Stem - Uncemented

 Oceania Orthopaedics

OO082 MUTARS - Arthrodesis stems Arthrodesis tibial and femoral stems,  11-20mm x 100 - 250mm  $3,920.00

 cvd, straight, cemented/cementless length

Prostheses List by Category, Groups and Sponsor Page 524 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 06.03.17.39 - Tibial Stem - Uncemented

 Oceania Orthopaedics

OO119 MUTARS - Arthodesis Tibial  MUTARS - Arthodesis femoral  45mm $6,571.00

 component component

 06.03.17.41 - Valgus Sleeve

 Oceania Orthopaedics

OO120 MUTARS - Arthodesis femoral  MUTARS - Arthodesis femoral  45mm left and right $6,571.00

 component component

6.3.7 - Wire/Cable Accessories

 6.3.7.2 - Hook/Grip

 Smith & Nephew Surgical Pty Ltd

SN735 Accord Orthopaedic Cable System, Std Cable  85-265mm $2,000.00

 Grip

Group 10: Shoulder - Humeral

 Stryker Australia Pty Ltd

HW216 Howmedica Modular Resection  Distal Humerus Cone -  Vitallium One size only $4,580.00

 System

HW217 Howmedica Modular Resection  Distal Humerus Flange -  Vitallium One size only $4,347.00

 System

HW218 Howmedica Modular Resection  Humerus Connection Piece -   One size only $4,122.00

 System

HW221 Howmedica Modular Resection  Humerus Extension Piece -  Vitallium 5, 15, 30, 45, 60, 75, 90,  $5,243.00

 System 105, 120, 135, 150, 165mm

HW255 Howmedica Modular Resection  Oncology Humeral Body -  Titanium 40 - 140mm in 20mm  $2,827.00

 System increments

Prostheses List by Category, Groups and Sponsor Page 525 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Group 10b: Humeral Stem

 Stryker Australia Pty Ltd

HW222 Howmedica Modular Resection  Humeral Anchorage Piece -  Vitallium 9, 10, 11, 12mm $4,393.00

 System

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

 Stryker Australia Pty Ltd

HW254 HMRS Oncology Humeral  Cobalt Chromium 40, 44mm, Cap $4,260.00

Group 11: Shoulder Glenoid

 Group11e: Other

 Stryker Australia Pty Ltd

HW200 Howmedica Modular Resection  Plug Screw Axis -  Vitallium One size only $217.00

 System

HW202 Howmedica Modular Resection  Wedge -  Vitallium One size only $211.00

 System

HW219 Howmedica Modular Resection  Humerus Connecting Screw -  Vitallium One size only $653.00

 System

HW220 Howmedica Modular Resection  Humerus Hex Socket Bolt -  Vitallium One size only $565.00

 System

Prostheses List by Category, Groups and Sponsor Page 526 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

Group 14: Intramedullary Nails

 Group 14c: Humeral

 P, D

 Biomet Australia Pty Ltd

BH357 VersaNail IM Nailing Platform Humeral Nails, Universal and  7-10 mm x 150-280mm $2,195.00

 Proximal, Titanium, Locking,

 cannulated

 Group 14d: Other

 Biomet Australia Pty Ltd

BH264 Small Bone Fixation System - Small  Intramedullary Nail 1.6mm and 1.1mm $700.00 $950.00

 Bone Flexible Nail

Group 15: Intramedullary Nail Accessories

 Group 15a: Screws

 Smith & Nephew Surgical Pty Ltd

SN520 TriGen Captured Screws Titanium 4.5 & 5.0mm diameters, 20- $120.00

 110mm lengths

 Stryker Australia Pty Ltd

SK204 Stryker Trauma Locking Nail  SCN Nut for Condyle Screws  $232.00

Group 16: Plates

 Group 16b: Small 2.71 4.49mm

 Smith & Nephew Surgical Pty Ltd

SN731 Accord Orthopaedic Cable System, Sm Cable  75-255mm $1,400.00

 Grip

 Group 16d: Other

 Com

 Synthes Australia Pty Ltd

SY111 AO/ASIF Plates Specially manufactured plate 1.0mm - 6.5mm $3,914.00

Prostheses List by Category, Groups and Sponsor Page 527 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

Group 17: Screws

 Group 17f: Other

 Smith & Nephew Surgical Pty Ltd

SN713 Trigen Stable-Lok Nut One Size Only $346.00

 HA Coated

 Biomet Australia Pty Ltd

BI820 EBI XFIX DynaFix System Screw, HA coated, cortical, cancellous Dia 2-6mm $274.00

Group 18: Pins

 Group 18b: Threaded

 Stryker Australia Pty Ltd

ST038 Stryker Plating System -  Reduction  4.5mm Diameter, Stainless Steel One size only $175.00

 Pin

Group 22: Soft Tissue Fixation Devices

 Group 22a: No Suture

 Johnson & Johnson Medical Pty Ltd

JJ083 Mitek GII Anchor Threader Tab Titanium Suture Anchor 2.4 x 8.8mm $287.00

Group 31: Other Devices

 Biomet Australia Pty Ltd

BI855 EBI XFIX Dynafix System Wrench Ex Small, Small, Adult, 3-6mm $200.00

 Global Manufacturing Technology Pty Ltd

GM110 OsteoBridge Nail 7mm, 8mm, 9mm, 10mm,  $4,322.00

 12mm, 14mm, 16mm & 18mm

Prostheses List by Category, Groups and Sponsor Page 528 of 1059


06 - SPECIALIST ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

Group 9: Elbow

 Group 9g: Other

 Stryker Australia Pty Ltd

HW213 Howmedica Modular Resection  Humeral Bearing -  Vitallium One size only $175.00

 System

Prostheses List by Category, Groups and Sponsor Page 529 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

07.01.01 - Mesh - Metal

 07.01.01.01 - <0.2mm thick, 1-50cm²

 Medical & Optical Instruments Australia Pty Ltd

MO291 Martin Level One Fixation Mesh, Titanium <0.2mm thick, 1 to 10cm² area $165.00

 07.01.01.02 - <0.2mm thick, 51-100cm²

 Medical & Optical Instruments Australia Pty Ltd

MO290 Martin Level One Fixation Mesh, Titanium <0.2mm, 51 to 100cm² area $380.00

 07.01.01.03 - 0.2-0.49mm thick, 1-10cm²

 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

 Medical & Optical Instruments Australia Pty Ltd

MO303 Martin Level One Fixation Mesh, Titanium 0.2 to 0.49mm thick, 1 to  $725.00

 10cm² area

 Synthes Australia Pty Ltd

SY577 AO/ASIF Plate Titanium contourable mesh; Orbital & <0.5mm $725.00

  Pre-Shaped

 07.01.01.04 - 0.2-0.49mm thick, 11-50cm²

 Australian Surgical Innovations Pty Ltd

AI005 ASI Plates and Screws Mesh . $700.00

 Biomet Australia Pty Ltd

BI604 W Lorenz Osteosynthesis System Sheet, 1mm System. Titanium 85x50x0.2mm $700.00

BI645 W Lorenz Osteosynthesis System Mesh panel, 1.5mm System Titanium (41-83) x (39-54mm) (0.3 or  $700.00

 0.2mm)

Prostheses List by Category, Groups and Sponsor Page 530 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Johnson & Johnson Medical Pty Ltd

JJ850 Bioplate Biomesh System Titanium cranial biomesh 0.3 to 0.45mm thickness,  $700.00

 32-60mm x 43-60mm

 Lifehealthcare Pty Ltd

LH508 Martin Osteosynthesis 1.5mm  Mesh, Titanium 0.2-0.49mm thick, 11-50cm2 $700.00

 System Mesh thin 50cm2

 Medical & Optical Instruments Australia Pty Ltd

MO409 Martin Level One Fixation Mesh, Titanium 0.9-0.49mm thick, 11-50cm² $700.00

 Medtronic Australasia Pty Ltd

MC889 TiMesh Square-rectangular Gridmesh Panel 11 to 25 cm2 area $700.00

MC914 TiMesh Titanium Rigid Fixation  FlexMesh 1.5mm System.  26 to 50 cm2 area; 0.3mm  $700.00

 Bone Grafting and Plating System Composition: Titanium thick

 Surgiplas Medical

SP068 Plates Micro, Mini, Maxi Mesh 50mm x 74mm Mesh  $700.00

 26 to 50cm2 area

SP080 Plates Micro, Mini Mesh 50mm x 37, 36 x  $700.00

 50mm, Mesh 11 to 25cm2

 area

SP107 OsteoMed Plating & Fixation System Plates 40 x 40mm Osteoform Mesh,  $700.00

 Mesh 11 to 25cm2 area.

 Complex

 Stryker Australia Pty Ltd

HW528 Stryker Neuro Mesh Plates Titanium malleable mesh plates for  0.2-0.49mm $850.00

 cranial reconstruction

 Synthes Australia Pty Ltd

SY578 AO/ASIF Plate Titanium contourable mesh; Mastoid,  0.2mm-0.49mm $850.00

 Cranial & Pre-Shaped

 07.01.01.05 - 0.2-0.49mm thick, 51-200cm²

 Johnson & Johnson Medical Pty Ltd

JJ851 Bioplate Biomesh System Titanium cranial biomesh 0.45mm thickness, 85- $1,400.00

 132mm x 90-134mm

Prostheses List by Category, Groups and Sponsor Page 531 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Lifehealthcare Pty Ltd

LH512 Martin Osteosynthesis 1.5mm  3D Mesh, Titanium 0.2-0.49mm thick, 51-200cm2 $1,400.00

 System 3D Mesh 200cm2

 Medical & Optical Instruments Australia Pty Ltd

MO347 Martin Level One Fixation Mesh, Titanium & 3D 0.2-0.49mm thick, 51-200cm² $1,400.00

 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

MI084 TiMesh Rigid Fixation Bone  FlexMesh 1.0 - 1.5mm system.  51 to 100cm² area, 0.3mm  $1,400.00

 Grafting and Plating System Composition: Titanium thickness

 Stryker Australia Pty Ltd

SK582 Stryker Leibinger Plating System Craniofacial Titanium Mesh System 0.2 - 0.49mm thick, 51 -  $1,400.00

 200cm²

 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 AO/ASIF Plate Titanium Contourable mesh plate <0.5mm $1,400.00

 Complex

 Biomet Australia Pty Ltd

BH024 W Lorenz Osteosynthesis System Pre-contoured Neuro Mesh, titanium 163 x 115 x 0.3mm $1,480.00

 07.01.01.06 - 0.2-0.49mm thick, >200cm²

 Biomet Australia Pty Ltd

BH018 W Lorenz Osteosynthesis System Sheet 1.5mm System. Titanium (203-206)mm x (123- $1,500.00

 127)mm x (0.2-0.3)mm

 Johnson & Johnson Medical Pty Ltd

JJ441 Titanium Mesh Titanium Mesh Sterile 0.2mm thickness, 15cm x  $1,500.00

 15cm

Prostheses List by Category, Groups and Sponsor Page 532 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medtronic Australasia Pty Ltd

MC387 TiMesh Rigid Fixation Bone  Titanium, Square Grid Mesh Large $1,500.00

 Grafting and 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

SY786 AO/ASIF Plate Titanium Contourable mesh, Cranial  <0.5mm $1,500.00

 Neuro

 07.01.01.07 - 0.5-0.8mm thick, 1-10cm²

 Medical & Optical Instruments Australia Pty Ltd

MO330 Martin Level One Fixation Mesh Titanium 0.5-0.8mm thick, 1-10cm² $315.00

 Medtronic Australasia Pty Ltd

MC389 TiMesh Rigid Fixation Bone  Titanium, Square Grid Mesh Small $315.00

 Grafting and Plating System

 Stryker Australia Pty Ltd

ST245 Leibinger Titanium Implant System Leibinger Mesh Implants Titanium 75 x 12 x 0.5mm $315.00

 07.01.01.08 - 0.5-0.8mm thick, 11-50cm²

 Biomet Australia Pty Ltd

BH023 W Lorenz Osteosynthesis System Panel, Regular or Small Grid.  (42-85) x (40-53)mm x  $510.00

 0.6mm

BI644 W Lorenz Osteosynthesis System Mesh panel, 1.5mm System. Titanium 83 x 51mm x 0.6mm $510.00

 Johnson & Johnson Medical Pty Ltd

JJ852 Bioplate Biomesh System Titanium cranial biomesh 0.6mm thickness, 36-65 x  $510.00

 52-65mm

 Lifehealthcare Pty Ltd

LH509 Martin Osteosynthesis 1.5mm  Mesh, Titanium 0.5-0.8mm thick, 11-50cm2 $510.00

 System Mesh 50cm2

 Medical & Optical Instruments Australia Pty Ltd

MO411 Martin Level One Fixation Mesh, Titanium 0.5-0.8mm thick, 11-50cm² $510.00

Prostheses List by Category, Groups and Sponsor Page 533 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medtronic Australasia Pty Ltd

MC915 TiMesh Titanium Rigid Fixation  FlexMesh 1.5mm System.  26 to 50 cm2 area; 0.6mm  $510.00

 Bone Grafting and Plating System Composition: Titanium thick

 Stryker Australia Pty Ltd

HW507 Stryker Leibinger Plating System Craniofacial Titanium Mesh System 0.5 - 0.8mm thick, 11 -  $510.00

 Surgiplas Medical

SP093 OsteoMed Plating & Fixation System Plates - Reconstruction Mesh Malleable/Ridgid, 74  $510.00

 x 50mm, Mesh, 0.5 to 0.8mm

 thick, 26 to 50cm3 area

SP108 OsteoMed Plating & Fixation System Plates 40 x 40mm Osteoform Mesh,  $510.00

 Mesh 11 to 25cm2 area.

 07.01.01.09 - 0.5-0.8mm thick, 51-200cm²

 B Braun Australia Pty Ltd

BB315 Aesculap CranioPlate System/Plate  Cranial fixation system, internal  Plate Neuro, 65 x 90 mm,  $1,175.00

 Neuro, 65 x 90mm, 0.6mm mesh fracture, non biodegradable. Consists  0.6mm Mesh

 of screws, plates.

 Johnson & Johnson Medical Pty Ltd

JJ799 BIOPLATE Biomesh Titanium cranial biomesh 0.6mm thickness, 90-127 x  $1,175.00

 92-131mm

 Lifehealthcare Pty Ltd

LH510 Martin Osteosynthesis 1.5mm  Mesh, Titanium 0.5-0.8mm thick, 51-200cm2 $1,175.00

 System Mesh 64cm2

 Medical & Optical Instruments Australia Pty Ltd

MO251 Martin Level One Fixation Mesh, Titanium 0.50 to 0.80mm thick, 51 to  $1,175.00

 100cm² area

 Medtronic Australasia Pty Ltd

MC877 TiMesh Rigid Fixation Bone  Titanium, Mesh 51 to 100 cm2 area, 0.6mm  $1,175.00

 Grafting and Plating System thickness

MI085 TiMesh Rigid Fixation Bone  FlexMesh 1.0 - 2.2mm system.  51 to 100cm² area, 0.6mm  $1,175.00

 Grafting and Plating System Composition : Titanium thickness

 National Surgical Pty Ltd

NK025 Jeil Medical Meshes - 51-200cm² Craniofacial fixation plate 36cm² and 100cm² $1,175.00

Prostheses List by Category, Groups and Sponsor Page 534 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 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

 Mesh 51 to 100cm2 area.

 Synthes Australia Pty Ltd

SY579 AO/ASIF Plate Titanium mesh 0.5mm-0.8mm $1,175.00

 07.01.01.10 - 0.5-0.8mm thick, >200cm²

 Biomet Australia Pty Ltd

BH019 W Lorenz Osteosynthesis System Sheet 1.5mm System. Titanium 206 x 123 x 0.6mm $2,243.00

 Johnson & Johnson Medical Pty Ltd

JJ260 BIOPLATE Biomesh Titanium cranial biomesh 3ME,  20 x 20cm $2,243.00

 packaged non-sterile

 Lifehealthcare Pty Ltd

LH492 Standard Approach Mesh Pre-contoured titanium mesh implants 0.6mm thick $2,243.00

  for 11 standard approaches.

LH511 Martin Osteosynthesis 1.5mm  Mesh, Titanium 0.5-0.8mm thick, >200cm2 $2,243.00

 System Mesh 200cm2

 Medtronic Australasia Pty Ltd

MI083 TiMesh Titanium rigid Fixation  FlexMesh 1.5mm - 2.2mm system.  148 - 154mm x 148 - 154mm, $2,243.00

 Bone Grafting and Plating System Composition: Titanium  0.6mm

 National Surgical Pty Ltd

NK026 Jeil Medical Meshes - >200cm² Craniofacial fixation mesh 225cm² and 400cm² $2,243.00

 Surgiplas Medical

SP112 OsteoMed Plating & Fixation System Plates 125 x 180mm Mesh Plate,  $2,243.00

 150 x 300mm Mesh Plate,

 Mesh >200cm2 area.

 Synthes Australia Pty Ltd

SY785 AO/ASIF Plate Titanium Contourable Mesh, Cranial  0.5mm-0.8mm $2,243.00

 Neuro

Prostheses List by Category, Groups and Sponsor Page 535 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

07.01.02 - Mesh - Non-metal

 07.01.02.01 - <0.2mm thick, 1-10cm²

 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

 07.01.02.02 - <0.2mm thick, 11-25cm²

 Johnson & Johnson Medical Pty Ltd

JJ687 PDS Plates Absorbable synthetic (poly-p- 0.25mm x 30mm x 40mm          $515.00

 dioxanone) plate/foil                                      0.5mm x

 30mm x 40mm                           

                     0.25mm x 40mm x

 50mm                                          

    0.5mm x 40mm x 50mm        

                            

 07.01.02.03 - 0.2-0.49mm thick, 1-10cm²

 Biomet Australia Pty Ltd

BI399 Lactosorb Resorbable  Panel or Sheet, Solid or Holed,  0.25mm x 25x25mm $450.00

 Craniomaxillofacial Fixation System PGA/PLA

 Medical & Optical Instruments Australia Pty Ltd

MO299 Martin Level One Fixation Resorb x  Mesh PDLLA (resorbable) 0.20 to 0.49mm thick, 1 to  $450.00

 & SonicWeld 10 cm2 area

 07.01.02.04 - 0.2-0.49mm thick, 11-25cm²

 Biomet Australia Pty Ltd

BI400 Lactosorb Resorbable  Cover, Solid or Holed, PGA/PLA (0.25, 0.5, 0.75mm) x  $680.00

 Craniomaxillofacial Fixation System 38x38mm

BI401 Lactosorb Resorbable  Cover, Solid or Holed, PGA/PLA 0.25mm x 50x50mm $680.00

 Craniomaxillofacial Fixation System

Prostheses List by Category, Groups and Sponsor Page 536 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Surgical Specialties

SQ049 Inion GTR Biodegradable System PLGA/TMC Copolymer: membrane &  a) 30 x 40mm membrane kit;  $680.00

 tacks b) 6 tack kit and applicator

 07.01.02.05 - 0.2-0.49mm thick, 26-50cm²

 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

 07.01.02.06 - 0.2-0.49mm thick, 51-100cm²

 Biomet Australia Pty Ltd

BI998 Lactosorb Resorbable  Panel or Sheet, Solid or Holed,  0.25mmx100x100mm $1,750.00

 Craniomaxillofacial Fixation System PGA/PLA

 07.01.02.07 - 0.5-0.8mm thick, 1-10cm²

 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

MO402 Martin Level One Fixation Resorb X Mesh, PDLLA (resorbable) 0.50 to 0.80mm thick, 1 to  $600.00

  & SonicWeld RX 10cm²

 Medtronic Australasia Pty Ltd

MC630 Macropore FRP (fast resorbing  Polylactide and Polyglycolide  25mm x 25mm x 0.75mm $600.00

 polymer)

MI088 Macropore Protective Sheets 1 to 10cm² area; 0.5mm thick $600.00

 07.01.02.08 - 0.5-0.8mm thick, 11-25cm²

 Biomet Australia Pty Ltd

BI418 Lactosorb Resorbable  Panel, Lactosorb. 1.5mm System.  25 x 50mm (5 x 10 hole) $945.00

 Craniomaxillofacial Fixation System PGA/PLA

BI419 Lactosorb Resorbable  Cover, Solid or Holed, PGA/PLA (0.5 or 0.8)mm x 50x50mm $945.00

 Craniomaxillofacial Fixation System

Prostheses List by Category, Groups and Sponsor Page 537 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medtronic Australasia Pty Ltd

MC629 Macropore FRP (fast resorbing  Polylactide and Polyglycolide  50mm x 50mm 0.75mm $945.00

 polymer)

MC893 Macropore Protective Sheets 11 to 25 cm2 area, 0.5mm  $945.00

 thick

 Surgical Specialties

SQ052 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5-2.5 mesh plate, 7 x 7  $945.00

   Polylactic Acid Trimethylene  holes; 1.5mm baby mesh

 Carbonate Copolymer plate 7 x 7 holes

 Synthes Australia Pty Ltd

SY544 PolyMax Rapid-Resorbable  Mesh Plate 0.5-0.8mm $945.00

 Fixation System

 07.01.02.09 - 0.5-0.8mm thick, 26-50cm²

 Medical & Optical Instruments Australia Pty Ltd

MO346 Martin Level One Fixation Mesh PDLLA resorbable 0.5-0.8mm thick, 26-50cm² $1,230.00

 Medtronic Australasia Pty Ltd

MC560 Macropore Protective Sheets 60 x 80 x 0.5mm - 60 x 80 x  $1,230.00

 0.8mm

MC628 Macropore FRP (fast resorbing  Polylactide and Polyglycolide  60mm x 80mm x 0.75mm $1,230.00

 polymer)

 07.01.02.10 - 0.5-0.8mm thick, 51-100cm²

 Biomet Australia Pty Ltd

BI999 Lactosorb Resorbable  Panel or Sheet, Solid or Holed,  (0.5 or 0.8)mm 100x100mm $1,940.00

 Craniomaxillofacial Fixation System PGA/PLA

 Medtronic Australasia Pty Ltd

MC627 Macropore FRP (fast resorbing  Polylactide and Polyglycolide  100mm x 100mm x 0.75mm $1,940.00

 polymer)

MC899 Macropore Protective Sheets 51 to 100 cm2 area; 0.5mm  $1,940.00

 thick

Prostheses List by Category, Groups and Sponsor Page 538 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Surgical Specialties

SQ066 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5-2.5 mesh plates, 14 x 14  $1,940.00

   Polylactic Acid Trimethylene  holes; 1.5mm baby mesh

 Carbonate Copolymer plate 14 x 14 holes

 Synthes Australia Pty Ltd

SY547 PolyMax Rapid-Resorbable  Mesh Plate 0.5-0.8mm $1,940.00

 Fixation System

 07.01.02.11 - 0.5-0.8mm thick, 101-200cm²

 Medical & Optical Instruments Australia Pty Ltd

MO358 Martin Level One Fixation Mesh PDLLA resorbable 0.5-0.8mm thick, 101-200cm² $2,100.00

 07.01.02.12 - >0.8mm thick, 1-10cm²

 Medical & Optical Instruments Australia Pty Ltd

MO344 Martin Level One Fixation Mesh PDLLA resorbable >0.8mm thick, 1-10cm² $600.00

 Medtronic Australasia Pty Ltd

MC896 Macropore Protective Sheets 1 to 10 cm2 area; 1.0mm thick $600.00

 07.01.02.13 - >0.8mm thick, 11-25cm²

 Biomet Australia Pty Ltd

BI427 Lactosorb Resorbable  Mesh, Mandibular Lactosorb 2.5mm  1.42mm x 42x42mm $950.00

 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

 Medtronic Australasia Pty Ltd

MC894 Marcropore Protective Sheets 11 to 25 cm2 area, 1.0mm  $950.00

 thick

 Synthes Australia Pty Ltd

SY545 PolyMax Rapid-Resorbable  Mesh Plate >0.8mm $950.00

 Fixation System

Prostheses List by Category, Groups and Sponsor Page 539 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.01.02.14 - >0.8mm thick, 26-50cm²

 Medical & Optical Instruments Australia Pty Ltd

MO345 Martin Level One Fixation Mesh PDLLA resorbable >0.8mm thick, 26-50cm² $1,020.00

 Stryker Australia Pty Ltd

ST516 Stryker Leibinger Resorbable  Resorbable plate: blank panel  55x55mm  $1,020.00

 Fixation System Tripolymer

ST526 Stryker Leibinger Resorbable  Resorbable Mesh Tripolymer 55x55mm $1,020.00

 Fixation System

 07.01.02.15 - >0.8mm thick, 51-100cm²

 Medtronic Australasia Pty Ltd

MC900 Macropore Protective Sheets 51 to 100 cm2 area; 1.0mm  $1,175.00

 thick

 Synthes Australia Pty Ltd

SY546 PolyMax Rapid-Resorbable  Mesh Plate >0.8mm $1,175.00

 Fixation System

 07.01.02.16 - >0.8mm thick, 101-200cm2

 Medical & Optical Instruments Australia Pty Ltd

MO359 Martin Level One Fixation Mesh PDLLA resorbable >0.8mm thick, 101-200cm2 $2,100.00

07.01.03 - Mesh - Composite

 07.01.03.01 - 0.5-0.8mm thick, 1-25cm²

 Stryker Australia Pty Ltd

HW443 E-POR Biomaterial/ Panel - Porous  Panel - Porous Polyethylene  0.5mm - 0.8mm thick, 38mm  $900.00

 Polyethlene Titanium Mesh  Titanium Mesh Composite x 50mm

 Composite

 Synthes Australia Pty Ltd

SY699 SynPOR Anatomical Porous Polyethylene  08.mm - 1.5mm thick $900.00

 with Titanium

Prostheses List by Category, Groups and Sponsor Page 540 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.01.03.02 - 0.5-0.8mm thick, 26-50cm²

 Stryker Australia Pty Ltd

HW440 E-POR Biomaterial/ Panel - Porous  Panel - Porous Polyethlene Titanium  >0.8mm thick, 38mm x 50mm $975.00

 Polyethlene Titanium Mesh  Mesh Composite

 Composite

HW444 E-POR Biomaterial/ Panel - Porous  Panel - Porous Polyethylene  0.5mm-0.8mm thick, 76mm x  $975.00

 Polyethlene Titanium Mesh  Titanium Mesh Composite 50mm

 Composite

 07.01.03.03 - >0.8mm thick 26-50cm²

 Stryker Australia Pty Ltd

HW441 E-POR Biomaterial/ Panel - Porous  Panel - Porous Polyethylene  >0.8mm thick, 76mm x 50mm $1,150.00

 Polyethylene Titanium Mesh  Titanium Mesh Composite

 Composite

 Synthes Australia Pty Ltd

SY697 SynPOR Porous Polyethylene with Titanium > 08.mm thick $1,150.00

07.01.04 - Non-mesh

 Stryker Australia Pty Ltd

SK515 Nasal Sheet (Strut). Nasal Sheet (Strut). Model 9536 Nasal Sheet (Strut): 40 x 9 x  $220.00

 1.1mm

 07.01.04.01 - 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

Prostheses List by Category, Groups and Sponsor Page 541 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Henry Schein-Halas Pty Ltd

HD010 Bio-Gide Bio-Gide & Bio-Gide Perio are  30mm x 40mm $345.00

 collagen membranes containing

 porcine collagen in a bilayer

 structure.  They are used for guided

 bone regeneration and peridontal

 tissue regeneration in oral and

HD011 Bio-Gide Bio-Gide & Bio-Gide Perio are  25mm x 25mm $345.00

 collagen membranes containing

 porcine collagen in a bilayer

 structure.  They are used for guided

 bone regeneration and peridontal

 tissue regeneration in oral and

HD012 Bio-Gide Bio-Gide & Bio-Gide Perio are  13 x 25mm $345.00

 collagen membranes containing

 porcine collagen in a bilayer

 structure.  They are used for guided

 bone regeneration and peridontal

 tissue regeneration in oral and

HD013 Bio-Gide Perio Bio-Gide & Bio-Gide Perio are  Bio-Gide perio - 16mm x  $345.00

 collagen membranes containing  22mm

 porcine collagen in a bilayer

 structure.  They are used for guided

 bone regeneration and peridontal

 tissue regeneration in oral and

HD022 Mucograft Collagen Matrix 15mm x 20mm, 20mm x 30mm $345.00

 Medical & Optical Instruments Australia Pty Ltd

MO302 Martin Level One Fixation Resorb x  Reconstruction sheet not mesh  25x25mm-0.1mm $345.00

 & SonicWeld PDLLA (resorbable)

 07.01.04.02 - Polymer

 Johnson & Johnson Medical Pty Ltd

JJ303 Cranioplastic Kit (Type 1) Cranioplastic kit containing 2  30grams $240.00

 complete sets.  Consists of 2 bags of

 sterile powder, 2 vials sterile liquid, 2

  sterile matrix bags

Prostheses List by Category, Groups and Sponsor Page 542 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW006 Biopore Ultra thin Sheet An implantable device intended to  38 x 50mm $240.00

 support, contour, and provide

 structure for the craniofacial anatomy

 during reconstructive and plastic

 surgery procedures. Made of high-

 density polyethylene material with an

  interconnecting pore structure that

 supports tissue ingrowth. The device

 is available in various shapes and can

 be cut by the surgeon to meet the

 patient's specific needs.

MW007 Biopore Ultra Thin Sheet Large An implantable device intended to  76 x 127mm $240.00

 support, contour, and provided

 structure for the craniofacial anatomy

 during reconstructive and plastic

 surgery procedures. Made of high-

 density polyethylene material with an

  interconnecting pore structure that

 supports tissue ingrowth. The device

 is available in various shapes and can

 be cut by the surgeon to meet the

 patient's specific needs

 Stryker Australia Pty Ltd

HW416 Micro Thin Sheet Model/s 8438, 83020, 83022, 83029 8438: 30 x 50 x 0.4mm,   $240.00

 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,  Sheets 6330: 38 x 50 x  $240.00

 6331, 8662, 9562. Micro single  1.5mm, 6331: 50 x 76 x

 channel sheet, model 9528. Barrier  1.5mm, 8662: 76 x 127 x

 microplate single channel sheet,  1.5mm, 9862: 38 x 50 x 3mm.

 model 9527 Medpor Titan Implant   Microplate single channel

 Sheets Plain, Barrier & Double  Sheet 9528: 38 x 50 x

 Barrier, and Medpor Titan Orbital  0.85mm. Barrier microplate

 floor and wall sheets 8102 single channel Sheet 9527:

 38 x 50 x 0.85mm. Titan

 implant sheets 81020: 76 x

 50 x

Prostheses List by Category, Groups and Sponsor Page 543 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

HW418 Barrier Sheet: Barrier Sheet - Orbital Porus Polyethylene. Barrier  sheet -   Barrier  sheet - Rectangle:  $240.00

  Floor Rectangle, models 8312 and 9312.  50 x 76  x 1mm, 50 x 76 x

 Orbital floor implants, models 8305  1.6mm: 50 x 76 x 1mm, 50 x

 and 9305 76 x 1.6mm.  Orbital Floor:

 38 x 50 x 1mm, 38 x 50 x

 1.6mm

HW426 Ultra Thin Sheet Porus Polyethylene. Model 7214 76 x 127 x 0.85mm $240.00

HW427 Ultra Thin Sheet Porus Polyethylene. Model 7216 127 x 178 x 0.85mm $240.00

HW428 Sheet - Multi Channel, Barrier  Porus Polyethylene. Miniplate  Miniplate channel: 40 x 52  $240.00

 Channel. channel sheet, model 9529.  x 2.3mm. Mircoplate

 Microplate channel sheet, model  channel: 40 x 52 x 2.3mm.

 9530. Barrier Miniplate and  Barier Miniplate and

 Microplate Channel Sheets, Models  Microplate Channel Sheets:

 40 x 52 x 2.3mm, 40 x 52 x

HW442 E-POR Biomaterial/ Sheet - Porous  Sheet - Porous Polyethylene 30mm - 50mm x 0.4mm - 3mm $240.00

 Polyethylene

SK513 Ultra Thin Sheet Porus Polyethylene. Models 7210 38 x 50 x 0.85mm $240.00

SK516 Ultra Thin Sheet Porus Polyethylene. Model 7212 50 x 76 x 0.85mm $240.00

SK517 Sheet - Barrier Single Channel  Porus Polyethylene. Barrier Single  Barrier Single Channel: 38 x $240.00

 Channel Sheet, Model 9527.  50 x 0.85mm

 Synthes Australia Pty Ltd

SY696 SynPOR Porous Polyethylene 0.45mm - 3.0mm thick $240.00

 07.01.04.03 - Block

 Anatomics Pty Ltd

AT072 E-POR Biomaterial Block Preform - various 3D 13mm - $825.00

  63mm

Prostheses List by Category, Groups and Sponsor Page 544 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW001 Bipore Flexible Block An implantable device intended to  38 x50 x 3mm and 76 x 50 x  $825.00

 support, contour, and provide  9mm

 structure for the craniofacial anatomy

 during reconstructive and plastic

 surgery procedures. Made of high

 density polyethylene material with an

  interconnecting pore structure that

 supports tissue ingrowth. The device

 is available in various shapes and can

 be cut by the surgeon to meet the

 patient's specific needs.

 Stryker Australia Pty Ltd

HW506 Stryker MEDPOR Implant Porous Polyethylene Mesh Block $825.00

SK520 Medpor Porous Polyethylene  Porous Polyethylene Biomaterial  Custom designed and made  $825.00

 Biomaterial Custom Made Implant Custom Made Product for ear, nose,  from CT scan image

 face and Orbit reconstruction

07.01.05 - Fracture or Reconstruction Plates

 07.01.05.01 - <0.5mm thick, <4 holes

 Biomet Australia Pty Ltd

BI949 Neurological Packs Plate & screws: Neuro pack - single  1.5mm or 2mm system $65.00

 plate or thinflip 2 hole plate set

 Johnson & Johnson Medical Pty Ltd

JJ535 BIOPLATE Low Profile Low Profile 2-hole Straight Plate 11mm - 14mm length $65.00

 Medical & Optical Instruments Australia Pty Ltd

MO389 KLS Martin Neuro Fixation System Ultra low profile neuro plates 0.3mm thick 2 holes $65.00

 Surgiplas Medical

SP076 Plates Micro, Midface & Mini Straight Plate - 2 Hole,  $65.00

 Plate < 4 holes.

 Synthes Australia Pty Ltd

SY561 Matrix Micro Y Plate < 4 holes $65.00

Prostheses List by Category, Groups and Sponsor Page 545 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.01.05.02 - <0.5mm thick, 4-7 holes

 Johnson & Johnson Medical Pty Ltd

JJ845 Bioplate Plating System Plates of various shape 4 to 7 holes $140.00

 Medical & Optical Instruments Australia Pty Ltd

MO390 KLS Martin Neuro Fixation System Ultra low profile neuro plates 0.3mm thick 4-7 holes $140.00

 Synthes Australia Pty Ltd

SY562 Matrix Micro X, Frame plates 4  - 7 Holes $140.00

 Burr

 Johnson & Johnson Medical Pty Ltd

JJ544 BIOPLATE Low Profile Low Profile Flex Contoured Burr  Low profile 0.3mm, 1.5mm  $190.00

 Hole Cover diam hole, 12 - 18mm diam

 plate

 Lifehealthcare Pty Ltd

LH495 Martin Level One Fixation Plate, titanium <0.5mm thick, 4 to 7 holes $190.00

 Medical & Optical Instruments Australia Pty Ltd

MO121 Martin Level One Fixation Plate, titanium <0.5mm thick, 4 to 7 holes $190.00

 07.01.05.03 - <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

 Lifehealthcare Pty Ltd

LH504 Martin Osteosynthesis 1.5mm  Plate, Titanium <0.5mm thick, 8-15 holes $281.00

 System 8-15 hole plate

 Medical & Optical Instruments Australia Pty Ltd

MO391 KLS Martin Neuro Fixation System Ultra low profile neuro plates 0.3mm thick 8-15 holes $281.00

 Synthes Australia Pty Ltd

SY563 Matrix Micor Orbital curved plate 12 hole $281.00

Prostheses List by Category, Groups and Sponsor Page 546 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.01.05.04 - <0.5mm thick, 16-32 holes

 Lifehealthcare Pty Ltd

LH506 Martin Osteosynthesis 1.5mm  Plate, Titanium <0.5mm thick, 16-32 holes $380.00

 System 16-32 hole plate

 Synthes Australia Pty Ltd

SY558 Matrix Micro Adaption, Strut Plates 18-20 hole $380.00

 07.01.05.05 - 0.5-0.99mm thick, <4 holes

 Australian Surgical Innovations Pty Ltd

AI004 ASI Plates and Screws Plate Straight, Left, Right, X, T  $95.00

 and Y shaped

 B Braun Australia Pty Ltd

BB304 Aesculap CranioPlate System/ Plate Cranial fixation system, internal  Plate Neuro, 2 hole 11 &  $95.00

  Neuro, 2 hole straight fracture, non biodegradable.  Consists  16mm straight

 of screws, plates

 Biomet Australia Pty Ltd

BI677 W Lorenz Osteosynthesis System Plate, Neuro Straight, 1.5mm System,  2 hole (medium or long) $95.00

 Titanium

 Johnson & Johnson Medical Pty Ltd

JJ853 Bioplate Plating System Plates of various shape Less than 4 holes $95.00

 Lifehealthcare Pty Ltd

LH502 Martin Osteosynthesis 1.5mm  Plate, 0.6mm thick, titanium 2-4 hole $95.00

 System 2 hole plate

 Medical & Optical Instruments Australia Pty Ltd

MO283 Martin Micro Plate Osteosynthesis  1.5mm system Straight Plate Titanium 2 hole, 0.6mm profile $95.00

 System

 Medtronic Australasia Pty Ltd

MC872 TiMesh Rigid Fixation Bone  Titanium, Straight Plate < 4 holes $95.00

 Grafting and Plating System

MC908 Timesh Rigid Straight Plates < 4 holes $95.00

 National Surgical Pty Ltd

NK022 Jeil Medical - Plate , 4 holes Craniofacial fixation plate One size $95.00

Prostheses List by Category, Groups and Sponsor Page 547 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Stryker Australia Pty Ltd

HW497 Stryker Leibinger Plating System Craniofacial Fixation Plates 0.5 - 0.99mm thick, <4 holes $95.00

 Surgiplas Medical

SP075 Plates Micro, Midface & Mini Straight Plate - 2 Hole,  $95.00

 Plate < 4 holes.

