Schedule - Part C - Other Prostheses February 2014

03 - GENERAL MISCELLANEOUS

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Notations

03.02.03 - Infusion Pumps, Battery Powered

 03.02.03.02 - Insulin infusion pump (as 3.2.3.1) with integral calculator to determine boluses and

 Managing Diabetes Pty Ltd

DF001 DANAIIS Insulin Pump Continuous insulin infusion pump 75mm x 45mm x 19mm $4,000.00

 DE, SS

 Australasian Medical & Scientific Ltd

AN011 Animas Vibe Insulin Pump & CGM  Ambulatory insulin infusion pump  Pump/Monitor: 8.26 x 5.08  $8,950.00

 System with real-time continuous glucose  x 2.18cm

 monitoring (CGM) capability Sensor/Transmitter: 3.8 x

 2.3 x 1.3cm

 Managing Diabetes Pty Ltd

DF002 DANAR Insulin Pump The DANAR Insulin Pump is a small  75 x 45 x 19mm, 60grams $8,950.00

 device about the size of a pager. It

 holds up to 300 units of insulin,

 which is delivered continuously

 through a small tube to the patient.

 The DANAR Insulin Pump also has

 an integrated blood glucose meter and

  remote control via bluetooth

 communication.

 Roche Diagnostics Australia Pty Ltd

RO044 Accu-Chek Combo System Insulin delivery device capable of  The Accu-Chek Combo  $8,950.00

 remotely receiving and acting on  System is only available in

 information about blood glucose  one size.

 levels, performing bolus calculation

 and bolus advice on additional

 parameters than what is normally

 SS

 Australasian Medical & Scientific Ltd

AN005 Animas 2020 Insulin Pump. Ambulatory Insulin Infusion Pump 7.4cm x 5cm x 1.9cm $7,750.00

 Page 1 of 3

03 - GENERAL MISCELLANEOUS

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Notations

 03.02.03.03 - Device has capability to automatically adjust the insulin delivery based on

 DE, SS

 Medtronic Australasia Pty Ltd

MC839 Medtronic MiniMed Insulin  Paradigm Veo Model MMT-554.  5.1 x 7.6 x 2.0cm $9,500.00

 Infusion Pump 'Smart' Insulin Pump with REAL-

 Time continuous glucose monitoring

 capability, incorporating a low

 glucose suspend and with remote

MC840 Medtronic MiniMed Insulin  Paradigm Veo Model MMT-754.  5.1 x 9.4 x 2.0cm $9,500.00

 Infusion Pump 'Smart' Insulin Pump with REAL-

 Time continuous glucose monitoring

 capability, incorporating a low

 glucose suspend and with remote

 Page 2 of 3

08 - CARDIAC

 Minimum  Maximum

Billing Code Product  Description Size Benefit Benefit Notations

08.14.01 - Implantable Cardiac Event Recorders

 Medtronic Australasia Pty Ltd

MC763 Reveal XT Reveal XT Insertable Cardiac Monitor 61 x 19 x 8 mm with a  $3,900.00

 volume of 9cc

MC768 Reveal DX Insertable Cardiac Monitor 61 x 19 x 8 mm with a  $3,900.00

 volume of 9cc

 St Jude Medical Australia Pty Ltd

SJ152 SJM Confirm Model DM2102 Implantable cardiac monitor with  6.5cc, 12g $3,900.00

 atrial fibrillation monitoring.

SJ159 SJM Confirm Model DM2100 Implantable cardiac monitor 6.5cc, 12g $3,900.00

 Grand Total: 11 Records

 Page 3 of 3