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 0° 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
patient’s 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 1.6mL–BONE A silicate substituted synthetic bone 1.6mL $760.00
MATRIX IMPLANT ARTIFICIAL graft
BX297 ACTIFUSE SHAPE 2.6mL–BONE A silicate substituted synthetic bone 2.6mL $760.00
MATRIX IMPLANT ARTIFICIAL graft
BX305 ACTIFUSE A silicate substituted synthetic bone 2.5mL $760.00
MICROGRANULES2.5mL–BONE graft
MATRIX IMPLANT ARTIFICIAL
BX306 ACTIFUSE MICROGRANULES A silicate substituted synthetic bone 5mL $760.00
5mL–BONE 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
10mL–BONE 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
40mL–BONE 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 (β-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. (β-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. (β-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. (β-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 (β-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 (β-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 (β-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 (β-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. (β-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 (β-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. (β-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 Protégé GPS Peripheral Stent Protégé RX Peripheral Stent Diameter 6-10mm Length $1,800.00
20-60mm
AS194 Protégé EverFlex Peripheral Stent Protégé EverFlex is a self expanding Diameter 5-8, Length 20- $1,800.00
Nitinol stent premounted on an OTW 120mm
delivery system.
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 Protégé EverFlex Peripheral Stent Protégé EverFlex is a self expanding Diameter 5-8mm, Length $2,970.00
Nitinol stent premounted on an OTW 150-200mm
delivery system.
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