SP101 Bioresorbable Fixation System Plates Neuro Fixation Set $95.00

 Burr

 Medtronic Australasia Pty Ltd

MC867 TiMesh Rigid Fixation Bone  Titanium, Plate Ohata Tristar 8.4 10mm, < 4  $140.00

 Grafting and 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 Plating System Titanium cranial compression plate 2 holes $140.00

 Lifehealthcare Pty Ltd

LH493 Neuro Flap Fix Kit (Sterile) Neuro Flapfix Kit (sterile) consists of  Plates: length 15mm / width $140.00

 three low-profile 2-hole plates & six   1mm /thick 0.6mm

 self-drilling 1.5-mm Screws: length 4mm/ width

 maxDrive screws. 1.5mm

 Synthes Australia Pty Ltd

SY580 AO/ASIF Plate Titanium adaption plate <4 holes $140.00

 Resorbable

 Synthes Australia Pty Ltd

SY512 AO/ASIF Plate Rapid resorbable reconstruction plate <4 holes $180.00

 07.01.05.06 - 0.5-0.99mm thick, 4-7 holes

 Aus Systems Pty Ltd

AU007 Aus Systems Titanium Miniplates  Plate Titanium 0.7mm profile 4-7 holes $170.00

 (Bone Plates)

Prostheses List by Category, Groups and Sponsor Page 548 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 B Braun Australia Pty Ltd

BB305 Aesculap CranioPlate System/Plate  Cranial fixation system, internal  Plate Neuro, 6 hole 10 x 17  $170.00

 Neuro, 6 hole rectangular fracture, non biodegradable.  Consists  mm rectangular

 of screws, plates.

BB306 Aesculap CranioPlate System/ Plate Cranial fixation system, internal  Plate Neuro, 4 hole 10mm  $170.00

  Neuro, 4 hole square fracture, non biodegradable.  Consists  square

 of screws, plates.

BB307 Aesculap CranioPlate System/ Plate Cranial fixation system, internal  Plate Neuro, 4 hole 17 & 20 $170.00

  Neuro, 4 hole straight fracture, non biodegradable.  Consists   mm straight

 of screws, plates.

BB308 Aesculap CranioPlate System/ Plate Cranial fixation system, internal  Plate Neuro, 6 hole 15 &  $170.00

  Neuro, 6 hole double Y fracture, non biodegradable.  Consists  17mm, double Y shape

 of screws, plates.

BB309 Aesculap CranioPlate System/ Plate Cranial fixation system, internal  Plate Neuro, 5 hole 17mm,  $170.00

  neuro, 5 hole Y fracture, non biodegradable.  Consists  Y shape

 of screws, plates

BB313 Aesculap CranioPlate System/ Plate Cranial fixation system, internal  Plate Neuro, 6 hole x 16 &  $170.00

  Neuro, Burr hole cover 12 & 16mm fracture, non biodegradable.  Consists  20mm Burr hole cover

 of screws, plates.

 Biomet Australia Pty Ltd

BI348 W Lorenz Osteosynthesis System L-Plate, 2mm System, Left or Right.  2 x 2 hole, Mini or Low  $170.00

 Titanium Profile

BI351 W Lorenz Osteosynthesis System L-Plate, 2mm System, Left or Right.  2 x 2 hole, long $170.00

 Titanium

BI605 W Lorenz Osteosynthesis System Plate, Matrix, 1.0 or 1.5mm System,  6 hole $170.00

 Titanium

BI617 W Lorenz Osteosynthesis System Plate, Straight, 1mm System. Titanium 4 hole $170.00

BI620 W Lorenz Osteosynthesis System Plate, Straight, low profile, 2.0mm  4 - 8 hole $170.00

 System, Titanium

BI621 W Lorenz Osteosynthesis System Plate, L , 2.5mm or 2m system,  2 x2 or 3x3 hole $170.00

 Titanium

BI622 W Lorenz Osteosynthesis System Z-Shape Plate, Left or Right, 1.5mm or  2 x 2 hole $170.00

 2mm System. Titanium

BI623 W Lorenz Osteosynthesis System T-Plate, Left or Right, 1.5mm System.  3x3 hole, 7x7 hole $170.00

 Titanium

Prostheses List by Category, Groups and Sponsor Page 549 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BI624 W Lorenz Osteosynthesis System T-Plate 90 degrees, Left or Right, 2mm 2x5hole, 3x3hole, 2x3hole $170.00

  System. Titanium

BI625 W Lorenz Osteosynthesis System Plate, Y, Double Y, X, 1.5mm System  One size only $170.00

 or 2.0mm System, Titanium

BI627 W Lorenz Osteosynthesis System Plate, Straight, 1.5mm System, Titanium 4 or 6 hole $170.00

BI638 W Lorenz Osteosynthesis System Plate, Orbital. 1mm System, Titanium One size only $170.00

BI639 W Lorenz Osteosynthesis System Plate, Square. 1mm System. Titanium 4 hole $170.00

BI656 W Lorenz Osteosynthesis System Plate, Orbital, 1.5mm, 2.0mm System,  6 hole $170.00

 Titanium

BI717 W Lorenz Osteosynthesis System Neuro Gap Plate, Titanium 6 hole, 45mm length $170.00

BI718 W Lorenz Osteosynthesis System Neuro Gap Plate, Titanium 6 hole 25mm length $170.00

BI720 W.Lorenz Osteosynthesis System Neuro Gap Plate; titanium 6 hole, 35mm length $170.00

BI728 W.Lorenz Osteosynthesis System Neuro Square or Rectangular Plate,  1.5mm system, 4 hole $170.00

 titanium

BI988 W Lorenz Osteosynthesis System Plate Straight 2mm System 4 - 7 hole $170.00

 Johnson & Johnson Medical Pty Ltd

JJ847 Bioplate Plating System Plates of various shape 4 to 7 holes $170.00

 Lifehealthcare Pty Ltd

LH503 Martin Osteosynthesis 1.5mm  Plate, 0.6mm thick, Titanium 4-7 hole $170.00

 System 4-7 hole plate

 Medical & Optical Instruments Australia Pty Ltd

MO401 Martin Level One Fixation Plate Titanium 0.5 to 0.99mm thick, 4 - 7  $170.00

 holes

 Medtronic Australasia Pty Ltd

MC393 TiMesh Rigid Fixation Bone  Titanium, Z Plate Left and Right 4 hole - 5mm, 9.5mm $170.00

 Grafting and Plating System

MC519 TiMesh Squareplate 4 holes x 1mm - 4 holes x  $170.00

 2.2mm

MC520 TiMesh X Plate 4 holes x 1mm - 4 holes x  $170.00

 2.2mm

MC576 Timesh Double Y Plates 3 Hole - 2.5mm - 7mm $170.00

MC870 TiMesh Rigid Fixation Bone  Titanium, Y Plate Double and Single 4 - 7 hole $170.00

 Grafting and Plating System

Prostheses List by Category, Groups and Sponsor Page 550 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

MC875 TiMesh Rigid Fixation Bone  Titanium, T Plate 4 - 7 hole $170.00

 Grafting and Plating System

MC883 TiMesh Rigid Fixation Bone  Titanium, L Plate (Left and right  4 to 7 holes $170.00

 Grafting and Plating System configurations)

MC885 TiMesh Rigid Fixation Bone  Titanium, H Plate 4 - 7 hole $170.00

 Grafting and Plating System

MC891 Macropore Oblique Plates 4 to 7 holes $170.00

MC909 Timesh Rigid Straight Plates 4 - 7 holes $170.00

 National Surgical Pty Ltd

NK023 Jeil Medical - Plates - 4-7 Holes Craniofacial fixation plates Straight plate: Holes 6, Burr $170.00

  hole plates: Holes: 5 -6,

 Diam: 15mm - 22mm

 Stryker Australia Pty Ltd

HW498 Stryker Leibinger Plating System Craniofacial Fixation Plates 0.5 - 0.99mm thick, 4 -7 holes $170.00

 Surgiplas Medical

SP074 Plates Micro, Midface, Mini, BSSO, TR  4 Hole BSSO Plate Short,  $170.00

 BSSO 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  $170.00

 Plates 4 to 7 Holes

SP087 Plates Mini & Maxi Zygomatic Plates, Pyriform  $170.00

 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

Prostheses List by Category, Groups and Sponsor Page 551 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Burr

 Aus Systems Pty Ltd

AU014 Aus Systems Titanium Miniplates  Low profile burr hole cover 10mm, 14mm, 18mm, 22mm $170.00

 (Bone Plates)

 Biomet Australia Pty Ltd

BI353 W Lorenz Osteosynthesis System Plate, Burr Hole, 1mm, 1.5mm, 2mm  13mm, 17mm, 18.5mm $170.00

 system

BI721 W Lorenz Osteosynthesis System Plate, Burr Hole, 1.5mm System,  22mm, 25mm $170.00

 Titanium

BI870 Neurological Packs Plate & screws: Neuro pack Burr  1.5mm or 2mm system $170.00

 cover or multi plate set.  Thinflap 4

 hole plus plate sets

 Johnson & Johnson Medical Pty Ltd

JJ848 Bioplate Plating System Titanium Burr Hole Covers 4 to 7 holes $170.00

 Lifehealthcare Pty Ltd

LH507 Martin Osteosynthesis 1.5mm  Burr Hole Plate, Titanium 0.6mm thick, 4-7 holes $170.00

 System Burr hole plate

 Medtronic Australasia Pty Ltd

MC868 TiMesh Rigid Fixation Bone  Titanium, Plate Fan Blade 11-18mm, Mesh  $170.00

 Grafting and Plating System 11-25mm, 4 - 7 hole

 Stryker Australia Pty Ltd

ST141 Leibinger Titanium Implant System Leibinger Burr Hole Cover: curved   7, 10, 14mm $170.00

 Titanium

 Surgiplas Medical

SP072 Plates Micro, Mini, Maxi Burr Hole Plates, Calvarium $170.00

  Plate - Small & Large -

 Calvarium Plate, Plates 4 to

 7 Holes

 Synthes Australia Pty Ltd

SY319 AO/ASIF Plate Low profile neurosurgical plate, burr  4-7 holes $170.00

 hole

 Complex

 Biomet Australia Pty Ltd

BI591 W Lorenz Osteosynthesis System Chin Plates, Paulus, 2mm System,  4 - 12mm $246.00

 Titanium

Prostheses List by Category, Groups and Sponsor Page 552 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medical & Optical Instruments Australia Pty Ltd

MO224 Martin Level One Fixation Plate, titanium 0.5-0.99mm thick, 4-7 holes $246.00

 Surgiplas Medical

SP070 Plates Micro, Mini, Maxi Gap Plates, Plates 4 to 7  $246.00

 holes

 Synthes Australia Pty Ltd

SY582 AO/ASIF Plate Titanium adaption plate 4-7 holes $246.00

 Compression

 Biomet Australia Pty Ltd

BI349 W Lorenz Osteosynthesis System Plate, Compression Straight, 2mm  4 hole $170.00

 System. Titanium

 Stryker Australia Pty Ltd

HW501 Stryker Leibinger Plating System Craniofacial Fixation Plates,  0.5 - 0.9mm thick, 4 -7 holes $170.00

 Compression

 Surgiplas Medical

SP033 OsteoMed Plating & Fixation System Compression Plates - Micro, Mini &  Micro: 2 x 3 Hole  $170.00

 Maxi Compression 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

SY581 AO/ASIF Plate Titanium adaption plate 4-7 holes $170.00

 Locking

 Stryker Australia Pty Ltd

HW500 Stryker Leibinger Plating System Craniofacial Fixation Plates ,Locking 0.5 - 0.9mm thick, 4 -7 holes $195.00

 Resorbable

 Biomet Australia Pty Ltd

BH001 Lactosorb Resorbable  Lactosorb Plates, 2mm System, All  4 - 7 hole $200.00

 Craniomaxillofacial Fixation System shapes PGA/PLA

Prostheses List by Category, Groups and Sponsor Page 553 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BI990 Lactosorb Resorbable CMF System Lactosorb Plates, 1.5mm System 4 - 7 hole $200.00

 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

MC563 Macropore Straight Plates 4 hole $200.00

 Stryker Australia Pty Ltd

HW499 Delta Resorbable Fixation System Craniofacial Resorbable Fixation  0.5 -0.99mm thick, 4 - 7 holes $200.00

 Synthes Australia Pty Ltd

SY504 AO/ASIF Plate Rapid resorbable reconstruction plate 4-7 holes $200.00

 07.01.05.07 - 0.5-0.99mm thick, 8-32 holes

 Aus Systems Pty Ltd

AU060 Aus systems titanium Miniplates  titanium miniplates 8,19 hole $204.00

 (Bone plates)

 B Braun Australia Pty Ltd

BB310 Aesculap CranioPlate System/ Plate Cranial fixation system, internal  Plate Neuro, 8 hole 10 x 24  $204.00

  Neuro, 8 hole rectangular fracture, non biodegradable.  Consists  mm rectangular

 of screws, plates.

BB317 Aesculap CranioPlate System/ Plate Cranial fixation system, internal  Plate Neuro, 16 hole 63mm  $204.00

  Neuro, 16 hole straight fracture, non biodegradable.  Consists  straight

 of screws, plates.

 Biomet Australia Pty Ltd

BI641 W Lorenz Osteosynthesis System Plate, Matrix.  1mm System, 1.5mm  2 x 4 hole $204.00

 System. Titanium

BI658 W Lorenz Osteosynthesis System Plate, Orbital. 1.5mm System, 2mm  8-10 hole $204.00

 System. Titanium

BI719 W Lorenz Osteosynthesis System Neuro Sub-Temporal Plate, Titanium medium $204.00

BI773 W Lorenz Osteosynthesis System Neuro sub-temporal plate, 1.5 system,  Small $204.00

 titanium

BI985 W Lorenz Osteosynthesis System Plates Straight, 1.5, 2.0 or 1.0mm  15 - 32 holes $204.00

 System

Prostheses List by Category, Groups and Sponsor Page 554 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BI989 W Lorenz Osteosynthesis System Plate Straight, 2mm System 8 - 15 hole $204.00

 Johnson & Johnson Medical Pty Ltd

JJ846 Bioplate Plating System Plates of various shape 8 to 32 holes $204.00

 Lifehealthcare Pty Ltd

LH505 Martin Osteosynthesis 1.5mm  Plate, 0.6mm thick, Titanium 8-32 hole $204.00

 System 8-32 hole plate

 Medical & Optical Instruments Australia Pty Ltd

MO328 Martin Level One Fixation Plate Titanium 0.5-0.99mm thick, 8-32 holes $204.00

 Medtronic Australasia Pty Ltd

MC678 TiMesh Rigid Fixation Bone  Titanium, Universal Plate 12h $204.00

 Grafting and Plating System

MC871 Ti Mesh Rigid Fixation Bone  Titanium ,Straight Plate 8 - 32 holes $204.00

 Grafting and Plating System

MC876 TiMesh Rigid Fixation Bone  Titanium, T Plate 8 - 15 hole $204.00

 Grafting and Plating System

MC884 TiMesh Rigid Fixation Bone  Titanium, L Plate (Left and right  8 - 15 hole $204.00

 Grafting and Plating System configurations)

MC886 TiMesh Rigid Fixation Bone  Titanium, H Plate 8-15 hole $204.00

 Grafting and Plating System

MC892 Macropore Oblique Plates 8 to 15 holes $204.00

MI091 TiMesh Rigid Straight Plate 8 -32 holes $204.00

 Stryker Australia Pty Ltd

HW502 Stryker Leibinger Plating System Craniofacial Fixation Plates 0.5 - 0.99mm thick, 8 -32  $204.00

 holes

 Surgiplas Medical

SP077 Plates Micro, Midface & Mini Quad Plate, Quad Plate -  $204.00

 Short, Plate 8 to 15 holes.

SP083 Plates Mini & Maxi 16 & 18 Hole Straight  $204.00

 Plate, 18 Hole Straight

 Plate, Plates 15 to 32 Holes

Prostheses List by Category, Groups and Sponsor Page 555 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

SP085 Plates Mini & Maxi Curved Plate, 8 Hole  $204.00

 Straight 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

 3D

 Surgiplas Medical

SP071 Plates Micro, Mini, Maxi Quad Plates, Medium 2 x 4  $210.00

 Hole Quad Plate, Plates 8

 to 15 holes

 Burr

 Medtronic Australasia Pty Ltd

MC869 TiMesh Rigid Fixation Bone  Titanium, Plate Ohata Kerf Cover, 5 - 32 hole $430.00

 Grafting and Plating System

 Stryker Australia Pty Ltd

SK355 Universal Neuro Titanium Low  Titanium Low Profile plates used for  Small, large, 20mm burr  $430.00

 Profile Plate the fixation of cranial bone flaps hole, 16 hole without bar

 Complex

 Biomet Australia Pty Ltd

BI774 W Lorenz Osteosynthesis System Lefort plate, 1.5mm system, 0.6mm  Flat, 2-11mm $280.00

 thickness, titanium

 Stryker Australia Pty Ltd

SK345 Leibinger Titanium Implant System - Le Fort 1 Plate, Right/Left 11hole, Advancement 2 -  $280.00

  Universal CMF Plate 10mm

 Surgiplas Medical

SP082 Plates Micro, Mini Sub - Temporal Plates,  $280.00

 Plates 8 to 15 Holes

 Synthes Australia Pty Ltd

SY585 AO/ASIF Plate Titanium adaption plate 8-32 holes $280.00

Prostheses List by Category, Groups and Sponsor Page 556 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Compression

 Synthes Australia Pty Ltd

SY583 AO/ASIF Plate Titanium adaption plate 8-32 holes $200.00

 Locking

 Stryker Australia Pty Ltd

HW486 Stryker Leibinger Hybrid MMF Plate SMARTLOCK Hybrid MMF Plate,  One size - 9 Hole Straight  $312.00

 Locking Plate, for maxilla and

 System - Universal SMARTLOCK  Mandible

 Hybrid MMF

 Component - MMF Plate

HW504 Stryker Leibinger Plating System Craniofacial Locking Fixation Plates 0.5 - 0.99mm thick, 8 -32  $312.00

 holes

 Resorbable

 Biomet Australia Pty Ltd

BH002 Lactosorb Resorbable  Lactosorb Plates, 2mm System, All  8 - 15 hole $215.00

 Craniomaxillofacial Fixation System shapes PGA/PLA

BI991 Lactosorb Resorbable CMF System Lactosorb Plates, 1.5mm System 8 - 15 hole $215.00

BI992 Lactosorb Resorbable CMF System Lactosorb Plates, 1.5mm System 16 - 32 holes- $215.00

 Medtronic Australasia Pty Ltd

MC547 Macropore Z Plates 10 hole $215.00

MC559 Macropore L Plates 8 hole, Left & Right $215.00

MI089 Macropore Straight Plates 8 -20 hole $215.00

 Stryker Australia Pty Ltd

HW503 Delta Resorbable fixation System Craniofacial Resorbable Fixation  0.5 - 0.99mm thick, 8 -32  $215.00

 holes

 Synthes Australia Pty Ltd

SY397 PolyMax Resorbable Fixation System 1.5 Burr Hole Cover 8 Hole $215.00

SY584 AO/ASIF Plate Rapid resorbable reconstruction plate 8-32 holes $215.00

 07.01.05.08 - 0.5-0.99mm thick, >32 holes

 Johnson & Johnson Medical Pty Ltd

JJ255 BIOPLATE Biomesh Titanium, lattice, 48 hole, packaged  32 x 44mm $300.00

 non-sterile

Prostheses List by Category, Groups and Sponsor Page 557 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Surgiplas Medical

SP081 Plates Micro, Mini 40 Hole Straight Plate,  $300.00

 Mesh 18 row, Plate >32

 Synthes Australia Pty Ltd

SY466 AO/ASIF Plate Titanium adaption plates >32 holes $300.00

 Resorbable

 Biomet Australia Pty Ltd

BI993 Lactosorb Resorbable CMF System Lactosorb Plates, 1.5mm System 32+ holes- $380.00

 Synthes Australia Pty Ltd

SY514 AO/ASIF Plate Rapid resorbable reconstruction plate >32 holes $380.00

 07.01.05.09 - 1.0-1.99mm 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

HW505 Stryker Leibinger Plating System Mandible Fixation Plates 1.0 - 1.99mm thick, <4 holes $115.00

 Synthes Australia Pty Ltd

SY317 AO/ASIF Plate Titanium Plate - straight 1.6mm Profile, 2-4 holes $115.00

 Resorbable

 Surgical Specialties

SQ055 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5-2.5mm plates:- 2-10  $220.00

   Polylactic Acid Trimethylene  hole plates and extended, c-

 Carbonate Copolymer plate & x-plate 7 hole, H-

 plate 8 hole, orthognathic

 hole and L-plate L & R 7

 Synthes Australia Pty Ltd

SY506 AO/ASIF Plate Rapid resorbable reconstruction plate <4 holes $220.00

 07.01.05.10 - 1.0-1.99mm thick, 4-7 holes

 Aus Systems Pty Ltd

AU061 Aus Systems Titanium Miniplates  Titanium Miniplates 1.0-1.99mm thick, 4-7 holes $165.00

 (bone Plates)

Prostheses List by Category, Groups and Sponsor Page 558 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Biomet Australia Pty Ltd

BH026 Mandibular Fracture System Plates, Angled or Curved, 2.0  4 - 7 hole $165.00

 Mandibular System, Titanium

BH028 Manibular Fracture System Plates, matrix shape, 2.0 mandibular  4 or 6 hole $165.00

 system. Titanium

BI635 W Lorenz Osteosynthesis System Plate, DoubleT, Double Y, 1mm, 2mm  4-7 Hole $165.00

 system, plate thickness 0.6 or 1mm,

 Titanium

BI755 Mandibular Fracture System Plates, Y Shapek, 2.0 Mandibular  5 hole long, 5 hole medium,  $165.00

 Fracture System, Titanium 5 hole regular

BI764 Mandibular Fracture System Plates, 2.0 / 2.4 Mandibular Fracture  4-7 hole $165.00

 System, Titanium

 Lifehealthcare Pty Ltd

LH513 Martin Osteosynthesis 1.5mm  Plate, Titanium 1.0-1.99mm thick, 4-7 holes $165.00

 System Mesh 1mm 4-7 hole plate

 Medical & Optical Instruments Australia Pty Ltd

MO403 Martin Level  One Fixation Plate Martin Level One Fixation 1.0-1.99mm thick, 4-7 holes $165.00

 Medtronic Australasia Pty Ltd

MC517 TiMesh Mandibular "J" Plate One size only $165.00

 Stryker Australia Pty Ltd

HW492 Stryker Leibinger Plating System Mandible Fixation plates 1.0 - 1.99mm thick, 4 - 7  $165.00

 holes

 Surgiplas Medical

SP073 Plates Micro, Midface, Mini, BSSO, TR  2 x 3 Hole Quad Plate, Plate $165.00

 BSSO  4 to 7 holes.

 Complex

 Stryker Australia Pty Ltd

SK131 Leibinger Titanium Implant System - Items used for reconstruction and  Universal Mandible  $350.00

  Universal Mandible Fracture Plate fixation of mandibular fractures and  Fracture Plate, C-shaped, 4

 tumour resection.

SK132 Leibinger Titanium Implant System - Items used for reconstruction and  Universal Mandible  $350.00

  Universal Mandible Fracture Plate fixation of mandibular fractures and  Fracture Plate, Angled

 tumour resection. Shaped, 6 holes, 115-140 deg

Prostheses List by Category, Groups and Sponsor Page 559 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Surgiplas Medical

SP018 Plates Micro, Midface, Mini & Maxi Chin Plate 2, 3, 4, 6, 8, 10 & $350.00

  12mm, Plates 4 to 7 holes.

 Compression

 Biomet Australia Pty Ltd

BI754 Mandibular Fracture System Plates, Compression, 2.0 Mandibular  4 hole $165.00

 Fracture System, Titanium

BI756 Mandibular Fracture System Plates, Compression, 2.0 Mandibular  4-6 hole $165.00

 Fracture System, Titanium

 Stryker Australia Pty Ltd

SK129 Leibinger Titanium Implant System - Items used for reconstruction and  Universal Mandible  $165.00

  Universal Mandible Compression  fixation of mandibular fractures and  Compression Plate, 4-6

 Plate tumour resection.

 Surgiplas Medical

SP028 OsteoMed Plating & Fixation System Plates - Fracture 4 hole Fracture Plate 32 - $165.00

 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 $165.00

  Plate

 Synthes Australia Pty Ltd

SY498 AO/ASIF Plate Mandible plate 4-7 holes $165.00

 Locking

 Medical & Optical Instruments Australia Pty Ltd

MO342 Martin Level One Fixation Plate Titanium locking 1.0 to 1.99 mm thick, 4 - 7  $470.00

 holes

 Stryker Australia Pty Ltd

HW493 Stryker Leibinger Plating System Mandible Locking Fixation Plates 1.0 -1.9mm thick, 4 - 7 holes $470.00

 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

SY587 AO/ASIF Plate Titanium mandible locking plate,  4-7 holes $470.00

 complex shape

Prostheses List by Category, Groups and Sponsor Page 560 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 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

 & SonicWeld Rx holes

 Medtronic Australasia Pty Ltd

MC567 Macropore Clover Leaf Plates 4 hole $260.00

 Stryker Australia Pty Ltd

ST519 Stryker Leibinger Resorbable  Resorbable plate: L-shape plate, 110  7 holes $260.00

 Fixation System deg, right/left Tripoymer

 Surgical Specialties

SQ054 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5mm plates:- 20 holes, c- $260.00

   Polylactic Acid Trimethylene  plate & x-plate 7 hole, L-

 Carbonate Copolymer plate 7 hole L & R. burrhole

 Synthes Australia Pty Ltd

SY507 AO/ASIF Plate Rapid resorbable reconstruction plate 4-7 holes $260.00

 07.01.05.11 - 1.0-1.99mm thick, 8-15 holes

 Biomet Australia Pty Ltd

BH027 Mandibular Fracture System Plates, Angled or Curved, 2.0  8 hole $420.00

 Mandibular System, Titanium

BH029 Mandibular Fracture System Plates, matrix shape, 2.0 mandibular  8 to 16 hole $420.00

 system. Titanium

BI767 Mandibular Fracture System Plates, Straight, 2.0 Mandibular  8-15 hole $420.00

 Fracture System, Titanium

 Lifehealthcare Pty Ltd

LH514 Martin Osteosynthesis 1.5mm  Plate, Titanium 1.0-1.99mm thick, 8-15 holes $420.00

 System 1mm 8-15 hole plate

 Medical & Optical Instruments Australia Pty Ltd

MO400 Martin Level One Fixation Plate ,Titanium 1.0 to 1.99mm thick, 8 -15  $420.00

 holes

 Medtronic Australasia Pty Ltd

MC522 TiMesh Curved Plate:  Standard, Rigid, Left,  1mm x 12 holes $420.00

 Right

Prostheses List by Category, Groups and Sponsor Page 561 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Stryker Australia Pty Ltd

HW508 Stryker Leibinger Plating System Mandible Locking Fixation Plates 1.0 - 1.99mm thick, 8 - 15  $420.00

 holes

 Surgiplas Medical

SP086 Plates Mini & Maxi 12 Hole Straight Plate 1.0  $420.00

 mm thick, 8 Hole Straight

 Plate 1.0 mm thick, Plates 8

 to 15 holes

 Locking

 Stryker Australia Pty Ltd

HW494 Stryker Leibinger Plating System Mandible Fixation Plates 1.0 - 1.99mm thick, 8 -15  $645.00

 holes

 Surgiplas Medical

SP117 OsteoMed Plating & Fixation System Mandible Locking plates 8-15 Hole Plates, 1.0-1.99  $645.00

 mm thick

 Synthes Australia Pty Ltd

SY588 AO/ASIF Plate Titanium mandible locking plate,  8-15 holes $645.00

 complex shape

 Resorbable

 Medical & Optical Instruments Australia Pty Ltd

MO326 Martin Level One Fixation Resorb x  Plate PDLLA (resorbable) 1.0 to 1.99mm thick, 8 to 15  $420.00

 & Sonic Weld holes

 Medtronic Australasia Pty Ltd

MC566 Macropore C Plates 8 hole $420.00

 Surgical Specialties

SQ062 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Plates 6 & 8 hole $420.00

 copolymer

 Synthes Australia Pty Ltd

SY508 AO/ASIF Plate Rapid resorbable reconstruction plate 8-15 holes $420.00

 07.01.05.12 - 1.0-1.99mm thick, 16-32 holes

 Aus Systems Pty Ltd

AU019 Aus Systems Titanium Miniplates  Plate Titanium 1mm & 1.2mm profile 16 &  $204.00

 (Bone Plates) 19 hole

Prostheses List by Category, Groups and Sponsor Page 562 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Biomet Australia Pty Ltd

BI762 Mandibular Fracture System Plates, 2.4 Mandibular Fracture  16 - 24 Hole $204.00

 System, Titanium

 Lifehealthcare Pty Ltd

LH515 Martin Osteosynthesis 1.5mm  Plate, Titanium 1.0-1.99mm thick, 16-32  $204.00

 System 1mm 16-32 hole plate holes

 Medical & Optical Instruments Australia Pty Ltd

MO295 Martin Level One Fixation Plate Titanium 1.0 to 1.99mm thick, 16 to  $204.00

 32 holes

 Stryker Australia Pty Ltd

HW495 Stryker Leibinger Plating System Mandible Fixation Plates 1.0 - 1.9mm thick, 16- 32  $204.00

 holes

 Surgiplas Medical

SP067 Plates Micro, Mini, Maxi 16 Hole Straight Plate,  $204.00

 1.0mm thick, Plate 15 to 32

 holes

 3D

 Medical & Optical Instruments Australia Pty Ltd

MO294 Martin Level One Fixation Plate, titanium 1.0 to 1.99mm thick, 16 to  $818.00

 32 holes

 Locking

 Stryker Australia Pty Ltd

HW496 Stryker Leibinger Plating System Mandible Fixation Plates 1.0 -1.9mm thick, 16 - 32  $818.00

 holes

 Surgiplas Medical

SP118 OsteoMed Plating & Fixation System Mandible Locking Plates 16-32 Hole Plates, 1.0-1.99  $818.00

 mm thick

 Locking, Complex

 Synthes Australia Pty Ltd

SY493 AO/ASIF Plate Titanium Mandibular locking plate,  16-32 holes $1,400.00

 complex shape

Prostheses List by Category, Groups and Sponsor Page 563 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 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  $420.00

 & SonicWeld Rx 32 holes

 Surgical Specialties

SQ053 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates. 1.5mm baby plates:- 20  $420.00

   Polylactic Acid Trimethylene  hole, c-plate & x-plate 7

 Carbonate Copolymer hole, 2 hole

 Synthes Australia Pty Ltd

SY589 AO/ASIF Plate Rapid resorbable reconstruction plate 16-32 holes $420.00

 07.01.05.13 - 1.0-1.99mm thick, >32 holes

 Complex

 Synthes Australia Pty Ltd

SY700 AO/ASIF Plate Titanium Mandibular locking plate,  >32 holes $840.00

 complex shape

 Resorbable

 Synthes Australia Pty Ltd

SY511 AO/ASIF Plate Rapid resorbable reconstruction plate >32 holes $420.00

 07.01.05.14 - 2.0-2.99mm thick, 4-7 holes

 Surgiplas Medical

SP120 OsteoMed  Plating & Fixation System Mandible locking plates 4-7 Holes, 2.0-2.99 mm  $620.00

 Compression

 Synthes Australia Pty Ltd

SY499 AO/ASIF Plate Titanium mandible plate 4-7 holes $720.00

 07.01.05.15 - 2.0-2.99mm thick, 8-15 holes

 Compression

 Synthes Australia Pty Ltd

SY497 AO/ASIF Plate Titanium mandible plate 8-15 holes $780.00

Prostheses List by Category, Groups and Sponsor Page 564 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Locking

 Biomet Australia Pty Ltd

BI447 Lorenz 2.4mm Locking  Plate, Curved, Std Thickness, 2.4mm  8 or 15 hole $950.00

 Reconstruction System System, Titanium

BI987 Lorenz 2.4mm Locking  Plates Plate, Angled 2.4mm System, Ti 5 x 11 hole $950.00

 Reconstruction System

 Stryker Australia Pty Ltd

SK140 Leibinger Titanium Implant System - Items used for reconstruction and  Universal Mandible  $950.00

  Universal Mandible  fixation of mandibular fractures and  Reconstruction Plate, 11 -

 Reconstruction Plate tumour resection. 17 holes, straight with

 Synthes Australia Pty Ltd

SY599 AO/ASIF Plates Titanium mandible locking plate 8-15 holes $950.00

 07.01.05.16 - 2.0-2.99mm thick, 16-32 holes

 Complex, Locking

 Synthes Australia Pty Ltd

SY780 AO/ASIF Plate Anatomical Preformed Complex  Small, Medium, Large $1,320.00

 Locking Reconstruction Plates

 Compression

 Synthes Australia Pty Ltd

SY500 AO/ASIF Plate Titanium mandible plate 15-32 holes $900.00

 Locking

 Biomet Australia Pty Ltd

BI448 Lorenz 2.4mm Locking  Plate, curved, std or low profile,  16-32 hole $1,100.00

 Reconstruction System 2.4mm system, titanium

BI452 Lorenz 2.4mm Locking  Plate, curved. Std or low profile,  16 hole $1,100.00

 Reconstruction System 2.4mm System, Titanium

BI455 Lorenz 2.4mm Locking  Plate, Double Angled, 2.0 or 2.4mm  5 x (22 or 24) x 5 hole $1,100.00

 Reconstruction System System, Titanium

BI986 Lorenz 2.4mm Locking  Plates Plate, Angled 2.4mm System Ti 5 x (22 -24) hole $1,100.00

 Reconstruction System

 Medical & Optical Instruments Australia Pty Ltd

MO399 KLS Martin Plating System Preshaped reconstruction plates, in  2.0mm and 2.5mm thickness  $1,100.00

 left and right options with 26 holes

Prostheses List by Category, Groups and Sponsor Page 565 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Stryker Australia Pty Ltd

SK138 Leibinger Titanium Implant System - Items used for reconstruction and  Universal Mandible  $1,100.00

  Universal Mandible  fixation of mandibular fractures and  Reconstruction Plate,

 Reconstruction Plate tumour resection. (Full), 6 + 13 + 6 holes,

 with template

SK141 Leibinger Titanium Implant System - Items used for reconstruction and  Universal Mandible  $1,100.00

  Universal Mandible  fixation of mandibular fractures and  Reconstruction Plate,

 Reconstruction Plate tumour resection (Hemi), Right and Left, 6 +

 17 holes with template

SK142 Leibinger Titanium Implant System - Items used for reconstruction and  Universal Mandible  $1,100.00

  Universal Mandible  fixation of mandibular fractures and  Reconstruction Plate,

 Reconstruction Plate tumour resection (Full), 6 + 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

SY600 AO/ASIF Plate Titanium mandible locking plate 16-32 holes $1,100.00

 07.01.05.17 - 2.0-2.99mm thick, >32 holes

 Complex

 Synthes Australia Pty Ltd

SY472 AO/ASIF Plate Titanium mandible locking plate,  >32 holes $1,450.00

 complex shape

 07.01.05.18 - 3mm thick, 4-7 holes

 Complex

 Synthes Australia Pty Ltd

SY550 Titanium Sternal Fixation System Locking Plate - Star Star: 6 holes $1,480.00

 07.01.05.19 - 3mm thick, 8-15 holes

 Complex

 Lifehealthcare Pty Ltd

LH500 Martin Sternal Talon® An advanced system for rigid sternal  Widths: XS, S, M, L, $1,480.00

 fixation made of titanium alloy. Single   Foot plate lengths: 11, 14

 sternal talon         ( Two legs) ,17 ,20mm

Prostheses List by Category, Groups and Sponsor Page 566 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 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

 07.01.05.20 - 3mm thick, 16-32 holes

 Complex

 Lifehealthcare Pty Ltd

LH501 Martin Sternal Talon® an advanced system of rigid sternal  Widths: S, M; Four foot  $1,800.00

 fixation made of titanium alloy.  plate depths: 11, 14, 17,

 Double sternal talon     (4 legs) 20mm

 Synthes Australia Pty Ltd

SY347 Titanium Sternal Fixation System Locking Plate - straight 20 or 30 holes $1,800.00

 Compression

 Synthes Australia Pty Ltd

SY501 AO/ASIF Plate Titanium mandible plate 16-32 holes $1,350.00

 Locking

 Medical & Optical Instruments Australia Pty Ltd

MO410 Martin Level One Fixation Plate, Titanium 3mm thick, 16 to 32 Holes $1,420.00

07.01.06 - Screws

 07.01.06.01 - Diameter 1.24mm

 Biomet Australia Pty Ltd

BH013 W Lorenz Osteosynthesis System Small Fragment Titanium System,  Screw, 1.2mm diameter,  $70.00

 Titanium 1.4mm diameter

 Medical & Optical Instruments Australia Pty Ltd

MO287 Martin Level One Fixation Screw Titanium diameter <1.24mm $70.00

 Medtronic Australasia Pty Ltd

MC574 Timesh X-Drive Screws 2 - 15mm $70.00

MC879 TiMesh Rigid Fixation Bone  Titanium, Screw - Cruciate Head, 12  Diameter <1.24mm $70.00

 Grafting and Plating System point Flat Head

Prostheses List by Category, Groups and Sponsor Page 567 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Stryker Australia Pty Ltd

HW511 Stryker Leibinger Plating System Micro Screws 1.0 - 1.2mm diameter, 3 -  $70.00

 15mm length

 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,  1.0mm-1.20mm various  $70.00

 emergency, self-tapping,self-drilling lengths

 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;

 07.01.06.02 - Diameter 1.25-3.24mm

 Aus Systems Pty Ltd

AU059 Aus systems titanium bone screws titanium bone screws 1.5mm diameter - 2.3mm  $43.00

 diameter, 3mm length to

 15mm length

 Australian Surgical Innovations Pty Ltd

AI007 ASI Plates and Screws Screw Width 1.0 - 3.0mm. Length  $43.00

 3.0 - 25mm

 B Braun Australia Pty Ltd

BB314 Aesculap CranioPlate System/  Cranial fixation system, internal  Screws Neuro, Emergency,  $43.00

 Screws Neuro Emergency, self  fracture, non biodegradable.  Consists  self tapping, magazine of 8,

 tapping, 1.8mm x 3 & 5mm of screws, plates. 1.8mm x 3 & 5mm lengths

BB316 Aesculap CranioPlate  Cranial fixation system, internal  screws neuro, self drilling,  $43.00

 System/Screws Neuro, self-drilling,  fracture, non biodegradable.  Consists  magazine of 8, 1.5mm x 3, 4

 of screws, plates. & 5 mm lengths

 Biomet Australia Pty Ltd

BH016 TMJ System Screw, Cross Drive, Fossa. Titanium 2.0mm dia x (5 - 13)mm $43.00

BH017 TMJ System Screw, Cross Drive, Fossa. Titanium 2.3mm Dia x (5 - 13)mm $43.00

Prostheses List by Category, Groups and Sponsor Page 568 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BH020 W Lorenz Osteosynthesis System Bone Screw, Cross Drive or Centre  1.5mm dia x (3.5 - 17)mm $43.00

 Drive. Titanium

BH021 W Lorenz Osteosynthesis System Bone Screw, Cross Drive or Centre  1.8mm dia x (3.5 - 17)mm $43.00

 Drive. Titanium

BI360 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive,  2.0mm x (4 - 7) mm $43.00

 Std or Self Drilling; Titanium

BI365 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive;  2.0mm x (9 - 19) mm $43.00

 Titanium

BI723 Mandibular Fracture System Screw, High Torque 2.0/2.4  2.7 x (6-20)mm $43.00

 Mandibular Fracture, Titanium

BI726 Mandibular Fracture System Screw, High Torque (HT), Emergency,  Dia 2.3mm x 4.0, 5.0, 7.0,  $43.00

 2.0/2.4 Mandibular Fracture System,  9.0, 11.0, 13.0, 15.0mm 

 Titanium Lengths

BI733 W.Lorenz Osteosynthesis System Bone Screw, Self Drilling, Cross  1.5 mm (dia) x 6.0, 7.0mm  $43.00

 Drive, Titanium [lengths]

BI734 W.Lorenz Osteosynthesis System Bone Screw, Self Drilling, Cross  1.5 mm (dia) x 3.5, 4.0,  $43.00

 Drive, Titanium 5.0mm, [lengths]

BI735 W.Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive;  2.3mm x (5 - 9) mm $43.00

 Titanium

BI742 TMJ System Screw, Cross Drive Mandibular  (2.7 - 3.2mm) x (8 - 12mm) $43.00

 Component, Titanium

BI744 Mandibular Fracture System Screw, High Torque 2.0/2.4  2.0 x (9-17)mm $43.00

 Mandibular Fracture, Titanium

BI748 Mandibular Fracture System Screw, High Torque (HT), 2.0/2.4  Dia 2.4 x 6.0mm, 8.0, 10.0,  $43.00

 Mandibular Fracture System, Titanium 12.0, 14.0, 16.0, 18.0mm

 Lengths

 Johnson & Johnson Medical Pty Ltd

JJ854 Bioplate Plating System Titanium Screws 1.25 to 3.24mm Diameter $43.00

 Lifehealthcare Pty Ltd

LH516 Martin Osteosynthesis 1.5mm  Self retaining, Titanium 3-7mm length, 1.5-1.8mm  $43.00

 System Screw diam

 Medical & Optical Instruments Australia Pty Ltd

MO329 Martin Level One Fixation Screw Titanium Diameter 1.25 to 3.24mm $43.00

 Medtronic Australasia Pty Ltd

MC571 Timesh 12 Point Screws 3 - 20mm $43.00

Prostheses List by Category, Groups and Sponsor Page 569 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

MC880 TiMesh Rigid Fixation Bone  Titanium, Screw - Cruciate Head, 12  Diameter 1.25 - 1.74mm $43.00

 Grafting and Plating System point Flat Head

MI092 TiMesh Internal Drive Screws Diameter: 1.5 - 1.8mm $43.00

MI093 TiMesh Rescue Screws Diameter: 1.8 - 2.4mm $43.00

 National Surgical Pty Ltd

NK024 Jeil Medical- Screws Screw for craniofacial bone fracture  Diameter 1.5mm and 1.8mm:  $43.00

 fixation Length 3.0 - 5.0mm

 Stryker Australia Pty Ltd

HW491 Stryker Leibinger Plating System Craniofacial Fixation Screws 1.5 - 2.7mm diameter, 3 -  $43.00

 20mm length

 Surgiplas Medical

SP089 Screws Micro, Maxi & Self Drilling "Size1.6mm x (4-8)mm self- $43.00

 drilling screws,1.5mm

 Safety ,Screws diameter 

 1.25-1.75mm"

SP090 Screws Micro, Maxi & Self Drilling "Size2.0mm x (4-8)mm self- $43.00

 drilling screws,1.9mm

 Safety ,Screws diameter 

 1.75-2.24mm"

SP091 Screws Micro, Maxi & Self Drilling 2.4mm x (4-22)mm self- $43.00

 drilling screws, 2.7mm x (8-

 20)mm; 2.7mm Safety

 Screws, diameter 2.25-2.74mm

 Synthes Australia Pty Ltd

SY590 AO/ASIF Screw Cortex, Cortical, Emergency, Self- 1.25-3.24mm $43.00

 tapping, Self-drilling; Low Profile

 Screws

 Compression

 Stryker Australia Pty Ltd

SK152 Leibinger Screw - Universal  Items used for reconstruction and  Universal Mandible Lag  $121.00

 Mandibular Screws fixation of mandibular fractures and  Screws, 2.0mm Diameter,

 tumour resection 24mm-42mm Length

 Distractor

 Synthes Australia Pty Ltd

SY591 External Midface Distractor System Fixation; Set - Screws 1.25-3.24mm $85.00

Prostheses List by Category, Groups and Sponsor Page 570 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Locking

 Biomet Australia Pty Ltd

BI457 Lorenz 2.4mm Locking  Screw, Locking Reconstruction  2.4 x (6-18)mm $90.00

 Reconstruction System Modular. Titanium

 Medical & Optical Instruments Australia Pty Ltd

MO312 Martin Level One Fixation Screw, titanium Diameter 2.25 - 2.74mm $90.00

 Stryker Australia Pty Ltd

HW487 Stryker Leibinger Hybrid MMF  SMARTLock Hybrid MMF Screws,  Two Sizes -  $90.00

 Screws Locking 2.0mm Diameter, 6mm

 System - Universal SMARTLock  Length

 Hybrid MMF 2.0mm Diameter, 8mm

 Component - MMF Screws Length

HW509 Stryker Leibinger Plating System Universal Mandibular Locking Screws 2.0 - 2.7mm diameter, 3 -  $90.00

 24mm length

 Surgiplas Medical

SP094 OsteoMed Plating & Fixation System Screws 2.4mm x (6-22)mm Locking  $90.00

 Screws, Screws 2.25-

SP116 OsteoMed Plating & Fixation System Locking Screws Diameter 2.0mm, length 4- $90.00

 18mm

 Synthes Australia Pty Ltd

SY592 AO/ASIF Screw Cortex, Cortical, Emergency, Self- 1.25-3.24mm $90.00

 tapping, Self-drilling; Locking

 Resorbable

 Biomet Australia Pty Ltd

BI415 Lactosorb Resorbable  Bone Screw,  2 Pack, Endobrow,  2 x 5mm $141.00

 Craniomaxillofacial Fixation System Lactosorb. PGA/PLA

BI994 Lactosorb Resorbable  Bone Screw Lactosorb, single screw  1.5mm dia $141.00

 Craniomaxillofacial Fixation System (multiple screws per pack) PGA/PLA

BI995 Lactosorb Resorbable  Bone Screw Lactosorb, single screw  2.0mm dia $141.00

 Craniomaxillofacial Fixation System (multiple screws per pack) PGA/PLA

BI996 Lactosorb Resorbable  Bone Screw Lactosorb,single screw  2.5mm dia $141.00

 Craniomaxillofacial Fixation System (multiple screws per pack) PGA/PLA

BI997 Lactosorb Resorbable  Bone Screw Lactosorb, single screw  2.8mm dia $141.00

 Craniomaxillofacial Fixation System (multiple screws per pack) PGA/PLA

Prostheses List by Category, Groups and Sponsor Page 571 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medical & Optical Instruments Australia Pty Ltd

MO331 Martin Level One Fixation Resorb x  Sonic Pin PDDLA (resorbable) Diameter 1.25 - 3.24mm $141.00

 & Sonic Weld

 Medtronic Australasia Pty Ltd

MC626 Macropore FRP (fast resorbing  Polylactide and Polyglycolide  1.8mm x 3-8mm $141.00

 polymer)

MI090 Macropore Screws 1.75 - 2.75 x 2.24 - 3.24mm $141.00

 Stryker Australia Pty Ltd

HW510 Delta Resorbable Fixation System Resorbable Screws 1.7mm diameter, 3 -6mm  $141.00

 length

 Surgical Specialties

SQ051 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Screws 1.5 - 2.5mm dia x 5- $141.00

 copolymer 8mm long

SQ056 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Screws 2.8 x 6-23mm, 3.1 x  $141.00

 copolymer 6-8mm

SQ057 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Screws 3.1 x 6 - 30mm and  $141.00

 copolymer 2.5 x 30mm

SQ060 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Screws 2 x 9-19mm, 2.5 x  $141.00

 copolymer 10-23mm and 2.8 x 10 - 23mm

 Synthes Australia Pty Ltd

SY593 PolyMax Rapid-Resorbable  Polyactide Resorbable Screw/Tack 1.25-3.24mm $141.00

 Fixation System

 07.01.06.03 - Diameter 3.25mm

 Resorbable

 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

07.01.07 - Ancillary Components

 07.01.07.01 - Pin

 Synthes Australia Pty Ltd

SY345 Titanium Sternal Fixation System Titanium Emergency Release Pin One Size only $95.00

Prostheses List by Category, Groups and Sponsor Page 572 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.01.07.02 - Tack

 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

 07.01.07.03 - Washer

 Stryker Australia Pty Ltd

SK146 Leibinger Titanium Implant System - Items used for reconstruction and  Universal Mandible Bi- $30.00

  Universal Mandible Biconcave  fixation of mandibular fractures and  concave Washer

 Washer tumour resection

 07.01.07.04 - Wedges and Burr Hole Covers

 Stryker Australia Pty Ltd

HW435 E-POR Biomaterial/ Craniotomy  Craniotomy Gap Wedge Porous  One Size - V and T shape $385.00

 Gap Wedge Porous Polyethylene Polyethylene

HW439 E-POR Biomaterial/ Burr Hole  Burr Hole Cover, Porous Polyethylene 15mm x 3mm x 5mm; 29mm x  $385.00

 Cover, Porous Polyethylene 7mm x 14mm

 07.01.07.05 - Anchor Bone

 Surgiplas Medical

SP096 OsteoMed Plating & Fixation System Screws MMF / Anchorage Screws  $140.00

 1.2/1.6/2.0mm Anchor,

 07.01.07.06 - 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

Prostheses List by Category, Groups and Sponsor Page 573 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BB289 CranioFix Absorbable Double sided Cranial clamp,  11mm, 16mm $95.00

 absorbable polyester

 Biomet Australia Pty Ltd

BI714 RapidFlap Cranial Clamp Clamp, Burr Hole or Craniotomy Line, 12, 16, 20mm $95.00

  Titanium

 Cantley Medical Services

CF005 Cranial Loop Cranial Loop is a smart system for  One size - is suitable for  $95.00

 fixing Bone Flaps resulting from  1.5mm up to 24mm bone

 craniotomies. Its instrument free, made  thickness as it is adjustable

 from Peek - 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

JJ849 Bioplate ZIP Titanium Clamp 11 to 20 mm $95.00

 Medtronic Australasia Pty Ltd

MI094 Invisx Locks Invisx polymer cranial fixation system One size $95.00

 Synthes Australia Pty Ltd

SY252 AO/ASIF Facio-Maxillary Plates Flapfix - Plates for fixation of cranial  10 - 20mm $95.00

 bone flaps

 07.01.07.07 - Screws

 Surgiplas Medical

SP095 OsteoMed Plating & Fixation System Screws Locking Screw Inserts,  $140.00

 Other ancillary

 Synthes Australia Pty Ltd

SY784 SynPOR Chin Connector One Size $140.00

 07.01.07.08 - Locks

 Medtronic Australasia Pty Ltd

MC580 Macropore Locks 2 - 20mm $700.00

Prostheses List by Category, Groups and Sponsor Page 574 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.01.07.09 - Probe

 Cook Medical Australia Pty Ltd

WC264 SYSTEM-  Doppler Blood Flow  The Cook-Swartz Implantable  Cuff Lengths: 17.4 and  $390.00

 Monitoring System. COMPONENT  Doppler Flow Probe is an implantable 32mm

 - Cook-Swartz Implantable Doppler   20MHz Probe with epoxy-coated

 Flow Probe Crystal and patented Silicone Cuff

 which provides continuous direct

 vessel monitoring of microvascular

 anastomoses. A 30cm wire with

 external Retention Tabs is attached to

 the 1mm diameter Crystal.

07.02.01 - Chin

 Device Technologies Australia Pty Ltd

DE320 Facial Implant Chin Anotomical chin Small, medium, large/left,  $286.00

 right

DE321 Facial Implant Chin Chin Small, medium, large/left,  $286.00

 right

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW010 Biopore Chin Two Piece  An implantable device intended to  78 x 9mm $286.00

 Anatomical contour. support, contour, and provide

 structure for the chin. Made of high

 density polyethylene material with an

  interconnecting pore structure that

 supports tissue ingrowth. The device

 is available in various shapes and can

 be cut by the surgeon to meet the

 patient's specific needs.

Prostheses List by Category, Groups and Sponsor Page 575 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Stryker Australia Pty Ltd

HW412 Chins Extended chin implants: Round RZ  Extended chin Implants  $286.00

 (Models 8313 - 8315) and extended  design RZ round small: 45 x

 square RZ (Models 8316, 8318). Two   47 x 3mm, medium 45 x 47 x

 piece chin design (Models 8320 -  5mm, large 45 x 47 x 7mm;

 8322). Single piece chin design,  Extneded Chin Implants

 contoured (Models 7520 - 7522).  square small 45 x 47 x3mm;

 Additional chin shapes (Models 6341 Medium 45 x 47 x 5mm;

  - 6344) Contoured t Large 45 x 47 x 7mm; Two

 piece design small 46 x 33 x

 5mm; Medium 56 x 36 x 7mm

 Surgiplas Medical

SP004 Facial Prosthesis Silicone elastomer Small / Medium / Large / X- $286.00

 Large

 Complex

 Synthes Australia Pty Ltd

SY782 SynPOR Porous Polyethylene Chin Implant 4-9mm $950.00

07.02.02 - Cranium

 Medtronic Australasia Pty Ltd

MC548 Macropore Cranial Recon 29 - 165mm $481.00

 07.02.02.01 - Complex

 Australian Surgical Innovations Pty Ltd

AI006 ASI Plates and Screws Custom Mesh . $6,700.00

 Biomodelled

 Medtronic Australasia Pty Ltd

MC528 TiMesh Cranial Custom Mesh 121mm x 72mm - 152  x  $9,930.00

 152mm

 Synthes Australia Pty Ltd

SY772 PSI Biomodelled Patient Specific  Custom $9,930.00

 Craniofacial implant, PEEK Titanium

Prostheses List by Category, Groups and Sponsor Page 576 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Biomodelled Three Piece

 Synthes Australia Pty Ltd

SY774 PSI Biomodelled Patient Specific  Custom $10,930.00

 Craniofacial implant, PEEK Titanium,

 3 Piece

 Biomodelled Two Piece

 Synthes Australia Pty Ltd

SY773 PSI Biomodelled Patient Specific  Custom $10,430.00

 Craniofacial Implant, Titanium, 2

 Biomodelled, Dual Mesh

 Medtronic Australasia Pty Ltd

MC625 Modified Dual TiMesh TiMesh Surgical Mesh Modified,  121mm x 77mm - 152mm x  $10,500.00

 includes two cranial plates.  152mm.

 Composition: Titanium

 07.02.02.02 - Polymer

 Anatomics Pty Ltd

AT061 E-POR Biomaterial/ Contour  Contour Porous Polyethylene One Size 56mm x 91mm $1,300.00

 Porous Polyethylene

 Stryker Australia Pty Ltd

HW437 E-POR Biomaterial/ Mastoid,  Mastoid, Pterional, Contourable  Left, Right, 43mm - 57mm x  $1,300.00

 Pterional, Contourable Porous  Porous Polyethylene 0.6mm, 1.5mm

 Polyethylene

 Complex

 Anatomics Pty Ltd

AT063 E-POR Biomaterial/ Patient Specific Patient Specific Cranial Implant,  Cranial Shape - Customised $9,930.00

  Cranial Implant, Porous  Porous Polyethylene

Prostheses List by Category, Groups and Sponsor Page 577 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW009 Biopore Custom Made Implant An implantable device made of high- Custom designed and  $9,930.00

 density polyethylene material with an biomodelled from patient's

  interconnecting pore structure that  CT scan image.

 supports tissue ingrowth. The device

 is custom made/biomodelled from

 individual patient's CT scan, on

 doctors prescription, used for

 correction and reconstruction of any

 facial, head or any non weight bearing

  bone structure.

 07.02.02.03 - Composite

 Surgiplas Medical

SP113 OsteoMed Plating & Fixation System Plates 90 x 90mm, 95 x 165mm, &  $2,600.00

 Large Pre-formed Osteoform

 Mesh, Cranium.

 07.02.02.04 - Surgical Guide

 Biomodelled

 Synthes Australia Pty Ltd

SY777 ProPlan Patient Specific Cranical Surgical  Custom $2,650.00

 Guides, Implants

07.02.03 - Ear

 07.02.03.01 - Helical Rim

 Stryker Australia Pty Ltd

HW420 Ear Reconstruction Porus Polyethylene. Helical rim,  Helical rim: 37 x 62mm $420.00

 models 8328 and 8329

 07.02.03.02 - Ear Base

 Stryker Australia Pty Ltd

HW432 Ear Reconstruction Porus Polyethylene. Ear base left and  Ear base: 29 x 55 x 13mm,  $600.00

 right, models 7542 and 7525  - 7527.  32 x 65 x 16mm. Ear base

 Ear base extended left and right,  extended: 30 x 60mm.

 models 8330 and 8331.

Prostheses List by Category, Groups and Sponsor Page 578 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

07.02.04 - Malar

 Device Technologies Australia Pty Ltd

DE333 Facial Implant Malar Malar Anatomical Small, medium, large/left or  $330.00

 right

 Stryker Australia Pty Ltd

HW413 Genioplasty Wedge Porus Polyethylene. Genioplasty  Small 60 x 25 x 5mm,  $330.00

 wedges, models 8340 - 8343 medium 60 x 25 x 7.5mm,

 large 60 x 25 x 10mm

HW414 Prejowl Shape Porus Polyethylene. Model 8319 45 x 41 x 4mm $330.00

SK512 Malar Shape Porus Polyethylene. Design RZ malar  Design RZ malar shapes:  $330.00

 shapes, super petite and petite, left  super petite left and right 50

 and right (Models 9501 - 9504).   x 19 x 3mm, Design RZ

 Design M malar shapes, left and right  malar shapes petite left and

 (Models 9507 - 9512). Additional  right 50 x 19 x 5mm. Design

 malar shapes, extended contoured left  malar shapes: small left and

 and right (Models 9513 - 9518)  right  64 x 19 x 3mm, left and

  right medium 64 x 19 x

 4.5mm, Left and right large

 64 x 19 x

 07.02.04.01 - Complex

 Stryker Australia Pty Ltd

HW434 E-POR Biomaterial/ Midface  Midface Contour Porous  One size $1,150.00

 Contour Porous Polyethylene

HW438 E-POR Biomaterial/ Temporal Fossa Temporal Fossa Implant Porous  61mm - 105mm x 18mm -  $1,150.00

  Implant Porous Polyethylene Polyethylene 20mm

 Synthes Australia Pty Ltd

SY783 SynPOR Porous Polyethylene Malar Implant 3-5 mm $1,150.00

Prostheses List by Category, Groups and Sponsor Page 579 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.02.04.02 - Polymer

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW004 Biopore Malar Implant An implantable device intended to  Left and Right (47mm x  $430.00

 support, contour and provide  24mm x 4mm)

 structure for the face including the

 cheeks and eye sockets. Made of high-

 density polyethylene material with an

  interconnecting pore structure that

 supports tissue ingrowth. The device

 is available in various shapes and can

 be cut by the surgeon to meet the

 patient's specific needs.

 Stryker Australia Pty Ltd

HW436 E-POR Biomaterial/  Transphenoidal Sellar Contourable  2.5mm x 20mm - 40mm $500.00

 Transsphenoidal Sellar Contourable Porous Polyethylene

  Porous Polyethylene

07.02.05 - Mandible, Maxilla and Temperomandibular Joint (TMJ)

 07.02.05.01 - Mandible, Full

 Medtronic Australasia Pty Ltd

MC513 TiMesh Full Mandible One size only $1,520.00

 Surgiplas Medical

SP092 Osteo Plating & Fixation System Plates - Reconstruction 5 x 20 x 5 Hole Full  $1,520.00

 Mandible Plate; 5 x 16 x 5

 Hole Full Mandible Plate;

 Mandible, Full

 07.02.05.02 - Fossa Replacement

 Biomet Australia Pty Ltd

BI569 TMJ System Fossa Component, Left or Right;  Small, Medium Large $5,850.00

 Titanium, UHMWPE

Prostheses List by Category, Groups and Sponsor Page 580 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.02.05.03 - Mandibular Angle

 Compression

 Stryker Australia Pty Ltd

ST369 Luhr Fixation System  Luhr Mandibular Compression  Curved: 30,38, 45mm,  $152.00

 System: curved, straight, metacarpal  Straight: 30, 40, 50, 60,

 plate Vitallium 80mm, metacarpal: 41, 45mm

 Surgiplas Medical

SP069 Plates Micro, Mini, Maxi Angled EDC Plate, Angled  $152.00

 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

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW003 Biopore Mandible (Left / Right) An implantable device intended to  74 x 33 x5mm $1,485.00

 support, contour, and provide

 structure for the mandible. Made of

 high-density polyethylene material

 with an interconnecting pore

 structure that supports tissue

 ingrowth. The device can be cut by

 the surgeon to meet the patient's

 specific needs.

 Stryker Australia Pty Ltd

HW422 Mandibular angle Porus Polyethylene. RZ mandibular  RZ mandibular angles: 65 x  $1,485.00

 angles left and right (Models 9955 -  35 x 3 x 6.5 x 3 x 3mm, 65 x

 9960); Porus Polyethylene.  35 x 7 x 6.5 x 3 x 3mm, 65 x

 Contoured mandibular angles left and  35 x 11 x 6.5 x 3 x 3mm.

 right (Models 88037 - 88038) Contoured mandibular

 angles left and right:59 x 29

  x 7 x 11mm.

Prostheses List by Category, Groups and Sponsor Page 581 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.02.05.04 - Condylar Device

 Biomet Australia Pty Ltd

BI792 Lorenz 2.4mm Locking  Condyle left or right, chrome cobalt  One size only $1,545.00

 Reconstruction System (CoCr)

 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  Universal Mandible  $1,545.00

  Universal Mandible Condylar  following trauma or tumor resection of Condylar Device Left and

  the mandible. Included are 2x cross  Right

 pin fixation screw.

 Synthes Australia Pty Ltd

SY694 Condylar Head Add-On System Condylar Head - Left, Right One Size $1,545.00

 Fixation Plate

 Synthes Australia Pty Ltd

SY695 Condylar Head Add-On System Fixation Plate 0-6mm positions 2 Holes $645.00

 07.02.05.05 - Plate

 Biomet Australia Pty Ltd

BI559 TMJ System Mandibular Component, Left or Right, (40 - 60mm), 5-13 hole $6,875.00

  Titanium

 Biomodelled

 Synthes Australia Pty Ltd

SY776 ProPlan Biomodelled Patient specific  Custom $4,200.00

 Mandible Complex Locking

 Hemimandible

 Medtronic Australasia Pty Ltd

MC515 TiMesh Hemimandible, Left/Right One size only $645.00

 Surgiplas Medical

SP024 OsteoMed Plating & Fixation System Plates - Reconstruction 5 x 16 Hole plate Right &  $645.00

 Left

Prostheses List by Category, Groups and Sponsor Page 582 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Maxilla

 Medtronic Australasia Pty Ltd

MC512 TiMesh Maxillary Prosthesis One size only $2,124.00

 Symphsis

 Medtronic Australasia Pty Ltd

MC516 TiMesh Mandibular Symphysis One size only $1,294.00

 07.02.05.06 - External Midface System

 Synthes Australia Pty Ltd

SY594 Mandible External Fixator Hemi, 3/4, Full and Ramus Various $1,460.00

 07.02.05.07 - Surgical Guide

 Biomodelled

 Synthes Australia Pty Ltd

SY778 ProPlan Pateint specific Maxillofacial Surgical Custom $2,650.00

  Guides, Implants

07.02.06 - Nose and Zygoma

 07.02.06.01 - Nasal Dorsum

 Device Technologies Australia Pty Ltd

DE322 Facial Implant Nasal Zygomatic Right, left $279.00

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW005 Biopore Nasal Dorsum Shape An implantable device intended to  53 x 5mm, 66 x 6 mm, 76 x  $279.00

 support, contour, and provide  15mm, 40 x 9mm

 structure for the nose and zygoma.

 Made of high-density polyethylene

 material with an interconnecting pore

 structure that supports tissue

 ingrowth. The device is available in

 various shapes and can be cut by the

 surgeon to meet the patient's specific

 needs.

Prostheses List by Category, Groups and Sponsor Page 583 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Stryker Australia Pty Ltd

HW423 Nasal Shape. Petite Nasal Dorsum. Porus Polyethylene. Petite Nasal  Petite Nasal Dorsum: 4 x 4 x $279.00

 Dorsum ( Models 84000 - 84004).  45mm, 4 x 4 x 55mm, 5 x 5 x

 45mm, 5 x 5 x 55mm, 6 x 9 x

 55mm.

 07.02.06.02 - Nasal Arch

 Stryker Australia Pty Ltd

HW415 Nasal Shape or Rhinoplasty Shape Porus Polyethylene. Nasal Arch  Nasal arch shapes: small 70  $350.00

 shapes, nasal arch and nasal sheet  x 13 x 2mm, medium 70 x 15

 (Models 9533 - 9536). Nasal dorsum  x 2mm, large 70 x 15 x 2mm,

 shapes, design A and design B  sheet 40 x 9 x 1.1mm. Nasal

 (Models 7516 - 7518). Nasal valve  dorsum shapes: design A

 support, lateral nasal valve support  small 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

 07.02.06.03 - Nasal Shell Shape

 Stryker Australia Pty Ltd

HW425 Nasal Shell Shapes. Nasal Shell Shapes, Regular and  Regular: 38 x 21 x 17mm,  $490.00

 Large with Inserts Small and Large  Insert Small 30 x 4 x 9mm,

 (included). Models 9553 - 9554. Thin  Insert Large 38 x 2.5 x 9mm.

 Nasal Shell 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

 07.02.06.04 - Nasal Valve Support

 Stryker Australia Pty Ltd

HW424 Nasal Valve Support. Lateral Nasal Valve, Model 7545.  Lateral Nasal Valve:13 x 3.5 $227.00

 External Nasal Valve Batten, Model   x 0.85mm, External Nasal

 7546. External Nasal Valve Batten -  Valve Batten: 25 x 11 x

 Thin, Model 7167 0.85mm, External Nasal

 Valve Batten - Thin: 24 x

 11.5 x 0.6mm.

Prostheses List by Category, Groups and Sponsor Page 584 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.02.06.05 - 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

07.02.07 - Orbit

 07.02.07.01 - Complete Orbital Shape

 Stryker Australia Pty Ltd

HW411 Complete Orbital Shape Porus Polyethylene. Complete and 2 / Inferior: 83 x 78mm $1,940.00

  3 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

 07.02.07.02 - Orbital Floor

 Biomet Australia Pty Ltd

BI738 W.Lorenz Osteosynthesis System Orbital Floor Plate; Titanium 1.5mm system, Large $890.00

BI740 W.Lorenz Osteosynthesis System Orbital Floor Plate (Small) or NOE  Small or NOE plate $890.00

 plate, 1.5mm System, Titanium

BI924 Lactosorb Resorbable  Orbital Floor Plate, 1.5mm System,  Left or right $890.00

 Craniomaxillofacial Fixation System PGA/PLA

 Stryker Australia Pty Ltd

HW522 Stryker Leibinger 3D Orbital Floor  Stryker Leibinger 3D Orbital Floor  Small, Right $890.00

 Plate Plate Small, Left

 Large, Right

 Large, Left

 Surgiplas Medical

SP079 Plates Micro, Mini Orbital Plate, Orbital Plate  $890.00

 Large

 Synthes Australia Pty Ltd

SY391 Orbital Fixation System Orbital Floor Plate S, M, L $890.00

SY698 SynPOR Anatomical Porous Polyethylene 0.8mm - 1.5mm thick $890.00

Prostheses List by Category, Groups and Sponsor Page 585 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Coated

 Stryker Australia Pty Ltd

HW433 E-POR Biomaterial/ Orbital Wall  Orbital Wall and Floor Porous  41 x 42 x 0.6-1.0mm $985.00

 and Floor Porous Polyethylene  Polyethylene Titanium Mesh

 Titanium Mesh Composite (large)

 07.02.07.03 - Rim

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW008 Biopore Orbital Rim, Extended An implantable device intended to  Left and Right (44mm x  $395.00

 support, contour, and provide  38mm)

 structure for the face including the

 cheeks and eye socket. Made of high-

 density polyethylene material with an

  interconnecting pore structure that

 supports tissue ingrowth. The device

 is available in various shapes and can

 be cut by the surgeon to meet the

 patient's specific needs.

 Stryker Australia Pty Ltd

SK511 Orbital Rim Orbital rims, left and right extended.  Left & right extended  $395.00

 Models 9539, 9540 Orbital Rim  models 47 x 40mm Oribtal

 Onlay Implants 81001, 81002 Rim Onlay Implants left &

 right 40 x 40mm

 07.02.07.04 - Wedge for Orbit

 Stryker Australia Pty Ltd

HW410 Enophthalmos Wedge Regular left and right. Large left and  Regular: 22 x 31 x 7mm.  $460.00

 right. (Models 9541 - 9544) Large: 28 x 40 x 7.5mm

07.02.08 - External Prostheses, Bone Attachment

 07.02.08.01 - Endosseous Implant

 Cochlear Limited

CO042 Vistafix™ Fixture ST Titanium self-tapping fixtures for the  3mm and 4mm $635.00

 retention of midface and orbital

 prostheses.

Prostheses List by Category, Groups and Sponsor Page 586 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Concave

 Cochlear Limited

CO058 Cochlear Vistafix 3 VXI300 Implants Titanium implant with TiOblast™ for  3 mm and 4 mm $1,082.00

 Vistafix one-stage or two-stage surgery

 Flanged

 Cochlear Limited

CO030 Flange fixture ST 3mm and 4mm Self tapping titanium flange fixture  Self Tapping 4mm and 3mm $1,035.00

 pre-mounted with a disposable fixture

 mount.  Available in two sizes: 3mm

 and 4mm.  Used in two stage surgical

 procedures.

 07.02.08.02 - Abutment, Permanent

 Cochlear Limited

CO036 Standard Abutments Abutment Complete - Titanium 3.0mm - 90780, 4.0mm -  $412.00

 90778, 5.5mm - 90776,

 7.0mm - 90774

 Angled/Offset

 Cochlear Limited

CO037 Face to Face Console Abutment Unigrip - Titanium 30, 60, 90, 110 Degrees $895.00

 Concave

 Cochlear Limited

CO061 Cochlear Vistafix 3 VXA300  Titanium  abutment for Vistafix one- 3.5 mm, 4.5 mm, 6 mm, 7.5  $936.00

 Abutments stage and two-stage surgery. VXA  mm

 Abutments are only compatible with

 VXI300 Implants

 07.02.08.03 - 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 587 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

CO059 Cochlear Vistafix 3 VXA300  Titanium healing abutment can be  9 mm $285.00

 Healing Abutment used during healing to avoid having

 to select the abutment length during

 surgery. The markings can be used to

 indicate thickness of the soft tissue.

 The healing abutment is mounted on

 the implant and is only compatible

 with theVXI300 implants

 07.02.08.04 - Abutment Fixtures

 Cochlear Limited

CO035 Face to Face Cover Screw with Internal Hexagon One Size Only $142.00

CO060 Cochlear Vistafix 3 Cover screw  Cover screw conical for Vistafix  One size $142.00

 conical VXI300 implant. The Cover screw is

 only compatible with VXI300 implants

07.02.09 - Anatomical Biomodel

 Synthes Australia Pty Ltd

SY775 PSI Patient specific Craniofacial  Custom $2,000.00

 Anatomical Biomodel

SY779 ProPlan Patient Specific Craniofacial  Custom $2,000.00

 Anatomical Biomodel

07.03.01 - Abutment

 07.03.01.01 - Permanent

 Biomet 3i Australia Pty Ltd

NW001 3i Abutment Complete Titanium 3.25 - 6mm diameter $175.00

 More Group Pty Ltd

MV005 MIS Abutments Abutments Height: 1mm - 5mm, Crown  $175.00

 height: 4 - 11mm, Platform:

 Narrow, Standard or Wide

 Neoss Australia Pty Ltd

NJ003 Neoss Titanium Abutment Neoss Abutment Titanium Universal $175.00

Prostheses List by Category, Groups and Sponsor Page 588 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 07.03.01.02 - Temporary

 DENTSPLY IH Pty Ltd

DH001 Astra Tech Cover Screws Cover Screw Diameter 3.0mm, 3.5mm,  $70.00

 4.0mm, 4.5/5.0mm Short,

 4.5/ 5.0mm Long

DH003 Astra Tech Healing Abutments Healing Abutments, Healing  Healing Abutments 3.0,1.5,  $70.00

 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

DH004 Astra Tech Abutments Temporary Abutment Diam 3.0 - 5.0mm $70.00

 Neoss Australia Pty Ltd

NJ009 Neoss Implant System Healing Abutment with Screw Universal $70.00

 Nobel Biocare Australia Pty Ltd

NR004 Nobel Biocare Abutments Abutment, temporary or healing,  NP, RP, WP, 6.0mm $70.00

 complete

 Straumann Pty Ltd

SB004 Straumann Bone Level Implant  Straumann Healing Abutment NC/RC Height 0 - 6 mm $70.00

 Healing Abutment

 07.03.01.03 - Cover Screw/Cap

 More Group Pty Ltd

MV006 MIS Cover Screws and Healing  Cover screws and healing caps  1.5mm - 6mm height, 4mm -  $52.00

 (Biocom, Seven, Mistral) 6.3mm diameter

 Nobel Biocare Australia Pty Ltd

NR002 Nobel Biocare Cover Screws Cover screw NP, RP, WP, 6.0mm $52.00

Prostheses List by Category, Groups and Sponsor Page 589 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Straumann Pty Ltd

SB002 Straumann Pty Ltd Straumann Healing Cap  Height 1.5 - 4.5 mm $52.00

07.03.02 - Zygomatic Bone Implant

 Henry Schein-Halas Pty Ltd

HD015 Southern Zygomatic and Oncology  Zygomatic Titanium dental implants  4 to 6mm diameter, 27 to  $800.00

 Implants with 45 or 55 degree angulation 52.5mm length

 Nobel Biocare Australia Pty Ltd

NR007 Branemark Titanium Fixture Zygomaticus Fixture 30, 35, 42.5, 40, 45, 47.5,  $800.00

 50, 52.5mm Length

07.03.03 - Endosseous Implant

 07.03.03.01 - Screws

 Medical & Optical Instruments Australia Pty Ltd

MO337 Martin Level One Fixation Orthodontic Locking Screw 2mm $78.00

MO338 Martin Level One Fixation Screw Titanium Diameter 1.25 to 1.74mm $78.00

 Stryker Australia Pty Ltd

SK422 Orthodontic Skeletal Anchor Screw Anchor Screw for Mandibular  1.7mm $78.00

 Maxillary Fixation Screw, Self-Drilling

SK423 Orthodontic Skeletal Anchor Screw Anchor Screw for Mandibular  2.0mm $78.00

 Maxillary Fixation Screw, Self-Drilling

 Synthes Australia Pty Ltd

SY750 Orthodontic Bone Anchor System Anchor Screw, Self Drilling, Self  1.5mm - 1.8mm $78.00

 Tapping

 07.03.03.02 - Plates

 Medical & Optical Instruments Australia Pty Ltd

MO412 Martin Level One Fixation Orthodontic skeletal anchorage plate 0.5 to 0.99mm thick, 2 to 7  $226.00

 holes

Prostheses List by Category, Groups and Sponsor Page 590 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Stryker Australia Pty Ltd

SK420 Orthodontic Skeletal Anchor Plate Orthodontic Skeletal Anchor Plate,  1.7mm $226.00

 Standard

 Synthes Australia Pty Ltd

SY749 Orthodontic Bone Anchor System Anchor Plate, Various Designs 4-5 Holes $226.00

 Locking

 Stryker Australia Pty Ltd

SK421 Orthodontic Skeletal Anchor Plate Orthodontic Skeletal Anchor Plate  1.7mm $320.00

 Locking

 07.03.03.03 - Implants and Fixtures

 Biomet 3i Australia Pty Ltd

NW002 3i Self Tapping Threaded Implants  Osseotite/Ice 3.25 - 6mm diameter $360.00

 and 3i Coverscrew

 DENTSPLY IH Pty Ltd

DH002 Astra Tech MicroThread Fixtures  Titanium fixture with microthreaded  Diameter 3.0 - 5.0mm,  $360.00

 and MicroThread Osseospeed  cervical neck Length 8-19mm

 Henry Schein-Halas Pty Ltd

HD016 Southern Dental Implants Titanium dental implants in External- 3.25 to 6.0mm diameter, 6.0  $360.00

 Hex, Tri-Nex or Internal Octagon (IT)  to 52.5mm length

 connection

 More Group Pty Ltd

MV004 MIS Implants Titanium implants (Biocom, Seven,  3mm - 6mm Diameter, 6mm -  $360.00

 Mistral) 16mm length

 Neoss Australia Pty Ltd

NJ001 NEOSS IMPLANT SYSTEM TITANIUM DENTAL IMPLANT DIAMETERS 3.25, 3.5, 4.0,  $360.00

 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 $360.00

NR006 Branemark Novum System Titanium - Kit Fixture System One size only $360.00

NR009 NobelDirect Implant Dental Implant Endosseous  10mm, 13mm, 16mm $360.00

 incorporating abutment, Titanium

NR010 Replace Implant Dental Implant Endosseous, Titanium 10mm, 13mm, 16mm $360.00

Prostheses List by Category, Groups and Sponsor Page 591 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

NR011 NobelPerfect Implant Dental Implant Edosseous, Titanium 10mm, 13mm, 16mm $360.00

NR012 Groovy Implants (NobelReplace  Dental Implants, endosseous Diameter 3.5 - 6.0mm;  $360.00

 Straight Groovy, NobelReplace  Length 8.0 - 18.0mm

 Tapered Groovy, NobelSpeedy

 Replace, Branemark System Mk III

 Groovy, NobelSpeedy Groovy)

NR013 NobelActive implants Dental implants, endosseous Diameter 3.5 - 5.0mm;  $360.00

 Length 8.5 - 18.0mm

 Straumann Pty Ltd

SB001 Straumann Pty Ltd Straumann Dental Implant  Diameter 3.3 - 4.8mm  $360.00

 NNI/RN/WNI Length 6 - 16mm

SB003 Straumann Bone Level Implants  Straumann Bone Level Implants NC/RC Diameter 3.3 - 4.8 mm  $360.00

 NC/RC Length 8-14 mm

 Summit Healthcare Solutions

HS011 Periosave Z1-M Transgingival  Periosave Z1-M Zirconia-titanium  All Ø3.2mm transgingival  $360.00

 dental implant. Transgingival hybrid dental implant. implants have a zirconia

 platform of 4.4mm, all

 Ø3.90mm transgingival

 implants have zirconia

 platform of 5.0mm, all

 Ø4.7mm transgingival

 implants have a zirconia

 platform of 6.0mm.

 Zirconia gingival collar

 height of all implants =

 1.5mm. All above implant

 diameters are available in

 lengths of 8mm, 10.0mm,

 11.5mm, 13.0mm, 15mm

 07.03.03.04 - Graft Material <0.5ml

 Straumann Pty Ltd

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

Prostheses List by Category, Groups and Sponsor Page 592 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.03.03.05 - Graft Material 0.5ml-<1.0ml

 Biomet 3i Australia Pty Ltd

NW006 Endobon Xenograft Granules Hydroxyapatite granules, 0.5-1mm  0.5ml $300.00

 diameter

 Henry Schein-Halas Pty Ltd

HD019 Bio-Oss Pen Pen applicator with natural bone  0.25 to 1mm; 0.25g  $300.00

 mineral derived from bovine bone (0.5125cc)

 Straumann Pty Ltd

SB006 Straumann Bone Ceramic 070.204 Straumann Bone Ceramic 500 070.204 Straumann Bone  $300.00

  -1000 Ceramic 500 -1000, Granule

  size: 500 -1000 microns,

 Unit size: 0.5 g, Volume:

 approx 0.95 ml

 07.03.03.06 - Graft Material 1.0ml

 Biomet 3i Australia Pty Ltd

NW007 Endobon Xenograft Granules Hydroxyapatite granules, 0.5-1mm  2 - 8ml $300.00

 diameter or 1-2mm diameter

 Henry Schein-Halas Pty Ltd

HD018 Bio-Oss Natural bone mineral derived from  1 to 2mm: 0.5g (1.5cc) $300.00

 bovine bone

HD020 Bio-Oss Pen Pen applicator with natural bone  0.25 to 1mm; 0.5g (1.025cc) $300.00

 mineral derived from bovine bone

HD021 Bio-Oss Pen Pen applicator with natural bone  1 to 2mm; 0.5g (1.5cc) $300.00

 mineral derived from bovine bone

 Straumann Pty Ltd

SB007 Straumann Bone Ceramic 070.205 Straumann Bone Ceramic 500 070.205 Straumann Bone  $300.00

  -1000 Ceramic 500 -1000, Granule

  size: 500 -1000 microns,

 Unit Size 1g, Volume

 approx 1.9 ml

Prostheses List by Category, Groups and Sponsor Page 593 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

07.04.01 - Complete

 07.04.01.01 - External Midface System

 Multivector

 Medical & Optical Instruments Australia Pty Ltd

MO236 Martin Distraction Osteogenesis  Distractor System, Complete, External, one size only $8,100.00

 Rigid External Distraction (Polley   Midface, Aluminium, Carbon Fibre

 RED II)

 Synthes Australia Pty Ltd

SY401 External Midface Distractor System Head Frame Assembly, Carbon Fibre  One size only $8,100.00

 Rods

 Single Vector

 Medical & Optical Instruments Australia Pty Ltd

MO233 Martin Distraction Osteogenesis Distractor System, Complete, other,  1.5mm $7,100.00

 titanium

 07.04.01.02 - External Set

 Multivector

 Synthes Australia Pty Ltd

SY349 Multi Vector Distractor Set Titanium Multi Vector Distractor MVD Arms:15mm-85mm.  $1,955.00

 Pin holding clamps-

 ramus,body,universal,limite

 d bone stock ramus and

 body. Assembly left & right

 35mm. K wires 2.0mm

 150mm length. Connecting

 bar 4.0mm 100mm-200mm

 length

 07.04.01.03 - Internal/Intraoral

 Multivector

 Medical & Optical Instruments Australia Pty Ltd

MO239 Martin Distraction Osteogenesis Distractor System, Complete, other,  15-60 mm distraction length $3,100.00

 titanium

Prostheses List by Category, Groups and Sponsor Page 594 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Stryker Australia Pty Ltd

SK183 Leibinger Intraoral Distractor  Manufactured from stainless steel,  Frame 20mm - 35mm, 2.0mm  $3,100.00

 (Multiguide II) allows gradual, independent, and  diameter, 50 - 90 mm length

 simultaneous distraction of the  Auto - Pilot Pins

 mandible in 3 planes.

 Surgiplas Medical

SP045 Logic Distraction System Distractor, spacers & activation set Straight, Curved 18-52mm $3,100.00

 Synthes Australia Pty Ltd

SY753 Curvilinear Distraction System Curvilinear Distraction, Right Left 30mm - 100mm radius $3,100.00

 Single Vector

 Biomet Australia Pty Ltd

BI823 Alveolar Ridge Distraction System - distraction device, single tooth 10-20mm $1,955.00

  titanium

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

 internal/intraoral, titanium

 Synthes Australia Pty Ltd

SY399 Alveolar Distractor Vertical mandibular, maxilla alveolar  8-16mm $1,955.00

 ridge distractor

 Single VectorResorbable

 Biomet Australia Pty Ltd

BI934 Lactosorb Distraction System Plate, drive screw and distractor,  Small, Medium, Large $3,500.00

 PGA/PLLA, Ti

07.04.02 - Component

 07.04.02.01 - Distractor Body

 Medical & Optical Instruments Australia Pty Ltd

MO396 KLS Martin Distractor Zurich II distractor bodies 15mm - 30mm distraction  $2,200.00

 length

 Synthes Australia Pty Ltd

SY515 Midface Distractor System Distractor System, Distractor Body 10-40mm distraction length $2,200.00

Prostheses List by Category, Groups and Sponsor Page 595 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.04.02.02 - Footplate

 Medical & Optical Instruments Australia Pty Ltd

MO242 Martin Distraction Osteogenesis  Distractor System, Component,  1.5mm $156.00

 Rigid External Distraction (Polley  Footplate, titanium

 RED II)

 Synthes Australia Pty Ltd

SY406 External Midface Distractor System Titanium Zygomatic, Maxxilary  3 holes, 40mm $156.00

 Footplate

 Assembly

 Synthes Australia Pty Ltd

SY595 External Midface Distractor Distractor Footplate Various $480.00

 07.04.02.03 - Cross Bar/Rod

 Medical & Optical Instruments Australia Pty Ltd

MO246 Martin Distraction Osteogenesis  Distractor System, Component, Cross  one size only $990.00

 Rigid External Distraction (Polley  Bar, aluminium.carbon fibre

 RED II)

 Synthes Australia Pty Ltd

SY402 External Midface Distractor System Horizontal Rod Assembly One size only $990.00

 07.04.02.04 - Shim Plate

 Biomet Australia Pty Ltd

BI825 Alveolar Ridge Distraction System - Shim plate, titanium 1-3mm $100.00

  titanium

 07.04.02.05 - Pin

 Medical & Optical Instruments Australia Pty Ltd

MO234 Martin Distraction Osteogenesis  Distractor System, Component,  45-55mm $148.00

 Rigid External Distraction (Polley  Screws/Pins (other than bone screws),

 RED II)  titanium

Prostheses List by Category, Groups and Sponsor Page 596 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.04.02.06 - Screws

 Synthes Australia Pty Ltd

SY517 Midface Distractor System Distractor System, Screw 4-10mm $75.00

 07.04.02.07 - External Distractor Component

 Medical & Optical Instruments Australia Pty Ltd

MO240 Martin Distraction Osteogenesis  Distractor System, Component, Other,  1.5-1.58mm $1,461.00

 Rigid External Distraction (Polley  titanium, aluminium

 RED II)

 07.04.02.08 - Body Extension

 Medical & Optical Instruments Australia Pty Ltd

MO397 KLS Martin Distractors Zurich II remote release activators 20mm - 50mm $500.00

 Synthes Australia Pty Ltd

SY518 Midface Distractor System Distractor System , Body extensions 20-40mm $500.00

07.05.01 - Muscular

 07.05.01.01 - Calf Implant

 Device Technologies Australia Pty Ltd

DE316 Calf Implants Asymmetrical shape, silicone gel  85-180cc $517.00

 smooth  surface

DE325 Calf Implants Symmetrical shape, silicone gel 12-140cc $517.00

 Precise Medical Supplies

PR007 ContourFlex Calf Implant Calf implant 70-170cc $517.00

 07.05.01.02 - Gluteal

 Device Technologies Australia Pty Ltd

DE327 Gluteal Implants filled with Gel Oval Shape, Silicone Gel, Textured  200-400cc $620.00

 Surface

DE328 Gluteal Implants filled with Gel Round Shape, Silicone Gel, Smooth  200-300cc $620.00

 Surface

Prostheses List by Category, Groups and Sponsor Page 597 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Precise Medical Supplies

PR008 ContourFlex Gluteal Implant Gluteal Implant 280-460cc, Round and  $620.00

 Anatomical

 07.05.01.03 - Pectoral

 Precise Medical Supplies

PR009 PowerFlex Pectoralis Implant Pectoralis Implant Length: 14.2-17.6cm,  $950.00

 Width: 9.0-13.5cm, Depth:

 1.6-3.2cm,Shape: Symetrical

  or Asymetrical.

07.05.02 - Tissue Expanders

 07.05.02.01 - Skin or Mammary

 Device Technologies Australia Pty Ltd

DE336 Silimed Tissue Expander various shapes, textured, magnetic port 150ml-1000ml $670.00

 J T Medical Pty Ltd

JT005 Polytech Smooth Tissue Expander  Smooth with integrated or remote  The  tissue expanders vary  $670.00

 with integrated or remote magnetic  in maximum volume from

 valve 100 - 960mls

 Johnson & Johnson Medical Pty Ltd

MN001 Mentor Radovan Tissue Expander Tissue Expander Volume 25cc - 1000cc $670.00

 Surgiplas Medical

SP010 Nagor Tissue Expander Two Stage, Valved 10 to 2000cc $670.00

 Expander Implant

 Allergan Australia Pty Limited

AW012 McGhan Style 150 Biodimensional  Full height, Short Height, textured 9.6 -16cm width x 8 - 17cm  $2,040.00

 Biocell Textured Expand Gel/Saline  height x 4.2 - 7.1cm

 Filled Mammary Implant, Low Pole projection

 Expander Implant, Textured

 Johnson & Johnson Medical Pty Ltd

MN013 Mentor Siltex Becker  Textured Becker Expander/Mammary  145 to 800cc $2,040.00

 Expander/Mammary Implant Implant

Prostheses List by Category, Groups and Sponsor Page 598 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Multiple Chamber

 Device Technologies Australia Pty Ltd

DE335 Silimed Tissue Expander Double chamber, textured, magnetic,  470mm-780mm $1,250.00

 with suture tabs. Catalogue number:

 20799

 Self Expanding

 Spectrum Surgical

SO042 Osmed Tissue Expanders Self inflating, Hydrogel 0.24ml-650ml $1,250.00

 Textured

 Allergan Australia Pty Limited

AW013 Allergan Biospan Tissue Expander Silicone Elastomer. Saline filled. 150-950 cm3 $1,050.00

 Device Technologies Australia Pty Ltd

DE337 Silimed Tissue Expander Anatomical superior-pole/inferior- 200ml-840ml $1,050.00

 pole shape, textured, magnetic

 J T Medical Pty Ltd

JT006 Polytech Textured Mammary or   Textured with integrated or remote  The tissue expanders vary in $1,050.00

 Tissue Expander with integrated or  valve.  maximum volume from 100 -

 remote magnetic valve 960mls

JT007 Polytech Textured Mammary  Textured  with integrated or remote  The mammary expanders  $1,050.00

 Expander with integrated or remote  magnetic valve. Anatomically shaped  vary in maximum volume

 magnetic valve with reinforced inner base from 200 - 960mls

 Johnson & Johnson Medical Pty Ltd

MN002 Mentor Siltex Contour Profile  Siltex Contour Tissue Expander Volume 250cc - 850cc $1,050.00

 Breast Tissue Expander

MN042 Mentor Siltex Contour Breast Tissue Siltex Contour Tissue Expander with  250-850cc $1,050.00

  Expander suture tab (CPX3)

 Textured, Multiple Chamber

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW011 PMT Integra tissue expander Tissue/skin Expander 5cc to 1400cc $1,250.00

Prostheses List by Category, Groups and Sponsor Page 599 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.05.02.02 - Orbital

 Self Expanding

 Spectrum Surgical

SO041 Osmed Sphere / Hemisphere tissue  Self inflating, Hydrogel 6mm, 8mm, 9mm, 10mm $865.00 The provision of the prosthesis is

 expander for a child who is under 18 years

 of age.

 

 See rule 5B for effect of Condition.

07.05.03 - Skin, Artificial

 07.05.03.01 - <50cm²

 Integra Neurosciences Pty Ltd

IG034 Integra Artificial Skin (IDRT)  INTEGRA  Dermal Regeneration  5cm x 5cm $900.00

 Terminally 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.

 07.05.03.02 - 50-149cm²

 Integra Neurosciences Pty Ltd

IG035 Integra Artificial Skin (IDRT)  INTEGRA  Dermal Regeneration  10cm x 12.5cm $1,140.00

 Terminally 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 600 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 07.05.03.03 - 150-400cm²

 Integra Neurosciences Pty Ltd

IG036 Integra Artificial Skin (IDRT)  INTEGRA  Dermal Regeneration  10cm x 25cm $1,740.00

 Terminally 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.

 07.05.03.04 - >400cm²

 Integra Neurosciences Pty Ltd

IG037 Integra Artificial Skin (IDRT)  INTEGRA  Dermal Regeneration  20cm x 25cm $3,380.00

 Terminally 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.

07.05.04 - Coupler

 LMT Surgical Pty Ltd

LM030 Synovis Coupler High Density polyethylene (ring);  Diameter 1-3mm $625.00

 Stainless Steel (pins)

07.06.01 - Saline Filled

 07.06.01.01 - <500cc

 Textured

 Johnson & Johnson Medical Pty Ltd

MN053 Mentor Siltex Round Saline Implant Textured, round implant <500cc $685.00

Prostheses List by Category, Groups and Sponsor Page 601 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Valved

 Johnson & Johnson Medical Pty Ltd

MN045 Mentor Spectrum Saline Tissue  Smooth, round adjustable implant  <500cc $715.00

 Expander/Adjustable Implant with posterior spectrum valve

MN118 Mentor Smooth Round Saline  Smooth Round implant with Anterior  <500cc $715.00

 Diaphragm Valve

 Surgiplas Medical

SP011 Nagosil SFS-LP-Saline Filled Low  Smooth surface 100 to 600cc $715.00

 Profile Smooth Surface Breast

 Prostheses, Nagosil SFS-HP-Saline

 Filled High Profile Smooth Surface

 Breast Prostheses

 Valved, Textured

 Johnson & Johnson Medical Pty Ltd

MN049 Mentor Spectrum Saline Tissue  Textured, round adjustable implant  105 to 475cc $715.00

 Expander/Adjustable Implant with posterior spectrum valve

 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

 Valved, Textured, Pre-shaped

 Johnson & Johnson Medical Pty Ltd

MN047 Mentor Spectrum Saline Tissue  Textured, Contour Profile adjustable  <500cc $715.00

 Expander/Adjustable Implant implant with posterior spectrum valve

MN120 Mentor Siltex Contour Profile  Textured, Contour Profile implant  <500cc $715.00

 Saline Implant with Anterior Diaphragm Valve

 07.06.01.02 - 500cc

 Valved

 Johnson & Johnson Medical Pty Ltd

MN046 Mentor Spectrum Saline Tissue  Smooth, round adjustable implant  500cc $640.00

 Expander/Adjustable Implant with posterior spectrum valve

MN119 Mentor Smooth Round Saline  Smooth Round implant with Anterior  500cc $640.00

 Diaphragm Valve

Prostheses List by Category, Groups and Sponsor Page 602 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Valved, Textured, Pre-shaped

 Johnson & Johnson Medical Pty Ltd

MN048 Mentor Spectrum Saline Tissue  Textured, Contour Profile adjustable  500cc $685.00

 Expander / Adjustable Implant implant with posterior spectrum valve

MN121 Mentor Siltex Contour Profile  Textured, Contour Profile implant  500cc $685.00

 Saline Implant with Anterior Diaphragm Valve

07.06.02 - Gel Filled

 07.06.02.01 - <500cc

 Allergan Australia Pty Limited

AW008 Allergan Type SLD, SHD, SRL,  Low, Medium, High or Extra High  100 - 800 grams $610.00

 SRM, SRF, SRX Smooth Silicone  Profile

 Gel-filled Mammary Implant

AW010 Allergan Style 40, 45, SSL, SSM,  Round: low, medium, high & extra  110 - 800 grams $610.00

 SSF, SSX Intrashiel Gel-Filled  high profile

 Round Mammary Implant

 Johnson & Johnson Medical Pty Ltd

MN122 Mentor Smooth Round Gel Implant Smooth, Round, Cohesive l Gel  <500cc $610.00

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW012 Cereform Silicone Gel-filled Breast  Silicone Gel-filled Breast Implant 100cc to 500cc $610.00

 Implant, Round, Smooth and

 Textured Surface

MW014 Cereform "Aptima" Silicone Gel  Silicone gel-filled breast implant with 100cc to 500cc $610.00

 Filled Breast Implant  very high profile and filled with

 "Aptima" high cohesive gel

 Surgical Supplies Australia Pty Ltd

ZW002 Eurosilicone Breast Implants Round Cohesive Gel Breast Implants  100cc to 900cc $610.00

 for Plastic and Reconstructive

 Surgiplas Medical

SP048 Gel Filled Mammary Prosthesis  Smooth Round 80 to 800ml $610.00

 Models RGI-D, RGI-DH and RGI-

 DEH

Prostheses List by Category, Groups and Sponsor Page 603 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Pre-shaped

 J T Medical Pty Ltd

JT003 Sublime Line Mammary Implant The Sublime Line Mammary Implants  Low Profile, Moderate  $1,000.00

 are silicone gel-filled implants with  Profile, High Profile and

 either a smooth, textured or  Extra High Profile. Sizes

 Microthane surface and are available  45-495cc.

 in sizes less than 500cc. The implants

 either have a round base with a central

  or anatomical-projection or an oval

 base with an anatomical projection.

 The filling level of the Sublime Line

 implants is maximised to provide more

  volume. The implants are very close

 to the haptics and motional properties

  of the female breast tissue.

 Surgical Supplies Australia Pty Ltd

ZW003 Eurosilicone Breast Implants Anatomical Cohesive Gel Breast  100cc to 500cc $1,000.00

 Implants for Plastic and

 Reconstructrive Surgery

 Textured

 Allergan Australia Pty Limited

AW005 Allergan Type MLP, MHP, TRL,  Low, Medium, High & Extra High  80 - 800 grams $760.00

 TRM, TRF, TRX Low, Medium, High profile, textured surface

  & Extra High Profile Gel-Filled

 Mammary Implant

AW009 Allergan styles CML, CMH, TSL,  Silicone Cohesive Gel-Filled Breast  80 - 800 grams $760.00

 TSM, TSF, TSX Implant

 Device Technologies Australia Pty Ltd

DE362 Silimed Textured Mammary Implant Silimed Textured Mammary Implant 40cc - 499cc $760.00

 Johnson & Johnson Medical Pty Ltd

MN124 Mentor Siltex Round Gel Implant Textured, Round Cohesive l Gel  <500cc $760.00

 implant

MN128 Mentor Perthese Sensitive Gel  Perthese Sensitive Textured, Round  <500cc $760.00

 Breast Implants Implants

MN130 Mentor Siltex Round Gel Implant Textured, Round Cohesive Gel ll  <500cc $760.00

 Implant

Prostheses List by Category, Groups and Sponsor Page 604 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Surgical Supplies Australia Pty Ltd

ZW001 Eurosilicone Breast Implants Textured Cohesive Gel Breast  100cc to 900cc $760.00

 Implants for Plastic and

 Surgiplas Medical

SP047 Gel Filled Mammary Prosthesis  Textured Round 80 to 800ml $760.00

 Models GFX-LP, GFX and GFX-EHP

SP114 Nagor Breast Implants Silicone Firm and Stable Gel Breast  150 - 620cc $760.00

 Implants

 Textured, Pre-shaped

 Device Technologies Australia Pty Ltd

DE338 Silimed Anatomical Textured  Anatomical shape, textured surface,  115cc to 600cc $1,000.00

 Mammary Implant silicone gel filled mammary implant

 Johnson & Johnson Medical Pty Ltd

MN126 Mentor Contour Profile Gel Implant Textured, Contour Profile, Cohesive  <500cc $1,000.00

 lll, Gel implant

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW016 Cereform Silicone Breast Implant,  Silicone Gel-Filled Breast Implant 100cc to 500cc $1,000.00

 Anatomical, Textured Surface

 07.06.02.02 - 500cc

 Johnson & Johnson Medical Pty Ltd

MN123 Mentor Smooth Round Gel Implant Smooth, Round Cohesive l Gel  500cc $685.00

 Pre-shaped

 Allergan Australia Pty Limited

AW004 Style 510 Dual Gel Breast Prosthesis Anatomical textured implant with  LX sizes from 130-575  $1,200.00

 dual gel for projection of  grams, MX sizes from 145-

 nipple/areola complex, concave base  600 grams, FX sizes from

 and tapered edges for minimisation of  165-630 grams

 edge/thoracic wall palpability.

AW007 McGhan Style 410 & 410 Soft  Full, moderate or low height, Extra  125 - 775 grams $1,200.00

 Touch Biodimensional Biocell  Full, Full, moderate or low projection

 Textured Cohesive Gel-filled

Prostheses List by Category, Groups and Sponsor Page 605 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 J T Medical Pty Ltd

JT004 Sublime Line Mammary Implant The Sublime Line Mammary Implants  Low Profile, Moderate  $1,200.00

 are silicone gel-filled implants with  Profile, High Profile and

 either a smooth, textured or  Extra High Profile. Sizes

 Microthane surface and are available  500-1035cc.

 in sizes 500cc and above. The

 implants either have a round base

 with a central or anatomical-

 projection or an oval base with an

 anatomical projection. The filling

 level of the Sublime Line implants is

 maximised to provide more volume.

 The implants are very close to the

 haptics and motional properties of the

 female breast tissue.

 Surgiplas Medical

SP049 Gel Filled Mammary Prosthesis  CoGel High Cohesive 100 to 790gm $1,200.00

 Models CoGel-XR, CoGel-XRH,

 CoGel-XL, CoGel- XM and CoGel XF

 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

 Device Technologies Australia Pty Ltd

DE340 Silimed Polyurethane Breast  Polyurethane coated silicone gel  40cc to 695cc $760.00

 breast implant

DE363 Silimed Textured Mammary Implant Silimed Textured Mammary Implant 500cc - 695cc $760.00

 Johnson & Johnson Medical Pty Ltd

MN125 Mentor Siltex Round Gel Implant Textured, Round Cohesive l Gel  500cc $760.00

 implant

MN129 Mentor Perthese Sensitive Gel  Perthese Sensitive Textured, Round  500cc $760.00

 Breast Implants Implants

MN131 Mentor Siltex Round Gel Implant Textured, Round Cohesive Gel ll  500cc $760.00

 Implant

Prostheses List by Category, Groups and Sponsor Page 606 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW013 Cereform Silicone Gel-filled Breast  Silicone Gel-filled Breast Implant 500cc to 650cc $760.00

 Implant, Round, Smooth and

 Textured Surface

MW015 Cereform "Aptima" Silicone Gel  Silicone gel-filled breast implant with 500cc to 650cc $760.00

 Filled Breast Implant  very high profile and filled with

 "Aptima" high cohesive gel

MW019 Cereform Silicone Gel-filled Breast  Silicone Gel-filled Breast Implant 650cc to 850cc $760.00

 Implant, Round, Smooth and

 Textured Surface

MW020 Cereform "Aptima" Silicone Gel  Silicone gel-filled breast implant with 650cc to 850cc $760.00

 Filled Breast Implant  very high profile and filled with

 "Aptima" high cohesive gel

 Textured, Pre-shaped

 Device Technologies Australia Pty Ltd

DE341 Silimed Anatomical Polyurethane  Polyurethane coated silicone gel  115cc to 640cc $1,200.00

 Breast Implant breast implant

 Johnson & Johnson Medical Pty Ltd

MN127 Mentor Contour Profile Gel Implant Textured, Contour Profile, Cohesive  500cc $1,200.00

 lll, Gel implant

 Medical Vision Australia Plastic and Cosmetic Pty Ltd

MW017 Cereform Silicone Breast Implant,  Silicone Gel-Filled Breast Implant 500cc to 650cc $1,200.00

 Anatomical, Textured Surface

MW018 Cereform Silicone Breast Implant,  Silicone Gel-Filled Breast Implant 650 cc to 850cc $1,200.00

 Anatomical, Textured Surface

 07.06.02.03 - Pectoral Implant

 Device Technologies Australia Pty Ltd

DE334 Pectoral Implants Gel - Smooth surface 190cc - 300cc $950.00

 07.06.02.04 - Adjustable

 Johnson & Johnson Medical Pty Ltd

MN028 Mentor Spectra Adjustable Gel  Smooth Round Spectra Adjustable  190cc-760cc $1,050.00

 Breast Implants Gel Implant

Prostheses List by Category, Groups and Sponsor Page 607 of 1059


07 - PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

MN029 Mentor Spectra Adjustable Gel  Textured Round Spectra Adjustable  190cc - 760cc $1,050.00

 Breast Implants Gel Implant

07.07.01 - Bar

 Biomet Australia Pty Ltd

BI472 Pectus Bar Pectus Bar, Stainless Steel 80-432mm $1,256.00

07.07.02 - Stabiliser

 Biomet Australia Pty Ltd

BI483 Pectus Bar Stabilizer, Triangular or Elongated,  One size only $505.00

 Stainless Steel

Prostheses List by Category, Groups and Sponsor Page 608 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

08.01.01 - 29-42cc, 5-7 yrs longevity, Lead perf trends, Complex

 a

 Sorin Group Australia Pty Ltd

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

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

 response Volume: 32.6cc

 St Jude Medical Australia Pty Ltd

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

 verter defibrillator

 a, d

 Biotronik Australia Pty Ltd

BT098 Lumax 340 VR-T XL Single-chamber ICD with 40 J output,  Dimensions: 66mm x 55mm  $42,640.00

 Home Monitoring and Extended  x 13mm, Volume: 37cc,

 Longevity Mass: 92g

 Boston Scientific Australia Pty Ltd

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

 with RF

BS204 ENERGEN VR ICD High energy single chamber ICD with 31.5cc, 9.9mm, 72g $42,640.00

  DF-1 RV connector

BS208 INCEPTA VR ICD High energy single chamber ICD with 31.5cc, 9.9mm, 72g $42,640.00

  DF-1 RV connector

 a, d, e

 Boston Scientific Australia Pty Ltd

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

  RF

BS199 ENERGEN DF-4 VR ICD High energy single chamber ICD with 30.5cc, 9.9mm, 72g $43,390.00

  DF-4 RV connector

BS210 INCEPTA DF-4 VR ICD High energy single chamber ICD with 30.5cc, 9.9mm, 72g $43,390.00

  DF-4 RV connector

Prostheses List by Category, Groups and Sponsor Page 609 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

08.01.02 - Features of 8.1.1 plus auto test sensing parameters, auto

 a, d

 Biotronik Australia Pty Ltd

BT100 Lumax 540 VR-T Single-Chamber ICD with 40 J output  Dimensions: 66mm x 55mm  $43,920.00

 with Advanced Patient Management,  x 13mm, Volume: 37cc,

 Home Monitoring, Automatic  Mass: 92g

 Threshold Monitoring and Extended

 Longevity.

BT124 Lumax 540 VR-T DX Lumax 540 VR-T DX high energy  66 x 55 x 13 W x H x D  $43,920.00

 single-chamber ICD, with Atrial  (mm); Volume 37.2(cm3);

 Diagnostics and Home Monitoring®  Mass 92(g)

 functionality

 Medtronic Australasia Pty Ltd

MC813 Secura VR Model D234VRG Fully Automatic, Wireless  37cc, 68g $43,920.00

 Implantable cardioverter defibrillator

 with high energy capability and

 therapies for ventricular

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

 cardioverter 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  79g, 38cc $43,920.00

 Defibrillator with RF Telemetry

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

 defibrillator with 40J delivered

 energy and ST segment monitoring

SJ296 Ellipse VR CD1277-36 Single chamber cardioverter  66g, 31cc $43,920.00

 defibrillator with 36J delivered

 energy and ST segment monitoring

SJ299 Fortify Assura VR CD1259-40 Single chamber cardioverter  76g, 35cc $43,920.00

 defribrillator with 40J delivered

 energy and ST segment monitoring

Prostheses List by Category, Groups and Sponsor Page 610 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 a, d, e

 Medtronic Australasia Pty Ltd

MI024 Protecta XT VR D354VRM Single chamber implantable  Volume 38cc, Mass 73g $44,670.00

 cardioverter defibrillator with

 SmartShock Technology, OptiVol 2.0

 Fluid Status Monitoring and

 Complete Capture Management

 Specifications (DF-4)

MI054 Secura VR Model D214VRM Fully Automatic, Wireless  37cc $44,670.00

 Implantable cardioverter defibrillator

 with high energy capability and

 therapies for ventricular

 tachyarrhythmia. DF-4 lead connector.

 St Jude Medical Australia Pty Ltd

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

 Defibrillator with RF Telemetry and

 SJ4 connector

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

 defibrillator with 40J delivered

 energy and ST segment monitoring

 and SJ4 connector

SJ309 Fortify Assura VR CD1259-40Q Single chamber cardioverter  35cc, 75g $44,670.00

 defribrillator with 40J delivered

 energy and ST segment monitoring

 and DF4 connector

SJ311 Ellipse VR CD1277-36Q Single chamber cardioverter  67g, 30cc $44,670.00

 defibrillator with 36J delivered

 energy and ST segment monitoring

 and DF4 connector

 a,d

 Biotronik Australia Pty Ltd

BT143 Ilesto 7 VR-T Single Chamber ICD, rate adaptive  W x H x D (mm) 65 x 55 x  $43,920.00

 pacing, max. 40J shock energy, Home  11, Volume: 31cc, Mass:

 Monitoring, MRI conditional, IS-

 1/DF-1 connector

Prostheses List by Category, Groups and Sponsor Page 611 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BT144 Ilesto 7 VR-T DX Single Chamber ICD, rate adaptive,  W x H x D (mm) 65 x 55 x  $43,920.00

 additional atrial detection, max. 40J  11, Volume: 31cc,  Mass: 80g

 shock energy, Home Monitoring, MRI

  conditional, IS-1/DF-1 connector

 Medtronic Australasia Pty Ltd

MI112 Evera XT VR DF1 Single Chamber Implantable  33cm³ 77g $43,920.00

 Cardioverter Defibrillator with

 PhysionCurve Design, Optimised

 Battery Chemistry, SmartShock

 Technology 2.0, Optivol 2.0 Fluid

 Status Monitoring, Complete Capture

 Management. DF1

MI114 Evera S VR DF1 Single Chamber Implantable  33cm³ 77g $43,920.00

 Cardioverter Defibrillator with

 PhysioCurve Design, Optimised

 Battery Chemistry, Smart Shock

 Technology 2.0, DF1

 Sorin Group Australia Pty Ltd

SA157 PARADYM™ RF VR 9250 Single Chamber, High Energy,  69.5 x 73.4 x 11mm 38.6cc  $43,920.00

 Implantable Cardioverter Defibrillator 95g

  with rate response and remote

 monitoring.

 St Jude Medical Australia Pty Ltd

SJ326 Ellipse VR CD1377-36/CD1377-36C Single Chamber Cardioverter  31cc, 66g $43,920.00

 Defribrillator

SJ333 Fortify Assura VR CD1359- Single Chamber Cardioverter  76g , 35cc $43,920.00

 40/CD1359-40C Defibrillator with 40J delivered energy

 a,d,e

 Medtronic Australasia Pty Ltd

MI111 Evera XT VR DF4 Single Chamber Implantable  33cm³ 77g $44,670.00

 Cardioverter Defibrillator with

 PhysioCurve Design, Optimised

 Battery Chemistry, Smart Shock

 Technology 2.0, Optivol 2.0 Fluid

 Status Monitoring, Complete Capture

 Management. DF4

Prostheses List by Category, Groups and Sponsor Page 612 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

MI113 Evera S VR DF4 Single Chamber Implantable  33cm³ 77g $44,670.00

 Cardioverter Defibrillator with

 PhysioCurve Design, Optimised

 Battery Chemistry, Smart Shock

 Technology 2.0, DF4

 St Jude Medical Australia Pty Ltd

SJ318 Fortify Assura VR CD1359- Single Chamber Cardioverter  75g, 35cc $44,670.00

 40Q/CD1359-40QC Defibrillator

SJ332 Ellipse VR CD1377-36Q/CD1377- Single Chamber Cardioverter  67g, 30cc $44,670.00

 36QC Defibrillator with 36 J delivered

 d

 St Jude Medical Australia Pty Ltd

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

 defibrillator with RF telemetry

 a,d

 Biotronik Australia Pty Ltd

BT129 Lumax 740 VR-T DX High Energy Single Chamber ICD  W x H x D (mm) 66 x 55 x  $43,920.00

 with Atrial Diagnostics and Home  13, Volume: 37.2cc, Mass:

 Monitoring. Conditionally MRI  92g

 compatible

BT131 Lumax 740 VR-T Single Chamber ICD with 40J output  WxHxD (mm) 66 x 55 x 13,  $43,920.00

 with Advanced Patient Management,  Volume: 37cc, Mass: 92g

 Home Monitoring, Automatic

 Threshold Monitoring and MRI

 Conditional compatibility

 a,d,e

 Biotronik Australia Pty Ltd

BT150 Ilesto 7 VR-T DF-4 Single Chamber ICD, rate adaptive,  W x H x D (mm) 65 x 55 x  $44,670.00

 max. 40J shock energy, Home  11, Volume: 31cc, Mass:

 Monitoring, MR conditional, IS-

 1/DF4 connector

Prostheses List by Category, Groups and Sponsor Page 613 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

08.02.01 - 29-42cc, 5-7 yrs longevity, Lead perf trends, Complex

 a

 Sorin Group Australia Pty Ltd

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

 Implantable Cardioverter Defibrillator 32.6cc; Dimensions: 58.4 x

  with rate response 73.4 x 11mm

 a, d

 Biotronik Australia Pty Ltd

BT086 Lumax 340 DR-T Dual-chamber ICD with 40 J output  Dimensions: 66mm x 55mm  $45,760.00

 and Home Monitoring x 13mm, Volume: 37cc,

 Mass: 92g

BT101 Lumax 540 DR-T Dual-Chamber ICD with 40 J output  Dimensions: 66mm x 55mm  $45,760.00

 with Advanced Patient Management,  x 13mm, Volume: 37cc,

 Home Monitoring, Automatic  Mass: 92g

 Ventricular Threshold Monitoring

 and Extended Longevity.

 Boston Scientific Australia Pty Ltd

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

 RF

BS200 ENERGEN DR ICD High energy dual chamber ICD with  32cc, 9.9mm, 72g $45,760.00

 DF-1 RV connector

BS206 INCEPTA DR ICD Hight energy dual chamber ICD with  31.5cc, 9.9mm, 72g $45,760.00

 DF-1 RV connector

 a, d, e

 Boston Scientific Australia Pty Ltd

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

 RF IS4

BS201 ENERGEN DF-4 DR ICD High energy dual chamber ICD with  31.5cc, 9.9mm, 72g $46,510.00

 DF-4 RV connector

BS207 INCEPTA DF-4 DR ICD High energy dual chamber ICD with  31.5cc, 9.9mm, 72g $46,510.00

 DF-4 RV connector

Prostheses List by Category, Groups and Sponsor Page 614 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 a,d

 Biotronik Australia Pty Ltd

BT130 Lumax 740 DR-T Dual Chamber ICD with 40J output  WxHxD (mm) 66 x 55 x 13,  $45,760.00

 with Advanced Patient Management,  Volume: 37cc, Mass: 92g

 Home Monitoring, Automatic

 Ventricular Threshold Monitoring

 and conditionally MRI compatible.

08.02.02 - Features of 8.2.1 plus auto test sensing parameters, auto

 a, c, d

 Medtronic Australasia Pty Ltd

MC814 Secura DR Model D234DRG Fully Automatic, Wireless  37cc, 68g $47,130.00

 Implantable cardioverter defibrillator

 with high energy capability and

 therapies for ventricular and atrial

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

 cardioverter defribillator with

 SmartShock Technology, OptiVol 2.0

 Fluid Status Monitoring and

 Complete Capture Management

 a, c, d, e

 Medtronic Australasia Pty Ltd

MI025 Protecta XT DR D354DRM Dual chamber implantable  Volume 41cc, Mass 73g $47,880.00

 cardioverter defribillator with

 SmartShock Technology, OptiVol 2.0

 Fuild Status Monitoring and

 Complete Capture Management

MI034 Secura DR Model D214DRM Fully Automatic, Wireless  37cc $47,880.00

 Implantable cardioverter defibrillator

 with high energy capability and

 therapies for ventricular and atrial

 tachyarrhythmia. DF-4 lead connector.

Prostheses List by Category, Groups and Sponsor Page 615 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 a, d

 St Jude Medical Australia Pty Ltd

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

 Defibrillator with RF Telemetry

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

 defibrillator with 40J delivered

 energy and ST segment monitoring

SJ297 Fortify Assura DR CD2259-40 Dual chamber cardioverter  35cc, 76g $47,130.00

 defibrillator with 40J delivered

 energy and ST segment monitoring

SJ300 Ellipse DR CD2277-36 Dual chamber cardioverter  66g, 31cc $47,130.00

 defibrillator with 36J delivered

 energy and ST segment monitoring

 a, d, e

 St Jude Medical Australia Pty Ltd

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

 Defibrillator with RF Telemetry and

 SJ4 connector

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

  with 40J delivered energy and ST

 segment monitoring

SJ310 Fortify Assura DR CD2259-40Q Dual Chamber cardioverter defrillator  35cc, 75g $47,880.00

 with 40J delivered energy and ST

 segment monitoring with DF4

 connector

SJ313 Ellipse DR CD2277-36Q Dual chamber cardioverter  68g, 31cc $47,880.00

 defibrillator with 36J delivered

 energy and ST segment monitoring

 with DF4 connector

Prostheses List by Category, Groups and Sponsor Page 616 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 a,c,d

 Medtronic Australasia Pty Ltd

MI116 Evera XT DR IS1/DF1 Dual Chamber Implantable  34cm³ 78g $47,130.00

 Cardioverter Defibrillator with

 PhysioCurve Design, Optimised

 Battery Chemistry, Smart Shock

 Technology 2.0, Optivol 2.0 Fluid

 Status Monitoring, Complete Capture

 Management and Atrial Therapies. DF1

MI118 Evera S DR IS1/DF1 Dual Chamber Implantable  34cm³ 78g $47,130.00

 Cardioverter Defibrillator with

 PhysioCurve Design, Optimised

 Battery Chemistry, Smart Shock

 Technology 2.0, DF1

 a,c,d,e

 Medtronic Australasia Pty Ltd

MI115 Evera XT DR IS1/DF4 Dual Chamber Implantable  34cm³ 78g $47,880.00

 Cardioverter Defibrillator with

 PhysioCurve Design, Optimised

 Battery Chemistry, Smart Shock

 Technology 2.0, Optivol 2.0 Fluid

 Status Monitoring, Complete Capture

 Management and Atrial Therapies. DF4

MI117 Evera S DR IS1/DF4 Dual Chamber Implantable  34cm³ 78g $47,880.00

 Cardioverter Defibrillator with

 PhysioCurve Design, Optimised

 Battery Chemistry, Smart Shock

 Technology 2.0, DF4

 a,d

 Biotronik Australia Pty Ltd

BT145 Ilesto 7 DR-T Dual Chamber ICD, rate adaptive,  W x H x D (mm) 65 x 55 x  $47,130.00

 Max. 40J shock energy, Home  11, Volume: 31cc, Mass:

 Monitoring, MRI conditional, IS-

 1/DF-1 connector

Prostheses List by Category, Groups and Sponsor Page 617 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Sorin Group Australia Pty Ltd

SA156 PARADYM™ RF DR 9550 Dual Chamber Implantable  69.5 x 73.4 x 11mm 38.6cc  $47,130.00

 Cardioverter Defibrillator with rate  95g

 response, high output extended

 longevity and remote monitoring.

 St Jude Medical Australia Pty Ltd

SJ324 Fortify Assura DR CD2359- Dual Chamber Cardioverter  75g, 35cc $47,130.00

 40/CD2359-40C Defibrillator

SJ327 Ellipse DR CD2377-36/CD2377- Dual Chamber ICD 66g, 31cc $47,130.00

 a,d,e

 St Jude Medical Australia Pty Ltd

SJ325 Fortify Assura DR CD2359- Dual Chamber Cardioverter  75g, 35cc $47,880.00

 40Q/CD2359-40QC Defibrillator with 40J delivered energy

SJ331 Ellipse DR CD2377-36Q/CD2377- Dual Chamber Cardioverter  68g, 31cc $47,880.00

 36QC Defibrillator with 36J delivered energy

 d

 St Jude Medical Australia Pty Ltd

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

 defribillator with RF telemetry

 a,d,e

 Biotronik Australia Pty Ltd

BT151 Ilesto 7 DR-T DF-4 Dual chamber ICD, rate adaptive, max.  W x H x D (mm) 65 x 55 x  $47,880.00

 40J shock energy, Home Monitoring,  11, Volume: 31 cc, Mass: 80g

 MR conditional, IS-1/DF4 connector

08.03.01 - Dual Chamber, Bivent pacing, Vent tachyarrhythmia

 a

 Sorin Group Australia Pty Ltd

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

  with Cardiac Resynchronisation   x 11mm

 therapy, High Energy

Prostheses List by Category, Groups and Sponsor Page 618 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 a, d

 Biotronik Australia Pty Ltd

BT102 Lumax 540 HF-T CRT-ICD with 40 J output with  Dimensions: 66mm x 59mm  $47,840.00

 Advanced Patient Management, Home x 13 mm, Volume: 39.8cc,

  Monitoring, Automatic right and left- Mass: 94g

 ventricular 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)

BS203 ENERGEN CRT-D High energy CRT-D with DF-1 RV  32.5cc, 9.9mm, 72g $47,840.00

 connector and IS-1 LV connector

BS209 INCEPTA CRT-D High energy CRT-D with DF-1 RV  32.5cc, 9.9mm, 72g $47,840.00

 connector & lS-1 (N163) or LV-1

 (N165) LV connector

 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

BS202 ENERGEN DF-4 CRT-D High energy CRT-D with DF-4 RV  32cc, 9.9mm, 72g $48,590.00

 connector and IS-1 LV connector

BS205 INCEPTA DF-4 CRT-D High energy CRT-D with DF-4 RV  32cc, 9.9mm. 72g $48,590.00

 connector and  lS-1 LV connector

 a,d

 Biotronik Australia Pty Ltd

BT128 Lumax 740 HF-T CRT-ICD with 40J output with  W x H x D (mm) 66 x 59 x  $47,840.00

 Advanced Patient Management, Home 13, Volume: 39.8cc, Mass:

  Monitoring, automatic right and left  94g

 ventricular Threshold Monitoring and

  conditionally MRI compatible

Prostheses List by Category, Groups and Sponsor Page 619 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

08.03.02 - Features of 8.3.1 plus auto test sensing parameters, auto

 a, c, d

 Medtronic Australasia Pty Ltd

MC812 Consulta CRT-D Model D234TRK Fully Automatic, Wireless  38cc, 68g $52,000.00

 Implantable cardioverter defibrillator

 with cardiac resynchronization

 therapy (CRT), and therapies for

 ventricular and atrial tachyarrhythmia

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

  with 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  38cc $52,750.00

 Implantable cardioverter defribillator

 with cardiac resynchronization

 therapy (CRT), and therapies for

 ventrilcular and atrial

MI026 Protecta XT CRT-D D354TRM Implantable Cardioverter Defibrillator Volume 40cc, Mass 73g $52,750.00

  with Cardiac Resynchronisation

 therapy, SmartShock Technology,

 OptiVol 2.0 Fluid Status Monitoring

 and Complete Capture Management

 Specifications (DF-4)

MI070 VIVA XT CRT-D DTBA2D4 Implantable Cardioverter Defibrillator 35cc, 82g $52,750.00

  with Cardiac Resynchronisation

 therapy, SmartShock Technology,

 OptiVol 2.0 Fluid Status Monitoring,

 Complete Capture Management

 Specifications (DF4), and

 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 620 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

SJ271 Unify Quadra CRT CD 3251-40 Cardiac Resynchronisation Therapy  40cc, 83g $52,000.00

 Defibrillator with 40J delivered plus

 Quadripolar pacing

SJ281 Promote Quadra CRT CD3237-40 Cardiac Resynchronisation Therapy  46cc, 88g $52,000.00

 Defibrillator with 40J delivered

 energy, VectSelect Quartet

 Programmable LV pulse configuration

  and Multisite Pacing

SJ298 Quadra Assura CD3267-40 Cardiac Resynchronisation Therapy  40cc, 83g $52,000.00

 Defibrillator with 40J delivered and

 Multisite Left Ventricular Pacing and

 Quadripolar pacing

SJ301 Unify Assura CD3261-40 Cardiac Resynchronisation Therapy  36cc, 78g $52,000.00

 Defribrillator with 40J delivered

 a, d, e

 St Jude Medical Australia Pty Ltd

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

 Defibrillator with RF Telemetry and

 SJ4 connector

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

 Defibrillator with 40J delivered

 energy and SJ4 connector

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

SJ272 Unify Quadra CRT CD 3251-40Q Cardiac Resynchronisation Therapy  38cc, 81g $52,750.00

 Defibrillator with 40J delivered

 energy with quadripole pacing and

 SJ4 connector

Prostheses List by Category, Groups and Sponsor Page 621 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

SJ312 Quadra Assura CD3267-40Q Cardiac Resynchronisation Therapy  38cc, 81g $52,750.00

 Defribrillator with 40J delivered

 energy, Multisite Left Ventricular

 Pacing plus Quadripolar pacing and

 SJ4 connector

SJ314 Unify Assura CD3261-40Q Cardiac Resynchronisation Therapy  36cc, 77g $52,750.00

 Defribrillator with 40J delivered

 energy and SJ4 connector

 a,c,d

 Medtronic Australasia Pty Ltd

MI069 VIVA XT CRT-D DTBA2D1 Implantable Cardioverter Defibrillator 35cc, 82g $52,000.00

  with Cardiac Resynchronisation

 therapy, SmartShock Technology,

 OptiVol 2.0 Fluid Status Monitoring,

 Complete Capture Management

 Specifications (DF1), and

MI071 VIVA S CRT-D DTBB2D1 Implantable Cardioverter Defibrillator 35cc, 82g $52,000.00

  with Cardiac Resynchronisation

 therapy, SmartShock Tehnology,

 OptiVol 2.0 Fluid Status Monitoring

 and Complete Capture Management

 Specifications (DF1)

 a,c,d,e

 Medtronic Australasia Pty Ltd

MI072 VIVA S CRT-D DTBB2D4 Implantable Cardioverter Defibrillator 35cc, 82G $52,750.00

  with Cardiac Resynchronisation

 therapy, SmartShock Tehnology,

 OptiVol 2.0 Fluid Status Monitoring

 and Complete Capture Management

 Specifications (DF4)

 a,d

 Biotronik Australia Pty Ltd

BT146 Ilesto 7 HF-T Triple Chamber CRT-D device, rate  W x H x D (mm) 65 x 58.5 x  $52,000.00

 adaptive, max. 40J shock energy,  11, Volume: 33 cc, Mass: 80g

 Home Monitoring, MRI conditional, 

 IS-1/DF-1 connector

Prostheses List by Category, Groups and Sponsor Page 622 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Sorin Group Australia Pty Ltd

SA158 PARADYM™ RF CRT-D 9750 Implantable Cardioverter  69.5 x 73.4 x 11mm 38.6cc  $52,000.00

 Defibrillator, for resyncronisation of  95g

 heart failure, high output extended

 longevity and home monitoring.

SA159 PARADYM™ RF CRT-D SonR  Implantable Cardioverter Defibrillator 69.5 x 73.4 x 11mm 38.6cc  $52,000.00

  for resyncronisation of heart failure,  95g

 high output, extended longevity and

 home monitoring, and in conjunction

 with a dedicated atrial lead with SonR

  sensor provides automatic adjustment

  of AV/VV delays for optimisation of

 resynchronisation therapy.

 St Jude Medical Australia Pty Ltd

SJ319 Quadra Assura MP CD3371- Cardiac Resynchronisation Therapy  83g, 40cc $52,000.00

 40/CD3371/40C Cardioverter Defibrillator

SJ320 Unify Assura CD3361-40/CD3361- Cardiac Resynchronisation Therapy  78g, 36cc $52,000.00

 40C Cardioverter Defibrillator

SJ323 Quadra Assura CD3367- Cardiac Resynchronisation Therapy  83g, 40cc $52,000.00

 40/CD3367-40C Defibrillator with 40J delivered energy

SJ328 Unify Quadra MP CD 3255-40 Cardiac Resynchronisation Therapy  40cc, 83g $52,000.00

 Defibrillator with 40J delivered and

 Multisite Left Ventricular Pacing and

 Quadripolar pacing

 a,d,e

 Medtronic Australasia Pty Ltd

MI109 VIVA QUAD XT CRT-D IS4/DF4 ICD with CRT. PhysioCurve Design,  35cm³ 81g $52,750.00

 AdaptivCRT Algorithm, CardioSync

 Optimisation, VextorExpress, LV

 Automated Test, Optimised Battery

 Chemistry, Smart Shock Technology

 2.0, Optivol 2.0 Fluid Status

 Monitoring, Complete Capture

 Management and Atrial Therapies. IS4

  DF4

Prostheses List by Category, Groups and Sponsor Page 623 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

MI110 VIVA QUAD S CRT-D IS4/DF4 ICD with CRT. PhysioCurve Design,  35cm³ 81g $52,750.00

 CardioSync Optimisation,

 VectorExpress, V Automated Test,

 Optimised Battery Chemistry, Smart

 Shock Technology 2.0. Complete

 Capture management. IS4 DF4

 St Jude Medical Australia Pty Ltd

SJ282 Promote Quadra CD3237-40Q Cardiac Resynchronisation Therapy  44cc, 87g $52,750.00

 Defibrillator with 40J delivered

 energy and VectSelect Quartet

 Programmable LV pulse configuration

  plus Multisite Left Ventricular

 Pacing and SJ4 connector.

SJ321 Quadra Assura MP CD3371- Cardiac Resynchronisation Therapy  80gm, 38cc $52,750.00

 40Q/CD3371-40QC Defibrillator

SJ322 Unify Quadra MP CD 3255-40Q Cardiac Resynchronisation Therapy  38cc , 81g $52,750.00

 Defibrillator with 40J delivered

 energy, Multisite Left Ventricular

 Pacing plus Quadripolar pacing and

SJ329 Unify Assura CD3361- Cardiac Resynchronisation Therapy  77g, 36cc $52,750.00

 40Q/CD3361-40QC Cardioverter Defibrillator

SJ330 Quadra Assura CD3367- Cardiac Resynchronisation Therapy  80g, 38cc $52,750.00

 40Q/CD3367-40QC Defibrillator with 40J delivered energy

 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 624 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 a,d

 Medtronic Australasia Pty Ltd

MI130 VIVA QUAD XT CRT-D IS4/DF1 ICD with CRT. PhysioCurve Design,  35cm³ 81g $52,000.00

 Adaptiv CRT Algorithm, CardioSync

 Optimisation, VectorExpress, LV

 Automated Test, Optimised Battery

 Chemistry, Smart Shock Technology

 2.0, Optivol 2.0 Fluid Status

 Monitoring, Complete Capture

 Management and Atrial Therapies. IS4

  DF1

MI131 VIVA QUAD S CRT-D IS4/DF1 ICD with CRT. PhysioCurve Design,  35cm³ 81g $52,000.00

 CardioSync Optimisation,

 VectorExpress, LV Automated Test,

 Optimised Battery Chemistry, Smart

 Shock Technology 2.0. Complete

 capture management. IS4 DF1

 a,d,e

 Biotronik Australia Pty Ltd

BT152 Ilesto 7 HF-T DF-4 Triple Chamber CRT-D device, rate  W x H x D (mm) 65 x 56 x  $52,750.00

 adaptive, max. 40J shock energy,  11, Volume: 33 cc, Mass: 80g

 Home Monitoring, MR conditional,

 lS-1/DF4 connector.

08.04.02 - SSIR pacemakers with rate responsive feature

 St Jude Medical Australia Pty Ltd

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

  implantable pacemaker rate-adaptive pacing devices with

 extended longevity

Prostheses List by Category, Groups and Sponsor Page 625 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

08.04.03 - SSIR with small/compact size, multi-programmability &

 Biotronik Australia Pty Ltd

BT109 Entovis SR Fully automatic, single chamber  Size: 53mm x 39mm x 6.5mm  $5,928.00

 pacemaker with Closed Loop  (W x H x D), Volume: 11cc,

 Stimulation and extended longevity Mass: 24g

BT113 Evia SR Fully automatic, single chamber  Size: 53mm x 39mm x 6.5mm  $5,928.00

 pacemaker with Closed Loop  (W x H x D), Volume: 11

 Stimulation and extended longevity cm3, Mass: 24 g

 Boston Scientific Australia Pty Ltd

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

 pacemaker

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

 pacemaker

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

 pacemaker

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

 pacemaker

 Medtronic Australasia Pty Ltd

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

 ADSR06, ADSR03

 Sorin Group Australia Pty Ltd

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

 with 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

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

Prostheses List by Category, Groups and Sponsor Page 626 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

SJ294 Accent MRI SR PM1124 Single Chamber Pacemaker with MRI  23g, 13.1cc $5,928.00

 testing capability

 f

 St Jude Medical Australia Pty Ltd

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

 Model 2525T Pacemaker Pacemaker

 i

 Biotronik Australia Pty Ltd

BT108 Entovis SR-T Fully automatic, single chamber  Size: 53mm x 39mm x 6.5mm  $5,928.00

 pacemaker with Closed Loop  (W x H x D), Volume: 11cc,

 Stimulation, Home Monitoring and  Mass: 24g

 extended longevity

BT110 Evia SR-T Fully automatic, single chamber  Size: 53mm x 39mm x 6.5mm  $5,928.00

 pacemaker with Closed Loop  (W x H x D), Volume: 11cc,

 Stimulation, Home Monitoring and  Mass: 24g

 extended longevity

 Boston Scientific Australia Pty Ltd

BS220 INGENIO SR Single Chamber Pacemaker 11.5cc $5,928.00

BS223 ADVANTIO SR Single Chamber Pacemaker 11.5cc $5,928.00

BS233 ADVANTIO MRI SR Single Chamber Pacemaker, MRI  11.5cc $5,928.00

 Compatible

BS236 INGENIO MRI SR Single Chamber Pacemaker, MRI  11.5cc $5,928.00

 Compatible

 St Jude Medical Australia Pty Ltd

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

 telemetry

SJ257 Accent ST RF PM1222 Single Chamber Pacemaker with ST  12.8g, 23g $5,928.00

 Segment Monitoring and RF

SJ259 Accent MRI SR RF PM1224 Single Chamber Pacemaker with RF  23g, 13.1cc $5,928.00

 Telemetry and MRI testing capability

Prostheses List by Category, Groups and Sponsor Page 627 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 St Jude Medical Australia Pty Ltd

SJ335 Endurity PM1160 Single Chamber Rate Responsive  10.5cc, 19g $5,928.00

 Pacemaker

 i

 Boston Scientific Australia Pty Ltd

BS267 VITALIO SR Single Chamber Pacemaker,  11.5cc $5,928.00

 Compatible

BS271 VITALIO MRI SR Single Chamber Pacemaker, MRI  11.5cc $5,928.00

 Compatible

 St Jude Medical Australia Pty Ltd

SJ334 Assurity PM1240 Single Chamber Rate-Responsive  10.4cc, 20g $5,928.00

 Pacemaker with RF Telemetry

SJ340 Assurity+ PM1260 Single Chamber Rate-Responsive  10.4cc. 20g $5,928.00

 Pacemaker with RF Telemetry

08.05.01 - DDD/VDD (Communication capability)

 Boston Scientific Australia Pty Ltd

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

08.05.02 - DDDR/VDDR including rate responsive feature

 Medtronic Australasia Pty Ltd

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

08.05.03 - DDDR with four or more advanced features

 Boston Scientific Australia Pty Ltd

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

 pacemaker

Prostheses List by Category, Groups and Sponsor Page 628 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 pacemaker

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

 pacemaker

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

 pacemaker

 Sorin Group Australia Pty Ltd

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

 with Rate Response Modulation Dimensions:41.2 x 41.5 x

 6.1mm

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

 with Rate Response Modulation Dimensions:41.2 x 41.5 x

 6.1mm

 St Jude Medical Australia Pty Ltd

SJ051 Verity ADX XL DR 5357 M/S Dual - Chamber, multi-programmable,  45x52x6mm,11cc, 23g, 5mm  $9,360.00

 rate-responsive pacemaker withAF  or 6mm M/S

 suppression

 i

 Boston Scientific Australia Pty Ltd

BS218 INGENIO EL DR Dual Chamber Pacemaker, extended  14cc $11,440.00

BS219 INGENIO DR Dual Chamber Pacemaker 12cc $11,440.00

BS221 ADVANTIO EL DR Dual Chamber Pacemaker, Extended  14cc $11,440.00

 Life

BS222 ADVANTIO DR Dual Chamber Pacemaker 12cc $11,440.00

BS231 ADVANTIO MRI EL DR Dual Chamber Pacemaker, Extended  14cc $11,440.00

 Life, MRI Conditional

BS232 ADVANTIO MRI DR Dual Chamber Pacemaker, MRI  12cc $11,440.00

 Compatible

BS234 INGENIO MRI EL DR Dual Chamber Pacemaker, Extended  14cc $11,440.00

 Life, MRI Compatible

BS235 INGENIO MRI DR Dual Chamber Pacemaker, MRI  12cc $11,440.00

 Compatible

Prostheses List by Category, Groups and Sponsor Page 629 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

08.05.04 - DDDR with continuous threshold monitoring in atrium +

 Biotronik Australia Pty Ltd

BT111 Entovis DR Fully automatic, dual chamber  Size: 53mm x 43mm x 6.5mm  $11,440.00

 pacemaker with Closed Loop  (W x H x D), Volume: 11cc,

 Stimulation, Vp suppression and  Mass: 26g

 extended longevity

BT112 Evia DR Fully automatic, dual chamber  Size: 53mm x 43mm x 6.5mm  $11,440.00

 pacemaker with Closed Loop  (W x H x D), Volume: 11cc,

 Stimulation, Vp suppression and  Mass: 26g

 extended longevity

 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  $11,440.00

 Pacemaker 5820 - 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

SJ295 Accent MRI DR PM2124 Dual Chamber Pacemaker with MRI  24g, 13.1cc $11,440.00

 testing capability

 g

 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 Fea

Prostheses List by Category, Groups and Sponsor Page 630 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 i

 Biotronik Australia Pty Ltd

BT114 Evia DR-T Fully automatic, dual chamber  Size: 53mm x 43mm x 6.5mm  $11,440.00

 pacemaker with Closed Loop  (W x H x D), Volume: 11cc,

 Stimulation, Home Monitoring, Vp  Mass: 26g

 suppression and extended longevity

BT115 Entovis DR-T Fully automatic, dual chamber  Size: 53mm x 43mm x 6.5mm  $11,440.00

 pacemaker with Closed Loop  (W x H x D), Volume: 11cc,

 Stimulation, Home Monitoring, Vp  Mass: 26g

 suppression and extended longevity

 St Jude Medical Australia Pty Ltd

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

 telemetry

SJ254 Accent ST RF PM2222 Dual Chamber Pacemeker with ST  23g, 12.9cc $11,440.00

 Segment Monitoring and RF

SJ258 Accent MRI DR RF PM2224 Dual Chamber Pacemaker with RF  24g, 13.1cc $11,440.00

 Telemetry and MRI testing capability

 St Jude Medical Australia Pty Ltd

SJ336 Endurity PM2160 Dual Chamber Rate  Responsive  10.4cc, 19g $11,440.00

 Pacemaker

 i

 Boston Scientific Australia Pty Ltd

BS264 FORMIO DR Dual Chamber Pacemaker, Compatible 12cc $11,440.00

BS265 VITALIO EL DR Dual Chamber Pacemaker, extended  14cc $11,440.00

 life, Compatible

BS266 VITALIO DR Dual Chamber Pacemaker, Compatible 12cc $11,440.00

Prostheses List by Category, Groups and Sponsor Page 631 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BS268 FORMIO MRI DR Dual Chamber Pacemaker, MRI  12cc $11,440.00

 Compatible

BS269 VITALIO MRI EL DR Dual Chamber Pacemaker, extended  14cc $11,440.00

 life MRI Compatible

BS270 VITALIO MRI DR Dual Chamber Pacemaker, MRI  12cc $11,440.00

 Compatible

 St Jude Medical Australia Pty Ltd

SJ339 Assurity PM2240 Dual Chamber Rate Responsive  10.4cc, 20g $11,440.00

 Pacemaker with RF Telemetry

SJ341 Assurity+ PM2260 Dual Chamber Rate Responsive  10.4cc, 20g $11,440.00

 Pacemaker with RF Telemetry

08.06.01 - Dual Chamber, Biven pacing, programming enabling

 Guidant Australia Pty Ltd

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

 Model H140, Model H145

 i

 Biotronik Australia Pty Ltd

BT085 Stratos LV-T Multiprogrammable biventricular  Size: 55mm x 50mm x 6mm  $12,480.00

 pacemaker with Home Monitoring (W x H x D), Volume: 14

 cm3, Mass: 30 g

 Boston Scientific Australia Pty Ltd

BS216 INVIVE LV-1 Cardiac Resynchronization Therapy  15cc $12,480.00

 Pacemaker

BS217 INVIVE IS-1 Cardiac Resyncronization Therapy  15cc $12,480.00

 Pacemaker

08.06.02 - Features of 8.6.1 plus continuous threshold monitoring in

 St Jude Medical Australia Pty Ltd

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

 Pacemaker

Prostheses List by Category, Groups and Sponsor Page 632 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 g

 Medtronic Australasia Pty Ltd

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

 Pacemaker, Model C3TR01

 i

 Biotronik Australia Pty Ltd

BT147 Evia HF-T MRI conditional Multiprogrammable  53mm x 49mm x 6.5mm (W x  $13,520.00

 biventricular pacemaker with Home  H x D), Volume: 14cm3

 Monitoring Mass: 26 grams

 St Jude Medical Australia Pty Ltd

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

 i

 Boston Scientific Australia Pty Ltd

BS262 INLIVEN IS-1 Cardiac Resynchronization therapy  15cc $13,520.00

 pacemaker

BS263 INLIVEN LV-1 Cardiac Resynchronization therapy  15cc $13,520.00

 pacemaker

 St Jude Medical Australia Pty Ltd

SJ337 Allure RF PM3222 CRT Rate Responsive Pacemaker with 14cc, 24g $13,520.00

  RF Telemetry

SJ338 Allure Quadra RF PM3242 CRT Quadripolar, Rate Responsive  15cc, 27g $13,520.00

 Pacemaker with RF Telemetry

08.07.01 - Coronary Sinus

 Medtronic Australasia Pty Ltd

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

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

 Silicone;

Prostheses List by Category, Groups and Sponsor Page 633 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

08.07.02 - Subcutaneous

 Guidant Australia Pty Ltd

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

 0085

 Medtronic Australasia Pty Ltd

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

 Defibrillator Lead Model 6996SQ

 41cm, 58cm, 85cm

08.07.05 - Transvenous/Steroid/Passive

 Biotronik Australia Pty Ltd

BT092 Linox TD Fractal and steroid coated passive  65, 74 or 100cm length and  $9,000.00

 fixation quadripolar ICD lead 16 or 18mm electrode spacing

BT093 Linox T Single-shock coil ICD lead with  Lengths: 65, 75 cm $9,000.00

 passive fixation

BT119 Linox SMART TD Dual-shock coil ICD lead with  Lengths: 65, 75 cm,  $9,000.00

 passive fixation and hydrophilic  Diameter: 7.8Fr

 coating on lead body.

BT137 VIGILA 1 CT Single-shock coil ICD lead with  65, 75cm length $9,000.00

 passive fixation

BT149 Linox Smart T Single-shock coil ICD lead with  65 cm length $9,000.00

 passive fixation, and SilGlide

 technology

 Guidant Australia Pty Ltd

GU115 Endotak Reliance Lead Passive Dual Coil 59cm, 64cm, 90cm $9,000.00

GU158 Endotak Reliance SG Passive Passive Single Coil wih GORE  54cm - 90cm $9,000.00

 ePTFE covered coils

GU159 Endotak Reliance G Passive Passive Dual Coil with GORE ePTFE 54cm - 90cm $9,000.00

  covered coils

Prostheses List by Category, Groups and Sponsor Page 634 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medtronic Australasia Pty Ltd

MC002 Medtronic Sprint Quattro Lead  Silicone and polyurethane 65-100cm $9,000.00

 Model 6944RV/SVC 65cm; Model

 6944RV/SVC 75cm; or Model

 6944RV/SVC 100cm; Medtronic

 Sprint Quattro Lead Model

 6944RV/SVC 58cm

 St Jude Medical Australia Pty Ltd

SJ158 Durata 7170, 7171 Passive fixation, true bipolar, dual  60, 65 and 70cm $9,000.00

 coil, steroid eluting, endocardial

 defibrillation leads with Optium

 insulation overlay

 e

 Boston Scientific Australia Pty Ltd

BS170 Endotak Reliance S 4-SITE Passive fixation single coil  50-70cm $9,000.00

 defibrillation leads & 4-SITE

BS180 Endotak Reliance G 4-SITE Passive fixation dual coil  50-70cm $9,000.00

 defibrillation leads with ePTFE

 covered coils & 4-SITE connector

BS181 Endotak Reliance SG 4-SITE Passive fixation single coil  50-70 $9,000.00

 defibrillation leads with ePTFE

 covered coil & 4-SITE connector

BS183 Endotak Reliance 4-SITE Passive fixation dual coil  50-70cm $9,000.00

 defibrillation leads with 4-SITE

 St Jude Medical Australia Pty Ltd

SJ245 Durata 7170Q, 7171Q and 7172Q 7170Q/7171Q - passive fixation,  52, 58 and 65cm, 7F  $9,000.00

 bipolar, dual coil, 7172Q - passive  introducer

 fixation, bipolar - single coil steroid

 eluting endocardial defibrillation

 leads with Optim insulation overlay

 and SJ4 quadripolar lead connector

 Biotronik Australia Pty Ltd

BT154 Volta 1 CT Singe-shock coil ICD lead with  65cm length $9,000.00

 passive fixation, and SilGlide

Prostheses List by Category, Groups and Sponsor Page 635 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 e

 Boston Scientific Australia Pty Ltd

BS261 RELIANCE 4-FRONT Passive, single/dual coil,  Length: 59cm - 70cm $9,000.00

 defibrillation lead

08.07.06 - Transvenous/Steroid/Active

 Biotronik Australia Pty Ltd

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

 active fixation quadrapolar elec dis

BT096 Linox S Single-shock coil ICD lead with  Lengths: 65, 75 cm $9,000.00

 active fixation, fractal coating and

 steroid elution

BT120 Linox SMART SD Dual-shock coil ICD lead with active  Lengths: 60, 65, 75 cm,  $9,000.00

 fixation helix and hydrophilic coating Diameter: 7.8Fr

  on lead body.

BT125 Linox SMART SD X LinoxSmart S DX pentapolar, single- Length: 65cm. Distance of  $9,000.00

 coil ICD lead with floating atrial  dipole from tip: Linox Smart

 dipole. Permanent, transvenous   SD X 65/15: 15 (cm), Linox

 implantation in the right ventricle.  Smart SD X 65/17: 17 (CM)

BT134 VIGILA 2 CR Fractal coated and steroid electrode,  65, 75cm length, 16, 18mm  $9,000.00

 active fixation quadrapolar electrode spacing

BT140 VIGILA 1 CR Single shock coil ICD lead with  Lengths 65, 75cm $9,000.00

 active fixation, fractal coating and

 steroid elution

BT142 VIGILA 2 CT Fractal coated and steroid electrode,  Lengths: 65, 75cm;  $9,000.00

 active fixation, quadrapolar Diameter: 7.8Fr

BT148 Linox Smart S Single shock coil ICD lead with  Lengths; 60, 65, 75 cm $9,000.00

 active fixation, fractal coating and

 steroid elution. Coated in SilGlide

 silicone based coating for improved

 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

Prostheses List by Category, Groups and Sponsor Page 636 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medtronic Australasia Pty Ltd

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

 Lead Model 6947 58cm; Model  Silicone, polyurethane, platinized

 6947 65cm; Model 6947 75cm;  tantalum coils, steroid eluting tip

 Model 6947 100cm

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

 Coil Defibrillation Lead

 St Jude Medical Australia Pty Ltd

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

 coil/single coil Steroid-eluting

 Endocardial Defibrillation Leads

 e

 Boston Scientific Australia Pty Ltd

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

 defibrillation leads with ePTFE

 covered coil & 4-SITE connector.

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

  leads with 4-SITE connector

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

 defibrillation leads & 4-SITE

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

  leads with ePTFE covered coils & 4-

 SITE connector.

 Medtronic Australasia Pty Ltd

MI033 Sprint Quattro Secure 6947M Lead Active fixation, true bipolar, dual coil  45-110cm $9,000.00

 defibrillation leads with silicone

 backfill and DF-4 connector

MI108 Sprint Quattro Secure S DF4 Dexamethasone acetate and  49 - 97 cm $9,000.00

 dexamethasone sodium phosphate

 steroid-eluting, tripolar, screw-in,

 ventricular lead with RV

 defibrillation coil electrode

Prostheses List by Category, Groups and Sponsor Page 637 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 St Jude Medical Australia Pty Ltd

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

 bipolar; 7122Q - Active fixation true

 bipolar - single coil steroid eluting

 endocardial defibrillation leads with

 Optim insulation overlay and SJ4

 quadripolar lead connector.

 Biotronik Australia Pty Ltd

BT155 VOLTA 2 CR Fractal coated and steroid electrode,  60, 65, 75cm length, 16,  $9,000.00

 active fixation quadrapolar 18mm electrode spacing

BT157 Volta 1CR Single shock coil ICD lead with  Lengths: 60, 65 and 75 cm $9,000.00

 active fixation, fractal coating and

 steroid elution. Coated in SilGlide

 silicone based coating for improved

BT158 Volta 2 CT Fractal coated and steriod electrode,  Lengths: 65, 75 cm,  $9,000.00

 active fixation, quadrapolar Diameter: 7.8Fr

 e

 Boston Scientific Australia Pty Ltd

BS260 RELIANCE 4-FRONT Active, Single/Dual coil,  Length: 59cm -70cm $9,000.00

 defibrillation lead

08.07.07 - Epicardial Patches

 Medtronic Australasia Pty Ltd

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

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

08.08.01 - Non-transvenous, Bi-Polar, Steroid

 Boston Scientific Australia Pty Ltd

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

 lead

Prostheses List by Category, Groups and Sponsor Page 638 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medtronic Australasia Pty Ltd

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

 epicardial lead Model 4968 -

 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  Steroid -Eluting Bipolar Sutureless  35cm and 54cm, Lead  $1,716.00

 Lead Implant Tool Myocardial Pacing Lead with  implant tool - 44cm

 Titanium Nitride Electrodes and Lead

 implant tool with articulating distal

08.08.02 - Non-transvenous, Uni-Polar, Steroid

 Medtronic Australasia Pty Ltd

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

 unipolar epicardial lead Model

08.08.03 - Non-transvenous, Uni-Polar, Non-Steroid

 Medtronic Australasia Pty Ltd

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

 IS-1 Model 5071

08.08.04 - Transvenous, Uni-Polar, Passive, Steroid, Right

 Medtronic Australasia Pty Ltd

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

 Models 4073

Prostheses List by Category, Groups and Sponsor Page 639 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

08.08.06 - Transvenous, Uni-Polar, Passive, Steroid, Left Ventricular

 Biotronik Australia Pty Ltd

BT070 Corox OTW UP Steroid Unipolar, steroid eluting coronary  Lengths: 77, 87cm $3,120.00

 sinus pacing lead

 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

 Biotronik Australia Pty Ltd

BT156 Sentus OTW UP H 4.8F Unipolar, steroid eluting  overall length 77, 87, 97 cm, $3,120.00

 coronary sinus pacing lead  4.8F

08.08.08 - Transvenous, Bi-Polar, Passive, Steroid, Right

 Biotronik Australia Pty Ltd

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

 Ventricular Pacing Lead, fractal

BT067 Selox JT Bipolar, passive fixation, steroid  Lengths: 45, 53 cm $1,248.00

 eluting pacing lead with fractal

 coating and J-shape

BT117 Siello JT Sub 6F, steroid-eluting, transvenous,  Lengths: 45, 53 cm;  $1,248.00

 endocardial, bipolar passive-fixation  Diameter: 5.6Fr

 lead that carries a J-shaped distal end.

BT118 Siello T Sub 6F, steroid-eluting, transvenous,  Lengths: 53, 60 cm;  $1,248.00

 endocardial, bipolar passive-fixation  Diameter: 5.6Fr

 lead

BT138 TILDA T Bipolar, passive fixation, steroid  53, 60cm length $1,248.00

 eluting pacing lead with fractal coating

Prostheses List by Category, Groups and Sponsor Page 640 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BT141 TILDA JT Bipolar, passive fixation, steroid  Length 45, 53cm $1,248.00

 eluting pacing lead with fractal

 coating and J-shape

 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

 Medtronic Australasia Pty Ltd

MC010 Medtronic Capsure SP Novus  Bipolar, steroid, pasive fixation  45 -110cm $1,248.00

 Model 5092 pacing lead

MC229 Medtronic Capsure SP Novus  Bipolar, steroid, passive fixation  30-100cm $1,248.00

 Model 5594 Lead pacing lead

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

 5054 Pacing Lead anchoring 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  45-58cm $1,248.00

 5554 Pacing Lead anchoring sleeve, stylet & guide, 1 x

 vein lifter, 2 x fixation tools, extra

 stylets

MC372 CapSure Sense MRI SureScan  Bipolar, steroid, passive fixation  Model 4074:  52 - 58cm;  $1,248.00

 pacemaker leads Models 4074 &  pacing lead Model 4574: 45 - 53cm

 Pacing Importers Pty Ltd - Life Systems

PI023 Refino™ ER Series Passive fixation, bi-polar, permanent  44, 48, 52 and 58cm length $1,248.00

 pacing leads with a steroid eluting

 Sorin Group Australia Pty Ltd

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

 pacing lead.  Permanent pacing lead,   and 58cm lengths and has a

 Model Refino ER, is indicated for the  6.0F (polyurethane 6.3F

 pacing and sensing of the ventricle.   (silicone) lead body

 This permanent pacing lead is used in

 conjunction with an IS-1 compatible

 implantable pulse generator (pacema

Prostheses List by Category, Groups and Sponsor Page 641 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 pacing lead. Permanent pacing lead,  52, 58, 70 and 78cm lengths

 Petite ER series, is indicated for the   and has a 4.8 F lead body.

 pacing and sensing of the ventricle. 

 This permanent pacing lead is used in

 conjunction with an IS-1 compatible

 implantable pulse generator (pacema

 St Jude Medical Australia Pty Ltd

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

 Eluting, Endocardial Pacing Lead

 with Optim insulation

 k

 Guidant Australia Pty Ltd

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

 Lead

 Medtronic Australasia Pty Ltd

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

 5038 AV Pacing Lead anchoring sleeve, stylet & guide, 1 x

 vein lifter, 2 x fixation tools, extra

 stylets

08.08.09 - Transvenous, Bi-Polar, Active, Steroid, Right

 Biotronik Australia Pty Ltd

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

 fractal coated and steroid eluting

BT097 Dextrus (marketed by Boston  Bipolar, silicone, active fixation,  Lengths: 45, 53 and 60 cm,  $1,248.00

 Scientific) steroid eluting, pacing lead Diameter: 7Fr

BT116 Siello S Sub 6F, steroid-eluting, trasvenous,  Lengths: 45, 53, 60 cm;  $1,248.00

 endocardial, bipolar active-fixation  Diameter: 5.6Fr

 lead with an extendable/retractable,

 electrically active screw.

Prostheses List by Category, Groups and Sponsor Page 642 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BT123 Safio S Steroid eluting active fixation  Length: 53, 60cm;  $1,248.00

 pacemaker lead with an electrically  Diameter: 6.6F

 active extendable/ retractable screw

 for fixating the lead in the

 myocardium. The lead body is

 insulated in Silicone. The entire lead

 is conditionally safe to be used in a

BT139 TILDA R Bipolar active fixation lead with  length 45, 53, 60cm $1,248.00

 fractal coated and steroid eluting

 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 30 - 85cm $1,248.00

 Pacing Leads  lead

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

 5076 Pacing Lead anchoring sleeve, stylet & guide, 1 x

 vein lifter, 2 x fixation tools, extra

 stylets

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

 Pacing Lead

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

 Sorin Group Australia Pty Ltd

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

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

 Physique ER is indicated for the  4.8F lead body

 pacing and sensing of the ventricle or

 atrium.  This permanent pacing lead is

 used in conjunction with a

 compatible implantable pulse

Prostheses List by Category, Groups and Sponsor Page 643 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 lead. Permanent pacing lead PY2-ER  52, 58cm lengths and has a

 series, is indicated for pacing and  6.3F lead body

 sensing of the 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 1688TC Endocardial Steroid-Eluting Active  100cm, 25cm, 34cm, 40cm,  $1,248.00

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

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  40, 46 & 52cm $1,248.00

 Eluting, endocardial, atrial pacing

 lead with Optim insulation

SJ238 Tendril STS 2088TC Endocardial Bi-polar Steroid-Eluting  34cm-100cm $1,248.00

 Active Fixation Pacing Leads

SJ270 Tendril MRI LPA 1200M The Tendril MRI™ lead, Model  46cm, 52cm and 58cm $1,248.00

 LPA1200M, is an MR Conditional,

 bipolar, steroid-eluting, active

 fixation implantable pacing lead with

 Optim™  insulation.

 j

 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

08.08.11 - Transvenous, Multi-Polar, Passive, Steroid, Left Ventricular

 Biotronik Australia Pty Ltd

BT095 Corox OTW BP; Corox OTW-S BP; Bipolar, steroid eluting coronary  Lengths: 77, 87 cm $6,240.00

 sinus pacing lead with fractal coating

Prostheses List by Category, Groups and Sponsor Page 644 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BT121 Corox OTW-L BP Corox OTW-L BP is a bipolar  Length: 75, 85cm;  $6,240.00

 coronary sinus lead, intended for  Diameter: 5.4F

 permanent implantation in the venous

 system and left ventricular pacing

 with appropriate single or multi

 chamber cardiac pacemakers or ICDs

 as part of cardiac resynchornisation

BT135 CELERITY PILOT Bipolar, steroid eluting coronary  Lengths: 77, 87cm (in  $6,240.00

 sinus pacing lead with fractal coating model number as 75 and 85

 for simplicity)

BT136 CELERITY 2D, CELERITY 3D Bipolar, steroid eluting coronary  Lengths: 77, 87cm (model  $6,240.00

 sinus pacing lead with fractal coating. shows 75 and 85 for

  2D preshaped curved distal end; 3D - simplicity)

  preshaped helix distal end

 Guidant Australia Pty Ltd

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

 4516, 4517, 4518, 4519, 4520

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

  4543 & 4544

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

 4522, 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  78cm, 88cm $6,240.00

 ventricular lead

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

 St Jude Medical Australia Pty Ltd

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

 Lead with Optim Lead Insulation introducer

Prostheses List by Category, Groups and Sponsor Page 645 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 j

 St Jude Medical Australia Pty Ltd

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

 Lead

 Medtronic Australasia Pty Ltd

MI129 Attain Perfoma Leads LV lead family with four electrodes  78, 88cm $6,240.00

 and an IS4 connector for LV pacing

 w/premium and standard IS4 CRT-D

 devices. The Attain Perfoma™ Lead

 provides LV pacing options to avoid

 the following: phrenic nerve

 stimulation, high pacing thresholds,

 and ischemic tissue

08.08.13 - 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

08.09.01 - Pacemaker/ICD Adaptors

 Medtronic Australasia Pty Ltd

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

 6726 25cm & 37cm

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

  bipolar IS-1

MI045 Adaptor Kit Model 5866-24M,  5866-24M: 5mm Bifurcated Bipolar  14cm $500.00

 5866-40M, 5866-37M Lead or Two 5mm Unipolar Leads to

 IS-1 Bipolar IPG; 5866-40M: 3.2mm

 BI Lead to IS-1 BI IPG; 5866-37M:

 5mm UNI Lead to IS-1 UNI IPG

MI046 Bipolar Lead Adaptor Kit Model  Two IS-1 BI Leads to IS-1 BI IPG One size only $500.00

Prostheses List by Category, Groups and Sponsor Page 646 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

MI053 5019 Adaptor Adapts DF-4 lead to enable use of  One size $500.00

 additional leads for high

 defibrillation thresholds

08.10.01 - Pacemaker/ICD Adaptors

 Medtronic Australasia Pty Ltd

MC831 Medtronic Lead Extender Kit  6984M: IS-1 BI Lead to IS-1 BI IPG;  37 - 50cm $530.00

 Model: 6984M, 6981M,  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

08.11.01 - Pacemaker/Lead Accessories

 Boston Scientific Australia Pty Ltd

BS212 Pacemaker/Defibrillator port safety  Pacemaker/Defibrillator Plug that  3.2mm x 38mm $80.00

 plug seals unused IS-1 and DF-1 port

BS213 Lead Cap Kit Caps used to protect lead terminal  4.75mm and 3.2mm $80.00

 connector pin

 Medtronic Australasia Pty Ltd

MI042 Medtronic Lead End Cap Kit  Lead End Cap Kit One size only $80.00

 Model: 5867-3M

MI043 Medtronic DF-1 Port Pin Plug Kit:  DF-1 unipolar connector port pin  One size per model $80.00

 Model 6719; Medtronic IS-1 Port  plug, one per kit

 Pin Plug Kit: Model 6725

MI044 Medtronic Upsizing Sleeve: Model  5866-45: IS1 UNI Lead to 5/6mm  18-25mm $80.00

 5866-45, Model 5866-46 UNI IPG; 5866-46: IS1 UNI Lead to

 5mm UNI IPG or 5mm Bifurcated BI

08.12.01 - Drug Eluting

 08.12.01.01 - General Purpose

 Abbott Australasia Pty Ltd

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

 System 8mm to 28mm lengths

Prostheses List by Category, Groups and Sponsor Page 647 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 Eluting Coronary Stent; Xience  2.75; 3.00; 3.50; 4.0 x

 PRIME Everolimus Eluting  33MM;  XIENCE PRIME

 Coronary Stent;  Xience PRIME SV  LL 2.50; 2.75; 3.00; 3.50;

 Everolimus Eluting Coronary Stent 4.0 x 38MM;  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

AY040 XIENCE Xpedition Everolimus  Coronary Artery Stent, Drug Eluting Xience Xpedition DES -  $3,450.00

 Eluting Coronary Stent System 2.25 x (8,12,15,18,23,28)

 RX CE, 2.50 x

 (8,12,15,18,23,28,33,38)

 RX CE; 2.75 x

 (8,12,15,18,23,28,33,38)

 RX CE; 3.00 x

 (8,12,15,18,23,28,33,38)

 RX CE; 3.25 x

 (8,12,15,18,23,28,33,38)

 RX CE; 3.50 x

 (8,12,15,18,23,28,33,38)

 RX CE; 4.00 x

 (8,12,15,18,23,28,33,38)

 RX CE;

 Boston Scientific Australia Pty Ltd

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

 with a blended polymer mixed with  reference vessel diameter of

 everolimus. 2.25mm - 4.0mm.

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

 with a blended polymer mixed with  reference vessel diameter of

 Paclitaxel 2.25mm - 4.5mm

BS224 PROMUS Element Plus Platinum chromium alloy stent coated  8mm to 38mm in length,  $3,450.00

 with a blended polymer mixed with  diameter of 2.25mm to 4mm.

 everolimus.

 Medical Logistics Australia Pty Ltd

JE001 BioMatrix Flex Drug Eluting  Coronary Artery Stent, Drug Eluting Diameter: 2.25mm to 4.0mm $3,450.00

 Coronary Stent System 

Prostheses List by Category, Groups and Sponsor Page 648 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medtronic Australasia Pty Ltd

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

 Stent System Length: 8.00mm-38.0mm

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

  System Length: 8.0mm-30.0mm

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

 Coronary Stent System Polymer Length: 8.00mm-30.0mm

MI037 Resolute Integrity Zotarolimus- Cobalt-alloy, ABT-578, BioLinx  Small Vessel - Diameter:  $3,450.00

 Eluting Coronary Stent System Polymer 2.25mm-2.75mm; Length:

 8.0mm-30.0mm

 Medium Vessel - Diameter:

 3.0mm-4.0mm; Length:

 9.0mm-38.0mm

08.12.02 - Bare Metal

 08.12.02.01 - General Purpose

 Abbott Australasia Pty Ltd

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

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

 Coronary Stent System and MULTI- Stent System (CSS) is comprised of  Length: 8, 12, 15, 18, 23,

 LINK 8 LL Coronary Stent System two main components: the cobalt  28mm; MULTI-LINK 8 SV

 chromium (CoCr) stent and the  CSS: Diam: 2.25mm, Stent

 balloon expandable delivery system. Length: 8, 12, 15, 18, 23,

 28mm; MULTI-LINK 8 LL

 CSS: Diam: 2.5, 2.75, 3.0,

 3.5, 4.0mm, Stent Length:

 33 and 38mm

 Atrium Australia - Pacific Rim Pty Limited

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

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

 balloon expandable Cobalt Chromium   25mm

 stent premounted on a rapid exchange

 system

Prostheses List by Category, Groups and Sponsor Page 649 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 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 Coronary Cobalt Chromium stent  Diameters: 2 -5mm,  $1,248.00

 system Lenghts: 8 - 40mm

BT107 PRO-Kinetic Energy Balloon-expandable cobalt chromium  Lengths: 8 - 40mm,  $1,248.00

 (CoCr) stent. The stent surface is fully  Diameters: 2.0 - 5.0mm.

 coated with amorphous hydrogen-rich

  silicon carbide (aSiC:H).

 Boston Scientific Australia Pty Ltd

BS069 Liberte Coronary Stent System Consists of a balloon expandable  Stent lengths:  $1,248.00

 stent, pre-mounted on a Maverick 2  8,12,16,20,24,28 & 32 mm

 Monorail delivery catheter. Stent diameters: 2.25, 2.5,

 2.75, 3.0, 3.5, 4.0, 4.5 & 5.0

 mm

BS211 OMEGA Bare Metal Stent Platinum Chromium Bare Metal Stent 2.25mm to 4.50mm Diameter. $1,248.00

  8mm to 38mm Length.

 Imaxeon Pty Ltd

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

 cobalt chromium stent premounted  16mm, 20mm, 24mm, 28mm,

 onto a rapid exchange delivery  32, 36, 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  Cobalt Chromium, bare metal coronary Stent length 8 - 40mm x  $1,248.00

 Stent on RX System  stent Stent Diameter 2.5 - 5.0 mm

 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  Cobalt Alloy Diameter: 2.25 - 4.5 mm;  $1,248.00

 Length: 8-30mm

Prostheses List by Category, Groups and Sponsor Page 650 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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 Azule Coronary Stent Delivery  L605 Cobalt Chromium alloy balloon  Expanded Stent Diameter  $1,248.00

 System expandable vascular prosthesis 2.5 to 4.0mm, Stent Length

 9 to 33mm

 Reid Healthcare

RH010 Avantgarde Chrono Carbostent The Avantgarde Chrono Carbostent  Lengths: from 7mm to 31  $1,248.00

 device consists of a coronary stent  mm; Sizes: from 2.25mm to

 firmly held on the distal end of a semi  4.5mm

 compliant balloon catheter. The

 coronary stent is a flexible

 implantable deivce that can be

 expanded using a PTCA catheter. The

 stent is made of cobalt chronmium

 alloy coated with Carbofilm. Two

 radio-opaque platinum markers are

 located at either end of the stent.

 Terumo Corporation Australia

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

 catheter Length 8mm - 30mm length

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

 3.0mm; 3.5mm; 4.0mm  x 

 Lengths : 9mm; 12mm;

 15mm; 18mm; 24mm; 28mm.

 08.12.02.02 - Special Purpose for specific indications

 l, m

 Abbott Australasia Pty Ltd

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

 n.2

 Imaxeon Pty Ltd

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

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

 for bifurcation lesions treatment Lengths 18 mm and 24 mm

Prostheses List by Category, Groups and Sponsor Page 651 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 n.3

 Imaxeon Pty Ltd

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

 Stent System intracoronary cobalt chromium stent  x 8mm length; Nile Delta

 premounted onto a rapid exchange  3.00mm diameter x 8mm

 delivery catheter with tapered  length

08.13.01 - Cardiac Defect Occluders

 St Jude Medical Australia Pty Ltd

SJ280 Amplatzer Duct Occluder II  Single use implantable transcatheter  0.2cm-0.6cm $10,200.00

 Additional Sizes device for minimally invasive closure

 of Patent Ductus Arterious

 o

 Pyramed Pty Limited

PY032 Occlutech Figulla Flex ASD  The Occlutech Figulla® Flex ASD  6, 7.5, 9, 10.5, 12, 15, 18,  $10,200.00

 occluder is an implant for closure of an 21, 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 fo

PY033 Occlutech Figulla Flex PFO  The Figulla® Flex PFO is an implant  16/18, 23/25, 27/30 and  $10,200.00

 for closure of a patent foramen ovale  31/35

 (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-

Prostheses List by Category, Groups and Sponsor Page 652 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

PY034 Figulla Flex II PFO Occluder The Figulla® Flex II PFO is an  Figulla Flex II PFO Disc Ø  $10,200.00

 implant for closure of a patent foramen  (mm): 23/25, 16/18, 27/30,

 ovale (PFO) defect in the heart and is  31/35

 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.

PY035 Figulla Flex II ASD Occluder Occlutech Flexx II ASD Occlusion  Figulla Flex II ASD Waist  $10,200.00

 device Ø (mm): Size

 4,5,6,7.5,9,10.5,12,13.5,15,

 16.5,18,21,24,27,30,33,36,3

 9,40

 St Jude Medical Australia Pty Ltd

SJ091 Premere PFO Closure System Percutaneous, transcatheter, self- Left Atrial Anchor diameter  $10,200.00

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

 and 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  Nitinol wire mesh, double disc  4-24mm, Length 7-10mm $10,200.00

 Occluder occluder and delivery system

SJ267 AMPLATZER Duct Occluder II Self expandable multiple Nitinol wire  Waist diameter 3-6mm,  $10,200.00

 mesh PDA occlusion device Nominal length 4-6mm

 W L Gore & Associates

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

 consists of an implantable  and 35mm

 endoprosthesis 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

Prostheses List by Category, Groups and Sponsor Page 653 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

GT270 Gore Septal Occluder  "The GORE® Septal Occluder  15mm Nominal Disc  $10,200.00

 consists of an implantable occluder  Diameter; 20mm Nominal

 comprised of a platinum-filled nickel- Disc Diameter; 25mm

 titanium (Nitinol) wire frame covered  Nominal  Disc Diameter;

 with expanded  30mm Nominal Disc

 polytetrafluoroethylene (ePTFE). The  Diameter

 occluder is available in sizes of 15,

 p

 Abbott Australasia Pty Ltd

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

 System delivery system

08.13.02 - Vascular Occlusion Devices

 Cook Medical Australia Pty Ltd

WC294 Flipper PDA Closure Detachable  Delivery system and one coil: the  Delivery system: Length  $600.00

 Coil Delivery System and Mreye  Flipper PDA Closure Detachable Coil 80cm and 110cm. Extended

 Flipper PDA Detachable   Delivery System is a TFE coated  embolus lengths of: 3cm,

 stainless steel delivery wire with a  5cm, 6.5cm, 8cm, 10cm,

 straightening mandril and a pin vise  12cm.  Coiled embolus

 handle for detachment. The Mreye  diameters: 3mm, 5mm,

 Flipper PDA Closure Detachable Coil 6.5mm, 8mm.  Configuration

  is made from Iconel material with  loops of deployed coil: 3,4

 synthetic fibers. or 5 loops

WC295 Mreye Flipper PDA Detachable  Coil only: the Mreye Flipper PDA  Extended embolus lengths  $250.00

 Embolization Coil Closure Detachable Coil is made from  of: 3cm, 5cm, 6.5cm, 8cm,

 Iconel material with synthetic fibers. 10cm, 12cm.  Coiled

 embolus diameters: 3mm,

 5mm, 6.5mm, 8mm. 

 Configuration loops of

 deployed coil: 3,4 or 5 loops

Prostheses List by Category, Groups and Sponsor Page 654 of 1059


08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

08.14.01 - Implantable Cardiac Event Recorders

 Biotronik Australia Pty Ltd

BT153 BioMonitor Implantable cardiac monitor for  53.3mm x 42.7mm x 7.1mm,  $3,900.00

 continuous remote monitoring of  26 grams

 patients with Atrial Fibrillation (AF)

 or unexplained syncope

 i

 Medtronic Australasia Pty Ltd

MI141 Reveal LINQ Insertable Cardiac Monitor 45 x 7 x 3.5mm, 1.18cc $3,900.00

08.15.01 - Uncovered

 Medical Vision Australia Cardiology Thoracic Pty Ltd

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

 length

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

 balloon length

08.15.02 - Covered

 Medical Vision Australia Cardiology Thoracic Pty Ltd

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

 length

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

 balloon length

Prostheses List by Category, Groups and Sponsor Page 655 of 1059


09 - CARDIOTHORACIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

09.01.01 - Bi-Leaflet, rotatable

 Medtronic Australasia Pty Ltd

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

 500FA)Open Pivot Heart Valve  Polyester, Titanium

 (Model 500DM)

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

 501DA)Open Pivot Heart Valve  Polyester, Titanium

 (Model 501DM)

 Reid Healthcare

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

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

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

 27/29; ONXM-23; ONXM-25;

 ONXM-27/29; ONXM31/33;

 Sorin Group Australia Pty Ltd

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

 St Jude Medical Australia Pty Ltd

SJ037 Masters Series Heart Valve Mitral  Aortic Expanded Cuff, Aortic  Aortic Expanded 19 - 31mm, $6,000.00

 and Aortic - Expanded  Hemodynamic Plus Cuff, Mitral   Aortic Hemodynamic 17 -

 Cuff/Hemodynamic Plus hemodynamic Cuff, Aortic & Mitral  27mm, Mitral Hemodynamic

 Rotatable Cuff 17 - 27mm, Rotable 17 - 33mm

SJ317 Regent Prosthetic Heart Valve Standard Cuff Standard cuff - 17- $6,000.00

 23mm/25mm-29mm, Flex cuff

  - 17-23mm/25mm-29mm

 Medtronic Australasia Pty Ltd

MI124 Open Pivot Heart Valve AP360 -  Supra-annular mechanical valve;  Mitral: 16, 18, 20, 22, 24,  $6,000.00

 Mitral Pyrolythic Carbon, Double Velour  26,  28 and 30 mm

 Polyester, Titanium

MI125 Open Pivot Heart Valve AP360 -  Supra-annular mechanical valve;  Aortic: 16, 18, 20, 22, 24,  $6,000.00

 Aortic Pyrolythic Carbon, Double Velour  26 and 28 mm

 Polyester, Titanium

Prostheses List by Category, Groups and Sponsor Page 656 of 1059


09 - CARDIOTHORACIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

09.01.02 - Tilting Disc, rotatable

 Medtronic Australasia Pty Ltd

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

 Model A7700, Medtronic Hall  Dacron, A7700EZ/M7700EZ   M7700 - Diameter 23-

 Heart Valve Mitral Model M7700,  Titanium. Pyrolite. PET 33mm, A7700EZ - Diameter

 Hall Easy Fit Aortic Heart Valve  19-29mm, M7700EZ -

 Model A7700, Hall Easy Fit Mitral  Diameter 23-31mm

 Heart Valve Model M7700

09.02.01 - Stented, anatomical

 b

 Edwards Lifesciences Pty Ltd

EL056 Carpentier-Edwards PERIMOUNT  Stented Bovine Pericardial Mitral  25mm, 27mm, 29mm, 31mm,  $5,000.00

 Magna Mitral Bioprosthesis  Tissue Valve with a reduced profile  33mm

 (Model: 7000TFX) height and assymetric sewing band

 design

EL058 Carpentier-Edwards PERIMOUNT  Stented Bovine Pericardial Aortic  19mm, 21mm, 23mm, 25mm,  $5,000.00

 Magna Ease Aortic Bioprosthesis  Tissue Valve with a reduced profile  27mm and 29mm

 (Model: 3300TFX) height

 p

 Edwards Lifesciences Pty Ltd

EL030 CE Supra Annular Aortic Valve  Carpentier-Edwards SAV  19mm-33mm $5,000.00

 Model 2650 Carpentier-Edwards  Bioprosthesis. Composition: Porcine

 S.A.V Bioprosthesis Model 6650  Valve; Elgiloy Alloy; Silicone

 Mitral Valve Rubber, Polytetrafluoroethylene

 Medtronic Australasia Pty Ltd

MC701 Mosaic Cinch, Aortic, Mitral Models 305cxx, 310cxx 19mm - 35mm $5,000.00

MC950 Mosaic Ultra Cinch II Small Aortic Root Bioprosthesis 19mm - 29mm $5,000.00

MC962 Mosaic Cinch II Aortic Bioprosthesis 19mm -29mm $5,000.00

MC993 Hancock II Aortic Cinch II Aortic valve bioprosthesis 21mm to 29mm $5,000.00

MI007 Hancock II Aortic Valve Aortic bioprosthesis 21mm to 29mm $5,000.00

MI008 Hancock II Mitral Valve Mitral bioprosthesis 25mm to 33mm $5,000.00

Prostheses List by Category, Groups and Sponsor Page 657 of 1059


09 - CARDIOTHORACIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

MI009 Hancock II Ultra Aortic Valve Small aortic root bioprosthesis 21mm to 29mm $5,000.00

 St Jude Medical Australia Pty Ltd

SJ136 SJM Biocor Heart Valve Stented Porcine tissue valve Aortic Valves - Tissue  $5,000.00

 Annulus Diameter - 21 -

 29mm                                          

                                   Mitral

 Valves - Tissue Annulus

 Diameter - 25-35mm

SJ192 Epic Flexfit Triple-composite Bioprosthetic heart  Aortic Valves 21-29mm  $5,000.00

 valve tissue 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  Tissue Annulus Diameter -  $5,000.00

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

 the aortic position 14mm-16mm.

09.02.02 - Stented, non anatomical

 b

 Edwards Lifesciences Pty Ltd

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

 Pericardial Bioprosthesis - Models  Bioprosthesis. Composition: Bovine  33mm, Model 6900P 25, 27,

 2900/6900  Carpentier-Edwards  Pericardium; Elgiloy Alloy; Silicone   29, 31, 33mm

 Perimount Plus Pericardial  Rubber, Polytetrafluoroethylene

 Bioprosthesis Mitral - Model

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

 3000 Magna composition: Glutaraldehyde  Tissue Valve; 21MM Aortic

 treated bovine pericardium/elgiloy   Pericardial Tissue Valve;

 wireform stent/polyester  23MM Aortic Pericardial

 band/silicone rubber suture  Tissue Valve; 25MM Aortic

 ring/polytetrafluoroethylene   Pericardial Tissue Valve;

 27MM Aortic Pericardial

 Tissue Valve; 29MM Aortic

  Pericardial Tissue Valve

 Sorin Group Australia Pty Ltd

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

Prostheses List by Category, Groups and Sponsor Page 658 of 1059


09 - CARDIOTHORACIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 Valve (Model LX)

 St Jude Medical Australia Pty Ltd

SJ284 Trifecta Valve Tri-leaflet, stented pericardial valve. 19-29mm Annulus diameter  $5,000.00

 and 15-20mm height

 b bovine

 Edwards Lifesciences Pty Ltd

EL060 Carpentier-Edwards PERIMOUNT  The Carpentenier-Edwards  25, 27, 29, 31, 33mm $5,000.00

 Magna Mitral Ease Tissue Valve PERIMOUNT Magna Mitral Ease

 Tissue is comprised of Bovine

 Pericardial Tissue and is

 bioengineered to withstand the

 higher pressures encountered in the

 mitral position, whilst maximising

09.02.03 - Non-Stented

 e

 Medtronic Australasia Pty Ltd

MC982 3f Aortic Bioprosthesis (Model  Model 1000 - EQUINE Pericardium  19 - 29 mm $5,100.00

 Bioprostheseis (non stented)

 p

 Medtronic Australasia Pty Ltd

MC015 Freestyle bioprosthesis Models 995xx, 995MSxx 19 - 35mm $5,100.00

09.03.01 - Mechanical Valve

 Medtronic Australasia Pty Ltd

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

 (Model 502AG) Polyester, Titanium

Prostheses List by Category, Groups and Sponsor Page 659 of 1059


09 - CARDIOTHORACIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Sorin Group Australia Pty Ltd

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

 Prosthesis, sterile, CarboSeal

 Ascending Aortic Prosthesis with

 Handle Model AP21, Model AP23,

 Model AP25, Model AP27, Model

 AP29, Model AP31, Model AP33,

 Carboseal Valsalva

 b

 St Jude Medical Australia Pty Ltd

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

 Valved Graft

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

 Prosthesis - VAVGJ Valve sewn into the base of a woven

 polyester fibre graft which has been

 impregnated with bovine-derived

 gelatin

09.03.02 - Tissue Valve, stented anatomical

 p

 Medtronic Australasia Pty Ltd

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

  Model 100/150 30mm.

09.04.01 - Ring, Standard

 Edwards Lifesciences Pty Ltd

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

 Prostheses, Non-Animal Origin  Annuloplasty Ring. Composition:

 Annuloplasty: Ring-Mitral Ring  Titanium Alloy; Silicone Rubber;

 with Holder; Mitral Cosgrove- Polyester Fabric Carpentier-Edwards

 Edwards Annuloplasty System  Physio Annuloplasty Ring.

 Model 4600; Classic Annuloplasty  Composition: Elgiloy Bands;

 Polyester Film Strips; Silicone

 Rubber; Polyester Cloth, Cosgrove-

 Edwards

Prostheses List by Category, Groups and Sponsor Page 660 of 1059


09 - CARDIOTHORACIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Medtronic Australasia Pty Ltd

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

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

 Duran Ancore Chordal Model 620RG Dacron.

 Sorin Group Australia Pty Ltd

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

09.04.02 - Ring, with modification

 Edwards Lifesciences Pty Ltd

EL049 McCarthy-Edwards IMR Etlogix  Rigid mitral annuloplasty ring with  24mm, 26mm, 28mm, 30mm,  $2,400.00

 Annuloplasty Ring (Model: 4100) an assymetric design 32mm, 34mm, 36mm

EL050 Edwards MC3 Tricuspid Ring  3D rigid annuloplasty ring with a  26mm, 28mm, 30mm, 32mm,  $2,400.00

 Annuloplalsty System (Model:  tricuspid specific design 34mm, 36mm

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

 4200 with Holder

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

 Mitral Annuloplasty Ring annuloplasty ring, with an improved  38, 40mm

 saddle shape and global disease based

  design

EL061 Carpentier-Edwards Physio  The Carpentier-Edwards Physio  24,  26, 28, 30, 32, 34, 36mm $2,400.00

 Tricuspid Annuloplasty Ring Tricuspid annuloplasty ring, model

 6200 is intended for use in patients

 with tricuspid valvular insufficiency.

 Designed with selective flexibility

 and 3D waveform shape.

 Medtronic Australasia Pty Ltd

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

 with anterior flexibility 38mm

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

 physiologic mitral valve shape

MI121 Contour 3D Tricuspid  Annuloplasty Ring: Titanium core  26, 28, 30 32, 34, 36mm $2,400.00

 Annuloplasty Ring encapsulated with silicone, covered

 with polyester fabric

Prostheses List by Category, Groups and Sponsor Page 661 of 1059


09 - CARDIOTHORACIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Sorin Group Australia Pty Ltd

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

 Annuloplasty 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  Flexible annuloplasty ring 25mm - 43mm $2,400.00

 Annuloplasty Ring

SJ316 Seguin Annuloplasty Ring Semi-rigid annuloplasty ring 24-40mm $2,400.00

09.04.03 - Band, with modification

 Medtronic Australasia Pty Ltd

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

 Colvin - Galloway Future Band  Silicone / Barium Sulphate, Dacron.  Models 620B & 620BG:

 Model 638B; Duran Ancore Band  Models 638B semi-regid metal alloy  23-35mm, Model 638B - 26-

 620B; Duran Ancore Chordal  core, silicone coating, polyester knit  38mm

 Model 620BG fabric, kit includes-band, malleable

 handle, template with suture markers,

 sizers

 St Jude Medical Australia Pty Ltd

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

09.05.01 - Tissue

 09.05.01.01 - < 25cm²

 Baxter Healthcare Pty Ltd

BX292 Supple Peri-Guard (4 x 4cm) Model No PC0404SN - 4 x 4cm  4 x 4cm $350.00

 Bovine pericardium patch

 09.05.01.02 -   25-75cm²

 Baxter Healthcare Pty Ltd

BX293 Supple Peri-Guard (6 x 8cm) Model No PC0608SN -6 x 8cm  6 x 8cm $550.00

 Bovine pericardium patch

Prostheses List by Category, Groups and Sponsor Page 662 of 1059


09 - CARDIOTHORACIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 09.05.01.03 - >75cm²

 Baxter Healthcare Pty Ltd

BX294 Supple Peri-Guard (10 x 16cm) Model No PC1016SN - 10 x 16  10 x 16cm $760.00

 Bovine pericardium patch

BX295 Supple Peri-Guard (8 x 14cm) Nodel No PC0814SN - 8 x 14 Bovine  8 x 14cm $760.00

 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.

09.05.02 - Synthetic

 09.05.02.01 - Cardiovascular < 75cm²

 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 6cm0.6mm -  $240.00

 2.5cm x 15cm & 5cm x 7.5cm

GT126 Acuseal Cardiovascular Patch  ePTFE 0.5mm Thickness 1 x 9cm;  $240.00

 Vascular 0.8 x 7.5cm

GT127 Acuseal Cardiovascular Patch  ePTFE 0.5mm Thickness 3 x 6cm &  $240.00

 5 x 7.5cm

 09.05.02.02 - Cardiovascular 75cm²

 W L Gore & Associates

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 $521.00

Prostheses List by Category, Groups and Sponsor Page 663 of 1059


09 - CARDIOTHORACIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

09.06.01 - Non-cardiovascular < 100cm²

 W L Gore & Associates

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

09.06.02 - Non-cardiovascular 100cm² and <200cm²

 W L Gore & Associates

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

GT124 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 12 x 12cm $643.00

09.06.03 - Non-cardiovascular  200cm²

 W L Gore & Associates

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

09.09.01 - Modified Tube (end modified eg valsalva)

 Terumo Corporation Australia

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

  gelatin sealed Overall length 18.4 -

09.09.02 - Tube with one side branch

 Terumo Corporation Australia

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

 side branch, Polyester, woven, gelatin

  sealed

Prostheses List by Category, Groups and Sponsor Page 664 of 1059


09 - CARDIOTHORACIC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

09.09.03 - 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

09.09.04 - Hybrid stent graft (unbranched)

 Reid Healthcare

RH011 E-vita open plus stentgraft system Hybrid device consisting of a  Overall length: 180, 220, or $20,000.00

 conventional vascular graft   230mm. Vascular graft

 incorporated with and endovascular  length 50, 70mm; Stentgraft

 stent graft that allows treatment of the  length 130, 150, 160mm.

 ascending aorta, the arch and the  Diameter 24-40mm

 descending aorta, in one procedure.

09.10.01 - Skeletal fixation, sternum

 Advanced Biomedical Pty Ltd

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

 various sizes

 Synthes Australia Pty Ltd

SY688 Sternal ZipFix System Sternal Closure Tie with Needle One Size $140.00

Prostheses List by Category, Groups and Sponsor Page 665 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

10.01.01 - Bare Metal Stents

 10.01.01.01 - Balloon Expandable

 Abbott Australasia Pty Ltd

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

 Expandable Peripheral Stent 12-58mm

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

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

 38, 58mm length

 B Braun Australia Pty Ltd

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

 length

 Bard Australia Pty Ltd

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

 Peripheral Stent length

 Biotronik Australia Pty Ltd

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

 Lengths: 15, 25, 38, 56mm

 Boston Scientific Australia Pty Ltd

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

 Vascular SD Stent Stent and lengths up to 60mm

 Cook Medical Australia Pty Ltd

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

 80-135cm delivery system.

 Diameters 4-10mm, lengths

 0.8 - 4cm

 Johnson & Johnson Medical Pty Ltd

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

 Opta Pro (Medium) stent mounted on an Opta Pro  39mm

JJ306 Palmaz Genesis Peripheral Stent on  Stainless steel balloon expandable  Diameter 4-12mm, length  $1,800.00

 Opta Pro (Large) stent mounted on an Opta Pro  11-79mm

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

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

Prostheses List by Category, Groups and Sponsor Page 666 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 System (on Aviator Plus)                                    40, 50,

 60, 70mm diameters                

                    80, 142cm shaft

 lengths

 MD Solutions Pty Ltd

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

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

 exchange balloon expandable stent

 system for the treatment of

 atherosclerotic stenosis at the renal-

 ostial junction. It consists of a 316L

 stainless steel stent with flaring of the

  proximal 1/5 segment, and a dual

 balloon delivery catheter featuring a

 Locator balloon that enables the

 operator to precisely position and

 conform the stent to aorto-ostial

 anomalies.

 Medtronic Australasia Pty Ltd

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

 12 &18mm

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

 Length:  20 - 80mm

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

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

 sheath, 0.014" guide wire compatible

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

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

 compatable stent

 10.01.01.02 - Self Expandable, <150mm

 Abbott Australasia Pty Ltd

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

  exchange delivery system  + 30mm Straight; Diameter

 8-6, 9-7, 10-8mm Length 20

 + 30mm Tapered

Prostheses List by Category, Groups and Sponsor Page 667 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 expanding stent, used to treat  80mm in length

 peripheral vessel disease, Xpert is a

 low profile system designed for small

 vessels and is 4 french.

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

 length

AY041 Absolute Self Expanding Peripheral Laser cut nitinol self expanding stent,  Size ranges from: $1,800.00

  stent 20mm - 120mm lengths 5.0X20MM, 80CM -

 8.0x120MM, 135CM

AY043 Supera Peripheral Stent System Interwoven Self-Expanding Nitnol  20mm x 4,5,6,7mm $1,800.00

 30mm x 4,5,6,7mm

 60mm x 4,5,6,7mm

 80mm x 4,5,6,7mm

 100mm x 4,5,6,7mm

 120mm x 4,5,6,7mm

 40mm, x 4, 5, 6, 7mm

 40mm x 8mm diameter

 60mm x 8mm diameter

 80mm x 8mm diameter

 100mm x 8mm diameter

 Bard Australia Pty Ltd

BA178 Peripheral Vascular Bare Metal  Nitonol self expanding stent 4mm - 14mm diameters, $1,800.00

 2cm - 12cm lengths

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

 used to treat peripheral disease 120mm

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

 120mm length

 Biotronik Australia Pty Ltd

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

 coated stent Lengths: 30 - 100mm

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

 Nitinol self expanding stent (OTW

 design) used to treat peripheral vessel

  disease.

BT126 Pulsar 18 Peripheral self expanding  Pulsar 18  self expanding Nitinol  Stent: Ø 4- 7mm length: 20- $1,800.00

 Nitinol stent system stent system 120mm Catheter length: 90-

 135mm

Prostheses List by Category, Groups and Sponsor Page 668 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

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

  90cm

 Boston Scientific Australia Pty Ltd

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

  stent and lengths up to 100mm

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

 and lengths up to 40mm

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

 and lengths up to 120mm

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

 expanding stent and lengths up to 100mm

BS168 Wallstent RP Tracheobronchial, Iliac, Biomedical  Diameter up to 10mm;  $1,800.00

 Superalloy Wire, Braided Mesh,  lengths up to 100mm

 Stainless Steel Stent with Unistep

 Delivery System

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

 diameter

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

 lengths less than 150mm

 Cook Medical Australia Pty Ltd

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

 14mm diameter, 2 - 8cm

 length

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

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

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

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

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

  and high flexibility.  The stent has

 radiopaque markers at both ends.  The

 stent is supplied preloaded in a 6.0

 French inducer catheter. A radiopaque

  marker on the distal tip of the sheath

 is used to visualize deployment of the

 stent. Stent deployment is controlled

 by means of a hand held device.

Prostheses List by Category, Groups and Sponsor Page 669 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

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

 nitinol stent. Post-deployment, the  lengths.

 stent is designed to impart an outward

  radial force upon the inner lumen of

 the vessel, establishing patency in the

  stented region.

 Covidien Pty Ltd

AS189 Proté GPS Peripheral Stent Proté RX Peripheral Stent Diameter 6-10mm Length  $1,800.00

 20-60mm

AS194 Proté EverFlex Peripheral Stent Proté EverFlex is a self expanding  Diameter 5-8, Length 20- $1,800.00

 Nitinol stent premounted on an OTW  120mm

 delivery system.

 Endotherapeutics Pty Ltd

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

 Johnson & Johnson Medical Pty Ltd

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

 System self expanding stent, used to treat  100mm

 peripheral vessel disease.

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

 stent length, 120cm

 delivery system

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

 10mm;  Length:  20, 30, 40mm

 Medtronic Australasia Pty Ltd

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

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

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

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

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

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

 compatible.

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

 Expanding Stent System stent system Length: 30-120mm

Prostheses List by Category, Groups and Sponsor Page 670 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Pyramed Pty Limited

PY028 Sinus-XL Stent Self-expanding Nitinol stent Diameter: 16mm - 24mm.  $1,800.00

 Length: 40-100mm

 nominal; 41-100 Expanded.

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

 130mm Length

PY036 sinus-Venous Stents sinus-Venous Stent used for treating  12-18mm Diameter, 60- $1,800.00

 venous insufficiency, occlusion and  150mm Length

 stenosis

 Terumo Corporation Australia

TU056 MISAGO Rapid Exchange, Self- Bare Metal, Rapid Exchange, Self- 6mm - 12mm Diameter;  $1,800.00

 Expanding Peripheral Stent Expanding Peripheral Stent length 20mm - 140mm

 LD (large diameter, >25mm)

 Pyramed Pty Limited

PY029 Sinus-XL Stent 25mm Self-expanding Nitinol stent Diameter: 25mm - 34mm.  $2,970.00

 Length: 30-100mm

 nominal; 32-102 Expanded.

 10.01.01.03 - Self Expandable, 150mm

 Abbott Australasia Pty Ltd

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

 150 length 150mm, 170mm,

 200mm

AY042 Supera Peripheral Stent System Interwooven Self-Expanding Nitinol  150mm x 4, 5, 6mm $2,970.00

 Stent 180mm x 4, 5, 6mm

 200 x 4, 5, 6mm

 Bard Australia Pty Ltd

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

 length 150mm - 200mm

 Biotronik Australia Pty Ltd

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

 Nitinol stent system stent system 150-200mm Catheter

 length: 90-135mm

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

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

 length: 90cm, 135cm

Prostheses List by Category, Groups and Sponsor Page 671 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Boston Scientific Australia Pty Ltd

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

 Lengths greater than 150mm

 Cook Medical Australia Pty Ltd

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

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

  The special laser-cut pattern of the

 nitinol tube provides a construction

 with a strong radial force and high

 flexibility.  The stent has radiopaque

 markers at both ends.

 Covidien Pty Ltd

AS195 Proté EverFlex Peripheral Stent Proté EverFlex is a self expanding  Diameter 5-8mm, Length  $2,970.00

 Nitinol stent premounted on an OTW  150-200mm

 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

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

 Expanding Stent System stent system Length: 150mm

 Pyramed Pty Limited

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

PY037 sinus-Venous Stent sinus-Venous stent used for treating  18mm diameter, 150mm  $2,970.00

 venous insufficiency, occlusion and  Length

 stenosis

 Terumo Corporation Australia

TU055 MISAGO Self-expanding, Rapid  Bare metal, Self Expanding, Rapid  6mm - 12mm Diameter;  $2,970.00

 Exchange Peripheral Stent Exchange Peripheral Stent length 150mm - 200mm

Prostheses List by Category, Groups and Sponsor Page 672 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 10.01.01.04 - Self-Expanding, large diameter for treatment of aortic dissection disease

 Cook Medical Australia Pty Ltd

WC288 Zenith Dissection Endovascular  The Zenith Dissection Endovascular  Diameter: 46mm (designed  $4,650.00

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

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

 the endovascular treatment of patients  164mm

 with aortic dissection distal to the left

  subclavian artery.

WC316 Zenith Dissection Endovascular  Dissection Endovascular Stent Diameter: 36mm and 46mm $4,650.00

 Stent with the Z-Trak Plus  Lengths: 80mm, 120mm,

 Introduction System 180mm, 185mm

10.01.02 - Drug Eluting Stents

 Cook Medical Australia Pty Ltd

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

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

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

 the drug Paclitaxel.  The stent is

 preloaded in a 6.0 French delivery

 catheter.  Stent deployment is

 controlled by retraction of the handle

 while holding the metal cannula

 stationary.

10.02.01 - Tube (Thoracic Aorta)

 10.02.01.01 - <180mm length

 Cook Medical Australia Pty Ltd

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

 115mm to 179mm Length

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

 127mm to 179mm Length

Prostheses List by Category, Groups and Sponsor Page 673 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 Graft with Pro_Form and the Z-Trak  Length 115mm - 167mm

 Plus Introduction System Short

 Proximal Component

WC307 Zenith TX2 Dissection  Short Thoracic Proximal Graft Diameter 22mm - 42mm  $11,027.00

 Endovascular Graft with Pro-Form  Length 117mm - 165

 and the Z-Trak Plus Introduction

 System (Short proximal component)

 Medical Specialties Australia Pty Ltd

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

 Material Braided Polyester PFTE   103 - 179mm

 impregnated Suture Dual Sheath

 Delivery System

 Medtronic Australasia Pty Ltd

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

 Thoracic Stent Graft System

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

 length

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

 length

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

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

 Delivery System length

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

 delivery system  length

 W L Gore & Associates

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

 Length

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

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

 31, 34, 37, 40, 45

 Length (cm): 10

 Tapered Stent Grafts:

 Diameters (mm): 26x21;

 31x26

 Lengths (cm): 10

Prostheses List by Category, Groups and Sponsor Page 674 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 Endoprosthesis 37, 40, 45

 Length (cm) 15

 10.02.01.02 - 180mm length

 Cook Medical Australia Pty Ltd

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

 180mm to 216mm Length

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

 180mm to 207mm Length

WC276 Zenith TX2 TAA Endovascular  Long Thoracic Proximal  Diameter: 22mm-42mm  $14,500.00

 Graft with Pro-Form and the Z-Trak  Endovascular Graft Length: 192mm-216mm

 Plus Introduction System - Long

 Proximal Component

WC305 Zenith TX2 Dissection  Long thoracic proximal graft Diameter 28mm-42mm;  $14,500.00

 Endovascular Graft with Pro-Form  Length 194mm-218

 and the Z-Trak Plus Introduction

 System (Long proximal component)

 Medical Specialties Australia Pty Ltd

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

 Material Braided Polyester PFTE  180 - 271mm

 impregnated Suture Dual Sheath

 Delivery System

 Medtronic Australasia Pty Ltd

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

 227mm length

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

 Delivery System length

 W L Gore & Associates

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

 20cm Lengths

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

 Endoprosthesis 45

 Length (cm): 20

Prostheses List by Category, Groups and Sponsor Page 675 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

10.02.02 - Tube (Abdominal Aorta)

 Medtronic Australasia Pty Ltd

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

 System - Abdominal Tube

MI060 Endurant II AAA Abdominal Tube Endurant II Endoluminal Stent Graft  Proximal diameter: 23 to  $4,850.00

 System - Abdominal Tube 36mm; Distal diameter: 23

 to 36mm; Covered length:

 70mm

 Cook Medical Australia Pty Ltd

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

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

 section) 43 - 100mm

10.02.03 - Tube (Aorto-uni-iliac)

 Cook Medical Australia Pty Ltd

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

 Converter  situ AAA stent grafts  distal diameter 12mm,

 lengths 91-161mm

 Medtronic Australasia Pty Ltd

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

 Graft System - AUI  Tapered System.

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

 System - AUI

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

 System - AUI 36mm; Distal daimeter:

 14mm; Covered length:

 102mm

Prostheses List by Category, Groups and Sponsor Page 676 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

10.02.04 - Bifurcated

 10.02.04.01 - Body and 2 limbs

 Terumo Corporation Australia

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

 woven polyester, nitinol ring stents,

 tantalum markers

 10.02.04.02 - Body and 1 limb

 Medtronic Australasia Pty Ltd

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

 System - Bifurcated Graft 135 -185mm

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

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

 to 20mm; Covered lengths:

 124 to 166mm

 W L Gore & Associates

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

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

 Trunk - Ipsilateral Limb

GT263 GORE EXCLUDER AAA  AAA Stent Graft Nitinol & ePTFE  Diameters (mm): 23, 26,  $8,955.00

 Endoprosthesis Two piece system (1/2) Trunk- 28.5, 35mm

 ipsilateral component Length: 12, 14, 16, 18cm

 Diameter: 31mm

 Lengths: 13, 15, 17cm

 Diameters: 35mm

 Lengths: 14, 16, 18cm

 10.02.04.03 - Body only

 Cook Medical Australia Pty Ltd

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

 Graft - body only 140mm

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

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

 length 76 - 121mm

Prostheses List by Category, Groups and Sponsor Page 677 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

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

 System - main body

WC293 Zenith Low Profile AAA  Bifurcated main body graft Diameter: 22-36mm,  $5,794.00

 Endovascular Graft - Bifurcated  Length: 70-128mm

 Main Body

10.02.05 - Branched

 Cook Medical Australia Pty Ltd

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

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

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

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

 nitinol z-stents and woven polyester,

 mounted on H&LB one shot delivery

 system

 10.02.05.02 - Multiple Branch

 Cook Medical Australia Pty Ltd

WC312 Zenith Universal Distal Body  The Zenith Universal Distal Body  Diameters: 22 - 24mm $7,500.00

 Endovascular Graft Endovascular Graft (Unibody)  Lengths: 81 - 32mm

 consists of a bifurcated graft loaded

 into the H&L-B One-Shot delivery

 L

 Cook Medical Australia Pty Ltd

WC313 Zenith t-Branch Endovascular Graft The t-Branch is an endovascular graft  Diameter: 34mm $14,500.00

 designed for use in the  Length: 202mm

 thoracabdominal aorta.

Prostheses List by Category, Groups and Sponsor Page 678 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

10.02.06 - Fenestrated

 Cook Medical Australia Pty Ltd

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

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

 Length

10.02.07 - Accessory Component (Aortic)

 10.02.07.01 - Thoracic

 Cook Medical Australia Pty Ltd

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

 Length 77;Dia 26 Length

 77; Dia 28 Length 80; Dia

 30 Length 80; Dia 32

 Length 80; Dia 34 Length

 77; Dia 36 Length 77; Dia

 38 Length 77; Dia 40

 Length 81

 Diameter 42 Length 81

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

 77mm to 81mm length

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

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

 Plus Introduction System (thoracic

 body extension)

WC306 Zenith TX2 Dissection  Thoracic Proximal Extension Diameter 22mm - 42mm;  $6,300.00

 Endovascular Graft with Pro-Form  Length 79mm - 83mm

 and the Z-Trak Plus Introduction

 System (thoracic body extension)

 10.02.07.02 - Abdominal

 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

Prostheses List by Category, Groups and Sponsor Page 679 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

WC302 Zenith Low Profile AAA  Converter Proximal Diameter: 24- $2,555.00

 Endovascular Graft - Converter 36mm, Distal Diameter:

 12mm, Working Length:

 66mm

WC303 Zenith Low Profile AAA  Main Body Extension Diameter: 22-36mm,  $2,555.00

 Endovascular Graft - Main Body  Working Length: 45-58mm

 Extension

 Medtronic Australasia Pty Ltd

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

 Aortic Extension

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

 System - Aortic Extension

MI061 Endurant II AAA Aortic Extension Endurant II Endoluminal Stent Graft  Proximal diameter: 23 to  $2,555.00

 System - Aortic Extension 36mm; distal diameter: 23 to

  36mm; Covered length:

 49mm

 Terumo Corporation Australia

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

 woven polyester, nitinol ring stents,

 tantalum markers

 W L Gore & Associates

GT189 GORE EXCLUDER AAA  Abdominal Stent Graft Nitinol &  Diameters: 23, 26, 28.5mm $2,555.00

 Endoprosthesis ePTFE - Aortic Extender Lengths: 3.3cm

 Diameters: 32mm

 Length: 4.5cm

 Diameter: 36mm

 Length: 4.5cm

10.02.08 - Accessory Component (Other including iliac limb and

 Cook Medical Australia Pty Ltd

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

 Length 55

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

 Contralateral/Ipsilateral Iliac Legs lengths from 37 to 122mm

Prostheses List by Category, Groups and Sponsor Page 680 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

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

 mm

 Working Length - 39 mm to

 122 mm

WC301 Zenith Low Profile AAA  Contralateral/Ipsilateral lliac Leg Diameter: 10-24mm,  $3,308.00

 Endovascular Graft -  Working Length: 36-

 Contralateral/Ipsilateral lliac Leg

 Medtronic Australasia Pty Ltd

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

 Limb System - Contralateral Iliac Limb

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

 System - Iliac Extension

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

  Limb System - Contralateral Iliac Limb Distal diameter: 10 to

 28mm; Covered length:

 82mm; 93mm; 124mm

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

 28mm; Distal diameter: 10

 to 28mm; Covered length:

 82mm

 Terumo Corporation Australia

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

 polyester, nitinol ring stents,

 tantalum markers

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

 nitinol ring stents, tantalum markers

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

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

 tantalum markers Length 80-130mm

 W L Gore & Associates

GT188 EXCLUDER AAA Endovascular  AAA Stent Graft Nitinol & ePTFE  Diameters: 12, 14.5, 23,  $3,308.00

 Prostheses Two piece system (2/2) Contralateral  27mm

 Limb Lenghts: 10, 12, 14cm

 Diameters: 16, 18, 20mm

 Lenghts: 9.5, 11.5, 13.5cm

GT190 Excluder AAA Endovascular  Abdominal Stent Graft Nitinol &  Diameters: 10, 12, 14.5mm $3,308.00

 Prostheses ePTFE - Iliac Extender Lengths: 7cm

Prostheses List by Category, Groups and Sponsor Page 681 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 L (long length)

 Medtronic Australasia Pty Ltd

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

  Limb System - Contralateral Iliac Limb Distal diameter: 10 to

 28mm; Covered length:

 156mm, 199mm

10.02.09 - Iliac Graft Plug

 Medtronic Australasia Pty Ltd

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

 graft sealed both ends 31 - 35mm

 Cook Medical Australia Pty Ltd

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

 24mm

10.02.10 - Tube, Peripheral, Balloon Expandable

 10.02.10.01 - 12mm diameter

 Atrium Australia - Pacific Rim Pty Limited

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

 Encapsulated Stainless Steel

 Peripheral Vascular Stent

 10.02.10.02 - >12mm diameter

 Atrium Australia - Pacific Rim Pty Limited

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

 Encapsulated Stainless Steel Vascular length. 80cm and 120cm

  Stent catheter lengths

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

 Encapsulated Stainless Steel Vascular length. 80cm and 120cm

  Stent catheter lengths

Prostheses List by Category, Groups and Sponsor Page 682 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

 Encapsulated Stainless Steel Vascular length. 80cm and 120cm

  Stent catheter lengths

10.02.11 - Tube, Peripheral, Self Expandable

 10.02.11.01 - <150mm length

 Bard Australia Pty Ltd

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

 Graft stent - 12cm length

 W L Gore & Associates

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

 Graft-Lined Length 2cm

 Unlined Length

 H

 W L Gore & Associates

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

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

 self expanding endoluminal device  6mmx5cm 75cm 6mmx5cm

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

 external nitinol support 7mmx5cm 75cm

 7mmx5cm 120cm 8mmx2.5cm

  120cm 8mmx5cm 75cm

 8mmx5cm 120cm 9mmx 5cm

 75cm 9mmx 5cm 120cm

 10mmx 5cm 75cm

 10mmx 5cm 120cm 11mmx

 5cm 75cm

 11mmx 5cm 120cm 13mmx

 5cm 75cm 13mmx 5cm

 120cm

Prostheses List by Category, Groups and Sponsor Page 683 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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

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

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

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

 external nitinol support 10cm 75cm 8mmx 10cm

 120cm

 9mmx 10cm 75cm 9mmx

 10cm 120cm

 10mmx 10cm 75cm 10mmx

 10cm 120cm

 11mmx 10cm 75cm 11mmx

 10cm 120cm

 13mmx 10cm 75cm 13mmx

 10cm 120cm

 10.02.11.02 - 150-249mm length

 H

 W L Gore & Associates

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

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

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

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

 external nitinol support 15cm 75cm 8mmx 15cm

 120cm 9mmx 15cm 75cm

 9mmx 15cm 120cm 10mmx

 15cm 75cm, 10mmx 15cm

 120cm 11mmx 15cm 75cm

 11mmx 15cm 120cm 13mmx

 15cm  75cm 13mmx 15cm

 120cm

 10.02.11.03 - 250mm length

 H

 W L Gore & Associates

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

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

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

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

 with external nitinol support

Prostheses List by Category, Groups and Sponsor Page 684 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

10.03.01 - Tube

 10.03.01.01 - 10cm length

 B Braun Australia Pty Ltd

BB025 Vascular Uni - Graft Vascular graft 10cm $245.00

 W L Gore & Associates

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

 10cm

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

 10cm

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

 10cm

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

 10cm

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

 Systemic-Pulmonary Shunts (ePTFE)  5cm

 Stretch & Non Stretch

GT168 Gore-Tex Vascular Grafts Vascular Grafts - Aorto-Pulmonary &  Diameter 3.5 - 5mm, Length  $245.00

 Systemic-Pulmonary Shunts (ePTFE)  10cm

 Stretch & Non Stretch

 R

 Terumo Corporation Australia

TU029 SEALPTFE Graft Standard Wall, Straight, Sealed,  5 to 10mm x 10 to 40cm $655.00

 Externally Reinforcement, PTFE

 10.03.01.02 - 11-20cm length

 Atrium Australia - Pacific Rim Pty Limited

AC079 Intergard W - Woven Straight Woven Straight 15cm $800.00

 B Braun Australia Pty Ltd

BB023 Vascular Uni - Graft Vascular graft 20cm $800.00

BB024 Vascular Uni - Graft Vascular graft 15cm $800.00

BB126 Vascugraft Thin Wall Straight Dia 3 - 8mm, length10 -  $800.00

 40cm

Prostheses List by Category, Groups and Sponsor Page 685 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BB127 Vascugraft Thin Wall Straight Dia 3 - 8mm, length 10 - 40cm $800.00

 Bard Australia Pty Ltd

BA020 Impra PTFE Vascular Grafts ePTFE graft - thin wall, 10 - 50cm  3mm - 10mm diameter $800.00

BA025 Impra PTFE Vascular Grafts ePTFE graft - regular wall, 10-50cm  3 - 19mm diameter $800.00

 long

 Bio Nova International Pty Ltd

BN004 Omniflow II Vascular Prosthesis -  Biosynthetic vascular prosthesis for  3 - 4 mm x 20 cm $800.00

 Straight peripheral revascularisation and

 vascular access

 Lifehealthcare Pty Ltd

LH006 Thoratec, Vectra Vascular Graft -  Vectra, Biocompatible Polyurethane  Length 20cm $800.00

 Synthetic Vascular Access Graft

 Terumo Corporation Australia

TU048 Gelweave Graft Straight Polyester Knitted 6-38mm x 15-20cm $800.00

TU049 SEALPTFE Graft Standard Wall, Straight, Sealed, PTFE 5 to 10mm x 10 to 20cm $800.00

 W L Gore & Associates

GT009 Gore-Tex Vascular Grafts Vascular Grafts - Aorto -Pulmonary &  3.5-5mm Diameter x 15- $800.00

 Systemic-Pulmonary Shunts (ePTFE) 20cm Length

GT146 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 12 - 24mm, Length $800.00

  20cm

GT150 Gore-Tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 6 - 10mm, Length  $800.00

 20cm

GT159 Gore-Tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length  $800.00

 20cm

GT195 Gore-Tex Vascular Graft Standard wall grafts (ePTFE) Diameter 6mm x 20cm length $800.00

GT200 Gore-Tex Vascular Graft Standard wall grafts stretch (ePTFE) Diameter 6-12mm x 20cm  $800.00

 length

 R

 Atrium Australia - Pacific Rim Pty Limited

AC056 Advanta PTFE Vascular Graft Trilaminate PTFE Graft with Graft  4mm - 8mm  11cm - 20cm  $1,520.00

 Deployment System length

Prostheses List by Category, Groups and Sponsor Page 686 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 B Braun Australia Pty Ltd

BB120 Vascugraft Straight Standard Wall with Helix  Dia 6 - 10mm, length 10 -  $1,520.00

 Support 50cm

 Bard Australia Pty Ltd

BA019 Impra PTFE Vascular Grafts ePTFE graft - radially supported, thin  4mm - 8mm diameter $1,520.00

 wall, 10 - 50cm long

BA022 Impra PTFE Vascular Grafts ePTFE graft - radially supported,  4 - 19mm diameter $1,520.00

 regular wall, 10-50cm long

 R, ID

 Atrium Australia - Pacific Rim Pty Limited

AC054 Advanta PTFE Vascular Graft with  Trilaminate PTFE. Vascular Access  4mm - 8mm diameter  11cm -  $1,720.00

 Graft Deployment System PTFE 20cm length

 10.03.01.03 - 21-49cm length

 Atrium Australia - Pacific Rim Pty Limited

AC083 Maquet InterVascular Straight  Straight Vascular Grafts 5mm - 24mm diameter, 21 - $870.00

 vascular Grafts 49am length

 B Braun Australia Pty Ltd

BB021 Vascular Uni - Graft Vascular graft 40cm $870.00

BB022 Vascular Uni - Graft Vascular graft 30cm $870.00

BB119 Vascugraft PTFE, Straight Standard Wall Dia 4 - 10mm, length 40 -  $870.00

 50cm

BB142 Vascugraft Easy Glide - Standard Wall Straight Dia 6mm, length 40 - 60cm $870.00

BB144 Vascugraft Easy Glide - Thin Wall Straight Dia 6 - 8mm, length 40 - 70cm $870.00

 Bio Nova International Pty Ltd

BN026 Omniflow II Vascular Prosthesis Biosynthetic vascular prosthesis for  9 and 10mm internal  $870.00

 peripheral revascularisation and  diameter, 20 to 40cm length

 vascular access

BN027 Omniflow II Vascular Prosthesis Biosynthetic vascular prosthesis for  5, 6, 7 and 8mm internal  $870.00

 peripheral revascularisation and  diameter; 45 to 65cm length

 vascular access

Prostheses List by Category, Groups and Sponsor Page 687 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BN028 Omniflow II Vascular Prosthesis Biosynthetic vascular prosthesis for  9 and 10mm internal  $870.00

 peripheral revascularisation and  diameter; 45 to 85cm length

 vascular access

BN029 Omniflow II Vascular Prosthesis Biosynthetic vascular prosthesis for  5, 6, 7 and 8mm internal  $870.00

 peripheral revascularisation and  diameter; 20 to 40cm length

 vascular access

 Lifehealthcare Pty Ltd

LH004 Thoratec, Vectra Vascular Graft -  Vectra, Biocompatible Polyurethane  Length 40cm $870.00

 Synthetic Vascular Access Graft

 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

TU025 SEALPTFE Graft Thin Wall, Straight, Sealed, PTFE 5 to 10mm x 30 to 40cm $870.00

TU047 Gelweave Graft Straight Polyester Knitted 6-38mm x 25-40cm $870.00

TU050 SEALPTFE Graft Standard Wall, Straight, Sealed, PTFE 5 to 10cm x 20 to 40cm $870.00

 W L Gore & Associates

GT139 Gore-Tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length  $870.00

 20 - 30cm

GT147 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 12 - 24mm, Length $870.00

  30cm

GT148 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 12 - 24mm, Length $870.00

  40cm

GT151 Gore-Tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 6 - 10mm, Length  $870.00

 30cm

GT152 Gore-Tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length  $870.00

 40cm

GT160 Gore-Tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length  $870.00

 30cm

GT161 Gore-Tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 6 - 10mm, Length  $870.00

 40cm

GT193 Gore-Tex Vascular Grafts Standard  Wall Grafts (ePTFE) 6-10mm Diameter x 40cm  $870.00

 Length

GT240 Gore-Tex Vascular Graft Stretch Standard Wall Graft (ePTFE) 10mm x 40cm $870.00

GT241 Gore-Tex Vascular Graft Stretch Standard Wall Graft (ePTFE) 6 & 8mm x 40cm $870.00

Prostheses List by Category, Groups and Sponsor Page 688 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 H

 W L Gore & Associates

GT221 Gor-Tex Propaten Stretch Thin  Stretch Thin Walled Graft (ePTFE) -  6-8mm diameter, non- $970.00

 Walled Vascular Graft Heparin Bonded Ringed 40cm length

 ID

 Terumo Corporation Australia

TU039 Rapidax™ Rapid Access  Triple layered self sealing  6mm x 20-40cm $1,300.00

 Haemodialysis Graft haemodialysis Access Graft. ePTFE

 internal and external layer with

 proprietary elastomer inner layer -

 Straight and Pre-curved

TU040 Rapidax™ Rapid Access  Triple layered self sealing  6mm x 45-50cm $1,300.00

 Haemodialysis Graft haemodialysis Access Graft. ePTFE

 internal and external layer with

 proprietary elastomer inner layer -

 Straight and Per-curved

 R

 Atrium Australia - Pacific Rim Pty Limited

AC044 Advantra PTFE Vascular Graft Trilaminate PTFE Aortic Graft with  12mm - 24mm diameter 30cm $1,520.00

 hydrostatic membrane  length

AC057 Advanta PTFE Vascular Graft Trilaminate PTFE Graft with Graft  4mm - 8mm diameter 21cm -  $1,520.00

 Deployment System 49cm length

 B Braun Australia Pty Ltd

BB132 Vascugraft Thin Wall Centre Helix Dia 6mm, length 45cm $1,520.00

BB133 Vascugraft Thin Wall Centre Helix Dia 5 - 6mm, length 45 - 50cm $1,520.00

BB146 Vascugraft Easy Glide - Thin Wall Straight with  Dia 6 - 8mm, length 40 - 80cm $1,520.00

 Helix Support

 Terumo Corporation Australia

TU010 Fluoropassiv Graft Straight Graft, Thin Wall, Externally  5 to10mm x 30 to 40cm $1,520.00

 Reinforced. Fluoropolymer/polyester,

 Knitted

TU019 Gelsoft Plus Graft Femoro-femoral, Polyester, Knitted,  6mmx30cm to  8mmx40cm $1,520.00

 Externally reinforced

Prostheses List by Category, Groups and Sponsor Page 689 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 W L Gore & Associates

GT211 Gore-Tex Intering Stretch Thin  ePTFE integrated rings in the wall of  Diameter 6-8mm, 40cm  $1,520.00

 Walled Vascular Graft a stretch thin walled graft radial supported length x

 40cm length

GT252 Gore-Tex Stretch Removable Ringed Stretch Removable Ringed Thin  8mm diameter, 40cm length,  $1,520.00

  Vascular Graft Walled Graft (ePTFE) 30cm removable ringed

 section

GT253 Gore-Tex Stretch Removable Ringed Stretch Removable Ringed Thin  8mm diameter, 40cm length,  $1,520.00

  Vascular Graft Walled Graft (ePTFE) 30cm removable ringed

 section

 R, H

 W L Gore & Associates

GT235 Gore-Tex Propaten Vascular Graft Stretch (ePTFE), Heparin Bonded,  8mm diameter, 40cm length $1,620.00

 Graft

GT264 Stretch Thin Walled Graft,  Stretch Thin Walled Graft, Removable  40cm length $1,620.00

 Removable Rings (ePTFE) Heparin  Rings (ePTFE) Heparin Bonded

 Bonded

 R, ID

 Atrium Australia - Pacific Rim Pty Limited

AC055 Advanta PTFE Vascular Graft with  Trilaminate PTFE. Vascular Access  4mm - 8mm diameter  21cm -  $1,720.00

 Graft Deployment System PTFE 49cm length

 10.03.01.04 - 50cm length

 Atrium Australia - Pacific Rim Pty Limited

AC052 Advanta PTFE Vascular Graft Straight PTFE Vascular Graft 6mm - 10mm; 50cm - 90cm $970.00

AC084 Maquet InterVascular Straight  Straight Vascular Grafts 6mm - 24mm Diameter, 50- $970.00

 Vascular Grafts 100cm length

 B Braun Australia Pty Ltd

BB018 Vascular Uni - Graft Vascular graft 100cm $970.00

BB019 Vascular Uni - Graft Vascular graft 60cm $970.00

BB020 Vascular Uni - Graft Vascular graft 50cm $970.00

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

Prostheses List by Category, Groups and Sponsor Page 690 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

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 $970.00

 Bard Australia Pty Ltd

BA024 Impra PTFE Vascular Grafts ePTFE graft - thin wall, greater than  3 - 10 diameter $970.00

 50cm long

BA026 Impra PTFE Vascular Grafts ePTFE graft - regular wall, greater  3 - 10mm diameter $970.00

 than 50cm long

 Lifehealthcare Pty Ltd

LH005 Thoratec, Vectra Vascular Graft -  Vectra, Biocompatible Polyurethane  Length 50cm $970.00

 Synthetic Vascular Access graft

 Terumo Corporation Australia

TU006 Twillweave Graft Straight, Polyester, Woven, Unsealed 6-24mm x 50-60cm $970.00

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

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

 80cm

GT143 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length  $970.00

 70cm

GT145 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 4 - 10mm, Length  $970.00

 90 - 100cm

GT157 Gore-Tex Stretch Thin Walled  Thin Wall Grafts Stretch (ePTFE) Diameter 4 - 10mm, Length  $970.00

 Vascular Graft 90 - 100cm

GT164 Gore-Tex Vascular Grafts Thin wall grafts (ePTFE) Dia 3 - 10mm, length 70cm $970.00

GT236 Gore-Tex Vascular Graft Standard Wall Grafts (ePTFE) 10mm diameter, 70-80cm  $970.00

 length

GT237 Gore-Tex Vascular Graft Standard Wal Grafts(ePTFE) 5mm-8mm diameter, 70-80cm $970.00

  length

Prostheses List by Category, Groups and Sponsor Page 691 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

GT238 Gore-Tex Vascular Graft Standard Wal Grafts (ePTFE) 10mm diameter, 90-100cm  $970.00

 length

GT239 Gore-Tex Vascular Graft Standard Wall Grafts (ePTFE) 5-8mm diameter, 90-100cm  $970.00

 length

GT242 Gore-Tex Stretch Standard Walled  Stretch Standard Wall Graft (ePTFE) 10mm diameter, 80cm length $970.00

 Vascular Graft

GT243 Gore-Tex Stretch Standard Walled  Stretch Standard Walled Graft (ePTFE) 6-8mm diameter, 80cm  $970.00

 Vascular Graft

GT244 Gore-Tex Stretch Thin Walled  Thin Wall Graft Stretch (ePTFE) 10mm diameter, 70cm length $970.00

 Vascular Graft

GT245 Gore-Tex Stretch Thin Walled  Thin Wall Graft Stretch (ePTFE) 6-8mm diameter, 70cm  $970.00

 Vascular Graft

GT246 Gore-Tex Stretch Thin Walled  Thin Wall Graft Stretch (ePTFE) 10mm diameter, 80cm length $970.00

 Vascular Graft

GT247 Gore-Tex Vascular Graft Thin Wall Graft Stretch (ePTFE) 6-8mm diameter, 80cm  $970.00

GT248 Gore-Tex Vascular Graft Thin Wall Grafts (ePTFE) 10mm diameter, 80cm length $970.00

GT249 Gore-Tex Vascular Graft Thin Wall Grafts (ePTFE) 4-8mm diameter, 80cm  $970.00

GT250 10mm Thin Walled Vascular Graft Thin Walled Graft (ePTFE) 10mm x 90-100cm $970.00

GT251 4-8mm Thin Walled Vascular Graft Thin Walled Graft (ePTFE) 4-8mm x 90-100cm $970.00

 H

 W L Gore & Associates

GT222 Gortex Stretch Thin Walled  Stretch Thin Wall Graft (ePTFE)-  6-8mm diameter Non- $1,070.00

 Propaten Graft Heparin Bonded Ringed 80cm length

 R

 Atrium Australia - Pacific Rim Pty Limited

AC045 Advantra PTFE Vascular Graft Trilaminate PTFE Graft with Graft  4 - 8mm diameter 50cm -  $1,630.00

 Deployment System 100cm lengths

AC053 Atrium PTFE Vascular Graft Ringed PTFE 4mm - 10mm; 50cm - 100cm $1,630.00

 B Braun Australia Pty Ltd

BB121 Vascugraft Straight Standard Wall with Helix  Dia 6 - 10mm, length 60 -  $1,630.00

 Support 80cm

BB122 Vascugraft Straight Standard Wall with Helix  Dia 5 - 8mm, length 90cm $1,630.00

 Support

Prostheses List by Category, Groups and Sponsor Page 692 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BB128 Vascugraft Straight Standard Wall with Helix  Dia 6mm x  length 100cm $1,630.00

 Support

BB129 Vascugraft Straight Standard Wall with Helix  Dia 5 - 8mm, length 80 - 90cm $1,630.00

 Support

BB130 Vascugraft Straight Standard Wall with Helix  Dia 4 - 6mm, length 50 - 70cm $1,630.00

 Support

BB134 Vascugraft Thin Wall Centre Helix Dia 4 - 8mm, length 70 - 80cm $1,630.00

BB137 Vascugraft Standard with Centred Helix Dia 4 - 8mm, length 70 - 90cm $1,630.00

 Bard Australia Pty Ltd

BA021 Impra PTFE Vascular Grafts ePTFE graft - radially supported, thin  4 - 8mm diameter, greater  $1,630.00

 wall. than 50cm long

BA023 Impra PTFE Vascular Grafts ePTFE graft - radially supported,  4 - 10mm diameter, greater  $1,630.00

 regular wall. than 50cm long

 Terumo Corporation Australia

TU011 Fluoropassiv Graft Straight Graft, Thin Wall, Externally  5 to10mm x 50 to 70cm $1,630.00

 Reinforced. Fluoropolymer/polyester,

 Knitted

TU030 SEALPTFE Graft Standard Wall, Straight, Sealed,  5 to 10mm x 50 to 80cm $1,630.00

 Externally Reinforcement, PTFE

TU045 Gelsoft Plus Graft Polyester, Externally Reinforced,  6 to 10cm x 75 to 100cm $1,630.00

 Knitted

TU046 SEALPTFE Graft Thin Wall, Straight, Sealed,  5 to 10mm x 50 to 80cm $1,630.00

 Externally Reinforced, PTFE

 W L Gore & Associates

GT008 Gore-Tex Vascular Ring Graft Ringed Grafts removable thin wall -  6-8mm Diameter x 80cm  $1,630.00

 stretch (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

 (ePTFE) Length, Ringed Section

 60cm Length

Prostheses List by Category, Groups and Sponsor Page 693 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

GT182 Gore-Tex Vascular Ring Graft Ringed Grafts Removable Thin Wall  Diameter 6mm, Lengths 80 -  $1,630.00

 (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

 (ePTFE) 90 cm, Ringed Section 70cm

  Length

GT185 Gore-Tex Vascular Ring Graft Ringed Grafts Removable Thin Wall  Diameter 6mm x 80cm  $1,630.00

 Stretch (ePTFE) Length, Ringed Section

 30cm Length

GT186 Gore-tex Stretch Removable Ringed  Stretch Thin Walled Removable  Diameter 6mm x 70cm  $1,630.00

 Vascular Graft Ringed (ePTFE) Graft Length, Ringed Section 60cm

GT187 Gore-tex Stretch Removable Ringed  Stretch Thin Walled Removable  Diameter 6 - 8mm x 70cm  $1,630.00

 Vascular Graft Ringed (ePTFE) Graft Length, Ringed Section 60 -

  70cm Length

GT212 Gore-Tex Stretch Intering Vascular  Stretch Thin Walled ePTFE graft with  Dia 6-8mm, 60cm radial  $1,630.00

 Graft Integrated Rings supported length x 60cm

 length

GT213 Gore-Tex Intering Vascular Graft ePTFE integrated rings in the wall of  Dia 6-8mm, 80cm radial  $1,630.00

 a stretch thin walled graft supported length x 80cm

 length

GT218 Gortex Propaten Vascular Graft Stretch Thin Wall Graft (ePTFE) 6mm diameter 30cm  $1,630.00

 Removable Ring - 70cm

 length

 R (ringed)

 Atrium Australia - Pacific Rim Pty Limited

AC085 Maquet InterVascular redially  Radially Supported Vascular Grafts 5mm - 24mm diameter, 50 - $1,630.00

 Supported Vascular Grafts 100m length

 R, H

 W L Gore & Associates

GT234 Gore-Tex Stretch Propaten with  Stretch Thin Walled (ePTFE), Heparin 6mm diameter, 70cm length,  $1,730.00

 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  $1,730.00

 Graft Rings (ePTFE), Heparin Bonded length, 60-70cm Ringed

 Section

GT265 Stretch Thin Walled Graft,  Stretch Thin Walled Graft, Removable  50cm $1,730.00

 Removable Rings (ePTFE) Heparin  Rings (ePTFE) Heparin Bonded

 Bonded

Prostheses List by Category, Groups and Sponsor Page 694 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

10.03.02 - Bifurcated

 Atrium Australia - Pacific Rim Pty Limited

AC026 Advanta SST Bifurcated PTFE Graft 12mm - 24mm X 6mm - 12mm $975.00

  Length 40cm

AC086 Maquet InterVascular Bifurcated  Bifurcated Vascular Grafts 6mm - 24mm diameter, 50cm  $975.00

 Vascular Grafts length

 B Braun Australia Pty Ltd

BB027 Vascular Uni - Graft - Bifurcated Vascular graft 12x7 to 12x12 $975.00

 Terumo Corporation Australia

TU007 Twillweave Graft Bifurcated, Polyester, Woven,  12mm x 6mm x 45cm to  $975.00

 24mm x 12mm x 45cm

TU013 Gelweave Graft Bifurcated, Polyester, Woven 12mmx 6mmx 45 cm to  $975.00

 24mmx12mm x 45cm

TU014 Gelsoft Plus Graft Bifurcated, Polyester, Knitted 12mmx6mmx45cm to  $975.00

 24mmx12mmx45cm

 W L Gore & Associates

GT006 Gore-Tex Stretch Bifurcated Graft Stretch Bifurcated Graft with Thin  12x6mm to 24x12mm 40- $975.00

 Walled Limbs (ePTFE) 50cm long

10.03.03 - Branched or Fenestrated

 Atrium Australia - Pacific Rim Pty Limited

AC064 Intergard W Woven Aortic Arch 24mm x 10mm x 8mm x 8mm x $1,950.00

  50cm - 30mm x 10mm x 8mm

 x 8mm

AC067 Intergard K Knitted Axillobifemoral Diameter (mm) Length (cm)  $1,950.00

 8 x 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

Prostheses List by Category, Groups and Sponsor Page 695 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 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  Stretch vascular graft with removable  Diameter 8mm x 90cm 40cm $1,950.00

 Graft rings (ePTFE)

10.03.04 - 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

AC046 Advantra PTFE Vascular Graft Tapered Trilaminate PTFE Graft with  4mm - 8mm diameter 50cm -  $875.00

 Graft Deployment System 80cm lengths

AC047 Advantra PTFE Vascular Graft Tapered Trilaminate PTFE Graft with  4mm - 8mm diameter, 10 -  $875.00

 Graft Deployment System 40cm lengths

 Australasian Medical & Scientific Ltd

AN010 Tayflow TFT SLF Graft Spiral laminar flow graft 70cm length x 7mm diameter  $875.00

 80cm length x 7mm diameter

 70cm length x 8mm diameter

 80cm length x 8mm diameter

 B Braun Australia Pty Ltd

BB026 Vascular Uni - Graft - Tapered Vascular graft 12x6 to 24x12 $875.00

BB131 Vascugraft Thin Wall Tapered Dia 4 - 8mm, length 40 - 90cm $875.00

BB136 Vascugraft Standard Tapered Dia 4 - 8mm, length 70 - 90cm $875.00

BB138 Vascugraft Standard with Short Taper Dia 4 - 8mm, length 30 - 70cm $875.00

BB139 Vascugraft Standard with Short Taper Dia 4 - 8mm, length 80cm $875.00

BB143 Vascugraft Easy Glide - Standard Wall with  Dia 6 - 8mm, length 40 - 70cm $875.00

 Helix Short Taper

Prostheses List by Category, Groups and Sponsor Page 696 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BB145 Vascugraft Thin Wall Centred Helix Tapered Dia 4 - 7mm, length 70cm $875.00

BB155 Vascugraft Standard Tapered Dia 4 - 7mm, length 30 - 70cm $875.00

BB156 Vascugraft Standard Wall with Tapered Centre  Dia 4 - 8mm, length 40 - 45cm $875.00

 Helix

BB157 Vascugraft Standard Wall Stepped Taper Dia 4 - 8mm, length 40 - 45cm $875.00

 Bard Australia Pty Ltd

BA028 Impra PTFE Vascular Grafts Distaflo ePTFE graft with preformed  6-10mm diameter, 40 - 80cm  $875.00

 cuff and flex support length

BA029 Impra PTFE Vascular Grafts Venaflo ePTFE graft with preformed  4mm - 8mm diameter, 10cm -  $875.00

 cuff 50cm length

BA171 Dynaflo AK Bypass Graft PTFE Graft 7 & 8mm diameter. 50, 60,  $875.00

 70, 80cm lengths

 Terumo Corporation Australia

TU033 SEALPTFE Graft Standard Wall, Tapered, Sealed, PTFE 4 to 7mm Taper x 45 to 50cm $875.00

 W L Gore & Associates

GT171 Gore-tex Vascular Grafts Standard Wall Grafts Stretch Tapered  Diameter 4-6mm & 4-7 mm,  $875.00

 (ePTFE) Length 45 - 48cm

GT172 Gore-Tex Vascular Grafts Standard Wall Grafts Stretch Tapered  Diameter 4-7 mm, Length  $875.00

 (ePTFE) 70cm

GT214 Gore-Tex Intering Vascular Graft Internally radially supported vascular 4-6 tapered diameter 38cm  $875.00

  graft (ePTFE) radial support length 45cm

 length; 4-7 tapered diameter

  38cm radial support length

 45cm length; 6mm diameter

 40cm radial support length

 40cm length

 ID

 Atrium Australia - Pacific Rim Pty Limited

AC049 Advantra PTFE Vascular Graft with  Trilaminate PTFE. Vascular Access  4mm - 8mm diameter. 50 -  $3,000.00

 Graft Deployment System Graft 80cm length

Prostheses List by Category, Groups and Sponsor Page 697 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 R

 W L Gore & Associates

GT175 Gore-tex Vascular Grafts Ringed Grafts Removable Standard  4-7 mm x 70cm - Rings 30cm $875.00

 Wall Tapered (ePTFE)   Length

 R (ringed)

 Medtel Australia Pty Ltd

ME195 Spiral Laminar Flow ™ graft Spiral Laminar flow graft Length (cm)      $875.00

 50,60,70,80,50,60,70,80

 Diameter(mm)  6, 6,  6,  6,  8,

  8,  8,  8

10.04.01 - Vascular Patches

 10.04.01.01 - 0 - 100 sq cm

 Atrium Australia - Pacific Rim Pty Limited

AC041 Atrium Ultramax Patches Knitted Double Velour Vascular  6 sq cm $205.00

AC042 Atrium Ultramax Patches Knitted Double Velour Vascular  19 76 sq cm $205.00

 B Braun Australia Pty Ltd

BB017 Vascular Patch Vascular patch 12x9 to 3x4 $205.00

 Bard Australia Pty Ltd

BA031 Grafts Vascular Polyester soft tissue patch 1mm thick  5cm x 10cm $205.00

BA035 Grafts Vascular PTFE Felt 2mm thick 5cm x 10cm $205.00

BA089 Impra PTFE Vascular Grafts ePTFE Cardiovascular Patch 0.4mm  20 x 90mm $205.00

 Oval

BA091 Impra PTFE Vascular Grafts  ePTFE Cardiovascular, Patch 0.6mm,  50 x 75mm $205.00

 Rectangular

BA092 Impra PTFE Vascular Grafts  ePTFE Cardiovascular, Patch 0.6mm,  50 x 150mm $205.00

 Rectangular

BA093 Impra PTFE Vascular Grafts  ePTFE Cardiovascular, Patch 0.6mm,  30 x 30mm, 10 x 90mm, 30 x  $205.00

 Rectangular, Patch 0.4 Oval,  60mm

 Rectangular

BA095 Impra PTFE Vascular Grafts  ePTFE Cardiovascular, Patch 0.6mm,  25 x 150mm $205.00

 Rectangular

Prostheses List by Category, Groups and Sponsor Page 698 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Bio Nova International Pty Ltd

BN020 Omniflow II Vascular Prostheses -  Vascular Patch 1.5cm x 5cm (less than 8 sq.  $205.00

 Straight Cm)

BN021 Omniflow II Vascular Prostheses -  Vascular Patch 2.5cm x 10cm (more than 8  $205.00

 Straight sq. cm

 Terumo Corporation Australia

TU042 Fluoropassiv Patch Thin wall, Fluoropolymer/polyester,  6-15mm x 5-7.5cm $205.00

 Koper Knitted

 W L Gore & Associates

GT012 Soft Tissue Patch ePTFE 1mm Thickness 5 x 10cm $205.00

GT016 Soft Tissue Patch ePTFE 2mm Thickness 5 x 10cm $205.00

 10.04.01.02 - 101 - 150 sq cm

 Bard Australia Pty Ltd

BA032 Grafts Vascular Polyester soft tissue patch 1mm thick  10cm x 15cm $295.00

BA036 Grafts Vascular PTFE Felt 2mm thick 10cm x 15cm $295.00

BA090 Impra PTFE Vascular Grafts  ePTFE Cardiovascular, Patch 0.6mm,  100 x 150mm $295.00

 Circular

 Terumo Corporation Australia

TU043 Fluoropassiv Patch Thin wall, Fluoropolymer/polyester,  10-15mm x 7.5-10cm $295.00

 Koper Knitted

 W L Gore & Associates

GT013 Soft Tissue Patch ePTFE 1mm Thickness 10 x 15cm $295.00

GT017 Soft Tissue Patch ePTFE 2mm Thickness 10 x 15cm $295.00

 10.04.01.03 - >150 sq cm

 Bard Australia Pty Ltd

BA033 Grafts Vascular Polyester soft tissue patch 1mm thick  15cm x 20cm $400.00

BA034 Grafts Vascular Polyester soft tissue patch 1mm thick  20cm x 30cm $400.00

BA037 Grafts Vascular PTFE Felt 2mm thick 15cm x 20cm $400.00

BA038 Grafts Vascular PTFE Felt 2mm thick 20cm x 30cm $400.00

Prostheses List by Category, Groups and Sponsor Page 699 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 W L Gore & Associates

GT014 Soft Tissue Patch ePTFE 1mm Thickness  15 x 20cm $400.00

GT015 Soft Tissue Patch ePTFE 1mm Thickness 20 x 30cm $400.00

GT018 Soft Tissue Patch ePTFE 2mm Thickness 15 x 20cm $400.00

GT019 Soft Tissue Patch  ePTFE 2mm Thickness 20 x 30cm $400.00

 10.04.01.04 - Pledgets

 Bard Australia Pty Ltd

BA039 Grafts Vascular Polyester pledgets Rectangle, Oval, Circle,  $87.00

 Square 2.9mm-8mm x 6mm -

 9.5mm

10.05.01 - Vessel Bands

 AllVascular Pty Ltd

VA001 Venous Valve Ring Dacron/silicone variable diameter  52mmx15mmx0.09 mm $1,065.00

10.06.01 - Venous

 B Braun Australia Pty Ltd

BB106 Temporary Vena Cava System Phynox/ combination of various  One size, expands to Max  $2,348.00

 metals inc. Nickel,Copper,  length 38mm/Max diameter

 30mm

BB169 Vena Cava Filter System PHYNOX Introducer system, 'J'  Diameter 28 mm $2,348.00

 Guidewire, Seldinger needle,

 disposable scalpel

 Bard Australia Pty Ltd

BA010 Bard Inferior Vena Cava Filter Nitinol self expanding vena cava filter For IVC with a diameter less $2,348.00

  than or equal to 28mm

 diameter

 Cook Medical Australia Pty Ltd

WC096 Cook Vena Cava Filter Universal Filter Diameter up to 40mm,  $2,348.00

 Length up to 60mm

Prostheses List by Category, Groups and Sponsor Page 700 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

WC283 Vena Cava Filter with NavAlign  The filter consists of a non-magnetic  Filter measures 30mm in  $2,348.00

 Delivery System filter (30mm diameter, 48mm long)  diameter and 48mm long

 preloaded 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.

 Inovanz (PTY) LTD

IZ001 ALN Vena Cava Filter The ALN Vena Cava Filter is  One size, diameter up to  $2,348.00

 implanted into the SVC via the  32mm

 femoral, brachial and jugular vein to

 prevent pulmonary emboli (PEs).

 Johnson & Johnson Medical Pty Ltd

JJ423 OPTEASE retrievable vena cava  OPTEASE is a laser cut nitinol vena  Suitable for vessels up to  $2,348.00

 cava filter, used to treat patients at  30mm

 high risk of pulmonary embolisation

10.06.02 - Arterial

 Abbott Australasia Pty Ltd

AY018 Emboshield Embolic Protection Device, including Large and small. Two wire  $2,100.00

  delivery system, device specific  lengths: 190cm for

 procedural wire, filter for capturing  Monorail system and 315cm

 embolic matter and retrieval system  for Over the wire

AY030 Accunet Embolic Protection Device, including 4.5 - 7.5; 190cm, 300cm  $2,100.00

  delivery system, device specific  length catheter

 procedural wire, filter for capturing

 embolic matter and retrieval system.

 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.

Prostheses List by Category, Groups and Sponsor Page 701 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Covidien Pty Ltd

AS192 Spider FX Embolic Protection  The Spider FX is a rapid exchange  Filter:  3.0 - 7.0mm; Capture  $2,100.00

 device percutaneously delivered  Wire:  190 and 320cm

 distal embolic protection device with

 components designed to capture and

 remove debris from vessels during

 interventional procedures in the

 vasculature.

 Johnson & Johnson Medical Pty Ltd

JJ480 Angioguard RX Emboli Capture  Distal protection device and delivery  Length 180cm, Diameter  $2,100.00

 Guidewire System system 0.014"; basket sizes 4mm,

 5mm, 6mm, 7mm and 8mm

 Medtronic Australasia Pty Ltd

MC954 Mo.Ma Proximal Cerebral  Mo.Ma Proximal Cerebral Protection  Minimum sheath size = 8F  $2,100.00

 Protection Device Device. Protects the brain from  or 9F, Minimum diameter of

 embolisation, blocking antigrade  inner working channel =

 blood flow from the common Carotid  0.069"/1.76mm (8F sheath)

 Artery and retrograde blood flow from  or 0.083"/2.12mm (9F

 the External Carotid Artery. sheath); 0.035" guide wire

 compatible

MI035 Mo.Ma Ultra Proximal Cerebral  Cerebral embolic protection device:  Minimum sheath size = 8F  $2,100.00

 Protection Device blocks antegrade blood flow from the  (5F inner working channel)

 common carotid artery and retrograde  or 9F (6F inner working

 blood flow from the external carotid  channel)

 artery. Embolic protection is

 established before the lesion is

10.07.01 - Arterial Closure Devices

 Abbott Australasia Pty Ltd

AY017 Starclose 6 Fr Exchange Sheath, Dilator,  6 Fr $410.00

 Guidewire, implantable nitinol clip

 pre-mounted on a Clip Applier

AY033 Proglide Suture Mediated Closure Device 5 - 8 French $410.00

 Johnson & Johnson Medical Pty Ltd

JJ823 EXOSEAL (TM) Vascular Closure  Vascular Closure Device 5 - 7F $410.00

 Device

Prostheses List by Category, Groups and Sponsor Page 702 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 MD Solutions Pty Ltd

MB008 Mynx Vascular Closure Device Water-soluble synthetic sealant made  5F, 6/7F $410.00

 of a polyethylene glycol (PEG) The

 sealant is resorbed by the body

 within 30 days

 St Jude Medical Australia Pty Ltd

SJ014 Angio-Seal Vascular Closure  Angio-Seal Haemostatic Puncture  6F $410.00

 Device - STS Platform and STS Plus Closure Device, Models 6F-STS

 Platform and 6F STS Plus

SJ015 Angio-Seal Vascular Closure  Angio-Seal Haemostatic Puncture  8F $410.00

 Device - STS Platform and STS Plus Closure Device, Models 8F-STS

 Platform and 8F STS Plus

SJ094 Angio-Seal VIP Angio-Seal Haemostatic Puncture  6F $410.00

 Closure Device Models 6F STS

 Platform, 6F STS Plus and 7F VIP

SJ095 Angio-Seal VIP Angio-Seal Haemostatic Puncture  8F $410.00

 Closure Device Models 8F STS

 Platform, 8F STS Plus and 8F VIP

SJ155 Angio-Seal Evolution Haemostatic Puncture Closure Device 6F and 8F $410.00

  6F-8F

SJ218 FemoSeal Vascular Closure System Haemostatic Puncture Closure Device One Size $410.00

 large

 Abbott Australasia Pty Ltd

AY034 Prostar Suture Mediated Closure Device -  Up to 24 French $750.00

 Closure of Large holes

10.08.01 - Particle

 Boston Scientific Australia Pty Ltd

BS034 Contour PVA, Contour SE Polyvinyl Alcohol (PVA)  Up to 1200 micron, volume  $204.00

 embolization particles spherical- up to 2ml.

 Device Technologies Australia Pty Ltd

DE294 Bead Block Plyvinyl Alcohol hydrogel  2ml- (100 - 300, 300 - 500,  $204.00

 microspheres in pre-loaded syringe 500 - 700, 700 - 900, 900 -

 1200 microns

Prostheses List by Category, Groups and Sponsor Page 703 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Cook Medical Australia Pty Ltd

WC044 PVA Embolisation particles Embolisation & Occlusion Particle Size Ranges  $204.00

 (microns) 50-100, 100-200,

 200-300,300-500, 500-700,

  700-1000, 1000-1500,

 1500-2000, 2000-2800

10.08.02 - Coil, Peripheral

 10.08.02.01 -  200mm length

 Cook Medical Australia Pty Ltd

WC190 Detachable Mreye Embolization  Standard Mreye Diameters: .035 and .038,  $66.00

 Extended Lengths: 1cm to

 20cm, Coil Diameters: 3mm

 to 20mm

 P

 Boston Scientific Australia Pty Ltd

BS026 VortX and Pushable Coils Pushable coils Diameters up to 30mm and  $143.00

 lengths up to 60mm

 Cook Medical Australia Pty Ltd

WC038 Coil - Embolisation Coils MWCE- Tornado Platinum Diameters: .018, .035 and  $143.00

 TORNADO .038, Coil Taper Diameters:

 2mm to 10mm

WC039 Cook Embolization Coil Hilal Platinum Diameters: .018, Extended  $143.00

 Lengths: .5cm to 6cm, Coil

 Diameters: Straight to 10mm

 Johnson & Johnson Medical Pty Ltd

JJ224 TruFill Pushable coil Platinum pushable  coil of 1. Straight,  Size .014" outer diameter.   $143.00

 2. C, 3. Flat spiral and 4. Complex  Size 2 - 10mm and length 2 -

 shapes.  Embolic coil and delivery   100mm

 Pyramed Pty Limited

PY008 Platinum Spirale and Cirrus  Embolisation coils with or without  Spiral diameter 2mm - 16mm; $143.00

 embolisation coils <100mm fibers  length 25mm - 80mm; coil

 diameter 0.27mm - 0.82mm

Prostheses List by Category, Groups and Sponsor Page 704 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

PY009 Platinum Spirale and Cirrus  Embolisation coils with or without  Spiral diameter 4mm - 10mm; $143.00

 embolisation coils 100-150mm fibers  length 100mm - 150mm;

 coil diameter 0.27mm -

 0.82mm

 P (Platinum)

 Cook Medical Australia Pty Ltd

WC173 Cook Embolisation Coils Nester Platinum Recommended catheter ID  $143.00

 and end hole  diameter inch:

  .018 and .035inch. Coiled

 embolus diameters:  2mm to

 20mm. Extended embolus

 lengths: 30 to 200mm.

 P, Gel

 Terumo Corporation Australia

TU051 AZUR Peripheral HydroCoil,  AZUR Peripheral HydroCoil,  2-20mm diameter, length 2- $180.00

 pushable 15cm

 P, Gel, repositionable

 Terumo Corporation Australia

TU053 AZUR Peripheral HydroCoil AZUR Peripheral Coil, detachable 3-20mm diameter, length 3- $1,293.00

 50cm

 P, ids (Platinum, integral delivery system)

 Boston Scientific Australia Pty Ltd

BS021 Interlock Detachable Coils Platinum-tungsten, Fibered  Coil diameters up to 30mm  $1,250.00

 Occlusion System and lengths up to 100cm.

 Delivery system lengths up

 200cm

 P, repositionable

 Terumo Corporation Australia

TU052 AZUR Peripheral Framing Coil AZUR Peripheral Coil,detachable,  8-20mm diameter, length 20- $1,250.00

 Framing Coil three dimensional  50cm

 complex shape

Prostheses List by Category, Groups and Sponsor Page 705 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 P, repositionable (Platinum, repositionable)

 Cook Medical Australia Pty Ltd

WC319 Detach Coil with Fibers The Detach Coil with Fibers consists  Diameters: 3-20mm $1,250.00

 of a Teflon coated stainless delivery  Length: 4-30cm

 wire with a premounted platinum

 detachable coil with fibers.

WC320 Retracta Detachable Embolization  The Retracta Detachable Embolization Coiled embolus diameters:  $1,250.00

 Coil  Coil is a platinum coil with spaced  4-20mm

 synthetic fibers, and is attached to a  Length: 7-14cm

 delivery wire.

 10.08.02.02 - >200mm length

 P

 Pyramed Pty Limited

PY010 Platinum Spirale and Cirrus  Embolisation coils with and without  Spiral diameter 5mm - 16mm; $286.00

 embolisation coils 200-450mm fibers  length 200mm - 450mm;

 Coil diameter 0.82mm.

10.08.03 - Polymer

 10.08.03.01 - 0.5ml

 Endotherapeutics Pty Ltd

ET008 Embospheres - .5ml per implant $320.00

 10.08.03.02 - 1ml

 Endotherapeutics Pty Ltd

ET007 Embospheres - 1ml per implant $420.00

 10.08.03.03 - 2ml

 Endotherapeutics Pty Ltd

ET006 Embospheres - 2ml per implant $630.00

Prostheses List by Category, Groups and Sponsor Page 706 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

10.08.04 - Detachable Balloon or Sphere

 St Jude Medical Australia Pty Ltd

SJ265 Amplatzer Vascular Plug Self expandable nitinol wire mesh Diameter 4mm - 16mm,  $1,900.00

 Length 7 & 8mm

SJ268 Amplatzer Vascular Plug III AVP III is a self-expanding, Nitinol  Size: (mm): 4, 6, 8, 10, 10,  $1,900.00

 mesh occlusion device. 12, 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 occlusion device. The Device  5mm 5 diameter 10.5 length

 has a radiopaque marker band at each  

 end and a micro screw attachment at  6mm 6 diameter 11.0 length

 one end for 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 707 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 ids

 St Jude Medical Australia Pty Ltd

SJ266 AMPLATZER Vascular Plug - II The AMPLATZER Vascular Plug II is 9-AVP2-003, 3mm  $2,100.00

  a self-expandable, multi-lobed  Diameter, 6mm Plug Length,

 cylindraical device made from a   9-AVP2-004, 4mm

 nitinol wire mesh. 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

10.08.05 - Liquid

 Covidien Pty Ltd

AS190 Onyx DSMO/Liquid Embolic Material 18, 20, 34 (formulations) $2,300.00

 ids

 Covidien Pty Ltd

AS191 Onyx System DSMO Liquid Embolic Material 500 Formulation $4,950.00

Prostheses List by Category, Groups and Sponsor Page 708 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

10.08.06 - Delivery Device For Occlusion Media

 10.08.06.01 - Catheter

 Boston Scientific Australia Pty Ltd

BS028 GDC and PVA Delivery Catheters Microcatheter Delivery Systems Delivery system lengths up  $700.00

 to 175cm

 Cook Medical Australia Pty Ltd

WC296 Cantata Superselective Microcatheter Cantata 2.5 and Cantata 2.8  2.5F and 2.8F. Length: 100- $700.00

 Microcatheter 150cm

 10.08.06.02 - Detachment Controller

 Terumo Corporation Australia

TU054 AZUR Peripheral Coil Detachment  Hand held battery powered coil  One size only $350.00

 Controller detachment controller

10.09.01 - Percutaneous Catheters, Single Lumen

 Cook Medical Australia Pty Ltd

WC111 Cook Central Venous  Single lumen peripherally inserted  3 - 6 Fr, 40 - 80cm $119.00

 Catheterisation Kit catheter set, which may include

 catheter, standard or micropuncture

 introducer set

WC113 Cook Central Venous  Single lumen peripherally inserted  Fr 3, 4, 5 and Length 50 and $119.00

 Catheterisation Kit catheter set, includes catheter, needle,   60cm

 J-wire, MPIS wire and introducer

WC201 Cook Central Venous Catherisation  Turbo-Flo Peripherally Inserted  4Fr - 60cm and 5Fr - 60cm $119.00

 Kits Central Venous Catheter Set, Single

 Lumen Polyurethane with

 Micropuncture Peel-Away Sheath

 Introducer and Wire Guide

WC202 Cook Central Venous  Turbo-Flo Peripherally Inserted  5Fr - 60cm $119.00

 Catheterisation Kits Central Venous Catheter Set, Single

 Lumen Polyurethane with Peel Away

 Sheath Introducer and Wire Guide

Prostheses List by Category, Groups and Sponsor Page 709 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

WC204 Cook Central Venous  Turbo-Flo Over-The-Wire  4Fr - 60cm and 5Fr -60cm $119.00

 Catheterisation Kits Peripherally Inserted Central Venous

 Catheter Set, Single Lumen

 Polyurethane with Micropuncture

 Peel-Away Sheath Introducer and

WC207 Cook Central Venous  PICC Peripherally Inserted Central  3Fr - 50cm and 4Fr and 5Fr - $119.00

 Catheterisation 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  84cm, 1.3mm OD, 94cm  $119.00

 of radiopaque silicone rubber 2.2mm OD, 94cm 3.2mm OD

 Mayo Healthcare Pty Ltd

YO001 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

YO002 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

 cu

 Bard Australia Pty Ltd

BA049 Hickman/Broviac Catheters Open-Ended CVC, Single Lumen 2.7Fr - 9.6Fr $180.00

BA125 Groshong Central Venous Catheter Closed-Ended CVC, Single Lumen 5.5Fr - 9.5Fr $180.00

BA129 Groshong Peripherally Inserted  Closed-Ended PICC, Single Lumen 3Fr - 5Fr $180.00

 Central Catheter

 Cook Medical Australia Pty Ltd

WC117 Cook Central Venous Long Term  Cook TPN single lumen catheter set Fr 3, length 55; Fr 4, length  $180.00

 Catheter 65cm, Fr 6.5 length 65,

 90cm, Fr 9.5, length 90cm

 pi

 Bard Australia Pty Ltd

BA184 Peripherally Inserted Central  Power Injectable PICC, Single Lumen 4Fr - 6Fr $165.00

BA212 Peripherally Inserted Central  Valved, Power Injectable PICC,  4Fr - 6Fr $165.00

 Single Lumen

Prostheses List by Category, Groups and Sponsor Page 710 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BA220 Groshong Peripherally Inserted  Closed-Ended, Power Injectable  5Fr $165.00

 Central Catheter PICC, Single Lumen

 Medical Specialties Australia Pty Ltd

MS063 Peripherally Inserted Central  Single Lumen Power Injectable PICC 3 - 5Fr; 55 - 65cm $165.00

 pi (power injection)

 Emergo Asia Pacific Pty Ltd

ER134 Single Lumen Peripherally Inserted  Power injectable with Pressure  3F x55cm, 4F x 55cm, 5F x  $165.00

 Central Catheter Activated Safely Valve (PASV)  55cm

 technology

 A (Anti-infective Agent Coating)

 Mayo Healthcare Pty Ltd

YO005 ARROWg+ard Blue Single Lumen  A polyurethane central venous  CS-24301 - 16g x 20cm,  $150.00

 Central Venous Catheters catheter with Blue FlexTip (of various  Single Lumen, Adult

 lengths, sizes and lumen  CS-24306E-16g x 16cm,

 configurations) with antimicrobial  Single Lumen Adult

 impregnation (chlorhexidine and  CS-24701 - 14g x 20cm,

 silver sulphadiazine) on the external  Single Lumen Adult

 surface of the polyurethane catheter  CS-24706E -14g x 16cm,

 Single Lumen, Adult

 pi (power injection)

 Cook Medical Australia Pty Ltd

WC279 Turbo-Ject Peripherally Inserted  3/4/5/6 Fr Single Lumen  3, 4, 5, 6 French, 40 and 60  $165.00

 Central Catheter Set ( Single Lumen) Polyurethane PICC with  cm catheter length, single

 Micropuncture Peel-Away Sheath  lumen catheter

 Mayo Healthcare Pty Ltd

YO011 Arrow single lumen pressure  Single lumen pressure injectable  3, 4, Fr single lumen  $165.00

 injectable peripherally inserted  peripherally inserted central catheter  Pressure Injectable PICCs

 central catheter (PICC) sets (PICC) sets various Pressure Injection

 rates, various lengths.

Prostheses List by Category, Groups and Sponsor Page 711 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

10.09.02 - Percutaneous Catheters, Multiple Lumen

 Bard Australia Pty Ltd

BA130 Groshong Peripherally Inserted  Closed-Ended PICC, Multiple Lumen 3Fr - 5Fr $119.00

 Central Catheter

 Cook Medical Australia Pty Ltd

WC112 Cook Central Venous  Double or triple lumen peripherally  3 - 8 Fr 40 - 80cm $119.00

 Catheterisation Kit inserted catheter set, which may

 include catheter, standard or

 micropuncture introducer set

WC114 Cook Central Venous  Double lumen peripherally inserted  Fr 6, 7 and Length 58 and  $119.00

 Catheterisation Kit catheter set, includes catheter, needle,  60cm

 J-wire, MPIS wire and introducer

WC203 Cook Central Venous Catherisation  Turbo-Flo Peripherally Inserted  5Fr - 60cm $119.00

 Kits Central Venous Catheter Set, Dual

 Lumen Polyurethane with Peel-Away

  Sheath Introducer and Wire Guide

WC205 Cook Central Venous  Turbo-Flo Over-The Wire  5Fr - 60cm $119.00

 Catheterisation Kits Peripherally Inserted Central Venous

 Catheter Set, Dual Lumen

 Polyurethane with Micropuncture

 Peel-Away Sheath Introducer and

 Mayo Healthcare Pty Ltd

YO003 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

 Antibatcterial

 Cook Medical Australia Pty Ltd

WC230 Cook Spectrum CVC Catheter 3  Triple lumen CVC line with antibiotic 5Fr, 7Fr, 9Fr $150.00

 Lumen with antibiotic impregnation  impregnation

WC231 Cook Spectrum 5 Lumen CVC  5 lumen CVC with antibiotic  10Fr $150.00

 Catheter with antibiotic  impregnation

 cu

 Bard Australia Pty Ltd

BA051 Hickman/Leonard Catheters Open-Ended CVC, Multiple Lumen 7Fr - 12.5Fr $361.00

Prostheses List by Category, Groups and Sponsor Page 712 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

BA126 Groshong Central Venous Catheter Closed-Ended CVC, Multiple Lumen 5.5Fr - 9.5 Fr $361.00

BA209 HemoStar Long Term Haemodialysis Dialysis Catheter, Multiple Lumen 14.5Fr - 16Fr $361.00

  Catheter

 Cook Medical Australia Pty Ltd

WC119 Cook Central Venous Long Term  Cook TPN double lumen catheter set Fr 7, length 65cm, Fr 9  $361.00

 Catheter Set length 90cm, Fr 12, 90,

 special

WC122 Cook Central Venous Long Term  Cook TPN triple lumen catheter set Fr 8, length 90cm $361.00

 Catheter

 Medical Specialties Australia Pty Ltd

MS009 Catheterisation kits(Horizon  Central Venous Catheter - right atrial  2.7 -14F $361.00

 catheter, silicone

 pi

 Bard Australia Pty Ltd

BA183 Peripherally Inserted Central  Power Injectable PICC, Multiple  4Fr - 6Fr $225.00

 Lumen

BA213 Peripherally Inserted Central  Valved, Power Injectable PICC,  4Fr-6Fr $225.00

 Multiple Lumen

 Cook Medical Australia Pty Ltd

WC297 Turbo-Ject Peripherally Inserted  Turbo-Ject Peripherally Inserted  6Fr, Catheter length 60cm $225.00

 Central Venous Catheters Set (Triple Central Venous Catheters (PICC) Sets

  Lumen) are intended for short- or long-term

 use for venous pressure monitoring,

 blood sampling, administration of

 drugs (eg chemotherapy) and fluids

 (eg TPN), and for use with power

 injectors for delivery of contrast in CT

  studies.

 Mayo group

CM024 Arrow Pressure Injectable Triple- Pressure injectable triple lumen PICC  6Fg x 50cm, triple lumen $225.00

 Lumen PICC. (Peripherally Inserted Central

 Catheter) Set

 Medical Specialties Australia Pty Ltd

MS064 Peripherally Inserted Central  Multiple Lumen Power Injectable  5 - 7Fr; 55 - 65cm $225.00

Prostheses List by Category, Groups and Sponsor Page 713 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 pi (power injection)

 Emergo Asia Pacific Pty Ltd

ER135 Dual Lumen Peripherally Inserted  Power injectable with Pressure  5F x55cm, 6F x 55cm $225.00

 Central Catheter Accivated Safety Valve (PASV)

 technology

ER136 Triple Lumen Peripherally Inserted  Power injectable with Pressure  6F x 55cm $225.00

 Central Catheter Activated Safety Valve (PASV)

 technology

 A (Anti-infective Agent Coating)

 Cook Medical Australia Pty Ltd

WC321 Cook Spectrum Central Venous  Double lumen CVC line with  4 Fr, 5 Fr, 8 Fr. Catheter  $150.00

 Catheter with antibiotic  antibiotic impregnation length 5-25cm

 impregnation - 2 lumen

 Mayo Healthcare Pty Ltd

YO006 ARROWg+ard Four & Five Lumen  A polyurethane central catheter with  CS-22854E - 8.5 Fr x 16cm,  $150.00

 Central Venous Catheters Blue FlexTip (of various lengths, sizes Quad Lumen

  and lumen configurations) with  CS-25854E - 8.5Fr x 20cm,

 antimicrobial impregnation  Quad Lumen

 (chlorhexidine and silver  CS-22855 - 8.5 x 16cm, Five

 sulphadiazine) on the external surface   Lumen

 of the polyurethane catheter material CS-25855 - 8.5Fr x 20cm,

 Five Lumen

Prostheses List by Category, Groups and Sponsor Page 714 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

YO007 ARROWg+ard Blue Double &  A polyurethane central venous  CS-24402 - 4Fr x 13cm,  $150.00

 Triple Lumen Central Venous  catheter with Blue FlexTip (of various  Dual Lumen CS-22502 -5Fr

 lengths, sizes and lumen  x 5cm, Dual Lumen CS-

 configurations) with antimicrobial  25402 - 4Fr x 8cm, Dual

 impregnation (chlorhexidine and  Lumen CS-25502 - 5Fr x

 silver sulphadiazine) on the external  12cm, Dual Lumen

 surface of the polyurethane catheter  CS-22702E - 7Fr x 16cm,

 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

YO008 ARROWg+ard Blue Plus QUAD  Central Venous Catheters (of various  CS-42854E - 8.5Fr x 16cm,  $150.00

 Lumen Central Venous Catheters lengths, sizes and lumen  Quad Lumen CS-45854E -

 configurations with antimicrobial  8.5Fr x 20cm, Quad Lumen

 impregnation on: 1. The external

 indwelling surface of catheter material

 (chorhexidine and silver

 sulphadiazine) 2. The entire internal

 fluid pathway including catheter,

 extension-lines and hubs

 (chlorhexidine acetate)

YO009 ARROWg+ard Blue Plus Double &  Double & Triple  Lumen Central  CS-45802E - 8 Fr x 20cm,  $150.00

 Triple Lumen Central Venous  Venous Catheters (of various lengths  Dual Lumen CS-46702E -

 Catheters sizes and lumen configurations) with  7Fr x 20cm, Dual Lumen CS-

 antimicrobial impregnation on: 1. The  47702E - 7Fr x 20cm, Dual

 external indwelling surface of catheter  Lumen CS-42703E - 7Fr x

 material (chlorhexidine and silver  16cm, Triple Lumen CS-

 sulphadiazine) 2. The entire internal  45703E - 7Fr x 20cm, Triple

 fluid pathway including catheter,  Lumen

 extension-lines and hubs

 (chlorhexidine acetate)

Prostheses List by Category, Groups and Sponsor Page 715 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 A (Anti-infective Agent Coating), pi (power injection)

 Mayo group

CM027 Pressure Injectable ARROWg+ard® Pressure Injectable Multi Lumen  CS42703HP: 16cm x 7Fr  $225.00

  Blue Plus Antimicrobial Multi- Central Venous Catheters (of various  Triple Lumen Catheter

 Lumen Central Venous Catheters lengths sizes and lumen  CS45703HP: 20cm x 7Fr

 configurations) with antimicrobial  Triple Lumen Catheter

 impregnation of the internal and  CS42854HP: 16cm x 8.5Fr

 external catheter with Chlorhexidine  Quad Lumen Catheter

 and Silver Sulphadiazine. CS45854HP: 20cm x 8.5Fr

 Quad Lumen Catheter

 pi (power injection)

 Cook Medical Australia Pty Ltd

WC280 Turbo-Ject Peripherally Inserted  4/5 Fr Double Lumen Polyurethane  4 and 5 French, 60 cm  $225.00

 Central Catheter Set (Double  PICC with Micropuncture Peel-Away Catheter length, double

  Sheath Introducer and Echogenic  lumen catheter

 Mayo Healthcare Pty Ltd

YO010 Arrow multi lumen pressure  Arrow multi lumen pressure injectable 4, 5, 6Fr multi lumen  $225.00

 injectable peripherally inserted   PICC (peripherally inserted central  Pressure Injectable PICCs

 central catheter (PICC) sets catheter) sets various Pressure Injection

 rates, various lengths.

 Double & triple Lumen

 configurations.

10.09.03 - Percutaneous Catheters, Multiple Lumen for Haemodialysis

 Bard Australia Pty Ltd

BA211 Haemodialysis Catheters Haemodialysis Catheters, multiple  11Fr - 13.5Fr $127.00

 lumen

 Gambro Pty Ltd

GA001 GamCath Dolphin Protect  Haemodialysis catheter with a  109585 - 13Fr x 15cm  $127.00

 HighFlow Haemodialysis Catheter  modified anti-thrombogenic surface  double lumen: 109584 -

 (polymer system of  13FRx 20cm double lumen,

 polydimethysilxane blocks) and a  109705 - 13Fr x 25cm

 non-release anti-microbial coating  double lumen; 109706 -

 (Bismith copolymer film) on internal  13Fr x 15cm curved double

 and external surfaces of catheter. lumen; 109707 - 13Fr x

 20cm curved double lumen.

Prostheses List by Category, Groups and Sponsor Page 716 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 Kendall Australasia Pty Ltd TA Covidien Pty Ltd

KA007 Mahurkar Subclavian Catheter Kit Chronic haemodialysis, long term  36, 40cm $127.00

 vascular access for haemodialysis and

 apheresis. Constructed of radiopaque

 silicone rubber.

KA012 Mahurkar Subclavian Catheter Kit Acute haemodialysus, short term  11.5 Fr, 13.5cm Straight  $127.00

 vascular access. Catheters constructed Exten, 11.5 Fr, 16cm

  of radiopaque polyurethane. Tips are  Straight Exten, 11.5 Fr

 made of polyvinyl chloride and are  19.5cm Straight Exten, 10 Fr

 more radiopaque than the rest of the   12cm Curved Exten, 10 Fr

 catheter. 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 $127.00

 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

KA019 Mahurkar 12Fr Triple Lumen  Mahurkar 12Fr Triple Lumen Catheter  12Fr - 13cm, 16cm, 19cm &  $127.00

 Curved Extension Kit 24cm lengths available

KA020 Mahurkar 13.5Fr Q-Plus Dual  Mahurkar 13.5Fr Q-Plus Curved  13.5Fr - 13.5cm, 16cm, 19cm $127.00

 Lumen Catheter Extension Double Lumen Catheter   & 24cm lengths available

 cu

 Bard Australia Pty Ltd

BA140 Haemodialysis Catheters Dialysis Catheter, Multiple Lumen 12.5Fr - 16FR $330.00

 Kendall Australasia Pty Ltd TA Covidien Pty Ltd

KA011 Permcath Dual Lumen Catheter Chronic Haemodialysis, long term  36cm, 40cm $330.00

 vascular access for haemodialysis and

 aphaeresis.  Constructed of

 radiopaque silicone rubber.

KA013 Permcath Dual Lumen Catheter Chronic haemodialysis, long term  28, 36, 40cm $330.00

 vascular access for haemodialysis and

 aphaeresis.  Constructed of

 radiopaque silicone rubber.

Prostheses List by Category, Groups and Sponsor Page 717 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

KA018 Palindrome Haemodialysis catheter 14.5Fr. 19, 23, 28, 33, 55cm  $330.00

 Insertion Lengths, with 36,

 40, 45, 50, 72cm Overall

 length, with side slots,

 symmetric tip

 Mayo Healthcare Pty Ltd

YO012 Arrow Cannon II Plus Chronic  Dual Lumen, Retrograde Tunneled,  15Fg x 24 - 55cm $330.00

 Haemodialysis Catheter Set Cuffed, Tip First, Chronic

 Haemodialysis Catheter Set

 Tekmed Pty Ltd

TK005 Medcomp Long Term Catheter sets  ASH, TESIO-BioFlex with cuff 10, 14 French   24,28,32 &  $330.00

 for Haemodialysis 36cm lengths

TK006 Medcomp Long Term Catheter sets  HemoFlow HFS-Carbothane with cuff 14.5 French   24,28,32 &  $330.00

 for Haemodialysis 36cm lengths

 pi

 Bard Australia Pty Ltd

BA215 Haemodialysis Catheter Power Injectable, Triple Lumen  13Fr $368.00

 Haemodialysis Catheter

Prostheses List by Category, Groups and Sponsor Page 718 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

 A (Anti-infective Agent Coating)

 Mayo Healthcare Pty Ltd

YO004 ARROWg+ard Blue Haemodialysis  Haemodialysis Catheters (of various  CS-22122 - 12Fr 16cm,  $158.00

 Catheters lengths, sizes and lumen  Dual Lumen CS-22123

 configurations) with antimicrobial  12Fr 16cm, Triple Lumen

 impregnation (chlorhexidine and  CS-25122 12Fr x 20cm,

 silver sulphadiazine) on the external  Dual Lumen CS-22142CF

 surface of the polyurethane catheter  14Fr x 15cm, 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,

 Dueal Lumen CS-22142CF -

  14Fr x 15cm, Dual Lumen,

 Curved, Firm CS-22142F -

 14Fr x 15cm, Dual Lumen

 Firm CS-25122 - 12Fr x

 20cm

Prostheses List by Category, Groups and Sponsor Page 719 of 1059


10 - VASCULAR

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Condition

10.09.04 - Infuser Ports, Single Chamber

 B Braun Australia Pty Ltd

BB170 Celsite Access Port for pain relief Composition - polysulphone.  Kit  Diameter of septum:11.7mm.  $500.00

 includes tunnelling rod, filter,   Height: 11.5mm. 

 connectors, needles, syringe, tuohy  Dimension: 25.8 x 37.8mm

 needle

 Bard Australia Pty Ltd

BA057 Groshong Subcutaneous Ports Titanium or MRI Implatable Port,  7Fr - 8 Fr $500.00

 Closed-Ended Catheter, Single

 Chamber

BA221 Implanted infusion Port Titanium or MRI Implanted Port,  6Fr - 9.6Fr $500.00

 Open-Ended Catheter, Single

 Cook Medical Australia Pty Ltd

WC093 Cook Implantable  Petite or Standard, single or multiple  3 - 12 Fr pre-attached or  $500.00

 Injection/Infusion Ports chamber Polysulfone Port which may  detached catheter or valve

 include micropuncture or standard  system

 introducer set

WC115 Cook Implantable  Mini, single or multiple chamber  3 - 12 Fr pre-attached or  $500.00

 Injection/Infusion Port titanium Port which may include  detached  catheter or valve

 micropuncture introducer set system

WC299 Vital-Port Mini, petite or standard, single  5-6.5Fr pre-attached  $500.00

 chamber Titanium port which may  catheter or valve system

 include micropuncture or standard

 introducer set

 Denward Dell Pty Ltd TA Surimex

DW003 Jet Port Plus Set - Vascular Access  Implantable injection / infusion port  Port:  Diameter: 28.0mm,  $500.00

 Port system:  port chamber with silicone  Height: 12.3mm; Catheter: 

 membrane; connectable polyurethane  6.6 French, Length: 750mm

 catheter; and introducer kit.

DW004 Jet Port Plus Low Profile Peripheral Implantable injection / infusion port  Port:  Length: 24.0mm,  $500.00

  Set - Vascular Access Port system:  low profile port chamber with Width: 20.5mm, Height:

  silicone membrane; connectable  10.3mm  Catheter: 6.6

 polyurethane catheter; and introducer  French, Length: 750mm

 kit

Prostheses List by Category, Groups and Sponsor Page 720 of 1059